Abstract
Aromatic dicationic drugs have a broad spectrum of activity against protozoal and fungal pathogens including Pneumocystis carinii, Leishmania mexicana amazonensis, Cryptosporidium parvum and Cryptococcus neoformans. Pentamidine serves as the exemplar for an extensive collection of newly synthesized related compounds, which have reduced toxicity and a wider range of target organisms. Assays of pentamidine and related compounds have depended on HPLC‐tandem mass spectrometry (HPLC‐TMS) for the quantitation and identification of drug and metabolites. Immunoassays for pentamidine would have many advantages over the HPLC methods including relative simplicity of assay format and required equipment, convenience in sample preparation and reduction in time and cost of assays.
In this report we describe a simple ELISA based immunoassay for pentamidine and pentamidine‐like drugs with requisite sensitivity and specificity for use as a clinical assay (EC50 value of about 50 nanomolar). Immunogen was synthesized by coupling the hapten aminopentamidine to ovalbumin (chemically modified to provide an optimal number of –SH groups) using sulfo‐MBS. Maleic‐anhydride activated ELISA plates were covalently sensitized using the aminopentamidine hapten and used in an inhibitory ELISA assay format whereby the ability of analyte to suppress antibody binding to sensitized plate was measured. The assay detects primarily the phenolic amidine of pentamidine when in a para position and hence can also detect structurally related derivatives of pentamidine of potential interest as new therapeutic agents. J. Clin. Lab. Anal. 14:73–82, 2000. © 2000 Wiley‐Liss, Inc.
Keywords: immunoassay, ELISA, pentamidine, dicationic molecules, Pneumocystis carinii, Leishmania mexicana amazoniensis
REFERENCES
- 1. Bell CA, Hall JE, Kyle DE, et al. Structure‐activity relationships of analogs of pentamidine against Plasmodium falciparum and Leishmania mexicana amazonensis . Antimicrob Agents Chemother 1990;34:1381. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Tidwell RR, Jones SK, Naiman NA, Berger LC, Brake WB, Dykstra, CC , Hall JE. Activity of cationically substituted bis‐benzimidazoles against experimental Pneumocystis carinii pneumonia. Antimicrob Agents Chemother 1993;37:1713. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Hall JE, Kerrigan JE, Ramachandran K, et al. Anti‐pneumocystis activities of aromatic diamidoxime prodrugs. Antimicrob Agents Chemother 1998;42:666. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Del Poeta M, Schell WA, Dykstra CC, et al. Structure‐in vitro activity relationships of pentamidine analogues and dicationic‐substituted bis‐benzimidazoles as new antifungal agents. Antimicrob Agents Chemother 1998a;42:2495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Schoenbach EB, Greenspan EM. The pharmacology, mode of action and therapeutic potentialities of stilbamidine, pentamidine, propamidine, and other aromatic diamidines—A review. Medicine 1948;27:327. [DOI] [PubMed] [Google Scholar]
- 6. Sands M, Kron MA, Brown RB. Pentamidine: a review. Rev Infect Dis 1985;7:625. [DOI] [PubMed] [Google Scholar]
- 7. Tidwell RR, Jones SK, Geratz JD, Ohemeng KA, Bell CA, Berger BJ, Hall JE. Development of pentamidine analogues as new agents for the treatment of Pneumocystis carinii pneumonia. Ann NY Acad Sci 1990b;616:421. [DOI] [PubMed] [Google Scholar]
- 8. Berger BJ, Naiman NA, Hall JE, Peggins J, Brewer TG, Tidwell RR. Primary and secondary metabolism of pentamidine by rats. Antimicrob and Chemother 1992b;36:1825. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Bronner U, Ericsson O, Nordin J, et al. Metabolism is an important route of pentamidine elimination in the rat: disposition of 14C‐pentamidine and identification of metabolites in urine using liquid chromatography‐tandem mass spectrometry. Pharmacol Toxicol 1995;77:114. [DOI] [PubMed] [Google Scholar]
- 10. Ioannidis JPA, Capelleri JC, Skolnik PR, Lau J, Sacks HS. A meta‐analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Arch Intern Med 1996;156:177. [PubMed] [Google Scholar]
- 11. Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last ten years. Clin Infect Dis 1997;24:684. [DOI] [PubMed] [Google Scholar]
- 12. Machado CM, Macedo MCA, Medeiros RSS, et al. Primary Pneumocystis carinii prophylaxis with aerosolized pentamidine after bone marrow transplantation. Acta Haematol 1998;99:54. [DOI] [PubMed] [Google Scholar]
- 13. Jones JL, Hanson DL, Alderton DL, Fleming PL, Kaplan JE, Ward J. Surveillance for AIDS‐Defining Opportunistic Illnesses, 1992–1997. In: CDC Surveillance Summaries. MMWR 1999;48:1. [PubMed] [Google Scholar]
- 14. Assan R, Perronne C, Assan D, Chotard L, Mayaud C, Matheron S, Zucman D. Pentamidine‐induced derangements of glucose homeostasis: Determinant roles of renal failure and drug accumulation—A study of 128 patients. Diabetes Care 1995;18:47. [DOI] [PubMed] [Google Scholar]
- 15. O'Brien JG, Dong BJ, Coleman RL, Gee L, Balano KB. A 5‐year retrospective review of adverse drug reactions and their risk factors in human immunodeficiency virus‐infected patients who were receiving intravenous pentamidine therapy for Pneumocystis carinii pneumonia. Clin Infect Dis 1997;24:854. [DOI] [PubMed] [Google Scholar]
- 16. Edwards KJ, Jenkins TC, Neidle S. Crystal structure of a pentamidine‐oligonucleotide complex: implications for DNA‐binding properties. Biochemistry 1992;31:7104. [DOI] [PubMed] [Google Scholar]
- 17. Tidwell RR, Bell CA. Pentamidine and Related Compounds in the Treatment of Pneumocystis carinii Infection. In: Walzer PD, editor, Pneumocystis carinii Pneumonia. 2nd ed.,Revised and Expanded. New York: Marcel Dekker, Inc.; 1994. p 561. [Google Scholar]
- 18. Tuttle RH, Hall JE, Tidwell RR. High‐performance liquid chromatographic assay detects pentamidine metabolism by Fisher rat liver microsomes. J Chromatogr B Biomed Sci App 1997;688:319. [DOI] [PubMed] [Google Scholar]
- 19. Berger BJ, Reddy VV, Le ST, Lombardy RJ, Hall JE, Tidwell RR. Hydroxylation of pentamidine by rat liver microsomes. J Pharm Exp Ther 1991;256:883. [PubMed] [Google Scholar]
- 20. Wood DH, Hall JE, Rose BG, Tidwell RR. 1,5‐Bis(4‐amidinophenoxy)pentane (pentamidine) is a potent inhibitor of [3H] idazoxan binding to imidazoline I2 binding sites. Eur J Pharmacol 1998;353:97. [DOI] [PubMed] [Google Scholar]
- 21. Berger BJ, Naiman NA, Hall JE, Peggins J, Brewer TG, Tidwell RR. Problems and pitfalls in the assay of pentamidine. Implications for clinical use. Clin Pharmacokinet 1992a;22:163. [DOI] [PubMed] [Google Scholar]
- 22. Nordin J, Wikström I, Bronner U, Gustafsson LL, Ericsson O. Liquid chromatography tandem mass spectrometry applied to a study of the metabolism of pentamidine—Discussion of possibilities and problems. J Chromatogr A 1997;777:73. [DOI] [PubMed] [Google Scholar]
- 23. Lidman C, Bronner U, Gustafsson LL, Rombo L. Plasma pentamidine concentrations vary between individuals with Pneumocystis carinii pneumonia and the drug is actively secreted by the kidney. J Antimicrob Chemother J Chromatogr A 1994;33:803. [DOI] [PubMed] [Google Scholar]
- 24. Sattler FR, Jelliffe RW. Pharmacokinetic and Pharmacodyanmic Considerations for Drug Dosing in the Treatment of Pneumocystis carinii Pneumonia In: Walzer PD, editor, Pneumocystis carinii Pneumonia. 2nd ed.,Revised and Expanded. New York: Marcel Dekker, Inc.; 1994. p 467. [Google Scholar]
- 25. Tidwell RR, Jones SK, Geratz JD, Ohemeng KA, Cory M, Hall JE. Analogues of 1,5‐bis(4‐amidinophenoxy)pentane (pentamidine) in the treatment of experimental Pneumocystis carinii pneumonia. J Med Chem 1990a;33:1252. [DOI] [PubMed] [Google Scholar]
- 26. Ashley JN, Barber HJ, Ewins AJ, Newberry G, Self ADH. J Chem Soc 1942; 103. [Google Scholar]
- 27. Berg SS, Newberry G. J Chem Soc 1949. [Google Scholar]
- 28. Parrish RF, Strauss JW, Paulson JD, Polakoski KL, Tidwell RR, Geratz JD, Stevens FM. Structure‐activity relationships for the inhibition of acrosin by benzamidine derivatives. J Med Chem 1978;21:1132. [DOI] [PubMed] [Google Scholar]
- 29. Blättler WA, Kuenzi BS, Lambert JM, Senter PD. New heterobifunctional protein cross‐linking reagent that forms an acid‐labile link. Biochem 1985;24:1517. [Google Scholar]
- 30. Aithal HN, Knigge KM, Kartha S, Czyzewski AE, Toback FG. An alternate method utilizing small quantities of ligand for affinity purification of monospecific antibodies. J Immunol Methods 1988;112:63. [DOI] [PubMed] [Google Scholar]
- 31. Levin LG, Rudd A, Bletsa A, Reisner HM. Expression of IL‐8 mRNA by cells of the odontoblast layer in‐vivo. Eur J Oral Sci 1999;107:131. [DOI] [PubMed] [Google Scholar]
- 32. Hermanson GT. Types of Immunogen Carriers. In: Bioconjugate Techniques. San Diego: Academic Press; 1996. p 421. [Google Scholar]
- 33. Patrick DA, Boykin DW, Wilson WD, et al. Anti‐Pneumocystic carinii pneumonia activity of dicationic carbazoles. Eur J Med Chem 1997; 32:781. [Google Scholar]
- 34. Del Poeta M, Dykstra CC, Jones SK, Tidwell RR, Kumar A, Boykin DW, Perfect JR. In vitro antifungal activities of a series of dication‐substituted carbazoles, furans, and benzimidazoles. Antimicrob Agents Chemother 1998. b; 42:2503. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35. Hopkins KT, Wilson DW, Bender BC, et al. Extended aromatic furan amidino derivatives as anti‐Pneumocystis carinii agents. J Med Chem 1998;41:3872. [DOI] [PubMed] [Google Scholar]
- 36. Kitagawa T, Fujiwara K, Tomonoh S, Takahashi K, Koida M. Enzyme immunoassays of kanamycin group antibiotics with high sensitivities using anti‐kanamycin as a common antiserum: reasoning and selection of a heterologous enzyme label. J Biochem 1983;94:1165. [DOI] [PubMed] [Google Scholar]
- 37. Erlanger BF. The Preparation of Antigenic Hapten‐Carrier Cojugates: A Survey In: Van Vunakis H. and Langone JL, editors. Immunochemical Techniques Part A. New York: Academic Press; 1980. p 85. [DOI] [PubMed] [Google Scholar]
- 38. Berger BJ, Lombardy RJ, Marbury DG, Bell CA, Dykstra CC, Hall JE, Tidwell RR. Metabolic N‐hydroxylation of pentamidine in vitro. Antimicrob Agents Chemother 1990;34:1678. [DOI] [PMC free article] [PubMed] [Google Scholar]
