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Enzyme Replacement Therapy may Affect Blood Immunosuppressant Monitoring

Author(s):

Ataman Gönel*, Ismail Koyuncu, Nihayet Bayraktar, Cüneyt Tayman, Osman Bardakçı, Ali Uzunköy and Ahmet Guzelcicek   Pages 1 - 6 ( 6 )

Abstract:


Background: Although LC-MS/MS is preferred as a reliable method, therapeutic enzyme drugs in the blood matrix may lead to false results.

Objective: The purpose of this article is to experimentally investigate the effect of five different enzymes used in the treatment of metabolic diseases on blood immunosuppressant measurement.

Methods: Five different enzyme drugs (galsulfase, alglucosidase alfa, imiglucerase, elosulfase alfa, laronidase) were added to control materials containing tacrolimus, everolimus, sirolimus, and cyclosporine A drugs. Measurements were performed using an LCMS/MS instrument (Shimadzu 8040, Japan). The amount of deviations from the target values was calculated.

Results: Blood Immunosuppressant levels significantly changed after the administration of enzyme drugs. Four different enzyme drugs led to false positive results in the tacrolimus levels at a rate of 10.58% (95% CI, 9.83-11.32) to 37.28% (95% CI, 33.55-41.27). The highest deviations were observed with the administration of galsulfase and alglucosidase alpha in the sirolimus levels at rates of 336.54% (95% CI, 306.25-366.82) and 395.88% (95% CI, 360.25-431.50), respectively. Imiglucerase was the least effective enzyme for the sirolimus level (0.80% (95% CI, 0.71-0.89). Different deviations between the ratios of - 9.37% (95% CI, -10.40 - -8.33) and 8.33% (95% CI, 7.41-9.24) were determined at the cyclosporin A level.

Conclusion: Galsulfase, alglucosidase alpha, imigluserase, elosulfase alpha, laronidase can significantly interfere with immunosuppressant measurements with LC-MS/MS. False immunosuppressant results associated with enzyme injection may result in immunosuppression failure, organ rejection. For the measurement of immunosuppressant levels, sampling should be done before the enzyme infusion. Clinicians should question the time of enzyme infusion and sampling when confounding results in immunsupressant measurement.

Keywords:

immunosuppressant, enzyme replacement therapy, interference, matrix effect

Affiliation:

Department of Biochemistry, Harran University Faculty of Medicine, Sanliurfa, Department of Biochemistry, Harran University Faculty of Medicine, Sanliurfa, Department of Biochemistry, Harran University Faculty of Medicine, Sanliurfa, Department of Neonatology, Health Sciences University, Zekai Tahir Burak Maternity Hospital, Ankara, Department of General Surgery, Harran University Faculty of Medicine, Sanliurfa, Department of General Surgery, Harran University Faculty of Medicine, Sanliurfa, Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa



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