Simultaneous Measurement of Cyclosporine A, Everolimus, Sirolimus and Tacrolimus Concentrations in Human Blood by UPLC-MS/MS

Liquid chromatography coupled with tandem mass spectrometry for therapeutic drug monitoring of immunosuppressants has been widely adopted in clinical chemistry laboratories. However, UPLC is replacing classical LC techniques, providing higher resolution and speed. We developed and validated an UPLC-MS/MS method for the simultaneous measurement of cyclosporine A, everolimus, sirolimus and tacrolimus concentrations in human blood. Following extraction with a zinc sulfate solution and acetonitrile, the chromatographic separation was achieved using an Acquity(A (R)) UPLCA (R) BEH (TM) (2.1 x 30 mm id, 1.7 A mu m) reverse-phase C-18 column, with a water/methanol linear gradient containing 2 mM ammonium acetate with 0.1 % formic acid at a 0.5 mL min(-1) flow rate. All immunosuppressants were detected by ESI mass spectrometry in positive ion multiple reaction monitoring mode using mass-to-charge transitions of 1219.8 -> 1202.6/1184.4, 975.5 -> 908.3/891.6, 931.5 -> 864.3/883.3, 821.4 -> 768.2/719.9 for cyclosporine A, everolimus, sirolimus and tacrolimus, respectively. Coefficients of variation and relative bias were less than 5.8 and 9.7 % for cyclosporine A, 8.7 and 6.4 % for everolimus, 8.5 and 7.2 % for sirolimus and 6.7 and 4.7 % for tacrolimus. Limits of quantification were 15.4 A mu g L-1 for cyclosporine A, 1.42 A mu g L-1 for everolimus, 1.58 A mu g L-1 for sirolimus and 0.65 A mu g L-1 for tacrolimus. Mean recoveries were greater than 77.6 % for all immunosuppressants. Evaluation of the matrix effect showed ion suppression for all the immunosuppressants, except for cyclosporine A, which suffered ion enhancement. No carry-over was observed. The validated method appears to be well adapted for therapeutic drug monitoring of multiple immunosuppressants in daily clinical practice.