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Human subcutaneous tissue distribution of fluconazole: comparison of microdialysis and suction blister techniques
Lucy Sasongko1, Kenneth M Williams, Richard O Day
1Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia.
Insights
Microdialysis effectively measures fluconazole uptake into subcutaneous interstitial fluid, unlike suction blisters. Physiologically based pharmacokinetic (PBPK) modeling confirms this, highlighting tissue blood flow
Area of Science:
- Pharmacokinetics and drug distribution studies.
- Biomedical engineering and analytical chemistry.
Background:
- Understanding drug distribution in interstitial fluid is crucial for optimizing therapeutic efficacy.
- Fluconazole is a widely used antifungal agent, but its penetration into specific tissues requires detailed investigation.
Purpose of the Study:
- To compare the efficacy of microdialysis and suction blister techniques in assessing fluconazole uptake into human subcutaneous interstitial fluid.
- To evaluate the performance of a physiologically based pharmacokinetic (PBPK) model in predicting fluconazole distribution.
Main Methods:
- Healthy volunteers received an oral dose of fluconazole (200 mg).
- Microdialysis probes and suction blisters were used to collect interstitial fluid, alongside plasma and microdialysate samples over 8 hours.
- Fluconazole concentrations were quantified using HPLC, with in vivo recovery determined for microdialysis probes.
Main Results:
- Microdialysis demonstrated a rapid uptake of fluconazole into subcutaneous interstitial fluid, with concentrations similar to unbound plasma levels (Kp ≈ 1.16).
- Suction blister fluid showed significantly lower fluconazole concentrations compared to plasma in the initial hours.
- PBPK model predictions showed good agreement with microdialysis-derived fluconazole concentrations.
Conclusions:
- Microdialysis is a more suitable technique than suction blisters for evaluating fluconazole's rate of uptake into subcutaneous tissue.
- The distribution of fluconazole into subcutaneous interstitial fluid is influenced by tissue blood flow, as indicated by PBPK modeling.
Aims:
To investigate uptake of fluconazole into the interstitial fluid of human subcutaneous tissue using the microdialysis and suction blister techniques.
Methods:
A sterile microdialysis probe (CMA/60) was inserted subcutaneously into the upper arm of five healthy volunteers following an overnight fast. Blisters were induced on the lower arm using gentle suction prior to ingestion of a single oral dose of fluconazole (200 mg). Microdialysate, blister fluid and blood were sampled over 8 h. Fluconazole concentrations were determined in each sample using a validated HPLC assay. In vivo recovery of fluconazole from the microdialysis probe was determined in each subject by perfusing the probe with fluconazole solution at the end of the 8 h sampling period. Individual in vivo recovery was used to calculate fluconazole concentrations in subcutaneous interstitial fluid. A physiologically based pharmacokinetic (PBPK) model was used to predict fluconazole concentrations in human subcutaneous interstitial fluid.
Results:
There was a lag-time (approximately 0.5 h) between detection of fluconazole in microdialysate compared with plasma in each subject. The in vivo recovery of fluconazole from the microdialysis probe ranged from 57.0 to 67.2%. The subcutaneous interstitial fluid concentrations obtained by microdialysis were very similar to the unbound concentrations of fluconazole in plasma with maximum concentration of 4.29 +/- 1.19 microg ml(-1) in subcutaneous interstitial fluid and 3.58 +/- 0.14 microg ml(-1) in plasma. Subcutaneous interstitial fluid-to-plasma partition coefficient (Kp) of fluconazole was 1.16 +/- 0.22 (95% CI 0.96, 1.35). By contrast, fluconazole concentrations in blister fluid were significantly lower (P < 0.05, paired t-test) than unbound plasma concentrations over the first 3 h and maximum concentrations in blister fluid had not been achieved at the end of the sampling period. There was good agreement between fluconazole concentrations derived from microdialysis sampling and those estimated using a blood flow-limited PBPK model.
Conclusions:
Microdialysis and suction blister techniques did not yield comparable results. It appears that microdialysis is a more appropriate technique for studying the rate of uptake of fluconazole into subcutaneous tissue. PBPK model simulation suggested that the distribution of fluconazole into subcutaneous interstitial fluid is dependent on tissue blood flow.
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