A. James Clark School of Engineering

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    The Binding Effect of Proteins on Medications and Its Impact on Electrochemical Sensing: Antipsychotic Clozapine as a Case Study
    (MDPI, 2017-08-01) Banis, George E.; Winkler, Thomas; Barton, Patricia; Chocron, Sheryl E.; Kim, Eunkyoung; Kelly, Deanna L.; Payne, Gregory F.; Ben-Yoav, Hadar; Ghodssi, Reza
    Clozapine (CLZ), a dibenzodiazepine, is demonstrated as the optimal antipsychotic for patients suffering from treatment-resistant schizophrenia. Like many other drugs, understanding the concentration of CLZ in a patient’s blood is critical for managing the patients’ symptoms, side effects, and overall treatment efficacy. To that end, various electrochemical techniques have been adapted due to their capabilities in concentration-dependent sensing. An open question associated with electrochemical CLZ monitoring is whether drug–protein complexes (i.e., CLZ bound to native blood proteins, such as serum albumin (SA) or alpha-1 acid-glycoprotein (AAG)) contribute to electrochemical redox signals. Here, we investigate CLZ-sensing performance using fundamental electrochemical methods with respect to the impact of protein binding. Specifically, we test the activity of bound and free fractions of a mixture of CLZ and either bovine SA or human AAG. Results suggest that bound complexes do not significantly contribute to the electrochemical signal for mixtures of CLZ with AAG or SA. Moreover, the fraction of CLZ bound to protein is relatively constant at 31% (AAG) and 73% (SA) in isolation with varying concentrations of CLZ. Thus, electrochemical sensing can enable direct monitoring of only the unbound CLZ, previously only accessible via equilibrium dialysis. The methods utilized in this work offer potential as a blueprint in developing electrochemical sensors for application to other redox-active medications with high protein binding more generally. This demonstrates that electrochemical sensing can be a new tool in accessing information not easily available previously, useful toward optimizing treatment regimens.
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    The Binding Effect of Proteins on Medications and Its Impact on Electrochemical Sensing: Antipsychotic Clozapine as a Case Study
    (Multidisciplinary Digital Publishing Institute (MDPI), 2017-08-01) Banis, George E.; Winkler, Thomas; Barton, Patricia; Chocron, Sheryl E.; Kim, Eunkyoung; Kelly, Deanna L.; Payne, Gregory F.; Ben-Yoav, Hadar; Ghodssi, Reza
    Clozapine (CLZ), a dibenzodiazepine, is demonstrated as the optimal antipsychotic for patients suffering from treatment-resistant schizophrenia. Like many other drugs, understanding the concentration of CLZ in a patient’s blood is critical for managing the patients’ symptoms, side effects, and overall treatment efficacy. To that end, various electrochemical techniques have been adapted due to their capabilities in concentration-dependent sensing. An open question associated with electrochemical CLZ monitoring is whether drug–protein complexes (i.e., CLZ bound to native blood proteins, such as serum albumin (SA) or alpha-1 acid-glycoprotein (AAG)) contribute to electrochemical redox signals. Here, we investigate CLZ-sensing performance using fundamental electrochemical methods with respect to the impact of protein binding. Specifically, we test the activity of bound and free fractions of a mixture of CLZ and either bovine SA or human AAG. Results suggest that bound complexes do not significantly contribute to the electrochemical signal for mixtures of CLZ with AAG or SA. Moreover, the fraction of CLZ bound to protein is relatively constant at 31% (AAG) and 73% (SA) in isolation with varying concentrations of CLZ. Thus, electrochemical sensing can enable direct monitoring of only the unbound CLZ, previously only accessible via equilibrium dialysis. The methods utilized in this work offer potential as a blueprint in developing electrochemical sensors for application to other redox-active medications with high protein binding more generally. This demonstrates that electrochemical sensing can be a new tool in accessing information not easily available previously, useful toward optimizing treatment regimens.
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    Microsystems Integration Towards Point-of-Care Monitoring of Clozapine Treatment for Adherence, Efficacy, and Safety
    (2017) Winkler, Thomas E.; Ghodssi, Reza; Bioengineering; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Schizophrenia is a challenging and complex disorder with 30–50% of patients not responding to first line antipsychotic treatment. Clozapine is the only antipsychotic approved by the FDA for treatment-resistant schizophrenia and is the most effective antipsychotic medication currently available. Yet, clozapine remains underutilized because of the requirements for frequent invasive and burdensome monitoring to 1) titrate doses to achieve effective blood levels, as well as 2) monitor white blood cells on a weekly basis for the first six months due to risk of agranulocytosis, a rare but potentially fatal side effect of clozapine. These blood draws, and the time lag in receiving reports from central labs, can add several more visits to the caregivers' treatment plan, which may not be feasible for the patient nor the treatment team. This contributes to a very low prescription rate for clozapine, making it one of the most underutilized evidence-based treatments in the field of mental health. The objective of this work is to progress toward a point-of-care approach to monitor both white blood cells and clozapine within a clinical setting. This would significantly lower the burden associated with clozapine treatment by allowing both tests to be performed rapidly during a single doctor's office visit or at the pharmacy. Specifically, I have developed and studied novel clozapine detection schemes based on electrochemical signal amplification in chitosan-based films. Moreover, I have investigated impedance cytometry coupled with hydrodynamic focusing and osmotic lysis to provide label- and reagent-free differential white blood cell counting capabilities. Finally, I have integrated the components in a microsystem capable of concurrent sensing of both biomarkers in whole blood samples. This proof-of-concept device lays the foundation for a fully integrated and automated lab-on-a-chip for point-of-care or even at-home testing to ensure treatment adherence, efficacy, and safety. This will allow for broader use of clozapine by increasing convenience to patients as well as medical professionals, thus improving the lives of people affected by schizophrenia through personalized medicine.