Saliva offers an alternative specimen for the
therapeutic monitoring of cyclosporine (CsA) in children and patients with difficult
venous access. For a highly
protein-
bound drug such as CsA,
saliva provides a practical approach for measuring the unbound concentration. Liquid
chromatography-
tandem mass spectrometry (LC-MS / MS) is ideally suited for the measurement of drugs in
saliva. A
solid-phase extraction technique, analytic liquid
chromatography over an Aqua Perfect column, maintained at 65° C., and
electrospray tandem mass spectrometry were used to quantify CsA in
saliva. The method used cyclosporine C (CsC) as the
internal standard. Mobile phase comprised of a 97:3 voL mixture of
methanol and 30 mmol / L
ammonium acetate at a flow rate of 0.5 mL / min. Chromatograms using
mass transitions of m / z 1219.9→m / z 1202.9 for CsA and m / z 1235.9→m / z 1218.9 for CsC were obtained. The
calibration curve was linear from 1 to 300 μg / L with
correlation coefficient values
ranging from 0.9732 to 0.9968). The
lower limit of quantification was 1 μg / L and limit of detection was 0.6 μg / L with an average extraction
recovery of 84.7±2.6% for CsA and 93.7±4.4% for CsC from the saliva matrix. The accuracy of the method ranged from 92% to 104.7%, and the intra- and interim coefficients of variation were 6.9-12.2% and 8.3-12.1%, respectively. The
correlation coefficient value between the CsA concentration measurements in 15 paired blood-saliva samples from
kidney transplant recipients was 0.695 (P=0.006). The noninvasive and simple method of
saliva collection coupled with the LC-MS / MS quantification technique for CsA analysis would generate novel data that could benefit patients undergoing CsA therapy.