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Frontiers | Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)

<!doctype html> <html data-n-head-ssr lang="en" data-n-head="%7B%22lang%22:%7B%22ssr%22:%22en%22%7D%7D"> <head > <link data-n-head="ssr" rel="icon" type="image/png" sizes="16x16" href="https://brand.frontiersin.org/m/ed3f9ce840a03d7/favicon_16-tenantFavicon-Frontiers.png"> <link data-n-head="ssr" rel="icon" type="image/png" sizes="32x32" href="https://brand.frontiersin.org/m/ed3f9ce840a03d7/favicon_32-tenantFavicon-Frontiers.png"> <link data-n-head="ssr" rel="apple-touch-icon" type="image/png" sizes="180x180" href="https://brand.frontiersin.org/m/ed3f9ce840a03d7/favicon_180-tenantFavicon-Frontiers.png"> <title>Frontiers | Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)</title><meta data-n-head="ssr" charset="utf-8"><meta data-n-head="ssr" name="viewport" content="width=device-width, initial-scale=1"><meta data-n-head="ssr" data-hid="charset" charset="utf-8"><meta data-n-head="ssr" data-hid="mobile-web-app-capable" name="mobile-web-app-capable" content="yes"><meta data-n-head="ssr" data-hid="apple-mobile-web-app-title" name="apple-mobile-web-app-title" content="Frontiers | Articles"><meta data-n-head="ssr" data-hid="theme-color" name="theme-color" content="#0C4DED"><meta data-n-head="ssr" data-hid="description" property="description" name="description" content="Introduction: This study was performed to determine the levels of α1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is co..."><meta data-n-head="ssr" data-hid="og:title" property="og:title" name="title" content="Frontiers | Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)"><meta data-n-head="ssr" data-hid="og:description" property="og:description" name="description" content="Introduction: This study was performed to determine the levels of α1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is co..."><meta data-n-head="ssr" data-hid="keywords" name="keywords" content="HPLC,α1-acid glycoprotein,human plasma,Hip joint surgery patients,Protein Binding"><meta data-n-head="ssr" data-hid="og:site_name" property="og:site_name" name="site_name" content="Frontiers"><meta data-n-head="ssr" data-hid="og:image" property="og:image" name="image" content="https://images-provider.frontiersin.org/api/ipx/w=1200&amp;f=png/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg"><meta data-n-head="ssr" data-hid="og:type" property="og:type" name="type" content="article"><meta data-n-head="ssr" data-hid="og:url" property="og:url" name="url" content="https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1145962/full"><meta data-n-head="ssr" data-hid="twitter:card" name="twitter:card" content="summary_large_image"><meta data-n-head="ssr" data-hid="citation_volume" name="citation_volume" content="14"><meta data-n-head="ssr" data-hid="citation_journal_title" name="citation_journal_title" content="Frontiers in Pharmacology"><meta data-n-head="ssr" data-hid="citation_publisher" name="citation_publisher" content="Frontiers"><meta data-n-head="ssr" data-hid="citation_journal_abbrev" name="citation_journal_abbrev" content="Front. Pharmacol."><meta data-n-head="ssr" data-hid="citation_issn" name="citation_issn" content="1663-9812"><meta data-n-head="ssr" data-hid="citation_doi" name="citation_doi" content="10.3389/fphar.2023.1145962"><meta data-n-head="ssr" data-hid="citation_firstpage" name="citation_firstpage" content="1145962"><meta data-n-head="ssr" data-hid="citation_language" name="citation_language" content="English"><meta data-n-head="ssr" data-hid="citation_title" name="citation_title" content="Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)"><meta data-n-head="ssr" data-hid="citation_keywords" name="citation_keywords" content="HPLC; α1-acid glycoprotein; human plasma; Hip joint surgery patients; Protein Binding"><meta data-n-head="ssr" data-hid="citation_abstract" name="citation_abstract" content="&lt;p&gt;&lt;bold&gt;Introduction:&lt;/bold&gt; This study was performed to determine the levels of α1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is considered an acute phase protein produced during the acute phase reaction in the body to various stimuli; their proper monitoring is thus important.&lt;/p&gt;&lt;p&gt;&lt;bold&gt;Methods:&lt;/bold&gt; In order to study how AGP concentrations in old age patients change in response to surgical stress (total hip arthroplasty), a high-performance liquid chromatography assay was performed to measure AGP levels. AGP was isolated from the plasma by adding perchloric acid and was analyzed using PLRP-S 4000°A column. The mobile phase consisted of 1 mL TFA/L of water (Solvent A pH 2) and 1 mL TFA/L of acetonitrile (Solvent B). The gradient used was as follows: 0 min 18% B and 82% A, 15 min 60% B and 40% A, and 17 min 60% B and 40% A followed by column re-equilibration for 7 min before the next injection. AGP peak was obtained between 8.8 and 8.9 min. The method was fully optimised according to established guidelines.&lt;/p&gt;&lt;p&gt;&lt;bold&gt;Results:&lt;/bold&gt; The data obtained were analyzed on ChromQuest software. AGP concentrations were determined in all samples, including baseline and samples taken at different timed intervals. The peak for AGP was obtained between 8.8 and 8.9 min for both standard AGP and patient plasma. The graphs indicate that AGP concentration in almost all patient samples increased considerably, especially after 4 h and 24 h—for example, initial concentration in patient 1 was 10.36 mg/100 mL but, after 24 h, increased to 23.50 mg/100 mL. There was thus almost a 13 mg/100 mL increase in 24 h, which is confirmed by AGP concentration increasing after various conditions, including surgery. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug.&lt;/p&gt;&lt;p&gt;&lt;bold&gt;Conclusion:&lt;/bold&gt; This surgically induced increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable during the postoperative period.&lt;/p&gt;"><meta data-n-head="ssr" data-hid="citation_pdf_url" name="citation_pdf_url" content="https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1145962/pdf"><meta data-n-head="ssr" data-hid="citation_online_date" name="citation_online_date" content="2023/05/16"><meta data-n-head="ssr" data-hid="citation_publication_date" name="citation_publication_date" content="2023/06/26"><meta data-n-head="ssr" data-hid="citation_author_0" name="citation_author" content="Abbas, Muhammad"><meta data-n-head="ssr" data-hid="citation_author_institution_0" name="citation_author_institution" content="Department of Pharmacy, Pakistan"><meta data-n-head="ssr" data-hid="citation_author_1" name="citation_author" content="Alossaimi, Manal A."><meta data-n-head="ssr" data-hid="citation_author_institution_1" name="citation_author_institution" content="Department of Pharmaceutical Chemistry, Saudi Arabia"><meta data-n-head="ssr" data-hid="citation_author_2" name="citation_author" content="Altamimi, Abdulmalik S. A."><meta data-n-head="ssr" data-hid="citation_author_institution_2" name="citation_author_institution" content="Department of Pharmaceutical Chemistry, Saudi Arabia"><meta data-n-head="ssr" data-hid="citation_author_3" name="citation_author" content="Alajaji, Mai"><meta data-n-head="ssr" data-hid="citation_author_institution_3" name="citation_author_institution" content="College of Pharmacy, Saudi Arabia"><meta data-n-head="ssr" data-hid="citation_author_4" name="citation_author" content="Watson, David G."><meta data-n-head="ssr" data-hid="citation_author_institution_4" name="citation_author_institution" content="Strathclyde Institute of Pharmacy and Biomedical Sciences, United Kingdom"><meta data-n-head="ssr" data-hid="citation_author_5" name="citation_author" content="Shah, Sayyed I."><meta data-n-head="ssr" data-hid="citation_author_institution_5" name="citation_author_institution" content="Department of Pharmacy, Pakistan"><meta data-n-head="ssr" data-hid="citation_author_6" name="citation_author" content="Shah, Yasar"><meta data-n-head="ssr" data-hid="citation_author_institution_6" name="citation_author_institution" content="Department of Pharmacy, Pakistan"><meta data-n-head="ssr" data-hid="citation_author_7" name="citation_author" content="Anwar, Mohammad S."><meta data-n-head="ssr" data-hid="citation_author_institution_7" name="citation_author_institution" content="Department of Pharmacy, Pakistan"><meta data-n-head="ssr" data-hid="dc.identifier" name="dc.identifier" content="doi:10.3389/fphar.2023.1145962"><link data-n-head="ssr" rel="manifest" href="/article-pages/_nuxt/manifest.c499fc0a.json" data-hid="manifest"><link data-n-head="ssr" rel="canonical" href="https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1145962/full"><script data-n-head="ssr" data-hid="newrelic-browser-script" type="text/javascript">window.NREUM||(NREUM={});NREUM.info = {"agent":"","beacon":"bam.nr-data.net","errorBeacon":"bam.nr-data.net","licenseKey":"598a124f17","applicationID":"588603994","agentToken":null,"applicationTime":2.06482,"transactionName":"MQcDMkECCkNSW0YMWghNIgldDQFTRxd1IGFJTQ==","queueTime":0,"ttGuid":"501c4af784b5a76a"}; (window.NREUM||(NREUM={})).init={privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]},distributed_tracing:{enabled:true}};(window.NREUM||(NREUM={})).loader_config={agentID:"594400880",accountID:"230385",trustKey:"230385",xpid:"VgUHUl5WGwYIXFdSBAgOUg==",licenseKey:"598a124f17",applicationID:"588603994"};;/*! 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Pharmacol.</span> <span>, 26 June 2023</span></p> <p class="ArticleLayoutHeader__info__journalDate"> Sec. Translational Pharmacology </p> <p class="ArticleLayoutHeader__info__doiVolume"><span> Volume 14 - 2023 | </span> <a href="https://doi.org/10.3389/fphar.2023.1145962" class="ArticleLayoutHeader__info__doi"> https://doi.org/10.3389/fphar.2023.1145962 </a></p> <!----></div> <!----> <p class="ArticleLayoutHeader__isPartOfRT"><span class="ArticleLayoutHeader__isPartOfRT__label">This article is part of the Research Topic</span> <span class="ArticleLayoutHeader__isPartOfRT__title">The Practical Implication of Clinical Pharmacokinetics in Drug Development, Pharmaceuticals Analysis, and Clinical Research</span> <span class="Link__wrapper"><a aria-label="View all 6 articles" href="https://www.frontiersin.org/research-topics/45495/the-practical-implication-of-clinical-pharmacokinetics-in-drug-development-pharmaceuticals-analysis-and-clinical-research/magazine" target="_self" data-event="customLink-link-a_viewAll6Articles" class="Link Link--linkType Link--maincolor Link--medium Link--icon Link--chevronRight Link--right"><span>View all 6 articles</span></a></span></p></div> <div class="ArticleDetails__main__content"><div class="ArticleDetails__main__content__main ArticleDetails__main__content__main--fullArticle"><div class="JournalAbstract"><div class="JournalAbstract__titleWrapper"><h1>Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)</h1> <!----></div> <!----></div> <div class="JournalFullText"><div class="JournalAbstract"><a id="h1" name="h1"></a><div class="authors"><span class="author-wrapper notranslate"><a href="https://loop.frontiersin.org/people/1417926" class="user-id-1417926"><img class="pr5" src="https://loop.frontiersin.org/images/profile/1417926/74" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';" alt="Muhammad Abbas&#xa;">Muhammad Abbas</a><sup>1</sup>&#x0002a;</span><span class="author-wrapper notranslate"><a href="https://loop.frontiersin.org/people/1109038" class="user-id-1109038"><img class="pr5" src="https://loop.frontiersin.org/images/profile/1109038/74" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';" alt="Manal A. Alossaimi">Manal A. Alossaimi</a><sup>2</sup></span><span class="author-wrapper notranslate"><img class="pr5" src="https://loop.frontiersin.org/cdn/images/profile/default_32.jpg" alt="Abdulmalik S. A. Altamimi" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';">Abdulmalik S. A. Altamimi<sup>2</sup></span><span class="author-wrapper notranslate"><img class="pr5" src="https://loop.frontiersin.org/cdn/images/profile/default_32.jpg" alt="Mai Alajaji" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';">Mai Alajaji<sup>3</sup></span><span class="author-wrapper notranslate"><a href="https://loop.frontiersin.org/people/2176267" class="user-id-2176267"><img class="pr5" src="https://loop.frontiersin.org/images/profile/2176267/74" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';" alt="David G. Watson">David G. Watson</a><sup>4</sup></span><span class="author-wrapper notranslate"><img class="pr5" src="https://loop.frontiersin.org/cdn/images/profile/default_32.jpg" alt="Sayyed I. Shah" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';">Sayyed I. Shah<sup>1</sup></span><span class="author-wrapper notranslate"><img class="pr5" src="https://loop.frontiersin.org/cdn/images/profile/default_32.jpg" alt="Yasar Shah" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';">Yasar Shah<sup>1</sup></span><span class="author-wrapper notranslate"><img class="pr5" src="https://loop.frontiersin.org/cdn/images/profile/default_32.jpg" alt="Mohammad S. Anwar" onerror="this.onerror=null;this.src='https://loop.frontiersin.org/cdn/images/profile/default_32.jpg';">Mohammad S. Anwar<sup>5</sup></span></div><ul class="notes"><li><span><sup>1</sup></span>Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan</li><li><span><sup>2</sup></span>Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al-Kharj, Saudi Arabia</li><li><span><sup>3</sup></span>College of Pharmacy, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</li><li><span><sup>4</sup></span>Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom</li><li><span><sup>5</sup></span>Department of Pharmacy, University of Swabi, Swabi, Pakistan</li></ul><p class="mb15"><b>Introduction:</b> This study was performed to determine the levels of &#x003b1;1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is considered an acute phase protein produced during the acute phase reaction in the body to various stimuli; their proper monitoring is thus important.</p><p class="mb15"><b>Methods:</b> In order to study how AGP concentrations in old age patients change in response to surgical stress (total hip arthroplasty), a high-performance liquid chromatography assay was performed to measure AGP levels. AGP was isolated from the plasma by adding perchloric acid and was analyzed using PLRP-S 4000&#x000b0;A column. The mobile phase consisted of 1&#x000a0;mL TFA/L of water (Solvent A pH 2) and 1&#x000a0;mL TFA/L of acetonitrile (Solvent B). The gradient used was as follows: 0&#x000a0;min 18% B and 82% A, 15&#x000a0;min 60% B and 40% A, and 17&#x000a0;min 60% B and 40% A followed by column re-equilibration for 7&#x000a0;min before the next injection. AGP peak was obtained between 8.8 and 8.9&#x000a0;min. The method was fully optimised according to established guidelines.</p><p class="mb15"><b>Results:</b> The data obtained were analyzed on ChromQuest software. AGP concentrations were determined in all samples, including baseline and samples taken at different timed intervals. The peak for AGP was obtained between 8.8 and 8.9&#x000a0;min for both standard AGP and patient plasma. The graphs indicate that AGP concentration in almost all patient samples increased considerably, especially after 4&#x000a0;h and 24&#x000a0;h&#x02014;for example, initial concentration in patient 1 was 10.36&#x000a0;mg/100&#x000a0;mL but, after 24&#x000a0;h, increased to 23.50&#x000a0;mg/100&#x000a0;mL. There was thus almost a 13 mg/100&#x000a0;mL increase in 24&#x000a0;h, which is confirmed by AGP concentration increasing after various conditions, including surgery. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug.</p><p class="mb15"><b>Conclusion:</b> This surgically induced increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable during the postoperative period.</p><div class="clear"></div></div><div class="JournalFullText"><a id="h2" name="h2"></a><h2>1 Introduction</h2><p class="mb15">Drug binding to different proteins in plasma may be significantly important in drug therapy because drug protein binding serves as a depot for the drug and has an influence on the pharmacokinetic and pharmacodynamic parameters and metabolism of the compound (<a href="#B25">Zeitlinger et al., 2011</a>). The pharmacological action of the drug is only due to the unbound portion of the drug and not to the total drug present in the plasma (<a href="#B13">Kratochwil et al., 2002</a>; <a href="#B2">Banker et al., 2003</a>). Thus, the effect of plasma protein binding on the pharmacokinetic and pharmacodynamic parameters needs careful attention. Many cases have been reported where a small change in plasma protein binding resulted in clinically vital changes in the pharmacokinetic parameters of the drug (<a href="#B19">Schmidt et al., 2010</a>). &#x0201c;Unbound fraction&#x0201d; is the concentration of a drug which is not bound to plasma proteins, and only this concentration of the drug produces the pharmacological effect. This unbound concentration varies during the dosing interval and must be accurately and correctly explained to determine the drug&#x00027;s effect (<a href="#B18">Roberts et al., 2013</a>). Drug binding to plasma proteins plays a vital role in determining the diffusion rate of the drug between extracellular and intracellular space; therefore, any change in this diffusion affects pharmacokinetic parameters, including the distribution volume and the clearance rate of the drug (<a href="#B3">Bohnert and Gan, 2013</a>). Generally, in cases of highly protein-bound drugs, a little change in protein binding is responsible for significant changes in the unbound concentration of drug, thereby increasing the clearance and volume of distribution (<a href="#B3">Bohnert and Gan, 2013</a>; <a href="#B18">Roberts et al., 2013</a>).</p><p class="mb15">Acute phase proteins (&#x003b1;1-acid glycoprotein&#x02014;AGP or AAP) are produced during the acute phase reaction in the body to various stimuli and play a role in the defence response shown by the body. The initiation of acute phase reactions in the body prevents any further injury by removing any harmful material and initiating the repair process to restore the organ to normal function. Their levels also inform us about the progression of the disease or inflammatory response by monitoring their concentrations in the blood. The changes in the plasma concentration of these proteins lead to altered drug binding and ultimately affect the pharmacokinetic and pharmacodynamic parameters of the drug (<a href="#B22">Tesseromatis et al., 2011</a>).</p><p class="mb15">Among the acute phase proteins, AGP is the most important (<a href="#B17">Rice et al., 1997</a>; <a href="#B22">Tesseromatis et al., 2011</a>). It is also called orosomucoid (ORM) and is the main protein responsible for binding basic drugs (<a href="#B23">Wood and Wood, 1981</a>; <a href="#B14">Kremer et al., 1988</a>; <a href="#B4">Booker et al., 1996</a>; <a href="#B7">Fournier et al., 2000</a>; <a href="#B9">Hochepied et al., 2003</a>; <a href="#B22">Tesseromatis et al., 2011</a>; <a href="#B10">Huang and Ung, 2013</a>; <a href="#B21">Taguchi et al., 2013</a>). AGP was first described by Karl Schmid and Richard J. Winzler and their colleagues in 1950; they considered it an unusual protein because of its low p<em>I</em> value, which ranges from 2.8&#x02013;3.8 and has a comparatively high content of carbohydrate (45% w/w) (<a href="#B12">Kishino and Miyazaki, 1997</a>; <a href="#B15">Kremmer et al., 2004</a>). AGP was considered as having the highest carbohydrate content of any protein until the characterisation of galactoglycoprotein in 1980, which has a 76% carbohydrate content (<a href="#B8">Hellerstein et al., 1985</a>; <a href="#B7">Fournier et al., 2000</a>; <a href="#B24">Xuan and Hage, 2005</a>). AGP is also reported as playing a role in drug&#x02013;drug interactions due to the displacement of drugs and other endogenous molecules from their binding sites, resulting in significant clinical implications (<a href="#B22">Tesseromatis et al., 2011</a>).</p><p class="mb15">The concentration of AGP in serum increases in various conditions, like post-surgical inflammation due to burn injury, cancer, and various other conditions (<a href="#B8">Hellerstein et al., 1985</a>; <a href="#B12">Kishino and Miyazaki, 1997</a>; <a href="#B16">Larsson et al., 1997</a>; <a href="#B9">Hochepied et al., 2003</a>; <a href="#B10">Huang and Ung, 2013</a>; <a href="#B6">Eckersall and Schmidt, 2014</a>). AGP synthesis mostly occurs in the liver, and then it is secreted by hepatocytes (<a href="#B22">Tesseromatis et al., 2011</a>; <a href="#B11">Keser et al., 2021</a>). However, there is also evidence of extra hepatic synthesis, which is production of AGP in places apart from hepatic tissue like human breast epithelial cells, the kidney, adipose tissue, and the spleen, thymus, and heart (<a href="#B9">Hochepied et al., 2003</a>). There is also variation in the levels of AGP among healthy individuals depending on age, sex, and hormonal variations (<a href="#B10">Huang and Ung, 2013</a>). The effectiveness of a drug in these cases depends on whether it is acidic in nature or a basic drug, as well on whether the drug binds to the albumin, to which acidic drugs normally bind, or to AGP, to which basic drugs bind. Drug displacement from protein binding sites by another strongly binding drug will also have a significant effect on the concentration of the displaced drug; dose adjustment should be taken into consideration in the use of such drugs (<a href="#B18">Roberts et al., 2013</a>; <a href="#B5">Bteich, 2019</a>).</p><a id="h3" name="h3"></a><h2>2 Methodology</h2><h3 class="pt0">2.1 Patients</h3><p class="mb0">We measured AGP in 20 patients (12 male and 8 female patients) aged 65&#x000a0;years or over undergoing unilateral total hip arthroplasty following high-volume, high-dose local infiltration analgesia. The study protocol was approved by the Regional Ethics Committee and conducted in accordance with the Helsinki Declaration (NCT01873313) from August 2012 to March 2013 in Golden Jubilee Hospital, Glasgow Scotland. Ten blood samples at different timed intervals were taken from each patient, and AGP was determined. A total of 200 samples were thus analysed for AGP. (20&#x0002a;10 &#x0003d; 200). Local anaesthetic infiltration was performed intra-operatively by the surgeon using 180&#x000a0;mL plain ropivacaine 0.2%. Circumferential infiltration of the deep and peri-capsular tissues with up to 80&#x000a0;mL was followed by infiltration of the gluteal muscles and fascia lata with approximately 70&#x000a0;mL. Finally, 30&#x000a0;mL was used to infiltrate the subcutaneous tissues and skin, completing the total of 180&#x000a0;mL.</p><h3 class="pt0">2.2 Chemicals and blood plasma for AGP analysis</h3><p class="mb0">Human AGP (standard), trifluoroacetic acid, and perchloric acid (70%) were purchased from Sigma Aldrich (UK). HPLC-grade water was produced by a Direct-Q 3 Ultrapure Water System from Millipore, UK. HPLC-grade acetonitrile (ACN) was purchased from Fisher Scientific, United Kingdom. Blank plasma was provided by the Blood Transfusion Service of Gartnavel Hospital, Glasgow. Plasma samples were obtained from Dr Mike Gill from patients undergoing hip joint surgery at the Golden Jubilee Hospital in Clydebank. The samples were stored at &#x02212;20&#x000b0;C until analysis.</p><h3 class="pt0">2.3 HPLC analysis</h3><p class="mb0">A high-performance liquid chromatographic (HPLC) system was used in the analysis and consisted of a SpectraSYSTEM P2000 gradient pump, a SpectraSYSTEM AS3000 autosampler (equipped with a Type 7010-150 Rheodyne injection valve (20&#x000a0;&#x000b5;L loop)), and a SpectraSYSTEM UV 1000 detector. The column used in the analysis was a PLRP-S 4000&#x000b0;A column (50&#x000a0;mm &#x000d7; 4.6&#x000a0;mm I.D., 5&#x000a0;&#x000b5;m particle size, Agilent Technologies). The pressure maintained at the column head was about 9,000 psi. The mobile phase consisted of 1&#x000a0;mL TFA/L of water (Solvent A pH 2) and 1&#x000a0;mL TFA/L of acetonitrile (Solvent B). The gradient used was as follows: 0&#x000a0;min 18% B and 82% A, 15&#x000a0;min 60% B and 40% A, and 17&#x000a0;min 60% B and 40% A followed by column re-equilibration for 7&#x000a0;min before the next injection. The flow rate of the mobile phase was 1&#x000a0;mL/min. The detection wavelength was set to 220&#x000a0;nm. The column was kept at room temperature. The data acquired were processed using ChromQuest software.</p><a id="h3-1" name="h3-1"></a><h3 class="pt0">2.4 Standards preparation</h3><p class="mb0">Stock solution of AGP was prepared at a concentration of 2&#x000a0;mg/mL in water. Different calibration solutions were then prepared from the stock solution by diluting it in 0.5&#x000a0;M perchloric acid. Different standards at concentrations of 6.25 mg/100&#x000a0;mL (0.0625&#x000a0;mg/mL), 12.5 mg/100&#x000a0;mL (0.125&#x000a0;mg/mL), 25 mg/100&#x000a0;mL (0.25&#x000a0;mg/mL), 50 mg/100&#x000a0;mL (0.5&#x000a0;mg/mL), and 100 mg/100&#x000a0;mL (1&#x000a0;mg/mL) were prepared and directly injected into the chromatographic system.</p><a id="h3-2" name="h3-2"></a><h3 class="pt0">2.5 Sample preparation</h3><p class="mb0">Venous blood samples from each patient participating in the study were taken at 5, 10, 15, 20, 25, and 30&#x000a0;min, then 1, 4, and 24&#x000a0;h following the injection of local anaesthetic, at the Golden Jubilee Hospital in Clydebank. The samples were then transferred to the University of Strathclyde, Glasgow, for analysis.</p><p class="mb0">The concentrations of AGP in all the patient plasma were then determined as follows: to 50&#x000a0;&#x000b5;L of patient or control plasma, 100&#x000a0;&#x000b5;L of 0.5&#x000a0;M of perchloric acid was added and was vortexed for 20&#x000a0;S in an Eppendorf tube to mix it thoroughly. The acidified plasma was then centrifuged at 9,000&#x000a0;rpm for 5&#x000a0;min at room temperature. The supernatant was then transferred to the insert in the HPLC vial for analysis. Both the extracted standards and samples were stored at 4&#x000b0;C before being chromatographed.</p><p class="mb0">The AGP concentration was then calculated from its linear correlation versus the values of peak areas obtained from the perchloric acid extract, expressed as mg/100&#x000a0;mL of plasma.</p><h3 class="pt0">2.6 Method validation</h3><p class="mb0">The method was validated according to ICH guidelines.</p><h4>2.6.1 Linearity</h4><p class="mb0">The method&#x02019;s linearity was established using the standards for AGP dissolved in perchloric acid as described in <a href="#h3-1">Section 2.4</a>.</p><h4>2.6.2 Recovery</h4><p class="mb0">In order to determine the accuracy of the extraction procedure, the recovery of AGP by perchloric acid extraction was determined. AGP was added to a constant volume of plasma (50&#x000a0;&#x003bc;L) in two different concentrations (25 and 50&#x000a0;mg/100&#x000a0;mL) and then mixed with perchloric acid as before in order to prepare a standard addition curve.</p><h4>2.6.3 Accuracy and precision</h4><p class="mb0">The within-run reproducibility of retention time and peak area was examined by repeated injection (<em>n</em> &#x0003d; 3) of an AGP standard (50&#x000a0;mg/100&#x000a0;mL). Three replicates prepared from the 50&#x000a0;&#x003bc;L amounts of the pooled plasma QC sample were run on three different occasions to calculate within- and between-run precision.</p><h4>2.6.4 Reproducibility</h4><p class="mb0">Replicates of the same QC samples (50&#x000a0;mg/100&#x000a0;mL) were run alongside the patient samples to monitor the performance of each assay.</p><h4>2.6.5 Sensitivity</h4><p class="mb0">The sensitivity of the method was determined in standard solutions and blank plasma spiked with the analyte. The limit of detection was defined as the minimum concentration for which a signal-to-noise ratio of 3 was obtained; for LOQ, a signal-to-noise ratio of 10 was considered.</p><h4>2.6.6 Application of the method to patient plasma</h4><p class="mb0">To determine the clinical relevance of the method, the concentration of AGP was identified and determined in the plasma of old-age hip joint surgery patients. The procedure was discussed in <a href="#h3-2">Section 2.5</a>.</p><h3 class="pt0">2.7 Ropivacaine determination</h3><p class="mb0">A fully validated method was developed on LC-MS to determine the free and bound portions of ropivacaine and published in <a href="#B1">Abbas et al. (2013</a>).</p><a id="h4" name="h4"></a><h2>3 Results</h2><p class="mb15">The normal mean value for AGP concentration in the plasma is 77&#x000a0;mg/100&#x000a0;mL (<a href="#B4">Booker et al., 1996</a>). However, there is great variation of this value among individuals. The results we obtained in our analysis gave concentrations which were generally below those specified by previous studies.</p><h3 class="pt0">3.1 Results of standard AGP samples and patient plasma</h3><p class="mb0">The AGP concentrations were analysed in the plasma of 20 hip joint surgery patients. These samples were taken at 5&#x000a0;min, 10&#x000a0;min, 15&#x000a0;min, 20&#x000a0;min, 25&#x000a0;min, 30&#x000a0;min, 1&#x000a0;h, 4&#x000a0;h, and 24&#x000a0;h. <a href="#F1">Figure 1</a> shows a typical chromatogram of the AGP standard injected directly into the chromatographic system, and <a href="#F2">Figure 2</a> shows a chromatogram of the AGP in patient plasma following removal of the rest of the protein with 0.5&#x000a0;M perchloric acid. The peak for AGP was obtained between 8.8 and 8.9&#x000a0;min. This method works very well for determining AGP, and there is minimal interference from other serum proteins like HSA, which is precipitated out almost completely by the perchloric acid; AGP remains in solution because of its high water solubility, which is due to its 40% carbohydrate content (<a href="#B20">Stumpe et al., 2006</a>).</p><div class="DottedLine"></div><div class="Imageheaders">FIGURE 1</div><div class="FigureDesc"><a href="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" name="Figure1" target="_blank"> <picture> <source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=480&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" media="(max-width: 563px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=370&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" media="(max-width: 1024px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=290&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" media="(max-width: 1441px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=410&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" media=""><source type="image/jpg" srcset="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" media=""> <img src="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g001.jpg" alt="www.frontiersin.org" id="F1" loading="lazy"> </picture> </a><p><b>FIGURE 1</b>. Typical chromatogram of an unextracted aqueous standard containing 50 mg/100&#x000a0;mL of AGP. The elution was performed on a PLRP-S 4000&#x000b0;A column (50&#x000a0;mm &#x000d7; 4.6&#x000a0;mm I.D., 5&#x000a0;&#x000b5;m particle size, Agilent Technologies). The mobile phase consisted of 1&#x000a0;mL TFA/L of water (Solvent A) and 1&#x000a0;mL TFA/L of acetonitrile (Solvent B). The gradient used was 0&#x000a0;min 18% B, 15&#x000a0;min 60% B, and 17&#x000a0;min 60% B followed by column re-equilibration for 7&#x000a0;min before the next injection. The flow rate of the mobile phase was 1&#x000a0;mL/min. The detection wavelength was set to 220&#x000a0;nm. Retention time observed was 8.9&#x000a0;min.</p></div><div class="clear"></div><div class="DottedLine"></div><div class="Imageheaders">FIGURE 2</div><div class="FigureDesc"><a href="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" name="Figure2" target="_blank"> <picture> <source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=480&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" media="(max-width: 563px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=370&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" media="(max-width: 1024px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=290&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" media="(max-width: 1441px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=410&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" media=""><source type="image/jpg" srcset="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" media=""> <img src="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g002.jpg" alt="www.frontiersin.org" id="F2" loading="lazy"> </picture> </a><p><b>FIGURE 2</b>. Typical chromatogram of AGP extracted from 50&#x000a0;&#x000b5;L of patient plasma. Analysis was performed on PLRP-S 4000&#x000b0;A column (50&#x000a0;mm &#x000d7; 4.6&#x000a0;mm I.D., 5&#x000a0;&#x000b5;m particle size, Agilent Technologies). The mobile phase consisted of 1&#x000a0;mL TFA/L of water (Solvent A) and 1&#x000a0;mL TFA/L of acetonitrile (Solvent B). The gradient used was 0&#x000a0;min 18% B, 15&#x000a0;min 60% B, and 17&#x000a0;min 60% B followed by column re-equilibration for 7&#x000a0;min before the next injection. The flow rate of the mobile phase was 1&#x000a0;mL/min. The detection wavelength was set to 220&#x000a0;nm. Retention time observed was 8.89&#x000a0;min.</p></div><div class="clear"></div><div class="DottedLine"></div><h3 class="pt0">3.2 Method validation</h3><h4>3.2.1 Linearity</h4><p class="mb0">The calibration curve obtained by plotting the areas of the AGP peaks versus AGP concentration on different days was linear (calibration curve added in <a href="#SM1">Supplementary Material</a>). The data were obtained for the calibration curve on three different days, and the average of these data was used for the calibration curve. The curve covered the concentration range from 6&#x000a0;mg/100&#x000a0;mL to 100&#x000a0;mg/100&#x000a0;mL, which also covered the concentration of AGP in the patient plasma.</p><h4>3.2.2 Recovery</h4><p class="mb0">In the recovery test, the recovery after liquid&#x02013;liquid extraction with perchloric acid of 25&#x000a0;mg/100&#x000a0;mL spiking of AGP into plasma was 91.7% &#x000b1; 8.9% (<em>n</em> &#x0003d; 6), and, for 50&#x000a0;mg/100&#x000a0;mL spiking, the recovery was 90.1% &#x000b1; 3.7% (<em>n</em> &#x0003d; 6).</p><h4>3.2.3 Accuracy and precision</h4><p class="mb0">The within-run precision of the extraction/HPLC procedure ranged from &#x000b1;1.2% to &#x000b1;3.8%, and the between-run precision was &#x000b1;6.1%.</p><h4>3.2.4 Reproducibility</h4><p class="mb0">Having established linearity, a single-point standard of 50&#x000a0;mg/100&#x000a0;mL was run every day with the patient samples, and results were always well within limits.</p><h4>3.2.5 Sensitivity</h4><p class="mb0">The method was sensitive enough to determine the lowest level of AGP 5&#x000a0;mg/100&#x000a0;mL (LOD), while LOQ was found to be 10&#x000a0;mg/100&#x000a0;mL.</p><h4>3.2.6 Application of the method to patient plasma</h4><p class="mb0">The results for the AGP concentrations in patients receiving a continuous infusion of a local anaesthetic ropivacaine following total hip arthroplasty are presented in <a href="#F4">Figure 4</a>.</p><a id="h5" name="h5"></a><h2>4 Discussion</h2><p class="mb15">The margin of therapeutic safety for many drugs like anaesthetics should be considered in older age because the body&#x00027;s ageing process may result in toxicity of the drugs. Very little data have been published regarding the binding of local anaesthetics to plasma proteins. This study was performed to determine the level of AGP in the plasma of old-aged hip joint surgery patients.</p><p class="mb15">The level of AGP in the plasma increased during the study period, which indicated that the level of AGP increases during or following surgical procedures. Similar results were shown in a previous study (<a href="#B3">Bohnert and Gan, 2013</a>) which determined the concentration of AGP in neonates and also by two other studies <a href="#B8">Hellerstein et al. (1985</a>) and <a href="#B22">Tesseromatis et al. (2011</a>).</p><p class="mb15">As can be seen from graphs of the results (<a href="#F4">Figure 4</a>), nearly all patients had AGP levels which were higher after 4&#x000a0;h and 24&#x000a0;h than early timed samples. This increase in AGP level is directly related to plasma protein binding, which increases in the samples taken after 24&#x000a0;h. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug. As the effect of the drug is mainly due to its free or unbound portion, any altered concentration of AGP will ultimately affect the level of the unbound portion of the drug and its subsequent effect. This surgically related increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable and within limits during the postoperative period, as shown in <a href="#F3">Figure 3</a>. A detailed method regarding ropivacaine determination was published in <a href="#B1">Abbas et al. (2013</a>).</p><div class="DottedLine"></div><div class="Imageheaders">FIGURE 3</div><div class="FigureDesc"><a href="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" name="Figure3" target="_blank"> <picture> <source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=480&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" media="(max-width: 563px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=370&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" media="(max-width: 1024px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=290&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" media="(max-width: 1441px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=410&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" media=""><source type="image/jpg" srcset="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" media=""> <img src="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g003.jpg" alt="www.frontiersin.org" id="F3" loading="lazy"> </picture> </a><p><b>FIGURE 3</b>. Mean plasma concentration of ropivacaine following local infiltration analgesia <b>(A)</b> total concentration i.e., bound to AGP <b>(B)</b> free concentration of ropivacaine. The error bars indicates SD.</p></div><div class="clear"></div><div class="DottedLine"></div><p class="mb15">The data and graphs in <a href="#F4">Figure 4</a> clearly show a significant increase in AGP concentration after surgery, especially in samples taken after 4&#x000a0;h and 24&#x000a0;h. In patient 1, the initial concentration is 10.36 mg/100&#x000a0;mL, but, after 24&#x000a0;h, it increases to 23.50&#x000a0;mg/100&#x000a0;mL. There is thus almost a 13 mg/100&#x000a0;mL increase in 24&#x000a0;h. In patient 2H, there is also a significant increase in initial concentration and after 24&#x000a0;h, as seen in the table and from the graph, of 8.8 mg/100&#x000a0;mL and, after 24&#x000a0;h, 26.44&#x000a0;mg/100&#x000a0;mL. In patient 3H, there is also a considerable increase in the initial concentration of 5.19&#x000a0;mg/100&#x000a0;mL and, after 24&#x000a0;h, 27.05&#x000a0;mg/100&#x000a0;mL. There is likewise an increase in the concentration of AGP in all 20 patients. This confirms that there is an increase in AGP concentration after surgical conditions as well as in stress conditions as shown in different studies.</p><div class="DottedLine"></div><div class="Imageheaders">FIGURE 4</div><div class="FigureDesc"><a href="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" name="Figure4" target="_blank"> <picture> <source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=480&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" media="(max-width: 563px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=370&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" media="(max-width: 1024px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=290&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" media="(max-width: 1441px)"><source type="image/webp" srcset="https://images-provider.frontiersin.org/api/ipx/w=410&f=webp/https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" media=""><source type="image/jpg" srcset="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" media=""> <img src="https://www.frontiersin.org/files/Articles/1145962/fphar-14-1145962-HTML-r3/image_m/fphar-14-1145962-g004.jpg" alt="www.frontiersin.org" id="F4" loading="lazy"> </picture> </a><p><b>FIGURE 4</b>. Concentrations of AGP at different time intervals in 20 hip joint patients. The graphs indicate a significant increase in AGP concentration after surgery, especially in samples taken after 4&#x000a0;h and 24&#x000a0;h. In patient 1, initial concentration is 10.36 mg/100&#x000a0;mL, but, after 24&#x000a0;h, it increases to 23.50&#x000a0;mg/100&#x000a0;mL. There is thus almost a 13&#x000a0;mg/100&#x000a0;mL increase in 24&#x000a0;h. In patient 2H, there is also a significant increase in the initial concentration, and, after 24&#x000a0;h, the table and from graph show it as 8.8&#x000a0;mg/100&#x000a0;mL and, after 24&#x000a0;h, 26.44&#x000a0;mg/100&#x000a0;mL. In patient 3H, there is also a considerable increase in initial concentration of 5.19&#x000a0;mg/100&#x000a0;mL; after 24&#x000a0;h, it is 27.05&#x000a0;mg/100&#x000a0;mL. Likewise, there is an increase in AGP concentration in all 20 patients.</p></div><div class="clear"></div><div class="DottedLine"></div><p class="mb15">It is also clear from the data that there is considerable inter-individual variation in the level of AGP. It was found by <a href="#B4">Booker et al. (1996</a>) that the mean concentration is 77&#x000a0;mg/100&#x000a0;mL; however, based on our results, it is difficult to determine any exact concentration because of this inter-individual variability in AGP concentration. Therefore, this is a solid base for any dose adjustment in the case of surgical condition because of increased levels of AGP.</p><a id="h6" name="h6"></a><h2>5 Conclusion</h2><p class="mb15">The results confirmed that AGP concentration in almost all patients increased considerably in all samples, especially after 4&#x000a0;h and 24&#x000a0;h, which confirms that AGP concentration increases after surgical conditions. Therefore, dose adjustment should be considered in the use of drugs which bind to AGP.</p><a id="h7" name="h7"></a><h2>Data availability statement</h2><p class="mb15">The original contributions presented in the study are included in the article/<a href="#SM1">Supplementary Material</a>; further inquiries can be directed to the corresponding authors.</p><a id="h8" name="h8"></a><h2>Ethics statement</h2><p class="mb0">The studies involving human participants were reviewed and approved by the Regional Ethics Committee and conducted in accordance with the Declaration of Helsinki (NCT01873313). The patients/participants provided their written informed consent to participate in this study.</p><a id="h9" name="h9"></a><h2>Author contributions</h2><p class="mb0">MuA: sample preparation and sample analysis, data interpretation, and manuscript preparation. DW: project design. YS: sample analysis. SS: data interpretation. MoA: manuscript preparation. MaA: manuscript preparation and data analysis. LM: manuscript preparation and data analysis<em>.</em> All authors contributed to the article and approved the submitted version.</p><a id="h10" name="h10"></a><h2>Acknowledgments</h2><p class="mb03">The authors are thankful to the University of Strathclyde, Glasgow, and Abdul Wali Khan University, Mardan, Pakistan, for facilitating the study<b>.</b> This study is supported via funding from Prince sattam bin Abdulaziz University project number (PSAU/2023/R/1444).</p><a id="h11" name="h11"></a><h2>Conflict of interest</h2><p class="mb0">The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p><a id="h12" name="h12"></a><h2>Publisher&#x02019;s note</h2><p class="mb15">All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. 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Protein binding: Do we ever learn? <em>Antimicrob. agents Chemother.</em> 55, 3067&#x02013;3074. doi:10.1128/AAC.01433-10</p><p class="ReferencesCopy2"><a href="https://pubmed.ncbi.nlm.nih.gov/21537013/">PubMed Abstract</a> &#x0007c; <a href="https://doi.org/10.1128/AAC.01433-10">CrossRef Full Text</a> &#x0007c; <a href="https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C5&amp;q=Protein+binding:+Do+we+ever+learn?&amp;btnG=">Google Scholar</a></p></div></div><div class="thinLineM20"></div><div class="AbstractSummary"><p><span>Keywords:</span> HPLC, &#x003b1;1-acid glycoprotein, human plasma, hip joint surgery patients, protein binding</p><p><span>Citation:</span> Abbas M, Alossaimi MA, Altamimi ASA, Alajaji M, Watson DG, Shah SI, Shah Y and Anwar MS (2023) Determination of &#x003b1;1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound). <em>Front. Pharmacol.</em> 14:1145962. doi: 10.3389/fphar.2023.1145962</p><p id="timestamps"><span>Received:</span> 16 January 2023; <span>Accepted:</span> 16 May 2023;<br><span>Published:</span> 26 June 2023.</p><div><p>Edited by:</p> <a href="https://loop.frontiersin.org/people/243834/overview">Tahir Ali</a>, University of Calgary, Canada</div><div><p>Reviewed by:</p> <a href="https://loop.frontiersin.org/people/1943882/overview">Swati Jaiswal</a>, University of Massachusetts Medical School, United States<br><a href="https://loop.frontiersin.org/people/542593/overview">Mohammed Abdessadek</a>Universit&#x000e9; Ibn Zohr, Morocco</div><p><span>Copyright</span> &#x000a9; 2023 Abbas, Alossaimi, Altamimi, Alajaji, Watson, Shah, Shah and Anwar. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY).</a> The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p><p><span>&#x0002a;Correspondence:</span> Muhammad Abbas, <a id="encmail">bXVoYW1tYWRhYmJhc0Bhd2t1bS5lZHUucGs=</a></p><div class="clear"></div></div> </div></div> <p class="AbstractSummary__disclaimer"><span>Disclaimer: </span> All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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class="Avatar Avatar--size-32"><img src="https://loop.frontiersin.org/images/profile/243834/32" alt="Tahir Ali" class="Avatar__img is-inside-mask"></figure> <div class="ArticleDetailsEditors__ediorInfo__info"><div class="ArticleDetailsEditors__ediorInfo__name notranslate"> Tahir Ali </div> <div class="ArticleDetailsEditors__ediorInfo__affiliation notranslate"> University of Calgary, Canada </div></div></a></div></div> <div class="ArticleDetailsEditors"><div class="ArticleDetailsEditors__editors"><div class="ArticleDetailsEditors__title">Reviewed by</div> <a href="https://loop.frontiersin.org/people/542593/overview" data-event="editorInfo-a-mohammedAbdessadek" class="ArticleDetailsEditors__ediorInfo"><figure class="Avatar Avatar--size-32"><img src="https://loop.frontiersin.org/images/profile/542593/32" alt="Mohammed Abdessadek" class="Avatar__img is-inside-mask"></figure> <div class="ArticleDetailsEditors__ediorInfo__info"><div class="ArticleDetailsEditors__ediorInfo__name notranslate"> Mohammed Abdessadek </div> <div class="ArticleDetailsEditors__ediorInfo__affiliation notranslate"> Université Ibn Zohr, Morocco </div></div></a><a href="https://loop.frontiersin.org/people/1943882/overview" data-event="editorInfo-a-swatiJaiswal" class="ArticleDetailsEditors__ediorInfo"><figure class="Avatar Avatar--size-32"><img src="https://loop.frontiersin.org/images/profile/1943882/32" alt="Swati Jaiswal" class="Avatar__img is-inside-mask"></figure> <div class="ArticleDetailsEditors__ediorInfo__info"><div class="ArticleDetailsEditors__ediorInfo__name notranslate"> Swati Jaiswal </div> <div class="ArticleDetailsEditors__ediorInfo__affiliation notranslate"> University of Massachusetts Medical School, United States </div></div></a></div></div> <div class="ArticleDetailsGlossary ArticleDetailsGlossary--open"><button class="ArticleDetailsGlossary__header"><div class="ArticleDetailsGlossary__header__title">Table of contents</div> <div 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Indexed in PubMed Central (PMC), Scopus, Web of Science (SCIE), and the DOAJ, the journal welcomes academic, industrial, and clinical work focused on pharmacology.\u003C\u002Fp\u003E\n\n\u003Cp\u003ETopics include, but are not limited to:\u003C\u002Fp\u003E\n\u003Cul\u003E\n \u003Cli\u003Ecardiovascular and smooth muscle pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Edrug metabolism and transport\u003C\u002Fli\u003E\n \u003Cli\u003Edrugs outcomes research and policies\u003C\u002Fli\u003E\n \u003Cli\u003EELSI in science and genetics\u003C\u002Fli\u003E\n \u003Cli\u003Eethnopharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Eexperimental pharmacology and drug discovery\u003C\u002Fli\u003E\n \u003Cli\u003Egastrointestinal and hepatic pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Einflammation pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Eintegrative and regenerative pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Eneuropharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Eobstetric and pediatric pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Epharmacoepidemiology\u003C\u002Fli\u003E\n \u003Cli\u003Epharmacogenetics and pharmacogenomics\u003C\u002Fli\u003E\n \u003Cli\u003Epharmacology of anti-cancer drugs\u003C\u002Fli\u003E\n \u003Cli\u003Epharmacology of infectious diseases\u003C\u002Fli\u003E\n \u003Cli\u003Epharmacology of ion channels and channelopathies\u003C\u002Fli\u003E\n \u003Cli\u003Epredictive toxicology\u003C\u002Fli\u003E\n \u003Cli\u003Erenal pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Erespiratory pharmacology\u003C\u002Fli\u003E\n \u003Cli\u003Etranslational pharmacology.\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\n\u003Cp\u003EAll submissions to the journal involving natural products, including plant extracts or preparations, must adhere to \u003Ci\u003E'The Four Pillars of Ethnopharmacology'\u003C\u002Fi\u003E to be considered for peer review, regardless of the specialty section, as a baseline standard for sample characterization. These are a set of mandatory guidelines designed to maintain the scientific, cultural, and ethical integrity of the Journal, and describe what the leading journals in the field consider as the basic aspects of good research (full ConPhyMP statement available \u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Fjournals\u002Fpharmacology\u002Farticles\u002F10.3389\u002Ffphar.2022.953205\u002Ffull\" target=\"_blank\"\u003Ehere\u003C\u002Fa\u003E, ConPhyMP statement overview \u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Fjournals\u002Fpharmacology\u002Farticles\u002F10.3389\u002Ffphar.2023.1338710\u002Ffull\" target=\"_blank\"\u003Ehere\u003C\u002Fa\u003E, and GA-tool \u003Ca href=\"https:\u002F\u002Fga-online.org\u002Fbest-practice\u002F\" target=\"_blank\"\u003Ehere\u003C\u002Fa\u003E). Please refer to the \u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002Fpdf\u002F4_pillars_FULL_TEXT.pdf\" target=\"_blank\"\u003EFULL VERSION\u003C\u002Fa\u003E of these guidelines before submitting a manuscript to the journal.\u003C\u002Fp\u003E \n\u003Cp\u003ETo be considered for publication in Frontiers in Pharmacology, studies incorporating complementary or alternative medicine must be based on a set of data linked to local or traditional uses that can be evaluated pharmacologically. A clear and plausible set of pharmacological data must be generated in these studies. Similarly, the journal endorses protocols including a minimum of 2 cell-lines in vitro as an evidential basis to demonstrate proposed anti-cancer effects in all relevant studies submitted to all specialty sections in the journal.\u003C\u002Fp\u003E\n\u003Cp\u003EIsolated data mining studies using disproportionality analyses of databases containing spontaneously reported adverse events, frequently lead to misinterpretation due to various reporting biases, lack of structured control, and insufficient demographic details. Presenting such analyses in isolation typically does not yield clinically actionable safety findings without the broader context of a comprehensive signal evaluation. To ensure rigor and relevance, all submissions to the journal must be complemented by a proper systematic review and\u002For thorough analyses of reported cases, and adhere to the READUS-PV guidelines (\u003Ca href=\"https:\u002F\u002Fwww.equator-network.org\u002Freporting-guidelines\u002Fthe-reporting-of-a-disproportionality-analysis-for-drug-safety-signal-detection-using-individual-case-safety-reports-in-pharmacovigilance-readus-pv-development-and-statement\u002F\" target=\"_blank\"\u003EThe Reporting of a Disproportionality Analysis for Drug Safety Signal Detection Using Individual Case Safety Reports in PharmacoVigilance\u003C\u002Fa\u003E). Authors are expected to ensure compliance with the corresponding \u003Ca href=\"https:\u002F\u002Freadus-statement.org\u002Fwp-content\u002Fuploads\u002F2024\u002F03\u002Freadus-checklist.pdf\" target=\"_blank\"\u003Echecklist\u003C\u002Fa\u003E before proceeding with submission to the journal. Full publication of the READUS-PV guidelines is available \u003Ca href=\"https:\u002F\u002Fpmc.ncbi.nlm.nih.gov\u002Farticles\u002FPMC11116242\u002Fpdf\u002F40264_2024_Article_1421.pdf\" target=\"_blank\"\u003Ehere\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\n\u003Cp\u003EFurther unique criteria for the conception and review of submissions may apply, where appropriate, for individual specialty sections.\u003C\u002Fp\u003E\n\n\u003Cp\u003EThe journal welcomes submissions that support and advance the \u003Ca href=\"https:\u002F\u002Fwww.globalgoals.org\u002Fgoals\u002F\" target=\"_blank\"\u003EUN Sustainable Development Goals\u003C\u002Fa\u003E (SDGs), notably the \u003Ca href=\"https:\u002F\u002Fwww.globalgoals.org\u002Fgoals\u002F3-good-health-and-well-being\u002F\" target=\"_blank\"\u003ESDG 3: Good Health and Well-being\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\n\u003Cp\u003EManuscripts that focus solely on clinical trials, patient management, or conventional therapies without a focus on pharmacological research are not suitable for publication in this journal. Additionally, studies that are purely statistical or predictive in nature, without providing novel insights into pharmacological mechanisms or drug development, are not within the scope of this journal.\u003C\u002Fp\u003E\n\n\u003Cp\u003EFrontiers in Pharmacology is committed to advancing developments in the field of pharmacological discoveries by allowing unrestricted access to articles and communicating scientific knowledge to researchers and the public alike, to enable the scientific breakthroughs of the future.\u003C\u002Fp\u003E\n\n\u003Cb\u003E\u003Cp\u003EEthics Information\u003C\u002Fp\u003E\u003C\u002Fb\u003E\n\u003Cp\u003EResearch involving human subjects should comply with the ethical guidelines outlined in the \u003Ca href= https:\u002F\u002Fwww.wma.net\u002Fpolicies-post\u002Fwma-declaration-of-helsinki\u002F” target=”_blank”\u003EWorld Medical Association’s Declaration of Helsinki\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003ESimilarly, authors are required to specify the institutional and national standards adhered to for the care and use of laboratory animals. Transparent and accurate reporting of animal studies is required, with references to guidelines such as \u003Ca href=\"https:\u002F\u002Farriveguidelines.org\u002Farrive-guidelines\" target=\"_blank\"\u003EARRIVE\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fnc3rs.org.uk\u002Fsites\u002Fdefault\u002Ffiles\u002F2022-01\u002FThe%20IMPROVE%20Guidelines%20%28poster%29.pdf\" target=\"_blank\"\u003E IMPROVE\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EExtended information on research ethics can be found under the Frontiers Policies and Publication Ethics page.\u003C\u002Fp\u003E",palette:"purple",impactFactor:"5.6",citeScore:"6.3",citations:"356000",showTagline:e,twitter:"@FrontPharmacol",__typename:"Journal"},currentFrontiersJournal:{id:t,name:p,slug:u,printISSN:e,shortName:J,electronicISSN:K,abbreviation:Y,specialtyId:e,publicationDate:e,isOnline:h,isOpenForSubmissions:h,spaceId:c,field:{id:Z,domainId:c,__typename:_},__typename:a},articleHubSlug:g,articleHubPage:L,currentArticle:{id:1145962,doi:$,title:aa,acceptanceDate:new Date(1684214740000),receptionDate:new Date(1673889744000),publicationDate:new Date(1687737600000),isPublished:h,abstract:ab,researchTopic:{id:45495,title:"The Practical Implication of Clinical Pharmacokinetics in Drug Development, Pharmaceuticals Analysis, and Clinical Research",articlesCount:M,isMagazinePage:h,slug:"the-practical-implication-of-clinical-pharmacokinetics-in-drug-development-pharmaceuticals-analysis-and-clinical-research",isOpenForSubmission:j},articleType:{id:24,name:"Original Research"},stage:{id:N,name:g},keywords:["HPLC","α1-acid glycoprotein","human plasma","Hip joint surgery patients","Protein Binding"],authors:[{id:ac,firstName:ad,lastName:"Abbas",givenNames:ad,isCorresponding:j,isProfilePublic:h,userId:ac,affiliations:[{organizationName:x,countryName:y,cityName:g,stateName:g,zipCode:g}]},{id:ae,firstName:af,lastName:"Alossaimi",givenNames:af,isCorresponding:j,isProfilePublic:h,userId:ae,affiliations:[{organizationName:ag,countryName:O,cityName:g,stateName:g,zipCode:g}]},{id:l,firstName:ah,lastName:"Altamimi",givenNames:ah,isCorresponding:j,isProfilePublic:j,userId:l,affiliations:[{organizationName:ag,countryName:O,cityName:g,stateName:g,zipCode:g}]},{id:l,firstName:ai,lastName:"Alajaji",givenNames:ai,isCorresponding:j,isProfilePublic:j,userId:l,affiliations:[{organizationName:"College of Pharmacy",countryName:O,cityName:g,stateName:g,zipCode:g}]},{id:aj,firstName:ak,lastName:"Watson",givenNames:ak,isCorresponding:j,isProfilePublic:h,userId:aj,affiliations:[{organizationName:"Strathclyde Institute of Pharmacy and Biomedical Sciences",countryName:"United Kingdom",cityName:g,stateName:g,zipCode:g}]},{id:l,firstName:al,lastName:am,givenNames:al,isCorresponding:j,isProfilePublic:j,userId:l,affiliations:[{organizationName:x,countryName:y,cityName:g,stateName:g,zipCode:g}]},{id:l,firstName:an,lastName:am,givenNames:an,isCorresponding:j,isProfilePublic:j,userId:l,affiliations:[{organizationName:x,countryName:y,cityName:g,stateName:g,zipCode:g}]},{id:l,firstName:ao,lastName:"Anwar",givenNames:ao,isCorresponding:j,isProfilePublic:j,userId:l,affiliations:[{organizationName:x,countryName:y,cityName:g,stateName:g,zipCode:g}]}],editors:[{id:ap,firstName:aq,lastName:"Ali",givenNames:aq,isCorresponding:j,isProfilePublic:h,userId:ap,affiliations:[{organizationName:"University of Calgary",countryName:"Canada",cityName:g,stateName:g,zipCode:g}]}],reviewers:[{id:ar,firstName:as,lastName:"Abdessadek",givenNames:as,isCorresponding:j,isProfilePublic:h,userId:ar,affiliations:[{organizationName:"Université Ibn Zohr",countryName:"Morocco",cityName:g,stateName:g,zipCode:g}]},{id:at,firstName:au,lastName:"Jaiswal",givenNames:au,isCorresponding:j,isProfilePublic:h,userId:at,affiliations:[{organizationName:"University of Massachusetts Medical School",countryName:"United States",cityName:g,stateName:g,zipCode:g}]}],journal:{id:t,slug:u,name:p,shortName:J,electronicISSN:K,field:{id:Z,domainId:c,__typename:_},specialtyId:e,journalSectionPaths:[{section:av,__typename:"journal_journalSectionPath"}],__typename:a},section:av,impactMetrics:{views:1811,downloads:417,citations:q},volume:az,articleVolume:"Volume 14 - 2023",relatedArticles:[],isPublishedV2:j,contents:{titleHtml:"Determination of &#x003b1;1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)",fullTextHtml:"\u003Cdiv class=\"JournalAbstract\"\u003E\u003Ca id=\"h1\" name=\"h1\"\u003E\u003C\u002Fa\u003E\u003Cdiv class=\"authors\"\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Ca href=\"https:\u002F\u002Floop.frontiersin.org\u002Fpeople\u002F1417926\" class=\"user-id-1417926\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fimages\u002Fprofile\u002F1417926\u002F74\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\" alt=\"Muhammad Abbas&#xa;\"\u003EMuhammad Abbas\u003C\u002Fa\u003E\u003Csup\u003E1\u003C\u002Fsup\u003E&#x0002a;\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Ca href=\"https:\u002F\u002Floop.frontiersin.org\u002Fpeople\u002F1109038\" class=\"user-id-1109038\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fimages\u002Fprofile\u002F1109038\u002F74\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\" alt=\"Manal A. Alossaimi\"\u003EManal A. Alossaimi\u003C\u002Fa\u003E\u003Csup\u003E2\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg\" alt=\"Abdulmalik S. A. Altamimi\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\"\u003EAbdulmalik S. A. Altamimi\u003Csup\u003E2\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg\" alt=\"Mai Alajaji\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\"\u003EMai Alajaji\u003Csup\u003E3\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Ca href=\"https:\u002F\u002Floop.frontiersin.org\u002Fpeople\u002F2176267\" class=\"user-id-2176267\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fimages\u002Fprofile\u002F2176267\u002F74\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\" alt=\"David G. Watson\"\u003EDavid G. Watson\u003C\u002Fa\u003E\u003Csup\u003E4\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg\" alt=\"Sayyed I. Shah\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\"\u003ESayyed I. Shah\u003Csup\u003E1\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg\" alt=\"Yasar Shah\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\"\u003EYasar Shah\u003Csup\u003E1\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003Cspan class=\"author-wrapper notranslate\"\u003E\u003Cimg class=\"pr5\" src=\"https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg\" alt=\"Mohammad S. Anwar\" onerror=\"this.onerror=null;this.src='https:\u002F\u002Floop.frontiersin.org\u002Fcdn\u002Fimages\u002Fprofile\u002Fdefault_32.jpg';\"\u003EMohammad S. Anwar\u003Csup\u003E5\u003C\u002Fsup\u003E\u003C\u002Fspan\u003E\u003C\u002Fdiv\u003E\u003Cul class=\"notes\"\u003E\u003Cli\u003E\u003Cspan\u003E\u003Csup\u003E1\u003C\u002Fsup\u003E\u003C\u002Fspan\u003EDepartment of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan\u003C\u002Fli\u003E\u003Cli\u003E\u003Cspan\u003E\u003Csup\u003E2\u003C\u002Fsup\u003E\u003C\u002Fspan\u003EDepartment of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al-Kharj, Saudi Arabia\u003C\u002Fli\u003E\u003Cli\u003E\u003Cspan\u003E\u003Csup\u003E3\u003C\u002Fsup\u003E\u003C\u002Fspan\u003ECollege of Pharmacy, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia\u003C\u002Fli\u003E\u003Cli\u003E\u003Cspan\u003E\u003Csup\u003E4\u003C\u002Fsup\u003E\u003C\u002Fspan\u003EStrathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom\u003C\u002Fli\u003E\u003Cli\u003E\u003Cspan\u003E\u003Csup\u003E5\u003C\u002Fsup\u003E\u003C\u002Fspan\u003EDepartment of Pharmacy, University of Swabi, Swabi, Pakistan\u003C\u002Fli\u003E\u003C\u002Ful\u003E\u003Cp class=\"mb15\"\u003E\u003Cb\u003EIntroduction:\u003C\u002Fb\u003E This study was performed to determine the levels of &#x003b1;1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is considered an acute phase protein produced during the acute phase reaction in the body to various stimuli; their proper monitoring is thus important.\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003E\u003Cb\u003EMethods:\u003C\u002Fb\u003E In order to study how AGP concentrations in old age patients change in response to surgical stress (total hip arthroplasty), a high-performance liquid chromatography assay was performed to measure AGP levels. AGP was isolated from the plasma by adding perchloric acid and was analyzed using PLRP-S 4000&#x000b0;A column. The mobile phase consisted of 1&#x000a0;mL TFA\u002FL of water (Solvent A pH 2) and 1&#x000a0;mL TFA\u002FL of acetonitrile (Solvent B). The gradient used was as follows: 0&#x000a0;min 18% B and 82% A, 15&#x000a0;min 60% B and 40% A, and 17&#x000a0;min 60% B and 40% A followed by column re-equilibration for 7&#x000a0;min before the next injection. AGP peak was obtained between 8.8 and 8.9&#x000a0;min. The method was fully optimised according to established guidelines.\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003E\u003Cb\u003EResults:\u003C\u002Fb\u003E The data obtained were analyzed on ChromQuest software. AGP concentrations were determined in all samples, including baseline and samples taken at different timed intervals. The peak for AGP was obtained between 8.8 and 8.9&#x000a0;min for both standard AGP and patient plasma. The graphs indicate that AGP concentration in almost all patient samples increased considerably, especially after 4&#x000a0;h and 24&#x000a0;h&#x02014;for example, initial concentration in patient 1 was 10.36&#x000a0;mg\u002F100&#x000a0;mL but, after 24&#x000a0;h, increased to 23.50&#x000a0;mg\u002F100&#x000a0;mL. There was thus almost a 13 mg\u002F100&#x000a0;mL increase in 24&#x000a0;h, which is confirmed by AGP concentration increasing after various conditions, including surgery. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug.\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003E\u003Cb\u003EConclusion:\u003C\u002Fb\u003E This surgically induced increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable during the postoperative period.\u003C\u002Fp\u003E\u003Cdiv class=\"clear\"\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"JournalFullText\"\u003E\u003Ca id=\"h2\" name=\"h2\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003E1 Introduction\u003C\u002Fh2\u003E\u003Cp class=\"mb15\"\u003EDrug binding to different proteins in plasma may be significantly important in drug therapy because drug protein binding serves as a depot for the drug and has an influence on the pharmacokinetic and pharmacodynamic parameters and metabolism of the compound (\u003Ca href=\"#B25\"\u003EZeitlinger et al., 2011\u003C\u002Fa\u003E). The pharmacological action of the drug is only due to the unbound portion of the drug and not to the total drug present in the plasma (\u003Ca href=\"#B13\"\u003EKratochwil et al., 2002\u003C\u002Fa\u003E; \u003Ca href=\"#B2\"\u003EBanker et al., 2003\u003C\u002Fa\u003E). Thus, the effect of plasma protein binding on the pharmacokinetic and pharmacodynamic parameters needs careful attention. Many cases have been reported where a small change in plasma protein binding resulted in clinically vital changes in the pharmacokinetic parameters of the drug (\u003Ca href=\"#B19\"\u003ESchmidt et al., 2010\u003C\u002Fa\u003E). &#x0201c;Unbound fraction&#x0201d; is the concentration of a drug which is not bound to plasma proteins, and only this concentration of the drug produces the pharmacological effect. This unbound concentration varies during the dosing interval and must be accurately and correctly explained to determine the drug&#x00027;s effect (\u003Ca href=\"#B18\"\u003ERoberts et al., 2013\u003C\u002Fa\u003E). Drug binding to plasma proteins plays a vital role in determining the diffusion rate of the drug between extracellular and intracellular space; therefore, any change in this diffusion affects pharmacokinetic parameters, including the distribution volume and the clearance rate of the drug (\u003Ca href=\"#B3\"\u003EBohnert and Gan, 2013\u003C\u002Fa\u003E). Generally, in cases of highly protein-bound drugs, a little change in protein binding is responsible for significant changes in the unbound concentration of drug, thereby increasing the clearance and volume of distribution (\u003Ca href=\"#B3\"\u003EBohnert and Gan, 2013\u003C\u002Fa\u003E; \u003Ca href=\"#B18\"\u003ERoberts et al., 2013\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003EAcute phase proteins (&#x003b1;1-acid glycoprotein&#x02014;AGP or AAP) are produced during the acute phase reaction in the body to various stimuli and play a role in the defence response shown by the body. The initiation of acute phase reactions in the body prevents any further injury by removing any harmful material and initiating the repair process to restore the organ to normal function. Their levels also inform us about the progression of the disease or inflammatory response by monitoring their concentrations in the blood. The changes in the plasma concentration of these proteins lead to altered drug binding and ultimately affect the pharmacokinetic and pharmacodynamic parameters of the drug (\u003Ca href=\"#B22\"\u003ETesseromatis et al., 2011\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003EAmong the acute phase proteins, AGP is the most important (\u003Ca href=\"#B17\"\u003ERice et al., 1997\u003C\u002Fa\u003E; \u003Ca href=\"#B22\"\u003ETesseromatis et al., 2011\u003C\u002Fa\u003E). It is also called orosomucoid (ORM) and is the main protein responsible for binding basic drugs (\u003Ca href=\"#B23\"\u003EWood and Wood, 1981\u003C\u002Fa\u003E; \u003Ca href=\"#B14\"\u003EKremer et al., 1988\u003C\u002Fa\u003E; \u003Ca href=\"#B4\"\u003EBooker et al., 1996\u003C\u002Fa\u003E; \u003Ca href=\"#B7\"\u003EFournier et al., 2000\u003C\u002Fa\u003E; \u003Ca href=\"#B9\"\u003EHochepied et al., 2003\u003C\u002Fa\u003E; \u003Ca href=\"#B22\"\u003ETesseromatis et al., 2011\u003C\u002Fa\u003E; \u003Ca href=\"#B10\"\u003EHuang and Ung, 2013\u003C\u002Fa\u003E; \u003Ca href=\"#B21\"\u003ETaguchi et al., 2013\u003C\u002Fa\u003E). AGP was first described by Karl Schmid and Richard J. Winzler and their colleagues in 1950; they considered it an unusual protein because of its low p\u003Cem\u003EI\u003C\u002Fem\u003E value, which ranges from 2.8&#x02013;3.8 and has a comparatively high content of carbohydrate (45% w\u002Fw) (\u003Ca href=\"#B12\"\u003EKishino and Miyazaki, 1997\u003C\u002Fa\u003E; \u003Ca href=\"#B15\"\u003EKremmer et al., 2004\u003C\u002Fa\u003E). AGP was considered as having the highest carbohydrate content of any protein until the characterisation of galactoglycoprotein in 1980, which has a 76% carbohydrate content (\u003Ca href=\"#B8\"\u003EHellerstein et al., 1985\u003C\u002Fa\u003E; \u003Ca href=\"#B7\"\u003EFournier et al., 2000\u003C\u002Fa\u003E; \u003Ca href=\"#B24\"\u003EXuan and Hage, 2005\u003C\u002Fa\u003E). AGP is also reported as playing a role in drug&#x02013;drug interactions due to the displacement of drugs and other endogenous molecules from their binding sites, resulting in significant clinical implications (\u003Ca href=\"#B22\"\u003ETesseromatis et al., 2011\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003EThe concentration of AGP in serum increases in various conditions, like post-surgical inflammation due to burn injury, cancer, and various other conditions (\u003Ca href=\"#B8\"\u003EHellerstein et al., 1985\u003C\u002Fa\u003E; \u003Ca href=\"#B12\"\u003EKishino and Miyazaki, 1997\u003C\u002Fa\u003E; \u003Ca href=\"#B16\"\u003ELarsson et al., 1997\u003C\u002Fa\u003E; \u003Ca href=\"#B9\"\u003EHochepied et al., 2003\u003C\u002Fa\u003E; \u003Ca href=\"#B10\"\u003EHuang and Ung, 2013\u003C\u002Fa\u003E; \u003Ca href=\"#B6\"\u003EEckersall and Schmidt, 2014\u003C\u002Fa\u003E). AGP synthesis mostly occurs in the liver, and then it is secreted by hepatocytes (\u003Ca href=\"#B22\"\u003ETesseromatis et al., 2011\u003C\u002Fa\u003E; \u003Ca href=\"#B11\"\u003EKeser et al., 2021\u003C\u002Fa\u003E). However, there is also evidence of extra hepatic synthesis, which is production of AGP in places apart from hepatic tissue like human breast epithelial cells, the kidney, adipose tissue, and the spleen, thymus, and heart (\u003Ca href=\"#B9\"\u003EHochepied et al., 2003\u003C\u002Fa\u003E). There is also variation in the levels of AGP among healthy individuals depending on age, sex, and hormonal variations (\u003Ca href=\"#B10\"\u003EHuang and Ung, 2013\u003C\u002Fa\u003E). The effectiveness of a drug in these cases depends on whether it is acidic in nature or a basic drug, as well on whether the drug binds to the albumin, to which acidic drugs normally bind, or to AGP, to which basic drugs bind. Drug displacement from protein binding sites by another strongly binding drug will also have a significant effect on the concentration of the displaced drug; dose adjustment should be taken into consideration in the use of such drugs (\u003Ca href=\"#B18\"\u003ERoberts et al., 2013\u003C\u002Fa\u003E; \u003Ca href=\"#B5\"\u003EBteich, 2019\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Ca id=\"h3\" name=\"h3\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003E2 Methodology\u003C\u002Fh2\u003E\u003Ch3 class=\"pt0\"\u003E2.1 Patients\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EWe measured AGP in 20 patients (12 male and 8 female patients) aged 65&#x000a0;years or over undergoing unilateral total hip arthroplasty following high-volume, high-dose local infiltration analgesia. The study protocol was approved by the Regional Ethics Committee and conducted in accordance with the Helsinki Declaration (NCT01873313) from August 2012 to March 2013 in Golden Jubilee Hospital, Glasgow Scotland. Ten blood samples at different timed intervals were taken from each patient, and AGP was determined. A total of 200 samples were thus analysed for AGP. (20&#x0002a;10 &#x0003d; 200). Local anaesthetic infiltration was performed intra-operatively by the surgeon using 180&#x000a0;mL plain ropivacaine 0.2%. Circumferential infiltration of the deep and peri-capsular tissues with up to 80&#x000a0;mL was followed by infiltration of the gluteal muscles and fascia lata with approximately 70&#x000a0;mL. Finally, 30&#x000a0;mL was used to infiltrate the subcutaneous tissues and skin, completing the total of 180&#x000a0;mL.\u003C\u002Fp\u003E\u003Ch3 class=\"pt0\"\u003E2.2 Chemicals and blood plasma for AGP analysis\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EHuman AGP (standard), trifluoroacetic acid, and perchloric acid (70%) were purchased from Sigma Aldrich (UK). HPLC-grade water was produced by a Direct-Q 3 Ultrapure Water System from Millipore, UK. HPLC-grade acetonitrile (ACN) was purchased from Fisher Scientific, United Kingdom. Blank plasma was provided by the Blood Transfusion Service of Gartnavel Hospital, Glasgow. Plasma samples were obtained from Dr Mike Gill from patients undergoing hip joint surgery at the Golden Jubilee Hospital in Clydebank. The samples were stored at &#x02212;20&#x000b0;C until analysis.\u003C\u002Fp\u003E\u003Ch3 class=\"pt0\"\u003E2.3 HPLC analysis\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EA high-performance liquid chromatographic (HPLC) system was used in the analysis and consisted of a SpectraSYSTEM P2000 gradient pump, a SpectraSYSTEM AS3000 autosampler (equipped with a Type 7010-150 Rheodyne injection valve (20&#x000a0;&#x000b5;L loop)), and a SpectraSYSTEM UV 1000 detector. The column used in the analysis was a PLRP-S 4000&#x000b0;A column (50&#x000a0;mm &#x000d7; 4.6&#x000a0;mm I.D., 5&#x000a0;&#x000b5;m particle size, Agilent Technologies). The pressure maintained at the column head was about 9,000 psi. The mobile phase consisted of 1&#x000a0;mL TFA\u002FL of water (Solvent A pH 2) and 1&#x000a0;mL TFA\u002FL of acetonitrile (Solvent B). The gradient used was as follows: 0&#x000a0;min 18% B and 82% A, 15&#x000a0;min 60% B and 40% A, and 17&#x000a0;min 60% B and 40% A followed by column re-equilibration for 7&#x000a0;min before the next injection. The flow rate of the mobile phase was 1&#x000a0;mL\u002Fmin. The detection wavelength was set to 220&#x000a0;nm. The column was kept at room temperature. The data acquired were processed using ChromQuest software.\u003C\u002Fp\u003E\u003Ca id=\"h3-1\" name=\"h3-1\"\u003E\u003C\u002Fa\u003E\u003Ch3 class=\"pt0\"\u003E2.4 Standards preparation\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EStock solution of AGP was prepared at a concentration of 2&#x000a0;mg\u002FmL in water. Different calibration solutions were then prepared from the stock solution by diluting it in 0.5&#x000a0;M perchloric acid. Different standards at concentrations of 6.25 mg\u002F100&#x000a0;mL (0.0625&#x000a0;mg\u002FmL), 12.5 mg\u002F100&#x000a0;mL (0.125&#x000a0;mg\u002FmL), 25 mg\u002F100&#x000a0;mL (0.25&#x000a0;mg\u002FmL), 50 mg\u002F100&#x000a0;mL (0.5&#x000a0;mg\u002FmL), and 100 mg\u002F100&#x000a0;mL (1&#x000a0;mg\u002FmL) were prepared and directly injected into the chromatographic system.\u003C\u002Fp\u003E\u003Ca id=\"h3-2\" name=\"h3-2\"\u003E\u003C\u002Fa\u003E\u003Ch3 class=\"pt0\"\u003E2.5 Sample preparation\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EVenous blood samples from each patient participating in the study were taken at 5, 10, 15, 20, 25, and 30&#x000a0;min, then 1, 4, and 24&#x000a0;h following the injection of local anaesthetic, at the Golden Jubilee Hospital in Clydebank. The samples were then transferred to the University of Strathclyde, Glasgow, for analysis.\u003C\u002Fp\u003E\u003Cp class=\"mb0\"\u003EThe concentrations of AGP in all the patient plasma were then determined as follows: to 50&#x000a0;&#x000b5;L of patient or control plasma, 100&#x000a0;&#x000b5;L of 0.5&#x000a0;M of perchloric acid was added and was vortexed for 20&#x000a0;S in an Eppendorf tube to mix it thoroughly. The acidified plasma was then centrifuged at 9,000&#x000a0;rpm for 5&#x000a0;min at room temperature. The supernatant was then transferred to the insert in the HPLC vial for analysis. Both the extracted standards and samples were stored at 4&#x000b0;C before being chromatographed.\u003C\u002Fp\u003E\u003Cp class=\"mb0\"\u003EThe AGP concentration was then calculated from its linear correlation versus the values of peak areas obtained from the perchloric acid extract, expressed as mg\u002F100&#x000a0;mL of plasma.\u003C\u002Fp\u003E\u003Ch3 class=\"pt0\"\u003E2.6 Method validation\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EThe method was validated according to ICH guidelines.\u003C\u002Fp\u003E\u003Ch4\u003E2.6.1 Linearity\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe method&#x02019;s linearity was established using the standards for AGP dissolved in perchloric acid as described in \u003Ca href=\"#h3-1\"\u003ESection 2.4\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\u003Ch4\u003E2.6.2 Recovery\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EIn order to determine the accuracy of the extraction procedure, the recovery of AGP by perchloric acid extraction was determined. AGP was added to a constant volume of plasma (50&#x000a0;&#x003bc;L) in two different concentrations (25 and 50&#x000a0;mg\u002F100&#x000a0;mL) and then mixed with perchloric acid as before in order to prepare a standard addition curve.\u003C\u002Fp\u003E\u003Ch4\u003E2.6.3 Accuracy and precision\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe within-run reproducibility of retention time and peak area was examined by repeated injection (\u003Cem\u003En\u003C\u002Fem\u003E &#x0003d; 3) of an AGP standard (50&#x000a0;mg\u002F100&#x000a0;mL). Three replicates prepared from the 50&#x000a0;&#x003bc;L amounts of the pooled plasma QC sample were run on three different occasions to calculate within- and between-run precision.\u003C\u002Fp\u003E\u003Ch4\u003E2.6.4 Reproducibility\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EReplicates of the same QC samples (50&#x000a0;mg\u002F100&#x000a0;mL) were run alongside the patient samples to monitor the performance of each assay.\u003C\u002Fp\u003E\u003Ch4\u003E2.6.5 Sensitivity\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe sensitivity of the method was determined in standard solutions and blank plasma spiked with the analyte. The limit of detection was defined as the minimum concentration for which a signal-to-noise ratio of 3 was obtained; for LOQ, a signal-to-noise ratio of 10 was considered.\u003C\u002Fp\u003E\u003Ch4\u003E2.6.6 Application of the method to patient plasma\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003ETo determine the clinical relevance of the method, the concentration of AGP was identified and determined in the plasma of old-age hip joint surgery patients. The procedure was discussed in \u003Ca href=\"#h3-2\"\u003ESection 2.5\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\u003Ch3 class=\"pt0\"\u003E2.7 Ropivacaine determination\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EA fully validated method was developed on LC-MS to determine the free and bound portions of ropivacaine and published in \u003Ca href=\"#B1\"\u003EAbbas et al. (2013\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Ca id=\"h4\" name=\"h4\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003E3 Results\u003C\u002Fh2\u003E\u003Cp class=\"mb15\"\u003EThe normal mean value for AGP concentration in the plasma is 77&#x000a0;mg\u002F100&#x000a0;mL (\u003Ca href=\"#B4\"\u003EBooker et al., 1996\u003C\u002Fa\u003E). However, there is great variation of this value among individuals. The results we obtained in our analysis gave concentrations which were generally below those specified by previous studies.\u003C\u002Fp\u003E\u003Ch3 class=\"pt0\"\u003E3.1 Results of standard AGP samples and patient plasma\u003C\u002Fh3\u003E\u003Cp class=\"mb0\"\u003EThe AGP concentrations were analysed in the plasma of 20 hip joint surgery patients. These samples were taken at 5&#x000a0;min, 10&#x000a0;min, 15&#x000a0;min, 20&#x000a0;min, 25&#x000a0;min, 30&#x000a0;min, 1&#x000a0;h, 4&#x000a0;h, and 24&#x000a0;h. \u003Ca href=\"#F1\"\u003EFigure 1\u003C\u002Fa\u003E shows a typical chromatogram of the AGP standard injected directly into the chromatographic system, and \u003Ca href=\"#F2\"\u003EFigure 2\u003C\u002Fa\u003E shows a chromatogram of the AGP in patient plasma following removal of the rest of the protein with 0.5&#x000a0;M perchloric acid. The peak for AGP was obtained between 8.8 and 8.9&#x000a0;min. This method works very well for determining AGP, and there is minimal interference from other serum proteins like HSA, which is precipitated out almost completely by the perchloric acid; AGP remains in solution because of its high water solubility, which is due to its 40% carbohydrate content (\u003Ca href=\"#B20\"\u003EStumpe et al., 2006\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"Imageheaders\"\u003EFIGURE 1\u003C\u002Fdiv\u003E\u003Cdiv class=\"FigureDesc\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" name=\"Figure1\" target=\"_blank\"\u003E\n \u003Cpicture\u003E\n \u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=480&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" media=\"(max-width: 563px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=370&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" media=\"(max-width: 1024px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=290&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" media=\"(max-width: 1441px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=410&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" media=\"\"\u003E\u003Csource type=\"image\u002Fjpg\" srcset=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" media=\"\"\u003E \u003Cimg src=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg\" alt=\"www.frontiersin.org\" id=\"F1\" loading=\"lazy\"\u003E\n \u003C\u002Fpicture\u003E\n\u003C\u002Fa\u003E\u003Cp\u003E\u003Cb\u003EFIGURE 1\u003C\u002Fb\u003E. Typical chromatogram of an unextracted aqueous standard containing 50 mg\u002F100&#x000a0;mL of AGP. The elution was performed on a PLRP-S 4000&#x000b0;A column (50&#x000a0;mm &#x000d7; 4.6&#x000a0;mm I.D., 5&#x000a0;&#x000b5;m particle size, Agilent Technologies). The mobile phase consisted of 1&#x000a0;mL TFA\u002FL of water (Solvent A) and 1&#x000a0;mL TFA\u002FL of acetonitrile (Solvent B). The gradient used was 0&#x000a0;min 18% B, 15&#x000a0;min 60% B, and 17&#x000a0;min 60% B followed by column re-equilibration for 7&#x000a0;min before the next injection. The flow rate of the mobile phase was 1&#x000a0;mL\u002Fmin. The detection wavelength was set to 220&#x000a0;nm. Retention time observed was 8.9&#x000a0;min.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"clear\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"Imageheaders\"\u003EFIGURE 2\u003C\u002Fdiv\u003E\u003Cdiv class=\"FigureDesc\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" name=\"Figure2\" target=\"_blank\"\u003E\n \u003Cpicture\u003E\n \u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=480&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" media=\"(max-width: 563px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=370&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" media=\"(max-width: 1024px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=290&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" media=\"(max-width: 1441px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=410&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" media=\"\"\u003E\u003Csource type=\"image\u002Fjpg\" srcset=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" media=\"\"\u003E \u003Cimg src=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g002.jpg\" alt=\"www.frontiersin.org\" id=\"F2\" loading=\"lazy\"\u003E\n \u003C\u002Fpicture\u003E\n\u003C\u002Fa\u003E\u003Cp\u003E\u003Cb\u003EFIGURE 2\u003C\u002Fb\u003E. Typical chromatogram of AGP extracted from 50&#x000a0;&#x000b5;L of patient plasma. Analysis was performed on PLRP-S 4000&#x000b0;A column (50&#x000a0;mm &#x000d7; 4.6&#x000a0;mm I.D., 5&#x000a0;&#x000b5;m particle size, Agilent Technologies). The mobile phase consisted of 1&#x000a0;mL TFA\u002FL of water (Solvent A) and 1&#x000a0;mL TFA\u002FL of acetonitrile (Solvent B). The gradient used was 0&#x000a0;min 18% B, 15&#x000a0;min 60% B, and 17&#x000a0;min 60% B followed by column re-equilibration for 7&#x000a0;min before the next injection. The flow rate of the mobile phase was 1&#x000a0;mL\u002Fmin. The detection wavelength was set to 220&#x000a0;nm. Retention time observed was 8.89&#x000a0;min.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"clear\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Ch3 class=\"pt0\"\u003E3.2 Method validation\u003C\u002Fh3\u003E\u003Ch4\u003E3.2.1 Linearity\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe calibration curve obtained by plotting the areas of the AGP peaks versus AGP concentration on different days was linear (calibration curve added in \u003Ca href=\"#SM1\"\u003ESupplementary Material\u003C\u002Fa\u003E). The data were obtained for the calibration curve on three different days, and the average of these data was used for the calibration curve. The curve covered the concentration range from 6&#x000a0;mg\u002F100&#x000a0;mL to 100&#x000a0;mg\u002F100&#x000a0;mL, which also covered the concentration of AGP in the patient plasma.\u003C\u002Fp\u003E\u003Ch4\u003E3.2.2 Recovery\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EIn the recovery test, the recovery after liquid&#x02013;liquid extraction with perchloric acid of 25&#x000a0;mg\u002F100&#x000a0;mL spiking of AGP into plasma was 91.7% &#x000b1; 8.9% (\u003Cem\u003En\u003C\u002Fem\u003E &#x0003d; 6), and, for 50&#x000a0;mg\u002F100&#x000a0;mL spiking, the recovery was 90.1% &#x000b1; 3.7% (\u003Cem\u003En\u003C\u002Fem\u003E &#x0003d; 6).\u003C\u002Fp\u003E\u003Ch4\u003E3.2.3 Accuracy and precision\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe within-run precision of the extraction\u002FHPLC procedure ranged from &#x000b1;1.2% to &#x000b1;3.8%, and the between-run precision was &#x000b1;6.1%.\u003C\u002Fp\u003E\u003Ch4\u003E3.2.4 Reproducibility\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EHaving established linearity, a single-point standard of 50&#x000a0;mg\u002F100&#x000a0;mL was run every day with the patient samples, and results were always well within limits.\u003C\u002Fp\u003E\u003Ch4\u003E3.2.5 Sensitivity\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe method was sensitive enough to determine the lowest level of AGP 5&#x000a0;mg\u002F100&#x000a0;mL (LOD), while LOQ was found to be 10&#x000a0;mg\u002F100&#x000a0;mL.\u003C\u002Fp\u003E\u003Ch4\u003E3.2.6 Application of the method to patient plasma\u003C\u002Fh4\u003E\u003Cp class=\"mb0\"\u003EThe results for the AGP concentrations in patients receiving a continuous infusion of a local anaesthetic ropivacaine following total hip arthroplasty are presented in \u003Ca href=\"#F4\"\u003EFigure 4\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\u003Ca id=\"h5\" name=\"h5\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003E4 Discussion\u003C\u002Fh2\u003E\u003Cp class=\"mb15\"\u003EThe margin of therapeutic safety for many drugs like anaesthetics should be considered in older age because the body&#x00027;s ageing process may result in toxicity of the drugs. Very little data have been published regarding the binding of local anaesthetics to plasma proteins. This study was performed to determine the level of AGP in the plasma of old-aged hip joint surgery patients.\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003EThe level of AGP in the plasma increased during the study period, which indicated that the level of AGP increases during or following surgical procedures. Similar results were shown in a previous study (\u003Ca href=\"#B3\"\u003EBohnert and Gan, 2013\u003C\u002Fa\u003E) which determined the concentration of AGP in neonates and also by two other studies \u003Ca href=\"#B8\"\u003EHellerstein et al. (1985\u003C\u002Fa\u003E) and \u003Ca href=\"#B22\"\u003ETesseromatis et al. (2011\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cp class=\"mb15\"\u003EAs can be seen from graphs of the results (\u003Ca href=\"#F4\"\u003EFigure 4\u003C\u002Fa\u003E), nearly all patients had AGP levels which were higher after 4&#x000a0;h and 24&#x000a0;h than early timed samples. This increase in AGP level is directly related to plasma protein binding, which increases in the samples taken after 24&#x000a0;h. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug. As the effect of the drug is mainly due to its free or unbound portion, any altered concentration of AGP will ultimately affect the level of the unbound portion of the drug and its subsequent effect. This surgically related increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable and within limits during the postoperative period, as shown in \u003Ca href=\"#F3\"\u003EFigure 3\u003C\u002Fa\u003E. A detailed method regarding ropivacaine determination was published in \u003Ca href=\"#B1\"\u003EAbbas et al. (2013\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"Imageheaders\"\u003EFIGURE 3\u003C\u002Fdiv\u003E\u003Cdiv class=\"FigureDesc\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" name=\"Figure3\" target=\"_blank\"\u003E\n \u003Cpicture\u003E\n \u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=480&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" media=\"(max-width: 563px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=370&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" media=\"(max-width: 1024px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=290&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" media=\"(max-width: 1441px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=410&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" media=\"\"\u003E\u003Csource type=\"image\u002Fjpg\" srcset=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" media=\"\"\u003E \u003Cimg src=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g003.jpg\" alt=\"www.frontiersin.org\" id=\"F3\" loading=\"lazy\"\u003E\n \u003C\u002Fpicture\u003E\n\u003C\u002Fa\u003E\u003Cp\u003E\u003Cb\u003EFIGURE 3\u003C\u002Fb\u003E. Mean plasma concentration of ropivacaine following local infiltration analgesia \u003Cb\u003E(A)\u003C\u002Fb\u003E total concentration i.e., bound to AGP \u003Cb\u003E(B)\u003C\u002Fb\u003E free concentration of ropivacaine. The error bars indicates SD.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"clear\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Cp class=\"mb15\"\u003EThe data and graphs in \u003Ca href=\"#F4\"\u003EFigure 4\u003C\u002Fa\u003E clearly show a significant increase in AGP concentration after surgery, especially in samples taken after 4&#x000a0;h and 24&#x000a0;h. In patient 1, the initial concentration is 10.36 mg\u002F100&#x000a0;mL, but, after 24&#x000a0;h, it increases to 23.50&#x000a0;mg\u002F100&#x000a0;mL. There is thus almost a 13 mg\u002F100&#x000a0;mL increase in 24&#x000a0;h. In patient 2H, there is also a significant increase in initial concentration and after 24&#x000a0;h, as seen in the table and from the graph, of 8.8 mg\u002F100&#x000a0;mL and, after 24&#x000a0;h, 26.44&#x000a0;mg\u002F100&#x000a0;mL. In patient 3H, there is also a considerable increase in the initial concentration of 5.19&#x000a0;mg\u002F100&#x000a0;mL and, after 24&#x000a0;h, 27.05&#x000a0;mg\u002F100&#x000a0;mL. There is likewise an increase in the concentration of AGP in all 20 patients. This confirms that there is an increase in AGP concentration after surgical conditions as well as in stress conditions as shown in different studies.\u003C\u002Fp\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"Imageheaders\"\u003EFIGURE 4\u003C\u002Fdiv\u003E\u003Cdiv class=\"FigureDesc\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" name=\"Figure4\" target=\"_blank\"\u003E\n \u003Cpicture\u003E\n \u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=480&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" media=\"(max-width: 563px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=370&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" media=\"(max-width: 1024px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=290&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" media=\"(max-width: 1441px)\"\u003E\u003Csource type=\"image\u002Fwebp\" srcset=\"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=410&f=webp\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" media=\"\"\u003E\u003Csource type=\"image\u002Fjpg\" srcset=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" media=\"\"\u003E \u003Cimg src=\"https:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g004.jpg\" alt=\"www.frontiersin.org\" id=\"F4\" loading=\"lazy\"\u003E\n \u003C\u002Fpicture\u003E\n\u003C\u002Fa\u003E\u003Cp\u003E\u003Cb\u003EFIGURE 4\u003C\u002Fb\u003E. Concentrations of AGP at different time intervals in 20 hip joint patients. The graphs indicate a significant increase in AGP concentration after surgery, especially in samples taken after 4&#x000a0;h and 24&#x000a0;h. In patient 1, initial concentration is 10.36 mg\u002F100&#x000a0;mL, but, after 24&#x000a0;h, it increases to 23.50&#x000a0;mg\u002F100&#x000a0;mL. There is thus almost a 13&#x000a0;mg\u002F100&#x000a0;mL increase in 24&#x000a0;h. In patient 2H, there is also a significant increase in the initial concentration, and, after 24&#x000a0;h, the table and from graph show it as 8.8&#x000a0;mg\u002F100&#x000a0;mL and, after 24&#x000a0;h, 26.44&#x000a0;mg\u002F100&#x000a0;mL. In patient 3H, there is also a considerable increase in initial concentration of 5.19&#x000a0;mg\u002F100&#x000a0;mL; after 24&#x000a0;h, it is 27.05&#x000a0;mg\u002F100&#x000a0;mL. Likewise, there is an increase in AGP concentration in all 20 patients.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"clear\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"DottedLine\"\u003E\u003C\u002Fdiv\u003E\u003Cp class=\"mb15\"\u003EIt is also clear from the data that there is considerable inter-individual variation in the level of AGP. It was found by \u003Ca href=\"#B4\"\u003EBooker et al. (1996\u003C\u002Fa\u003E) that the mean concentration is 77&#x000a0;mg\u002F100&#x000a0;mL; however, based on our results, it is difficult to determine any exact concentration because of this inter-individual variability in AGP concentration. Therefore, this is a solid base for any dose adjustment in the case of surgical condition because of increased levels of AGP.\u003C\u002Fp\u003E\u003Ca id=\"h6\" name=\"h6\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003E5 Conclusion\u003C\u002Fh2\u003E\u003Cp class=\"mb15\"\u003EThe results confirmed that AGP concentration in almost all patients increased considerably in all samples, especially after 4&#x000a0;h and 24&#x000a0;h, which confirms that AGP concentration increases after surgical conditions. Therefore, dose adjustment should be considered in the use of drugs which bind to AGP.\u003C\u002Fp\u003E\u003Ca id=\"h7\" name=\"h7\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EData availability statement\u003C\u002Fh2\u003E\u003Cp class=\"mb15\"\u003EThe original contributions presented in the study are included in the article\u002F\u003Ca href=\"#SM1\"\u003ESupplementary Material\u003C\u002Fa\u003E; further inquiries can be directed to the corresponding authors.\u003C\u002Fp\u003E\u003Ca id=\"h8\" name=\"h8\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EEthics statement\u003C\u002Fh2\u003E\u003Cp class=\"mb0\"\u003EThe studies involving human participants were reviewed and approved by the Regional Ethics Committee and conducted in accordance with the Declaration of Helsinki (NCT01873313). The patients\u002Fparticipants provided their written informed consent to participate in this study.\u003C\u002Fp\u003E\u003Ca id=\"h9\" name=\"h9\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EAuthor contributions\u003C\u002Fh2\u003E\u003Cp class=\"mb0\"\u003EMuA: sample preparation and sample analysis, data interpretation, and manuscript preparation. DW: project design. YS: sample analysis. SS: data interpretation. MoA: manuscript preparation. MaA: manuscript preparation and data analysis. LM: manuscript preparation and data analysis\u003Cem\u003E.\u003C\u002Fem\u003E All authors contributed to the article and approved the submitted version.\u003C\u002Fp\u003E\u003Ca id=\"h10\" name=\"h10\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EAcknowledgments\u003C\u002Fh2\u003E\u003Cp class=\"mb03\"\u003EThe authors are thankful to the University of Strathclyde, Glasgow, and Abdul Wali Khan University, Mardan, Pakistan, for facilitating the study\u003Cb\u003E.\u003C\u002Fb\u003E This study is supported via funding from Prince sattam bin Abdulaziz University project number (PSAU\u002F2023\u002FR\u002F1444).\u003C\u002Fp\u003E\u003Ca id=\"h11\" name=\"h11\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EConflict of interest\u003C\u002Fh2\u003E\u003Cp class=\"mb0\"\u003EThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003C\u002Fp\u003E\u003Ca id=\"h12\" name=\"h12\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EPublisher&#x02019;s note\u003C\u002Fh2\u003E\u003Cp class=\"mb15\"\u003EAll claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.\u003C\u002Fp\u003E\u003Ca id=\"h13\" name=\"h13\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003ESupplementary material\u003C\u002Fh2\u003E\u003Cp class=\"mb15\" id=\"SM1\"\u003EThe Supplementary Material for this article can be found online at: \u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Farticles\u002F10.3389\u002Ffphar.2023.1145962\u002Ffull#supplementary-material\"\u003Ehttps:\u002F\u002Fwww.frontiersin.org\u002Farticles\u002F10.3389\u002Ffphar.2023.1145962\u002Ffull&#x00023;supplementary-material\u003C\u002Fa\u003E\u003C\u002Fp\u003E\u003Ca id=\"h14\" name=\"h14\"\u003E\u003C\u002Fa\u003E\u003Ch2\u003EReferences\u003C\u002Fh2\u003E\u003Cdiv class=\"References\"\u003E\u003Cp class=\"ReferencesCopy1\"\u003E\u003Ca name=\"B1\" id=\"B1\"\u003E\u003C\u002Fa\u003EAbbas, M., Ahmad, L., Shah, Y., Gill, M., and Watson, D. G. (2013). 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Protein binding: Do we ever learn? \u003Cem\u003EAntimicrob. agents Chemother.\u003C\u002Fem\u003E 55, 3067&#x02013;3074. doi:10.1128\u002FAAC.01433-10\u003C\u002Fp\u003E\u003Cp class=\"ReferencesCopy2\"\u003E\u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F21537013\u002F\"\u003EPubMed Abstract\u003C\u002Fa\u003E &#x0007c; \u003Ca href=\"https:\u002F\u002Fdoi.org\u002F10.1128\u002FAAC.01433-10\"\u003ECrossRef Full Text\u003C\u002Fa\u003E &#x0007c; \u003Ca href=\"https:\u002F\u002Fscholar.google.com\u002Fscholar?hl=en&amp;as_sdt=0%2C5&amp;q=Protein+binding:+Do+we+ever+learn?&amp;btnG=\"\u003EGoogle Scholar\u003C\u002Fa\u003E\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"thinLineM20\"\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"AbstractSummary\"\u003E\u003Cp\u003E\u003Cspan\u003EKeywords:\u003C\u002Fspan\u003E HPLC, &#x003b1;1-acid glycoprotein, human plasma, hip joint surgery patients, protein binding\u003C\u002Fp\u003E\u003Cp\u003E\u003Cspan\u003ECitation:\u003C\u002Fspan\u003E Abbas M, Alossaimi MA, Altamimi ASA, Alajaji M, Watson DG, Shah SI, Shah Y and Anwar MS (2023) Determination of &#x003b1;1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound). \u003Cem\u003EFront. Pharmacol.\u003C\u002Fem\u003E 14:1145962. doi: 10.3389\u002Ffphar.2023.1145962\u003C\u002Fp\u003E\u003Cp id=\"timestamps\"\u003E\u003Cspan\u003EReceived:\u003C\u002Fspan\u003E 16 January 2023; \u003Cspan\u003EAccepted:\u003C\u002Fspan\u003E 16 May 2023;\u003Cbr\u003E\u003Cspan\u003EPublished:\u003C\u002Fspan\u003E 26 June 2023.\u003C\u002Fp\u003E\u003Cdiv\u003E\u003Cp\u003EEdited by:\u003C\u002Fp\u003E \u003Ca href=\"https:\u002F\u002Floop.frontiersin.org\u002Fpeople\u002F243834\u002Foverview\"\u003ETahir Ali\u003C\u002Fa\u003E, University of Calgary, Canada\u003C\u002Fdiv\u003E\u003Cdiv\u003E\u003Cp\u003EReviewed by:\u003C\u002Fp\u003E \u003Ca href=\"https:\u002F\u002Floop.frontiersin.org\u002Fpeople\u002F1943882\u002Foverview\"\u003ESwati Jaiswal\u003C\u002Fa\u003E, University of Massachusetts Medical School, United States\u003Cbr\u003E\u003Ca href=\"https:\u002F\u002Floop.frontiersin.org\u002Fpeople\u002F542593\u002Foverview\"\u003EMohammed Abdessadek\u003C\u002Fa\u003EUniversit&#x000e9; Ibn Zohr, Morocco\u003C\u002Fdiv\u003E\u003Cp\u003E\u003Cspan\u003ECopyright\u003C\u002Fspan\u003E &#x000a9; 2023 Abbas, Alossaimi, Altamimi, Alajaji, Watson, Shah, Shah and Anwar. This is an open-access article distributed under the terms of the \u003Ca rel=\"license\" href=\"http:\u002F\u002Fcreativecommons.org\u002Flicenses\u002Fby\u002F4.0\u002F\" target=\"_blank\"\u003ECreative Commons Attribution License (CC BY).\u003C\u002Fa\u003E The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cspan\u003E&#x0002a;Correspondence:\u003C\u002Fspan\u003E Muhammad Abbas, \u003Ca id=\"encmail\"\u003EbXVoYW1tYWRhYmJhc0Bhd2t1bS5lZHUucGs=\u003C\u002Fa\u003E\u003C\u002Fp\u003E\u003Cdiv class=\"clear\"\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\r\n",menuHtml:"\u003Cul class=\"flyoutJournal\"\u003E\u003Cli\u003E\u003Ca href=\"#h1\"\u003EAbstract\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h2\"\u003E1 Introduction\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h3\"\u003E2 Methodology\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h4\"\u003E3 Results\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h5\"\u003E4 Discussion\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h6\"\u003E5 Conclusion\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h7\"\u003EData availability statement\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h8\"\u003EEthics statement\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h9\"\u003EAuthor contributions\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h10\"\u003EAcknowledgments\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h11\"\u003EConflict of interest\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h12\"\u003EPublisher&#x02019;s note\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h13\"\u003ESupplementary material\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"#h14\"\u003EReferences\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003C\u002Ful\u003E"},files:[{name:"EPUB.epub",fileServerPackageEntryId:g,type:{code:aA,name:aA}},{name:aB,fileServerPackageEntryId:"fphar-14-1145962-r3\u002Ffphar-14-1145962.pdf",type:{code:r,name:r}},{name:aB,fileServerPackageEntryId:g,type:{code:r,name:r}},{name:"fphar-14-1145962.xml",fileServerPackageEntryId:"fphar-14-1145962-r3\u002Ffphar-14-1145962.xml",type:{code:"NLM_XML",name:"XML"}},{name:"Provisional PDF.pdf",fileServerPackageEntryId:g,type:{code:r,name:r}}]},currentArticlePageMetaInfo:{title:aC,link:[{rel:"canonical",href:aD}],meta:[{hid:z,property:z,name:z,content:aE},{hid:aF,property:aF,name:"title",content:aC},{hid:aG,property:aG,name:z,content:aE},{hid:aH,name:aH,content:"HPLC,α1-acid glycoprotein,human plasma,Hip joint surgery patients,Protein Binding"},{hid:aI,property:aI,name:"site_name",content:A},{hid:aJ,property:aJ,name:H,content:"https:\u002F\u002Fimages-provider.frontiersin.org\u002Fapi\u002Fipx\u002Fw=1200&f=png\u002Fhttps:\u002F\u002Fwww.frontiersin.org\u002Ffiles\u002FArticles\u002F1145962\u002Ffphar-14-1145962-HTML-r3\u002Fimage_m\u002Ffphar-14-1145962-g001.jpg"},{hid:aK,property:aK,name:"type",content:"article"},{hid:aL,property:aL,name:"url",content:aD},{hid:aM,name:aM,content:"summary_large_image"},{hid:aN,name:aN,content:"14"},{hid:aO,name:aO,content:p},{hid:aP,name:aP,content:A},{hid:aQ,name:aQ,content:J},{hid:aR,name:aR,content:K},{hid:aS,name:aS,content:$},{hid:aT,name:aT,content:"1145962"},{hid:aU,name:aU,content:"English"},{hid:aV,name:aV,content:aa},{hid:aW,name:aW,content:"HPLC; α1-acid glycoprotein; human plasma; Hip joint surgery patients; Protein Binding"},{hid:aX,name:aX,content:ab},{hid:aY,name:aY,content:"https:\u002F\u002Fwww.frontiersin.org\u002Fjournals\u002Fpharmacology\u002Farticles\u002F10.3389\u002Ffphar.2023.1145962\u002Fpdf"},{hid:aZ,name:aZ,content:"2023\u002F05\u002F16"},{hid:a_,name:a_,content:"2023\u002F06\u002F26"},{hid:"citation_author_0",name:n,content:"Abbas, Muhammad"},{hid:"citation_author_institution_0",name:o,content:B},{hid:"citation_author_1",name:n,content:"Alossaimi, Manal A."},{hid:"citation_author_institution_1",name:o,content:a$},{hid:"citation_author_2",name:n,content:"Altamimi, Abdulmalik S. 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Pharmacology",2,"PDF",5,176,"pharmacology","Link",4,"Department of Pharmacy","Pakistan","description","Frontiers","Department of Pharmacy, Pakistan","Help center","Grey","Medium","ssph-journal.org","fship","image","landscape","Front. Pharmacol.","1663-9812",void 0,6,18,"Saudi Arabia",1920,"por-journal.com",7,"escubed.org",1918,"fipp","https:\u002F\u002Fd2csxpduxe849s.cloudfront.net\u002Fmedia\u002FE32629C6-9347-4F84-81FEAEF7BFA342B3\u002F754E12A9-443F-4EA8-AB01E0811E45131D\u002Fwebimage-9D720582-24AD-4D2E-9205AB9D241919DA.jpg","22C10171-81B3-4DA6-99342F272A32E8BB","2022-06-27T10:00:45Z","fphar",62,"journal_field","10.3389\u002Ffphar.2023.1145962","Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)","\u003Cp\u003E\u003Cbold\u003EIntroduction:\u003C\u002Fbold\u003E This study was performed to determine the levels of α1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. AGP is considered an acute phase protein produced during the acute phase reaction in the body to various stimuli; their proper monitoring is thus important.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbold\u003EMethods:\u003C\u002Fbold\u003E In order to study how AGP concentrations in old age patients change in response to surgical stress (total hip arthroplasty), a high-performance liquid chromatography assay was performed to measure AGP levels. AGP was isolated from the plasma by adding perchloric acid and was analyzed using PLRP-S 4000°A column. The mobile phase consisted of 1 mL TFA\u002FL of water (Solvent A pH 2) and 1 mL TFA\u002FL of acetonitrile (Solvent B). The gradient used was as follows: 0 min 18% B and 82% A, 15 min 60% B and 40% A, and 17 min 60% B and 40% A followed by column re-equilibration for 7 min before the next injection. AGP peak was obtained between 8.8 and 8.9 min. The method was fully optimised according to established guidelines.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbold\u003EResults:\u003C\u002Fbold\u003E The data obtained were analyzed on ChromQuest software. AGP concentrations were determined in all samples, including baseline and samples taken at different timed intervals. The peak for AGP was obtained between 8.8 and 8.9 min for both standard AGP and patient plasma. The graphs indicate that AGP concentration in almost all patient samples increased considerably, especially after 4 h and 24 h—for example, initial concentration in patient 1 was 10.36 mg\u002F100 mL but, after 24 h, increased to 23.50 mg\u002F100 mL. There was thus almost a 13 mg\u002F100 mL increase in 24 h, which is confirmed by AGP concentration increasing after various conditions, including surgery. The increased plasma protein binding was comparatively associated with the unchanged free fraction of the drug.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbold\u003EConclusion:\u003C\u002Fbold\u003E This surgically induced increase in AGP concentration resulted in increased plasma protein binding of the drug (ropivacaine), which in turn kept the free portion of ropivacaine stable during the postoperative period.\u003C\u002Fp\u003E",1417926,"Muhammad",1109038,"Manal A.","Department of Pharmaceutical Chemistry","Abdulmalik S. A.","Mai",2176267,"David G.","Sayyed I.","Shah","Yasar","Mohammad S.",243834,"Tahir",542593,"Mohammed",1943882,"Swati",{},1251,"Translational Pharmacology","translational-pharmacology",14,"EPUB","fphar-14-1145962.pdf","Frontiers | Determination of α1-acid glycoprotein (AGP) concentration by HPLC in patients following local infiltration analgesia for primary total hip arthroplasty and its relation to ropivacaine (total and unbound)","https:\u002F\u002Fwww.frontiersin.org\u002Fjournals\u002Fpharmacology\u002Farticles\u002F10.3389\u002Ffphar.2023.1145962\u002Ffull","Introduction: This study was performed to determine the levels of α1-acid glycoprotein (AGP) in old-age patients undergoing total hip arthroplasty. 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