Optimized blood sampling with cytidine deaminase inhibitor for improved analysis of capecitabine metabolites

The 5FU prodrug capecitabine undergoes a 3-step enzymatic conversion, including the conversion of 5′DFRC into 5′DFUR by cytidine deaminase (CDA). The presence of CDA activity in blood led us to analyze the possible ex vivo conversion of 5′DFCR into 5′DFUR in blood samples. We thus examined the impact of the addition of a CDA inhibitor (tetrahydrouridine (THU) 1 μM final) in blood. Blood samples from 3 healthy volunteers were taken on tubes containing or not THU. Blood was spiked with 5′DFCR (20 μM final) (T0) and was maintained at room temperature for 2 h. Plasma concentrations of 5′DFRC and 5′DFUR were analyzed with an optimized HPLC assay. In the absence of THU, 5′DFUR was detectable as early as T0. The percent of 5′DFUR produced relative to 5′DFCR increased over time, up to 7.7 % at 2 h. In contrast, the presence of THU totally prevents the formation of 5′DFUR. The impact of THU for preventing the conversion of 5′DFCR was confirmed by the analysis of blood samples from 2 capecitabine-treated patients. Addition of THU in the sampling-tube before the introduction of blood is thus strongly recommended in order to guarantee accurate conditions for reliable measurement of capecitabine metabolites in plasma, and thus faithful pharmacokinetic data.