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Chromatographia (2012) 75:103–109

DOI 10.1007/s10337-011-2165-5

ORIGINAL

Simultaneous Determination of Resibufogenin and Its Major


Metabolite 3-epi-Resibufogenin in Rat Plasma by HPLC
Coupled with Tandem Mass Spectrometry
Huirong Chen • Sa Deng • Peter R. Chang •
Changyuan Wang • Xiaochi Ma • Kexin Liu •

Yan Tian • Jihong Yao • Xiaoyu Guo

Received: 30 August 2011 / Revised: 5 November 2011 / Accepted: 10 November 2011 / Published online: 11 December 2011
Ó Springer-Verlag 2011

Abstract A rapid, sensitive and specific method for the (n = 6), respectively. The method was proved to be rapid,
simultaneous quantification of resibufogenin (RBG) and sensitive and specific, and has been successfully applied to
3-epi-resibufogenin (3-ERBG) in rat plasma was developed determine RBG and its major metabolite 3-ERBG in rat
by using a liquid–liquid extraction procedure and liquid plasma after oral administration of RBG for pharmacoki-
chromatography–electrospray ionization/tandem mass netic study. Comparison of pharmacokinetic data with anti-
spectrometric (LC–ESI–MS/MS) analysis. The separation tumor activities of RBG and ERBG suggested that
was performed by HPLC on a reversed phase C18 HPLC 3-ERBG, as a major metabolite of RBG in rats, was per-
column (150 9 2.1 mm, 3.5 lm) using a mobile phase of haps also a bioactive form of RBG in vivo.
acetonitrilel-0.1% formic acid aqueous solution (45:55,
v/v). The determination was performed by a triple-quad- Keywords Resibufogenin  3-epi-Resibufogenin 
rupole mass spectrometer in the multiple reaction moni- LC–ESI–MS/MS  Pharmacokinetics  Metabolite
toring using positive mode of electrospray ionization (ESI).
The calibration curves were both linear (R [ 0.995) over
the concentration range of 3.0–5,000 ng mL-1, and the Introduction
lower limits of quantification were 3.0 ng mL-1 for both
RBG and 3-ERBG. The intra-day and inter-day precisions ChanSu, also called toad venom, is one of important tra-
(% RSD) were all less than 15%, and the accuracies (%RE) ditional Chinese medicines (TCM), originated from the
were within the range of ±15%. The mean recoveries of skin secretions of Bufo bufo gargarizans Cantor and
RBG, 3-ERBG and IS were over 82.7, 84.8 and 90.0% B. melsanostictus Schneider. Chansu and its related prep-
arations, such as Liu-Shen pills and Niu-Huang-Xiao-Yan
tablets, are widely used for pain relief and anticancer in
H. Chen and S. Deng contributed equally to this work. China, Japan and other Asian countries [1, 2]. Resibufog-
enin (RBG) is a major bufadienolide with the content of
H. Chen  S. Deng  C. Wang  X. Ma (&)  K. Liu  Y. Tian  1–6% in Chansu, and it has strong cytotoxic activities
J. Yao
against human myeloid leukemia, prostate cancer and
School of Pharmacy, Dalian Medical University,
Dalian 116044, China human hepatoma cells with IC50 values of 1–10 nmol L-1
e-mail: maxc1978@sohu.com [3–5]. For some cancer cells, its activities were mediated
by induction of cell apoptosis and cell differentiation,
H. Chen  X. Guo (&)
stronger than that of Taxol. However, as a cardioactive
Department of Natural Medicines, School of Pharmaceutical
Sciences, Peking University, Beijing 100191, China steroid with a-pyrone ring, RBG can adversely affect the
e-mail: guoxy2006@bjmu.edu.cn myocardium to produce the most life-threatening toxicity
including ventricular ectopy and hyperkalemia with a
P. R. Chang
narrow therapeutic index [6, 7]. So it is necessary to
Bioproducts and Bioprocesses National Science Program,
Agriculture and Agri-Food Canada, 107 Science Place, investigate the pharmacokinetic behaviors of RBG and its
Saskatoon, SK S7N 0X2, Canada metabolites in vivo to define the pharmacokinetic and

123
104 H. Chen et al.

safety profiles, and to establish optimal doses for maximal of NMR and MS spectral analysis. Their purities were
efficacy as preclinical and clinical trials. [99.5% as determined by HPLC analysis. Deionized water
To our knowledge, only some literature on pharmacoki- was prepared from a Milli-Q Reagent Water System
netics of Chansu in animal plasma has been published (Millipore, MA, USA). Acetonitrile and methanol (Tedia,
[8–10]. In our previous report, the 3-epi-resibufogenin USA) were of HPLC grade. Other reagents were of ana-
(3-ERBG) as a major metabolite was detected in the plasma lytical grade, and purchased from Tianjin Kermel Chemi-
of rats after oral administration of RBG [11, 12]. The cal Reagent (Tianjing, China).
metabolites of cinobufagin (CB), as a derivative of RBG
from Chansu, were investigated. And a series of CB Apparatus and Chromatographic Conditions
metabolites excreted from bile were isolated and identified as
the mono- or dihydroxylated derivatives of 3-epi-cinobufa- Agilent 1200 HPLC system consisted of a quaternary
gin (3-ECB) at C-1 and C-5 by 1H, 13C and 2D NMR tech- delivery system, a degasser, an auto-sampler and UV-
nologies [13], all of which suggest that the isomerization of detector. The chromatograph was equipped with an Elite
bufadienolides such as RBG and CB was the major metabolic Kromasil C18 (150 9 2.1 mm, 3.5 lm) analytical column.
reaction in rats. So, 3-ERBG would be an important meta- The mobile phase was consisted of acetonitrile-0.1% for-
bolic intermediate, and perhaps play a vital role in the mic acid aqueous solution (45:55, v/v) at a flow rate of
pharmacologic activities and toxicity. But compared with the 0.7 mL min-1. The run time was 4.0 min for each injec-
extensive literature on phytochemical and pharmacological tion, and the column temperature was controlled at 30 °C.
investigations, no investigation in simultaneously deter- An Applied Biosystems MDS Sciex API 3200 Triple
mining pharmacokinetics of RBG and its metabolite by LC– Quadrapole mass spectrometer (MS/MS) equipped with an
ESI–MS/MS method was found. Due to its strong bioactiv- electrospray ionization (ESI) source was used, and the
ities and toxicities, it was very necessary to simultaneously system was operated in positive mode. Optimization of MS
determine RBG and its metabolite in vivo, and to clarify the conditions was carried out using standard solutions con-
relationships between pharmacologic activities and phar- taining 500 ng mL-1 of RBG, 3-ERBG and IS, delivered
macokinetics of RBG and its metabolite. via a Harvard syringe pump at a constant flow rate of
In the present paper, a LC–ESI–MS/MS method was 8 lL min-1. The optimized ionspray voltage and temper-
developed and applied successfully for simultaneous deter- ature were set at 5,000 V and 600 °C, respectively. The
mination of RBG and its major metabolite (3-ERBG) in rats curtain gas (CUR) was set at 8 L min-1; gas 1 and gas 2
after oral administration of RBG. In addition, according to (nitrogen) were set at 55 and 60 psi, respectively, and the
the pharmacokinetics and cytotoxicity profiles, our results dwell times were 200 ms. Nitrogen was used as the curtain
suggested that 3-epi-resibufogenin (3-ERBG), as a major gas and collision gas, which were controlled at 13 and
metabolite, should be one of bioactive form in vivo. 6 psi, respectively. The quantification assay was performed
using multiple reaction monitoring (MRM). The optimized
MRM parameters and product ions of detected analytes and
Experiment IS were listed in Table 1.

Chemicals and Materials Preparation of Stock and Working Solutions

Reference standards of RBG and bufalin (Internal standard, The standard stock solutions of RBG, 3-ERBG and bufalin
IS) were isolated from Chansu in our laboratory. Chan Su were prepared in acetonitrile with final concentrations of
was purchased from Ping-An Traditional Chinese Medicine 5 mg mL-1. The stock solutions were further diluted with
Trade (Qingdao, Shandong, China). Reference standard of acetonitrile together to achieve standard working solutions
3-ERBG was prepared by microbial transformation from with concentrations of 15, 25, 100, 250, 2,500, 5,000, and
Fusarium solani AS 3.1829 [11]. The chemical structures 25,000 ng mL-1 for RBG and 3-ERBG, respectively. Each
of RBG, 3-ERBG and bufalin were identified on the basis working standard solution contains both of the two analytes

Table 1 Optimized multiple reaction monitoring (MRM) parameters for resibufogenin, 3-epi-resibufogenin and bufalin (IS)
Analyte Precursor ion Product ion Declustering potential (eV) Entrance potential (eV) Collision energy (eV)

RBG 385.2 253.1 45 9 27


3-ERBG 385.2 253.1 45 9 27
Bufalin 387.4 351.3 40 6 25

123
Simultaneous Determination of Resibufogenin 105

with the same concentration. Internal standard working Bioassay


solution (1,500 ng mL-1) was prepared by diluting the
stock solution of bufalin with acetonitrile. All the stock and HeLa, HL-60, and Bel-7402 cells were maintained in
working solutions were kept at -20 °C. RPMI1640 medium (GIBCO/BRL; MD, USA) supple-
mented with 10% (v/v) fetal bovine serum and culture in
Calibration Curves 96-well microtiter plates for the assay. Appropriate dilu-
tions of both analytes were added to the cultures. And then
Calibration curves were prepared by spiking 20 lL of the cells were cultured at 37 °C, 5% CO2 for 72 h. The sur-
above-mentioned working standard solutions of RBG and vival rates of the cancer cells were evaluated by the MTT
3-ERBG into 100 lL of blank plasma to obtain the series method. The activity was shown as the IC50 value, which is
of standard solutions (3.0, 5.0, 20, 50, 250, 1,000, and the concentration of test compound given 50% inhibition of
5,000 ng mL-1) for calibration curves. cell growth. Results were expressed as the mean value of
triplicate determinations.
Sample preparation

A 100-lL aliquot of plasma sample was combined with Results and Discussion
20 lL IS, then vortexed for 30 s. Samples were then
extracted with 400 lL ethyl acetate by vortex-mixing for Chromatography
5.0 min. After centrifugation at 10,000g for 5 min, the
above extraction was repeated twice. The upper organic Different ionization methods (including positive and neg-
layer was collected and evaporated to dryness at 35 °C ative modes) were tested to obtain good specificities and
under a gentle stream of nitrogen gas. The residue was sensitivities for RBG and 3-ERBG. The positive ionization
dissolved in 100 lL mobile phase and a 10-lL aliquot was mode was more appropriate for both analytes detection
injected into the LC–MS/MS system. than the negative mode. The positive ion electrospray mass
spectra of RBG, 3-ERBG and IS in full-scan mode showed
Animal Handling and Sample Collection quasi-molecular ions [M ? H]? as the base peaks, at m/z
385.2 for RBG and 3-ERBG, and m/z 387.4 for IS,
Male Sprague–Dawley rats, weighing approximately respectively. Fragmentation patterns of the quasi-molecular
230–250 g, were provided by the SPF animal experiment ions were observed by increasing the collision energy. The
center of Dalian Medical University. The animal experi- product ion mass spectra of RBG and 3-ERBG are shown
mentation was approved by Dalian Medical University. Six in Fig. 1. The most intense product ions were observed at
rats received an oral administration of 10 mg kg-1 RBG. m/z 253.1 for RBG and 3-ERBG, and m/z 351.3 for IS,
The drug was suspended in aqueous solution containing respectively.
10% propylene glycol. Blood samples (300 lL) were col- The different organic solvents as mobile phase were
lected in heparinized tubes from each rat at 0, 2, 5, 10, 15, tested. The results suggested that acetonitrile could sig-
30, 45, 60, 120, 240, 480, and 720 min after administration. nificantly increase the response signals of both analytes.
Blood samples were immediately centrifuged and then the Formic acid was added to the mobile phase for helping to
plasma samples were stored at -20 °C before analysis. form the protonated molecule ion [M ? H]?. After opti-
Plasma collected from six vehicle-administrated rats served mization, a proper concentration of formic acid in the
as blank samples. mobile phase was chosen. In order to achieve a short run
time for the simultaneous analysis, the rate of acetonitrile
Determination of the Pharmacokinetic Parameters in mobile phase was increased, and all analytes were eluted
rapidly within 4.0 min with the satisfactory separation
Pharmacokinetic parameters including the elimination rate (Fig. 2). The retention times of RBG, 3-ERBG and IS were
constant (Ke), maximal concentration (Cmax), time for approximately 2.8, 3.4 and 1.8 min, respectively.
maximal concentration (tmax), half-life (t1/2Ka and t1/2Ke),
the area under the concentration–time curve from zero to Method Validation
the time of the final measurable sample (AUC0–t), the area
under the plasma concentration–time curve from zero to Assay Selectivity and Matrix Effect
infinity (AUC0–?), the area under the first moment curve
(AUMC), and the mean residence times (MRT) were cal- The LC–MS/MS method has high selectivity because only
culated with 3P97 software (Chinese Society of Mathe- selected ions produced from selected precursor ions are
matical Pharmacology). monitored. Comparison of the blank and the spiked rat

123
106 H. Chen et al.

Fig. 1 Full-scan product ion


spectra of [M ? H]? ions and
fragmentation pathways for
(a) resibufogenin, (b) 3-epi-
resibufogenin, and c IS (bufalin)

plasma indicated no significant interference at the retention analyte in plasma were both 3.0 ng mL-1. These LLOQs are
times of the analytes and IS. sufficient for the pharmacokinetic studies of two analytes
The possibility of a matrix effect caused by ionization after an oral administration of RBG to rats.
competition occurring between the analytes and endoge-
nous co-eluents was evaluated at three concentrations Precision and Accuracy
(n = 3). The matrix effect experiments were carried out by
comparing the mass peak responses of the post-extraction The accuracy of the method was determined by calculating
spiked samples with that of pure standards in mobile phase. the percentage deviation observed in the analysis of QCs.
Our results suggested that the matrix effect occurred was Intra- and inter-day precision was assessed from the results
negligible in this method. The rates of the peaks response of QC samples by using a one-way analysis of variance
were acceptable in the ranges from 91.5 to 101.0%. (ANOVA). The mean values and RSD for QC samples at
three concentration levels were calculated in triplicate.
Calibration Curves Table 2 summarized the intra- and interday precision and
accuracy for two analytes from the QC samples. All intra-
The calibration curves for spiked rat plasma containing each and inter-day precision and accuracy were acceptable.
analyte were good linear in the range 3.0–5,000 ng mL-1
with a correlation coefficient r [ 0.9990. The regression Extraction Recovery
equation of the target curves and their correlation coeffi-
cients were calculated as follows: resibufogenin, Spiked plasma samples were prepared at concentrations of
y = 7.82 9 10-3x ? 1.63 9 10-2 (r = 0.9992); 3-epi- 5, 100, and 2,000 ng mL-1, and assayed as described
resibufogenin, y = 1.56 9 10-2x ? 2.37 9 10-2 (r = above. Extraction recovery was calculated by comparing
0.9991). Signals 10 times higher than the peak noise height the peak area obtained from the extracted sample with that
was regarded as the lower limit of quantification (LLOQ). of standard solution containing the same concentration of
The lower limits of quantification for determination of each analytes and IS in the blank plasma. For both analytes at

123
Simultaneous Determination of Resibufogenin 107

Fig. 2 Representative MRM


chromatograms: (a) a blank rat
plasma sample; (b) a blank rat
plasma sample spiked with
resibufogenin at the LLQ
(3.0 ng mL-1), 3-epi-
resibufogenin at the LLOQ
(3.0 ng mL-1) and IS (bufalin,
150 ng mL-1); (c) a plasma
sample from a rat at 2 min after
oral administration of
resibufogenin at a dose of
10 mg kg-1. I resibufogenin
(m/z 385.2 ? 253.1) and
3-epi-resibufogenin
(m/z 385.2 ? 253.1); II IS
(m/z 387.4 ? 351.3)

Stability
Table 2 Precision and accuracy of resibufogenin and 3-epi-resibuf-
ogenin in rat plasma determined by LC–ESI–MS/MS assay (n = 6)
The stability of both analytes in plasma sample was
Analyte Added C Found C Intra-day Inter-day Accuracy
assessed by spiking the standard solution of RBG and
(ng mL-1) (ng mL-1) RSD RSD (%)
(%) (%) 3-ERBG in blank plasma at three different concentrations.
Both analytes were found to be stable under a variety of
RBG 5 5.1 5.2 8.6 102.3 storage and process conditions, the ranges of the accuracy
100 102.8 3.6 5.7 102.8 for the analytes were 86.4–113.8% (Table 4).
2,000 2,169.4 2.8 11.5 108.5
3-ERBG 5 5.0 4.3 9.6 100.7 Application of the Analytical
100 103.1 2.4 13.7 103.1 Method to Pharmacokinetic Studies
2,000 2,122.8 2.1 12.1 106.1
The present method was successfully applied to the phar-
macokinetic study of RBG and 3-ERBG after an oral
administration of 10 mg kg-1 RBG to six male rats. The
the plasma concentrations of 5, 100 and 2,000 ng mL-1, mean plasma concentration–time profiles of RBG and
the mean recoveries of RBG, 3-ERBG and IS were over 3-ERBG are presented in Fig. 3. It can be seen that two
82.7, 84.8 and 90.0% (n = 6), respectively, shown in analytes were rapidly eliminated from rat plasma. The
Table 3, which suggesting that a single step of liquid– concentration–time curves of two analytes in rat plasma
liquid extraction with EtOAc should be simple and fitted a one-compartment model. The main pharmacoki-
successful. netic parameters were listed in Table 5.

123
108 H. Chen et al.

To our knowledge, the transformation of RBG to 3-ERBG is 128 times that of RBG, which suggests that the
3-ERBG should use the 3-ketone-RBG as an intermediate, amount of 3-ERBG in vivo was obviously higher than that
which may include the involvement of CPY450 and other of RBG, and that RBG could be transformed to 3-ERBG in
enzymes [14–16]. In addition, small amounts of 3-ERBG rats. Comparison of pharmacokinetic data of RBG and
were detected in the intestinal contents of rats, and the ERBG with anti-tumor activities suggested that 3-ERBG,
plasma concentration of 3-ERBG could be detected in large
amounts in a short time of administration. These results
implied that RBG could be metabolized rapidly in vivo and
the formation of 3-ERBG maybe carried out in liver and
intestinal tract at the same time. The metabolic enzyme
systems and transporters of RBG should be investigated in
the future.
The in vitro cytotoxicities of RBG and 3-ERBG against
human cancer cell lines (HeLa, HL-60 and Bel-7402) were
also investigated. 3-ERBG showed cytotoxic activities with
IC50 values of 1.05 lM (Hela), 1.48 lM (HL-60) and
0.58 lM (Bel-7402), respectively, while the IC50 values
of RBG were 7.9 9 10-2 lM (Hela), 9.6 9 10-2 lM
(HL-60) and 6.8 9 10-2 lM (Bel-7402), respectively. Fig. 3 Mean plasma concentration–time profiles of resibufogenin
This evidence suggested that both RBG and 3-ERBG had and its metabolite after a single oral dose of resibufogenin to rats,
cytotoxic activities, but the activities of 3-ERBG against each point represents mean ± SD (n = 6)
three cancer cell lines were weaker than those of RBG.
From the pharmacokinetic data of RBG and 3-ERBG
(a major metabolite), it can be concluded that tmax of Table 5 Pharmacokinetic parameters of RBG and its metabolite
RBG is obviously shorter than that of 3-ERBG, Cmax 3-ERBG after oral administration of 10 mg kg-1 RBG in rats
(mean ± SD, n = 6)
of 3-ERBG is about 60 times that of RBG, and AUC0–? of
Parameter RBG 3-ERBG

Table 3 Recoveries of resibufogenin and 3-epi-resibufogenin in rat Ke (1 min-1) 0.025 ± 0.013 0.0097 ± 0.0029
plasma (mean ± SD, n = 6) t1/2(Ka) (min) 1.67 ± 1.52 4.15 ± 2.18
Analyte Added concentration Extraction RSD t1/2(Ke) (min) 37.9 ± 25.10 76.8 ± 22.01
(ng mL-1) recovery ± SD (%) (%) Tmax (min) 6.94 ± 5.63 17.5 ± 6.55
RBG 5 84.9 ± 3.8 4.5 Cmax (ng mL-1) 25.4 ± 13.02 1,457 ± 842
100 82.7 ± 11.9 14.4 CL/F 0.027 ± 0.048 0.000074 ± 0.000044
(mg kg-1 min-1)
2,000 83.9 ± 3.5 4.2
AUC0–? [(ng mL-1) 1,648 ± 948 2.106 9 105 ± 1.071 9 105
3-ERBG 5 93.2 ± 9.3 10.0 min]
100 84.8 ± 10.2 12.0 AUC0–t [(ng mL-1) 1,322 ± 1023 2.083 9 105 ± 1.085 9 105
2,000 86.4 ± 3.1 3.6 min]
IS 150 90.0 ± 2.4 2.7 MRT0-? (min) 56.8 ± 32.65 124 ± 37.12

Table 4 Stability of the resibufogenin and 3-epi-resibufogenin in rat plasma (n = 6)


Analyte Added (ng mL-1) Recovery (%, mean ± SD)
Storage at room Storage at 4 °C Storage at -20 °C 3 freeze–thaw
temperature for 8 h for 24 h for 30 days cycles

RBG 5 86.4 ± 2.90 113.8 ± 9.20 101.4 ± 8.00 96.2 ± 7.10


100 93.0 ± 4.80 102.6 ± 3.40 104.8 ± 6.40 108.2 ± 2.70
2,000 85.7 ± 2.20 103.4 ± 3.50 100.6 ± 3.40 109.2 ± 4.10
3-ERBG 5 93.8 ± 5.90 113.6 ± 8.40 100.1 ± 6.10 97.0 ± 7.00
100 92.3 ± 3.00 95.7 ± 3.50 109.2 ± 7.70 103.8 ± 6.00
2,000 91.6 ± 3.80 96.1 ± 4.10 107.6 ± 4.80 100.7 ± 4.90

123
Simultaneous Determination of Resibufogenin 109

as a major metabolite of RBG in rats, was also a bioactive 2. Ma XC, Zhang BJ, Xin XL, Huang SS, Deng S, Zhang HL,
form of RBG in vivo. The pharmacological function and Shu XH, Diao YP, Cui J (2009) Nat Prod Comm 4:179–184
3. Yeh JY, Huang WJ, Kan SF, Wang PS (2003) Prostate 54:112–124
toxicities of 3-ERBG will be evaluated in the future. 4. Masuda Y, Kawazoe N, Nakajo S, Yoshida T, Kuroiwa Y,
Nakaya K (1995) Leukemia Res 19:549–556
5. Ma XC, Xin XL, Liu KX, Han J, Guo DA (2008) J Nat Prod 71:
Conclusion 1268–1270
6. Arena JM, Drew RH (1985) Poisoning: toxicology, symptoms,
treatments. In: Charles C (ed) 5. Tomas, Springfield, pp 562–564
In this paper, a rapid, sensitive and specific LC–ESI–MS/ 7. Gilman A, Goodman LS, Rall TM, Murad F (1985) The phar-
MS method was developed and validated for simultaneous macological basis of therapeutics, 7th edn. Macmillan, New
quantification of RBG and its metabolite (3-ERBG) in rat York, pp 716–717
8. Xu W, Luo H (2007) J Chromatogr B 859:157–163
plasma. Due to the side effect of RBG, the present LC– 9. Liang Y, Liu A, Guo DA (2008) J Pharm Biomed Anal 46:442–448
ESI–MS/MS method could be used for preclinical and 10. Zhang Y, Tang X (2008) Anal Chim Acta 610:224–231
clinical pharmacokinetic evaluation. In addition, our 11. Ma XC, Zheng J, Guo DA (2007) Enzyme Microb Technol
research also indicated that 3-ERBG, as the major metab- 40:1585–1591
12. Ma XC, Cui J, Zheng J, Guo DA (2007) J Mol Catal B: Enzym
olite of RBG, was perhaps also the bioactive form after oral 48:42–50
administration of RBG. 13. Ning J, Wu TH, Tian Y, Wang CY, Tian G, Zhang BJ, Liu KX,
Ma XC (2010) Xenobiotica 40:48–54
Acknowledgments We thank Education Department of Liaoning 14. Matsunaga T, Tanaka H, Higuchi S, Shibayama K, Kishi N,
Province (LS2010059), Program for Liaoning Excellent Talents in Watanabe K, Yamamoto I (2001) Drug Metab Dispos 29:
University (LNET) and National Natural Science Foundation of 1485–1491
China (30701088, 81073013 and 81160559) for financial support. 15. Gal J, DeVito D, Harper TW (1981) Drug Metab Dispos 9:557–560
16. Lindstrom TD, Whitaker GW (1984) Drug Metab Dispos 12:72–76

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