Heat inhibition of in vitro lipolysis and 14C ibuprofen protein binding in plasma from heparinized uraemic subjects.

Protein binding determination in post heparin plasma samples is complicated by the continued post heparin lipase activity, in vitro, during the binding analysis. The decomposition of lipoproteins and accumulation of nonesterified fatty acids (NEFA) results in artifically elevated free fractions of many drugs. This artefact is particularly accentuated in haemodialysis patients who are frequently hypertriglyceridaemic and receive large doses of heparin. Rapid heat treatment (60 degrees for 15 min) of plasma from heparinized uraemic subjects is shown to inhibit the in vitro lipolysis occurring during 2 hours of equilibrium dialysis at 37 degrees (ED). Mean NEFA concentrations in heat treated plasma after ED (means = 400 +/- 141 mumol/L) were not different (p greater than 0.05, n = 9) from the baseline values in fresh plasma (means 351 +/- 117 mumol/L) but were considerably less (p less than 0.005) than NEFA levels in untreated plasma after ED (means = 1025 +/- 523 mumol/L). The degree of in vitro lipolysis inhibition (92 +/- 6.6%) was very much greater than using the chemical inhibitors phenyl methyl sulphonyl fluoride, EDTA, Triton X100 or protamine sulphate. Heat treatment at 60 degrees for 15 min increased the percentage of free 14C ibuprofen in 3.5% isolated human serum albumin from 0.34% to 0.62%. Reduced binding as a result of heat treatment was not observed however in whole plasma. The percentage free ibuprofen in heat treated, whole plasma from both heparinized and non heparinized subjects (means = 1.22 +/- 0.19; n = 29) was not different (p greater than 0.05) from the percentage free determined in plasma from a non heparinized group (means = 1.16 +/- 0.23; n = 15). In contrast the % free ibuprofen in untreated plasma from heparinized subjects was markedly higher (means = 1.56 +/- 0.41; n = 24; p less than 0.05). There was a strong correlation between % free ibuprofen and plasma NEFA concentration (r = 0.8; p less than 0.005; n = 68). The heat treatment of plasma for 15 min at 60 degrees is proposed as an effective means of controlling heparin induced lipolysis in vitro and may be valuable in overcoming the post heparin binding artefact.