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Therapeutic Drug Monitoring and Clinical Toxicology
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Interview with Antonio D'Avolio

Antonio D'Avolio

In the months leading up to our conference in Rome we are excited to be profiling Italian Scientists. This month we hear from Professor Antonio D'Avolio from Amedeo di Savoia Hospital, Turin, a centre known for their pioneering work in personalizing HIV therapy. More recently, this group was among the first to work with remdesivir and determining concentration in the critically ill COVID patient. We are very grateful to Professor D'Avolio for sharing his experiences. Read on!

 

Antonio D'Avolio
Professor of Pharmacology
Head of the Laboratory of Clinical Pharmacology and Pharmacogenetics
University of Turin, Amedeo di Savoia Hospital, Turin, Italy

 

Can you tell us a little bit about your respective roles? What is a typical day like for you?

I am a Professor of Pharmacology and head of the Laboratory of Clinical Pharmacology and Pharmacogenetics of the University of Turin and of the Amedeo di Savoia Hospital in Turin, Italy. My daily activity is carried out in coordinating the research and routine activities of the laboratory. Furthermore, I must carry out the university's didactic activities (lessons, exams, etc.), and part of the time is dedicated to finding the funds to pay for my collaborators' scholarships and the research activities.

Is there anything that your laboratory does, or that is done at your centre, that you would consider innovative?

Thanks to the close collaboration with clinicians, we were among the first centers in Europe (early 2000) to work on the true personalization of therapy, especially in the anti-infectious field. We have applied pharmacogenetics and therapeutic drug monitoring on HIV positive patients, becoming the Italian reference center for this activity.

What technological innovations have entered into use during your career that have permitted a change, or evolution, in practice?

Definitely liquid chromatography coupled with mass spectrometry. The use of LC-MS/MS has allowed us to simultaneously analyze a large number of drugs in a short time, making TDM routine at our center.

How did you become interested in your area of expertise?

As mentioned, in the early 2000s antiretroviral therapy for HIV positive patients underwent a notable innovation with the arrival of many new drugs in a short time, with few clinical pharmacokinetic data. It was a time of intense research activity with the need to measure the blood concentrations of these drugs in many patients.

Is there anything that you’ve seen or heard about recently and thought “I’d like to incorporate that idea at my centre”?

The study of the microbiome and the evaluation of possible biomarkers at very low concentrations. We are gearing up for this.

What sort of research do you have on the horizon that you think might influence clinical practice in the future?

A couple of things: very low concentration biomarkers and the TDM of monoclonal drugs.

What do you consider is the future for TDM and CT? What are you excited about? What are the challenges we face?

I think the future of TDM is bright. I am thinking of the increasingly important need to personalize therapy and the technologies that are evolving that will allow us to give ever faster and more reliable answers. The challenge will be to interpret and apply in the clinical setting the vast amount of information that the new tools, such as sequencers, will provide us.

How has COVID-19 affected your professional life?

Working in an infectious disease hospital, COVID-19 has hit us hard (professionally and humanly). We have almost totally dedicated ourselves to COVID-19-related activities. In our laboratory we were the first in the world to dose (and publish) remdesivir and apply the LC-MS/MS method on patients in intensive care. There has been a great deal of research activity on new diagnostics for SARS-CoV-2 that were proposed to us.

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