Structural motifs in primary oxidation products of palmitoyl‐arachidonoyl‐phosphatidylcholines by LC‐MS/MS

Oxidative modifications to phospholipids (OxPL) play a major role in modulating signaling events in inflammation and infection, and complete understanding on the induced biological effects can only be understood based on knowledge of the oxidative motifs present. Specific neutral losses observed in tandem mass spectrometry data (LC‐MS/MS) of primary peroxidation products in oxidized palmitoyl‐arachidonoyl‐phosphatidylcholines (OxPAPC) provide information on the prevailing structural motifs regarding the oxidized acyl carbon chain, the nature of oxidized group and the site of carbon oxidation. The higher hydrophobicity of hydroperoxides compared to di‐hydroxy derivatives under reverse‐phase conditions together with specific fragmentation patterns enabled the identification of 12 structurally different OxPAPC structural (di‐hydroxy and hydroperoxide derivatives) and positional isomers as well as the presence of poly‐hydroxy together with isoprostanes derivatives. The fragmentation patterns described in quadrupole time‐of‐flight and linear ion trap instruments complement the m/z value and retention time parameters in the identification of oxidative composition in OxPAPC products becoming a valuable tool for the exploratory screening of oxidized phosphatidylcholines in OxPAPC extracts, distinction of native and modified PC isobaric structures in complex samples contributing to the increased understanding of redox lipidomics in inflammation and infection. Copyright © 2013 John Wiley & Sons, Ltd.     

Effective Assignment of α2,3/α2,6‐Sialic Acid Isomers by LC‐MS/MS‐Based Glycoproteomics

Distinct structural changes of the α2,3/α2,6‐sialic acid glycosidic linkages on glycoproteins are of importance in cancer biology, inflammatory diseases, and virus tropism. Current glycoproteomic methodologies are, however, not amenable toward high‐throughput characterization of sialic acid isomers. To enable such assignments, a mass spectrometry method utilizing synthetic model glycopeptides for the analysis of oxonium ion intensity ratios was developed. This method was successfully applied in large‐scale glycoproteomics, thus allowing the site‐specific structural characterization of sialic acid isomers.     

Identification of short‐chain poly‐3‐hydroxybutyrates in Saiga horn extracts using LC–MS/MS

Saiga horn extracts were analyzed with the goal of obtaining new information about compounds present in it. The purpose of this study is to find synthetic alternatives to Saiga horn extract, which is used in traditional Chinese medicine, by identifying potentially biologically active compounds in the extracts. Using high‐performance liquid chromatography coupled with high‐resolution mass spectrometry, we have been able to identify a series of short‐chain polyhydroxybutyrates in alcoholic extracts of Saiga horn. Optimized high‐performance liquid chromatography coupled with tandem mass spectrometry methods for analysis of short‐chain poly‐3‐hydroxybutyrates were developed and subsequently applied to investigate Saiga horn extract for the presence of these compounds, which might explain its biological actions, particularly for its antipyretic and procoagulant properties.     

Detection and structural features of the βB2‐B3‐crystallin heterodimer by radical probe mass spectrometry (RP‐MS)

The predilection of the β‐crystallin B2 subunit to interact with the βB3 subunit rather than self associate is evident by the detection of the βB2‐B3‐crystallin heterodimer by native gel electrophoresis and electrospray ionisation time‐of‐flight (ESI‐TOF) mass spectrometry under non denaturing conditions. The complex has been detected for the first time and its molecular mass is measured to be 47 450 ± 1 Da. Radical probe mass spectrometry (RP‐MS) was subsequently applied to investigate the nature of the heterodimer through the limited oxidation of the subunits in the complex. Two peptide segments of the βB2 subunit and six of the βB3 subunit were found to oxidise, with far greater oxidation observed within the βB3 versus the βB2 subunit. This, and the observation that the oxidation data of βB2 subunit is inconsistent with the structure of the βB2 monomer, demonstrates that the protection of βB2 is conferred by its association with βB3 subunit within the heterodimer where only the residues of, and towards, its N‐terminal domain remain exposed to solvent. The results suggest that the βB2 subunit adopts a more compacted form than in its monomeric form in order for much of its structure to be enveloped by the βB3 subunit within the heterodimer. Copyright © 2009 John Wiley & Sons, Ltd.     

LC/MS study of the UV filter hexyl 2‐[4‐(diethylamino)‐2‐hydroxybenzoyl]‐benzoate (DHHB) aquatic chlorination with sodium hypochlorite

The fate of modern personal care products in the environment is becoming a matter of increasing concern because of the growing production and assortment of these compounds. More and more chemicals of this class are treated as emerging contaminants. Transformation of commercially available products in the environment may result in the formation of a wide array of their metabolites. Personal care products in swimming pools and in drinking water reservoirs may undergo oxidation or chlorination. There is much data on the formation of more toxic metabolites from original low toxicity commercial products. Therefore, reliable identification of all possible transformation products and a thorough study of their physicochemical and biological properties are of high priority. The present study deals with the identification of the products of the aquatic chlorination of the hexyl 2‐[4‐(diethylamino)‐2‐hydroxybenzoyl]‐benzoate ultraviolet filter. High‐performance liquid chromatography/mass spectrometry (HPLC/MS) and HPLC/MS/MS with accurate mass measurements were used for this purpose. As a result, three chlorinated transformation products were identified. Copyright © 2013 John Wiley & Sons, Ltd.     

Development of a solid‐phase microextraction LC–MS/MS method for determination of oxidative stress biomarkers in biofluids

Recently the connection between oxidative stress and various diseases, including cancer and Alzheimer's, attracts notice as a pathway suitable for diagnostic purposes. 8‐Oxo‐deoxyguanosine and 8‐oxo‐deoxyadenosine produced from the interaction of reactive oxygen species with DNA become prominent as biomarkers. Several methods have been developed for their determination in biofluids, including solid‐phase extraction and enzyme‐linked immunosorbent assays. However, still, there is a need for reliable and fast analytical methods. In this context, solid‐phase microextraction offers many advantages such as flexibility in geometry and applicable sample volume, as well as high adaptability to high‐throughput sampling. In this study, a solid‐phase microextraction method was developed for the determination of 8‐oxo‐deoxyguanosine and 8‐oxo‐deoxyadenosine in biofluids. The extractive phase of solid‐phase microextraction consisted of hydrophilic–lipophilic balanced polymeric particles. In order to develop a solid‐phase microextraction method suitable for the determination of the analytes in saliva and urine, several parameters, including desorption solvent, desorption time, sample pH, and ionic strength, were scrutinized. Analytical figures of merit indicated that the developed method provides reasonable interday and intraday precisions (<15% in both biofluids) with acceptable accuracy. The method provides a limit of quantification for both biomarkers at 5.0 and 10.0 ng/mL levels in saliva and urine matrices, respectively.     

Detection and characterization of prednisolone metabolites in human urine by LC‐MS/MS

Glucocorticosteroids are prohibited in sports when used by systemic administrations (e.g. oral), whereas they are allowed using other administration ways. Strategies to discriminate between administrations routes have to be developed by doping control laboratories. For this reason, the metabolism of prednisolone (PRED) was studied using liquid chromatography coupled to tandem mass spectrometry. A single oral (10 mg) dose of PRED was administered to two healthy male volunteers. Urine samples were collected up to 6 days after administration. Samples were hydrolyzed with β‐glucuronidase and subjected to liquid–liquid extraction with ethyl acetate in alkaline conditions. The extracts were analyzed by liquid chromatography coupled to tandem mass spectrometry. Precursor ion scan methods (m/z 77, 91, 105, 121, 147 and 171) in positive ionization and neutral loss scan methods (76 and 94 Da) in negative ionization modes were applied for the open detection of PRED metabolites. Using these methods, PRED parent compound plus 20 metabolites were detected. PRED and 11 metabolites were characterized by comparison with standards of the compounds (PRED, prednisone, 20β‐dihydro‐PRED and 20α‐dihydro‐PRED, 20β‐dihydro‐prednisone and 20α‐dihydro‐prednisone, 6β‐hydroxy‐PRED and 6α‐hydroxy‐PRED, 20β isomers and 20α isomers of 6β,11β,17α,20,21‐pentahydroxypregnan‐1,4‐diene‐3‐one, 6α,11β,17α,20β,21‐pentahydroxypregnan‐1,4‐diene‐3‐one and Δ⁶‐PRED). Using mass spectrometric data, feasible structures were proposed for seven of the remaining nine detected metabolites, including several 6‐hydroxy‐metabolites. Eleven of the characterized metabolites have not been previously described. Maximum excretion rates for PRED metabolites were achieved in first 24 h; however, most of the metabolites were still detectable in the last collected samples (day 6). Copyright © 2015 John Wiley & Sons, Ltd.     

A novel mass spectrometry‐based method for simultaneous determination of asymmetric and symmetric dimethylarginine,l‐arginine and l‐citrulline optimized for LC‐MS‐TOF and LC‐MS/MS

Nitric oxide (NO) is a regulatory molecule involved in many biological processes. NO is produced by nitric oxide synthase by conversion of l‐ arginine to l‐ citrulline. l‐ Arginine methylated derivatives, asymmetric and symmetric dimethylarginines (asymmetric dimethylarginine, ADMA, and symmetric dimethylarginine, SDMA), regulate l‐ arginine availability and the activity of nitric oxide synthase. As such, they have been frequently investigated as potential biomarkers in pathologies associated with dysfunctions in NO synthesis. Here, we present a new multistep analytical methodology based on liquid chromatography combined with mass spectrometry for the accurate identification of l‐ arginine, l‐ citrulline, ADMA and SDMA. Compounds are measured as stable 2,3,4,5,6‐pentafluorobenzoyl chloride derivatives, which allows for simultaneous analysis of all compounds through chromatographic separation of ADMA and SDMA using a reverse‐phase column. Serum aliquots (100 μL) were spiked with isotope‐labeled internal standards and sodium carbonate buffer. The derivatization process was carried out at 25°C for 10 minu using pentafluorobenzoyl chloride as derivatization reagent. Calibration demonstrated good linearity (R ² = 0.9966–0.9986) for all derivatized compounds. Good accuracy (94.67–99.91%) and precision (1.92–11.8%) were observed for the quality control samples. The applicability of the method was evaluated in a cohort of angiological patients and healthy volunteers. The method discerned significantly lower l‐ arginine and l‐ citrulline in angiologic patients. This robust and fast LC‐ESI‐MS method may be a useful tool in quantitative analysis of l‐ arginine, ADMA, SDMA and l‐ citrulline.     

The reactivity of human serum albumin toward trans‐4‐hydroxy‐2‐nonenal

Mass spectrometry was used to probe the preferred locations of trans‐4‐hydroxy‐2‐nonenal (HNE) addition to the cysteine, histidine, and lysine residues of human serum albumin (HSA). Considering only those modified peptides supported by high mass accuracy Orbitrap precursor ion measurements (high confidence hits), with HNE:HSA ratios of 1:1 and 10:1, 3 and 15 addition sites, respectively, were identified. Using less stringent criteria, a total of 34 modifications were identified at the higher concentration. To gain quantitative data, iTRAQ labeling studies were completed. Previous work had identified Cys³⁴, the only free cysteine, as the most reactive residue in HSA, and we have found that Lys¹⁹⁹, His^242/7, and His²⁸⁸ are the next most reactive residues. Although the kinetic data indicate that the lysines and histidines can react at relatively similar rates, the results show that lysine addition is much less favorable thermodynamically; under our reaction conditions, lysine addition generally does not go to completion. This suggests that under physiological conditions, HNE addition to lysine is only relevant in situations where unusually high HNE concentrations or access to irreversible secondary reactions are found. Copyright © 2012 John Wiley & Sons, Ltd.     

Recent advances in the assessment of the ratios of cortisol to cortisone and of some of their metabolites in urine by LC‐MS‐MS

A previously reported method for the assessment of the ratio of tetrahydrocortisol (THF) + allo‐tetrahydrocortisol (A‐THF) to tetrahydrocortisone (THE) by HPLC‐MS‐MS has been significantly improved, in order to increase either ruggedness and reliability. That was achieved by the introduction of an on‐line sample cleanup stage, which made use of a perfusion column as a solid phase microextraction (SPE) cartridge. The set of analytes was expanded, by introducing cortisol and cortisone, whose ratio supply additional diagnostic information. The response factors of both THF and A‐THF has been checked, resulting almost identical, as well as the influence of the matrix on the calibration curves which, although different for water and urine, had similar effect on the ratios of interest. As a consequence, the calibration solutions can be prepared in pure water. The influence of several different storage procedures has also been tested, resulting in no substantial effect on the final result. Finally, the improved method has been used to run real samples from healthy volunteers, with satisfactory results. Copyright © 2008 John Wiley & Sons, Ltd.     

Profiles analysis of proanthocyanidins in the argun nut (Medemia argun—an ancient Egyptian palm) by LC–ESI–MS/MS

Medemia argun is an ancient palm rich in proanthocyanidins (PACs). These polyphenolic compounds are widely distributed in plants and are an integral part of the human diet. A sensitive high‐performance liquid chromatography and electrospray ionization mass spectrometry (HPLC–ESI–MS) method in the negative ion mode for sequencing these ubiquitous and highly beneficial antioxidants is described in order to profile different PACs in M. argun nuts. The analytical protocol based on tandem mass spectrometry was used to sequence dimers, trimers, tetramers and pentamers with different A‐type, B‐type and A/B‐type linkages. Diagnostic ions resulting from heterocyclic ring fission and retro‐Diels–Alder reaction of flavan‐3‐ol provided information on the hydroxylation pattern and the type of interflavan bond. The sequences were discovered through ions derived from quinone methide cleavage of the interflavan bond. The identification of PACs linkages through LC–MSⁿ eliminates a number of tedious separation steps. The method was successfully applied to give a view of PAC profile in M. argun nuts. M. argun nuts contained 636.88 mg/g PACs (as equivalent of (þ)‐catechin). The data obtained in our research show that M. argun is a rich source of hydrolyzable PACs. Copyright © 2014 John Wiley & Sons, Ltd.     

Direct Detection of Key Intermediates in Rhodium(I)‐Catalyzed [2+2+2] Cycloadditions of Alkynes by ESI‐MS

The mechanism of the Rh‐catalysed [2+2+2] cycloaddition reaction of diynes with monoynes has been examined using ESI‐MS and ESI‐CID‐MS analysis. The catalytic system used consisted of the combination of a cationic rhodium(I) complex with bisphosphine ligands, which generates highly active complexes that can be detected by ESI(+) experiments. ESI‐MS on‐line monitoring has allowed the detection for the first time of all of the intermediates in the catalytic cycle, supporting the mechanistic proposal based mainly on theoretical calculations. For all ESI‐MS experiments, the structural assignments of ions are supported by tandem mass spectrometry analyses. Computer model studies based on density functional theory (DFT) support the structural proposal made for the monoyne insertion intermediate. The collective studies provide new insight into the reactivity of cationic rhodacyclopentadienes, which should facilitate the design of related rhodium‐catalysed C? C couplings.     

Structural identification of degradants of moexipril by LC–MS/MS

A gradient LC–MS method was developed for the identification and characterization of degradants of moexipril using liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI‐MS/MS). Moexipril was subjected to hydrolysis (acid, base and neutral), oxidation, photolytic and thermal degradation conditions as mentioned in ICH guidelines Q1A (R2). The drug degraded under hydrolysis, oxidation and photolytic conditions, but it was stable under thermal conditions. In total, five degradants were formed and separated on an Agilent XDB C‐18 column (4.6 × 150 mm, 5 μm) in a gradient elution method. Four degradants ( D1 , D2 , D4 and D5 ) under acidic conditions, three degradants ( D2 , D3 and D4 ) under basic conditions and three degradants ( D1 , D4 and D5 ) under neutral and oxidative stress conditions were formed. In addition, two degradants ( D4 and D5 ) were formed under photolytic stress conditions. To elucidate the structures of degradants, fragmentation of moexipril and its degradants was studied using LC–MS/MS experiments and accurate mass measurements (HRMS) data. The fragment ions in the product ion tandem mass spectra of all the degradants were compared with those of moexipril and assigned the probable structures for the degradants.     

Identification of leucine-enkephalin radical oxidation products by liquid chromatography tandem mass spectrometry

The oxidation of the peptide leucine-enkephalin (YGGFL) induced by the hydroxyl radical (HO*), formed under Fenton-like conditions [Cu (II)/H(2)O(2)], was studied and monitored by LC-MS. The oxidation products identified included products resultant from (a) the insertion of oxygen atoms (1-5), (b) peptide backbone cleavage (short-chain products formed by diamide pathway) and (c) radical-radical crosslinking reactions. In order to identify the modified residues, LC-MS/MS spectra were obtained. The insertion of oxygen atoms into the peptide originated hydroxide, di-hydroxide and/or hydroperoxide derivatives. In addition it was found that the aromatic amino acids are most susceptible to being hydroxylated, while the aliphatic amino acids are more prone to forming hydroperoxides. Oxidation products with double bonds were also identified. The short chain products resulted from the alpha-carbon radical of terminal amino acids (Tyr and Leu). Products resulting from cross-linking reactions between intact carbon-centered peptide radical (with and without one HO group) and a side chain radical (*C(7)H(7)O) were identified. It was found that, although all amino acids residues of the peptide undergo modifications, the N-terminal seems to be prone to oxidative modifications under these conditions.     

Identification of RNA sequence isomer by isotope labeling and LC–MS/MS

Recently, we developed a method for modified ribonucleic acid (RNA) analysis based on the comparative analysis of RNA digests (CARD). Within this CARD approach, sequence or modification differences between two samples are identified through differential isotopic labeling of two samples. Components present in both samples will each be labeled, yielding doublets in the CARD mass spectrum. Components unique to only one sample should be detected as singlets. A limitation of the prior singlet identification strategy occurs when the two samples contain components of unique sequence but identical base composition. At the first stage of mass spectrometry, these sequence isomers cannot be differentiated and would appear as doublets rather than singlets. However, underlying sequence differences should be detectable by collision‐induced dissociation tandem mass spectrometry (CID MS/MS), as y‐type product ions will retain the original enzymatically incorporated isotope label. Here, we determine appropriate instrumental conditions that enable CID MS/MS of isotopically labeled ribonuclease T1 (RNase T1) digestion products such that the original isotope label is maintained in the product ion mass spectrum. Next, we demonstrate how y‐type product ions can be used to differentiate singlets and doublets from isomer sequences. We were then able to extend the utility of this approach by using CID MS/MS for the confirmation of an expected RNase T1 digestion product within the CARD analysis of an Escherichia coli mutant strain even in the presence of interfering and overlapping digestion products from other transfer RNAs. Copyright © 2014 John Wiley & Sons, Ltd.     

Enantiomeric differentiation of β‐amino alcohols under electrospray ionization mass spectrometric conditions

The enantiomeric differentiation of a series of chiral β‐amino alcohols (A) is attempted, for the first time, by applying the kinetic method using L‐proline, L‐tryptophan, 4‐iodo‐L‐phenylalanine or 3, 5‐diiodo‐L‐tyrosine as the chiral references (Ref) and Cu²⁺ or Ni²⁺ ion (M) as the central metal ion. The trimeric diastereomeric adduct ions, [M+(Ref)₂+A‐H]⁺, formed under electrospray ionization conditions, are subjected for collision‐induced dissociation (CID) experiments. The products ions, formed by the loss of either a reference or an analyte, detected in the CID spectra are evaluated for the enantiomeric differentiation. All the references showed enantiomeric differentiation and the R_chiral values are better for the aromatic alcohols than for aliphatic alcohols. Notably, the R_chiral values of the aliphatic amino alcohols enhanced when Ni²⁺ is used as the central metal ion. The experimental results are well supported by computational studies carried out on the diastereomeric dimeric complexes. The computational data of amino alcohols is correlated with that of amino acids to understand the structural interaction of amino alcohols with reference molecule and central metal ion and their role on the stabilization of the dimeric complexes. Application of flow injection MS/MS method is also demonstrated for the enantiomeric differentiation of the amino alcohols. Copyright © 2014 John Wiley & Sons, Ltd.     

Determination of trace hydroxyl polycyclic aromatic hydrocarbons in urine using graphene oxide incorporated monolith solid‐phase extraction coupled with LC‐MS/MS

The biomonitoring of hydroxy polycyclic aromatic hydrocarbons in urine, as a direct way to access multiple exposures to polycyclic aromatic hydrocarbons, has raised great concerns due to their increasing hazardous health effects on humans. Solid‐phase extraction is an effective and useful technique to preconcentrate trace analytes from biological samples. Here, we report a novel solid‐phase extraction method using a graphene oxide incorporated monolithic syringe for the determination of six hydroxy polycyclic aromatic hydrocarbons in urine coupled with liquid chromatography‐tandem mass spectrometry. The effect of graphene oxide amount, washing solvent, eluting solvent, and its volume on the extraction performance were investigated. The fabricated monoliths gave higher adsorption efficiency and capacity than the neat polymer monolith and commercial C₁₈ sorbent. Under the optimum conditions, the developed method provided the detection limits (S/N = 3) of 0.02–0.1 ng/mL and the linear ranges of 0.1–1500 ng/mL for six analytes in urine sample. The recoveries at three spiked levels ranged from 77.5 to 97.1%. Besides, the intra column‐to‐column (n = 3) and inter batch‐to‐batch (n = 3) precisions were ≤ 9.8%. The developed method was successfully applied for the determination of hydroxy polycyclic aromatic hydrocarbons in urine samples of coke oven workers.     

Multiresidue analysis of nine β‐agonists in animal muscles by LC‐MS/MS based on a new polymer cartridge for sample cleanup

A novel, sensitive, and reliable LC‐MS/MS method for multiresidue analysis of nine β‐agonists (salbutamol, terbutaline, cimaterol, fenoterol, clorprenaline, ractopamine, tulobuterol, clenbuterol, and penbuterol) in four farm animal muscles was developed. Muscle matrix was extracted with acetonitrile–10% sodium carbonate solution, and then was subjected to cleanup using a SPE cartridge packed with new polymer synthesized in acetone. Chromatographic separation of the components was performed on a Luna C₁₈ column using 0.1% of formic acid in water and acetonitrile. The mass spectrometer was operated in the positive electrospray mode. Good precision and accuracy were obtained for all analytes (except for fenoterol) at the spiked three levels of 1.0, 10, and 50 μg/kg. The decision limit and detection capability of nine β‐agonists ranged from 0.04 to 0.18 and 0.15 to 0.69 μg/kg, respectively. The method developed was successfully applied to the monitoring of nine β‐agonists in pork, beef, mutton, and chicken from Chinese markets.     

Characterization of different poly(2‐oxazoline) block copolymers by MALDI‐TOF MS/MS and ESI‐Q‐TOF MS/MS

A complete library of poly(2‐oxazoline) block copolymers was synthesized via cationic ring opening polymerization for the characterization by two different soft ionization techniques, namely matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS) and electrospray ionization quadrupole time‐of‐flight mass spectrometry (ESI‐Q‐TOF MS). In addition, a detailed characterization was performed by tandem MS to gain more structural information about the block copolymer composition and its fragmentation behavior. The fragmentation of the poly(2‐oxazoline) block copolymers revealed the desired polymer structure and possible side reactions, which could be explained by different mechanisms, like 1,4‐ethylene or hydrogen elimination and the McLafferty +1 rearrangement. Polymers with aryl side groups showed less fragmentation due to their higher stability compared to polymers with alkyl side groups. These insights represent a further step toward the construction of a library with fragments and their fragmentation pathways for synthetic polymers, following the successful examples in proteomics. © 2010 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2010     

Multiplexed therapeutic drug monitoring of antipsychotics in dried plasma spots by LC‐MS/MS

In this work, a convenient method for the therapeutic monitoring of seven common antipsychotic drugs in “dried plasma spot” samples has been developed. It is based on the liquid chromatography tandem mass spectrometry technique, operating in multiple reaction monitoring mode, and a straightforward procedure for the simultaneous extraction of all antipsychotics in a single step, with high extraction yield. The method was fully validated with proper accuracy, precision, selectivity and sensitivity, for all the drugs. Limits of quantification were 0.12, 1.09, 1.46, 1.47, 5.70, 1.32, 1.33 µg/L for haloperidol, aripiprazole, olanzapine, quetiapine, clozapine, risperidone, and paliperidone, respectively. Accuracy, intra‐ and interday precision values were <10% for all drugs at all concentration levels examined. The method was tested in the analysis of 30 plasma samples from real patients for each drug. The proposed analytical approach, by combining practical and logistical advantages of microsampling with liquid chromatography tandem mass spectrometry analytical performance, could offer an ideal strategy for accurate and timely therapeutic drug monitoring of antipsychotic drugs in most clinical settings, even in remote centers and/or in out‐patient settings, bringing so many potential improvements in psychiatric patient care.