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A review of nanocarrier-based CNS delivery systems.

Drug delivery to the central nervous system (CNS) is one of the most challenging fields of research and development for pharmaceutical and biotechnology products. A number of hydrophilic therapeutic agents, such as antibiotics, anticancer agents, or newly developed neuropeptides do not cross the blood brain barrier (BBB) after systemic administration. The BBB is formed by the tight junctions at the brain capillary endothelial cells, which strictly control drug transfer from blood to brain. Drug modification, osmotic opening of cerebral capillary endothelium, and alternative routes for administration (e.g., intracerebral delivery) have been successfully used to enhance drug transport to the CNS. The use of nanocarriers, such as liposomes and solid polymeric or lipid nanoparticles may be advantageous over the current strategies. These nanocarriers can not only mask the BBB limiting characteristics of the therapeutic drug molecule, but may also protect the drug from chemical/enzymatic degradation, and additionally provide the opportunity for sustained release characteristics. Reduction of toxicity to peripheral organs can also be achieved with these nanocarriers. This review article discusses the various barriers for drug delivery to the CNS and reviews the current state of nanocarriers for enhancing drug transport into the CNS.

Animals↗

A delivery system for inhalation of nitric oxide evaluated with chemiluminescence, electrochemical fuel cells, and capnography.

OBJECTIVE: To evaluate a system for delivery of inhaled nitric oxide. DESIGN: Prospective, laboratory study. SETTING: Engineering laboratory. SUBJECTS: A standard ventilator (Servo Ventilator 300), supplemented with extra gas modules for nitric oxide delivery. INTERVENTIONS: Two ventilator-integrated gas modules, delivering < or = 10 parts per million (ppm) or < or = 100 ppm of nitric oxide, were used in adult and neonatal modes during volume-controlled ventilation. Set nitric oxide concentration and FIO2 were systematically changed and compared with the measured concentration. Short-term mixing was tested in adult, pediatric, and neonatal modes by substituting nitric oxide with CO2, and measuring the delivered concentration by a fast-response CO2 analyzer during five successive respiratory cycles. Long-term mixing was tested with the administration of 25 ppm of nitric oxide for 7 days. MEASUREMENTS AND MAIN RESULTS: Delivered concentration of nitric oxide and nitrogen dioxide were simultaneously measured at the Y-place by two methods-chemiluminescence and electro-chemical fuel cells. The maximum absolute difference between set and measured concentrations of nitric oxide in the adult mode was 0.6 ppm at a set concentration of 10 ppm and 2.7 ppm at a set concentration of 100 ppm. In the neonatal mode, the maximal difference was 3.1 ppm at a set concentration of 100 ppm. Nitrogen dioxide concentration increased with increasing concentration of nitric oxide and oxygen to 2.6 ppm (as measured by the chemiluminescence analyzer) and 3.6 ppm (as measured by the electro-chemical fuel cell), at a setting of 100 ppm of nitric oxide with an FIO2 of 0.90 in the neonatal mode (2 L/min). During the short-term test of mixing stability throughout the respiratory cycles, a constant set CO2 concentration varied maximally by +/-6.2% from the set value in the neonatal mode, whereas the variance was by +/-6.5% in pediatric mode, and by +/-8.0% in the adult mode. During the long-term test, nitric oxide concentration varied maximally by +/-2.6% (as measured by the chemiluminescence analyzer) and by +/-2.3% (as measured by the electrochemical fuel cell). CONCLUSIONS: An accurate precision in delivered nitric oxide concentration was achieved during intermittent flow ventilation, and this accuracy was independent of tested ventilator settings. The delivery system administered an almost stable concentration throughout a respiratory cycle and during long-term delivery. If the mixing point is in the inspiratory part of the ventilator, valid measurement of nitric oxide and nitrogen dioxide delivery concentrations are possible. Both techniques for measuring nitric oxide and nitrogen dioxide have drawbacks.

Administration, Inhalation↗

Floating drug delivery systems: an approach to oral controlled drug delivery via gastric retention.

In recent years scientific and technological advancements have been made in the research and development of rate-controlled oral drug delivery systems by overcoming physiological adversities, such as short gastric residence times (GRT) and unpredictable gastric emptying times (GET). Several approaches are currently utilized in the prolongation of the GRT, including floating drug delivery systems (FDDS), also known as hydrodynamically balanced systems (HBS), swelling and expanding systems, polymeric bioadhesive systems, modified-shape systems, high-density systems, and other delayed gastric emptying devices. In this review, the current technological developments of FDDS including patented delivery systems and marketed products, and their advantages and future potential for oral controlled drug delivery are discussed.

Administration, Oral↗

Clinical spectrum of the osmotic-controlled release oral delivery system (OROS), an advanced oral delivery form.

BACKGROUND: The osmotic-controlled release oral delivery system, OROS, is an advanced drug delivery technology that uses osmotic pressure as the driving force to deliver pharmacotherapy, usually once-daily, in several therapeutic areas. OBJECTIVE: The purpose of this review is to discuss the evolution of OROS technology and examine the many therapeutic areas where OROS products are being used. METHODS: A search of Medline and EMBASE were performed using the keywords 'OROS' and 'osmotic delivery' for the period January 1990 to June 2005. Data were also obtained from the manufacturers' websites and associated publications. RESULTS: OROS technology has evolved over the last 30 years, resulting in four systems: the elementary osmotic pump; the two-layer osmotic push-pull tablet; the advanced longitudinally compressed tablet multilayer formulation; and, the L-OROS system. OROS technology is employed for drug delivery in many therapeutic areas including: cardiovascular medicine, endocrinology, urology, and central nervous system (CNS) therapeutics. Two calcium channel blockers utilizing OROS technology for the treatment of hypertension are nifedipine and verapamil. Glipizide extended-release is used for the treatment of type 2 diabetes. Doxazosin is used for the treatment of benign prostatic hyperplasia, and oxybutynin for overactive bladder. Most recent developments are with drugs that affect the CNS, including the use of methylphenidate for treatment of attention deficit hyperactivity disorder, paliperidone extended-release and OROS hydromorphone, which are under clinical development for schizophrenia and chronic pain, respectively. CONCLUSIONS: Drug delivery using the various OROS products can result in an improved safety profile, stable drug concentrations, uniform drug effects, and reduced dosing frequency. OROS technology has also enabled the use of an effective starting dose, without the need for dose titration, which allows the achievement of symptom control much earlier than that observed with immediate-release preparations. Such attributes can enhance patient compliance and convenience, thereby ensuring efficacy and improving patient outcomes.

Administration, Oral↗

Colon targeted delivery systems: review of polysaccharides for encapsulation and delivery.

Colon-targeted delivery of bioactives has recently gained importance in addressing specific needs in the therapy of colon-based diseases. Many approaches have been attempted for the development of colon-specific delivery systems, with not much success in the past. Recent research into the utilization of the metabolic activity and the colonic microenvironment in the lower gastrointestinal tract has attained great value in the design of novel colon-targeted delivery systems based on natural biodegradable polymers. In the current article, special emphasis has been placed on polysaccharide systems, with minimal chemical modification, that have been exploitedfor colon targeting. These polysaccharide based encapsulation and targeted delivery systems are envisaged to have an immense potential for the development of food/nutraceutical formulations for colon-based diseases, including colorectal cancer.

Alginates↗

A novel in situ forming drug delivery system for controlled parenteral drug delivery.

The objective of this study was to investigate the in vitro drug (diltiazem hydrochloride and buserelin acetate) release from different in situ forming biodegradable drug delivery systems, namely polymer solutions (in situ implants) and in situ microparticle (ISM) systems. The drug release from ISM systems [poly(d,l-lactide) (PLA) or poly(d,l-lactide-co-glycolide) (PLGA)-solution dispersed into an external oil phase] was investigated as a function of the type of solvent and polymer, polymer concentration and internal polymer phase:external oil phase ratio and was compared to the drug release from in situ implant systems and microparticles prepared by conventional methods (solvent evaporation or film grinding). Upon contact with the release medium, the internal polymer phase of the ISM system solidified and formed microparticles. The initial drug release from ISM systems decreased with increasing polymer concentration and decreasing polymer phase:external oil phase ratio. The type of biocompatible solvent also affected the drug release. It decreased in the rank order DMSO>NMP>2-pyrrolidone. In contrast to the release of the low molecular weight diltiazem hydrochloride, the peptide release (buserelin acetate) was strongly dependent on the polymer degradation/erosion. One advantage of the ISM system when compared to in situ implant systems was the significantly reduced burst effect because of the presence of an external oil phase. ISM systems resulted in drug release profiles comparable to the drug release of microparticles prepared by the solvent evaporation method. Therefore, the ISM systems are an attractive alternative to existing complicated microencapsulation methods.

Buserelin↗

System integration--the need in future anesthesia delivery systems.

Although current anesthesia delivery systems possess the virtues of familiarity, ruggedness, reliability, and longevity, problems inherent in their design require remedy. These systems consist of discrete subsystems that are unrelated physically, functionally, or by communications. Production of derived values, as opposed to raw data, is almost unheard of, although transformed data may be much more useful in the clinical environment. Future anesthesia delivery systems will use microprocessors to integrate data from multiple sensors with calculation, display, and control functions--without removing the anesthesiologist from the control loop. New ergonomic data will promote design of equipment that can be optimally manufactured, marketed, and used in clinical care. The proliferation of new equipment with advanced design and application features creates challenges for a society conscious of rising health-care costs. Creative alternatives to conventional financing, ownership, and early obsolescence of anesthesia systems must be sought in order to ensure that the quality of and capability for anesthetic care will continue to advance.

Anesthesia↗

Possibility of a patch system as a new oral delivery system.

A new oral patch system has been designed to increase the residence time of model drugs within the gastrointestinal tract. The system consisted of three layers (1) water-insoluble backing layer (2) drug-carrying adhesive layer composed of a model drug, fluorescein (FL) or fluorescein isothiocyanate-dextran (FD), and gel-forming polymer and (3) pH-sensitive enteric polymer. These three layers system was prepared as 3.0 mm diameter patches. As references, tablet containing FL or FD was prepared. In vitro dissolution studies showed that the mean dissolution time (MDT) of model drugs from patch preparation was 0.739+/-0.021 h for FL and 0.407+/-0.021 h for FD, which were longer than from tablet, 0.327+/-0.008 h for FL and 0.270+/-0.019 h for FD. The two test preparations were orally administered to beagle dogs in a crossover manner at a FL dose of 30 mg/dog and the measured plasma FL concentrations were used for pharmacokinetic analysis. With FL patch preparation, area under the plasma drug concentration vs. time curve (AUC) was 2.12+/-0.24 microgh/ml and mean residence time (MRT) was 4.60+/-0.18 h, which were greater than those of tablet, AUC was 1.52+/-0.16 microgh/ml and MRT was 3.18+/-0.09 h, respectively. Oral patch preparation also increased both AUC and MRT of FD, a model macromolecular drug, which was formulated into both patches and tablets and administered to dogs (30 mg/dog). The AUC and MRT of FD from the patch preparation were 1.11+/-0.13 microgh/ml and 5.58+/-0.55 h and from tablets were 0.53+/-0.08 microg h/ml and 4.09+/-0.29 h, respectively. These results suggest that oral patch preparation has as a potential a new oral delivery system to obtain a long residence time of drug in the gastrointestinal tract.

Administration, Oral↗

A novel heparin/protamine-based pro-drug type delivery system for protease drugs.

Previously we proposed a heparin/protamine-based system for delivery of protease drugs such as tissue-specific plasminogen activator (tPA). To demonstrate the feasibility of this approach as well as its pro-drug and triggered release features, positively charged peptides [(Arg)(7)Cys] were successfully linked to tissue-specific plasminogen activator (tPA) using the crosslinking agent N-succinimidyl-3-(2-pyridyldithio)- propionate. This cation-modified tPA showed much stronger heparin affinity than the parent tPA. The complex formed by mtPA and heparin was stable in human plasma, and the activity of mtPA in such a complex was inhibited by the appended heparin. Similarly, the activity of mtPA could also be inhibited by a heparin-antifibrin IgG conjugate in which heparin was linked, via endpoint attachment, to the sugar moieties in the F(c) region of anti-fibrin IgG. Aside from this pro-drug feature exhibited by the binding of the macromolecule heparin to mtPA, results from chromogenic and in vitro clot lysis assay demonstrated that the heparin-induced inhibition of the mtPA activity could be easily reversed by the addition of an adequate amount of protamine. These findings suggest the applicability of the heparin/protamine delivery system to abort the potential bleeding risks associated with clinical use of tPA. In addition to the chemical conjugation method, modified tPA could also be produced by the recombinant DNA method. The expressed modified tPA (EmtPA) thus prepared retained the full catalytic activity of the parent tPA, and this activity could also be inhibited by heparin, and the heparin-induced inhibition could be reversed following the addition of protamine.

Drug Carriers↗

Chemotherapy and delivery systems--helminths.

The milbemycins are the only novel broad spectrum anthelmintic chemicals to reach the market place in the last 10 years. Many new systems for delivery and strategies for rational use have, however, been introduced. Boluses which are retained by virtue of specific gravity and by variable geometry are now available. They contain benzimidazoles, morantel, ivermectin and levamisole. Their release mechanisms involve preferential corrosion of a retaining metal core, constant diffusion from a laminated ethylene acetate sandwich, and a hydrostatic pump driven by osmotic pressure. Some are biodegradable. Experimental delivery systems have been developed incorporating ear implants and liposomes. The anthelmintic efficacy of some drugs has been potentiated by the synergistic action of metabolic inhibitors and these combinations hold promise for the future. Much new information is now available on those factors which affect anthelmintic efficacy such as concurrent administration with food and the presence of the target parasites themselves. This knowledge provides a sound basis for the rational use of anthelmintic drugs.

Alginates↗

Self-emulsifying drug delivery systems (SEDDS) for improved oral delivery of lipophilic drugs.

The oral delivery of hydrophobic drugs presents a major challenge because of the low aqueous solubility of such compounds. Self-emulsifying drug delivery systems (SEDDS), which are isotropic mixtures of oils, surfactants, solvents and co-solvents/surfactants, can be used for the design of formulations in order to improve the oral absorption of highly lipophilic drug compounds. SEDDS can be orally administered in soft or hard gelatin capsules and form fine relatively stable oil-in-water (o/w) emulsions upon aqueous dilution owing to the gentle agitation of the gastrointestinal fluids. The efficiency of oral absorption of the drug compound from the SEDDS depends on many formulation-related parameters, such as surfactant concentration, oil/surfactant ratio, polarity of the emulsion, droplet size and charge, all of which in essence determine the self-emulsification ability. Thus, only very specific pharmaceutical excipient combinations will lead to efficient self-emulsifying systems. Although many studies have been carried out, there are few drug products on the pharmaceutical market formulated as SEDDS confirming the difficulty of formulating hydrophobic drug compounds into such formulations. At present, there are four drug products, Sandimmune and Sandimmun Neoral (cyclosporin A), Norvir (ritonavir), and Fortovase (saquinavir) on the pharmaceutical market, the active compounds of which have been formulated into specific SEDDS. Significant improvement in the oral bioavailability of these drug compounds has been demonstrated for each case. The fact that almost 40% of the new drug compounds are hydrophobic in nature implies that studies with SEDDS will continue, and more drug compounds formulated as SEDDS will reach the pharmaceutical market in the future.

Administration, Oral↗

High-performance liquid chromatographic assay of a central nervous system (CNS)-directed estradiol chemical delivery system and its application after intravenous administration to rats.

A redox-based chemical delivery system for estradiol (E2-CDS) has been shown capable of sustained and brain-selective delivery of estradiol (E2). A reversed-phase high-performance liquid chromatographic (HPLC) method is presented for the analysis of E2-CDS and its oxidized quaternary metabolite (E2-Quat) in biological fluids or tissues. The assay utilized a precolumn enrichment technique and detects plasma levels down to 10 ng/ml E2-Quat and 20 ng/ml E2-CDS. Sample preparation is rapid and simple. Samples are homogenized with acetonitrile, then centrifuged, and the supernatant is directly injected into the HPLC system. A water delivering pump injects the sample on a precolumn where the drug is concentrated. The mobile phase backflushes the retained compound onto the analytical column. At the same time, another sample can be injected onto a second precolumn. This alternating precolumn sample enrichment technique allows the injection of large volumes, up to 1800 microliters. Plasma and tissue samples of rats collected after i.v. administration of a single 15-mg/kg E2-CDS dose were analyzed for E2-CDS and E2-Quat by this procedure. The results show sustained brain levels of E2-Quat and prolonged half-life in brain compared to six peripheral tissues measured. These data support the concept of brain-targeted delivery using redox carrier systems of this type.

Animals↗

Drug delivery systems. 4. Implants in drug delivery.

In comparison with many of the other drug delivery systems, implantable pumps and implants for variable rate delivery are at a crude stage of development. Although exceptions exist, the typical implantable pump consists of an electromechanically complex mechanism to regulate drug delivery from a percutaneous refillable reservoir, while power to drive the system comes from a transcutaneous energy transmission system. The potential for electrical or mechanical failure is high, and the systems are not yet sufficiently convenient or easy to use to recommend in a routine therapy. Problems with refilling of an apparently well designed implanted reservoir have been observed while, at the same time, cutaneous energy transmission systems are not well established. In most instances, the development of an elementary osmotic pump system dosage form follows a well defined path of physical-chemical formulation and clinical testing. The benefits most often provided by the dosage form are expected to be (1) increase in selectivity of drug action achieved by the system's zero-order release rate, and (2) decrease in frequency of administration. The success in achieving these values is quantifiable from the pharmacology of the drug substance and its pharmacokinetics. Osmotic and other technical approaches to producing economical, rate-controlled dosage forms will make it possible for all new pharmaecutical products to carry kinetic specification of rate as well as static specification of content. This review considers the characteristics of the ideal implantable pump, the clinical situations which require pumps, the limitations of portable pumps, and the detailed characteristics of existing implantable pumps and implants. Most of the review, however, focuses on insulin delivery because of the importance of this subject.

Chlorofluorocarbons, Methane↗

RGD-modified liposomes targeted to activated platelets as a potential vascular drug delivery system.

Local drug delivery has become an important treatment modality for the prevention of thrombotic events following coronary angioplasty. In this study, we investigate the ability of liposomes bearing surface conjugated linear Arg-Gly-Asp (RGD) peptide (GSSSGRGDSPA) moieties to target and bind activated platelets, and the effect of such RGD-modified liposomes on platelet activation and aggregation. The binding of RGD-liposomes to human platelets was assessed by fluorescence microscopy, phase contrast microscopy and flow cytometry. The effect of RGD-modified liposomes on platelet activation and aggregation was investigated in vitro, with and without platelet agonists. RGD-liposomes were found to bind activated platelets at levels significantly greater than the control RGE-liposomes. The RGD-liposomes did not exhibit any statistically significant effect on platelet activation or aggregation. The results demonstrate the ability of the RGD-modified liposomes to target and bind activated platelets without causing significant platelet aggregation and suggests a feasible way for the development of a platelet-targeted anti-thrombogenic drug delivery system. Furthermore, the approach can be extended to the development of liposomes for other vascular targets, for application in drug delivery or gene therapy.

Blood Platelets↗

Microencapsulation peptide and protein drugs delivery system.

Many methods were used to devise peptide and protein drugs delivery system (DDS). Because of their relatively large size, they have low transdermal bioavailabilities. In systemic delivery of proteins, biodegradable material as parenteral depot formulation occupy an important place because of several aspects like protection of sensitive proteins from degradation, prolonged or modified release, pulsatile release patterns. The main objective in developing controlled release protein injectables is avoidance of regular invasive doses which in turn provide patient compliance, comfort as well as control over blood levels. This review article presents the outstanding contributions in field of microencapsulation as protein delivery systems and different approaches of protein delivery are described. Then discusses how these advances may be applied to resolve the challenges face the development of microcapsule for the controllable delivery of protein drugs.

Alginates↗

Virosomes: evolution of the liposome as a targeted drug delivery system.

The drug delivery system (DDS) is attractive as a therapeutic method. Liposomes are of particular interest as a DDS because they can reduce drug toxicity, and offer promise as gene carriers. An evolution has occurred in the construction of liposomes in the effort to develop efficient vectors for in vivo use. To avoid uptake by the reticuloendothelial system (RES); Lipid components have been optimized. To enhance tissue targeting, liposome surface has been modified with antibodies or ligands recognized by specific cell types. To enhance the efficiency of gene delivery by the introduction of molecules directly into cells, virosomes have been developed by combining liposomes with fusiogenic viral envelope proteins. Liposomes are now being used in the treatment of intractable human diseases such as cancer and monogenic disorders. In the future, many medical procedures will be performed using liposomes.

Adenoviridae↗

[Transdermal drug delivery systems].

Transdermal drug delivery systems are pharmaceutical preparations, intended to be applied to the unbroken skin in order to deliver the active ingredient(s) to the systemic circulation after passing through the skin barrier. Transdermal patches are formulated in different ways, but normally they consist of release liner, adhesive layer and backing layer. Active ingredient(s) can be incorporated in reservoir, matrix, adhesive, membrane-matrix and microreservoir. The releasing rate of active substances from patches is controlled by membrane, matrix and adhesive. Only several transdermal systems are available on the market today, because for the penetration of most substances skin represents a strong barrier. With transdermal systems it is possible to obtain a controllable and sustained plasma levels, to minimaze the risk of undesirable side effects and to avoid the hepatic first- pass metabolism. These devices are easy to apply and also to remove from the skin. Of a great pharmaceutical interest are also socalled cosmetic patches. They are applied with aim of cleaning and protecting the skin.

Administration, Cutaneous↗

The preparation of the chronic hyper-endotoxemia experimental animal model by means of a drug delivery system.

A drug delivery system (DDS) consisting of lipopolysaccharide (LPS) as a drug and 2-hydroxyethyl methacrylate (HEMA)-diethylene glycol dimethacrylate (2G) or -polyethylene glycol dimethacrylate (4G, 9G) copolymer was prepared, and used for the efficient preparation of an experimental animal model of chronic hyper-endotoxemia. The release profiles of LPS in the in-vitro test were greatly influenced by the composition of HEMA-2G, 4G, 9G in the copolymer. It was found that LPS release from the DDS continued gradually and constantly throughout 2 weeks. In the in-vivo experiment with rats, the DDS maintained a high blood concentration level of LPS for 3 days. These results strongly suggest the possibility of convenient and reproducible preparation of a chronic hyper-endotoxemia animal model.

Abdomen↗