Polymer Characteristics for Drug Layering on Particles Using a Novel Melt Granulation Technology, MALCORE®

MALCORE®, a novel manufacturing technology for drug-containing particles (DCPs), relies on the melt granulation method to produce spherical particles with high drug content. The crucial aspect of particle preparation through MALCORE® involves utilizing polymers that dissolve in the melt component, thereby enhancing viscosity upon heating. However, only aminoalkyl methacrylate copolymer E (AMCE) has been previously utilized. Therefore, this study aims to discover other polymers and comprehend the essential properties these polymers need to possess. The results showed that polyvinylpyrrolidone (PVP) was soluble in the stearic acid (SA) melt component. FTIR examination revealed no interaction between SA and polymer. The phase diagram was used to analyze the state of the SA and polymer mixture during heating. It revealed the mixing ratio and temperature range where the mixture remained in a liquid state. The viscosity of the mixture depended on the quantity and molecular weight of the polymer dissolved in SA. Furthermore, the DCPs prepared using PVP via MALCORE® exhibited similar pharmaceutical properties to those prepared with AMCE. In conclusion, understanding the properties required for polymers in the melt granulation process of MALCORE® allows for the optimization of manufacturing conditions, such as temperature and mixing ratios, for efficient and consistent drug layering.

Impact of Properties of Hydrated Silicon Dioxide as Core Material on the Characteristics of Drug-containing Particles Prepared by the 2-step Process Melt Granulation Technology, MALCORE®

Drug-containing particles (DCPs) are frequently used as cores in the development of solid oral dosage forms. The wet layering technique, which is a typical approach for preparing DCPs, requires the use of solvents and a long manufacturing time. In our previous study, we developed a novel manufacturing technology, MALCORE^®, which can solve these problems through melt granulation. However, particle size control methods for DCPs in MALCORE^® and the effect of the physical properties of the hydrated silicon dioxide (HSD) used for the core have not been clarified. The aim of this study was to examine the effects of the particle and pore sizes of HSD on the properties of the prepared DCPs. The results showed that the DCPs prepared using MALCORE^® could be controlled by the particle size of HSD. The drug-loading efficiency tended to decrease as HSD particle size increased. Additionally, the amount of drug layering in DCPs increased as the pore size of HSD increased, but HSDs with a pore size much larger than the particle size were not able to properly layer the drug. These findings are helpful for applying MALCORE^® to a variety of oral drug formulations.

Impact of lipoprotein(a) levels on angiographic severity of femoropopliteal lesions

Background

High lipoprotein(a) [Lp(a)] levels are a risk factor for peripheral artery disease (PAD). However, the association between Lp(a) levels and angiographic severity of PAD has not been systematically studied.

Purpose

The aim of this study was to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal lesions in patients with PAD.

Methods

We retrospectively analyzed a single-center database including 108 patients (74±8 years, 69% male) who underwent endovascular therapy for de novo femoropopliteal lesions and measured Lp(a) levels before therapy between June 2016 and September 2019. Patients were divided into low Lp(a) [LP(a) <30 mg/dL; 77 patients] and high Lp(a) [LP(a) ≥30 mg/dL; 31 patients] groups. Trans-Atlantic Inter-Society Consensus (TASC) II classification, calcification [referring to peripheral arterial calcium scoring system (PACSS) classification] and lesion length were compared between the groups.

Results

Median Lp(a) was 16 (7–31) mg/dL.The prevalence of TASC II class D (13% vs 38%, P<0.01) and severe calcification (PACSS 4) (6% vs 23%, P=0.02) was significantly higher and lesion length was longer (123±88 mm vs 175±102 mm, P<0.01) in the high Lp(a) group than in the low Lp(a) group.(Table and Figure) In multivariate analysis, Lp(a)≥30 was an independent predictor for TASC II class D (HR=3.67, P=0.02) and PACSS 4 (HR=4.97, P=0.02) prevalence.

Conclusion

Lp(a) was associated with angiographic severity of femoropopliteal lesions in patients with PAD.

Comparison of angiographic severity

Funding Acknowledgement

Type of funding source: None

P937Impact of left ventricular diastolic dysfunction on long-term outcome in patients with lower extremity artery disease

Background

Left ventricular (LV) systolic dysfunction and heart failure (HF) in patients with lower extremity artery disease (LEAD) is associated with an increased risk for adverse events. However, relationship between long-term outcome in patient with LEAD and LV diastolic dysfunction remains unclear.

Purpose

The aim of this study was to assess the impact of LV diastolic dysfunction on long-term outcome in patients with LEAD.

Methods

Two hundred patients (male 66%, mean age 76±9 years) with preserved LV systolic function assessed by echocardiography (ejection fraction ≥50%) were enrolled from a single-center database between January 2013 to May 2015. Baseline LEAD was identified by ABI <0.9 or history of lower extremity revascularization. Diagnosis of LV diastolic dysfunction was based on the ASE/EACVI guidelines. The 3-year cumulative incidence of primary endpoint compared between LEAD patients with LV diastolic dysfunction than those without. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke and hospitalization for HF during 3 years follow-up. Multivariate analysis was performed to determine whether LV diastolic dysfunction was independently associated with the primary endpoint.

Results

LV diastolic dysfunction was identified in 31%. The mean observation period was 32±21 months. The primary endpoint occurred more frequently in patients with LV diastolic dysfunction than those without at 3 years (30% vs 16%, P=0.02). There were no significant differences between 2 groups in the myocardial infarction (3% vs 3%, P=0.73) and stroke (3% vs 3%, P=0.55). Cardiovascular death (19% vs 7%, P=0.01) and hospitalization for HF (19% vs 7%, P=0.01) were significantly higher in patients with LV diastolic dysfunction. In multivariate analysis, LV diastolic dysfunction was an independent predictor for primary endpoint (HR=2.28, 95% CI 1.10–4.73, P=0.02) (Table)

Predictor for primary endpoint Factors Univariate model Multivariate model Hazard ratio [95% CI] P value Hazard ratio [95% CI] P value Age 1.03 [0.98–1.08] 0.24 1.03 [0.98–1.08] 0.22 Chronic kidney disease 1.53 [0.77–3.07] 0.23 1.25 [0.60–2.58] 0.55 Coronary artery disease 1.08 [0.53–2.18] 0.84 1.18 [0.56–2.50] 0.65 Cerebrovascular disease 1.93 [0.74–5.02] 0.17 2.28 [0.86–6.05] 0.10 Critical limb ischemia 3.75 [1.68–8.37] <0.01 3.72 [0.56–2.50] <0.01 LV diastolic dysfunction 2.37 [1.18–4.74] 0.02 2.28 [1.10–4.73] 0.03

Conclusions

LV diastolic dysfunction increased the risk for adverse events in patients with LEAD.

Acknowledgement/Funding

None

P4591Impact of extent of non-culprit lesions on one-year outcomes in patients with acute myocardial infarction

Background

Presence of severe stenosis in non-infarct related arteries, i.e. multi-vessel disease (MVD), is associated with poor outcomes after acute myocardial infarction (AMI). However, impact of mild to moderate stenosis in non-culprit lesions remains unclear.Gensini score is an angiographic application grading the extent of coronary artery lesions including mild to moderate stenosis.

Purpose

To evaluate whether the extent of non-culprit lesion is related to one-year outcomes after AMI.

Methods

This study consisted of consecutive 168 patients who underwent primary percutaneous coronary intervention (PPCI) for AMI between 2015 and 2017. Patients with coronary bypass grafts were excluded from the analysis. To assess the extent of non-culprit lesions, we used “non-culprit Gensini score”, which is calculated by excluding score of the culprit lesion from the original Gensini score. Patients were divided into 2 groups by the median ofnon-culprit Gensini score: low score (0–14, n=84) and high score (>15, n=84). Major adverse cardiac events (MACE) included all cause of deaths, non-fatal MI, stroke and ischemia driven coronary revascularization during one-year follow-up period.

Results

MVDwas more frequent in patients with high score than those in those with low score (90% vs 25%, P<0.05). Kaplan-Mayer curves of patients with and without MVD are shown in left figure, and curves of patients with low score and those with high score are shown in right figure. Multivariable analysis showed that high score was an independent predictor of one-year MACE (HR 5.28, 95% CI 1.93–14.9, P<0.05), but MVD was not (HR 0.56, 95% CI 0.23–1.54, P=0.25) (Table).

Multivariable analyses Univariable analyses Multivariable analyses HR (95% CI) P-value HR (95% CI) P-value Age 1.03 (1.01, 1.06) <0.05 1.15 (0.99, 1.05) 0.31 eGFR (<45ml/min/1.73m2) 2.95 (1.59, 5.38) <0.05 2.35 (1.26, 4.35) <0.05 Multi-vessel disease 1.84 (1.01, 3.55) <0.05 0.56 (0.23, 1.54) 0.25 Non-culprit-Gensini score (>15) 3.37 (1.79, 6.78) <0.05 5.28 (1.93, 14.9) <0.05 HR = hazard ratio; CI = confidence interval; eGFR = estimated glomerular filtration rate.

Kaplan-Meier curves

Conclusion

These findings suggested that extent of mild to moderate stenosis in non-culprit lesions might affect the prognosis after AMI in patients undergoing PPCI. Non-culprit Gensini score may be useful to predict outcomes of patients with AMI.

Acknowledgement/Funding

None

Solid-state NMR characterization of triacylglycerol and polysaccharides in coffee beans

It is important to understand the structural characteristics of triacylglycerol (TAG), polysaccharides and trace elements in coffee beans, so that residues can be reutilized in applications including biodiesel oils. Here, we performed 1H and 13C solid-state NMR measurements on Indonesian green beans, roasted beans, and spent coffee grounds (SCGs). In the NMR spectra, there were liquid-like TAG containing linoleic acids based on observed signals of -CH=CH-CH2-CH=CH- group in an acyl chain, which play a role in decreasing TAG’s melting point. We found TAG was still abundant in the SCGs from NMR spectra. After lipids were removed from SCGs, the intensity of the TAG signal decreased considerably, with approximately 64% of the TAG was successfully extracted. We described the chemical structure of TAG in coffee beans and demonstrated that it is possible quantify the amount of extracted TAG using solid-state NMR.

Effect of Mold Temperature on Structure and Property Variations of PBT Injection Moldings in the Thickness Direction

During injection molding process, the surface of flowing resin in contact with the mold surface is cooled first followed by the cooling of inner part. This results in the variation of microstructure in moldings through the thickness direction. It has been reported that these phenomena result in the layered structure of injection moldings. Particularly, because of the rapid rate of crystallization, PBT injection moldings have well-defined skin and core layers. The purpose of this study is to investigate the effect of mold temperature on the development of structure and property variations of PBT injection moldings in the thickness direction. Tensile tests were performed using dumbbell specimens that were stamped out from the sliced specimens of moldings. Neck phenomenon occurred irrespective of mold temperature and distance from the surface of moldings. The start point of neck propagation shifted to higher strain with increasing distance from the surface. Tensile modulus increased with increasing distance from the surface. In order to discuss these results from a structural viewpoint, the microstructure of each layer was evaluated by density, wide-angle X-ray diffraction and Fourier transform infrared absorption measurements. The delay in necking start points with increasing distance from the surface is due to the higher crystallinity of the inner layer compared to that of the layer near the surface. Two crystal forms of PBT (α- and β-forms) were developed in injection moldings. The region near the surface, where content of α-form is larger than that of β-form, becomes thinner with increasing mold temperature. It is known that the crystal modulus of α-form is lower than that of β-form. Therefore the portion of moldings with lower tensile modulus and yield strength becomes smaller. It is suggested that the border between the skin and core layers, where tensile property changes, shifts to the surface of PBT injection moldings as mold temperature increases.

National HIV prevalence surveillance among TB patients through periodic surveys: experience in Cambodia

SETTING

The National Tuberculosis Programme (NTP) in Cambodia, one of the countries most affected by tuberculosis (TB) and human immunodeficiency virus (HIV) infection in Asia.

OBJECTIVE

To conduct national HIV prevalence surveillance among TB patients, to estimate HIV prevalence among TB patients and to determine the potential of the NTP as a source for antiretroviral treatment (ART) scale-up.

DESIGN

Anonymous unlinked cross-sectional seroprevalence surveys including all TB patients registered by the NTP in January 2003 and January 2005.

RESULTS

HIV prevalence among all TB patients fell from 11.8% in 2003 to 9.9% in 2005 (P < 0.05). In 2003 and 2005, respectively 265 and 261 TB patients were identified as HIV-positive in a given month. Among new smear-positive pulmonary TB patients, the prevalence dropped from 8.2% to 5.2% (P < 0.01).

CONCLUSION

The two periodic surveys demonstrated a high prevalence of HIV among TB patients in Cambodia. However, the declining incidence of HIV from the late 1990s might now be reflected in the HIV prevalence among new smear-positive TB patients. The NTP is a potential source of ART if HIV counselling and testing are made more widely available to TB patients.

Method for efficient storage and transportation of sputum specimens for molecular testing of tuberculosis

SETTING

The polymerase chain reaction (PCR) is a highly sensitive method for the detection of Mycobacterium tuberculosis and is available in most countries, though to a lesser extent in rural areas.

OBJECTIVE

To amplify M. tuberculosis DNA sequences of sputum spotted on FTA cards and compare them with the results of microscopic examination among culture-positive samples.

DESIGN

A total of 102 sputum specimens of TB patients in treatment were spotted on FTA cards and stored at room temperature until DNA analysis. We assessed the IS6110 region of M. tuberculosis. The efficacy of the PCR assay for the direct detection of M. tuberculosis was evaluated and compared with the results of cultures (Middlebrook 7H9 broth) and smears of fresh sputum specimens.

RESULTS

We were able to detect 10 fg/microl of mycobacterial DNA even after 6 months in storage. The PCR sensitivity and specificity using the FTA card system were 82% and 96%, while microscopic examination showed 41% and 95%, respectively.

CONCLUSION

The FTA card system for the storage of bacterial DNA from sputum samples should be considered for the molecular diagnosis of tuberculosis. Samples can easily be obtained from geographically isolated populations and shipped by mail for accurate molecular diagnosis.

Inactivation of human viruses by povidone-iodine in comparison with other antiseptics

Inactivation of a range of viruses, such as adeno-, mumps, rota-, polio- (types 1 and 3), coxsackie-, rhino-, herpes simplex, rubella, measles, influenza and human immunodeficiency viruses, by povidone-iodine (PVP-I) and other commercially available antiseptics in Japan was studied in accordance with the standardized protocol in vitro. In these experiments, antiseptics such as PVP-I solution, PVP-I gargle, PVP-I cream, chlorhexidine gluconate, alkyldiaminoethyl-glycine hydrochloride, benzalkonium chloride (BAC) and benzethonium chloride (BEC) were used. PVP-I was effective against all the virus species tested. PVP-I drug products, which were examined in these experiments, inactivated all the viruses within a short period of time. Rubella, measles, mumps viruses and HIV were sensitive to all of the antiseptics, and rotavirus was inactivated by BAC and BEC, while adeno-, polio- and rhinoviruses did not respond to the other antiseptics. PVP-I had a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics.

Early diagnosis of vertical HIV infection in infants by rapid detection of immune complex-dissociated HIV p24 antigen

Conventional HIV antibody detection was problematic for diagnosis of HIV infection in young infants < 18 months of age who were born to HIV-infected mothers. The HIV p24 antigen (Ag) is mainly bound to the antibody as an immune complex which causes underdetection by conventional methods. Attempts were made to dissociate these immune complexes to release free p24 Ag for detection. The current study's objective was to evaluate the rapid assays for detection of immune complex-dissociated p24 Ag (ICD p24 Ag) for early identification of HIV-infected infants as compared to the detection of HIV RNA by polymerase chain reaction (PCR) assay. The ICD was performed by acid dissociation and heat-denatured dissociation, and then the released ICD p24 Ag were detected. Tested were 41 HIV-infected children who acquired the infection perinatally and who had positive PCR and 30 HIV noninfected children with negative PCR. The overall sensitivity of the ICD p24 Ag detection after acid- and heat-denatured dissociation in the infected children was 85.4% and 87.8%, respectively, compared to 34.2% of p24 Ag without pretreatment for dissociation of the serum samples. The specificity of nonimmune complex dissociation and both methods of immune complex dissociation test were 100%. The sensitivity of ICD-p24 Ag test using these two methods showed excellent agreement (K = 0.893). Besides the relatively high sensitivity and specificity of the ICD p24 Ag test, its advantages include simplicity, rapidity, and relatively low cost--indicating ICD p24 Ag detection as a promising method for early diagnosis of vertical HIV infection in infants.