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Joly-Tonetti N, Legouffe R, Tomezyk A, Gumez C, Gaudin M, Bonnel D, Schaller M. Penetration Profiles of Four Topical Antifungals in Mycotic Human Toenails Quantified by Matrix-Assisted Laser Desorption Ionization-Fourier Transform Ion Cyclotron Resonance Imaging. Infect Dis Ther 2024; 13:1269-1279. [PMID: 38704491 PMCID: PMC11128420 DOI: 10.1007/s40121-024-00978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Onychomycosis is a fungal infection of the nails that can be challenging to treat. Here, matrix-assisted laser desorption ionization-Fourier transform ion cyclotron resonance (MALDI-FTICR) imaging was applied to the quantitative analysis of the penetration profile of the antifungal compound, amorolfine, in human mycotic toenails. The amorolfine profile was compared with those of three other antifungals, ciclopirox, naftifine, and tioconazole. METHODS Antifungal compounds (amorolfine 5% lacquer, ciclopirox 8% lacquer, naftifine 1% solution, and tioconazole 28% solution) were applied to mycotic nails (n = 42). Nail sections were prepared, and MALDI-FTICR analysis was performed on the sections at a spatial resolution of 70 μm to compare the distribution profiles. Based on the minimum inhibitory concentrations of the four test compounds needed to kill 90% (MIC90) of the fungal organism, Trichophyton rubrum, the fold differences between the MIC90 and the antifungal concentrations in the nails (termed the multiplicity of the MIC90) were calculated for each. RESULTS The penetration profiles indicated higher concentrations of amorolfine and ciclopirox in the deeper layers of the nails 3 h after treatment, compared with naftifine and tioconazole. The mean concentrations across the entire nail sections at 3 h were significantly different among the four antifungals: amorolfine, 2.46 mM; ciclopirox, 0.95 mM; naftifine, 0.63 mM; and tioconazole, 1.36 mM (p = 0.016; n = 8 per compound). The median multiplicity of the MIC90 at 3 h was 191-fold for amorolfine, tenfold for ciclopirox, 52-fold for naftifine, and 208-fold for tioconazole. CONCLUSION In this study, MALDI-FTICR was successfully applied to the quantitative analysis of antifungal distribution in human mycotic nails. The findings suggest that amorolfine penetrates deeper layers of the nail and accumulates at concentrations far exceeding the MIC needed to exert antimycotic activity.
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Affiliation(s)
| | - Raphael Legouffe
- Aliri, Parc Eurasanté, 152 Rue du Dr Yersin, 59120, Loos, France
| | - Aurore Tomezyk
- Aliri, Parc Eurasanté, 152 Rue du Dr Yersin, 59120, Loos, France
| | - Clémence Gumez
- Aliri, Parc Eurasanté, 152 Rue du Dr Yersin, 59120, Loos, France
| | - Mathieu Gaudin
- Aliri, Parc Eurasanté, 152 Rue du Dr Yersin, 59120, Loos, France
| | - David Bonnel
- Aliri, Parc Eurasanté, 152 Rue du Dr Yersin, 59120, Loos, France
| | - Martin Schaller
- Department of Dermatology, Eberhard-Karls-University, Liebermeisterstr. 25, 72076, Tübingen, Germany
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Helmy AM. Overview of recent advancements in the iontophoretic drug delivery to various tissues and organs. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chen K, Puri V, Michniak-Kohn B. Iontophoresis to Overcome the Challenge of Nail Permeation: Considerations and Optimizations for Successful Ungual Drug Delivery. AAPS JOURNAL 2021; 23:25. [PMID: 33439400 DOI: 10.1208/s12248-020-00552-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
Iontophoresis is a widely used drug delivery technique that has been used clinically to improve permeation through the skin for drugs and other actives in topical formulations. It is however not commonly used for the treatment of nail diseases despite its potential to improve transungual nail delivery. Instead, treatments for nail diseases are limited to relatively ineffective topical passive permeation techniques, which often result in relapses of nail diseases due to the thickness and hardness of the nail barrier resulting in lower permeation of the actives. Oral systemic antifungal agents that are also used are often associated with various undesirable side effects resulting in low patient compliance. This review article discusses what is currently known about the field of transungual iontophoresis, providing evidence of its efficacy and practicality in delivering drug to the entire surface of the nail for extended treatment periods. It also includes relevant details about the nail structure, the mechanisms of iontophoresis, and the associated in vitro and in vivo studies which have been used to investigate the optimal characteristics for a transungual iontophoretic drug delivery system. Iontophoresis is undoubtedly a promising option to treat nail diseases, and the use of this technique for clinical use will likely improve patient outcomes.Graphical abstract.
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Affiliation(s)
- Kevin Chen
- Ernest Mario School of Pharmacy, Department of Pharmaceutics, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.,Center for Dermal Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Vinam Puri
- Ernest Mario School of Pharmacy, Department of Pharmaceutics, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.,Center for Dermal Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Bozena Michniak-Kohn
- Ernest Mario School of Pharmacy, Department of Pharmaceutics, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA. .,Center for Dermal Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA. .,Life Sciences Building, Rutgers, The State University of New Jersey, 145, Bevier Road, Piscataway, New Jersey, 08854, USA.
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Endringer Pinto F, Bagger C, Kunze G, Joly-Tonetti N, Thénot JP, Osman-Ponchet H, Janfelt C. Visualisation of penetration of topical antifungal drug substances through mycosis-infected nails by matrix-assisted laser desorption ionisation mass spectrometry imaging. Mycoses 2020; 63:869-875. [PMID: 32406142 DOI: 10.1111/myc.13103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Matrix-assisted laser desorption ionisation mass spectrometry imaging (MALDI-MSI) is a mass spectrometry-based technique, which can be applied for compound-specific imaging of pharmaceuticals in tissues samples. MALDI-MSI technology is widely used to visualise penetration and distribution profile through different tissues but has never been used with nail tissue. OBJECTIVES This study used MALDI-MSI technology to visualise distribution profile and penetration into ex vivo human mycosis-infected toenails of three antifungal active ingredients amorolfine, ciclopirox and naftifine contained in topical onychomycosis nail treatment preparations, marketed as Loceryl® , Ciclopoli® and Exoderil® . METHODS Three mycosis-infected toenails were used for each treatment condition. Six and twenty-four hours after one single topical application of antifungal drugs, excess of formulation was removed, nails were cryo-sectioned at a thickness of 20 μm, and MALDI matrix was deposited on each nail slice. Penetration and distribution profile of amorolfine, ciclopirox and naftifine in the nails were analysed by MALDI-MSI. RESULTS All antifungal actives have been visualised in the nail by MALDI-MSI. Ciclopirox and naftifine molecules showed a highly localised distribution in the uppermost layer of the nail plate. In comparison, amorolfine diffuses through the nail plate to the deep layers already 6 hours after application and keeps diffusing towards the lowest nail layers within 24 hours. CONCLUSIONS This study shows for the first-time distribution and penetration of certain antifungal actives into human nails using MALDI-MSI analysis. The results showed a more homogeneous distribution of amorolfine to nail and a better penetration through the infected nails than ciclopirox and naftifine.
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Affiliation(s)
- Fernanda Endringer Pinto
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Bagger
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Christian Janfelt
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Vanstone S, Stone JM, Gordeev SN, Guy RH. Mechanism of human nail poration by high-repetition-rate, femtosecond laser ablation. Drug Deliv Transl Res 2020; 9:956-967. [PMID: 31016477 PMCID: PMC6731198 DOI: 10.1007/s13346-019-00638-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Optical poration, or drilling, of the human nail has the potential to drastically improve transungual drug delivery. However, this approach is accompanied by thermal damage to the nail tissue surrounding the laser radiation-created pore. In this paper, fluorescence microscopy has been employed to quantitatively evaluate thermal damage to the nail induced by laser ablation with 80 MHz, nanojoule, femtosecond pulses delivered via a hollow-core fibre. An empirical relation has been established between the intensity of the resulting fluorescence signal and temperature to which the nail was exposed. Using this relationship, detailed temperature maps have been created of the areas surrounding the pores, enabling the mechanism of poration to be better understood. It was deduced that plasma-mediated ablation is primarily responsible for nail tissue ablation at the centre of the pore, while cumulative photothermal processes dominate at the pore edges. It is concluded, furthermore, that temperature mapping represents a useful new tool with which to optimise the process of nail poration. The method is potentially generic and may be applicable to other biological materials.
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Affiliation(s)
- Simon Vanstone
- Department of Physics, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - James M Stone
- Department of Physics, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Sergey N Gordeev
- Department of Physics, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Centre for Nanoscience & Nanotechnology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Richard H Guy
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK. .,Centre for Nanoscience & Nanotechnology, University of Bath, Claverton Down, Bath, BA2 7AY, UK. .,Centre for Therapeutic Innovation and Centre for Biosensors, Bioelectronics & Biodevices, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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Cutrín Gómez E, Anguiano Igea S, Delgado-Charro MB, Gómez Amoza JL, Otero Espinar FJ. Microstructural alterations in the onychomycotic and psoriatic nail: Relevance in drug delivery. Eur J Pharm Biopharm 2018; 128:48-56. [PMID: 29673870 DOI: 10.1016/j.ejpb.2018.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/03/2018] [Accepted: 04/15/2018] [Indexed: 11/17/2022]
Abstract
Despite the important nail alterations caused by onychomycosis and psoriasis few studies have characterized the microstructure of the diseased nail plate and the diffusion and penetration of drugs through this altered structure. This work aimed to characterize the microstructure of the healthy, onychomycotic and psoriatic human nail using Raman spectroscopy, scanning electron microscopy, optical microscope profilometry and mercury intrusion porosimetry followed by analysis of the structure with PoreCor® software. The results showed that onychomycotic nails have higher porosity and lower amounts of disulphide bonds compared to healthy nails. This suggests that the presence and action of fungi on the nail plate makes this structure more permeable to water and drugs. Psoriatic nails had increased porosity compared to healthy nails but lower than fungal infected specimens. In vitro permeation studies showed that diseased nails were more permeable to ciclopirox (onychomycosis) and clobetasol (psoriasis) although drug permeation was highly variable and likely to be influenced by the degree of alteration of the nail structure. On the whole, this work provides new and valuable information about the microstructure and porosity of diseased nails and a plausible explanation of the increased drug permeability observed in this work and elsewhere.
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Affiliation(s)
- Elena Cutrín Gómez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
| | - Soledad Anguiano Igea
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
| | | | - José Luis Gómez Amoza
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
| | - Francisco J Otero Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
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Flores FC, Chiu WS, Beck RC, da Silva CB, Delgado-Charro MB. Enhancement of tioconazole ungual delivery: Combining nanocapsule formulation and nail poration approaches. Int J Pharm 2018; 535:237-244. [DOI: 10.1016/j.ijpharm.2017.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
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Thatai P, Sapra B. Structural and component mining of nails using bioengineering techniques. Int J Cosmet Sci 2016; 39:225-240. [PMID: 27709625 DOI: 10.1111/ics.12371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/01/2016] [Indexed: 11/29/2022]
Abstract
The human nail is one of the challenging membranes for the scientists to target and to improve the clinical efficacy of ungual formulations. The understanding of nail physiology, impact of hydration on its properties and presence of trace elements in nails as biomarkers has been explored by various researchers in clinical studies. Despite the importance of biophysical techniques for the assessment of structure and physiology of nail, minimum literature analyses biophysical, biochemical and bioanalytical approaches. However, nowadays scientists in bioengineering field are keen in developing non-invasive, reliable and reproducible techniques for the assessment of different anatomical and functional parameters of nails for testing of ungual products.
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Affiliation(s)
- P Thatai
- Pharmaceutics Division, Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
| | - B Sapra
- Pharmaceutics Division, Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
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9
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Kushwaha A, Shivakumar HN, Murthy SN. Iontophoresis for drug delivery into the nail apparatus: exploring hyponychium as the site of delivery. Drug Dev Ind Pharm 2016; 42:1678-82. [PMID: 26981643 DOI: 10.3109/03639045.2016.1165690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In present studies, a hyponychium pathway (from ventral side of the nail plate) was investigated as a potential route of drug delivery into the nail apparatus using iontophoresis as an active physical method. In vitro transport studies were performed across the human nail plate using sodium fluorescein as a marker substrate for 24 h. After transport studies, the amount of sodium fluorescein extracted from an active diffusion area of the nail plate in case of iontophoresis was found to be ∼54-folds more to that of passive. The amount of sodium fluorescein retained in the peripheral area of the nail plate after application of iontophoresis was found to be ∼30-folds more relative to passive. Ex vivo transport studies were performed on excised human cadaver toe using terbinafine hydrochloride as a model drug for three days (8 h/day). The amount of terbinafine retained in the nail plate after application of iontophoresis (3.43 ± 1.34 µg/mg) was ∼20-folds more when compared with passive (0.17 ± 0.10 µg/mg). The amount of drug extracted from the nail bed and nail matrix was 1.73 ± 0.12 µg/mg and 0.55 ± 0.22 µg/mg, respectively. On the other hand, there was no detectable amount of terbinafine found in the nail bed and nail matrix in case of control (passive delivery). These studies show that the iontophoretic drug delivery through hyponychium region to other parts of the nail apparatus could be a potential way of onychomycosis treatment.
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Affiliation(s)
- Avadhesh Kushwaha
- a Department of Pharmaceutics and Drug Delivery , University of Mississippi, University , MS , USA
| | - H N Shivakumar
- b Institute for Drug Delivery and Biomedical Research , Bangalore , India
| | - S Narasimha Murthy
- a Department of Pharmaceutics and Drug Delivery , University of Mississippi, University , MS , USA ;,b Institute for Drug Delivery and Biomedical Research , Bangalore , India
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Chiu WS, Belsey NA, Garrett NL, Moger J, Price GJ, Delgado-Charro MB, Guy RH. Drug delivery into microneedle-porated nails from nanoparticle reservoirs. J Control Release 2015; 220:98-106. [DOI: 10.1016/j.jconrel.2015.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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12
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Cinotti E, Fouilloux B, Perrot JL, Labeille B, Douchet C, Cambazard F. Confocal microscopy for healthy and pathological nail. J Eur Acad Dermatol Venereol 2013; 28:853-8. [DOI: 10.1111/jdv.12330] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- E. Cinotti
- Dermatology Department; University Hospital of Saint-Etienne; Saint-Etienne France
| | - B. Fouilloux
- Dermatology Department; University Hospital of Saint-Etienne; Saint-Etienne France
| | - J. L. Perrot
- Dermatology Department; University Hospital of Saint-Etienne; Saint-Etienne France
| | - B. Labeille
- Dermatology Department; University Hospital of Saint-Etienne; Saint-Etienne France
| | - C. Douchet
- Pathology Department; University Hospital of Saint-Etienne; Saint-Etienne France
| | - F. Cambazard
- Dermatology Department; University Hospital of Saint-Etienne; Saint-Etienne France
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