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Salústio P, Amaral M, Costa P. Different Carriers for Use in Dry Powder Inhalers: Characteristics of Their Particles. J Aerosol Med Pulm Drug Deliv 2024; 37:307-327. [PMID: 39120712 PMCID: PMC11669763 DOI: 10.1089/jamp.2023.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
In contemporary times, there has been a rise in the utilization of dry powder inhalers (DPIs) in the management of pulmonary and systemic diseases. These devices underwent a swift advancement in terms of both the equipment utilized and the formulation process. In this review, the carrier physicochemical characteristics that influence DPI performance are discussed, focusing its shape, morphology, size distribution, texture, aerodynamic diameter, density, moisture, adhesive and detachment forces between particles, fine carrier particles, and dry powder aerosolization. To promote the deposition of the active principal ingredient deep within the pulmonary system, advancements have been made in enhancing these factors and surface properties through the application of novel technologies that encompass particle engineering. So far, the most used carrier is lactose showing some advantages and disadvantages, but other substances and systems are being studied with the intention of replacing it. The final objective of this review is to analyze the physicochemical and mechanical characteristics of the different carriers or new delivery systems used in DPI formulations, whether already on the market or still under investigation.
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Affiliation(s)
- P.J. Salústio
- Research Institute for Medicines (iMed.UL), Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - M.H. Amaral
- UCIBIO-Applied Molecular Biosciences Unit, MedTech-Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - P.C. Costa
- UCIBIO-Applied Molecular Biosciences Unit, MedTech-Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Alizadeh H, Khoshhal P, Mirmoeini MS, Gilani K. Evaluating the effect of sodium alginate and sodium carboxymethylcellulose on pulmonary delivery of levofloxacin spray-dried microparticles. Daru 2024; 32:557-571. [PMID: 38955893 PMCID: PMC11554959 DOI: 10.1007/s40199-024-00526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Patients with cystic fibrosis commonly suffer from lung infections caused by Pseudomonas aeruginosa. Recently, the Levofloxacin (LVF) nebulizing solution (Quinsair®) has been prescribed for the antimicrobial management. The sustained-release (SR) dry powder formulation of LVF is a convenient alternative to Quinsair®. It has the potential to enhance patient convenience and decrease the likelihood of drug resistance over time. OBJECTIVE In this paper, we set forth to formulate and evaluate the potential application of sodium alginate (SA) and sodium carboxymethylcellulose (SCMC) for sustained pulmonary delivery of LVF. METHODS The spray-dried (SD) LVF microparticles were formulated using SCMC and SA along with L-leucine (Leu). The microparticles were analyzed in terms of particle size, morphology, x-ray diffraction (XRD), in-vitro drug release, and aerodynamic properties. Selected formulations were further proceeded to short-term stability test. RESULTS The polymer-containing samples displayed process yield of 33.31%-39.67%, mean entrapment efficiency of 89% and volume size within the range of 2-5 μm. All the hydrogel microparticles were amorphous and exhibited rounded morphology with surface indentations. Formulations with a drug-to-excipient ratio of 50:50 and higher, showed a 24-h SR. The aerodynamic parameters were fine particle fraction and emitted dose percentage ranging between 46.21%-60.6% and 66.67%-87.75%, respectively. The short-term stability test revealed that the formulation with a 50:50 drug-to-excipient ratio, containing SA, demonstrated better physical stability. CONCLUSION The selected formulation containing SA has the potential to extend the release duration. However, further enhancements are required to optimize its performance.
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Affiliation(s)
- Hanieh Alizadeh
- Aerosol Research Laboratory, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Khoshhal
- Aerosol Research Laboratory, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sadat Mirmoeini
- Aerosol Research Laboratory, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Gilani
- Aerosol Research Laboratory, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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3
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Islam N, Suwandecha T, Srichana T. Dry powder inhaler design and particle technology in enhancing Pulmonary drug deposition: challenges and future strategies. Daru 2024; 32:761-779. [PMID: 38861247 PMCID: PMC11555000 DOI: 10.1007/s40199-024-00520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/27/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES The efficient delivery of drugs from dry powder inhaler (DPI) formulations is associated with the complex interaction between the device design, drug formulations, and patient's inspiratory forces. Several challenges such as limited emitted dose of drugs from the formulation, low and variable deposition of drugs into the deep lungs, are to be resolved for obtaining the efficiency in drug delivery from DPI formulations. The objective of this study is to review the current challenges of inhaled drug delivery technology and find a way to enhance the efficiency of drug delivery from DPIs. METHODS/EVIDENCE ACQUISITION Using appropriate keywords and phrases as search terms, evidence was collected from the published articles following SciFinder, Web of Science, PubMed and Google Scholar databases. RESULTS Successful lung drug delivery from DPIs is very challenging due to the complex anatomy of the lungs and requires an integrated strategy for particle technology, formulation design, device design, and patient inhalation force. New DPIs are still being developed with limited performance and future device design employs computer simulation and engineering technology to overcome the ongoing challenges. Many issues of drug formulation challenges and particle technology are concerning factors associated with drug dispersion from the DPIs into deep lungs. CONCLUSION This review article addressed the appropriate design of DPI devices and drug formulations aligned with the patient's inhalation maneuver for efficient delivery of drugs from DPI formulations.
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Affiliation(s)
- Nazrul Islam
- Pharmacy Discipline, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
- Centre for Immunology and Infection Control (CIIC), Queensland University of Technology, Brisbane, QLD, Australia.
| | - Tan Suwandecha
- Drug and Cosmetic Excellence Center and School of Pharmacy, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand
| | - Teerapol Srichana
- Drug Delivery System Excellence Center and Department of Pharmaceutical Technology, Prince of Songkla University, Hat Yai, Songkla, 90110, Thailand.
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Berkenfeld K, Carneiro S, Corzo C, Laffleur F, Salar-Behzadi S, Winkeljann B, Esfahani G. Formulation strategies, preparation methods, and devices for pulmonary delivery of biologics. Eur J Pharm Biopharm 2024; 204:114530. [PMID: 39393712 DOI: 10.1016/j.ejpb.2024.114530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/13/2024]
Abstract
Biological products, including vaccines, blood components, and recombinant therapeutic proteins, are derived from natural sources such as humans, animals, or microorganisms and are typically produced using advanced biotechnological methods. The success of biologics, particularly monoclonal antibodies, can be attributed to their favorable safety profiles and target specificity. However, their large molecular size presents significant challenges in drug delivery, particularly in overcoming biological barriers. Pulmonary delivery has emerged as a promising route for administering biologics, offering non-invasive delivery with rapid absorption, high systemic bioavailability, and avoidance of first-pass metabolism. This review first details the anatomy and physiological barriers of the respiratory tract and the associated challenges of pulmonary drug delivery (PDD). It further discusses innovations in PDD, the impact of particle size on drug deposition, and the use of secondary particles, such as nanoparticles, to enhance bioavailability and targeting. The review also explains various devices used for PDD, including dry powder inhalers (DPIs) and nebulizers, highlighting their advantages and limitations in delivering biologics. The role of excipients in improving the stability and performance of inhalation products is also addressed. Since dry powders are considered the suitable format for delivering biomolecules, particular emphasis is placed on the excipients used in DPI development. The final section of the article reviews and compares various dry powder manufacturing methods, clarifying their clinical relevance and potential for future applications in the field of inhalable drug formulation.
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Affiliation(s)
- Kai Berkenfeld
- Laboratory of Pharmaceutical Technology and Biopharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Street 3, 53121 Bonn, Germany; Pharmaceutical Engineering and Technology Research Scientists (PETRS)
| | - Simone Carneiro
- Department of Pharmacy, Ludwig-Maximilians-Universität Munich, Butenandtstrasse 5-13, Haus B, 81377 München, Germany; Center for NanoScience (CeNS), Ludwig-Maximilians-Universität München, München 80799, Germany; Pharmaceutical Engineering and Technology Research Scientists (PETRS)
| | - Carolina Corzo
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria; Pharmaceutical Engineering and Technology Research Scientists (PETRS)
| | - Flavia Laffleur
- Department of Pharmaceutical Technology, Institute of Pharmacy, Center for Chemistry and Biomedicine, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; Pharmaceutical Engineering and Technology Research Scientists (PETRS)
| | - Sharareh Salar-Behzadi
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria; Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology, University of Graz, Graz, Austria; Pharmaceutical Engineering and Technology Research Scientists (PETRS)
| | - Benjamin Winkeljann
- Department of Pharmacy, Ludwig-Maximilians-Universität Munich, Butenandtstrasse 5-13, Haus B, 81377 München, Germany; Center for NanoScience (CeNS), Ludwig-Maximilians-Universität München, München 80799, Germany; RNhale GmbH, München 81371, Germany; Comprehensive Pneumology Center Munich (CPC-M), Helmholtz Munich, German Center for Lung Research (DZL), 81377 Munich, Germany; Pharmaceutical Engineering and Technology Research Scientists (PETRS)
| | - Golbarg Esfahani
- Department of Pharmaceutical Technology, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Straße 4, Halle 06120, Saale, Germany; Pharmaceutical Engineering and Technology Research Scientists (PETRS).
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Fatima A, Choudhary MI, Siddiqui S, Zafar H, Hu K, Wahab AT. Insights into the molecular interactions between urease subunit gamma from MRSA and drugs: an integrative approach by STD-NMR and molecular docking studies. RSC Adv 2024; 14:30859-30872. [PMID: 39355333 PMCID: PMC11443414 DOI: 10.1039/d4ra01732c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 09/07/2024] [Indexed: 10/03/2024] Open
Abstract
Staphylococcus aureus, an important human pathogen, is developing resistance against a wide range of antibiotics. The antibiotic resistance in S. aureus has created the need to identify new drug targets, and to develop new drugs candidates. In the current study, urease subunit gamma from Methicillin Resistant Staphylococcus aureus (MRSA 252) was studied as a potential drug target, through protein-ligand interactions. Urease is the main virulence factor of MRSA, it catalyzes the conversion of urea into ammonia that is required for the survival of bacteria during acid stress. Its subunits and accessory proteins can serve as targets for drug discovery and development. Present study describes the cloning, expression, and purification of urease subunit gamma from MRSA 252. This was followed by screening of 100 US-FDA approved drugs against this protein using STD-NMR spectroscopy and among them, 15 drugs showed significant STD effects. In silico studies predicted that these drugs interacted mainly via non-covalent interactions, such as hydrogen bond, aromatic hydrogen bonding, π-π stacking, π-cation interactions, salt bridges, and halogen bonding. The thermal stability of UreA in the presence of these interacting drugs was evaluated using differential scanning fluorimetry (DSF), which revealed a significant effect on the T m of UreA. Additionally, the inhibitory effects of these drugs on urease activity were assessed using a urease inhibition assay with Jack bean urease. The results showed that these drugs possess enzyme inhibitory activity, potentially impacting the survival of S. aureus. These hits need further biochemical and mechanistic studies to validate their therapeutic potential against the MRSA infections.
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Affiliation(s)
- Anum Fatima
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
| | - M Iqbal Choudhary
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
- Department of Biochemistry, Faculty of Science, King Abdulaziz University Jeddah-22254 Saudi Arabia
| | - Shezaib Siddiqui
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
| | - Humaira Zafar
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
| | - Kaifeng Hu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine Chengdu Sichuan-611137 China
| | - Atia-Tul Wahab
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi Karachi-75270 Pakistan
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Jeong JH, Kim JS, Choi YR, Shin DH, Kang JH, Kim DW, Park YS, Park CW. Preparation and Evaluation of Inhalable Microparticles with Improved Aerodynamic Performance and Dispersibility Using L-Leucine and Hot-Melt Extrusion. Pharmaceutics 2024; 16:784. [PMID: 38931905 PMCID: PMC11206964 DOI: 10.3390/pharmaceutics16060784] [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: 05/16/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Dry-powder inhalers (DPIs) are valued for their stability but formulating them is challenging due to powder aggregation and limited flowability, which affects drug delivery and uniformity. In this study, the incorporation of L-leucine (LEU) into hot-melt extrusion (HME) was proposed to enhance dispersibility while simultaneously maintaining the high aerodynamic performance of inhalable microparticles. This study explored using LEU in HME to improve dispersibility and maintain the high aerodynamic performance of inhalable microparticles. Formulations with crystalline itraconazole (ITZ) and LEU were made via co-jet milling and HME followed by jet milling. The LEU ratio varied, comparing solubility, homogenization, and aerodynamic performance enhancements. In HME, ITZ solubility increased, and crystallinity decreased. Higher LEU ratios in HME formulations reduced the contact angle, enhancing mass median aerodynamic diameter (MMAD) size and aerodynamic performance synergistically. Achieving a maximum extra fine particle fraction of 33.68 ± 1.31% enabled stable deep lung delivery. This study shows that HME combined with LEU effectively produces inhalable particles, which is promising for improved drug dispersion and delivery.
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Affiliation(s)
- Jin-Hyuk Jeong
- Department of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea; (J.-H.J.); (J.-S.K.); (Y.-R.C.); (D.H.S.); (J.-H.K.)
| | - Ji-Su Kim
- Department of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea; (J.-H.J.); (J.-S.K.); (Y.-R.C.); (D.H.S.); (J.-H.K.)
| | - Yu-Rim Choi
- Department of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea; (J.-H.J.); (J.-S.K.); (Y.-R.C.); (D.H.S.); (J.-H.K.)
| | - Dae Hwan Shin
- Department of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea; (J.-H.J.); (J.-S.K.); (Y.-R.C.); (D.H.S.); (J.-H.K.)
| | - Ji-Hyun Kang
- Department of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea; (J.-H.J.); (J.-S.K.); (Y.-R.C.); (D.H.S.); (J.-H.K.)
- Institute of New Drug Development and Respiratory Drug Development Research Institute, School of Pharmacy, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Dong-Wook Kim
- College of Pharmacy, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Yun-Sang Park
- Research & Development Center, P2K Bio, Cheongju 28160, Republic of Korea;
| | - Chun-Woong Park
- Department of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea; (J.-H.J.); (J.-S.K.); (Y.-R.C.); (D.H.S.); (J.-H.K.)
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7
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Suhaidi D, Dong YD, Wynne P, Hapgood KP, Morton DAV. Bulk Flow Optimisation of Amorphous Solid Dispersion Excipient Powders through Surface Modification. Pharmaceutics 2023; 15:pharmaceutics15051447. [PMID: 37242689 DOI: 10.3390/pharmaceutics15051447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Particulate amorphous solid dispersions (ASDs) have been recognised for their potential to enhance the performance of various solid dose forms, especially oral bioavailability and macromolecule stability. However, the inherent nature of spray-dried ASDs leads to their surface cohesion/adhesion, including hygroscopicity, which hinders their bulk flow and affects their utility and viability in terms of powder production, processing, and function. This study explores the effectiveness of L-leucine (L-leu) coprocessing in modifying the particle surface of ASD-forming materials. Various contrasting prototype coprocessed ASD excipients from both the food and pharmaceutical industries were examined for their effective coformulation with L-leu. The model/prototype materials included maltodextrin, polyvinylpyrrolidone (PVP K10 and K90), trehalose, gum arabic, and hydroxypropyl methylcellulose (HPMC E5LV and K100M). The spray-drying conditions were set such that the particle size difference was minimised, so that it did not play a substantial role in influencing powder cohesion. Scanning electron microscopy was used to evaluate the morphology of each formulation. A combination of previously reported morphological progression typical of L-leu surface modification and previously unreported physical characteristics was observed. The bulk characteristics of these powders were assessed using a powder rheometer to evaluate their flowability under confined and unconfined stresses, flow rate sensitivities, and compactability. The data showed a general improvement in maltodextrin, PVP K10, trehalose and gum arabic flowability measures as L-leu concentrations increased. In contrast, PVP K90 and HPMC formulations experienced unique challenges that provided insight into the mechanistic behaviour of L-leu. Therefore, this study recommends further investigations into the interplay between L-leu and the physico-chemical properties of coformulated excipients in future amorphous powder design. This also revealed the need to enhance bulk characterisation tools to unpack the multifactorial impact of L-leu surface modification.
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Affiliation(s)
- Danni Suhaidi
- School of Engineering, Deakin University, Waurn Ponds, VIC 3216, Australia
| | - Yao-Da Dong
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Paul Wynne
- Medicines Manufacturing Innovation Centre, Monash University, Clayton, VIC 3168, Australia
| | - Karen P Hapgood
- School of Engineering, Swinburne University, Hawthorn, VIC 3122, Australia
| | - David A V Morton
- School of Engineering, Deakin University, Waurn Ponds, VIC 3216, Australia
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8
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Okur AC, Erni P, Ouali L, Benczedi D, Amstad E. Controlling the crystal structure of succinic acid via microfluidic spray-drying. RSC Adv 2023; 13:7731-7737. [PMID: 36909742 PMCID: PMC9993402 DOI: 10.1039/d2ra06380h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/01/2023] [Indexed: 03/14/2023] Open
Abstract
Many properties of materials, including their dissolution kinetics, hardness, and optical appearance, depend on their structure. Unfortunately, it is often difficult to control the structure of low molecular weight organic compounds that have a high propensity to crystallize if they are formulated from solutions wherein they have a high mobility. This limitation can be overcome by formulating these compounds within small airborne drops that rapidly dry, thereby limiting the time molecules have to arrange into the thermodynamically most stable phase. Such drops can be formed with a surface acoustic wave (SAW)-based spray-drier. In this paper, we demonstrate that the structure of a model low molecular weight compound relevant to applications in pharmacology and food, succinic acid, can be readily controlled with the supersaturation rate. Succinic acid particles preserve the metastable structure over at least 3 months if the initial succinic acid concentration is below 2% of its saturation concentration such that the supersaturation rate is high. We demonstrate that also the stability of the metastable phases against their transformation into the most stable phase increases with decreasing initial solute concentration and hence with increasing supersaturation rate of the spray-dried solution. These insights open up new opportunities to control the crystal structure and therefore properties of low molecular weight compounds that have a high propensity to crystallize.
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Affiliation(s)
- Aysu Ceren Okur
- Soft Materials Laboratory, Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL) Lausanne 1015 Switzerland
| | - Philipp Erni
- Firmenich SA, Corporate R&D Division PO Box 239 CH-1211 Geneva 8 Switzerland
| | - Lahoussine Ouali
- Firmenich SA, Corporate R&D Division PO Box 239 CH-1211 Geneva 8 Switzerland
| | - Daniel Benczedi
- Firmenich SA, Corporate R&D Division PO Box 239 CH-1211 Geneva 8 Switzerland
| | - Esther Amstad
- Soft Materials Laboratory, Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL) Lausanne 1015 Switzerland
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Mahar R, Chakraborty A, Nainwal N. The influence of carrier type, physical characteristics, and blending techniques on the performance of dry powder inhalers. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Manipulation of Spray-Drying Conditions to Develop an Inhalable Ivermectin Dry Powder. Pharmaceutics 2022; 14:pharmaceutics14071432. [PMID: 35890327 PMCID: PMC9325229 DOI: 10.3390/pharmaceutics14071432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 12/24/2022] Open
Abstract
SARS-CoV-2, the causative agent of COVID-19, predominantly affects the respiratory tract. As a consequence, it seems intuitive to develop antiviral agents capable of targeting the virus right on its main anatomical site of replication. Ivermectin, a U.S. FDA-approved anti-parasitic drug, was originally shown to inhibit SARS-CoV-2 replication in vitro, albeit at relatively high concentrations, which is difficult to achieve in the lung. In this study, we tested the spray-drying conditions to develop an inhalable dry powder formulation that could ensure sufficient antiviral drug concentrations, which are difficult to achieve in the lungs based on the oral dosage used in clinical trials. Here, by using ivermectin as a proof-of-concept, we evaluated spray-drying conditions that could lead to the development of antivirals in an inhalable dry powder formulation, which could then be used to ensure sufficient drug concentrations in the lung. Thus, we used ivermectin in proof-of-principle experiments to evaluate our system, including physical characterization and in vitro aerosolization of prepared dry powder. The ivermectin dry powder was prepared with a mini spray-dryer (Buchi B-290), using a 23 factorial design and manipulating spray-drying conditions such as feed concentration (0.2% w/v and 0.8% w/v), inlet temperature (80 °C and 100 °C) and presence/absence of L-leucine (0% and 10%). The prepared dry powder was in the size range of 1−5 μm and amorphous in nature with wrinkle morphology. We observed a higher fine particle fraction (82.5 ± 1.4%) in high feed concentration (0.8% w/v), high inlet temperature (100 °C) and the presence of L-leucine (10% w/w). The stability study conducted for 28 days confirmed that the spray-dried powder was stable at 25 ± 2 °C/<15% RH and 25 ± 2 °C/ 53% RH. Interestingly, the ivermectin dry powder formulation inhibited SARS-CoV-2 replication in vitro with a potency similar to ivermectin solution (EC50 values of 15.8 µM and 14.1 µM, respectively), with a comparable cell toxicity profile in Calu-3 cells. In summary, we were able to manipulate the spray-drying conditions to develop an effective ivermectin inhalable dry powder. Ongoing studies based on this system will allow the development of novel formulations based on single or combinations of drugs that could be used to inhibit SARS-CoV-2 replication in the respiratory tract.
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Preparation and Evaluation of Mucus-Penetrating Inhalable Microparticles of Tiotropium Bromide Containing Sodium Glycocholate. Pharmaceutics 2022; 14:pharmaceutics14071409. [PMID: 35890304 PMCID: PMC9321333 DOI: 10.3390/pharmaceutics14071409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 12/10/2022] Open
Abstract
This study aimed to prepare mucus-penetrating inhalable microparticles for dry powder inhalers and to evaluate their applicability in an asthma-induced rat model. Microparticles were prepared from water solutions containing tiotropium bromide, L-leucine, and sodium glycocholate (NaGc) as permeation enhancers using the spray drying method. Four formulations (SDL1, SDL2, SDL3, and SDL4) were used, depending on the various NaGc concentrations. Tiotropium microparticles were characterized by standard methods. Additionally, an asthma-induced rat model was used to confirm the effects of the formulations on lung function. Tiotropium microparticles with NaGc resulted in formulations with a more corrugated morphology and smaller particle size distribution than those without NaGc. SDL 1 had a rough surface with irregular morphology, and SDL 2, 3, and 4 had a corrugated morphology. All SDL formulations had an aerodynamic size of <3 µm. The microparticles with a corrugated morphology aerosolized better than SDL1 microparticles. The apparent permeability coefficient (Papp) values of SDL3 and SDL4 were significantly higher than those for raw tiotropium. In an in vivo study using an asthma-induced rat model, the specific airway resistance (Sraw), airway wall thickness, and mean alveolus size recovered to those of the negative control group in the SDL4 formulation.
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Spray-dried Pneumococcal Membrane Vesicles are Promising Candidates for Pulmonary Immunization. Int J Pharm 2022; 621:121794. [PMID: 35525468 DOI: 10.1016/j.ijpharm.2022.121794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022]
Abstract
Pneumococcal infections represent a global health threat, which requires novel vaccine developments. Extracellular vesicles are secreted from most cells, including prokaryotes, and harbor virulence factors and antigens. Hence, bacterial membrane vesicles (MVs) may induce a protective immune response. For the first time, we formulate spray-dried gram-positive pneumococcal MVs-loaded vaccine microparticles using lactose/leucine as inert carriers to enhance their stability and delivery for pulmonary immunization. The optimized vaccine microparticles showed a mean particle size of 1-2µm, corrugated surface, and nanocrystalline nature. Their aerodynamic diameter of 2.34µm, average percentage emitted dose of 88.8%, and fine powder fraction 79.7%, demonstrated optimal flow properties for deep alveolar delivery using a next-generation impactor. Furthermore, confocal microscopy confirmed the successful encapsulation of pneumococcal MVs within the prepared microparticles. Human macrophage-like THP-1 cells displayed excellent viability, negligible cytotoxicity, and a rapid uptake around 60% of fluorescently labeled MVs after incubation with vaccine microparticles. Moreover, vaccine microparticles increased the release of pro-inflammatory cytokines tumor necrosis factor and interleukin-6 from primary human peripheral blood mononuclear cells. Vaccine microparticles exhibited excellent properties as promising vaccine candidates for pulmonary immunization and are optimal for further animal testing, scale-up and clinical translation.
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Scherließ R, Bock S, Bungert N, Neustock A, Valentin L. Particle engineering in dry powders for inhalation. Eur J Pharm Sci 2022; 172:106158. [DOI: 10.1016/j.ejps.2022.106158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
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Design and Characterization of Atorvastatin Dry Powder Formulation as a potential Lung Cancer Treatment. Saudi Pharm J 2022; 29:1449-1457. [PMID: 35002383 PMCID: PMC8720807 DOI: 10.1016/j.jsps.2021.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022] Open
Abstract
Lung cancer is the leading cause of cancer death. Many studies have shown the beneficial effects of Atorvastatin in decreasing the mortality risk and improving survival among patients with lung cancer. This research paper focuses on improving AVT cytotoxic activity and cellular uptake by developing mannitol microcarriers as a promising drug delivery system for lung cancer treatment and, studying the impact of improving inhalation deposition on the delivery and Dry Powder formulations efficiency. The AVT loaded mannitol (AM) microparticles (AVT-AM) formulation was prepared by spray drying and characterized for its physicochemical properties and aerodynamic deposition. The results revealed that the AVT-AM formulation has good flow properties and aerosol deposition with a particle size of 3418 nm ± 26.86. The formulation was also assessed in vitro for cytotoxicity effects (proliferation, apoptosis, and cell cycle progression) on A549 human lung adenocarcinoma. Compared with free AVT, the AVT-AM formulation has significantly higher cellular uptake and anti-cancer properties by disrupting cell cycle progression via either apoptosis or cell cycle arrest in the G2/M phase. This study shows that AVT loaded mannitol microcarriers may provide a potentially effective and sustained pulmonary drug delivery for lung cancer treatment.
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Rostamnezhad M, Jafari H, Moradikhah F, Bahrainian S, Faghihi H, Khalvati R, Bafkary R, Vatanara A. Spray Freeze-Drying for inhalation application: Process and Formulation Variables. Pharm Dev Technol 2021; 27:251-267. [PMID: 34935582 DOI: 10.1080/10837450.2021.2021941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
High porous particles with specific aerodynamic properties were processed by the spray freeze-drying (SFD) method. Comprehensive knowledge about all aspects of the SFD method is required for particle engineering of various pharmaceutical products with good flow properties. In this review, different types of the SFD method, the most frequently employed excipients, properties of particles prepared by this method, and most recent approaches concerning SFD are summarized. Generally, this technique can prepare spherical-shaped particles with a highly porous interior structure, responsible for the very low density of powders. Increasing the solubility of spray freeze-dried formulations achieves the desired efficacy. Also, due to the high efficiency of SFD, by determining the different features of this method and optimizing the process by model-based studies, desirable results for various inhaled products can be achieved and significant progress can be made in the field of pulmonary drug delivery.
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Affiliation(s)
- Mostafa Rostamnezhad
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Jafari
- Department of Food and Drug Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Moradikhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Sara Bahrainian
- Aerosol Research Laboratory, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Faghihi
- School of Pharmacy-International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Khalvati
- Food and Drug Administration, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Reza Bafkary
- Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alireza Vatanara
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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16
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Pramanik S, Mohanto S, Manne R, Rajendran RR, Deepak A, Edapully SJ, Patil T, Katari O. Nanoparticle-Based Drug Delivery System: The Magic Bullet for the Treatment of Chronic Pulmonary Diseases. Mol Pharm 2021; 18:3671-3718. [PMID: 34491754 DOI: 10.1021/acs.molpharmaceut.1c00491] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic pulmonary diseases encompass different persistent and lethal diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), asthma, and lung cancers that affect millions of people globally. Traditional pharmacotherapeutic treatment approaches (i.e., bronchodilators, corticosteroids, chemotherapeutics, peptide-based agents, etc.) are not satisfactory to cure or impede diseases. With the advent of nanotechnology, drug delivery to an intended site is still difficult, but the nanoparticle's physicochemical properties can accomplish targeted therapeutic delivery. Based on their surface, size, density, and physical-chemical properties, nanoparticles have demonstrated enhanced pharmacokinetics of actives, achieving the spotlight in the drug delivery research field. In this review, the authors have highlighted different nanoparticle-based therapeutic delivery approaches to treat chronic pulmonary diseases along with the preparation techniques. The authors have remarked the nanosuspension delivery via nebulization and dry powder carrier is further effective in the lung delivery system since the particles released from these systems are innumerable to composite nanoparticles. The authors have also outlined the inhaled particle's toxicity, patented nanoparticle-based pulmonary formulations, and commercial pulmonary drug delivery devices (PDD) in other sections. Recently advanced formulations employing nanoparticles as therapeutic carriers for the efficient treatment of chronic pulmonary diseases are also canvassed.
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Affiliation(s)
- Sheersha Pramanik
- Department of Pharmacy, Institute of Pharmacy Jalpaiguri, Netaji Subhas Chandra Bose Road, Hospital Para, Jalpaiguri, West Bengal 735101, India.,Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu 600036, India
| | - Sourav Mohanto
- Department of Pharmaceutics, Himalayan Pharmacy Institute, Majhitar, East Sikkim 737176, India.,Department of Pharmaceutics, Yenepoya Pharmacy College and Research Centre, Yenepoya, Mangalore, Karnataka 575018, India
| | - Ravi Manne
- Quality Control and Assurance Department, Chemtex Environmental Lab, 3082 25th Street, Port Arthur, Texas 77642, United States
| | - Rahul R Rajendran
- Department of Mechanical Engineering and Mechanics, Lehigh University, 19 Memorial Drive West, Bethlehem, Pennsylvania 18015, United States
| | - A Deepak
- Saveetha Institute of Medical and Technical Sciences, Saveetha School of Engineering, Chennai, Tamil Nadu 600128, India
| | - Sijo Joy Edapully
- School of Biotechnology, National Institute of Technology Calicut, NIT campus, Kozhikode, Kerala 673601, India.,Corporate Head Office, HLL Lifecare Limited, Poojappura, Thiruvananthapuram, Kerala 695012, India
| | - Triveni Patil
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University, Poona College of Pharmacy, Erandwane, Pune, Maharashtra 411038, India
| | - Oly Katari
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Guwahati, Assam 781101, India
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Effect of Lipidic Excipients on the Particle Properties and Aerosol Performance of High Drug Load Spray Dried Particles for Inhalation. J Pharm Sci 2021; 111:1152-1163. [PMID: 34506865 DOI: 10.1016/j.xphs.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
High drug load inhalable particles were prepared by co-spray drying a hydrophobic, crystalline, small molecule drug with various lipid or phospholipid excipients at a 9:1 molar ratio to understand the primary drivers of aerosol performance. The effect of excipient structure on solid-state, surface characteristics, and aerodynamic performance of the co-spray dried particles was studied while keeping the spray drying parameters constant. Spray drying of the drug with lipids produced crystalline drug particles, whereas phospholipids produced partially amorphous drug particles. All of the co-spray dried particles were nearly spherical with a smooth surface, except for the spray dried drug particles without excipients - which showed the presence of rough crystals on the surface. All co-spray dried particles showed surface enrichment of the excipient. The surface enrichment of the phospholipids was higher compared to the lipids. Co-spray dried particles that showed higher surface enrichment of excipients showed improved aerosol performance. In comparing all the excipients studied, distearyolphosphatidylcholine (DSPC) showed maximum enrichment on the particle surface and thereby significantly improved aerosol performance. This study demonstrated that the addition of small amounts of lipid excipients during spray drying can change surface morphology, composition, and cohesion, impacting aerosol performance of drugs.
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Alhajj N, O'Reilly NJ, Cathcart H. Leucine as an excipient in spray dried powder for inhalation. Drug Discov Today 2021; 26:2384-2396. [PMID: 33872799 DOI: 10.1016/j.drudis.2021.04.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
Leucine is a promising excipient with several applications in the development of inhalable spray-dried powder of high- and low-dose drugs. The addition of leucine has exhibited significant enhancing effects on the aerosolization and physical stability of the produced particles. Here, we focus not only on the applications of leucine in inhalable spray-drying powders, but also on the underlying mechanisms by which the formulation and processing parameters dictate the behavior of leucine during the drying process and, therefore, its functionalities within the dried powder. Additionally, we highlight the current regulatory status of leucine. Such insights are important for more efficient utilization of leucine in the future, both for dry powder inhaler formulations and other pharmaceutical applications.
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Affiliation(s)
- Nasser Alhajj
- Pharmaceutical and Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford, Ireland.
| | - Niall J O'Reilly
- Pharmaceutical and Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford, Ireland; SSPC - The Science Foundation Ireland Research Centre for Pharmaceuticals, Ireland
| | - Helen Cathcart
- Pharmaceutical and Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford, Ireland
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Rashid MA, Muneer S, Wang T, Alhamhoom Y, Rintoul L, Izake EL, Islam N. Puerarin dry powder inhaler formulations for pulmonary delivery: Development and characterization. PLoS One 2021; 16:e0249683. [PMID: 33848310 PMCID: PMC8043385 DOI: 10.1371/journal.pone.0249683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims at developing and characterizing the puerarin dry powder inhaler (DPI) formulations for pulmonary delivery. The inhalable particles size (<2 μm) was accomplished by micronization and its morphology was examined by scanning electron microscopy (SEM). The puerarin-excipient interaction in powder mixtures was analyzed by using Fourier transform infrared spectroscopy (FTIR), Raman confocal microscopy, X-Ray powder Diffraction (XRD), and differential scanning calorimetry (DSC) methods. Using a Twin stage impinger (TSI), the in-vitro aerosolization of the powder formulations was carried out at a flow rate of 60 L/min and the drug was quantified by employing a validated HPLC method. No significant interactions between the drug and the excipients were observed in the powder formulations. The fine particle fraction (FPF) of the drug alone was 4.2% which has increased five to six-fold for the formulations with aerosolization enhancers. Formulation containing lactose as large carriers produced 32.7% FPF, which further increased with the addition of dispersibility enhancers, leucine and magnesium stearate (40.8% and 41.2%, respectively). The Raman and FTIR techniques are very useful tool for understanding structural integrity and stability of the puerarin in the powder formulations. The puerarin was found to be compatible with the excipients used and the developed DPI formulation may be considered as an efficient formulation for pulmonary delivery for the management of various diseases at a very low dose.
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Affiliation(s)
- Md Abdur Rashid
- Department of Pharmaceutics, School of Pharmacy, King Khalid University, Guraiger, Abha, Kingdom of Saudi Arabia
- * E-mail: (NI); (MAR)
| | - Saiqa Muneer
- School of Chemistry and Physics, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Chemistry and Molecular Biosciences, Faculty of Science, University of Queensland, Brisbane, Australia
| | - Tony Wang
- Central Analytical Research Facility, Institution for Future Environment, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yahya Alhamhoom
- Department of Pharmaceutics, School of Pharmacy, King Khalid University, Guraiger, Abha, Kingdom of Saudi Arabia
| | - Llew Rintoul
- Central Analytical Research Facility, Institution for Future Environment, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Emad L. Izake
- School of Chemistry and Physics, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nazrul Islam
- Queensland University of Technology, Pharmacy Discipline, School of Clinical Sciences, Faculty of Health, Brisbane, Queensland, Australia
- Tier 2 Research Centre, Centre for Immunology and Infection, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail: (NI); (MAR)
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20
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Jouyban A, Farajzadeh MA, Khoubnasabjafari M, Jouyban-Gharamaleki V, Afshar Mogaddam MR. Derivatization and deep eutectic solvent-based air-assisted liquid-liquid microextraction of salbutamol in exhaled breath condensate samples followed by gas chromatography-mass spectrometry. J Pharm Biomed Anal 2020; 191:113572. [PMID: 32891041 DOI: 10.1016/j.jpba.2020.113572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
A microwave-induced air-assisted liquid-liquid microextraction method has been proposed for the pretreatment/quantization of salbutamol in exhaled breath condensate (EBC) samples prior to gas chromatography-mass spectrometry. In this procedure, 1-fluoro-2,4-dinitrobenzene and N,N-diethylethanolammonium chloride: dichloroacetic acid: octanoic acid deep eutectic solvent were exploited as derivatization reagent and extraction solvent, respectively. A mixture of the sample solution and pyridine was transferred into a test tube. Then, a mixture of extraction solvent and derivatization agent was placed at the bottom of the tube. After performing the predetermined extraction cycles in the microextraction method, the mixture was exposed to microwave irradiations to enhance derivatization and extraction efficiencies. The obtained turbid solution was centrifuged and a portion of the sedimented phase was used for quantification of salbutamol. The validated method showed low limits of detection (0.074 and 0.370 μg/L in deionized water and EBC, respectively), quantification (0.246 in deionized water and 1.23 μg/L in EBC), and lower limit of quantification (0.123 and 0.615 μg/L in deionized water and EBC, respectively). The method had appropriate repeatability, accuracy, and stability (expressed as relative standard deviation less than 9%). The developed method was used in quantification of salbutamol in the real samples collected from donors receiving salbutamol spray.
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Affiliation(s)
- Abolghasem Jouyban
- Food and Drug Safety Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mir Ali Farajzadeh
- Department of Analytical Chemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran; Engineering Faculty, Near East University, 99138 Nicosia, North Cyprus, Mersin 10, Turkey
| | - Maryam Khoubnasabjafari
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Jouyban-Gharamaleki
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Afshar Mogaddam
- Food and Drug Safety Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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