Functions of the human mononuclear phagocyte system (a condensed review)

Pharmacokinetics of PEGasparaginase in Infants with Acute Lymphoblastic Leukemia

BACKGROUND

PEGasparaginase is known to be a critical drug for treating pediatric acute lymphoblastic leukemia (ALL), however, there is insufficient evidence to determine the optimal dose for infants who are less than one year of age at diagnosis. This international study was conducted to identify the pharmacokinetics of PEGasparaginase in infants with newly diagnosed ALL and gather insight into the clearance and dosing of this population.

METHODS

Infants with ALL who received treatment with PEGasparaginase were included in our population pharmacokinetic assessment employing non-linear mixed effects modelling (NONMEM).

RESULTS

68 infants with ALL, with a total of 388 asparaginase activity samples, were included. PEGasparaginase doses ranging from 400 to 3,663 IU/m2 were administered either intravenously or intramuscularly. A one-compartment model with time-dependent clearance, modeled using a transit model, provided the best fit to the data. Body weight was significantly correlated with clearance and volume of distribution. The final model estimated a half-life of 11.7 days just after administration, which decreased to 1.8 days 14 days after administration. Clearance was 19.5% lower during the post-induction treatment phase compared to induction.

CONCLUSION

The pharmacokinetics of PEGasparaginase in infants diagnosed under one year of age with ALL is comparable to that of older children (1-18 years). We recommend a PEGasparaginase dosing at 1,500 IU/m2 for infants without dose adaptations according to age, and implementing therapeutic drug monitoring as standard practice.

Individualized dosing guidelines for PEGasparaginase and factors influencing the clearance: a population pharmacokinetic model

Considerable inter- and intra-patient variability exist in serum activity levels of PEGasparaginase, essential for pediatric acute lymphoblastic leukemia treatment. A population pharmacokinetic (popPK) model was developed, identifying patient characteristics explaining these variabilities. Patients (n=92) were treated according to the DCOG ALL-11 protocol, using therapeutic drug monitoring to individualize the PEGasparaginase doses. Non-linear mixed effects modeling (NONMEM) was used to analyze the popPK evaluating several covariates. The final model was validated using an independent database (n=28). Guidelines for starting doses and dose adjustments were developed. A one-compartment model with time-dependent clearance adequately described the popPK. Normalization of clearance and volume of distribution by body surface are (BSA) reduced inter-individual variability. Clearance was 0.084 L/day/m2 for 12.7 days, increasing with 0.082 L/day/m2/day thereafter. Clearance was 38% higher during an infection, and 11-19% higher during induction treatment than intensification and maintenance (p<0.001). Targeting an asparaginase activity level of 100 IU/L, a loading dose of 800 IU/m2 (induction) and 600 IU/m2 (intensification) is advised. In conclusion, variability of PEGasparaginase activity levels can be explained by BSA, treatment phase and the occurrence of an infection. With this popPK model, PEGasparaginase treatment can be individualized further, taking into account these covariates and the dosing guidelines provided.

Chemical Modifications of Heparin. II. Hydrophobization of Partially N-Desulfated Heparin

In order to hydrophobize heparin, dodecanal, cholic acid and stearic acid were conjugated, respectively, to partially N-desulfated heparin with the formation of imine bonds in the case of dodecanal and amide bonds in the case of the two latter compounds. It was found that the three conjugates were aggregated in aqueous solution with the formation of-300 nm aggregates. The conjugates retained the anticoagulant activity of the parent heparin according to in vitro tests. In vivo, slightly prolonged activity was observed after s.c. injection. The activity lasted for at least 2 hours after i.v. injection suggesting that aggregates of hydrophobized heparin were not captured by the reticuloendothelial system. These new water dispersed aggregates are of potential interest for the transport and slow release of hydrophobic drugs in blood either as macromolecular prodrugs or after molecular microencapsulation, and for oral administration.

Drug delivery strategies in the therapy of inflammatory bowel disease

Inflammatory bowel disease (IBD) is a frequently occurring disease in young people, which is characterized by a chronic inflammation of the gastrointestinal tract. The therapy of IBD is dominated by the administration of anti-inflammatory and immunosuppressive drugs, which suppress the intestinal inflammatory burden and improve the disease-related symptoms. Established treatment strategies are characterized by a limited therapeutical efficacy and the occurrence of adverse drug reactions. Thus, the development of novel disease-targeted drug delivery strategies is intended for a more effective therapy and demonstrates the potential to address unmet medical needs. This review gives an overview about the established as well as future-oriented drug targeting strategies, including intestine targeting by conventional drug delivery systems (DDS), disease targeted drug delivery by synthetic DDS and disease targeted drug delivery by biological DDS. Furthermore, this review analyses the targeting mechanisms of the respective DDS and discusses the possible field of utilization in IBD.

Non-Michaelis–Menten Type Hepatic Uptake of Liposomes in the Rat

The objective of this study was to verify the methodology for measuring uptake clearance of liposomes and to characterize kinetically the saturable hepatic uptake of liposomes through phagocytosis. The correction of vascular space was important in the evaluationof hepatic uptake. The efflux of liposomes from liver was shown to be negligible, by a repeated dose study, and thus, hepatic clearance can be obtained by the hepatic uptake divided by the area under the blood concentration-time curve (AUC). The determinant parameter which describes the saturability of uptake clearance of liposomes, independent of infusion rate, was investigated, using the data of an in-vivo constant infusion study, where infusion rate-dependent saturable hepatic clearance was observed. The mean blood concentration failed to obtain an infusion rate-independent function. On the other hand, the AUC could explain the saturability of hepatic clearance for every infusion rate by a unique relationship. The hepatic uptake amount could also explain this saturability, independent of infusion rate. These kinetic characteristics are inconsistent with Michaelis–Menten type kinetics, therefore a new model is required to describe the saturable hepatic clearance in the disposition of liposomes.

Stealth Me.PEG-PLA nanoparticles avoid uptake by the mononuclear phagocytes system

Nanoparticles were prepared from methoxy poly(ethylene glycol)poly(d,l-lactic acid) block copolymers (Me.PEG-PLA) or blends of Me.PEG-PLA and PLA by the precipitation-solvent diffusion method. These nanoparticles, labeled by introducing [14C]PLA in the formulation, were shown to be more slowly captured by cultured THP-1 monocytes than F68-coated PLA nanoparticles, in a PEG chain-length-dependent manner. In vivo, the half-life in plasma of the Me.PEG-PLA nanoparticles that were intravenously administered to rats is increased by a factor 180 compared with the F68-coated PLA nanoparticles. This mononuclear phagocytes system avoidance was explained according to a conformation model in which the PEG density at the surface of the particles is a key parameter.

Kinetic analysis of AUC-dependent saturable clearance of liposomes: mathematical description of AUC dependency

The objective of this study was to examine the AUC dependency of saturable hepatic clearance (CLh) of liposomes and to postulate a mathematical model to describe the characteristics. The AUC dependency of saturable CLh was examined under intravenous rapid administration at various doses. The CLh increased with increasing blood concentration but decreased with the increase of AUC at each dose. In addition, the relationship between AUC and CLh was consistent with that observed in previously reported infusion studies. These experimental data confirm the AUC dependency of saturable CLh of liposomes. A mathematical model was developed for this AUC dependency. The decrease of CLh was described by the uptake amount (X) as follows: CLh = CLm(1-X/Xm), where CLm and Xm represent the maximum uptake clearance and the maximum uptake amount, respectively. The rate equation for uptake was analytically solved as CLh = X/AUC = Xm/AUC(1-exp(CLm/XmAUC)). Uptake clearance can be described by CLm, Xm, and AUC, and so uptake clearance is constant if AUC is constant. These experimental analyses and theoretical considerations show the validity of the AUC-dependent saturable CLh of liposomes.

Liposomes as a drug delivery system for antisense oligonucleotides

Antisense oligonucleotides seem to provide a promising new tool for the therapy of viral diseases and of cancer. However, before the therapeutic potential of antisense compounds can be fulfilled, it will be necessary to overcome significant problems relating to their inefficient uptake by cells and their rapid loss from the body. Phospholipid vesicles (liposomes) have been widely used as a drug delivery system for standard anticancer and anti-infectious drugs. In this article we examine the potential role of liposomes as a drug delivery system for antisense oligonucleotides.

Body distribution of fully biodegradable [14C]-poly(lactic acid) nanoparticles coated with albumin after parenteral administration to rats

Fully biodegradable polylactic acid (PLA) nanoparticles (90-250 nm) coated with human serum albumin (HSA) were prepared by high-pressure emulsification and solvent evaporation, using the protein as surfactant. A new analytical tool was developed, based on Mie's law and size exclusion chromatography, to establish that, after evaporation of the solvent, the protein saturates the surface of the nanoparticles, masking the PLA core. According to this technique, no HSA is encapsulated in the polymer matrix. A radiolabelled [14C]-PLA50 was synthesized to follow the fate of this new drug carrier after i.v. administration to rats. The time necessary to clear the albumin-coated nanoparticles from the plasma was significantly longer than for the uncoated ones but not extended enough to target cells other than mononuclear phagocytes. As deduced from whole-body autoradiography and quantitative distribution experiments, the 14C-labelled polymer is rapidly captured by liver, bone marrow, lymph nodes, spleen and peritoneal macrophages. Nanoparticle degradation was addressed following 14C excretion. The elimination of the 14C was quick on the first day (30% of the administered dose) but then slowed down. In fact, if the metabolism of the PLA proceeds to lactic acid which is rapidly converted into CO2 via the Krebs cycle (80% of the total excretion was fulfilled by the lungs), anabolism from the lactic acid may also have taken place leading to long-lasting radioactive remnants, by incorporation of 14C into endogenous compounds.