Inhaled recombinant interferon gamma in patients with lung cancer: pharmacokinetics and effects on chemiluminescence responses of alveolar macrophages and peripheral blood neutrophils and monocytes

Present Situation and Future Progress of Inhaled Lung Cancer Therapy: Necessity of Inhaled Formulations with Drug Delivery Functions

Inhaled lung cancer therapy is promising because of direct and noninvasive drug delivery to the lungs with low potential for severe systemic toxicity. Thus chemotherapeutic drugs have been administered clinically by nebulization of solution or suspension formulations, which demonstrated their limited pulmonary absorption and relatively mild systemic toxicity. In all these clinical trials, however, there was no obviously superior anticancer efficacy in lung cancer patients even at the maximum doses of drugs limited by pulmonary toxicity. Therefore methods that deliver both higher anticancer efficacy and lower pulmonary toxicity are strongly desired. In addition to the worldwide availability of pressured metered dose inhalers (pMDIs) and dry powder inhalers (DPIs) to treat local respiratory diseases, recent innovations in medicines and technologies are encouraging next steps toward effective inhaled lung cancer therapy with new therapeutic or drug delivery concepts. These include the discovery of target cells/molecules and drug candidates for novel cancer therapy, the development of high-performance inhalation devices for effective pulmonary drug delivery, and the establishment of manufacturing technologies for functional nanoparticles/microparticles. This review highlights the present situation and future progress of inhaled drugs for lung cancer therapy, including an overview of available inhalation devices, pharmacokinetics, and outcomes in clinical trials so far and some novel formulation strategies based on drug delivery systems to achieve enhanced anticancer efficacy and attenuated pulmonary toxicity.

Effect of Inhaled Interferon Beta-1a on Carbon Monoxide Transfer Factor in Healthy Volunteers

Interferon beta-1a (IFNβ-1a) 30 μg weekly by intramuscular (IM) injection is used to treat relapsing forms of multiple sclerosis. We assessed if it can be given safely by inhalation. Twenty-one healthy volunteers inhaled IFNβ-1a 300 μg, formulated for deep delivery to the lungs, in a randomized, parallel-group, repeat-dose trial. Comparators were room air and placebo. The primary outcome measure was carbon monoxide transfer factor corrected for hemoglobin (TLCOc), which measures the CO transfer from inspired gas to pulmonary capillary blood. After 3 and 4 once-weekly doses, IFNβ-1a significantly reduced TLCOc compared with room air: after the third dose, mean standard deviation (SD) change in percent predicted TLCOc was-10.9 (2.8), and after the fourth dose was-12.1 (2.7). After 2, 3, and 4 doses, IFNβ-1a significantly reduced TLCOc compared with placebo: after the second dose, mean (SD) change in percent predicted TLCOc was-8.8 (5.5), after the third dose was-10.9 (2.8), and after the fourth dose was-12.1 (2.7). Circulating IFNβ-1a concentrations were about one-third those of the intramuscular dose regimen. Tolerability of IFNβ-1a and the comparators was equally good. In conclusion, IFNβ-1a reduced TLCOc, whereas placebo and room air did not. A dose of IFNβ-1a 300 μg by inhalation may not be safe for general use.

Nanocarriers for pulmonary administration of peptides and therapeutic proteins

Peptides and therapeutic proteins have been the target of intense research and development in recent years by the pharmaceutical and biotechnology industry. Preferably, they are administered through the parenteral route, which is associated with reduced patient compliance. Formulations for noninvasive administration of peptides and therapeutic proteins are currently being developed. Among them, inhalation appears as a promising alternative for the administration of such products. Several formulations for pulmonary delivery are in various stages of development. Despite positive results, conventional formulations have some limitations such as reduced bioavailability and side effects. Nanocarriers may be an alternative way to overcome the problems of conventional formulations. Some nanocarrier-based formulations of peptides and therapeutic proteins are currently under development. The results obtained are promising, revealing the usefulness of these systems in the delivery of such drugs.

Cytogenetic effects of recombinant interferon-gamma on lymphocytes cultures from patients with non-small cell lung cancer

Therapeutic effects of human interferons (IFN) on malignancies and infectious diseases have been demonstrated in several clinical trials. The effects of IFN alone or combined with other treatment modalities (radiotherapy and chemotherapy) in lung cancer are under investigation. Experimental data suggest that some cytokines, such as IFN-alpha and IFN-gamma, exhibit cytogenetic properties in human normal lymphocytes from peripheral blood, but the mechanisms are not clear. The aim of the present study was to investigate the in vivo cytotoxic and cytostatic activity of IFN-gamma. Patients with certain cases of non-small cell lung cancer not eligible for chemotherapy or chemoradiotherapy were treated with thoracic radiotherapy. After tumor relapse, local treatment with instillations of IFN-gamma through the fiberoptic bronchoscope followed. To clarify the cytogenetic activity of IFN-gamma, sister chromatid exchange (SCE) and proliferation rate index (PRI) were evaluated in lymphocyte cultures from these patients' peripheral blood samples immediately after diagnosis (baseline), 30 days after radiotherapy, and after the fifth instillation of IFN-gamma. Our results show a decrease in SCE frequency and PRI values in lymphocytes after treatment with IFN-gamma, suggesting that IFN-gamma does not have cytotoxic activity but, in contrast, may induce repair mechanisms, as shown in earlier studies in other biologic models.

Down modulation of IFN-gamma signaling in alveolar macrophages isolated from smokers

The master cytokine, IFN-gamma possesses a wide spectrum of biological effects and is crucial for development of the highly activated macrophage phenotype characteristically found during inflammation. However, no data exists regarding the potential influence of cigarette smoke on the status of the expression of the cell surface receptor for IFN-gamma (IFN-gammaR) on alveolar macrophages (AM) of smokers. Here in, we report reduction in the expression of the IFN-gammaR alpha-chain on AM of cigarette smokers, when compared with non-smokers. Ensuing from the loss of receptor expression on the AM of smokers there was a decrease in IFN-gamma-mediated cell signaling. This included a decrease in the phosphorylation of signal transducer and activator of transcription (STAT)-1 and induction of interferon regulatory factor (IRF)-1. Further, diminished activation/induction of transcription factors did not appear to result from induction of known members of the 'suppressors of cytokine signaling (SOCS)' family. Decreased IFN-gamma signal transduction in AM from smokers may have an important implication regarding the use of therapeutic IFN-gamma in the lungs of patients that develop respiratory disorders as a result of tobacco use.

IFN-gamma impairs release of IL-8 by IL-1beta-stimulated A549 lung carcinoma cells

BACKGROUND

Production of interferon (IFN)-gamma is key to efficient anti-tumor immunity. The present study was set out to investigate effects of IFNgamma on the release of the potent pro-angiogenic mediator IL-8 by human A549 lung carcinoma cells.

METHODS

A549 cells were cultured and stimulated with interleukin (IL)-1beta alone or in combination with IFNgamma. IL-8 production by these cells was analyzed with enzyme linked immuno sorbent assay (ELISA). mRNA-expression was analyzed by real-time PCR and RNase protection assay (RPA), respectively. Expression of inhibitor-kappa Balpha, cellular IL-8, and cyclooxygenase-2 was analyzed by Western blot analysis.

RESULTS

Here we demonstrate that IFNgamma efficiently reduced IL-8 secretion under the influence of IL-1beta. Surprisingly, real-time PCR analysis and RPA revealed that the inhibitory effect of IFNgamma on IL-8 was not associated with significant changes in mRNA levels. These observations concurred with lack of a modulatory activity of IFNgamma on IL-1beta-induced NF-kappaB activation as assessed by cellular IkappaB levels. Moreover, analysis of intracellular IL-8 suggests that IFNgamma modulated IL-8 secretion by action on the posttranslational level. In contrast to IL-8, IL-1beta-induced cyclooxygenase-2 expression and release of IL-6 were not affected by IFNgamma indicating that modulation of IL-1beta action by this cytokine displays specificity.

CONCLUSION

Data presented herein agree with an angiostatic role of IFNgamma as seen in rodent models of solid tumors and suggest that increasing T helper type 1 (Th1)-like functions in lung cancer patients e.g. by local delivery of IFNgamma may mediate therapeutic benefit via mechanisms that potentially include modulation of pro-angiogenic IL-8.

Disease guided optimization of the respiratory delivery of microparticulate formulations

BACKGROUND

Inhalation of microparticulate dosage forms can be effectively used in the treatment of respiratory and systemic diseases.

OBJECTIVE

Disease states investigated for treatment by inhalation of microparticles were reviewed along with the drugs' pharmacological, pharmacokinetic and physical chemical properties to identify the advantages of microparticulate inhalation formulations and to identify areas for further improvement.

METHODS

Microbial infections of the lung, asthma, diabetes, lung transplantation and lung cancer were examined, with a focus on those systems intended to provide a sustained release.

CONCLUSION

In developing microparticulate formulations for inhalation in the lung, there is a need to understand the pharmacology of the drug as the key to revealing the optimal concentration time profile, the disease state, and the pharmacokinetic properties of the pure drug as determined by IV administration and inhalation. Finally, in vitro release studies will allow better identification of the best dosing strategy to be used in efficacy and safety studies.

Inhaled cytokines and cytokine antagonists

Cytokine and cytokine antagonist have provided novel and effective therapies for many human diseases. A number of approved cytokines including the interferons (alpha, beta and gamma), interleukin-2 (IL-2), granulocyte macrophage colony stimulating factor (GM-CSF) as well as novel cytokine antagonists have been administered by the pulmonary route for both local lung disease and as a non-invasive method for systemic delivery. We review the published clinical experience of inhaled cytokines and cytokine antagonists. We discuss the limitations of the existing data and the type of clinical data desired to establish the advantages and safety of inhaled cytokines and cytokine antagonists.

Functional analysis of cells obtained from bronchoalveolar lavage fluid (BALF) of lung cancer patients

BALF from tumor segments provides access to immune system cells in contact with lung tumors. We analyzed BALF cells as to their production of H2O2 and NO, comparing tumor-affected to non-affected lung segments. Twelve patients were studied (4 NSCLC, 3 SCC, 5 Adenocarcinoma). The cell numbers recovered from BALF varied, and, in adenocarcinoma patients, smaller numbers were recovered from tumor-affected segments. H2O2 production (up to 6.3 nmoles/2x10(5)cells) was obtained in 7/12 patients and, in these, it was more frequent in non-affected segments (7/7) than in affected segments (2/7). After culture, NO production was observed in three patients (6 to 314 microM) that also produced H2O2. These functional characteristics of cells in contact with neoplasia may have a role in determining the fate of the interactions between the immune system and lung cancer.

Randomized, double-blind, placebo-controlled, dose-escalating study of aerosolized interferon gamma-1b in patients with mild to moderate cystic fibrosis lung disease

Interferon gamma-1b (IFN-gamma1b) is a pleiotropic cytokine with immunomodulatory activities that could decrease bacterial burden, inflammation, and obstruction in patients with CF. Patients with CF (> or =12 years old, FEV1 > or =40% predicted) were randomly assigned to sequential dose cohorts inhaling 500 microg IFN-gamma1b, 1,000 microg IFN-gamma1b, or placebo by Respirgard II nebulizer thrice weekly for 12 weeks. Sputum bacterial density and spirometry were measured. Safety, antibiotic use, hospitalization, and sputum neutrophils, elastase, DNA, IL-8, and myeloperoxidase were also evaluated. Sixty-six patients (mean age, 24 years, with mean baseline FEV1 of 74 +/- 20 (SD) percent predicted) were studied. One patient had bronchospasm after the first dose of IFN-gamma1b; the overall withdrawal rate was 15% (5 in the placebo group, 2 in the 500-microg IFN-gamma1b group, and 3 in the 1,000 microg IFN-gamma1b group). The 500-microg IFN-gamma1b dose was well-tolerated, but the 1,000-mug dose cohort, who had a higher baseline bacterial density than placebo patients (mean difference, 1.2 log(10) CFU/g sputum, 95% confidence interval (CI), 0.1,2.8, P=0.04), had 24% more hospitalizations for exacerbation than placebo patients (95% CI, 2,45%, P=0.05). There was a 0.12-l difference between the 500-microg IFN-gamma1b and placebo groups with respect to the 12-week change in FEV1 (active group minus placebo group, 95% CI, -0.03,0.26, P=0.11), as compared to a 0.01-l difference between the 1,000-microg IFN-gamma1b and placebo groups (95% CI, -0.16,0.17, P=0.96). No effects of IFN-gamma1b were seen in sputum bacterial density or inflammatory biomarkers at 12 weeks. Aerosolized IFN-gamma1b did not improve pulmonary function, reduce sputum bacterial density, or affect inflammatory sputum markers in patients with mild-moderate lung disease.

Development of inhalational agents for oncologic use

Because regional chemotherapy has been useful in treatment and palliation of many cancer types, the concept of delivering drugs by inhalation for the treatment of cancers in the lung is attractive. Much higher local drug exposure can be achieved with total doses considerably lower than those required for systemic administration, resulting in lower exposure of nonrespiratory tract tissues to potentially toxic drugs. Regional delivery of chemotherapy to the respiratory tract has been shown to have activity in preclinical and clinical studies. Technical improvements in delivery methods have now made it possible to conduct trials of inhalational agents, both to treat cancers affecting the respiratory tract and to deliver other drugs used in cancer patients. This review discusses the rationale of drug delivery by the inhalational route, its technical challenges, preclinical and clinical experiences, limitations, and promise.

Tumour response and radiation-induced lung injury in patients with recurrent small cell lung cancer treated with radiotherapy and concomitant interferon-alpha

The aim of this study was to determine whether either natural or recombinant interferon (IFN)-alpha can improve the response to radiotherapy (RT) in patients with small cell lung cancer (SCLC), and to assess the role of IFN in radiation-induced lung injury. All patients had previously participated in a randomised trial of chemotherapy alone or in combination with IFN-alpha in three arms (arm O: no IFN, arm I: natural IFN-alpha, arm II: recombinant IFN-alpha). Patients with locally progressive disease in the lungs following chemotherapy were treated with RT and they continued with their concomitant IFN-alpha. The RT dose was 50 Gy. Radiation-induced lung injury was assessed by lung function tests, computed tomography and bronchoalveolar lavage fluid (BALF) analysis which included cell findings, Interleukin (IL)-1 alpha/-1 beta expression by alveolar macrophages and surfactant components. Seventeen patients were entered in the study, 16 of whom were evaluable. Response rates in Arms O, I and II were 50, 67 and 50%, respectively. Median survival was 18.5, 7 and 23 months respectively, and 1-year survival was 67, 29 and 75% respectively. Long-term survival as assessed by 2- and 3-year survival rates was 29% in patients receiving natural IFN-alpha as compared to 17% in patients not receiving IFN (not statistically significant findings). Every patient had abnormal results when assessed for radiation-induced lung injury. No statistically significant difference was found in toxicity between the treatment arms. A high surfactant protein (SP)-A/phospholipid ratio and a high level of SP-A in BALF before RT was associated with a high degree of radiation-induced lung injury measured by lung function tests and computed tomography in all arms of the study. Thus, we could not show that the combination of IFN-alpha and RT induced more lung toxicity than RT alone as we did in our previous study. The role of high SP-A/phospholipid ratios and high SP-A levels in BALF before RT as predictors of the development of lung injury after RT needs to be determined in the future.

Augmented chemiluminescence response of bronchoalveolar lavage cells in calves receiving repeated daily sprayings of ammonia mist into the nasal cavities

The effect of ammonia inhalation on the luminol-dependent chemiluminescence response of bronchoalveolar lavage (BAL) cells was investigated in clinically normal calves receiving eight ml of ammonia water (5,000 ppm) in the form of aerosol sprayed into the nasal cavities (four ml into each nostril) once a day for two weeks. The chemiluminescence level of BAL cells was augmented following the sprayings of ammonia compared with prior to exposure. The level still remained high one week after the exposure was removed, but showed recovery after two weeks.