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Lu B, Wei L, Shi G, Du J. Nanotherapeutics for Alleviating Anesthesia-Associated Complications. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308241. [PMID: 38342603 PMCID: PMC11022745 DOI: 10.1002/advs.202308241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/22/2023] [Indexed: 02/13/2024]
Abstract
Current management of anesthesia-associated complications falls short in terms of both efficacy and safety. Nanomaterials with versatile properties and unique nano-bio interactions hold substantial promise as therapeutics for addressing these complications. This review conducts a thorough examination of the existing nanotherapeutics and highlights the strategies for developing prospective nanomedicines to mitigate anesthetics-related toxicity. Initially, general, regional, and local anesthesia along with the commonly used anesthetics and related prevalent side effects are introduced. Furthermore, employing nanotechnology to prevent and alleviate the complications of anesthetics is systematically demonstrated from three aspects, that is, developing 1) safe nano-formulization for anesthetics; 2) nano-antidotes to sequester overdosed anesthetics and alter their pharmacokinetics; 3) nanomedicines with pharmacodynamic activities to treat anesthetics toxicity. Finally, the prospects and challenges facing the clinical translation of nanotherapeutics for anesthesia-related complications are discussed. This work provides a comprehensive roadmap for developing effective nanotherapeutics to prevent and mitigate anesthesia-associated toxicity, which can potentially revolutionize the management of anesthesia complications.
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Affiliation(s)
- Bin Lu
- Department of AnesthesiologyThird Hospital of Shanxi Medical UniversityShanxi Bethune HospitalShanxi Academy of Medical SciencesTongji Shanxi HospitalTaiyuan030032China
- Key Laboratory of Cellular Physiology at Shanxi Medical UniversityMinistry of EducationTaiyuanShanxi Province030001China
| | - Ling Wei
- Shanxi Bethune Hospital Center Surgery DepartmentShanxi Academy of Medical SciencesTongji Shanxi HospitalThird Hospital of Shanxi Medical UniversityTaiyuan030032China
| | - Gaoxiang Shi
- Department of AnesthesiologyThird Hospital of Shanxi Medical UniversityShanxi Bethune HospitalShanxi Academy of Medical SciencesTongji Shanxi HospitalTaiyuan030032China
| | - Jiangfeng Du
- Key Laboratory of Cellular Physiology at Shanxi Medical UniversityMinistry of EducationTaiyuanShanxi Province030001China
- Department of Medical ImagingShanxi Key Laboratory of Intelligent Imaging and NanomedicineFirst Hospital of Shanxi Medical UniversityTaiyuanShanxi Province030001China
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2
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Yang J, Li H, Zou H, Ding J. Polymer Nanoantidotes. Chemistry 2023:e202301107. [PMID: 37335074 DOI: 10.1002/chem.202301107] [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: 04/06/2023] [Indexed: 06/21/2023]
Abstract
Intoxication is one of the most common causes of accidental death globally. Although some antidotes capable of neutralizing the toxicity of certain xenobiotics have become well established, the current reality is that clinicians primarily rely on nonspecific extracorporeal techniques to remove toxins. Nano-intervention strategies in which nanoantidotes neutralize toxicity in situ via physical interaction, chemical bonding, or biomimetic clearance have begun to show clinical potential. However, most nanoantidotes remain in the proof-of-concept stage, and the difficulty of constructing clinical relevance models and the unclear pharmacokinetics of nanoantidotes hinder their translation to clinic. This Concept reviews the detoxification mechanisms of polymer nanoantidotes and predicts the opportunities and challenges associated with their clinical application.
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Affiliation(s)
- Jiazhen Yang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230026, P. R. China
| | - Hongjie Li
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230026, P. R. China
| | - Haoyang Zou
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun, 130022, P. R. China
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun, 130022, P. R. China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230026, P. R. China
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3
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Jaffal K, Chevillard L, Mégarbane B. Lipid Emulsion to Treat Acute Poisonings: Mechanisms of Action, Indications, and Controversies. Pharmaceutics 2023; 15:pharmaceutics15051396. [PMID: 37242638 DOI: 10.3390/pharmaceutics15051396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Biodetoxification using intravenous lipid emulsion (ILE) in acute poisoning is of growing interest. As well as for local anesthetics, ILE is currently used to reverse toxicity caused by a broad-spectrum of lipophilic drugs. Both pharmacokinetic and pharmacodynamic mechanisms have been postulated to explain its possible benefits, mainly combining a scavenging effect called "lipid sink" and cardiotonic activity. Additional mechanisms based on ILE-attributed vasoactive and cytoprotective properties are still under investigation. Here, we present a narrative review on lipid resuscitation, focusing on the recent literature with advances in understanding ILE-attributed mechanisms of action and evaluating the evidence supporting ILE administration that enabled the international recommendations. Many practical aspects are still controversial, including the optimal dose, the optimal administration timing, and the optimal duration of infusion for clinical efficacy, as well as the threshold dose for adverse effects. Present evidence supports the use of ILE as first-line therapy to reverse local anesthetic-related systemic toxicity and as adjunct therapy in lipophilic non-local anesthetic drug overdoses refractory to well-established antidotes and supportive care. However, the level of evidence is low to very low, as for most other commonly used antidotes. Our review presents the internationally accepted recommendations according to the clinical poisoning scenario and provides the precautions of use to optimize the expected efficacy of ILE and limit the inconveniences of its futile administration. Based on their absorptive properties, the next generation of scavenging agents is additionally presented. Although emerging research shows great potential, several challenges need to be overcome before parenteral detoxifying agents could be considered as an established treatment for severe poisonings.
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Affiliation(s)
- Karim Jaffal
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, 75010 Paris, France
- INSERM UMRS-1144, Paris-Cité University, 75006 Paris, France
| | - Lucie Chevillard
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, 75010 Paris, France
- INSERM UMRS-1144, Paris-Cité University, 75006 Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, 75010 Paris, France
- INSERM UMRS-1144, Paris-Cité University, 75006 Paris, France
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4
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Liposomes to Augment Dialysis in Preclinical Models: A Structured Review. Pharmaceutics 2021; 13:pharmaceutics13030395. [PMID: 33809774 PMCID: PMC8002345 DOI: 10.3390/pharmaceutics13030395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022] Open
Abstract
In recent years, a number of groups have been investigating the use of “empty” liposomes with no drug loaded as scavengers both for exogenous intoxicants and endogenous toxic molecules. Preclinical trials have demonstrated that repurposing liposomes to sequester such compounds may prove clinically useful. The use of such “empty” liposomes in the dialysate during dialysis avoids recognition by complement surveillance, allowing high doses of liposomes to be used. The “reach” of dialysis may also be increased to molecules that are not traditionally dialysable. We aim to review the current literature in this area with the aims of increasing awareness and informing further research. A structured literature search identified thirteen papers which met the inclusion criteria. Augmenting the extraction of ammonia in hepatic failure with pH-gradient liposomes with acidic centres in peritoneal dialysis is the most studied area, with work progressing toward phase one trials. Liposomes used to augment the removal of exogenous intoxicants and protein-bound uraemic and hepatic toxins that accumulate in these organ failures and liposome-supported enzymatic dialysis have also been studied. It is conceivable that liposomes will be repurposed from the role of pharmaceutical vectors to gain further indications as clinically useful nanomedical antidotes/treatments within the next decade.
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Matoori S, Mooney DJ. Near-Infrared Fluorescence Hydrogen Peroxide Assay for Versatile Metabolite Biosensing in Whole Blood. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e2000369. [PMID: 32329223 DOI: 10.1002/smll.202000369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 05/17/2023]
Abstract
In emergency medicine, blood lactate levels are commonly measured to assess the severity and response to treatment of hypoperfusion-related diseases (e.g., sepsis, trauma, cardiac arrest). Clinical blood lactate testing is conducted with laboratory analyzers, leading to a delay of 3 h between triage and lactate result. Here, a fluorescence-based blood lactate assay, which can be utilized for bedside testing, based on measuring the hydrogen peroxide generated by the enzymatic oxidation of lactate is described. To establish a hydrogen peroxide assay, near-infrared cyanine derivatives are screened and sulfo-cyanine 7 is identified as a new horseradish peroxidase (HRP) substrate, which loses its fluorescence in presence of HRP and hydrogen peroxide. As hydrogen peroxide is rapidly cleared by erythrocytic catalase and glutathione peroxidase, sulfo-cyanine 7, HRP, and lactate oxidase are encapsulated in a liposomal reaction compartment. In lactate-spiked bovine whole blood, the newly developed lactate assay exhibits a linear response in a clinically relevant range after 10 min. Substituting lactate oxidase with glucose and alcohol oxidase allows for blood glucose, ethanol, and methanol biosensing, respectively. This easy-to-use, rapid, and versatile assay may be useful for the quantification of a variety of enzymatically oxidizable metabolites, drugs, and toxic substances in blood and potentially other biological fluids.
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Affiliation(s)
- Simon Matoori
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
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Choe JY, Son DS, Kim Y, Lee JK, Shin H, Kim WJ, Kang YG, Dua P, Hong SW, Park JH, Lee DK. L-Type Calcium Channel Blocker Enhances Cellular Delivery and Gene Silencing Potency of Cell-Penetrating Asymmetric siRNAs. Mol Pharm 2020; 17:777-786. [PMID: 31976668 DOI: 10.1021/acs.molpharmaceut.9b00942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The efficient delivery of small interfering RNAs (siRNAs) to the target cells is critical for the pharmaceutical success of RNA interference (RNAi) drugs. One of the possible strategies to improve siRNA delivery is to identify auxiliary molecules that augment their cellular uptake. Herein, we performed a chemical library screening in an effort to discover small molecules that enhance the potency of cholesterol-conjugated, cell-penetrating asymmetric siRNAs (cp-asiRNAs). Interestingly, three compounds identified from the screen share a common dihydropyridine (DHP) core and function as L-type calcium channel blockers (CCBs). Using confocal microscopy and quantitative analysis of small RNAs, we demonstrated that the L-type CCBs increased the endocytic cellular uptake of cp-asiRNAs. Furthermore, these small molecules substantially improved the potency of cp-asiRNAs, not only in vitro but also in vivo on rat skin. Collectively, our study provides an alternative pharmacological approach for the identification of small molecules that potentiate the effects of therapeutic siRNAs.
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Affiliation(s)
- Jeong Yong Choe
- Department of Chemistry, Sungkyunkwan University, Suwon 16419, Republic of Korea.,OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Da Seul Son
- Department of Chemistry, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Yanghee Kim
- Department of Chemistry, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Jun-Kyoung Lee
- OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Hanho Shin
- OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Won Jun Kim
- OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Young Gyu Kang
- Department of Chemistry, Sungkyunkwan University, Suwon 16419, Republic of Korea.,OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Pooja Dua
- OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Sun Woo Hong
- OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - June Hyun Park
- OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
| | - Dong-Ki Lee
- Department of Chemistry, Sungkyunkwan University, Suwon 16419, Republic of Korea.,OliX Pharmaceuticals, Inc., Suwon 16226, Republic of Korea
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7
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Cave G, Harvey M, Sleigh J, Kanamala M, Wu Z. Magnetic extraction of toxin binding liposomes; a method to ameliorate drug toxicity? Preliminary in vitro/ in vivo study. Nanomedicine (Lond) 2018; 13:3083-3089. [PMID: 30457425 DOI: 10.2217/nnm-2018-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Removal of a toxin from the body once absorbed is usually not possible. We describe the use of magnetite containing pH gradient 'MagnepH' liposomes to overcome limitations preventing removal. METHODS MagnepH liposomes were added to albumin solution containing amitriptyline and dosed intravenously in rats prior to amitriptyline injection. Albumin solution or drawn blood was exposed to a magnet and sampled. RESULTS One third of amitriptyline was extracted in vitro. In vivo amitriptyline concentrations were 1830 nmol/l (controls) and 10870 nmol/l (MagnepH; n = 2). Amitriptyline extraction increased from 0.6% (control) to 10.4% (MagnepH; 95% CI for difference 2.0-17.6%). CONCLUSION MagnepH liposomes sequestered amitriptyline and could then be extracted. This method has potential to ameliorate limitations to extracorporeal removal of toxins in poisoning.
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Affiliation(s)
- Grant Cave
- Department of Pharmacy, University of Auckland, Auckland, New Zealand 1148.,Intensive Care Unit, Tamworth Base Hospital, New South Wales, Australia 2340
| | - Martyn Harvey
- Emergency Department, Waikato Hospital, Hamilton, New Zealand 3204.,Waikato Clinical School, University of Auckland, Hamilton, New Zealand 3204
| | - Jamie Sleigh
- Emergency Department, Waikato Hospital, Hamilton, New Zealand 3204.,Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand 3204
| | - Manju Kanamala
- Department of Pharmacy, University of Auckland, Auckland, New Zealand 1148
| | - Zimei Wu
- Department of Pharmacy, University of Auckland, Auckland, New Zealand 1148
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8
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Engudar G, Schaarup-Jensen H, Fliedner FP, Hansen AE, Kempen P, Jølck RI, Kjæer A, Andresen TL, Clausen MH, Jensen AI, Henriksen JR. Remote loading of liposomes with a 124I-radioiodinated compound and their in vivo evaluation by PET/CT in a murine tumor model. Am J Cancer Res 2018; 8:5828-5841. [PMID: 30613265 PMCID: PMC6299439 DOI: 10.7150/thno.26706] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/21/2018] [Indexed: 11/09/2022] Open
Abstract
Long circulating liposomes entrapping iodinated and radioiodinated compounds offer a highly versatile theranostic platform. Here we report a new methodology for efficient and high-yield loading of such compounds into liposomes, enabling CT/SPECT/PET imaging and 131I-radiotherapy. Methods: The CT contrast agent diatrizoate was synthetically functionalized with a primary amine, which enabled its remote loading into PEGylated liposomes by either an ammonium sulfate- or a citrate-based pH transmembrane gradient. Further, the amino-diatrizoate was radiolabeled with either 124I (t1/2 = 4.18 days) for PET or 125I (t1/2 = 59.5 days) for SPECT, through an aromatic Finkelstein reaction. Results: Quantitative loading efficiencies (>99%) were achieved at optimized conditions. The 124I-labeled compound was remote-loaded into liposomes, with an overall radiolabeling efficiency of 77 ± 1%, and imaged in vivo in a CT26 murine colon cancer tumor model by PET/CT. A prolonged blood circulation half-life of 19.5 h was observed for the radiolabeled liposomes, whereas injections of the free compound were rapidly cleared. Lower accumulation was observed in the spleen, liver, kidney and tumor than what is usually seen for long-circulating liposomes. Conclusion: The lower accumulation was interpreted as release of the tracer from the liposomes within these organs after accumulation. These results may guide the design of systems for controlled release of remote loadable drugs from liposomes.
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Uzunget SC, Evrin T, Uzunget SB, Ertürk ZK, Akıncıoğlu E, Özdemir S, Korkmaz A. Evaluation of activated charcoal and lipid emulsion treatment in model of acute rivaroxaban toxicity. Am J Emerg Med 2018; 36:1346-1349. [PMID: 29395759 DOI: 10.1016/j.ajem.2017.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/20/2022] Open
Abstract
AIM Reducing or reversing the toxicity effects of new oral anticoagulants is an important question.The purpose of the present study is to evaluate the effect of lipid emulsion (LE) and Activated Charcoal (AC) therapy on the intoxication of rivaroxaban, on mice. METHODS Adult male Balb/c mice weighing approximately 30g were used in the study. Seven groups were assigned, with six mice in each group. Groups were defined; given only rivaroxaban, given only LE, given only AC, after the administration of rivaroxaban LE applied group in the 1st hour, after the administration of rivaroxaban LE applied group in the 3rd hour, after the administration of rivaroxaban AC applied group in the1st hour, after the administration of rivaroxaban AC applied group in the 1st hour and LE applied group in the 3rd hour. PT and Anti-Factor Xa activity were measured in all blood samples from subjects. RESULTS A statistically significant difference was found when all groups were compared in terms of mean PT values and Anti-FactorXa values. However, no statistically significant difference was found in the mean PT and Anti-FactorXa values when only rivaroxaban administrated group and after the administration of rivaroxaban LE and/or AC applied groups were compared one to one. No deaths occurred in groups during the observation. CONCLUSION Although the administration of either AC or LE alone or in combination resulted in a decrease in the mean values of PT and anti-Factor Xa, in case of rivaroxaban toxicity, but one-to-one comparison of the groups was not statistically significant.
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Affiliation(s)
- Sinan Cem Uzunget
- Department of Emergency Medicine, Ufuk University Faculty of Medicine, Ankara, Turkey.
| | - Togay Evrin
- Department of Emergency Medicine, Ufuk University Faculty of Medicine, Ankara, Turkey
| | | | - Zamir Kemal Ertürk
- Department of Emergency Medicine, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Egemen Akıncıoğlu
- Department of Pathology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Saffet Özdemir
- Department of Emergency Medicine, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Atila Korkmaz
- Department of Emergency Medicine, Ufuk University Faculty of Medicine, Ankara, Turkey.
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Cave G, Harvey M, Pianca N, Robertson I, Sleigh J, Wu Z. Intravenous DOPG liposomes do not augment pH gradient liposome supported peritoneal dialysis in treatment of acute intravenous amitriptyline intoxication in rats. TOXICOLOGY COMMUNICATIONS 2018. [DOI: 10.1080/24734306.2018.1555116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Grant Cave
- Department of Pharmacy, University of Auckland, Auckland, New Zealand
- Tamworth Base Hospital, North Tamworth, NSW, Australia
| | - Martyn Harvey
- Department of Pharmacy, University of Auckland, Auckland, New Zealand
- Emergency Department, Waikato Hospital, Hamilton, New Zealand
| | | | - Ivan Robertson
- Emergency Department, Waikato Hospital, Hamilton, New Zealand
| | - Jamie Sleigh
- Department of Pharmacy, University of Auckland, Auckland, New Zealand
- Emergency Department, Waikato Hospital, Hamilton, New Zealand
- Emergency Department, Waikato Hospital, Hamilton, New Zealand
| | - Zimei Wu
- Department of Pharmacy, University of Auckland, Auckland, New Zealand
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11
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Chapman R, Harvey M, Davies P, Wu Z, Cave G. Liposome supported peritoneal dialysis in rat amitriptyline exposure with and without intravenous lipid emulsion. J Liposome Res 2017; 29:114-120. [PMID: 29141481 DOI: 10.1080/08982104.2017.1403445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Liposome supported peritoneal dialysis is a recently described technique which may eventually be applicable in the clinical scenario of the intoxicated patient. We evaluated the hypothesis that intravenous injection of lipid emulsion (ILE) would augment acidic pH gradient liposome supported peritoneal dialysis (LSPD). Orogastrically amitriptyline dosed rats were treated with either Sodium bicarbonate (NaHCO3) intravenously and standard intraperitoneal dialysate (Group A); NaHCO3 intravenously and LSPD (Group B); or ILE and LSPD (Group C). The primary endpoint was dialysate amitriptyline concentration after a 60 min dwell. Secondary analysis included an estimate of extraction ratio for peritoneal blood flow (ERs). There were significantly higher intraperitoneal concentrations of amitriptyline and ERs in the two groups treated with LSPD (Group B, p = 0.02, Group C, p < 0.01 vs. Group A). There was no observed effect for ILE on intraperitoneal amitriptyline concentration or ERs (p > 0.20). LSPD increased the amitriptyline concentration in peritoneal dialysate. No further increase was demonstrated with ILE. This may be either because such an effect is absent, or type II error. Exploratory analysis suggests LSPD may be driven by total rather than free drug concentrations.
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Affiliation(s)
- Robin Chapman
- a Emergency Department , Bundaberg Base Hospital , Queensland , Australia
| | - Martyn Harvey
- b Emergency Department , Waikato Hospital , Hamilton , New Zealand
| | - Paul Davies
- a Emergency Department , Bundaberg Base Hospital , Queensland , Australia
| | - Zimei Wu
- c Department of Pharmacy , University of Auckland , Auckland , New Zealand
| | - Grant Cave
- d Tamworth Base Hospital , Tamworth , New South Wales , Australia.,e Department of Pharmacy , University of Auckland , Auckland , New Zealand
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12
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Liposome-supported enzymatic peritoneal dialysis. Biomaterials 2017; 145:128-137. [DOI: 10.1016/j.biomaterials.2017.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022]
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13
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Shao XR, Wei XQ, Zhang S, Fu N, Lin YF, Cai XX, Peng Q. Effects of Micro-environmental pH of Liposome on Chemical Stability of Loaded Drug. NANOSCALE RESEARCH LETTERS 2017; 12:504. [PMID: 28836126 PMCID: PMC6890883 DOI: 10.1186/s11671-017-2256-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/28/2017] [Indexed: 02/05/2023]
Abstract
Liposome is a promising carrier system for delivering bioactive molecules. However, the successful delivery of pH-sensitive molecules is still limited by the intrinsic instability of payloads in physiological environment. Herein, we developed a special liposome system that possesses an acidic micro-environment in the internal aqueous chamber to improve the chemical stability of pH-sensitive payloads. Curcumin-loaded liposomes (Cur-LPs) with varied internal pH values (pH 2.5, 5.0, or 7.4) were prepared. These Cur-LPs have similar particle size of 300 nm, comparable physical stabilities and analogous in vitro release profiles. Interestingly, the chemical stability of liposomal curcumin in 50% fetal bovine serum and its anticancer efficacy in vitro are both micro-environmental pH-dependent (Cur-LP-2.5 > Cur-LP-5.0 > Cur-LP-7.4). This serum stability still has space to be further enhanced to improve the applicability of Cur-LP. In conclusion, creating an acidic micro-environment in the internal chamber of liposome is feasible and efficient to improve the chemical stability of pH-sensitive payloads.
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Affiliation(s)
- Xiao-Ru Shao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China
| | - Xue-Qin Wei
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China
| | - Shu Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China
| | - Na Fu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China
| | - Yun-Feng Lin
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China
| | - Xiao-Xiao Cai
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China.
| | - Qiang Peng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Block 3, Renmin Road South, Chengdu, 610041, China.
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14
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Roveri M, Pfohl A, Jaaks P, Alijaj N, Leroux JC, Luciani P, Bernasconi M. Prolonged circulation and increased tumor accumulation of liposomal vincristine in a mouse model of rhabdomyosarcoma. Nanomedicine (Lond) 2017; 12:1135-1151. [PMID: 28447920 DOI: 10.2217/nnm-2017-0430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Our goal was to improve vincristine (VCR) based rhabdomyosarcoma (RMS) therapy by encapsulating the drug into liposomes. A targeting strategy was attempted to enhance tumor accumulation. MATERIALS & METHODS VCR was loaded in control and peptide-decorated liposomes via an active method. The interaction of an RMS-specific peptide with the presumed target furin and the cellular uptake of both liposomal groups were studied in vitro. Pharmacokinetics and biodistribution of VCR-containing liposomes were assessed in an RMS xenograft mouse model. RESULTS Liposomes ensured high VCR concentration in plasma and in the tumor. Peptide-decorated liposomes showed modest uptake in RMS cells. CONCLUSION The investigated peptide-modified liposomal formulation may not be optimal for furin-mediated RMS targeting. Nevertheless, VCR-loaded liposomes could serve as a delivery platform for experimental RMS.
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Affiliation(s)
- Maurizio Roveri
- Experimental Infectious Diseases & Cancer Research, University Children's Hospital Zurich, 8008 Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland.,Department of Chemistry & Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Alice Pfohl
- Experimental Infectious Diseases & Cancer Research, University Children's Hospital Zurich, 8008 Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland.,Department of Chemistry & Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Patricia Jaaks
- Experimental Infectious Diseases & Cancer Research, University Children's Hospital Zurich, 8008 Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Nagjie Alijaj
- Experimental Infectious Diseases & Cancer Research, University Children's Hospital Zurich, 8008 Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Jean-Christophe Leroux
- Department of Chemistry & Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, 8093 Zurich, Switzerland
| | - Paola Luciani
- Department of Chemistry & Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, 8093 Zurich, Switzerland.,Department of Pharmaceutical Technology, Institute of Pharmacy, Friedrich Schiller University, 07743 Jena, Germany
| | - Michele Bernasconi
- Experimental Infectious Diseases & Cancer Research, University Children's Hospital Zurich, 8008 Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
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Muhammad F, Nguyen TDT, Raza A, Akhtar B, Aryal S. A review on nanoparticle-based technologies for biodetoxification. Drug Chem Toxicol 2017; 40:489-497. [DOI: 10.1080/01480545.2016.1277736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Faqir Muhammad
- Institute of Pharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan, and
| | - Tuyen Duong Thanh Nguyen
- Nanotechnology Innovation Center of Kansas State, Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Ahmad Raza
- Institute of Pharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan, and
| | - Bushra Akhtar
- Institute of Pharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan, and
| | - Santosh Aryal
- Nanotechnology Innovation Center of Kansas State, Department of Chemistry, Kansas State University, Manhattan, KS, USA
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16
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Leroux JC. Mécanismes de détoxification attendus des technologies nouvelles. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Devuyst O, Schumann A. Peritoneal dialysis: nanoparticles have entered the game. Perit Dial Int 2015; 35:240. [PMID: 26015416 DOI: 10.3747/pdi.2015.00075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Devuyst
- Institute of Physiology, University of Zurich Zurich, Switzerland
| | - Anke Schumann
- Institute of Physiology, University of Zurich Zurich, Switzerland
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18
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Damitz R, Chauhan A. Parenteral emulsions and liposomes to treat drug overdose. Adv Drug Deliv Rev 2015; 90:12-23. [PMID: 26086091 DOI: 10.1016/j.addr.2015.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 11/25/2022]
Abstract
Drug overdoses from both pharmaceutical and recreational drugs are a major public health concern. Although some overdoses may be treated with specific antidotes, the most common treatment involves providing supportive care to allow the body to metabolize and excrete the toxicant. In many cases, supportive care is limiting, ineffective, and expensive. There is a clear medical need to improve the effectiveness of detoxification, in particular by developing more specific therapies or antidotes for these overdoses. Intravenous lipid emulsions (ILEs) have been investigated as a potential treatment for overdoses of local anesthetics and other hydrophobic drugs. While ILE therapy has been successful in several cases, its use beyond local anesthetic systemic toxicity is controversial and its mechanism of detoxification remains a subject of debate. ILEs were not originally developed to treat overdose, but clarifying the mechanisms of detoxification observed with ILE may allow us to design more effective future treatments. Liposomes are highly biocompatible and versatile formulations, thus it was a natural step to explore their use for drug overdose therapy as well. Several researchers have designed liposomes using a variety of approaches including surface charge, pH gradients, and inclusion of enzymes in the liposome core to optimize the formulations for detoxification of a specific drug or toxicant. The in vitro results for drug sequestration by liposomes are very promising and animal trials have in some cases shown comparable performance to ILE at reduced lipid dosing. This narrative review summarizes the current status and advances in the use of emulsions and liposomes for detoxification and also suggests several areas in which studies are needed for developing future therapies.
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Fettiplace MR, Weinberg G. Past, Present, and Future of Lipid Resuscitation Therapy. JPEN J Parenter Enteral Nutr 2015; 39:72S-83S. [DOI: 10.1177/0148607115595979] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Michael R. Fettiplace
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois
- Research & Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
- Neuroscience Program, University of Illinois at Chicago, Chicago, Illinois
| | - Guy Weinberg
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois
- Research & Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
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Abstract
The number of intoxications from xenobiotics—natural or synthetic foreign chemicals, or substances given in higher doses than typically present in humans—has risen tremendously in the last decade, placing poisoning as the leading external cause of death in the United States. This epidemic has fostered the development of antidotal nanomedicines, which we call “nano-antidotes,” capable of efficiently neutralizing offending compounds in situ. Although prototype nano-antidotes have shown efficacy in proof-of-concept studies, the gap to clinical translation can only be filled if issues such as the clinical relevance of intoxication models and the safety profile of nano-antidotes are properly addressed. As the unmet medical needs in resuscitative care call for better treatments, this Perspective critically reviews the recent progress in antidotal medicine and emerging nanotechnologies.
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Affiliation(s)
- Vincent Forster
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
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21
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Fettiplace MR, Pichurko A, Ripper R, Lin B, Kowal K, Lis K, Schwartz D, Feinstein DL, Rubinstein I, Weinberg G. Cardiac depression induced by cocaine or cocaethylene is alleviated by lipid emulsion more effectively than by sulfobutylether-β-cyclodextrin. Acad Emerg Med 2015; 22:508-17. [PMID: 25908403 DOI: 10.1111/acem.12657] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/24/2014] [Accepted: 11/29/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Cocaine intoxication leads to over 500,000 emergency department visits annually in the United States and ethanol cointoxication occurs in 34% of those cases. Cardiotoxicity is an ominous complication of cocaine and cocaethylene overdose for which no specific antidote exists. Because infusion of lipid emulsion (Intralipid) can treat lipophilic local anesthetic toxicity and cocaine is an amphipathic local anesthetic, the authors tested whether lipid emulsion could attenuate cocaine cardiotoxicity in vivo. The effects of lipid emulsion were compared with the metabolically inert sulfobutylether-β-cyclodextrin (SBE-β-CD; Captisol) in an isolated heart model of cocaine and cocaethylene toxicity to determine if capture alone could exert similar benefit as lipid emulsion, which exhibits multimodal effects. The authors then tested if cocaine and cocaethylene, like bupivacaine, inhibit lipid-based metabolism in isolated cardiac mitochondria. METHODS For whole animal experiments, Sprague-Dawley rats were anesthetized, instrumented, and pretreated with lipid emulsion followed by a continuous infusion of cocaine to assess time of onset of cocaine toxicity. For ex vivo experiments, rat hearts were placed onto a nonrecirculating Langendorff system perfused with Krebs-Henseleit solution. Heart rate, left ventricle maximum developed pressure (LVdevP), left ventricle diastolic pressure, maximum rate of contraction (+dP/dtmax), maximum rate of relaxation (-dP/dtmax), rate-pressure product (RPP = heart rate × LVdevP), and line pressure were monitored continuously during the experiment. A dose response to cocaine (10, 30, 50, and 100 μmol/L) and cocaethylene (10, 30, and 50 μmol/L) was generated in the absence or presence of either 0.25% lipid emulsion or SBE-β-CD. Substrate-specific rates of oxygen consumption were measured in interfibrillar cardiac mitochondria in the presence of cocaine, cocaethylene, ecgonine, and benzoylecgonine. RESULTS Treatment with lipid emulsion delayed onset of hypotension (140 seconds vs. 279 seconds; p = 0.008) and asystole (369 seconds vs. 607 seconds; p = 0.02) in whole animals. Cocaine and cocaethylene induced dose-dependent decreases in RPP, +dP/dtmax, and -dP/dtmaxabs (p < 0.0001) in Langendorff hearts; line pressure was increased by cocaine and cocaethylene infusion, but not altered by treatment. Lipid emulsion attenuated cocaine- and cocaethylene-induced cardiac depression. SBE-β-CD alone evoked a mild cardiodepressant effect (p < 0.0001) but attenuated further cocaine- and cocaethylene-induced decrements in cardiac contractility at high concentrations of drug (100 μmol/L; p < 0.001). Finally, both cocaine and cocaethylene, but not ecgonine and benzoylecgonine, inhibited lipid-dependent mitochondrial respiration by blocking carnitine exchange (p < 0.05). CONCLUSIONS A commercially available lipid emulsion was able to delay progression of cocaine cardiac toxicity in vivo. Further, it improved acute cocaine- and cocaethylene-induced cardiac toxicity in rat isolated heart while SBE-β-CD was effective only at the highest cocaine concentration. Further, both cocaine and cocaethylene inhibited lipid-dependent mitochondrial respiration. Collectively, this suggests that scavenging-independent effects of lipid emulsion may contribute to reversal of acute cocaine and cocaethylene cardiotoxicity, and the beneficial effects may involve mitochondrial lipid processing.
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Affiliation(s)
- Michael R. Fettiplace
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
- Neuroscience Program; University of Illinois at Chicago; Chicago IL
| | - Adrian Pichurko
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
| | - Richard Ripper
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
| | - Bocheng Lin
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
| | - Katarzyna Kowal
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
| | - Kinga Lis
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
| | - David Schwartz
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
| | - Douglas L. Feinstein
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
| | - Israel Rubinstein
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
- Section of Pulmonary, Critical Care, Sleep and Allergy Medicine; Department of Medicine, University of Illinois College of Medicine; Chicago IL
| | - Guy Weinberg
- Department of Anesthesiology; University of Illinois College of Medicine; Chicago IL
- Research & Development Service; Jesse Brown Veterans' Affairs Medical Center; Chicago IL
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22
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Fettiplace MR, Lis K, Ripper R, Kowal K, Pichurko A, Vitello D, Rubinstein I, Schwartz D, Akpa BS, Weinberg G. Multi-modal contributions to detoxification of acute pharmacotoxicity by a triglyceride micro-emulsion. J Control Release 2015; 198:62-70. [PMID: 25483426 PMCID: PMC4293282 DOI: 10.1016/j.jconrel.2014.11.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/12/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022]
Abstract
Triglyceride micro-emulsions such as Intralipid® have been used to reverse cardiac toxicity induced by a number of drugs but reservations about their broad-spectrum applicability remain because of the poorly understood mechanism of action. Herein we report an integrated mechanism of reversal of bupivacaine toxicity that includes both transient drug scavenging and a cardiotonic effect that couple to accelerate movement of the toxin away from sites of toxicity. We thus propose a multi-modal therapeutic paradigm for colloidal bio-detoxification whereby a micro-emulsion both improves cardiac output and rapidly ferries the drug away from organs subject to toxicity. In vivo and in silico models of toxicity were combined to test the contribution of individual mechanisms and reveal the multi-modal role played by the cardiotonic and scavenging actions of the triglyceride suspension. These results suggest a method to predict which drug toxicities are most amenable to treatment and inform the design of next-generation therapeutics for drug overdose.
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Affiliation(s)
- Michael R Fettiplace
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States; Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States
| | - Kinga Lis
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States; Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States
| | - Richard Ripper
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States; Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States
| | - Katarzyna Kowal
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States; Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States
| | - Adrian Pichurko
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States; Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States
| | - Dominic Vitello
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States
| | - Israel Rubinstein
- Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States; Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois College of Medicine, 840 South Wood Street (MC 719), Room 920-N CSB, Chicago, IL 60612, United States
| | - David Schwartz
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States
| | - Belinda S Akpa
- Department of Chemical Engineering, University of Illinois at Chicago, 810 S. Clinton Street, Chicago, IL 60607, United States.
| | - Guy Weinberg
- Department of Anesthesiology, University of Illinois College of Medicine, 1740 West Taylor Street, Suite 3200 W, MC515, Chicago, IL 60612, United States; Research & Development Service, Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, 60612, United States.
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St-Onge M, Dubé PA, Gosselin S, Guimont C, Godwin J, Archambault PM, Chauny JM, Frenette AJ, Darveau M, Le Sage N, Poitras J, Provencher J, Juurlink DN, Blais R. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol (Phila) 2014; 52:926-44. [PMID: 25283255 PMCID: PMC4245158 DOI: 10.3109/15563650.2014.965827] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 09/10/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Calcium channel blocker poisoning is a common and sometimes life-threatening ingestion. OBJECTIVE To evaluate the reported effects of treatments for calcium channel blocker poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in intensive care unit, duration of vasopressor use, functional outcomes, and serum calcium channel blocker concentrations. METHODS Medline/Ovid, PubMed, EMBASE, Cochrane Library, TOXLINE, International pharmaceutical abstracts, Google Scholar, and the gray literature up to December 31, 2013 were searched without time restriction to identify all types of studies that examined effects of various treatments for calcium channel blocker poisoning for the outcomes of interest. The search strategy included the following Keywords: [calcium channel blockers OR calcium channel antagonist OR calcium channel blocking agent OR (amlodipine or bencyclane or bepridil or cinnarizine or felodipine or fendiline or flunarizine or gallopamil or isradipine or lidoflazine or mibefradil or nicardipine or nifedipine or nimodipine or nisoldipine or nitrendipine or prenylamine or verapamil or diltiazem)] AND [overdose OR medication errors OR poisoning OR intoxication OR toxicity OR adverse effect]. Two reviewers independently selected studies and a group of reviewers abstracted all relevant data using a pilot-tested form. A second group analyzed the risk of bias and overall quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist and the Thomas tool for observational studies, the Institute of Health Economics tool for Quality of Case Series, the ARRIVE (Animal Research: Reporting In Vivo Experiments) guidelines, and the modified NRCNA (National Research Council for the National Academies) list for animal studies. Qualitative synthesis was used to summarize the evidence. Of 15,577 citations identified in the initial search, 216 were selected for analysis, including 117 case reports. The kappa on the quality analysis tools was greater than 0.80 for all study types. RESULTS The only observational study in humans examined high-dose insulin and extracorporeal life support. The risk of bias across studies was high for all interventions and moderate to high for extracorporeal life support. High-dose insulin. High-dose insulin (bolus of 1 unit/kg followed by an infusion of 0.5-2.0 units/kg/h) was associated with improved hemodynamic parameters and lower mortality, at the risks of hypoglycemia and hypokalemia (low quality of evidence). Extracorporeal life support. Extracorporeal life support was associated with improved survival in patients with severe shock or cardiac arrest at the cost of limb ischemia, thrombosis, and bleeding (low quality of evidence). Calcium, dopamine, and norepinephrine. These agents improved hemodynamic parameters and survival without documented severe side effects (very low quality of evidence). 4-Aminopyridine. Use of 4-aminopyridine was associated with improved hemodynamic parameters and survival in animal studies, at the risk of seizures. Lipid emulsion therapy. Lipid emulsion was associated with improved hemodynamic parameters and survival in animal models of intravenous verapamil poisoning, but not in models of oral verapamil poisoning. Other studies. Studies on decontamination, atropine, glucagon, pacemakers, levosimendan, and plasma exchange reported variable results, and the methodologies used limit their interpretation. No trial was documented in humans poisoned with calcium channel blockers for Bay K8644, CGP 28932, digoxin, cyclodextrin, liposomes, bicarbonate, carnitine, fructose 1,6-diphosphate, PK 11195, or triiodothyronine. Case reports were only found for charcoal hemoperfusion, dialysis, intra-aortic balloon pump, Impella device and methylene blue. CONCLUSIONS The treatment for calcium channel blocker poisoning is supported by low-quality evidence drawn from a heterogeneous and heavily biased literature. High-dose insulin and extracorporeal life support were the interventions supported by the strongest evidence, although the evidence is of low quality.
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Affiliation(s)
- M St-Onge
- Ontario and Manitoba Poison Centre , Toronto, ON , Canada
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Forster V, Signorell RD, Roveri M, Leroux JC. Liposome-supported peritoneal dialysis for detoxification of drugs and endogenous metabolites. Sci Transl Med 2014; 6:258ra141. [DOI: 10.1126/scitranslmed.3009135] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cave G, Harvey MG. Should we consider the infusion of lipid emulsion in the resuscitation of poisoned patients? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:457. [PMID: 25673255 PMCID: PMC4331416 DOI: 10.1186/s13054-014-0457-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of intravenous lipid emulsions (ILEs) as antidote in local anaesthetic systemic toxicity has gained widespread support following convincing data from animal models, and successful case reports in humans. Proposed beneficial mechanisms of action for ILEs include intravascular sequestration of intoxicant and subsequent enhanced redistribution to biologically inert tissues, augmentation of fatty acid utilisation for ATP synthesis in the context of metabolic poisoning, and direct cardiotonic and ion channel effects. The evidence base for use of ILEs in acute drug intoxication is evolving. The present evidence supports use of ILEs only in local anaesthetic systemic toxicity and in lipophilic cardiotoxin intoxication when there is an immediate threat to life, and other therapies have proven ineffective.
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Cave G, Harvey M, Shaw T, Damitz R, Chauhan A. Comparison of intravenous lipid emulsion, bicarbonate, and tailored liposomes in rabbit clomipramine toxicity. Acad Emerg Med 2013; 20:1076-9. [PMID: 24127716 DOI: 10.1111/acem.12224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Liposome (LIP)-like lipid dispersions have emerged as useful detoxification vehicles in vitro. The authors compare resuscitation with tailored LIPs, 20% intravenous lipid emulsion (ILE), and sodium bicarbonate (BIC), in a rabbit model of clomipramine toxicity. METHODS Sedated, instrumented New Zealand white rabbits underwent clomipramine infusion at 3.2 mg/kg/min to 50% baseline mean arterial pressure (MAP) and then at 1.6 mg/kg/min for 30 minutes. BIC (3 mL/kg 8.4%), ILE (3 mL/kg 20%), or LIP (24 mg/kg) were infused as rescue treatments at toxicity and were repeated at 10 minutes (n = 5 in each group). RESULTS Thirty-minute MAP was greatest in ILE-treated animals: 61 mm Hg ILE (interquartile range [IQR] = 49 to 64 mm Hg), 43 mm Hg LIP (IQR = 36.5 to 49 mm Hg), and 10 mm Hg BIC (IQR = 10 to 44 mm Hg; all p = 0.02). Two of the five BIC-treated animals survived to 30 minutes, compared with all five of the ILE-treated animals and all five of the LIP-treated animals (p = 0.044). CONCLUSIONS Both ILE and LIPs improved hemodynamic recovery compared with bicarbonate in clomipramine-induced cardiotoxicity in rabbits. Greater 30-minute MAP was observed in the ILE group.
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Affiliation(s)
- Grant Cave
- Tamworth Rural Referral Hospital; Tamworth NSW Australia
| | - Martyn Harvey
- Department of Emergency Medicine; Waikato Hospital; Hamilton New Zealand
| | - Tom Shaw
- Department of Emergency Medicine; Waikato Hospital; Hamilton New Zealand
| | - Robert Damitz
- Department of Chemical Engineering; University of Florida; Gainesville FL
| | - Anuj Chauhan
- Department of Chemical Engineering; University of Florida; Gainesville FL
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Zhang XQ, Xu X, Bertrand N, Pridgen E, Swami A, Farokhzad OC. Interactions of nanomaterials and biological systems: Implications to personalized nanomedicine. Adv Drug Deliv Rev 2012; 64:1363-84. [PMID: 22917779 DOI: 10.1016/j.addr.2012.08.005] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/25/2012] [Accepted: 08/09/2012] [Indexed: 12/16/2022]
Abstract
The application of nanotechnology to personalized medicine provides an unprecedented opportunity to improve the treatment of many diseases. Nanomaterials offer several advantages as therapeutic and diagnostic tools due to design flexibility, small sizes, large surface-to-volume ratio, and ease of surface modification with multivalent ligands to increase avidity for target molecules. Nanomaterials can be engineered to interact with specific biological components, allowing them to benefit from the insights provided by personalized medicine techniques. To tailor these interactions, a comprehensive knowledge of how nanomaterials interact with biological systems is critical. Herein, we discuss how the interactions of nanomaterials with biological systems can guide their design for diagnostic, imaging and drug delivery purposes. A general overview of nanomaterials under investigation is provided with an emphasis on systems that have reached clinical trials. Finally, considerations for the development of personalized nanomedicines are summarized such as the potential toxicity, scientific and technical challenges in fabricating them, and regulatory and ethical issues raised by the utilization of nanomaterials.
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