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Gabai A, Zeppieri M, Finocchio L, Salati C. Innovative Strategies for Drug Delivery to the Ocular Posterior Segment. Pharmaceutics 2023; 15:1862. [PMID: 37514050 PMCID: PMC10385847 DOI: 10.3390/pharmaceutics15071862] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2023] Open
Abstract
Innovative and new drug delivery systems (DDSs) have recently been developed to vehicle treatments and drugs to the ocular posterior segment and the retina. New formulations and technological developments, such as nanotechnology, novel matrices, and non-traditional treatment strategies, open new perspectives in this field. The aim of this mini-review is to highlight promising strategies reported in the current literature based on innovative routes to overcome the anatomical and physiological barriers of the vitreoretinal structures. The paper also describes the challenges in finding appropriate and pertinent treatments that provide safety and efficacy and the problems related to patient compliance, acceptability, effectiveness, and sustained drug delivery. The clinical application of these experimental approaches can help pave the way for standardizing the use of DDSs in developing enhanced treatment strategies and personalized therapeutic options for ocular pathologies.
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Affiliation(s)
- Andrea Gabai
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Lucia Finocchio
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
- Department of Ophthalmology, Nuovo Ospedale Santo Stefano, 59100 Prato, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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2
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Mostafa M, Al Fatease A, Alany RG, Abdelkader H. Recent Advances of Ocular Drug Delivery Systems: Prominence of Ocular Implants for Chronic Eye Diseases. Pharmaceutics 2023; 15:1746. [PMID: 37376194 DOI: 10.3390/pharmaceutics15061746] [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: 05/16/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic ocular diseases can seriously impact the eyes and could potentially result in blindness or serious vision loss. According to the most recent data from the WHO, there are more than 2 billion visually impaired people in the world. Therefore, it is pivotal to develop more sophisticated, long-acting drug delivery systems/devices to treat chronic eye conditions. This review covers several drug delivery nanocarriers that can control chronic eye disorders non-invasively. However, most of the developed nanocarriers are still in preclinical or clinical stages. Long-acting drug delivery systems, such as inserts and implants, constitute the majority of the clinically used methods for the treatment of chronic eye diseases due to their steady state release, persistent therapeutic activity, and ability to bypass most ocular barriers. However, implants are considered invasive drug delivery technologies, especially those that are nonbiodegradable. Furthermore, in vitro characterization approaches, although useful, are limited in mimicking or truly representing the in vivo environment. This review focuses on long-acting drug delivery systems (LADDS), particularly implantable drug delivery systems (IDDS), their formulation, methods of characterization, and clinical application for the treatment of eye diseases.
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Affiliation(s)
- Mahmoud Mostafa
- Department of Pharmaceutics, Faculty of Pharmacy, Minia University, Minya 61519, Egypt
| | - Adel Al Fatease
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 62223, Saudi Arabia
| | - Raid G Alany
- School of Pharmacy, Kingston University London, Kingston Upon Tames KT1 2EE, UK
- School of Pharmacy, The University of Auckland, Auckland 1010, New Zealand
| | - Hamdy Abdelkader
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 62223, Saudi Arabia
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3
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Ahmed S, Amin MM, Sayed S. Ocular Drug Delivery: a Comprehensive Review. AAPS PharmSciTech 2023; 24:66. [PMID: 36788150 DOI: 10.1208/s12249-023-02516-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023] Open
Abstract
The human eye is a sophisticated organ with distinctive anatomy and physiology that hinders the passage of drugs into targeted ophthalmic sites. Effective topical administration is an interest of scientists for many decades. Their difficult mission is to prolong drug residence time and guarantee an appropriate ocular permeation. Several ocular obstacles oppose effective drug delivery such as precorneal, corneal, and blood-corneal barriers. Routes for ocular delivery include topical, intravitreal, intraocular, juxtascleral, subconjunctival, intracameral, and retrobulbar. More than 95% of marketed products exists in liquid state. However, other products could be in semi-solid (ointments and gels), solid state (powder, insert and lens), or mixed (in situ gel). Nowadays, attractiveness to nanotechnology-based carries is resulted from their capabilities to entrap both hydrophilic and lipophilic drugs, enhance ocular permeability, sustain residence time, improve drug stability, and augment bioavailability. Different in vitro, ex vivo, and in vivo characterization approaches help to predict the outcomes of the constructed nanocarriers. This review aims to clarify anatomy of the eye, various ocular diseases, and obstacles to ocular delivery. Moreover, it studies the advantages and drawbacks of different ocular routes of administration and dosage forms. This review also discusses different nanostructured platforms and their characterization approaches. Strategies to enhance ocular bioavailability are also explained. Finally, recent advances in ocular delivery are described.
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Affiliation(s)
- Sadek Ahmed
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt.
| | - Maha M Amin
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
| | - Sinar Sayed
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
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4
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Innovation in the Development of Synthetic and Natural Ocular Drug Delivery Systems for Eye Diseases Treatment: Focusing on Drug-Loaded Ocular Inserts, Contacts, and Intraocular Lenses. Pharmaceutics 2023; 15:pharmaceutics15020625. [PMID: 36839947 PMCID: PMC9961328 DOI: 10.3390/pharmaceutics15020625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Nowadays, ocular drug delivery still remains a challenge, since the conventional dosage forms used for anterior and posterior ocular disease treatments, such as topical, systemic, and intraocular administration methods, present important limitations mainly related to the anatomical complexity of the eye. In particular, the blood-ocular barrier along with the corneal barrier, ocular surface, and lacrimal fluid secretion reduce the availability of the administered active compounds and their efficacy. These limitations have increased the need to develop safe and effective ocular delivery systems able to sustain the drug release in the interested ocular segment over time. In the last few years, thanks to the innovations in the materials and technologies employed, different ocular drug delivery systems have been developed. Therefore, this review aims to summarize the synthetic and natural drug-loaded ocular inserts, contacts, and intraocular lenses that have been recently developed, emphasizing the characteristics that make them promising for future ocular clinical applications.
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Kaya S, Kondolot Solak E. Development of ketorolac tromethamine loaded biocompatible polymeric microspheres and matrix films: designing for topical application. INT J POLYM MATER PO 2022. [DOI: 10.1080/00914037.2022.2097679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Seçil Kaya
- Department of Advanced Technologies, Gazi University, Ankara, Turkey
- Department of Material and Material Processing Technologies, Technical Sciences Vocational School, Gazi University, Ankara, Turkey
| | - Ebru Kondolot Solak
- Department of Advanced Technologies, Gazi University, Ankara, Turkey
- Department of Chemistry and Chemical Processing Technologies, Technical Sciences Vocational School, Gazi University, Ankara, Turkey
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Yang CD, Jessen J, Lin KY. Ultrasound-assisted ocular drug delivery: A review of current evidence. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:685-693. [PMID: 35474512 DOI: 10.1002/jcu.23214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 06/14/2023]
Abstract
Efficient ocular drug delivery is a challenging clinical problem with various therapeutic options but no clearly preferred methodology. Given the ubiquity of ultrasound as a diagnostic technique, the safety profile of ultrasound in an ocular context, and the prospect of custom-made ultrasound-sensitive contrast agents, ultrasound presents an attractive ocular drug delivery modality. In this review, we evaluate our present understanding of ultrasound as it relates to ocular drug delivery and significant knowledge gaps in the field. In doing so, we hope to call attention to a potentially novel drug delivery pathway that could be manipulated to treat or cure ocular diseases.
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Affiliation(s)
- Christopher D Yang
- Department of Ophthalmology, University of California, Irvine School of Medicine, Irvine, California, USA
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Jordan Jessen
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Ken Y Lin
- Department of Ophthalmology, University of California, Irvine School of Medicine, Irvine, California, USA
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
- Department of Biomedical Engineering, University of California, Irvine, California, USA
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Yang Y, Lockwood A. Topical ocular drug delivery systems: Innovations for an unmet need. Exp Eye Res 2022; 218:109006. [DOI: 10.1016/j.exer.2022.109006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/06/2022] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
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Tuft S, Somerville TF, Li JPO, Neal T, De S, Horsburgh MJ, Fothergill JL, Foulkes D, Kaye S. Bacterial keratitis: identifying the areas of clinical uncertainty. Prog Retin Eye Res 2021; 89:101031. [PMID: 34915112 DOI: 10.1016/j.preteyeres.2021.101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis is a common corneal infection that is treated with topical antimicrobials. By the time of presentation there may already be severe visual loss from corneal ulceration and opacity, which may persist despite treatment. There are significant differences in the associated risk factors and the bacterial isolates between high income and low- or middle-income countries, so that general management guidelines may not be appropriate. Although the diagnosis of bacterial keratitis may seem intuitive there are multiple uncertainties about the criteria that are used, which impacts the interpretation of investigations and recruitment to clinical studies. Importantly, the concept that bacterial keratitis can only be confirmed by culture ignores the approximately 50% of cases clinically consistent with bacterial keratitis in which investigations are negative. The aetiology of these culture-negative cases is unknown. Currently, the estimation of bacterial susceptibility to antimicrobials is based on data from systemic administration and achievable serum or tissue concentrations, rather than relevant corneal concentrations and biological activity in the cornea. The provision to the clinician of minimum inhibitory concentrations of the antimicrobials for the isolated bacteria would be an important step forward. An increase in the prevalence of antimicrobial resistance is a concern, but the effect this has on disease outcomes is yet unclear. Virulence factors are not routinely assessed although they may affect the pathogenicity of bacteria within species and affect outcomes. New technologies have been developed to detect and kill bacteria, and their application to bacterial keratitis is discussed. In this review we present the multiple areas of clinical uncertainty that hamper research and the clinical management of bacterial keratitis, and we address some of the assumptions and dogma that have become established in the literature.
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Affiliation(s)
- Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Tobi F Somerville
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Timothy Neal
- Department of Clinical Microbiology, Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - Surjo De
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
| | - Malcolm J Horsburgh
- Department of Infection and Microbiomes, University of Liverpool, Crown Street, Liverpool, L69 7BX, UK.
| | - Joanne L Fothergill
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Daniel Foulkes
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Stephen Kaye
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
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Recent advances in ophthalmic preparations: Ocular barriers, dosage forms and routes of administration. Int J Pharm 2021; 608:121105. [PMID: 34537269 DOI: 10.1016/j.ijpharm.2021.121105] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
The human eye is a complex organ with unique anatomy and physiology that restricts the delivery of drugs to target ocular tissues/sites. Recent advances in the field of pharmacy, biotechnology and material science have led to development of novel ophthalmic dosage forms which can provide sustained drug delivery, reduce dosing frequency and improve the ocular bioavailability of drugs. This review highlights the different anatomical and physiological factors which affect ocular bioavailability of drugs and explores advancements from 2016 to 2020 in various ophthalmic preparations. Different routes of drug administration such as topical, intravitreal, intraocular, juxtascleral, subconjunctival, intracameral and retrobulbar are discussed with their advances and limitations.
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Bertens CJF, Gijs M, Dias AAJ, van den Biggelaar FJHM, Ghosh A, Sethu S, Nuijts RMMA. Pharmacokinetics and efficacy of a ketorolac-loaded ocular coil in New Zealand white rabbits. Drug Deliv 2021; 28:400-407. [PMID: 33594935 PMCID: PMC7894442 DOI: 10.1080/10717544.2021.1883157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Eye drops are considered standard practice for the delivery of ocular drugs. However, low patient compliance and low drug levels compromise its effectiveness. Our group developed a ketorolac-loaded ocular coil for sustained drug delivery up to 28 days. The aim of this study was to gain insight into the pharmacokinetics and efficacy of the ocular coil. The pharmacokinetics of the ketorolac-loaded ocular coil versus eye drops were tested in New Zealand White rabbits by repetitive sampling for 28 days. Efficacy of the ocular coil was also tested in New Zealand White rabbits. Ocular inflammation was induced where after the ocular coil was inserted, or eye drops, or no treatment was provided. The total protein concentration and cytokine levels were measured in tears, aqueous humor, and plasma at 4 h, 8 h, 24 h, 4 d, 7 d, 14 d, 21 d, and 28 d. Four h after inserting the ocular coil in the eye, ketorolac levels in aqueous humor and plasma were higher in the ocular coil group than in the eye drop group. Ketorolac released from the ocular coil could be detected up to 28 d in tears, up to 4 d in aqueous humor and up to 24 h in plasma. After inducing inflammation, both the ocular coil and eye drops were able to suppress prostaglandin E2, TNFα and IL-6 levels in aqueous humor and plasma as compared to the group that received no treatment. To conclude, the ocular coil facilitated a sustained release of the drug and showed similar therapeutic benefit in suppressing post-operative inflammation as eye drops.
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Affiliation(s)
- Christian J F Bertens
- Chemelot Institute for Science and Technology (InSciTe), Maastricht, The Netherlands.,University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Marlies Gijs
- Chemelot Institute for Science and Technology (InSciTe), Maastricht, The Netherlands.,University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Aylvin A J Dias
- Chemelot Institute for Science and Technology (InSciTe), Maastricht, The Netherlands.,Eyegle bv, Maastricht, The Netherlands
| | - Frank J H M van den Biggelaar
- Chemelot Institute for Science and Technology (InSciTe), Maastricht, The Netherlands.,University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Rudy M M A Nuijts
- Chemelot Institute for Science and Technology (InSciTe), Maastricht, The Netherlands.,University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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Bertens CJF, Dunker SL, Dias AJAA, van den Biggelaar FJHM, Nuijts RMMA, Gijs M. Safety and Comfort of an Innovative Drug Delivery Device in Healthy Subjects. Transl Vis Sci Technol 2021; 9:35. [PMID: 33384889 PMCID: PMC7757610 DOI: 10.1167/tvst.9.13.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose The aim of this study was to investigate safety and comfort of two versions of a placebo-microsphere filled ocular coil (straight and curved) in healthy subjects. Methods The study was a single-center intervention study. One ocular coil was placed in the inferior conjunctival fornix for the intended duration of 28 days. Forty-two healthy adult subjects were included. At baseline, 30 minutes, 8 hours, 24 hours, 48 hours, 7 days, 14 days, 21 days, and 28 days after insertion, examinations were performed, including slit lamp evaluation to score ocular redness, intraocular pressure measurement, visual acuity, tear secretion test, and questionnaires. Results The straight and curved ocular coils had a median retention time of 5 days and 12 days, respectively. After 48 hours, 57% and 81% subjects retained the straight and curved ocular coil, respectively. Four (19%) subjects with the straight coil and six (29%) with the curved coil completed the entire study period. Minor changes in ocular hyperemia were observed in both groups. On day 7, the straight coil was more comfortable than the curved coil with a visual analogue scale (VAS) score of 77 ± 21 compared to 94 ± 11 (P = 0.028), respectively. No other ocular adverse events were observed. Conclusions Comfort and safety of the straight and curved ocular coil are high. Because the retention time is too short for long-term sustained drug release, the use in the perioperative or immediate postoperative period could prove to be more valuable. Translational Relevance The ocular coil is a noninvasive, comfortable and safe short-term drug delivery device.
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Affiliation(s)
- Christian J F Bertens
- Chemelot Institute for Science and Technology (InSciTe), GS Maastricht, The Netherlands
| | - Suryan L Dunker
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), HX Maastricht, The Netherlands.,Maastricht University, School for Mental Health and Neuroscience, University Eye Clinic Maastricht, ER Maastricht, The Netherlands
| | - Aylvin J A A Dias
- Chemelot Institute for Science and Technology (InSciTe), GS Maastricht, The Netherlands.,Eyegle bv. Gerbergaplantsoen 11, Maastricht, The Netherlands
| | - Frank J H M van den Biggelaar
- Chemelot Institute for Science and Technology (InSciTe), GS Maastricht, The Netherlands.,University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), HX Maastricht, The Netherlands
| | - Rudy M M A Nuijts
- Chemelot Institute for Science and Technology (InSciTe), GS Maastricht, The Netherlands.,University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), HX Maastricht, The Netherlands
| | - Marlies Gijs
- Chemelot Institute for Science and Technology (InSciTe), GS Maastricht, The Netherlands
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Sadr MS, Heydarinasab A, Panahi HA, Javan RS. Production and characterization of biocompatible nano‐carrier based on
Fe
3
O
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for magnetically hydroxychloroquine drug delivery. POLYM ADVAN TECHNOL 2020. [DOI: 10.1002/pat.5110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mahshad Sadat Sadr
- Department of Petroleum and Chemical Engineering, Science and Research Branch Islamic Azad University Tehran Iran
| | - Amir Heydarinasab
- Department of Petroleum and Chemical Engineering, Science and Research Branch Islamic Azad University Tehran Iran
| | - Homayon Ahmad Panahi
- Department of Chemistry, Central Tehran Branch Islamic Azad University Tehran Iran
| | - Raheleh Safaie Javan
- Department of Biology, Varamin‐Pishva Branch Islamic Azad University Varamin Iran
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