1
|
Temchura V, Wagner JT, Damm D. Immunogenicity of Recombinant Lipid-Based Nanoparticle Vaccines: Danger Signal vs. Helping Hand. Pharmaceutics 2023; 16:24. [PMID: 38258035 PMCID: PMC10818441 DOI: 10.3390/pharmaceutics16010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Infectious diseases are a predominant problem in human health. While the incidence of many pathogenic infections is controlled by vaccines, some pathogens still pose a challenging task for vaccine researchers. In order to face these challenges, the field of vaccine development has changed tremendously over the last few years. For non-replicating recombinant antigens, novel vaccine delivery systems that attempt to increase the immunogenicity by mimicking structural properties of pathogens are already approved for clinical applications. Lipid-based nanoparticles (LbNPs) of different natures are vesicles made of lipid layers with aqueous cavities, which may carry antigens and other biomolecules either displayed on the surface or encapsulated in the cavity. However, the efficacy profile of recombinant LbNP vaccines is not as high as that of live-attenuated ones. This review gives a compendious picture of two approaches that affect the immunogenicity of recombinant LbNP vaccines: (i) the incorporation of immunostimulatory agents and (ii) the utilization of pre-existing or promiscuous cellular immunity, which might be beneficial for the development of tailored prophylactic and therapeutic LbNP vaccine candidates.
Collapse
Affiliation(s)
- Vladimir Temchura
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | | | - Dominik Damm
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| |
Collapse
|
2
|
ÇOBAN S, SAKA OM, BOZKIR A. Evaluation of Biodegradable Microparticles for Mucosal Vaccination Against Diphtheria Toxoid: Nasal Efficacy Studies in Guinea Pigs. Turk J Pharm Sci 2023; 20:294-301. [PMID: 37933761 PMCID: PMC10631365 DOI: 10.4274/tjps.galenos.2022.05626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Objectives In this study, poly-(ɛ-caprolactone) (PCL) and poly-(lactic-co-glycolic acid) (PLGA) microparticles encapsulating diphtheria toxoid (DT) were investigated for their potential as a mucosal vaccine delivery system. Materials and Methods Antigen-containing microparticles were prepared using the double emulsion (w/o/w) solvent evaporation method. Results The average geometric diameter of the particles was found to be between 7 and 24 µm, which is suitable for uptake by the antigen-presenting cells in the nasal mucosa. Although the differences were insignificant, the PLGA polymer-containing formulations exhibited the highest encapsulation efficiency. Microparticle formulations, prepared with both PLGA and PCL polymers, were successfully produced at high production yields. The in vitro release profile was presented as a biexponential process with an initial burst effect due to the release of the protein adsorbed on the microsphere surface, and the subsequent sustained release profile is the result of protein diffusion through the channels or pores formed in the polymer matrix. DT-loaded microparticles, DT solution in phosphate-buffered saline (PBS), and empty microparticles (control) were administered via nasal route and subcutaneously to guinea pigs. The antibody content of each serum sample was determined using an enzyme-linked immunosorbent assay (ELISA). Conclusion Absorbance values of the ELISA test showed that PLGA- and PCL-bearing microparticles could stimulate an adequate systemic immune response with intranasal vaccination. In addition, PLGA and PCL microparticles resulted in significantly increased IgG titers with intranasal administration as a booster dose following subcutaneous administration. PCL polymer elicited a high immune response compared with PLGA polymer (p <0.05).
Collapse
Affiliation(s)
- Selin ÇOBAN
- Ankara University, Graduate School of Health Sciences, Ankara, Türkiye
| | - Ongun Mehmet SAKA
- Ankara University Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Türkiye
| | - Asuman BOZKIR
- Ankara University Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Türkiye
| |
Collapse
|
3
|
Vora LK, Sabri AH, Naser Y, Himawan A, Hutton ARJ, Anjani QK, Volpe-Zanutto F, Mishra D, Li M, Rodgers AM, Paredes AJ, Larrañeta E, Thakur RRS, Donnelly RF. Long-acting microneedle formulations. Adv Drug Deliv Rev 2023; 201:115055. [PMID: 37597586 DOI: 10.1016/j.addr.2023.115055] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
The minimally-invasive and painless nature of microneedle (MN) application has enabled the technology to obviate many issues with injectable drug delivery. MNs not only administer therapeutics directly into the dermal and ocular space, but they can also control the release profile of the active compound over a desired period. To enable prolonged delivery of payloads, various MN types have been proposed and evaluated, including dissolving MNs, polymeric MNs loaded or coated with nanoparticles, fast-separable MNs hollow MNs, and hydrogel MNs. These intricate yet intelligent delivery platforms provide an attractive approach to decrease side effects and administration frequency, thus offer the potential to increase patient compliance. In this review, MN formulations that are loaded with various therapeutics for long-acting delivery to address the clinical needs of a myriad of diseases are discussed. We also highlight the design aspects, such as polymer selection and MN geometry, in addition to computational and mathematical modeling of MNs that are necessary to help streamline and develop MNs with high translational value and clinical impact. Finally, up-scale manufacturing and regulatory hurdles along with potential avenues that require further research to bring MN technology to the market are carefully considered. It is hoped that this review will provide insight to formulators and clinicians that the judicious selection of materials in tandem with refined design may offer an elegant approach to achieve sustained delivery of payloads through the simple and painless application of a MN patch.
Collapse
Affiliation(s)
- Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Akmal H Sabri
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Yara Naser
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Achmad Himawan
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Department of Pharmaceutical Science and Technology, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Aaron R J Hutton
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Fabiana Volpe-Zanutto
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Deepakkumar Mishra
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Mingshan Li
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Aoife M Rodgers
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Alejandro J Paredes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | | | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
| |
Collapse
|
4
|
Wang H, Xu J, Xiang L. Microneedle-Mediated Transcutaneous Immunization: Potential in Nucleic Acid Vaccination. Adv Healthc Mater 2023; 12:e2300339. [PMID: 37115817 DOI: 10.1002/adhm.202300339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Indexed: 04/29/2023]
Abstract
Efforts aimed at exploring economical and efficient vaccination have taken center stage to combat frequent epidemics worldwide. Various vaccines have been developed for infectious diseases, among which nucleic acid vaccines have attracted much attention from researchers due to their design flexibility and wide application. However, the lack of an efficient delivery system considerably limits the clinical translation of nucleic acid vaccines. As mass vaccinations via syringes are limited by low patient compliance and high costs, microneedles (MNs), which can achieve painless, cost-effective, and efficient drug delivery, can provide an ideal vaccination strategy. The MNs can break through the stratum corneum barrier in the skin and deliver vaccines to the immune cell-rich epidermis and dermis. In addition, the feasibility of MN-mediated vaccination is demonstrated in both preclinical and clinical studies and has tremendous potential for the delivery of nucleic acid vaccines. In this work, the current status of research on MN vaccines is reviewed. Moreover, the improvements of MN-mediated nucleic acid vaccination are summarized and the challenges of its clinical translation in the future are discussed.
Collapse
Affiliation(s)
- Haochen Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Junhua Xu
- Biopharmaceutical Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lin Xiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| |
Collapse
|
5
|
Aroffu M, Manca ML, Pedraz JL, Manconi M. Liposome-based vaccines for minimally or noninvasive administration: an update on current advancements. Expert Opin Drug Deliv 2023; 20:1573-1593. [PMID: 38015659 DOI: 10.1080/17425247.2023.2288856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Vaccination requires innovation to provide effective protection. Traditional vaccines have several drawbacks, which can be overcome with advanced technologies and different administration routes. Over the past 10 years, a significant amount of research has focussed on the delivery of antigens into liposomes due to their dual role as antigen-carrying systems and vaccine adjuvants able to increase the immunogenicity of the carried antigen. AREAS COVERED This review encompasses the progress made over the last 10 years with liposome-based vaccines designed for minimally or noninvasive administration, filling the gaps in previous reviews and providing insights on composition, administration routes, results achieved, and Technology Readiness Level of the most recent formulations. EXPERT OPINION Liposome-based vaccines administered through minimally or noninvasive routes are expected to improve efficacy and complacency of vaccination programs. However, the translation from lab-scale production to large-scale production and collaborations with hospitals, research centers, and companies are needed to allow new products to enter the market and improve the vaccination programs in the future.
Collapse
Affiliation(s)
- Matteo Aroffu
- Department of Scienze della Vita e dell'Ambiente, University of Cagliari, Cagliari, Italy
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Maria Letizia Manca
- Department of Scienze della Vita e dell'Ambiente, University of Cagliari, Cagliari, Italy
| | - José Luis Pedraz
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
- Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
- BioAraba, NanoBioCel research Group, Vitoria-Gasteiz, Spain
| | - Maria Manconi
- Department of Scienze della Vita e dell'Ambiente, University of Cagliari, Cagliari, Italy
| |
Collapse
|
6
|
Chen X. Emerging adjuvants for intradermal vaccination. Int J Pharm 2023; 632:122559. [PMID: 36586639 PMCID: PMC9794530 DOI: 10.1016/j.ijpharm.2022.122559] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
The majority of vaccines have been delivered into the muscular tissue. Skin contains large amounts of antigen-presenting cells and has been recognized as a more immunogenic site for vaccine delivery. Intradermal delivery has been approved to improve influenza vaccine efficacy and spare influenza vaccine doses. In response to the recent monkeypox outbreak, intradermal delivery has been also approved to stretch the limited monkeypox vaccine doses to immunize more people at risk. Incorporation of vaccine adjuvants is promising to further increase intradermal vaccine efficacy and spare more vaccine doses. Yet, intradermal vaccination is associated with more significant local reactions than intramuscular vaccination. Thus, adjuvants suitable to boost intradermal vaccination need to have a good local safety without inducing overt local reactions. This review introduces currently approved adjuvants in licensed human vaccines and their relative reactogenicity for intradermal delivery and then introduces emerging chemical and physical adjuvants with a good local safety to boost intradermal vaccination. The rational to develop physical adjuvants, the types of physical adjuvants, and the unique advantages of physical adjuvants to boost intradermal vaccination are also introduced in this review.
Collapse
Affiliation(s)
- Xinyuan Chen
- Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, United States.
| |
Collapse
|
7
|
Recent progress in application of nanovaccines for enhancing mucosal immune responses. Acta Pharm Sin B 2022. [DOI: 10.1016/j.apsb.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
8
|
Ruan S, Zhang Y, Feng N. Microneedle-mediated transdermal nanodelivery systems: a review. Biomater Sci 2021; 9:8065-8089. [PMID: 34752590 DOI: 10.1039/d1bm01249e] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The greatest limitation in the development of transdermal drug delivery systems is that only a few drugs can permeate the skin due to the barrier function of the stratum corneum. Active and passive methods are generally available for improving the ability of drug transdermal delivery. However, nanoparticles, as a passive approach, exhibit capacity-constrained permeation enhancement. Thus, microneedle-mediated nanoparticles possess enormous potential and broad prospects. Microneedles promote the penetration of macromolecules by creating microchannels on the skin surface. In this review, the prevailing subknowledge on microneedles (mechanism, classification, and applications of microneedles combined with nanoparticles) is discussed to provide a guideline for readers and a basic reference for further in-depth studies of this novel drug delivery system.
Collapse
Affiliation(s)
- Shuyao Ruan
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Yongtai Zhang
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Nianping Feng
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| |
Collapse
|
9
|
Leboux RJT, Schipper P, van Capel TMM, Kong L, van der Maaden K, Kros A, Jiskoot W, de Jong EC, Bouwstra JA. Antigen Uptake After Intradermal Microinjection Depends on Antigen Nature and Formulation, but Not on Injection Depth. FRONTIERS IN ALLERGY 2021; 2:642788. [PMID: 35386985 PMCID: PMC8974696 DOI: 10.3389/falgy.2021.642788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
The skin is an attractive alternative administration route for allergy vaccination, as the skin is rich in dendritic cells (DCs) and is easily accessible. In the skin multiple subsets of DCs with distinct roles reside at different depths. In this study antigen (=allergen for allergy) formulations were injected in ex vivo human skin in a depth-controlled manner by using a hollow microneedle injection system. Biopsies were harvested at the injection site, which were then cultured for 72 h. Subsequently, the crawled-out cells were collected from the medium and analyzed with flow cytometry. Intradermal administration of ovalbumin (OVA, model antigen) solution at various depths in the skin did not affect the migration and maturation of DCs. OVA was taken up efficiently by the DCs, and this was not affected by the injection depth. In contrast, Bet v 1, the major allergen in birch pollen allergy, was barely taken up by dermal DCs (dDCs). Antigens were more efficiently taken up by CD14+ dDCs than CD1a+ dDCs, which in turn were more efficient at taken up antigen than Langerhans cells. Subsequently, both OVA and Bet v 1 were formulated in cationic and anionic liposomes, which altered antigen uptake drastically following intradermal microinjection. While OVA uptake was reduced by formulation in liposomes, Bet v 1 uptake in dDCs was increased by encapsulation in both cationic and anionic liposomes. This highlights the potential use of liposomes as adjuvant in intradermal allergy vaccine delivery. In conclusion, we observed that antigen uptake after intradermal injection was not affected by injection depth, but varied between different antigens and formulation.
Collapse
Affiliation(s)
- Romain J. T. Leboux
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Pim Schipper
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Toni M. M. van Capel
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, Netherlands
| | - Lily Kong
- Division of Supramolecular Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, Netherlands
- Tongji School of Pharmacy, HuaZhong University of Science and Technology, Wuhan, China
| | - Koen van der Maaden
- Tumor Immunology Group, Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
- TECO Development GmbH, Rheinbach, Germany
| | - Alexander Kros
- Division of Supramolecular Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, Netherlands
| | - Wim Jiskoot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Esther C. de Jong
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, Netherlands
- Esther C. de Jong
| | - Joke A. Bouwstra
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
- *Correspondence: Joke A. Bouwstra
| |
Collapse
|
10
|
Lipid Nanoparticle-Mediated Lymphatic Delivery of Immunostimulatory Nucleic Acids. Pharmaceutics 2021; 13:pharmaceutics13040490. [PMID: 33916667 PMCID: PMC8103501 DOI: 10.3390/pharmaceutics13040490] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022] Open
Abstract
Lymphatic delivery of a vaccine can be achieved using a dendritic cell (DC)-targeted delivery system that can cause DC to migrate to lymph nodes upon activation by an adjuvant. Here, we designed a mannose-modified cationic lipid nanoparticle (M-NP) to deliver the nucleic acid adjuvant, polyinosinic:polycytidylic acid (PIC). PIC-loaded M-NP (PIC/M-NP) showed stable lipoplexes regardless of the ligand ratio and negligible cytotoxicity in bone marrow-derived DC. DC uptake of PIC/M-NP was demonstrated, and an increased mannose ligand ratio improved DC uptake efficiency. PIC/M-NP significantly promoted the maturation of bone marrow-derived DC, and local injection of PIC/M-NP to mice facilitated lymphatic delivery and activation (upon NP uptake) of DC. Our results support the potential of PIC/M-NP in delivering a nucleic acid adjuvant for the vaccination of antigens.
Collapse
|
11
|
Loira-Pastoriza C, Vanvarenberg K, Ucakar B, Machado Franco M, Staub A, Lemaire M, Renauld JC, Vanbever R. Encapsulation of a CpG oligonucleotide in cationic liposomes enhances its local antitumor activity following pulmonary delivery in a murine model of metastatic lung cancer. Int J Pharm 2021; 600:120504. [PMID: 33753161 DOI: 10.1016/j.ijpharm.2021.120504] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 01/05/2023]
Abstract
Immunotherapy brings new hope to the fight against lung cancer. General immunostimulatory agents represent an immunotherapy strategy that has demonstrated efficacy with limited toxicity when delivered intratumorally. The goal of this study was to enhance the antitumor efficacy of unmethylated oligodeoxynucleotides containing CpG motifs (CpG) and polyinosinic-polycytidylic acid (poly I:C) double-stranded RNA following their local delivery in lung cancer by encapsulating them in liposomes. Liposomes encapsulation of nucleic acids could increase their uptake by lung phagocytes and thereby the activation of toll-like receptors within endosomes. Liposomes were prepared using a cationic lipid, dioleoyltrimethylammoniumpropane (DOTAP), and dipalmitoylphosphatidylcholine (DPPC), the main phospholipid in lung surfactant. The liposomes permanently entrapped CpG but could not efficiently withhold poly I:C. Both poly I:C and CpG delayed tumor growth in the murine B16F10 model of metastatic lung cancer. However, only CpG increased IFN-γ levels in the lungs. Pulmonary administration of CpG was superior to its intraperitoneal injection to slow the growth of lung metastases and to induce the production of granzyme B, a pro-apoptotic protein, and IFNγ, MIG and RANTES, T helper type 1 cytokines and chemokines, in the lungs. These antitumor activities of CpG were strongly enhanced by CpG encapsulation in DOTAP/DPPC liposomes. Delivery of low CpG doses to the lungs induced increased inflammation markers in the airspaces but the inflammation did not reach the systemic compartment in a significant manner. These data support the use of a delivery carrier to strengthen CpG antitumor activity following its pulmonary delivery in lung cancer.
Collapse
Affiliation(s)
- Cristina Loira-Pastoriza
- Université catholique de Louvain (UCLouvain), Louvain Drug Research Institute, Advanced Drug Delivery & Biomaterials, Brussels, Belgium
| | - Kevin Vanvarenberg
- Université catholique de Louvain (UCLouvain), Louvain Drug Research Institute, Advanced Drug Delivery & Biomaterials, Brussels, Belgium
| | - Bernard Ucakar
- Université catholique de Louvain (UCLouvain), Louvain Drug Research Institute, Advanced Drug Delivery & Biomaterials, Brussels, Belgium
| | - Maria Machado Franco
- Université catholique de Louvain (UCLouvain), Louvain Drug Research Institute, Advanced Drug Delivery & Biomaterials, Brussels, Belgium
| | - Aurélie Staub
- Université catholique de Louvain (UCLouvain), Louvain Drug Research Institute, Advanced Drug Delivery & Biomaterials, Brussels, Belgium
| | - Muriel Lemaire
- UCLouvain, de Duve Institute, Experimental Medicine Unit, Brussels, Belgium
| | | | - Rita Vanbever
- Université catholique de Louvain (UCLouvain), Louvain Drug Research Institute, Advanced Drug Delivery & Biomaterials, Brussels, Belgium.
| |
Collapse
|
12
|
Cárcamo-Martínez Á, Mallon B, Domínguez-Robles J, Vora LK, Anjani QK, Donnelly RF. Hollow microneedles: A perspective in biomedical applications. Int J Pharm 2021; 599:120455. [PMID: 33676993 DOI: 10.1016/j.ijpharm.2021.120455] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022]
Abstract
Microneedles (MN) have the potential to become a highly progressive device for both drug delivery and monitoring purposes as they penetrate the skin and pierce the stratum corneum barrier, allowing the delivery of drugs in the viable skin layers and the extraction of body fluids. Despite the many years of research and the different types of MN developed, only hollow MN have reached the pharmaceutical market under the path of medical devices. Therefore, this review focuses on hollow MN, materials and methods for their fabrication as well as their application in drug delivery, vaccine delivery and monitoring purposes. Furthermore, novel approaches for the fabrication of hollow MN are included as well as prospects of microneedle-based products on the market.
Collapse
Affiliation(s)
| | - Brónach Mallon
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita K Anjani
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
| |
Collapse
|
13
|
Alimardani V, Abolmaali SS, Yousefi G, Rahiminezhad Z, Abedi M, Tamaddon A, Ahadian S. Microneedle Arrays Combined with Nanomedicine Approaches for Transdermal Delivery of Therapeutics. J Clin Med 2021; 10:E181. [PMID: 33419118 PMCID: PMC7825522 DOI: 10.3390/jcm10020181] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 12/19/2022] Open
Abstract
Organic and inorganic nanoparticles (NPs) have shown promising outcomes in transdermal drug delivery. NPs can not only enhance the skin penetration of small/biomacromolecule therapeutic agents but can also impart control over drug release or target impaired tissue. Thanks to their unique optical, photothermal, and superparamagnetic features, NPs have been also utilized for the treatment of skin disorders, imaging, and biosensing applications. Despite the widespread transdermal applications of NPs, their delivery across the stratum corneum, which is the main skin barrier, has remained challenging. Microneedle array (MN) technology has recently revealed promising outcomes in the delivery of various formulations, especially NPs to deliver both hydrophilic and hydrophobic therapeutic agents. The present work reviews the advancements in the application of MNs and NPs for an effective transdermal delivery of a wide range of therapeutics in cancer chemotherapy and immunotherapy, photothermal and photodynamic therapy, peptide/protein vaccination, and the gene therapy of various diseases. In addition, this paper provides an overall insight on MNs' challenges and summarizes the recent achievements in clinical trials with future outlooks on the transdermal delivery of a wide range of nanomedicines.
Collapse
Affiliation(s)
- Vahid Alimardani
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (V.A.); (Z.R.); (M.A.); (A.T.)
| | - Samira Sadat Abolmaali
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (V.A.); (Z.R.); (M.A.); (A.T.)
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran;
| | - Gholamhossein Yousefi
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran;
| | - Zahra Rahiminezhad
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (V.A.); (Z.R.); (M.A.); (A.T.)
| | - Mehdi Abedi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (V.A.); (Z.R.); (M.A.); (A.T.)
| | - Alimohammad Tamaddon
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (V.A.); (Z.R.); (M.A.); (A.T.)
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran;
| | - Samad Ahadian
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| |
Collapse
|
14
|
Leboux RJT, Benne N, van Os WL, Bussmann J, Kros A, Jiskoot W, Slütter B. High-affinity antigen association to cationic liposomes via coiled coil-forming peptides induces a strong antigen-specific CD4 + T-cell response. Eur J Pharm Biopharm 2020; 158:96-105. [PMID: 33188929 DOI: 10.1016/j.ejpb.2020.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
Liposomes are widely investigated as vaccine delivery systems, but antigen loading efficiency can be low. Moreover, adsorbed antigen may rapidly desorb under physiological conditions. Encapsulation of antigens overcomes the latter problem but results in significant antigen loss during preparation and purification of the liposomes. Here, we propose an alternative attachment method, based on a complementary heterodimeric coiled coil peptide pair pepK and pepE. PepK was conjugated to cholesterol (yielding CPK) and pepE was covalently linked to model antigen OVA323 (yielding pepE-OVA323). CPK was incorporated in the lipid bilayer of cationic liposomes (180 nm in size). Antigen was associated more efficiently to functionalized liposomes (Kd 166 nM) than to cationic liposomes (Kd not detectable). In vivo co-localization of antigen and liposomes was strongly increased upon CPK-functionalization (35% -> 80%). CPK-functionalized liposomes induced 5-fold stronger CD4+ T-cell proliferation than non-functionalized liposomes in vitro. Both formulations were able to induce strong CD4+ T-cell expansion in mice, but more IFN-y and IL-10 production was observed after immunization with functionalized liposomes. In conclusion, antigen association via coiled coil peptide pair increased co-localization of antigen and liposomes, increased CD4+ T-cell proliferation in vitro and induced a stronger CD4+ T-cell response in vivo.
Collapse
Affiliation(s)
- R J T Leboux
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - N Benne
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - W L van Os
- Div. of Supramolecular & Biomaterials Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - J Bussmann
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - A Kros
- Div. of Supramolecular & Biomaterials Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - W Jiskoot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - B Slütter
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands.
| |
Collapse
|
15
|
Jamaledin R, Makvandi P, Yiu CKY, Agarwal T, Vecchione R, Sun W, Maiti TK, Tay FR, Netti PA. Engineered Microneedle Patches for Controlled Release of Active Compounds: Recent Advances in Release Profile Tuning. ADVANCED THERAPEUTICS 2020. [DOI: 10.1002/adtp.202000171] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rezvan Jamaledin
- Department of Chemical, Materials & Industrial Production Engineering University of Naples Federico II Naples 80125 Italy
- Center for Advanced Biomaterials for Health Care (iit@CRIB) Italian Institute of Technology Naples 80125 Italy
| | - Pooyan Makvandi
- Center for Micro‐BioRobotics Istituto Italiano di Tecnologia (IIT) Viale R. Piaggio 34, 56025 Pontedera Pisa Italy
| | - Cynthia K. Y. Yiu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Prince Philip Dental Hospital The University of Hong Kong Hong Kong SAR China
| | - Tarun Agarwal
- Department of Biotechnology Indian Institute of Technology Kharagpur 721302 India
| | - Raffaele Vecchione
- Center for Advanced Biomaterials for Health Care (iit@CRIB) Italian Institute of Technology Naples 80125 Italy
| | - Wujin Sun
- Department of Bioengineering Center for Minimally Invasive Therapeutics University of California, Los Angeles Los Angeles CA 90095 USA
| | - Tapas Kumar Maiti
- Department of Biotechnology Indian Institute of Technology Kharagpur 721302 India
| | | | - Paolo Antonio Netti
- Center for Advanced Biomaterials for Health Care (iit@CRIB) Italian Institute of Technology Naples 80125 Italy
| |
Collapse
|
16
|
Li D, Hu D, Xu H, Patra HK, Liu X, Zhou Z, Tang J, Slater N, Shen Y. Progress and perspective of microneedle system for anti-cancer drug delivery. Biomaterials 2020; 264:120410. [PMID: 32979655 DOI: 10.1016/j.biomaterials.2020.120410] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Transdermal drug delivery exhibited encouraging prospects, especially through superficial drug administration routes. However, only a few limited lipophilic drug molecules could cross the skin barrier, those are with low molecular weight and rational Log P value. Microneedles (MNs) can overcome these limitations to deliver numerous drugs into the dermal layer by piercing the outermost skin layer of the body. In the case of superficial cancer treatments, topical drug administration faces severely low transfer efficiency, and systemic treatments are always associated with side effects and premature drug degradation. MN-based systems have achieved excellent technical capabilities and been tested for pre-clinical chemotherapy, photothermal therapy, photodynamic therapy, and immunotherapy. In this review, we will focus on the features, progress, and opportunities of MNs in the anticancer drug delivery system. Then, we will discuss the strategies and advantages in these works and summarize challenges, perspectives, and translational potential for future applications.
Collapse
Affiliation(s)
- Dongdong Li
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Doudou Hu
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Hongxia Xu
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Hirak K Patra
- Wolfson College, University of Cambridge, Cambridge, CB3 9BB, United Kingdom; Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, United Kingdom
| | - Xiangrui Liu
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Zhuxian Zhou
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Jianbin Tang
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Nigel Slater
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 0AS, United Kingdom
| | - Youqing Shen
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education and Center for Bionanoengineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| |
Collapse
|
17
|
Abstract
Personalized cancer vaccines (PCVs) are reinvigorating vaccine strategies in cancer immunotherapy. In contrast to adoptive T-cell therapy and checkpoint blockade, the PCV strategy modulates the innate and adaptive immune systems with broader activation to redeploy antitumor immunity with individualized tumor-specific antigens (neoantigens). Following a sequential scheme of tumor biopsy, mutation analysis, and epitope prediction, the administration of neoantigens with synthetic long peptide (SLP) or mRNA formulations dramatically improves the population and activity of antigen-specific CD4+ and CD8+ T cells. Despite the promising prospect of PCVs, there is still great potential for optimizing prevaccination procedures and vaccine potency. In particular, the arduous development of tumor-associated antigen (TAA)-based vaccines provides valuable experience and rational principles for augmenting vaccine potency which is expected to advance PCV through the design of adjuvants, delivery systems, and immunosuppressive tumor microenvironment (TME) reversion since current personalized vaccination simply admixes antigens with adjuvants. Considering the broader application of TAA-based vaccine design, these two strategies complement each other and can lead to both personalized and universal therapeutic methods. Chemical strategies provide vast opportunities for (1) exploring novel adjuvants, including synthetic molecules and materials with optimizable activity, (2) constructing efficient and precise delivery systems to avoid systemic diffusion, improve biosafety, target secondary lymphoid organs, and enhance antigen presentation, and (3) combining bioengineering methods to innovate improvements in conventional vaccination, "smartly" re-educate the TME, and modulate antitumor immunity. As chemical strategies have proven versatility, reliability, and universality in the design of T cell- and B cell-based antitumor vaccines, the union of such numerous chemical methods in vaccine construction is expected to provide new vigor and vitality in cancer treatment.
Collapse
Affiliation(s)
- Wen-Hao Li
- Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology (Ministry of Education), Department of Chemistry, Tsinghua University, 100084 Beijing, China
| | - Yan-Mei Li
- Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology (Ministry of Education), Department of Chemistry, Tsinghua University, 100084 Beijing, China.,Beijing Institute for Brain Disorders, 100069 Beijing, China.,Center for Synthetic and Systems Biology, Tsinghua University, 100084 Beijing, China
| |
Collapse
|
18
|
Leone M, Romeijn S, Du G, Le Dévédec S, Vrieling H, O'Mahony C, Bouwstra J, Kersten G. Diphtheria toxoid dissolving microneedle vaccination: Adjuvant screening and effect of repeated-fractional dose administration. Int J Pharm 2020; 580:119182. [DOI: 10.1016/j.ijpharm.2020.119182] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
|
19
|
Jamaledin R, Di Natale C, Onesto V, Taraghdari ZB, Zare EN, Makvandi P, Vecchione R, Netti PA. Progress in Microneedle-Mediated Protein Delivery. J Clin Med 2020; 9:E542. [PMID: 32079212 PMCID: PMC7073601 DOI: 10.3390/jcm9020542] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
The growing demand for patient-compliance therapies in recent years has led to the development of transdermal drug delivery, which possesses several advantages compared with conventional methods. Delivering protein through the skin by transdermal patches is extremely difficult due to the presence of the stratum corneum which restricts the application to lipophilic drugs with relatively low molecular weight. To overcome these limitations, microneedle (MN) patches, consisting of micro/miniature-sized needles, are a promising tool to perforate the stratum corneum and to release drugs and proteins into the dermis following a non-invasive route. This review investigates the fabrication methods, protein delivery, and translational considerations for the industrial scaling-up of polymeric MNs for dermal protein delivery.
Collapse
Affiliation(s)
- Rezvan Jamaledin
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
| | - Concetta Di Natale
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
| | - Valentina Onesto
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
| | - Zahra Baghban Taraghdari
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
| | | | - Pooyan Makvandi
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
- Institute for polymers, Composites and biomaterials (IPCB), National research council (CNR), 80125 Naples, Italy
- Chemistry Department, Faculty of Science, Shahid Chamran University of Ahvaz, P.O. Box: 61537-53843, Ahvaz, Iran
| | - Raffaele Vecchione
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
| | - Paolo Antonio Netti
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
| |
Collapse
|
20
|
Jiang G, Xu B, Zhu J, Zhang Y, Liu T, Song G. Polymer microneedles integrated with glucose-responsive mesoporous bioactive glass nanoparticles for transdermal delivery of insulin. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab3202] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
21
|
Jiao Y, Jiang H, Lu H, Yang Y, Zhang Y, Zhang K, Liu H. Deficiency of hypoxia inducible factor-1α promoted progression of diabetic nephropathy with hypertension. Exp Ther Med 2018; 16:3658-3662. [PMID: 30233722 DOI: 10.3892/etm.2018.6621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
The present study was designed to investigate the effect of hypoxia inducible factor-1α (HIF-1α) on diabetic nephropathy (DN) with hypertension. HIF-1α deficient mice (Mx/HIF-1α-/-) were constructed and treated with streptozotocin (STZ) injection for hypertensive DN induction. Normal C57BL/6 mice received STZ or no treatment (normal) were considered as controls. Three days post STZ administration; body weight, fasting blood glucose (FBG), 24 h urinary albumin and systolic blood pressure (SBP) were measured weekly. Periodic acid-Schiff's staining was performed for histologic analysis of glomeruli damage. In comparison with the normal control, significant upregulation and downregulation of HIF-1α was, respectively, detected in diabetic and HIF-1α-/- mice (P<0.01). In comparison with STZ-induced diabetic mice, HIF-1α-/- + STZ mice displayed reduced body weight, and increased FBG, urinary albumin and SBP. PAS showed HIF-1α-/- + STZ mice had damaged kidney tissues, with more renal fibrosis and apparent glomerular hypertrophy. These results demonstrated that HIF-1α deficiency accelerated DN progression with increasing hypertension in mice.
Collapse
Affiliation(s)
- Yuejiang Jiao
- Department of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, P.R. China
| | - Hongwei Jiang
- Department of Endocrinology, The 1st Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471033, P.R. China
| | - Haibo Lu
- Department of Endocrinology, The 1st Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471033, P.R. China
| | - Yiping Yang
- Department of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, P.R. China
| | - Yanfang Zhang
- Department of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, P.R. China
| | - Kun Zhang
- Department of Endocrinology, The 1st Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471033, P.R. China
| | - Hui Liu
- Department of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471009, P.R. China
| |
Collapse
|