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Wong CYJ, Baldelli A, Hoyos CM, Tietz O, Ong HX, Traini D. Insulin Delivery to the Brain via the Nasal Route: Unraveling the Potential for Alzheimer's Disease Therapy. Drug Deliv Transl Res 2024; 14:1776-1793. [PMID: 38441832 PMCID: PMC11153287 DOI: 10.1007/s13346-024-01558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 06/06/2024]
Abstract
This comprehensive review delves into the potential of intranasal insulin delivery for managing Alzheimer's Disease (AD) while exploring the connection between AD and diabetes mellitus (DM). Both conditions share features of insulin signalling dysregulation and oxidative stress that accelerate inflammatory response. Given the physiological barriers to brain drug delivery, including the blood-brain barrier, intranasal administration emerges as a non-invasive alternative. Notably, intranasal insulin has shown neuroprotective effects, impacting Aβ clearance, tau phosphorylation, and synaptic plasticity. In preclinical studies and clinical trials, intranasally administered insulin achieved rapid and extensive distribution throughout the brain, with optimal formulations exhibiting minimal systemic circulation. The detailed mechanism of insulin transport through the nose-to-brain pathway is elucidated in the review, emphasizing the role of olfactory and trigeminal nerves. Despite promising prospects, challenges in delivering protein drugs from the nasal cavity to the brain remain, including enzymes, tight junctions, mucociliary clearance, and precise drug deposition, which hinder its translation to clinical settings. The review encompasses a discussion of the strategies to enhance the intranasal delivery of therapeutic proteins, such as tight junction modulators, cell-penetrating peptides, and nano-drug carrier systems. Moreover, successful translation of nose-to-brain drug delivery necessitates a holistic understanding of drug transport mechanisms, brain anatomy, and nasal formulation optimization. To date, no intranasal insulin formulation has received regulatory approval for AD treatment. Future research should address challenges related to drug absorption, nasal deposition, and the long-term effects of intranasal insulin. In this context, the evaluation of administration devices for nose-to-brain drug delivery becomes crucial in ensuring precise drug deposition patterns and enhancing bioavailability.
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Affiliation(s)
- Chun Yuen Jerry Wong
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- Faculty of Medicine and Health Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, 2109, Australia
| | - Alberto Baldelli
- Faculty of Land and Food Systems, The University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Camilla M Hoyos
- Faculty of Medicine and Health Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, 2109, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
| | - Ole Tietz
- Dementia Research Centre, Faculty of Medicine and Health Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, 2109, Australia
| | - Hui Xin Ong
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia.
- Faculty of Medicine and Health Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia.
- Faculty of Medicine and Health Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, 2109, Australia.
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Kulchar RJ, Singh R, Ding S, Alexander E, Leong KW, Daniell H. Delivery of biologics: Topical administration. Biomaterials 2023; 302:122312. [PMID: 37690380 PMCID: PMC10840840 DOI: 10.1016/j.biomaterials.2023.122312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
Biologics are unaffordable to a large majority of the global population because of prohibitively expensive fermentation systems, purification and the requirement for cold chain for storage and transportation. Limitations of current production and delivery systems of biologics were evident during the recent pandemic when <2.5% of vaccines produced were available to low-income countries and ∼19 million doses were discarded in Africa due to lack of cold-chain infrastructure. Among FDA-approved biologics since 2015, >90% are delivered using invasive methods. While oral or topical drugs are highly preferred by patients because of their affordability and convenience, only two oral drugs have been approved by FDA since 2015. A newly launched oral biologic costs only ∼3% of the average cost of injectable biologics because of the simplified regulatory approval process by elimination of prohibitively expensive fermentation, purification, cold storage/transportation. In addition, the cost of developing a new biologic injectable product (∼$2.5 billion) has been dramatically reduced through oral or topical delivery. Topical delivery has the unique advantage of targeted delivery of high concentration protein drugs, without getting diluted in circulating blood. However, only very few topical drugs have been approved by the FDA. Therefore, this review highlights recent advances in oral or topical delivery of proteins at early or advanced stages of human clinical trials using chewing gums, patches or sprays, or nucleic acid drugs directly, or in combination with, nanoparticles and offers future directions.
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Affiliation(s)
- Rachel J. Kulchar
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Rahul Singh
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Suwan Ding
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Elena Alexander
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Kam W Leong
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Henry Daniell
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
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Gracioso Martins AM, Snider DB, Popowski KD, Schuchard KG, Tenorio M, Akunuri S, Wee J, Peters KJ, Jansson A, Shirwaiker R, Cheng K, Freytes DO, Cruse GP. Low-dose intrapulmonary drug delivery device for studies on next-generation therapeutics in mice. J Control Release 2023; 359:287-301. [PMID: 37301267 PMCID: PMC10527740 DOI: 10.1016/j.jconrel.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/16/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Although nebulizers have been developed for delivery of small molecules in human patients, no tunable device has been purpose-built for targeted delivery of modern large molecule and temperature-sensitive therapeutics to mice. Mice are used most of all species in biomedical research and have the highest number of induced models for human-relevant diseases and transgene models. Regulatory approval of large molecule therapeutics, including antibody therapies and modified RNA highlight the need for quantifiable dose delivery in mice to model human delivery, proof-of-concept studies, efficacy, and dose-response. To this end, we developed and characterized a tunable nebulization system composed of an ultrasonic transducer equipped with a mesh nebulizer fitted with a silicone restrictor plate modification to control the nebulization rate. We have identified the elements of design that influence the most critical factors to targeted delivery to the deep lungs of BALB/c mice. By comparing an in silico model of the mouse lung with experimental data, we were able to optimize and confirm the targeted delivery of over 99% of the initial volume to the deep portions of the mouse lung. The resulting nebulizer system provides targeted lung delivery efficiency far exceeding conventional nebulizers preventing waste of expensive biologics and large molecules during proof-of-concept and pre-clinical experiments involving mice. (Word Count =207).
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Affiliation(s)
- Ana Maria Gracioso Martins
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA
| | - Douglas B Snider
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA; Comparative Medicine and Translational Research Training Program, North Carolina State University, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - Kristen D Popowski
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA
| | - Karl G Schuchard
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA
| | - Matias Tenorio
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA
| | - Sandip Akunuri
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA
| | - Junghyun Wee
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Kara J Peters
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Anton Jansson
- Analytical Instrumentation Facility, Monteith Research Center, North Carolina State University, Raleigh, NC, USA
| | - Rohan Shirwaiker
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA; Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA; Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Ke Cheng
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA
| | - Donald O Freytes
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, NC, USA
| | - Glenn P Cruse
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA.
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Bami MS, Raeisi Estabragh MA, Khazaeli P, Ohadi M, Dehghannoudeh G. pH-responsive drug delivery systems as intelligent carriers for targeted drug therapy: Brief history, properties, synthesis, mechanism and application. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Dholakia J, Prabhakar B, Shende P. Strategies for the delivery of antidiabetic drugs via intranasal route. Int J Pharm 2021; 608:121068. [PMID: 34481011 DOI: 10.1016/j.ijpharm.2021.121068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022]
Abstract
Diabetes is a metabolic disorder defined by higher blood glucose levels in the body generally controlled by antidiabetic agents (oral) and insulin (subcutaneous). To avoid the limitations of the conventional routes such as lower bioavailability and pain at the site of injection in case of parenteral route modified delivery systems are proposed like transdermal, pulmonary and inhalation delivery and among the other delivery systems nasal drug delivery system that shows the advantages such as reduced frequency of dose, higher patient compliance, safety, ease of administration, prolonged residence time, improved absorption of drug in the body, higher bioavailability and stability. This review article discusses the strategies adopted for the delivery of antidiabetic drugs by the intranasal delivery system. The insulin and glucagon-like peptides on experimentation show results of improved therapeutic levels and patient compliance. The drugs are transported by the paracellular route and absorbed through the epithelial tight junctions successfully by utilising different strategies. The limitations of the nasal delivery such as irritation or burning on administration, degradation by the enzymes, mucociliary clearance, lesser volume of the nasal cavity and permeation through the nasal mucosa. To overcome the challenges different strategies for the nasal administration are studied such as polymers, particulate delivery systems, complexation with peptides and smart delivery using glucose-responsive systems. A vast scope of intranasal preparations exists for antidiabetic drugs in the future for the management of diabetes and more clinical studies are the requirement for the societal impact to battle against diabetes.
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Affiliation(s)
- Jheel Dholakia
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Pravin Shende
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India.
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Maleki H, Khoshnevisan K, Sajjadi-Jazi SM, Baharifar H, Doostan M, Khoshnevisan N, Sharifi F. Nanofiber-based systems intended for diabetes. J Nanobiotechnology 2021; 19:317. [PMID: 34641920 PMCID: PMC8513238 DOI: 10.1186/s12951-021-01065-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 01/01/2023] Open
Abstract
Diabetic mellitus (DM) is the most communal metabolic disease resulting from a defect in insulin secretion, causing hyperglycemia by promoting the progressive destruction of pancreatic β cells. This autoimmune disease causes many severe disorders leading to organ failure, lower extremity amputations, and ultimately death. Modern delivery systems e.g., nanofiber (NF)-based systems fabricated by natural and synthetic or both materials to deliver therapeutics agents and cells, could be the harbinger of a new era to obviate DM complications. Such delivery systems can effectively deliver macromolecules (insulin) and small molecules. Besides, NF scaffolds can provide an ideal microenvironment to cell therapy for pancreatic β cell transplantation and pancreatic tissue engineering. Numerous studies indicated the potential usage of therapeutics/cells-incorporated NF mats to proliferate/regenerate/remodeling the structural and functional properties of diabetic skin ulcers. Thus, we intended to discuss the aforementioned features of the NF system for DM complications in detail.
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Affiliation(s)
- Hassan Maleki
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Research and Development Team, Evolution Wound Dressing (EWD) Startup Co., Tehran, Iran.
| | - Kamyar Khoshnevisan
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Research and Development Team, Evolution Wound Dressing (EWD) Startup Co., Tehran, Iran.
| | - Sayed Mahmoud Sajjadi-Jazi
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, 1411713137, Tehran, Iran
- Research and Development Team, Evolution Wound Dressing (EWD) Startup Co., Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 1411713137, Tehran, Iran
| | - Hadi Baharifar
- Department of Medical Nanotechnology, Applied Biophotonics Research Center, Science and Research Branch, Islamic Azad University, 1477893855, Tehran, Iran
- Research and Development Team, Evolution Wound Dressing (EWD) Startup Co., Tehran, Iran
| | - Maryam Doostan
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazanin Khoshnevisan
- Research and Development Team, Evolution Wound Dressing (EWD) Startup Co., Tehran, Iran
| | - Farshad Sharifi
- Research and Development Team, Evolution Wound Dressing (EWD) Startup Co., Tehran, Iran
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 1411713137, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 1411713137, Tehran, Iran
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Lau H, Khosrawipour T, Li S, Alexander M, Frelkiewicz P, Labbé MK, Stieglitz S, Lakey JRT, Kielan W, Khosrawipour V. Exploring Insulin Production Following Alveolar Islet Transplantation (AIT). Int J Mol Sci 2021; 22:ijms221910185. [PMID: 34638521 PMCID: PMC8508311 DOI: 10.3390/ijms221910185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Recent studies have demonstrated the feasibility of islet implantation into the alveoli. However, until today, there are no data on islet behavior and morphology at their transplant site. This study is the first to investigate islet distribution as well insulin production at the implant site. Using an ex vivo postmortem swine model, porcine pancreatic islets were isolated and aerosolized into the lung using an endoscopic spray-catheter. Lung tissue was explanted and bronchial airways were surgically isolated and connected to a perfusor. Correct implantation was confirmed via histology. The purpose of using this new lung perfusion model was to measure static as well as dynamic insulin excretions following glucose stimulation. Alveolar islet implantation was confirmed after aerosolization. Over 82% of islets were correctly implanted into the intra-alveolar space. The medium contact area to the alveolar surface was estimated at 60 +/− 3% of the total islet surface. The new constructed lung perfusion model was technically feasible. Following static glucose stimulation, insulin secretion was detected, and dynamic glucose stimulation revealed a biphasic insulin secretion capacity during perfusion. Our data indicate that islets secrete insulin following implantation into the alveoli and display an adapted response to dynamic changes in glucose. These preliminary results are encouraging and mark a first step toward endoscopically assisted islet implantation in the lung.
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Affiliation(s)
- Hien Lau
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
- Correspondence: (H.L.); (T.K.)
| | - Tanja Khosrawipour
- Department of Surgery (A), University-Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, D-40225 Duesseldorf, Germany
- Correspondence: (H.L.); (T.K.)
| | - Shiri Li
- Department of Surgery, Weill Medical College of Cornell University, New York, NY 10065, USA;
| | - Michael Alexander
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
| | - Piotr Frelkiewicz
- Center for Experimental Diagnostics and Biomedical Innovations, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland;
| | - Maya Karine Labbé
- School of Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Sven Stieglitz
- Department Pulmonary Medicine, Petrus-Hospital Wuppertal, University of Witten-Herdecke, D-42283 Wuppertal, Germany;
| | - Jonathan Robert Todd Lakey
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
| | - Wojciech Kielan
- 2nd Department of General Surgery and Surgical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Veria Khosrawipour
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
- 2nd Department of General Surgery and Surgical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Gaddam M, Singh A, Jain N, Avanthika C, Jhaveri S, De la Hoz I, Sanka S, Goli SR. A Comprehensive Review of Intranasal Insulin and Its Effect on the Cognitive Function of Diabetics. Cureus 2021; 13:e17219. [PMID: 34540446 PMCID: PMC8442633 DOI: 10.7759/cureus.17219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/01/2022] Open
Abstract
Diabetes mellitus continues to be a disease that affects a good percentage of our population. The majority affected need insulin on a day-to-day basis. Before the invention of the first manufactured insulin in 1978, dealing with diabetes took a significant toll on patient's lives. As technology and human innovation prevail, significant advancements have taken place in managing this chronic disease. Patients have an option to decide their mode of insulin delivery. Intranasal insulin, one such form, has a rapid mode of action while effectively controlling postprandial hyperglycemia. It has also been proven to reduce hypoglycemia and insulin resistance problems, which seem to be the main adverse effects of using conventional insulin regularly. However, due to the large dosages needed and high incurring costs, Intranasal Insulin is currently being used as adjunctive therapy along with conventional insulin. We conducted a literature search in PubMed indexed journals using the medical terms "Intranasal insulin," "diabetes," and "cognitive impairment" to provide an overview of the mechanism of action of Intranasal Insulin, its distinctive cognitive benefits, and how it can be compared to the standard parenteral insulin therapy. One unique feature of intranasal insulin is its ability to directly affect the central nervous system, bypassing the blood-brain barrier. Not only does this help in reducing the peripheral side effects of insulin, but it has also proven to play a role in improving the cognitive function of diabetics, especially those who have Alzheimer's or mild cognitive impairment, as decreased levels of insulin in the brain has been shown to impact cognitive function negatively. However, it does come with its limitations of poor absorption through the nasal mucosa due to mucociliary clearance and proteolytic enzymes, our body's natural defence mechanisms. This review focuses on the efficacy of intranasal insulin, its potential benefits, limitations, and role in cognitive improvement in people with diabetes with pre-existing cognitive impairment.
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Affiliation(s)
| | | | - Nidhi Jain
- Internal Medicine, Sir Ganga Ram Hospital, New Delhi, IND
| | | | - Sharan Jhaveri
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | | | - Sujana Sanka
- Internal Medicine, JC Medical Center, Orlando, USA
| | - Sri Rupa Goli
- Internal Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, IND
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Wei Z, Koya J, Reznik SE. Insulin Resistance Exacerbates Alzheimer Disease via Multiple Mechanisms. Front Neurosci 2021; 15:687157. [PMID: 34349617 PMCID: PMC8326507 DOI: 10.3389/fnins.2021.687157] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
Alzheimer disease (AD) is a chronic neurodegenerative disease that accounts for 60–70% of dementia and is the sixth leading cause of death in the United States. The pathogenesis of this debilitating disorder is still not completely understood. New insights into the pathogenesis of AD are needed in order to develop novel pharmacologic approaches. In recent years, numerous studies have shown that insulin resistance plays a significant role in the development of AD. Over 80% of patients with AD have type II diabetes (T2DM) or abnormal serum glucose, suggesting that the pathogenic mechanisms of insulin resistance and AD likely overlap. Insulin resistance increases neuroinflammation, which promotes both amyloid β-protein deposition and aberrant tau phosphorylation. By increasing production of reactive oxygen species, insulin resistance triggers amyloid β-protein accumulation. Oxidative stress associated with insulin resistance also dysregulates glycogen synthase kinase 3-β (GSK-3β), which leads to increased tau phosphorylation. Both insulin and amyloid β-protein are metabolized by insulin degrading enzyme (IDE). Defects in this enzyme are the basis for a strong association between T2DM and AD. This review highlights multiple pathogenic mechanisms induced by insulin resistance that are implicated in AD. Several pharmacologic approaches to AD associated with insulin resistance are presented.
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Affiliation(s)
- Zenghui Wei
- Department of Pharmaceutical Sciences, St. John's University, New York, NY, United States
| | - Jagadish Koya
- Department of Pharmaceutical Sciences, St. John's University, New York, NY, United States
| | - Sandra E Reznik
- Department of Pharmaceutical Sciences, St. John's University, New York, NY, United States.,Department of Pathology, Albert Einstein College of Medicine, New York, NY, United States.,Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, New York, NY, United States
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10
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Novel formulations and drug delivery systems to administer biological solids. Adv Drug Deliv Rev 2021; 172:183-210. [PMID: 33705873 DOI: 10.1016/j.addr.2021.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
Recent advances in formulation sciences have expanded the previously limited design space for biological modalities, including peptide, protein, and vaccine products. At the same time, the discovery and application of new modalities, such as cellular therapies and gene therapies, have presented formidable challenges to formulation scientists. We explore these challenges and highlight the opportunities to overcome them through the development of novel formulations and drug delivery systems as biological solids. We review the current progress in both industry and academic laboratories, and we provide expert perspectives in those settings. Formulation scientists have made a tremendous effort to accommodate the needs of these novel delivery routes. These include stability-preserving formulations and dehydration processes as well as dosing regimes and dosage forms that improve patient compliance.
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Wingrove JO, O'Daly O, Forbes B, Swedrowska M, Amiel SA, Zelaya FO. Intranasal insulin administration decreases cerebral blood flow in cortico-limbic regions: A neuropharmacological imaging study in normal and overweight males. Diabetes Obes Metab 2021; 23:175-185. [PMID: 33026175 DOI: 10.1111/dom.14213] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 12/13/2022]
Abstract
AIM To assess and compare the effects of 160 IU intranasal insulin (IN-INS) administration on regional cerebral blood flow (rCBF) in healthy male individuals with normal weight and overweight phenotypes. METHODS Thirty young male participants (mean age 25.9 years) were recruited and stratified into two cohorts based on body mass index: normal weight (18.5-24.9 kg/m2 ) and overweight (25.0-29.9 kg/m2 ). On separate mornings participants received 160 IU of IN-INS using an intranasal protocol and intranasal placebo as part of a double-blind crossover design. Thirty minutes following administration rCBF data were collected using a magnetic resonance imaging method called pseudocontinuous arterial spin labelling. Blood samples were collected to assess insulin sensitivity and changes over time in peripheral glucose, insulin and C-peptide. RESULTS Insulin sensitivity did not significantly differ between groups. Compared with placebo, IN-INS administration reduced rCBF in parts of the hippocampus, insula, putamen, parahippocampal gyrus and fusiform gyrus in the overweight group. No effect was seen in the normal weight group. Insula rCBF was greater in the overweight group versus normal weight only under placebo conditions. Peripheral glucose and insulin levels were not affected by IN-INS. C-peptide levels in the normal weight group decreased significantly over time following IN-INS administration but not placebo. CONCLUSION Insulin-induced changes within key regions of the brain involved in gustation, memory and reward were observed in overweight healthy male individuals. Following placebo administration, differences in gustatory rCBF were observed between overweight and normal weight healthy individuals.
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Affiliation(s)
- Jed O Wingrove
- Centre for Neuroimaging Sciences, King's College London, London, UK
- Centre for Obesity Research, University College London, London, UK
- Diabetes Research Group, King's College Hospital Campus, Weston Education Central, King's College London, London, UK
| | - Owen O'Daly
- Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Magda Swedrowska
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stephanie A Amiel
- Diabetes Research Group, King's College Hospital Campus, Weston Education Central, King's College London, London, UK
- Institute of Diabetes and Obesity, King's Health Partners, London, UK
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Insulin Release from NPH Insulin-Loaded Pluronic® F127 Hydrogel in the Presence of Simulated Tissue Enzyme Activity. Processes (Basel) 2020. [DOI: 10.3390/pr8101320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Despite the widespread use of newer basal insulins, Natural Protamine Hagedorn (NPH) insulin still represents a well-established basal formulation with its long history of use, featuring the native form of human insulin. However, NPH insulin exhibits an undesirable peak within hours after a single subcutaneous (s.c.) injection, which may lead to hypoglycemia followed by insufficient basal insulin delivery. This may be attributed to the s.c. enzyme activities degrading the protamine in NPH microcrystals. Methods: A thermogelling block copolymer Pluronic® F127 (PF127) was utilized as a protective carrier for NPH microcrystals and as a modulator for insulin release from NPH. NPH insulin-loaded PF127 gel was prepared with varying concentrations of the polymer (15–25%) under mild conditions. The formulations were characterized for their gelling temperature, morphology, gel erosion, and in vitro insulin release, with trypsin concentrations up to 5 U/mL. Results: Scanning electron microscopy (SEM) showed that the integrity of NPH microcrystals was maintained after preparation. The burst release of insulin from NPH was significantly attenuated over the course of ~16h in the presence of PF127 with or without enzyme activity. Conclusion: NPH-PF127 successfully resisted the acceleration of NPH crystal dissolution and insulin release in vitro in the presence of protamine-degrading enzyme activity, warranting further testing.
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Xie R, Xia Y, Chen Y, Li H, Shang H, Kuang X, Xia L, Guo Y. The RIGHT Extension Statement for Traditional Chinese Medicine: Development, Recommendations, and Explanation. Pharmacol Res 2020; 160:105178. [PMID: 32889127 PMCID: PMC7462769 DOI: 10.1016/j.phrs.2020.105178] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/05/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
Nowadays, the number of traditional Chinese medicine (TCM) guidelines is constantly increasing, but its reporting quality remains unsatisfactory. One of the main reasons is that there is a lack of suitable reporting standard to guide it. In response to this long-standing problem, the Reporting Items for practice Guidelines in HealThcare (RIGHT) Working Group has invited a group of TCM clinical experts, methodologists and epidemiology, and developed the RIGHT Extension Statement for TCM (RIGHT-TCM) through a multi-staged development process, including systematic review, reporting quality evaluation and online Delphi expert consensus. The RIGHT-TCM extends two sections of the RIGHT Statement, includes basic information and recommendations section. Seven strong recommendation sub-items were added to RIGHT Statement and formed the final RIGHT-TCM. The group hopes that the RIGHT-TCM may assist TCM guideline developers in reporting guidelines, support journal editors and peer reviewers when considering TCM guideline reports, and help health care practitioners understand and implement a TCM guideline. This article will introduce its background, development, recommendations and explanation.
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Affiliation(s)
- Runsheng Xie
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Yun Xia
- Office of Academic Research, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.
| | - Hui Li
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xinying Kuang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Linjun Xia
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Yi Guo
- College of acupuncture and massage, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Zaric BL, Obradovic M, Sudar-Milovanovic E, Nedeljkovic J, Lazic V, Isenovic ER. Drug Delivery Systems for Diabetes Treatment. Curr Pharm Des 2020; 25:166-173. [PMID: 30848184 DOI: 10.2174/1381612825666190306153838] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Insulin is essential for the treatment of Type 1 diabetes mellitus (T1DM) and is necessary in numerous cases of Type 2 diabetes mellitus (T2DM). Prolonged administration of anti-diabetic therapy is necessary for the maintenance of the normal glucose levels and thereby preventing vascular complications. A better understanding of the disease per se and the technological progress contribute to the development of new approaches with the aim to achieve better glycemic control. OBJECTIVE Current therapies for DM are faced with some challenges. The purpose of this review is to analyze in detail the current trends for insulin delivery systems for diabetes treatment. RESULTS Contemporary ways have been proposed for the management of both types of diabetes by adequate application of drug via subcutaneous, buccal, oral, ocular, nasal, rectal and pulmonary ways. Development of improved oral administration of insulin is beneficial regarding mimicking physiological pathway of insulin and minimizing the discomfort of the patient. Various nanoparticle carriers for oral and other ways of insulin delivery are currently being developed. Engineered specific properties of nanoparticles (NP): controlling toxicity of NP, stability and drug release, can allow delivery of higher concentration of the drug to the desired location. CONCLUSIONS The successful development of any drug delivery system relies on solving three important issues: toxicity of nanoparticles, stability of nanoparticles, and desired drug release rate at targeted sites. The main goals of future investigations are to improve the existing therapies by pharmacokinetic modifications, development of a fully automatized system to mimic insulin delivery by the pancreas and reduce invasiveness during admission.
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Affiliation(s)
- Bozidarka L Zaric
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Milan Obradovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Emina Sudar-Milovanovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Jovan Nedeljkovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiation Chemistry and Physics, Belgrade, Serbia
| | - Vesna Lazic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiation Chemistry and Physics, Belgrade, Serbia
| | - Esma R Isenovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
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Yarube IU, Ayo JO, Magaji RA, Umar IA. Insulin-induced oxidative stress in the brain is nitric oxide-dependent. PATHOPHYSIOLOGY 2019; 26:199-202. [DOI: 10.1016/j.pathophys.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022] Open
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Gao M, Sun Y, Kou Y, Shen X, Huo Y, Liu C, Sun Z, Zhang X, Mao S. Effect of Glyceryl Monocaprylate-Modified Chitosan on the Intranasal Absorption of Insulin in Rats. J Pharm Sci 2019; 108:3623-3629. [PMID: 31356762 DOI: 10.1016/j.xphs.2019.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
Nasal administration of insulin showed the attractive potential to improve the compliance of diabetic patients and alleviate mild cognitive impairment of Alzheimer's patients. However, the nasal absorption of insulin was not ideal, limiting its therapeutic effect in clinic. This study was to explore the potential of glyceryl monocaprylate-modified chitosan (CS-GMC) on the intranasal absorption of insulin via in vivo pharmacodynamic experiment in conscious rats. It was demonstrated that the absorption-enhancing effect of CS-GMC depended on the existing state of insulin in the formulation, substitution degree of GMC on chitosan and concentration of CS-GMC. Better insulin absorption was achieved when insulin existed in molecular form compared with that in polyelectrolyte complexes. CS-GMC with substitution degree 12% (CS-GMC 12%) was a preferred absorption enhancer, and its absorption enhancing effect increased linearly with the increment of its concentration in the range investigated. Compared with chitosan of the same concentration, CS-GMC12% showed remarkably enhanced and prolonged therapeutic effect up to at least 5 h under the concentration of 0.6% (w/v). CS-GMC12% showed almost no ciliotoxicity to the nasal cilia up to concentration 1.0% (w/v). In conclusion, CS-GMC was a promising absorption enhancer to improve the intranasal absorption of insulin.
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Affiliation(s)
- Mingyue Gao
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Ying Sun
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Yongqiang Kou
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Xin Shen
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Yingnan Huo
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Chang Liu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Zheng Sun
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Xin Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Shirui Mao
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China.
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Easa N, Alany RG, Carew M, Vangala A. A review of non-invasive insulin delivery systems for diabetes therapy in clinical trials over the past decade. Drug Discov Today 2019; 24:440-451. [DOI: 10.1016/j.drudis.2018.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/19/2018] [Accepted: 11/15/2018] [Indexed: 02/08/2023]
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18
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Micro/nanostructured inhalable formulation based on polysaccharides: Effect of a thermoprotectant on powder properties and protein integrity. Int J Pharm 2018; 551:23-33. [DOI: 10.1016/j.ijpharm.2018.08.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 08/12/2018] [Accepted: 08/24/2018] [Indexed: 01/16/2023]
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19
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Nabi B, Rehman S, Khan S, Baboota S, Ali J. Ligand conjugation: An emerging platform for enhanced brain drug delivery. Brain Res Bull 2018; 142:384-393. [DOI: 10.1016/j.brainresbull.2018.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/06/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
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20
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Mishraki-Berkowitz T, Cohen G, Aserin A, Garti N. Controlling insulin release from reverse hexagonal (H II) liquid crystalline mesophase by enzymatic lipolysis. Colloids Surf B Biointerfaces 2018; 161:670-676. [PMID: 29172155 DOI: 10.1016/j.colsurfb.2017.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/29/2017] [Accepted: 11/11/2017] [Indexed: 12/14/2022]
Abstract
In the present study we aimed to control insulin release from the reverse hexagonal (HII) mesophase using Thermomyces lanuginosa lipase (TLL) in the environment (outer TLL) or within the HII cylinders (inner TLL). Two insulin-loaded systems differing by the presence (or absence) of phosphatidylcholine (PC) were examined. In general, incorporation of PC into the HII interface (without TLL) increased insulin release, as a more cooperative system was formed. Addition of TLL to the systems' environments resulted in lipolysis of the HII structure. In the absence of PC, the lipolysis was more dominant and led to a significant increase in insulin release (50% after 8h). However, the presence of PC stabilized the interface, hindering the lipolysis, and therefore no impact on the release profile was detected during the first 8h. Entrapment of TLL within the HII cylinders (with and without PC) drastically increased insulin release in both systems up to 100%. In the presence of PC insulin released faster and the structure was more stable. Consequently, the presence of lipases (inner or outer) both enhanced the destruction of the carrier, and provided sustained release of the entrapped insulin.
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Affiliation(s)
- Tehila Mishraki-Berkowitz
- The Ratner Chair in Chemistry, Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Jerusalem 9190401, Israel
| | - Guy Cohen
- Skin Research Institute, Dead-Sea & Arava Science Center, Ein Gedi, Israel
| | - Abraham Aserin
- The Ratner Chair in Chemistry, Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Jerusalem 9190401, Israel
| | - Nissim Garti
- The Ratner Chair in Chemistry, Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Jerusalem 9190401, Israel.
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Villaverde Cendon F, Matos Jorge RM, Weinschutz R, Mathias AL. Effect of matrix composition, sphere size and hormone concentration on diffusion coefficient of insulin for controlled gastrointestinal delivery for diabetes treatment. J Microencapsul 2017; 35:13-25. [DOI: 10.1080/02652048.2017.1409820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Regina Weinschutz
- Chemical Engineering Department, Federal University of Paraná, Curitiba, Brazil
| | - Alvaro Luiz Mathias
- Chemical Engineering Department, Federal University of Paraná, Curitiba, Brazil
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22
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Mishraki-Berkowitz T, Aserin A, Garti N. Structural properties and release of insulin-loaded reverse hexagonal (HII) liquid crystalline mesophase. J Colloid Interface Sci 2017; 486:184-193. [DOI: 10.1016/j.jcis.2016.09.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 12/15/2022]
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23
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Rini CJ, McVey E, Sutter D, Keith S, Kurth HJ, Nosek L, Kapitza C, Rebrin K, Hirsch L, Pettis RJ. Intradermal insulin infusion achieves faster insulin action than subcutaneous infusion for 3-day wear. Drug Deliv Transl Res 2016; 5:332-45. [PMID: 26037035 PMCID: PMC4529466 DOI: 10.1007/s13346-015-0239-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rapid uptake previously demonstrated by intradermal (ID) drug administration indicates compound delivery within the dermis may have clinical and pharmacological advantages for certain drug therapies. This study is the first clinical trial to evaluate continuous microneedle-based drug infusion, device wearability, and intradermal microneedle insulin kinetics over a multi-day (72 h) wear period. This was a single center, open-label, two-period crossover study in T1DM patients on continuous subcutaneous insulin infusion (CSII). Patients received treatment during interventional visits: one SC and one ID basal/bolus infusion of insulin aspart (NovoRapid® U-100) administered over 3 days in a randomized order. Twenty-eight patients were randomized and exposed to trial product, and 23 completed the study. Bolus insulin infusions were given prior to standardized breakfast and lunch test meals on each of the three treatment days. Blood samples were drawn at predefined time points for measurements of insulin aspart and blood glucose in serum. The primary endpoint insulin Tmax demonstrated that ID bolus infusion was associated with a significantly shorter Tmax with statistically significantly smaller intra-subject variability, compared to SC infusion, and this difference was maintained over three treatment days. Analyses of secondary PK endpoints corresponded with the primary endpoint findings. Postprandial glycemic response was significantly less pronounced after ID bolus: For most endpoints ID vs. SC, differences were statistically significant within the 0–1.5 or 0–2 h time period. Intradermal delivery of insulin is a viable delivery route alternative providing reduced time for insulin absorption with less intra-subject variability and lower glycemic response.
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24
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Chou HS, Larsson M, Hsiao MH, Chen YC, Röding M, Nydén M, Liu DM. Injectable insulin-lysozyme-loaded nanogels with enzymatically-controlled degradation and release for basal insulin treatment: In vitro characterization and in vivo observation. J Control Release 2016; 224:33-42. [DOI: 10.1016/j.jconrel.2015.12.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022]
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25
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Schultz I, Wurzel J, Meinel L. Drug delivery of Insulin-like growth factor I. Eur J Pharm Biopharm 2015; 97:329-37. [DOI: 10.1016/j.ejpb.2015.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/15/2015] [Accepted: 04/22/2015] [Indexed: 12/20/2022]
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26
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Felice B, Prabhakaran MP, Zamani M, Rodríguez AP, Ramakrishna S. Electrosprayed poly(vinyl alcohol) particles: preparation and evaluation of their drug release profile. POLYM INT 2015. [DOI: 10.1002/pi.4972] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Betiana Felice
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería; Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán; Tucumán Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO); CONICET 4000 Tucumán Argentina
- START - Thrust 3, Create Research Wing 03-08, 1 Create Way; National University of Singapore; Singapore 138602
| | - Molamma P Prabhakaran
- START - Thrust 3, Create Research Wing 03-08, 1 Create Way; National University of Singapore; Singapore 138602
- Department of Mechanical Engineering; National University of Singapore; Singapore
| | - Maedeh Zamani
- START - Thrust 3, Create Research Wing 03-08, 1 Create Way; National University of Singapore; Singapore 138602
- Department of Mechanical Engineering; National University of Singapore; Singapore
| | - Andrea P Rodríguez
- Laboratorio de Medios e Interfases (LAMEIN), Departamento de Bioingeniería; Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán; Tucumán Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO); CONICET 4000 Tucumán Argentina
| | - Seeram Ramakrishna
- START - Thrust 3, Create Research Wing 03-08, 1 Create Way; National University of Singapore; Singapore 138602
- Department of Mechanical Engineering; National University of Singapore; Singapore
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27
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Al-Tabakha MM. Future prospect of insulin inhalation for diabetic patients: The case of Afrezza versus Exubera. J Control Release 2015. [PMID: 26222134 DOI: 10.1016/j.jconrel.2015.07.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current review was designed to compare between the insulin inhalation systems Exubera and Afrezza and to investigate the reasons why Exubera was unsuccessful, when Afrezza maker is expecting their product to be felicitous. In January 2006, Pfizer secured FDA and EC approval for the first of its kind, regular insulin through Exubera inhaler device for the management of types 1 and 2 diabetes mellitus (DM) in adults. The product was no longer available to the market after less than two years from its approval triggering a setback for competitive new inhalable insulins that were already in various clinical development phases. In contrary, MannKind Corporation started developing its ultra-rapid-acting insulin Afrezza in a bold bid, probably by managing the issues in which Exubera was not successful. Afrezza has been marketed since February, 2015 by Sanofi after getting FDA approval in June 2014. The results from this systematic review indicate the effectiveness of insulin inhalation products, particularly for patients initiating insulin therapy. Pharmaceutical companies should capitalize on the information available from insulin inhalation to produce competitive products that are able to match the bioavailability of subcutaneous (SC) insulin injection and to deal with the single insulin unit increments and basal insulin requirements in some diabetic patients or extending the horizon to inhalable drug products with completely different drug entities for other indications.
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Affiliation(s)
- Moawia M Al-Tabakha
- Pharmaceutical Sciences Unit, College of Pharmacy, Al Ain University of Science and Technology, P.O. Box 64141, Al Ain, United Arab Emirates.
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Fortuna A, Alves G, Serralheiro A, Sousa J, Falcão A. Intranasal delivery of systemic-acting drugs: Small-molecules and biomacromolecules. Eur J Pharm Biopharm 2014; 88:8-27. [DOI: 10.1016/j.ejpb.2014.03.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 01/14/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
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D’Souza B, Bhowmik T, Uddin MN, Oettinger C, D’Souza M. Development ofβ-cyclodextrin-based sustained release microparticles for oral insulin delivery. Drug Dev Ind Pharm 2014; 41:1288-93. [DOI: 10.3109/03639045.2014.947507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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de la Monte SM. Intranasal insulin therapy for cognitive impairment and neurodegeneration: current state of the art. Expert Opin Drug Deliv 2013; 10:1699-709. [PMID: 24215447 PMCID: PMC4551402 DOI: 10.1517/17425247.2013.856877] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Growing evidence supports the concept that insulin resistance plays an important role in the pathogenesis of cognitive impairment and neurodegeneration, including in Alzheimer's disease (AD). The metabolic hypothesis has led to the development and utilization of insulin- and insulin agonist-based treatments. Therapeutic challenges faced include the ability to provide effective treatments that do not require repeated injections and also the ability to minimize the potentially hazardous off-target effects. AREAS COVERED This review covers the role of intranasal insulin therapy for cognitive impairment and neurodegeneration, particularly AD. The literature reviewed focuses on data published within the past 5 years as this field is evolving rapidly. The review provides evidence that brain insulin resistance is an important and early abnormality in AD, and that increasing brain supply and utilization of insulin improves cognition and memory. Emphasis was placed on discussing outcomes of clinical trials and interpreting discordant results to clarify the benefits and limitations of intranasal insulin therapy. EXPERT OPINION Intranasal insulin therapy can efficiently and directly target the brain to support energy metabolism, myelin maintenance, cell survival and neuronal plasticity, which begin to fail in the early stages of neurodegeneration. Efforts must continue toward increasing the safety, efficacy and specificity of intranasal insulin therapy.
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Affiliation(s)
- Suzanne M de la Monte
- Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Departments of Pathology (Neuropathology), Neurology, and Neurosurgery , Pierre Galletti Research Building, Claverick Street, Room 419, Providence, RI 02903 , USA +1 401 444 7364 ; +1 401 444 2939 ;
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Zarogoulidis P, Petridis D, Ritzoulis C, Li Q, Huang H, Ning Y, Darwiche K, Freitag L, Zarogoulidis K. Further experimentation of inhaled; LANTUS, ACTRAPID and HUMULIN with todays' production systems. Int J Pharm 2013; 458:39-47. [PMID: 24140545 DOI: 10.1016/j.ijpharm.2013.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several aerosol production systems have been used for aerosol insulin production. However; since the first studies several new models of jet-nebulizers and ultrasound nebulizers have been introduced in the market. MATERIALS AND METHODS Three different models of jet-nebulizers (different brands, same properties) and three different ultrasound nebulizers (different brands, same properties). Six residual cups (2 small ≤ 6 ml and 3 large ≤ 8 ml) were used for the jet-nebulizers. The ultrasound nebulizers were used with their facemasks or with their inlets which were included in the purchase package. RESULTS Ultrasound nebulizers; LANTUS produces by far the lowest mean droplets (2.44) half the size of the other two drugs (4.43=4.97). GIMA nebulizer is the most efficient producing one third of the droplet size of SHIMED and one second of EASYNEB (2.06<3.15<6.62). Finally, the 4 ml loading concentration is more suitable for supporting the production of smaller droplets (3.65<4.24). Drugs and nebulizers act interactively yielding very large droplets when ACTRAPID and HUMULIN are administered in joint with SHIMED nebulizer (9.59=7.72). Jet-nebulizers; HUMULIN again is the least preferred insulin since it hardly reaches the low but equal performance of others at the loading level of 6 ml. Residual cups E and B produce uniquely lower mean droplets at loading level 6. CONCLUSIONS Ultrasound nebulizers; the best suggested combination should be LANTUS insulin, GIMA nebulizer administered at loading dose of 4 ml jet-nebulizers. A global review can give the best combination: the lowest mean droplets are produced when the drugs LANTUS (mostly) and ACTRAPID are administered, applying the SUNMIST nebulizer in concert with residual cup B at loading levels of 6 ml.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany.
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Abstract
Conopeptides from the venoms of marine snails have attracted much interest as leads in drug design. Currently, one drug, Prialt(®), is on the market as a treatment for chronic neuropathic pain. Conopeptides target a range of ion channels, receptors and transporters, and are typically small, relatively stable peptides that are generally amenable to production using solid-phase peptide synthesis. With only a small fraction of the predicted diversity of conopeptides examined so far, these peptides represent an exciting and largely untapped resource for drug discovery. Recent efforts at chemically re-engineering conopeptides to improve their biopharmaceutical properties promise to accelerate the translation of these fascinating marine peptides to the clinic.
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Dombu CY, Betbeder D. Airway delivery of peptides and proteins using nanoparticles. Biomaterials 2012; 34:516-25. [PMID: 23046753 DOI: 10.1016/j.biomaterials.2012.08.070] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/30/2012] [Indexed: 12/18/2022]
Abstract
Delivery of peptides and proteins via the airways is one of the most exciting potential applications of nanomedicine. These macromolecules could be used for many therapeutic applications, however due to their poor stability in physiological medium and difficulties in delivering them across biological barriers, they are very difficult to use in therapy. Nanoparticulate drug delivery systems have emerged as one of the most promising technologies to overcome these limitations, owing mainly to their proven capacity to cross biological barriers and to enter cells in high yields, thus improving delivery of macromolecules. In this review, we summarize the current advances in nanoparticle designed for transmucosal delivery of peptides and proteins. Challenges that must be overcome in order to derive clinical benefits are also discussed.
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Abstract
Recent work has demonstrated that the route of administration affects the pharmacokinetics and biological activity of peptides. For example, the physiological profile of insulin consists of basal and prandial components with a small-scale oscillatory element. Insulin is used more efficiently when the pharmacokinetic profile mimics features of physiological release. Noninvasive administration of insulin by oral, transdermal, nasal and pulmonary routes resembles the relatively sharp peak and short duration of exposure of prandial release. The route of administration per se, can affect the response by avoiding first-pass metabolism or perhaps altering the timing in which the peptide reaches different sets of receptors. GLP-I delivered by injection and inhalation produces different side effect profiles. Nonclinical studies on two potential treatments for obesity, oxyntomodulin and PYY 3-36, are also presented to illustrate the relationship between exposure and effect as functions of route of administration.
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Ott V, Benedict C, Schultes B, Born J, Hallschmid M. Intranasal administration of insulin to the brain impacts cognitive function and peripheral metabolism. Diabetes Obes Metab 2012; 14:214-21. [PMID: 21883804 DOI: 10.1111/j.1463-1326.2011.01490.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In recent years, the central nervous system (CNS) has emerged as a principal site of insulin action. This notion is supported by studies in animals relying on intracerebroventricular insulin infusion and by experiments in humans that make use of the intranasal pathway of insulin administration to the brain. Employing neurobehavioural and metabolic measurements as well as functional imaging techniques, these studies have provided insight into a broad range of central and peripheral effects of brain insulin. The present review focuses on CNS effects of insulin administered via the intranasal route on cognition, in particular memory function, and whole-body energy homeostasis including glucose metabolism. Furthermore, evidence is reviewed that suggests a pathophysiological role of impaired brain insulin signaling in obesity and type 2 diabetes, which are hallmarked by peripheral and possibly central nervous insulin resistance, as well as in conditions such as Alzheimer's disease where CNS insulin resistance might contribute to cognitive dysfunction.
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Affiliation(s)
- V Ott
- Department of Neuroendocrinology, University of Luebeck, Luebeck, Germany.
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Abstract
AbstractThe changes in hormone-regulated adenylyl cyclase (AC) signaling system implicated in control of the nervous, cardiovascular and reproductive systems may contribute to complications of diabetes mellitus (DM). We investigated the functional state of AC system in the brain, myocardium, ovary and uterus of rats with neonatal DM and examined the influence of intranasally administered insulin on the sensitivity of this system to biogenic amines and polypeptide hormones. The regulatory effects of somatostatin and 5-HT1BR-agonist 5-nonyloxytryptamine acting via Gi protein-coupled receptors were significantly decreased in DM and partially restored in insulin-treated rats. The effects of hormones, activators of AC, are changed in tissue- and receptorspecific manner, and intranasal insulin restored the effects rather close to the level in control. In insulin-treated non-diabetic rats, AC stimulating effects of isoproterenol and relaxin in the myocardium and of human chorionic gonadotropin in the ovaries were decreased, while the effects of hormones, inhibitors of AC, were increased. These data indicate that with intranasal insulin, Gi protein-mediated signaling pathways continue to gain strength. The obtained data on the influence of hormones on AC system in the brain, myocardium, ovary and uterus allow looking anew into the mechanisms of therapeutic effects of intranasal insulin.
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Mishraki T, Ottaviani MF, Shames AI, Aserin A, Garti N. Structural Effects of Insulin-Loading into HII Mesophases Monitored by Electron Paramagnetic Resonance (EPR), Small Angle X-ray Spectroscopy (SAXS), and Attenuated Total Reflection Fourier Transform Spectroscopy (ATR-FTIR). J Phys Chem B 2011; 115:8054-62. [DOI: 10.1021/jp2034455] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tehila Mishraki
- The Ratner Chair of Chemistry, Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 91904, Israel
| | - Maria Francesca Ottaviani
- Department of Geological Sciences, Chemical and Environmental Technologies, University of Urbino, Loc. Crocicchia, Urbino 61029, Italy
| | - Alexander I. Shames
- Department of Physics, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel
| | - Abraham Aserin
- The Ratner Chair of Chemistry, Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 91904, Israel
| | - Nissim Garti
- The Ratner Chair of Chemistry, Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 91904, Israel
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Agu RU, Ugwoke MI. In vitroandin vivotesting methods for respiratory drug delivery. Expert Opin Drug Deliv 2010; 8:57-69. [DOI: 10.1517/17425247.2011.543896] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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