In vivo transdermal delivery of large molecules by pressure-mediated electroincorporation and electroporation: a novel method for drug and gene delivery

Skin electroporation for transdermal drug delivery: Electrical measurements, numerical model and molecule delivery

Skin electroporation for drug delivery involves the application of Pulsed Electric Fields (PEFs) on the skin to disrupt its barrier function in a temporary and non-invasive manner, increasing the uptake of drugs. It represents a potential alternative to delivery methods that are invasive (e.g. injections) or limited. We have developed a drug delivery system comprising nanocomposite hydrogels which act as a reservoir for the drug and an electrode for applying electric pulses on the skin. In this study, we employed a multi-scale approach to investigate the drug delivery system on a mouse skin model, through electrical measurements, numerical modeling and fluorescence microscopy. The Electrical properties indicated a highly non-linear skin conductivity behavior and were used to fine-tune the simulations and study skin recovery after electroporation. Simulation of electric field distribution in the skin showed amplitudes in the range of reversible tissue electroporation (400-1200 V/cm), for 300 V PEF. Fluorescence microscopy revealed increased uptake of fluorescent molecules compared to the non-pulsed control. We reported two reversible electroporation domains for our configuration: (1) at 100 V PEF the first local transport regions appear in the extracellular lipids of the stratum corneum, demonstrated by a rapid increase in the skin's conductivity and an increased uptake of lucifer yellow, a small hydrophilic fluorophore and (2) at 300 V PEF, the first permeabilization of nucleated cells occurred, evidenced by the increased fluorescence of propidium iodide, a membrane-impermeable, DNA intercalating agent.

Carbon Nanotubes for Targeted Therapy: Safety, Efficacy, Feasibility and Regulatory Aspects

It is crucial that novel and efficient drug delivery techniques be created in order to improve the pharmacological profiles of a wide variety of classes of medicinal compounds. Carbon nanotubes (CNTs) have recently come to the forefront as an innovative and very effective technique for transporting and translocating medicinal compounds. CNTs were suggested and aggressively researched as multifunctional novel transporters designed for targeted pharmaceutical distribution and used in diagnosis. CNTs can act as vectors for direct administration of pharmaceuticals, particularly chemotherapeutic medications. Multi-walled CNTs make up the great majority of CNT transporters, and these CNTs were used in techniques to target cancerous cells. It is possible to employ Carbon nanotubes (CNTs) to transport bioactive peptides, proteins, nucleic acids, and medicines by functionalizing them with these substances. Due to their low toxicity and absence of immunogenicity, carbon nanotubes are not immunogenic. Ammonium-functionalized carbon nanotubes are also attractive vectors for gene-encoding nucleic acids. CNTs that have been coupled with antigenic peptides have the potential to be developed into a novel and efficient approach for the use of synthetic vaccines. CNTs bring up an enormous number of new avenues for future medicine development depending on targets within cells, which have until now been difficult to access. This review focuses on the numerous applications of various CNT types used as medicine transport systems and on the utilization of CNTs for therapeutical purposes.

Modeling the gene delivery process of the needle array-based tissue nanotransfection

Hollow needle array-based tissue nanotransfection (TNT) presents an in vivo transfection approach that directly translocate exogeneous genes to target tissues by using electric pulses. In this work, the gene delivery process of TNT was simulated and experimentally validated. We adopted the asymptotic method and cell-array-based model to investigate the electroporation behaviors of cells within the skin structure. The distribution of nonuniform electric field across the skin results in various electroporation behavior for each cell. Cells underneath the hollow microchannels of the needle exhibited the highest total pore numbers compared to others due to the stronger localized electric field. The percentage of electroporated cells within the skin structure, with pore radius over 10 nm, increases from 25% to 82% as the applied voltage increases from 100 to 150 V/mm. Furthermore, the gene delivery behavior across the skin tissue was investigated through the multilayer-stack-based model. The delivery distance increased nonlinearly as the applied voltage and pulse number increased, which mainly depends on the diffusion characteristics and electric conductivity of each layer. It was also found that the skin is required to be exfoliated prior to the TNT procedure to enhance the delivery depth. This work provides the foundation for transition from the study of murine skin to translation use in large animals and human settings.

Physical triggering strategies for drug delivery

Physically triggered systems hold promise for improving drug delivery by enhancing the controllability of drug accumulation and release, lowering non-specific toxicity, and facilitating clinical translation. Several external physical stimuli including ultrasound, light, electric fields and magnetic fields have been used to control drug delivery and they share some common features such as spatial targeting, spatiotemporal control, and minimal invasiveness. At the same time, they possess several distinctive features in terms of interactions with biological entities and/or the extent of stimulus response. Here, we review the key advances of such systems with a focus on discussing their physical mechanisms, the design rationales, and translational challenges.

Dual Propionibacterium acnes therapy using skin penetration-enhanced liposomes loaded with a photosensitizer and an antibiotic

Various antibiotics and photosensitizers are used for Propionibacterium acnes therapy. However, the success rate of therapy is limited because of antibiotic resistance, side-effects of photodynamic therapy using photosensitizer and the low skin-penetration efficiency of antibiotics and photosensitizers. In this study, to enhance the skin penetration efficiency, maintain their photodynamic activity and induce dual antibacterial therapeutic effects, we prepare erythromycin and branched polyethyleneimin-hematoporphyrin (bPEI-HPP) conjugates were loaded into liposomes (cationic photosensitizer-erythromycin loaded liposomes, CP-L (bPEI-HPP 10 mg; CP-L 1 and 20 mg; CP-L 2)). The tissue penetration efficiency of CP-Ls was determined by the Franz cell diffusion system and fluorescence microscopy. The penetration efficiency of CP-Ls is greater than that of bPEI-HPP, unloaded cationic photosensitizer and free HPP because CP-Ls comprised phospholipids that are similar to the cell membrane lipid composition. For in vitro antibacterial effects, Propionibacterium acnes (P. acnes) were used. The loss of viability rate of P. acnes by CP-L 2 (95%) from the colony forming unit (CFU) assay, was 2.4-fold higher than erythromycin-loaded liposomes (39%) and 1.9-fold higher than bPEI-HPP-loaded liposomes (50%). Therefore, we suggest that polycationic photosensitizer and antibiotic-loaded liposomes have potential applications in clinical photodynamic anti-bacterial therapy.

The effect of carbon nanotubes on drug delivery in an electro-sensitive transdermal drug delivery system

An electro-sensitive transdermal drug delivery system was prepared by the electrospinning method to control drug release. A semi-interpenetrating polymer network was prepared as the matrix with polyethylene oxide and pentaerythritol triacrylate polymers. Multi-walled carbon nanotubes were used as an additive to increase the electrical sensitivity. The release experiment was carried out under different electric voltage conditions. Carbon nanotubes were observed in the middle of the electrospun fibers by SEM and TEM. The amount of released drug was effectively increased with higher applied electric voltages. These results were attributed to the excellent electrical conductivity of the carbon additive. The suggested mechanism of drug release involves polyethylene oxide of the semi-interpenetrating polymer network being dissolved under the effects of carbon nanotubes, thereby releasing the drug. The effects of the electro-sensitive transdermal drug delivery system were enhanced by the carbon nanotubes.

Erbium:YAG laser-mediated oligonucleotide and DNA delivery via the skin: an animal study

Topical delivery of antisense oligonucleotides (ASOs) and DNA is attractive for treatment of skin disorders. However, this delivery method is limited by the low permeability of the stratum corneum (SC). The objective of this study was to enhance and optimize the skin absorption of gene-based drugs by an erbium:yttrium-aluminum-garnet (Er:YAG) laser. The animal model utilized nude mice. In the in vitro permeation study, the Er:YAG laser treatment produced a 3-30-fold increase in ASO permeation which was dependent on the laser fluence and ASO molecular mass used. The fluorescence microscopic images showed a more-significant localization of a 15-mer ASO in the epidermis and hair follicles after laser application as compared with the control. The expressions of reporter genes coding for beta-galactosidase and green fluorescent protein (GFP) in skin were assessed by X-gal staining and confocal laser scanning microscopy. The SC ablation effect and photomechanical waves produced by the Er:YAG laser resulted in DNA expression being extensively distributed from the epidermis to the subcutis. The GFP expression in 1.4 J/cm2-treated skin was 160-fold higher than that in intact skin. This non-invasive, well-controlled technique of using an Er:YAG laser for gene therapy provides an efficient strategy to deliver ASOs and DNA via the skin.

Skin electroporation for transdermal and topical delivery

Electroporation is the transitory structural perturbation of lipid bilayer membranes due to the application of high voltage pulses. Its application to the skin has been shown to increase transdermal drug delivery by several orders of magnitude. Moreover, electroporation, used alone or in combination with other enhancement methods, expands the range of drugs (small to macromolecules, lipophilic or hydrophilic, charged or neutral molecules) which can be delivered transdermally. Molecular transport through transiently permeabilized skin by electroporation results mainly from enhanced diffusion and electrophoresis. The efficacy of transport depends on the electrical parameters and the physicochemical properties of drugs. The in vivo application of high voltage pulses is well tolerated but muscle contractions are usually induced. The electrode and patch design is an important issue to reduce the discomfort of the electrical treatment in humans.

Joule heating during solid tissue electroporation

The application of high-voltage pulses to biological tissue causes not only electroporation, a non-thermal phenomenon of pore creation within a lipid membrane due to an elevated electric field, but also significant heating. Once a biological membrane is porated, the current density increases several times, causing Joule heating. A combined experimental and theoretical study is reported. The theoretical temperature rise for a 1.25 kV cm(-1), 6 ms pulse is about 11.2 K for a tissue conductivity of 0.5 S m(-1) (i.e. myocardial tissue) during high-voltage application. Owing to the inhomogeneous electric field obtained with the use of needle electrodes, the temperature rises first at the electrodes, where the field strength reaches a maximum. Only for highly conductive tissue such as muscle was a temperature effect primarily observed in the bulk. Even if the temperature effect is biologically insignificant, it can affect the creation of stabile aqueous pathways by electroporation. The calculation of temperature distribution during high-voltage application, taking the electric field strength and the heat transfer into account, can be a useful tool for electrode optimisation.

Enhanced delivery of naked DNA to the skin by non-invasive in vivo electroporation

DNA delivery to skin may be useful for the treatment of skin diseases, DNA vaccinations, and other gene therapy applications requiring local or systemic distribution of a transgene product. However, the effective, consistent and patient-friendly transfection of skin cells remains a challenge. In a mouse model, we evaluated the effectiveness of intradermal injection of plasmid DNA followed by noninvasive in vivo electroporation (EP) as a method to improve transfection in skin. We achieved a several hundred-fold stimulation of gene expression by EP, sufficient to produce clinically relevant amounts of transgene product. We studied the effect of DNA dose and time after treatment as well as various EP pulse parameters on the efficiency of gene expression. EP under conditions of constant charge transfer revealed that the applied voltage was the main determinant for transgene expression efficiency while other pulse parameters had lesser effects. Patient-friendly, noninvasive meander electrodes which we designed for clinical applications proved equally effective and safe as plate electrodes. We also showed for the first time that noninvasive EP is effective in stimulating transfection and gene expression in human skin, particularly in the epidermis. Our findings demonstrate the applicability of EP-enhanced DNA delivery to skin for gene therapy, DNA immunization and other areas.

Novel mechanisms and devices to enable successful transdermal drug delivery

Optimisation of drug delivery through human skin is important in modern therapy. This review considers drug-vehicle interactions (drug or prodrug selection, chemical potential control, ion pairs, coacervates and eutectic systems) and the role of vesicles and particles (liposomes, transfersomes, ethosomes, niosomes). We can modify the stratum corneum by hydration and chemical enhancers, or bypass or remove this tissue via microneedles, ablation and follicular delivery. Electrically assisted methods (ultrasound, iontophoresis, electroporation, magnetophoresis, photomechanical waves) show considerable promise. Of particular interest is the synergy between chemical enhancers, ultrasound, iontophoresis and electroporation.

Electrically-assisted transdermal delivery of buprenorphine

The objective of this study was to explore the electrically assisted transdermal delivery of buprenorphine. Oral delivery of buprenorphine, a synthetic opiate analgesic, is less efficient due to low absorption and large first-pass metabolism. While transdermal delivery of buprenorphine is expected to avoid the first-pass effect and thereby be more bioavailable, use of electrical enhancement techniques (iontophoresis and/or electroporation) could provide better programmability. Another use of buprenorphine is for opiate addiction therapy. However, a patch type device is subject to potential abuse as it could be removed by the addict. This abuse can be prevented if drug particles are embedded in the skin. The feasibility of doing so was investigated by electro-incorporation. Buprenorphine HCl (1 mg/ml) in citrate buffer (pH 4.0) was delivered in vitro across human epidermis via iontophoresis using a current density of 0.5 mA/cm(2) and silver-silver chloride electrodes. Electroporation pulses were also applied in some experiments. For electro-incorporation, drug microspheres or particles were driven into full thickness human skin by electroporation. It was observed that the passive transdermal flux of buprenorphine HCl was significantly enhanced by iontophoresis under anodic polarity. The effectiveness of electro-incorporation seemed inconclusive, with pressure also playing a potential role. Delivery was observed with electro-incorporation, but the results were statistically not different from the corresponding controls.

Electroporation-mediated topical delivery of vitamin C for cosmetic applications

It is now medically recognized that sagging skin and other signs of degenerative skin conditions, such as wrinkles and age spots, are caused primarily by oxy-radical damage. Vitamin C (Vit. C), in the form of L-ascorbic acid (Asc), is the one vitamin that can accelerate wound healing, protect fatty tissues from oxidation damage, and play an integral role in collagen synthesis. It is known that the lipid-rich stratum corneum (SC) is a highly resistant barrier to chemical agents penetrating into the skin. This report describes the first feasibility study of electroporation-mediated topical delivery (EMTD) of Asc for potential cosmetic applications. Both a cream formulation (20% Asc) and a crystal suspension (33% Asc) were applied respectively to human cadaver skin and fresh surgical skin. Six exponential pulses at 60 or 100 V and pulse lengths of 2.7-30 ms were selected. EMTD was more effective on fresh human skin than on human cadaver skin. For both skin models, EMTD with cream resulted in a greater enhancement of Vit. C penetration than with suspension. The distribution of electrical fields through the SC, epidermis, and dermis is demonstrated in computer simulation. Assuming that this fresh skin model and certain experimental conditions simulate projected in vivo applications, EMTD of Vit. C may represent an alternative method to ameliorate skin aging.

Iontophoresis and electroporation: comparisons and contrasts

The techniques of iontophoresis and electroporation can be used to enhance topical and transdermal drug delivery. Iontophoresis applies a small low voltage (typically 10 V or less) continuous constant current (typically 0.5 mA/cm2 or less) to push a charged drug into skin or other tissue. In contrast, electroporation applies a high voltage (typically, ?100 V) pulse for a very short (micros-ms) duration to permeabilize the skin. This electric assistance of drug delivery across skin will expand the scope of transdermal delivery to hydrophilic macromolecules such as the drugs of biotechnology. These two techniques differ in several aspects such as the mode of application and pathways of transport but can be used together for effective drug delivery. Iontophoresis is already used clinically in physical therapy clinics and is close to commercialization for development of a systemic delivery patch with miniaturized circuits and similar in overall size to a passive patch. The use of electroporation for drug delivery is relatively new and is being actively researched.

Charged microbeads are not transported across the human stratum corneum in vitro by short high-voltage pulses

There have been several reports of particle transport due to high-voltage pulsing of human skin. Here, several different short, high-voltage pulsing protocols were used in vitro to study the possible transport of highly charged, fluorescent polystyrene particles (14 nm to 2.1 microns in diameter; surface charges of -4.05 x 10(3) e to -2.77 x 10(7) e) across the skin. Two different methods were used to trap and measure particles on the other side of the skin. The first used a polycarbonate membrane to trap the particles, determining the amount of transport by enumeration under a fluorescence microscope. The second used spectrofluorimetry to measure the amount of particles transported. After pulsing, particles were found in randomly distributed clusters on the surface of the skin. No detectable transport across the stratum corneum for any size particle was observed.

Mechanistic studies of molecular transdermal transport due to skin electroporation

The application of electrical high voltage pulses has been shown to greatly enhance the transdermal transport of water-soluble compounds. The resistance of the skins most important barrier, the stratum corneum, drops within less than 1 µs by orders of magnitude. This effect is attributed to electroporation, a nonthermic phenomena known to occur in phospholipid double layers. The striking difference between the stratum corneum lipid layers and the usually investigated phospholipid systems is the phase transition temperature. While lipid layers used for electroporation experiments are in liquid crystal phase above the phase transition temperature, the stratum corneum lipids (phase transition at approximately 70 degrees C) form a rigid quasi-crystalline membrane at room temperature.After the electrical stimulus a recovery of the passive flux was found making high voltage pulsing a suitable tool for controlling transdermal drug delivery. By ordinary light microscopy no dramatic changes in skin structure were found supporting the thesis of electroporation. However the microstructure shows clearly persistent structural changes. Recently the involvement of Joule heating due to the electric stimulus was shown as an important factor for skin permeabilization and molecular transport.

In vivo efficacy and safety of skin electroporation

This article reviews the studies on skin electroporation carried out in vivo in animals and emphasizes its potential therapeutic applications for transdermal and topical drug delivery. In agreement with in vitro studies, transport across skin due to high-voltage pulses in vivo was shown to increase by orders of magnitude on a timescale of minutes. Increased transdermal transport was measured by systemic blood uptake and/or pharmacological response, and demonstrated for calcein, a fluorescent tracer, fentanyl, a potent analgesic and flurbiprofen, an antiinflammatory drug. Combined electroporation with iontophoresis was shown to provide rapidly responsive transdermal transport of luteinizing hormone releasing hormone ex vivo as well. These data underline the potential of skin electroporation for improving the delivery profile of existing conventional transdermal patches, but also for replacing the injectable route.High-voltage pulses can increase drug permeation within and across skin but are also an efficient tool to permeabilize the membrane of cells of the cutaneous or subcutaneous tissue. This was shown beneficial for targeting cutaneous cells with oligonucleotides or genes and might open new opportunities for gene therapy and DNA vaccination.The safety of the application of high-voltage pulses on skin was assessed in vivo, using histological and visual scores, and bioengineering methods. While changes in skin barrier and function were observed, the irritation was mild and short-lived. Further optimization of the electrode configuration for improved targeting of the stratum corneum should still improve tolerance and levels of sensation.

A practical assessment of transdermal drug delivery by skin electroporation

Transdermal drug delivery has many potential advantages, but the skin's poorly-permeable stratum corneum blocks delivery of most drugs at therapeutic levels. Short high-voltage pulses have been used to electroporate the skin's lipid bilayer barriers and thereby deliver compounds at rates increased by as much as four orders of magnitude. Evidence that the observed flux enhancement is due to physical alteration of the skin by electroporation, as opposed to only providing an iontophoretic driving force, is supported by a number of different transport, electrical and microscopy studies. Practical applications of electroporation's unique effects on skin are motivated by large flux increases for many different compounds, rapidly responsive delivery profiles, and efficient use of skin area and electrical charge. Greater enhancement can be achieved by combining skin electroporation with iontophoresis, ultrasound, and macromolecules. Sensation due to electroporation can be avoided by using appropriate electrical protocols and electrode design. To develop skin electroporation as a successful transdermal drug delivery technology, the strong set of existing in vitro mechanistic studies must be supplemented with studies addressing in vivo/clinical issues and device design.

Assessing the potential of skin electroporation for the delivery of protein- and gene-based drugs

Although transdermal drug delivery has many potential advantages, the permeability of skin to macromolecules is extremely low. However, the application of short, high-voltage pulses to electroporate skin has recently been shown to make it reversibly permeable. A number of studies have demonstrated that electroporation-mediated transdermal delivery of peptides, polysaccharides, oligonucleotides and genes may be possible at clinically relevant rates, leading to the current commercial development of electroporation techniques.