Liposome-mediated delivery of antiviral agents to human immunodeficiency virus-infected cells

ProLung™-budesonide Inhibits SARS-CoV-2 Replication and Reduces Lung Inflammation

Background:

Inhaled budesonide benefits patients with COVID-19. ProLung™-budesonide enables the sustained, low dose administration of budesonide within a delivery vehicle similar to lung surfactant. ProLung™-budesonide may offer anti-inflammatory and protective effects to the lung in COVID-19, yet it’s effect on SARS-CoV-2 replication is unknown.

Objective:

To determine the efficacy of ProLung™-budesonide against SARS-CoV-2-infection in vitro, evaluate its ability to decrease inflammation, and airway hyperresponsiveness in an animal model of lung inflammation.

Methods:

SARS-CoV-2-infected Vero 76 cells were treated with ProLung™-budesonide ([0.03–100 µg/ml]) for 3 days, and virus yield in the supernatant was measured. Ovalbumin-sensitized C57BL/6 mice received aerosolized (a) ProLung™-budesonide weekly, (b) only budesonide, either daily or weekly, or (c) weekly empty ProLung™ carrier (without budesonide). All treatment groups were compared to sensitized untreated, or normal mice using histopathologic examination, electron microscopy (EM), airway hyperresponsiveness (AHR) to Methacholine (Mch) challenge, and eosinophil peroxidase activity (EPO) measurements in bronchioalveolar lavage (BAL).

Results:

ProLung™-budesonide showed significant inhibition of viral replication of SARS-CoV-2-infected cells with the selectivity index (SI) value >24. Weekly ProLung™-budesonide and daily budesonide therapy significantly decreased lung inflammation and EPO in BAL. ProLung™-budesonide localized in type II pneumocytes, and was the only group to significantly decrease AHR, and EPO in BAL with Mch challenge

Conclusions:

ProLung™-budesonide significantly inhibited viral replication in SARS-CoV-2-infected cells. It localized into type II pneumocytes, decreased lung inflammation, AHR and EPO activity with Mch challenge. This novel drug formulation may offer a potential inhalational treatment for COVID-19.

Nanoparticle Uptake: The Phagocyte Problem

Phagocytes are key cellular participants determining important aspects of host exposure to nanomaterials, initiating clearance, biodistribution and the tenuous balance between host tolerance and adverse nanotoxicity. Macrophages in particular are believed to be among the first and primary cell types that process nanoparticles, mediating host inflammatory and immunological biological responses. These processes occur ubiquitously throughout tissues where nanomaterials are present, including the host mononuclear phagocytic system (MPS) residents in dedicated host filtration organs (i.e., liver, kidney spleen, and lung). Thus, to understand nanomaterials exposure risks it is critical to understand how nanomaterials are recognized, internalized, trafficked and distributed within diverse types of host macrophages and how possible cell-based reactions resulting from nanomaterial exposures further inflammatory host responses in vivo. This review focuses on describing macrophage-based initiation of downstream hallmark immunological and inflammatory processes resulting from phagocyte exposure to and internalization of nanomaterials.

Enhanced anti-HIV efficacy of indinavir after inclusion in CD4-targeted lipid nanoparticles

BACKGROUND

Combination drug therapy has reduced plasma HIV to undetectable levels; however, drug-sensitive virus persists in patients' lymphoid tissue. We have reported significant lymphoid tissue drug localization with indinavir-associated lipid nanoparticles (LNPs). Our current objective is to evaluate whether additional enhancement is achievable by targeting these particles to CD4-HIV host cells.

METHODS

We characterized 2 peptide-coated (CD4-BP2 and CD4-BP4) drug-associated LNPs and demonstrated CD4-cell specificity. Drug-associated LNPs expressing polyethyleneglycol were exposed on HIV-2-infected cells under dynamic conditions that emulated lymph node physiology for 15, 30, and 60 minutes at concentrations from 0 to 25 μM and evaluated for antiviral activity and cell-associated drug concentrations. The specificity of CD4-mediated enhancement of indinavir LNPs antiviral activity was evaluated by blocking with anti-CD4 antibody.

RESULTS

Inclusion of CD4-binding peptides on LNPs enhanced antiviral activity for all incubation conditions, compared with control particles or soluble drug (eg, 60 minutes exposure, EC50 = 0.12-0.13 vs. 0.46 μM for targeted nanoparticles vs. soluble drug). The CD4-BP4 peptide exhibited higher efficiency in eliciting antiviral activity than CD4-BP2-coated particles (EC50 = 7.5 μM vs. >25 μM at 15 minutes drug exposure). This enhancement seems to be driven by CD4 availability and cell-associated indinavir concentrations, as blocking of CD4 significantly ablated indinavir efficacy in targeted particles and indinavir concentrations reflected the observed anti-HIV activity.

CONCLUSIONS

We constructed CD4-targeted LNPs that provide selective binding and efficient delivery of indinavir to CD4-HIV host cells. Inclusion of polyethyleneglycol in LNPs would minimize immune recognition of peptides. The enhancement of anti-HIV effects is effective even under limited time exposure.

Design and characterization of novel peptide-coated lipid nanoparticles for targeting anti-HIV drug to CD4 expressing cells

Human immunodeficiency virus (HIV) persists in lymph nodes and lymphoid tissues even during aggressive drug treatment, likely due to insufficient drug concentrations at this site. Therefore, to eliminate this residual virus, methods that enhance lymph node drug concentrations are currently being evaluated. Although enhanced drug concentrations in tissue have been achieved with drug-associated lipid nanoparticles, targeting these particles to CD4(+) cells may provide specific delivery of drug to HIV target cells and further enhance drug efficacy. We have evaluated four candidate peptides with reported binding specificity to CD4 for anchoring on lipid nanoparticle preparations previously shown to localize in lymph nodes. Terminal cysteine containing candidate peptides were conjugated to lipid nanoparticles through maleimide-linked phospholipids for targeting to CD4 cells. Using fluorescently labeled lipid nanoparticle binding to cells with varying degree of CD4 expression (CEMx174, Molt-4, Jurkat, and Ramos), we indentified two peptide sequences that provided CD4 selectivity to nanoparticles. These two peptide candidates on lipid nanoparticles bound to cells corresponding to the degree of CD4 expression and in a peptide dose dependent manner. Further, binding of these targeted lipid nanoparticles was CD4 specific, as pre-exposure of CD4(+) cells to anti-CD4 antibodies or free peptides inhibited the binding interactions. These results indicate targeting of lipid nanoparticles for specific binding to CD4 can be accomplished by tagging CD4 binding peptides with peptides, and these results provide a basis for further evaluation of this targeted delivery system to enhance antiviral drug delivery to CD4(+) HIV host cells, particularly those in lymph nodes and lymphoid tissues.

Cell-mediated drug delivery

INTRODUCTION

Drug targeting to sites of tissue injury, tumor or infection with limited toxicity is the goal for successful pharmaceutics. Immunocytes (including mononuclear phagocytes (dendritic cells, monocytes and macrophages), neutrophils and lymphocytes) are highly mobile; they can migrate across impermeable barriers and release their drug cargo at sites of infection or tissue injury. Thus, immune cells can be exploited as Trojan horses for drug delivery.

AREAS COVERED

This paper reviews how immunocytes laden with drugs can cross the blood-brain or blood-tumor barriers to facilitate treatments for infectious diseases, injury, cancer, or inflammatory diseases. The promises and perils of cell-mediated drug delivery are reviewed, with examples of how immunocytes can be harnessed to improve therapeutic end points.

EXPERT OPINION

Using cells as delivery vehicles enables targeted drug transport and prolonged circulation times, along with reductions in cell and tissue toxicities. Such systems for drug carriage and targeted release represent a new disease-combating strategy being applied to a spectrum of human disorders. The design of nanocarriers for cell-mediated drug delivery may differ from those used for conventional drug delivery systems; nevertheless, engaging different defense mechanisms in drug delivery may open new perspectives for the active delivery of drugs.

Nanoparticulate Delivery Systems for Antiviral Drugs

Nanomedicine opens new therapeutic avenues for attacking viral diseases and for improving treatment success rates. Nanoparticulate-based systems might change the release kinetics of antivirals, increase their bioavailability, improve their efficacy, restrict adverse drug side effects and reduce treatment costs. Moreover, they could permit the delivery of antiviral drugs to specific target sites and viral reservoirs in the body. These features are particularly relevant in viral diseases where high drug doses are needed, drugs are expensive and the success of a therapy is associated with a patient's adherence to the administration protocol.

This review presents the current status in the emerging area of nanoparticulate delivery systems in antiviral therapy, providing their definition and description, and highlighting some peculiar features. The paper closes with a discussion on the future challenges that must be addressed before the potential of nanotechnology can be translated into safe and effective antiviral formulations for clinical use.

Development of a chimeric DNA-RNA hammerhead ribozyme targeting SARS virus

OBJECTIVE

Severe acute respiratory syndrome (SARS) is a severe pulmonary infectious disease caused by a novel coronavirus. To develop an effective and specific medicine targeting the SARS-coronavirus (CoV), a chimeric DNA-RNA hammerhead ribozyme was designed and synthesized using a sequence homologous with the mouse hepatitis virus (MHV).

METHOD

Chimeric DNA-RNA hammerhead ribozyme targeting MHV and SARS-CoV were designed and synthesized.To confirm its activity, in vitro cleavage reactions were performed with the synthesized ribozyme. Effects of the chimeric ribozyme were evaluated on multiplication of MHV. Effects of the chimeric ribozyme on expression of SARS-CoV were evaluated in cultured 3T3 cells.

RESULT

The synthetic ribozyme cleaved the synthetic target MHV and SARS-CoV RNA into fragments of predicted length. The chimeric DNA-RNA hammerhead ribozyme targeting SARS-CoV significantly inhibited multiplication of MHV in DBT cells by about 60%. The chimeric DNA-RNA hammerhead ribozyme targeting SARS-CoV significantly inhibited the expression of SARS-CoV RNA in 3T3 cells transfected with the recombinant plasmid. The chimeric DNA-RNA ribozyme targeting SARS-CoV significantly inhibited MHV viral activity and expression of recombinant SARS RNA in vitro.

CONCLUSION

These findings indicate that the synthetic chimeric DNA-RNA ribozyme could provide a feasible treatment for SARS.

Nanotechnology-based delivery systems in HIV/AIDS therapy

The therapeutic efficacy of anti-HIV agents is often hampered by poor bioavailability and lack of drug penetration in infected target tissues and cells. Using different types of nanotechnology-based delivery systems, it is possible to engineer strategies that can improve the therapeutic efficacy in HIV/AIDS by delivering drugs to cellular and anatomical viral reservoirs. The rationale for the use of nanocarrier systems relies on the fact that different types of therapeutic payloads can be encapsulated and the systemic pharmacokinetics and distribution are dictated by the properties of the nanocarriers rather than the drugs. The versatility of nanoplatforms can be further exploited in a formulation that has enhanced oral bioavailability, protects against degradation upon oral or systemic administration and prolongs the residence time at the target site. Nanocarriers can facilitate lymphatic transport, delivery across the blood–brain barrier, and efficient internalization in cells by nonspecific or receptor-mediated endocytosis. In this review, we will address the role of nanotechnology-based delivery systems in improving the delivery efficiency of anti-HIV drugs to cellular and anatomical sites of interest. Specific published examples will be highlighted with emphasis on the role of polymeric nanoparticle micelles, liposomes and nanoemulsions in improving delivery efficiency.

Nanoparticulate drug carriers for delivery of HIV/AIDS therapy to viral reservoir sites

Providing the optimum treatment of AIDS is a major challenge in the 21st Century. HIV is localised and harboured in certain inaccessible compartments of the body, such as the CNS, the cerebrospinal fluid, the lymphatic system and in the macrophages, where it cannot be reached by the majority of therapeutic agents in adequate concentrations or in which the therapeutic agents cannot reside for the necessary duration. Progression in HIV/AIDS treatment suggests that available therapy can lower the systemic viral load below the detection limit. However, on discontinuation of treatment, there is relapse of the infection from the reservoir sites and a potential for resistance development. This review discusses the aetiology and pathology of HIV, with emphasis on the viral reservoirs, current therapy of AIDS, and the opportunity for nanotechnology-based drug delivery systems to facilitate complete eradication of viral load from the reservoir sites. Literature-cited examples of drug delivery systems that are under investigation for the treatment of AIDS are discussed. The article also focuses on the future outlook and strategies for investigational drug formulations that use nanotherapeutic strategy for HIV/AIDS.

Nanotechnology: intelligent design to treat complex disease

The purpose of this expert review is to discuss the impact of nanotechnology in the treatment of the major health threats including cancer, infections, metabolic diseases, autoimmune diseases, and inflammations. Indeed, during the past 30 years, the explosive growth of nanotechnology has burst into challenging innovations in pharmacology, the main input being the ability to perform temporal and spatial site-specific delivery. This has led to some marketed compounds through the last decade. Although the introduction of nanotechnology obviously permitted to step over numerous milestones toward the development of the "magic bullet" proposed a century ago by the immunologist Paul Ehrlich, there are, however, unresolved delivery problems to be still addressed. These scientific and technological locks are discussed along this review together with an analysis of the current situation concerning the industrial development.

Cell-specific targeting of lipid-based carriers for ODN and DNA

It is well recognized that there is an urgent need for non-toxic systemically applicable vectors for biologically active nucleotides to fully exploit the current potential of molecular medicine in gene therapy. Cell-specific targeting of non-viral lipid-based carriers for ODN and DNA is a prerequisite to attain the concentration of nucleic acids required for therapeutic efficacy in the target tissue. In this review we will address the most promising approaches to selective targeting of liposomal nucleic acid carriers in vivo. In addition, the routes of entry and intracellular processing of these carrier systems are discussed as well as physiological factors potentially interfering with the biological and/or therapeutic activity of their nucleotide pay-load.

Lymphoid tissue targeting of anti-HIV drugs using liposomes

Considering that HIV-1 accumulates and replicates actively within lymphoid tissues, any strategy that will decrease viral stores in these tissues might be beneficial to the infected host. Follicular dendritic cells (FDC), B lymphocytes, antigen-presenting cells like macrophages, and activated CD4(+) T cells are abundant in lymphoid tissues, and all express substantial levels of the HLA-DR determinant of the major histocompatibility complex class II (MHC-II). Monocyte-derived macrophages, which are also CD4(+) and express HLA-DR, are considered to be the most frequent hosts of HIV-1 in tissues of infected individuals. This chapter describes a method for the generation of sterically stabilized immunoliposomes grafted with anti-HLA-DR antibodies that allows efficient delivery of drugs to lymphoid tissues. The method first involves the production of murine HLA-DR (clone Y-17, IgG(2b)) and human HLA-DR (clone 2.06, IgG(1)) antibodies from hybridomas in mice and their purification from ascites fluids. This step is followed by the production of Fab' fragments of antibodies 2.06 and Y-17 that are grafted at the surface of sterically stabilized immunoliposomes instead of the complete IgG to reduce their immunogenicity. The preparation of sterically stabilized liposomes, the composition of which allows an efficient entrapment and retention of several drugs, by the method of thin lipid film hydratation followed by extrusion through polycarbonate membranes is then described. This step is followed by the removal of unencapsulated drug, when present, by low-speed centrifugation of the liposomal preparation through a Sephadex G-50 column. These liposomes contain a fixed amount of poly(ethylene glycol) chain terminated by a maleimide reactive group for the coupling of Fab' fragments. The procedure for the coupling of Fab' fragments at the surface of sterically stabilized liposomes and the removal of uncoupled fragments of antibodies is described. In vitro binding studies of sterically stabilized immunoliposomes to cell lines expressing different surface levels of the mouse or human HLA-DR determinant of MHC-II demonstrate that these liposomes are very specific. When compared with conventional liposomes, the subcutaneous administration in the upper back, below the neck, of mice of anti-HLA-DR immunoliposomes resulted in a 2.9 and 1.6 times greater accumulation in the cervical and brachial lymph nodes, respectively. The use of sterically stabilized immunoliposomes increases 2 to 4.6 times the concentration of liposomes in all tissues, with a peak accumulation at 240 h in brachial, inguinal, and popliteal lymph nodes and at 360 h or greater in cervical lymph nodes. A single bolus injection of indinavir given subcutaneously to mice results in no significant drug levels in lymphoid organs. Most of the injected drug accumulates in the liver and is totally cleared within 24 h postadministration. In contrast, sterically stabilized immunoliposomes are very efficient in delivering high concentrations of indinavir to lymphoid tissues for at least 15 days postinjection. The drug accumulation in all tissues leads to a 21- to 126-fold increased accumulation when compared with the free agent. Anti-HLA-DR immunoliposomes containing indinavir are as efficient as the free agent in inhibiting HIV-1 replication in PM1 cells that express high levels of cell surface HLA-DR. Sterically stabilized anti-HLA-DR immunoliposomes mostly accumulate in the cortex in which follicles (B cells and FDCs) are located, and in parafollicular areas in which T cells, interdigitating dendritic cells, and other accessory cells are abundant. The delivery of drugs in this area of the lymph nodes could represent a convenient strategy to inhibit more efficiently HIV-1 replication. Although the method described in this chapter is specific to the coupling of anti-HLA-DR antibodies, any antibody fragment or peptide specific for an antigen present in relatively large quantities at the surface of lymphoid cells, that is anchored to the surface of sterically stabilized liposomes with an appropriate coupling method, can be used to concentrate drugs within target tissues and improve the therapeutic effect of drugs.

Delivery of antiviral agents in liposomes

The intracellular activity of certain antiviral agents, including antisense oligonucleotides, acyclic nucleoside phosphonates, and protease inhibitors, is enhanced when they are delivered in liposome-encapsulated form. In this chapter we describe the preparation of pH-sensitive liposomes encapsulating antisense oligonucleotides, ribozymes, and acyclic nucleoside phosphonate analogues and their effects on HIV replication in macrophages. We outline the use of liposomal HIV protease inhibitors in infected macrophages. We present two methods for the covalent coupling of soluble CD4 to liposomes and show the association of these liposomes with HIV-infected cells. We also describe the synthesis of a novel antiviral agent based on cyclodextrin and its incorporation into liposomes.

Endogenous expression of a high-affinity pseudoknot RNA aptamer suppresses replication of HIV-1

Aptamers, small oligonucleotides derived from an in vitro evolution process called SELEX, are promising therapeutic and diagnostic agents. Although very effective in vitro, only a few examples are available showing their potential in vivo. We have analyzed the effect of a well characterized pseudoknot RNA aptamer selected for tight binding to human immunodeficiency virus (HIV) type 1 reverse transcriptase on HIV replication. Transient intracellular expression of a chimeric RNA consisting of the human initiator tRNA(Met) (tRNA(Meti))/aptamer sequence in human 293T cells showed inhibition of HIV particle release by >75% when the cells were co-transfected with proviral HIV-1 DNA. Subsequent virus production of human T-lymphoid C8166 cells, infected with viral particles derived from co-transfected 293T cells, was again reduced by >75% as compared with the control. As the observed effects are additive, in this model for virus spread, the total reduction of HIV particle formation by transient intracellular expression of the pseudoknot RNA aptamer amounts to >95%. Low-dose HIV infection of human T cells stably expressing the aptamer did not show any virus replication over a period of 35 days. This is the first example of an RNA aptamer selected against a viral enzyme target to show powerful antiviral activity in HIV-1-permissive human T-lymphoid cell lines.

Mutations that confer resistance to template-analog inhibitors of human immunodeficiency virus (HIV) type 1 reverse transcriptase lead to severe defects in HIV replication

We isolated two template analog reverse transcriptase (RT) inhibitor-resistant mutants of human immunodeficiency virus (HIV) type 1 RT by using the DNA aptamer, RT1t49. The mutations associated, N255D or N265D, displayed low-level resistance to RT1t49, while high-level resistance could be observed when both mutations were present (Dbl). Molecular clones of HIV that contained the mutations produced replication-defective virions. All three RT mutants displayed severe processivity defects. Thus, while biochemical resistance to the DNA aptamer RT1t49 can be generated in vitro via multiple mutations, the overlap between the aptamer- and template-primer-binding pockets favors mutations that also affect the RT-template-primer interaction. Therefore, viruses with such mutations are replication defective. Potent inhibition and a built-in mechanism to render aptamer-resistant viruses replication defective make this an attractive class of inhibitors.

Long-circulating sterically stabilized liposomes as carriers of agents for treatment of infection or for imaging infectious foci

Liposomes are considered as potential carriers for biologically active compounds. One evident drawback of 'classical' liposomes is their fast elimination by cells of the mononuclear phagocyte system (MPS), primarily by liver and spleen. An important breakthrough in this respect is the development of long-circulating liposomes among which liposomes coated with polyethyleneglycol (PEG), the so-called 'sterically stabilized' liposomes (SSL). An important characteristic of SSL is that their prolonged blood residence time and infectious target localization is relatively independent of the lipid dose, particle size or lipid composition of the bilayer. SSL are applied as carriers of antimicrobial agents to achieve infectious target localization, to reduce side effects, or to serve as a micro-reservoir in the circulation. In addition, radiolabelled SSL are used to image infectious and inflammatory foci.

Targeted delivery of indinavir to HIV-1 primary reservoirs with immunoliposomes

The tissue distribution of indinavir, free or incorporated into sterically stabilized anti-HLA-DR immunoliposomes, has been evaluated after a single subcutaneous injection to C3H mice. Administration of free indinavir resulted in low drug levels in lymphoid organs. In contrast, sterically stabilized anti-HLA-DR immunoliposomes were very efficient in delivering high concentrations of indinavir to lymphoid tissues for at least 15 days post-injection increasing by up to 126 times the drug accumulation in lymph nodes. The efficacy of free and immunoliposomal indinavir has been evaluated in vitro. Results showed that immunoliposomal indinavir was as efficient as the free agent to inhibit HIV-1 replication in cultured cells. The toxicity and immunogenicity of repeated administrations of liposomal formulations have also been investigated in rodents. No significant differences in the levels of hepatic enzymes of mice treated with free or liposomal indinavir were observed when compared to baseline and control untreated mice. Furthermore, histopathological studies revealed no significant damage to liver and spleen when compared to the control group. Liposomes bearing Fab' fragments were 2.3-fold less immunogenic than liposomes bearing the entire IgG. Incorporation of antiviral agents into sterically stabilized immunoliposomes could represent a novel therapeutic strategy to target specifically HIV reservoirs and treat more efficiently this retroviral infection.

Acyclic nucleoside/nucleotide analogues with an imidazole ring skeleton

Syntheses of a few acyclic nucleoside and acyclic nucleoside phosphonate analogues containing an imidazole ring have been reported. These analogues include methyl 1-(2-hydroxyethoxymethyl)imidazole-4, 5-dicarbo-xylate (1), 4,5-dicarbamoyl-1-(2-hydroxyethoxymethyl)imidazole (2), 4,5-dicyano-1-(2-hydroxyethoxymethyl)imidazole (4), Methyl 1-(2-bromoethoxymethyl)imidazole-4,5-dicarboxylate (7), 4,5-dicyano-(2-bromoethoxymethyl)imidazole (8), and Methyl 1-(2-phosphonomethoxyethyl)imidazole (10). Also reported are a few potential prodrugs of the above compounds, including the acetyl derivatives 5 and 6 (of 1 and 4, respectively), and the diethyl phosphonate ester 9 (of 10). In addition, the corresponding benzyl-protected precursors 11 and 12 (of 1 and 4, respectively), along with their common hydrolysis product, 1-(2-benzyloxy-ethoxymethyl)-4,5-imidazoledicarboxylic acid (3), are reported. Another potential prodrug included in the list is 1-(2-acetoxyethyl)-4,5-dicyanoimidazole (15). The compounds were screened for in vitro antiviral activity against a wide variety of herpes and respiratory viruses. The most active compound was the phosphonate analogue 9 which exhibited an anti-measles virus activity with an EC50 of <2.5 microg/mL and an SI value of > 176.

Enhanced inhibition of HIV-1 replication in macrophages by antisense oligonucleotides, ribozymes and acyclic nucleoside phosphonate analogs delivered in pH-sensitive liposomes

An antisense oligodeoxynucleotide against the human immunodeficiency virus type 1 (HIV-1) Rev response element, a ribozyme complementary to the HIV-1 5'-LTR, and the reverse transcriptase inhibitors 9-(2-phosphonylmethoxyethyl) adenine (PMEA) and (R)-9-(2-phosphonylmethoxypropyl)-adenine (PMPA) inhibited virus replication in monocyte-derived macrophages more effectively when delivered in pH-sensitive liposomes compared to the free drugs.