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Hakim MH, Brindise MC, Ahmadzadegan A, Buno KP, Dos Santos ACF, Cragg KR, Dou Z, Ladisch MR, Ardekani AM, Vlachos PP, Solorio L. Rose Bengal Labeled Bovine Serum Albumin for Protein Transport Imaging in Subcutaneous Tissues Using Computed Tomography and Fluorescence Microscopy. Bioconjug Chem 2024; 35:1044-1052. [PMID: 38875443 DOI: 10.1021/acs.bioconjchem.4c00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Subcutaneous (SC) injection of protein-based therapeutics is a convenient and clinically established drug delivery method. However, progress is needed to increase the bioavailability. Transport of low molecular weight (Mw) biotherapeutics such as insulin and small molecule contrast agents such as lipiodol has been studied using X-ray computed tomography (CT). This analysis, however, does not translate to the investigation of higher Mw therapeutics, such as monoclonal antibodies (mAbs), due to differences in molecular and formulation properties. In this study, an iodinated fluorescein analog rose bengal (RB) was used as a radiopaque and fluorescent label to track the distribution of bovine serum albumin (BSA) compared against unconjugated RB and sodium iodide (NaI) via CT and confocal microscopy following injection into ex vivo porcine SC tissue. Importantly, the high concentration BSA-RB exhibited viscosities more like that of viscous biologics than the small molecule contrast agents, suggesting that the labeled protein may serve as a more suitable formulation for the investigation of injection plumes. Three-dimensional (3D) renderings of the injection plumes showed that the BSA-RB distribution was markedly different from unconjugated RB and NaI, indicating the need for direct visualization of large protein therapeutics using conjugated tags rather than using small molecule tracers. Whereas this proof-of-concept study shows the novel use of RB as a label for tracking BSA distribution, our experimental approach may be applied to high Mw biologics, including mAbs. These studies could provide crucial information about diffusion in SC tissue and the influence of injection parameters on distribution, transport, and downstream bioavailability.
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Affiliation(s)
- Mazin H Hakim
- Weldon School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Melissa C Brindise
- School of Mechanical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Adib Ahmadzadegan
- School of Mechanical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Kevin P Buno
- Weldon School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Antonio C F Dos Santos
- Laboratory of Renewable Resources Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
- Department of Agricultural and Biological Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Kevin R Cragg
- Weldon School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Zhongwang Dou
- School of Mechanical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Michael R Ladisch
- Weldon School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
- Laboratory of Renewable Resources Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
- Department of Agricultural and Biological Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Arezoo M Ardekani
- School of Mechanical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Pavlos P Vlachos
- Weldon School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
- School of Mechanical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
| | - Luis Solorio
- Weldon School of Biomedical Engineering, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
- Purdue Center for Cancer Research, Purdue University, 610 Purdue Mall, West Lafayette, Indiana 47907, United States
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Gomes C, Gridley K, Anastasiou I, Sinkó B, Mrsny RJ. Hydrogel formats to model potential drug interactions occurring at the subcutaneous injection site. Eur J Pharm Biopharm 2024; 199:114308. [PMID: 38688439 DOI: 10.1016/j.ejpb.2024.114308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/02/2024]
Abstract
We have previously developed an in vitro instrument, termed subcutaneous injection site simulator (SCISSOR), that can be used to monitor release properties of an active pharmaceutical ingredient (API) and formulation components of a medicine designed for SC injection. Initial studies to validate the SCISSOR instrument applications used a simple hyaluronic acid (HA) hydrogel to monitor early release events. We now report a type of cross-linked HA that can, when combined with HA, provide a hydrogel (HA-XR) with optical clarity and rheological properties that remain stable for at least 6 days. Incorporation of 0.05-0.1 mg/mL of collagens isolated from human fibroblasts (Col F), bovine type I collagen (Col I), chicken collagen type II (Col II), or chondroitin sulphate (CS) produced HA or HA-XR hydrogel formats with optical clarity and rheological properties comparable to HA or HA-XR alone. HA + Col F hydrogel had a much greater effect on release rates of 70 kDa compared to 4 kDa dextran, while Col F incorporated into the HA-XR hydrogel accentuated differences in release rates of prandial and basal forms of insulin as well as decreased the release rate of denosumab. A hydrogel format of HA + Col I was used to examine the complex events for bevacizumab release under conditions where a target ligand (vascular endothelial growth factor) can interact with extracellular matrix (ECM). Together, these data have demonstrated the feasibility of using a cross-linked HA format to examine API release over multiple days and incorporation of specific ECM elements to prepare more biomimetic hydrogels that allow for tractable examination of their potential impact of API release.
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Affiliation(s)
| | - Kate Gridley
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath BA2 7AY, UK
| | | | | | - Randall J Mrsny
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath BA2 7AY, UK.
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Jacquemier P, Retory Y, Virbel-Fleischman C, Schmidt A, Ostertag A, Cohen-Solal M, Alzaid F, Potier L, Julla JB, Gautier JF, Venteclef N, Riveline JP. New ex vivo method to objectively assess insulin spatial subcutaneous dispersion through time during pump basal-rate based administration. Sci Rep 2023; 13:20052. [PMID: 37973963 PMCID: PMC10654403 DOI: 10.1038/s41598-023-46993-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
Glycemic variability remains frequent in patients with type 1 diabetes treated with insulin pumps. Heterogeneous spreads of insulin infused by pump in the subcutaneous (SC) tissue are suspected but were barely studied. We propose a new real-time ex-vivo method built by combining high-precision imaging with simultaneous pressure measurements, to obtain a real-time follow-up of insulin subcutaneous propagation. Human skin explants from post-bariatric surgery are imaged in a micro-computed tomography scanner, with optimised parameters to reach one 3D image every 5 min during 3 h of 1UI/h infusion. Pressure inside the tubing is recorded. A new index of dispersion (IoD) is introduced and computed upon the segmented 3D insulin depot per time-step. Infusions were hypodermal in 58.3% among 24 assays, others being intradermal or extradermal. Several minor bubbles and one occlusion were observed. IoD increases with time for all injections. Inter-assay variability is the smallest for hypodermal infusions. Pressure elevations were observed, synchronised with air bubbles arrivals in the tissue. Results encourage the use of this method to compare infusion parameters such as pump model, basal rate, catheter characteristics, infusion site characteristics or patient phenotype.
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Affiliation(s)
- Pauline Jacquemier
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France
- Centre Explor, ALHIST - Air Liquide Healthcare, Bagneux, France
| | - Yann Retory
- LVL Médical Groupe, Lyon, France
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay Cedex, France
- CIAMS, Université d'Orléans, 45067, Orléans, France
| | | | | | - Agnes Ostertag
- Université Paris Cité, Inserm U1132 BIOSCAR, 75010, Paris, France
| | - Martine Cohen-Solal
- Université Paris Cité, Inserm U1132 BIOSCAR, 75010, Paris, France
- Service de Rhumatologie, Lariboisiere Hospital, AP-HP, 75010, Paris, France
| | - Fawaz Alzaid
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Louis Potier
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France
- Université Paris Cité, UFR de Médecine, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, APHP, Paris, France
| | - Jean-Baptiste Julla
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75013, Paris, France
- Service of Diabetology, Endocrinology and Nutrition, Federation de Diabetologie, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, AP-HP, France
| | - Jean-François Gautier
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France
- Université Paris Cité, UFR de Médecine, Paris, France
- Service of Diabetology, Endocrinology and Nutrition, Federation de Diabetologie, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, AP-HP, France
| | - Nicolas Venteclef
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France
| | - Jean-Pierre Riveline
- Institut Necker Enfants Malades (INEM), IMMEDIAB Laboratory, Université de Paris Cité, INSERM U1151, Paris, France.
- Université Paris Cité, UFR de Médecine, Paris, France.
- Service of Diabetology, Endocrinology and Nutrition, Federation de Diabetologie, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, AP-HP, France.
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Ausk BJ, Tucker AN, Huber P, Firoozabadi R, Gross JM, Gross TS, Bain SD. A microCT-based platform to quantify drug targeting. Eur Radiol Exp 2023; 7:38. [PMID: 37532922 PMCID: PMC10397158 DOI: 10.1186/s41747-023-00355-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) is a frequent and debilitating complication of traumatic musculoskeletal injuries and orthopedic procedures. Prophylactic dosing of botulinum toxin type A (BTxA) holds potential as a novel treatment option if accurately distributed throughout soft-tissue volumes where protection is clinically desired. We developed a high-resolution, microcomputed tomography (microCT)-based imaging strategy to assess drug distribution and validated this platform by quantifying distribution achieved via a prototype delivery system versus a single-bolus injection. METHODS We injected an iodine-containing contrast agent (iodixanol 320 mg I/mL) into dissected rabbit musculature followed by microCT imaging and analysis. To contrast the performance of distributed versus bolus injections, a three-dimensional (3D) 64-cm3-printed soft-tissue holder was developed. A centered 2-cm3 volume of interest (VOI) was targeted with a single-bolus injection or an equal volume distributed injection delivered via a 3D-printed prototype. VOI drug coverage was quantified as a percentage of the VOI volume that was < 1.0 mm from the injected fluid. RESULTS The microCT-based approach enabled high-resolution quantification of injection distribution within soft tissue. The distributed dosing prototype provided significantly greater tissue coverage of the targeted VOI (72 ± 3%, mean ± standard deviation) when compared to an equal volume bolus dose (43 ± 5%, p = 0.031) while also enhancing the precision of injection targeting. CONCLUSIONS A microCT-based imaging technique precisely quantifies drug distribution within a soft-tissue VOI, providing a path to overcome a barrier for clinical translation of prophylactic inhibition of HO by BTxA. RELEVANCE STATEMENT This platform will facilitate rapid optimization of injection parameters for clinical devices used to effectively and safely inhibit the formation of heterotopic ossification. KEY POINTS • MicroCT provides high-resolution quantification of soft-tissue drug distribution. • Distributed dosing is required to maximize soft-tissue drug coverage. • Imaging platform will enable rapid screening of 3D-printed drug distribution prototypes.
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Affiliation(s)
| | - Adam N Tucker
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA
| | - Philippe Huber
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA
| | - Reza Firoozabadi
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA
| | | | - Ted S Gross
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA
| | - Steven D Bain
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA
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Imaging of large volume subcutaneous deposition using MRI: exploratory clinical study results. Drug Deliv Transl Res 2023:10.1007/s13346-023-01318-7. [PMID: 36913105 PMCID: PMC10382358 DOI: 10.1007/s13346-023-01318-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/14/2023]
Abstract
Subcutaneous (SC) delivery is a preferred route of administration for biotherapeutics but has predominantly been limited to volumes below 3 mL. With higher volume drug formulations emerging, understanding large volume SC (LVSC) depot localization, dispersion, and impact on the SC environment has become more critical. The aim of this exploratory clinical imaging study was to assess the feasibility of magnetic resonance imaging (MRI) to identify and characterize LVSC injections and their effect on SC tissue as a function of delivery site and volume. Healthy adult subjects received incremental injections of normal saline up to 5 mL total volume in the arm and up to 10 mL in the abdomen and thigh. MRI images were acquired after each incremental SC injection. Post-image analysis was performed to correct imaging artifacts, identify depot tissue location, create 3-dimensional (3D) SC depot rendering, and estimate in vivo bolus volumes and SC tissue distention. LVSC saline depots were readily achieved, imaged using MRI, and quantified via subsequent image reconstructions. Imaging artifacts occurred under some conditions, necessitating corrections applied during image analysis. 3D renderings were created for both the depot alone and in relation to the SC tissue boundaries. LVSC depots remained predominantly within the SC tissue and expanded with increasing injection volume. Depot geometry varied across injection sites and localized physiological structure changes were observed to accommodate LVSC injection volumes. MRI is an effective means to clinically visualize LVSC depots and SC architecture allowing assessment of deposition and dispersion of injected formulations.Trial Registration: Not applicable for this exploratory clinical imaging study.
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6
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Rahimi E, Gomez H, Ardekani AM. Transport and distribution of biotherapeutics in different tissue layers after subcutaneous injection. Int J Pharm 2022; 626:122125. [PMID: 35988855 DOI: 10.1016/j.ijpharm.2022.122125] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022]
Abstract
The subcutaneous injection is the main route of administration for monoclonal antibodies (mAbs) and several other biotherapeutics due to the patient comfort and cost-effectiveness. However, their transport and distribution after subcutaneous injection is poorly understood. Here, we exploit a three-dimensional poroelastic model to find the biomechanical response of the tissue, including interstitial pressure and tissue deformation during the injection. We quantify the drug concentration inside the tissue. We start with a single-layer model of the tissue. We show that during injection, the difference between the permeability of the solvent and solute will result in a higher drug concentration proportional to the inverse permeability ratio. Then we study the role of tissue layered properties with primary layers, including epidermis, dermis, subcutaneous (SQ), and muscle layers, on tissue biomechanical response to injection and drug transport. We show that the drug will distribute mainly in the SQ layer due to its lower elastic moduli. Finally, we study the effect of secondary tissue elements like the deep fascia layer and the network of septa fibers inside the SQ tissue. We use the Voronoi algorithm to create random geometry of the septa network. We show how drugs accumulate around these tissue components as observed in experimental SQ injection. Next, we study the effect of injection rate on drug concentration. We show how higher injection rates will slightly increase the drug concentration around septa fibers. Finally we demonstrate how the concentration dependent viscosity will increase the concentration of biotherapeutics in the direction of septa fibers. .
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Affiliation(s)
- Ehsan Rahimi
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Hector Gomez
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Arezoo M Ardekani
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA.
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7
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Khadria A, Paavola CD, Maslov K, Valenzuela FA, Sperry AE, Cox AL, Cao R, Shi J, Brown-Augsburger PL, Lozano E, Blankenship RL, Majumdar R, Bradley SA, Beals JM, Oladipupo SS, Wang LV. Photoacoustic imaging reveals mechanisms of rapid-acting insulin formulations dynamics at the injection site. Mol Metab 2022; 62:101522. [PMID: 35671972 PMCID: PMC9207296 DOI: 10.1016/j.molmet.2022.101522] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Ultra-rapid insulin formulations control postprandial hyperglycemia; however, inadequate understanding of injection site absorption mechanisms is limiting further advancement. We used photoacoustic imaging to investigate the injection site dynamics of dye-labeled insulin lispro in the Humalog® and Lyumjev® formulations using the murine ear cutaneous model and correlated it with results from unlabeled insulin lispro in pig subcutaneous injection model. METHODS We employed dual-wavelength optical-resolution photoacoustic microscopy to study the absorption and diffusion of the near-infrared dye-labeled insulin lispro in the Humalog and Lyumjev formulations in mouse ears. We mathematically modeled the experimental data to calculate the absorption rate constants and diffusion coefficients. We studied the pharmacokinetics of the unlabeled insulin lispro in both the Humalog and Lyumjev formulations as well as a formulation lacking both the zinc and phenolic preservative in pigs. The association state of insulin lispro in each of the formulations was characterized using SV-AUC and NMR spectroscopy. RESULTS Through experiments using murine and swine models, we show that the hexamer dissociation rate of insulin lispro is not the absorption rate-limiting step. We demonstrated that the excipients in the Lyumjev formulation produce local tissue expansion and speed both insulin diffusion and microvascular absorption. We also show that the diffusion of insulin lispro at the injection site drives its initial absorption; however, the rate at which the insulin lispro crosses the blood vessels is its overall absorption rate-limiting step. CONCLUSIONS This study provides insights into injection site dynamics of insulin lispro and the impact of formulation excipients. It also demonstrates photoacoustic microscopy as a promising tool for studying protein therapeutics. The results from this study address critical questions around the subcutaneous behavior of insulin lispro and the formulation excipients, which could be useful to make faster and better controlled insulin formulations in the future.
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Affiliation(s)
- Anjul Khadria
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Chad D Paavola
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Konstantin Maslov
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Francisco A Valenzuela
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Andrea E Sperry
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Amy L Cox
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Rui Cao
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Junhui Shi
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | | | - Emmanuel Lozano
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Ross L Blankenship
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Ranajoy Majumdar
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Scott A Bradley
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - John M Beals
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Biotechnology Center, San Diego, CA, 92121, USA.
| | - Sunday S Oladipupo
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Lihong V Wang
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA; Caltech Optical Imaging Laboratory, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA.
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8
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Use of computed tomography to assess subcutaneous drug dispersion with recombinant human hyaluronidase PH20 in a swine model. J Pharmacol Toxicol Methods 2020; 106:106936. [PMID: 33191187 DOI: 10.1016/j.vascn.2020.106936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Subcutaneous (SC) formulations of therapeutics with recombinant human hyaluronidase PH20 (rHuPH20) are currently approved across various disease indications. The rHuPH20-mediated enzymatic degradation of SC hyaluronan (HA) facilitates bulk fluid flow and dispersion of co-administered therapeutics. However, current methods of quantifying dispersion in the SC space are limited. Here, a novel method is outlined to quantify and follow rapid SC volumetric dispersion of a representative therapeutic fluid in the presence of rHuPH20 using computed tomography (CT). METHODS Ten Yucatan miniature swine were randomized to three groups. Animals received simultaneous infusions of contrast agent (CA) alone (left side of the animal) or in combination with rHuPH20 (right side) at infusion rates of 2.5, 5, or 10 mL/min. Spiral CT scans (1.5 mm thickness) were conducted before and after the infusion and at regular time intervals throughout. Scans were used to create three-dimensional (3D) reconstructions of the fluid pockets and analyze surface area, volume, and sphericity. RESULTS 3D reconstruction showed increased dispersion of CA with rHuPH20 compared with CA alone, with fenestration and increased dispersion in the craniocaudal and lateromedial directions. The CA with rHuPH20 fluid pockets showed an average increase of 46% in surface area (p = 0.001), a 35% increase in volume (p = 0.001) and a 17% decrease in sphericity post-infusion compared with CA alone at 30 min post-infusion. DISCUSSION This exploratory study confirms the value of CT imaging as a non-invasive method of assessing real-time spatial and temporal behavior of SC-administered fluids. This technique could help to assess the dispersion pattern of novel rHuPH20 SC co-formulations.
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Schuster J, Koulov A, Mahler HC, Detampel P, Huwyler J, Singh S, Mathaes R. In Vivo Stability of Therapeutic Proteins. Pharm Res 2020; 37:23. [DOI: 10.1007/s11095-019-2689-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
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10
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Shrestha P, Stoeber B. Fluid absorption by skin tissue during intradermal injections through hollow microneedles. Sci Rep 2018; 8:13749. [PMID: 30213982 PMCID: PMC6137045 DOI: 10.1038/s41598-018-32026-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/31/2018] [Indexed: 12/16/2022] Open
Abstract
Hollow microneedles are an emerging technology for delivering drugs and therapeutics, such as vaccines and insulin, into the skin. Although the benefits of intradermal drug delivery have been known for decades, our understanding of fluid absorption by skin tissue has been limited due to the difficulties in imaging a highly scattering biological material such as skin. Here, we report the first real-time imaging of skin tissue at the microscale during intradermal injections through hollow microneedles, using optical coherence tomography. We show that skin tissue behaves like a deformable porous medium and absorbs fluid by locally expanding rather than rupturing to form a single fluid filled cavity. We measure the strain distribution in a cross section of the tissue to quantify local tissue deformation, and find that the amount of volumetric expansion of the tissue corresponds closely to the volume of fluid injected. Mechanically restricting tissue expansion limits fluid absorption into the tissue. Our experimental findings can provide insights to optimize the delivery of drugs into skin for different therapeutic applications, and to better model fluid flow into biological tissue.
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Affiliation(s)
- Pranav Shrestha
- Department of Mechanical Engineering, The University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Boris Stoeber
- Department of Mechanical Engineering, The University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, British Columbia, V6T 1Z4, Canada. .,Department of Electrical and Computer Engineering, The University of British Columbia, 2332 Main Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
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11
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Park H, Kim H, Lee SJ. Optimal Design of Needle Array for Effective Drug Delivery. Ann Biomed Eng 2018; 46:2012-2022. [PMID: 30051245 DOI: 10.1007/s10439-018-2100-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/17/2018] [Indexed: 02/07/2023]
Abstract
Recently, the multi-needle drug injection has been adopted to overcome the shortcomes of conventional single-needle injection, enhancing the efficiency of drug delivery. However, the effect of needle array on the efficacy of drug delivery has not been fully elucidated. In this study, the interactions of drug analogous solution injected from a pair of needles were analyzed to examine the design criteria of effective multi-needle devices for drug delivery. Temporal and spatial variations of relative contents of the solution in the tissues were compared according to the distance between two adjacent needles (DN). As the DN increases from 5 to 20 D, where D is the needle diameter, the solution from each needle encounters 3.5 times faster, and 4.22 times more solution was accumulated. At the same time, the effective spreading area was continuously increased from 54.2 to 177.8 mm2 and RCS gradient decreases from 0.087 to 0.037, due to the overlapping effect of the spreading solution from neighboring needles. Finally, based on the experimental results, an optimal design criterion of needle array for effective drug delivery was proposed. The present results would be helpful in the design of multi-needle injection devices and eventually offer advantage to patients with effective drug delivery.
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Affiliation(s)
- Hanwook Park
- Center for Biofluid and Biomimic Research, Pohang University of Science and Technology (POSTECH), 77 Cheongam-Ro, Nam-Gu, Pohang, Gyeongbuk, 37673, South Korea.,Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), 77 Cheongam-Ro, Nam-Gu, Pohang, Gyeongbuk, 37673, South Korea
| | - Hyejeong Kim
- Center for Biofluid and Biomimic Research, Pohang University of Science and Technology (POSTECH), 77 Cheongam-Ro, Nam-Gu, Pohang, Gyeongbuk, 37673, South Korea.,Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), 77 Cheongam-Ro, Nam-Gu, Pohang, Gyeongbuk, 37673, South Korea
| | - Sang Joon Lee
- Center for Biofluid and Biomimic Research, Pohang University of Science and Technology (POSTECH), 77 Cheongam-Ro, Nam-Gu, Pohang, Gyeongbuk, 37673, South Korea. .,Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), 77 Cheongam-Ro, Nam-Gu, Pohang, Gyeongbuk, 37673, South Korea.
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12
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Thompson JG, van der Sterren W, Bakhutashvili I, van der Bom IM, Radaelli AG, Karanian JW, Esparza-Trujillo J, Woods DL, Lewis AL, Wood BJ, Pritchard WF. Distribution and Detection of Radiopaque Beads after Hepatic Transarterial Embolization in Swine: Cone-Beam CT versus MicroCT. J Vasc Interv Radiol 2018; 29:568-574. [PMID: 29500000 PMCID: PMC5869084 DOI: 10.1016/j.jvir.2017.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/28/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To determine the true distribution of radiopaque beads (ROBs) after hepatic embolization in swine as imaged by micro-computed tomography (microCT) compared with in vivo cone-beam computerized tomography (CT) imaged at different kVp settings. MATERIALS AND METHODS Swine (n = 3) underwent hepatic transarterial embolization (n = 6) with the use of 70-150-μm ROBs under fluoroscopic guidance. After stasis, in vivo cone-beam CT was performed at 120, 100, and 80 kVp. The animal was euthanized, the liver resected, and microCT with 17 μm resolution performed on embolized tissue samples. The resulting cone-beam CT and microCT data were segmented and registered. Total vessel length, minimum volume-enclosing ellipsoid (MVEE), and number of independent volumes were measured. Maximum-intensity projections (MIPs) were generated for each cone-beam CT. RESULTS Metrics for all cone-beam CT segmentations differed significantly from microCT segmentations. Segmentations at 80 kVp presented significantly greater vessel length, MVEE, and number of independent volumes compared with 100 kVp and 120 kVp. In addition, 100 kVp segmentations presented significantly greater vessel length than 120 kVp. MIPs presented greater visualization than cone-beam CT segmentations and improved as kVp decreased. CONCLUSIONS The full ROB distribution was more extensive than was apparent on cone-beam CT. Quantitative measures of embolic distribution demonstrated significantly better correlation with microCT with decreasing kVp. Similarly, qualitative analysis of MIPs showed improved visualization of beads with decreasing kVp. These findings demonstrate the clinical value of 80 kVp and 100 kVp protocols in the imaging of radiopaque embolizations compared with 120 kVp. However, considerations on X-ray penetration and dose may favor use of 100 kVp imaging over 80 kVp.
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Affiliation(s)
- John G Thompson
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | | | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | | | - Alessandro G Radaelli
- Image-Guided Therapy Systems, Image-Guided Interventions, Philips, Best, The Netherlands
| | - John W Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Juan Esparza-Trujillo
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - David L Woods
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | | | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892.
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13
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Liu TT, Chen K, Pan M. Experimental and modelling characterisation of adjustable hollow Micro-needle delivery systems. Med Eng Phys 2017; 49:148-156. [DOI: 10.1016/j.medengphy.2017.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
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14
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Kim H, Park H, Lee SJ. Effective method for drug injection into subcutaneous tissue. Sci Rep 2017; 7:9613. [PMID: 28852051 PMCID: PMC5575294 DOI: 10.1038/s41598-017-10110-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/03/2017] [Indexed: 11/09/2022] Open
Abstract
Subcutaneous injection of drug solution is widely used for continuous and low dose drug treatment. Although the drug injections have been administered for a long time, challenges in the design of injection devices are still needed to minimize the variability, pain, or skin disorder by repeated drug injections. To avoid these adverse effects, systematic study on the effects of injection conditions should be conducted to improve the predictability of drug effect. Here, the effects of injection conditions on the drug permeation in tissues were investigated using X-ray imaging technique which provides real-time images of drug permeation with high spatial resolution. The shape and concentration distribution of the injected drug solution in the porcine subcutaneous and muscle tissues are visualized. Dynamic movements of the wetting front (WF) and temporal variations of water contents in the two tissues are quantitatively analyzed. Based on the quantitative analysis of the experimental data, the permeability of drug solution through the tissues are estimated according to permeation direction, injection speed, and tissue. The present results would be helpful for improving the performance of drug injection devices and for predicting the drug efficacy in tissues using biomedical simulation.
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Affiliation(s)
- Hyejeong Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Gyeongsangbuk, Republic of Korea
| | - Hanwook Park
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Gyeongsangbuk, Republic of Korea
| | - Sang Joon Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Gyeongsangbuk, Republic of Korea.
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15
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Mathaes R, Koulov A, Joerg S, Mahler HC. Subcutaneous Injection Volume of Biopharmaceuticals—Pushing the Boundaries. J Pharm Sci 2016; 105:2255-9. [DOI: 10.1016/j.xphs.2016.05.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
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16
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Laimer M, Melmer A, Mader JK, Schütz-Fuhrmann I, Engels HR, Götz G, Pfeifer M, Hermann JM, Stettler C, Holl RW. Variability of Basal Rate Profiles in Insulin Pump Therapy and Association with Complications in Type 1 Diabetes Mellitus. PLoS One 2016; 11:e0150604. [PMID: 26938444 PMCID: PMC4777503 DOI: 10.1371/journal.pone.0150604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditionally, basal rate profiles in continuous subcutaneous insulin infusion therapy are individually adapted to cover expected insulin requirements. However, whether this approach is indeed superior to a more constant BR profile has not been assessed so far. This study analysed the associations between variability of BR profiles and acute and chronic complications in adult type 1 diabetes mellitus. MATERIALS AND METHODS BR profiles of 3118 female and 2427 male patients from the "Diabetes-Patienten-Verlaufsdokumentation" registry from Germany and Austria were analysed. Acute and chronic complications were recorded 6 months prior and after the most recently documented basal rate. The "variability index" was calculated as variation of basal rate intervals in percent and describes the excursions of the basal rate intervals from the median basal rate. RESULTS The variability Index correlated positively with severe hypoglycemia (r = .06; p<0.001), hypoglycemic coma (r = .05; p = 0.002), and microalbuminuria (r = 0.05; p = 0.006). In addition, a higher variability index was associated with higher frequency of diabetic ketoacidosis (r = .04; p = 0.029) in male adult patients. Logistic regression analysis adjusted for age, gender, duration of disease and total basal insulin confirmed significant correlations of the variability index with severe hypoglycemia (β = 0.013; p<0.001) and diabetic ketoacidosis (β = 0.012; p = 0.017). CONCLUSIONS Basal rate profiles with higher variability are associated with an increased frequency of acute complications in adults with type 1 diabetes.
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Affiliation(s)
- Markus Laimer
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Bern, Switzerland
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Andreas Melmer
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia K. Mader
- Department of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Ingrid Schütz-Fuhrmann
- Medical Department of Metabolic Disease and Nephrology, Hospital Hitzing, Vienna, Austria
| | | | - Gabriele Götz
- Diabetes Centre Nürtingen, Clinics Esslingen, Baden-Württemberg, Germany
| | - Martin Pfeifer
- Department of Internal Medicine, Hospital Tettnang, Baden-Württemberg, Germany
| | - Julia M. Hermann
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Christoph Stettler
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Bern, Switzerland
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
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17
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Thomsen M, Rasmussen CH, Refsgaard HHF, Pedersen KM, Kirk RK, Poulsen M, Feidenhans'l R. Spatial distribution of soluble insulin in pig subcutaneous tissue: Effect of needle length, injection speed and injected volume. Eur J Pharm Sci 2015; 79:96-101. [PMID: 26341408 DOI: 10.1016/j.ejps.2015.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/07/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
Abstract
The spatial distribution of a soluble insulin formulation was visualized and quantified in 3-dimensions using X-ray computed tomography. The drug distribution was visualized for ex vivo injections in pig subcutaneous tissue. Pig subcutaneous tissue has very distinct layers, which could be separated in the tomographic reconstructions and the amount of drug in each tissue class was quantified. With a scan time of about 45min per sample, and a robust segmentation it was possible to analyze differences in the spatial drug distribution between several similar injections. It was studied how the drug distribution was effected by needle length, injection speed and injected volume. For an injected volume of 0.1ml and injection depth of 8mm about 50% of the injections were partly intramuscular. Using a 5mm needle resulted in purely subcutaneous injections with minor differences in the spatial drug distribution between injections. Increasing the injected volume from 0.1ml to 1ml did not increase the intramuscular volume fraction, but gave a significantly higher volume fraction placed in the fascia separating the deep and superficial subcutaneous fat layers. Varying the injection speed from 25l/s up to 300l/s gave no changes in the drug concentration distribution. The method presented gives novel insight into subcutaneous injections of soluble insulin drugs and can be used to optimize the injection technique for subcutaneous drug administration in preclinical studies of rodents.
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Affiliation(s)
- Maria Thomsen
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark; Niels Bohr Institute, University of Copenhagen, Blegdamsvej, DK-2100 Copenhagen, Denmark.
| | | | | | | | - Rikke K Kirk
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Mette Poulsen
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Robert Feidenhans'l
- Niels Bohr Institute, University of Copenhagen, Blegdamsvej, DK-2100 Copenhagen, Denmark
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18
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Thomsen M, Hernandez-Garcia A, Mathiesen J, Poulsen M, Sørensen DN, Tarnow L, Feidenhans'l R. Model study of the pressure build-up during subcutaneous injection. PLoS One 2014; 9:e104054. [PMID: 25122138 PMCID: PMC4133188 DOI: 10.1371/journal.pone.0104054] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/04/2014] [Indexed: 11/21/2022] Open
Abstract
In this study we estimate the subcutaneous tissue counter pressure during drug infusion from a series of injections of insulin in type 2 diabetic patients using a non-invasive method. We construct a model for the pressure evolution in subcutaneous tissue based on mass continuity and the flow laws of a porous medium. For equivalent injection forces we measure the change in the infusion rate between injections in air at atmospheric pressure and in tissue. From a best fit with our model, we then determine the flow permeability as well as the bulk modulus of the tissue, estimated to be of the order 10-11-10-10 m2 and 105 Pa, respectively. The permeability is in good agreement with reported values for adipose porcine tissue. We suggest our model as a general way to estimate the pressure build-up in tissue during subcutaneous injection.
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Affiliation(s)
- Maria Thomsen
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk A/S, Hillerød, Denmark
| | | | | | | | | | - Lise Tarnow
- Nordsjæ llands Hospital, Hillerød, Denmark
- Klinisk Epidemiologisk Afdeling, Aarhus Universitetshospital, Aarhus, Denmark
- Steno Diabetes Center A/S, Gentofte, Denmark
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Rasmussen CH, Røge RM, Ma Z, Thomsen M, Thorisdottir RL, Chen JW, Mosekilde E, Colding-Jørgensen M. Insulin aspart pharmacokinetics: an assessment of its variability and underlying mechanisms. Eur J Pharm Sci 2014; 62:65-75. [PMID: 24878388 DOI: 10.1016/j.ejps.2014.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/18/2014] [Accepted: 05/06/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insulin aspart (IAsp) is used by many diabetics as a meal-time insulin to control post-prandial glucose levels. As is the case with many other insulin types, the pharmacokinetics (PK), and consequently the pharmacodynamics (PD), is associated with clinical variability, both between and within individuals. The present article identifies the main physiological mechanisms that govern the PK of IAsp following subcutaneous administration and quantifies them in terms of their contribution to the overall variability. MATERIAL AND METHODS CT scanning data from Thomsen et al. (2012) are used to investigate and quantify the properties of the subcutaneous depot. Data from Brange et al. (1990) are used to determine the effects of insulin chemistry in subcutis on the absorption rate. Intravenous (i.v.) bolus and infusion PK data for human insulin are used to understand and quantify the systemic distribution and elimination (Pørksen et al., 1997; Sjöstrand et al., 2002). PK and PD profiles for type 1 diabetics from Chen et al. (2005) are analyzed to demonstrate the effects of IAsp antibodies in terms of bound and unbound insulin. PK profiles from Thorisdottir et al. (2009) and Ma et al. (2012b) are analyzed in the nonlinear mixed effects software Monolix® to determine the presence and effects of the mechanisms described in this article. RESULTS The distribution of IAsp in the subcutaneous depot show an initial dilution of approximately a factor of two in a single experiment. Injected insulin hexamers exist in a chemical equilibrium with monomers and dimers, which depends strongly on the degree of dilution in subcutis, the presence of auxiliary substances, and a variety of other factors. Sensitivity to the initial dilution in subcutis can thus be a cause of some of the variability. Temporal variations in the PK are explained by variations in the subcutaneous blood flow. IAsp antibodies are found to be a large contributor to the variability of total insulin PK in a study by Chen et al. (2005), since only the free fraction is eliminated via the receptors. The contribution of these and other sources of variability to the total variability is quantified via a population PK analysis and two recent clinical studies (Thorisdottir et al., 2009; Ma et al., 2012b), which support the presence and significance of the identified mechanisms. CONCLUSIONS IAsp antibody binding, oligomeric transitions in subcutis, and blood flow dependent variations in absorption rate seem to dominate the PK variability of IAsp. It may be possible via e.g. formulation design to reduce some of these variability factors.
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Affiliation(s)
- Christian Hove Rasmussen
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark; Department of Physics, Technical University of Denmark, Fysikvej 309, DK-2800 Kgs. Lyngby, Denmark.
| | - Rikke Meldgaard Røge
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark; Department of Pharmaceutical Biosciences, Uppsala University, P.O. Box 591, SE-75124 Uppsala, Sweden
| | - Zhulin Ma
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark
| | - Maria Thomsen
- Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark; Niels Bohr Institute, University of Copenhagen, Universitetsparken 5, DK-2100 Copenhagen, Denmark
| | | | - Jian-Wen Chen
- Novo Nordisk International Operations A/S, Thurgauerstrasse 36/38, CH-8050 Zürich, Switzerland
| | - Erik Mosekilde
- Department of Physics, Technical University of Denmark, Fysikvej 309, DK-2800 Kgs. Lyngby, Denmark
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