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Darquenne C, Corcoran TE, Lavorini F, Sorano A, Usmani OS. The effects of airway disease on the deposition of inhaled drugs. Expert Opin Drug Deliv 2024:1-16. [PMID: 39136493 DOI: 10.1080/17425247.2024.2392790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/06/2024] [Accepted: 08/12/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The deposition of inhaled medications is the first step in the pulmonary pharmacokinetic process to produce a therapeutic response. Not only lung dose but more importantly the distribution of deposited drug in the different regions of the lung determines local bioavailability, efficacy, and clinical safety. Assessing aerosol deposition patterns has been the focus of intense research that combines the fields of physics, radiology, physiology, and biology. AREAS COVERED The review covers the physics of aerosol transport in the lung, experimental, and in-silico modeling approaches to determine lung dose and aerosol deposition patterns, the effect of asthma, chronic obstructive pulmonary disease, and cystic fibrosis on aerosol deposition, and the clinical translation potential of determining aerosol deposition dose. EXPERT OPINION Recent advances in in-silico modeling and lung imaging have enabled the development of realistic subject-specific aerosol deposition models, albeit mainly in health. Accurate modeling of lung disease still requires additional refinements in existing imaging and modeling approaches to better characterize disease heterogeneity in peripheral airways. Nevertheless, recent patient-centric innovation in inhaler device engineering and the incorporation of digital technology have led to more consistent lung deposition and improved targeting of the distal airways, which better serve the clinical needs of patients.
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Affiliation(s)
- Chantal Darquenne
- Department of Medicine, University of California, San Diego, CA, USA
| | | | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Sorano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
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2
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Woodward IR, Fromen CA. Recent Developments in Aerosol Pulmonary Drug Delivery: New Technologies, New Cargos, and New Targets. Annu Rev Biomed Eng 2024; 26:307-330. [PMID: 38424089 PMCID: PMC11222059 DOI: 10.1146/annurev-bioeng-110122-010848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
There is nothing like a global pandemic to motivate the need for improved respiratory treatments and mucosal vaccines. Stimulated by the COVID-19 pandemic, pulmonary aerosol drug delivery has seen a flourish of activity, building on the prior decades of innovation in particle engineering, inhaler device technologies, and clinical understanding. As such, the field has expanded into new directions and is working toward the efficient delivery of increasingly complex cargos to address a wider range of respiratory diseases. This review seeks to highlight recent innovations in approaches to personalize inhalation drug delivery, deliver complex cargos, and diversify the targets treated and prevented through pulmonary drug delivery. We aim to inform readers of the emerging efforts within the field and predict where future breakthroughs are expected to impact the treatment of respiratory diseases.
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Affiliation(s)
- Ian R Woodward
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA;
| | - Catherine A Fromen
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA;
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3
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Gerde P, Sjöberg CO, Bäckroos H, Englund J, Wangheim M, Litorp H. Regional lung targeting with a fluticasone/salmeterol aerosol using a bolus breath hold method of the PreciseInhale® system: A first evaluation in humans. Eur J Pharm Sci 2024; 196:106742. [PMID: 38460609 DOI: 10.1016/j.ejps.2024.106742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND In development of inhaled drugs- and formulations the measured concentration in the systemic circulation is often used as a surrogate for local dosimetry in the lungs. To further elucidate regional differences in the fate of drugs in the lungs, different aerodynamic sizes of aerosols have been used to target major airway regions. An alternative approach to achieve regional targeting of aerosols, is to use a defined aerosol bolus together with a bolus breath hold strategy. A small volume of test aerosol is intercalated and stopped at different penetration depths, to achieve increased drug deposition at chosen lung locations. Drug permeation from the lung regions is then investigated by repeatedly sampling venous blood from the systemic circulation. The PreciseInhale® (PI) exposure platform was developed to allow generation of aerosols from different sources, including clinical inhalers, into a holding chamber, for subsequent use with alternative exposure modules in vitro and in vivo. In the current first-in-human study was investigated the feasibility of a new clinical exposure module added to the PI system. By extracting aerosol puffs from a medical inhaler for subsequent delivery to volunteers, it was possible to administer whole lung exposures, as well as regional targeting exposures. METHODS Aerosols containing 250 µg/25 µg fluticasone propionate (FP)/salmeterol xinafoate (SMX) were automatically actuated and extracted from the pressurized Metered Dose Inhaler (pMDI) Evohaler Seretide forte into the PI system's holding chamber, then administered to the healthy volunteers using controlled flowrate and volume exposure cycles. Two main comparisons were made by measuring the systemic PK response: I. One label dose directly from the inhaler to the subject was compared to the same dose extracted from the pMDI into the PI system and then administered to the subject. II A small aerosol bolus at a penetration level in the central airways was compared to a small aerosol bolus at a penetration level in the peripheral lung. RESULTS AND CONCLUSIONS When one inhaler dose was administered via the PI system, the absorbed dose, expressed as AUC24, was approximately twice as high and the CV was less than half, compared to direct inhalation from the same pMDI. Bolus breath hold targeting of drugs from the same aerosol mixture to the peripheral lung and the central airways showed a difference in their appearance in the systemic circulation. Normalized to the same deposited dose, SMX had a 57 % higher Cmax in the peripheral lung compared to the central airways. However, from 6 to 24 h after dosing the systemic concentrations of SMX from both regions were quite similar. FP had parallel concentrations curves with a 23 % higher AUC24 in the peripheral lung with no noticeable elevation around Cmax. The permeability of these two substances from similar sized aerosols was indeed higher in the thinner air/blood barriers of the peripheral lung compared to the central airways, but differences as measured on the venous side of the circulation were not dramatic. In conclusion, the PI system provided better control of actuation, aspiration, and dispensation of aerosols from the clinical inhaler and thereby delivered higher quality read outs of pharmacokinetic parameters such as tmax, Cmax, and AUC. Improved performance, using PI system, can likely also be employed for studying regional selectivity of other responses in the lungs, for use in drug development.
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Affiliation(s)
- Per Gerde
- Inhalation Sciences AB, Novum, Hälsovägen 7, Huddinge SE-141 57, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden.
| | - Carl-Olof Sjöberg
- Inhalation Sciences AB, Novum, Hälsovägen 7, Huddinge SE-141 57, Sweden; Flexura AB, Vitmåravägen 50, Upplands Väsby SE-194 60, Sweden
| | - Helen Bäckroos
- Inhalation Sciences AB, Novum, Hälsovägen 7, Huddinge SE-141 57, Sweden
| | - Joakim Englund
- Clinical Trial Consultants AB, Dag Hammarskjölds väg 10B, Uppsala SE-752 37, Sweden
| | - Marit Wangheim
- Clinical Trial Consultants AB, Dag Hammarskjölds väg 10B, Uppsala SE-752 37, Sweden
| | - Helena Litorp
- Clinical Trial Consultants AB, Dag Hammarskjölds väg 10B, Uppsala SE-752 37, Sweden; Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Stockholm, Sweden
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4
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Laube BL. Imaging Aerosol Deposition with Two-Dimensional Gamma Scintigraphy. J Aerosol Med Pulm Drug Deliv 2022; 35:333-341. [PMID: 36342668 DOI: 10.1089/jamp.2022.29072.bll] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Several imaging modalities have been employed to quantify lung dose and the distribution of the dose of orally inhaled aerosols in vivo. Two-dimensional (2D, or planar) imaging using gamma scintigraphy is the most widely used of these modalities. Two-dimensional gamma scintigraphy studies are accomplished using a single- or dual-headed gamma camera. The formulation to be tested is admixed with the gamma emitting radioisotope 99mtechnetium, which serves as a surrogate for the drug. This article provides details as to how 2D gamma scintigraphy images should be acquired and analyzed using recently standardized methods. Based on the new guidelines, the investigator should confirm that the drug formulation is unchanged with the addition of the radioisotope, determine the amount of radioactivity needed for inhalation to obtain appropriate radioactivity counts in the lungs, perform quality control procedures for the gamma camera, identify the lung borders of the study subject using a reference image such as an X-ray computed tomography scan, a ventilation scan, or a transmission scan, acquire a lung transmission image to correct for attenuation of radioactivity by lung tissue, instruct the subject how to inhale the radiolabel-drug mixture and record associated breathing parameters, acquire anterior and/or posterior views of the lungs and any other regions of interest (i.e., oropharynx, stomach) and assess the acquired images for total and regional dose to the lungs. Total dose should be assessed after identification of the right lung border and appropriate correction for tissue attenuation. Regional dose should be quantified as a normalized outer/inner deposition ratio (O/I) and expressed as the penetration index (PI). Mass balance should be performed as needed. By following the standardized methods, 2D gamma scintigraphy data from studies in different laboratories may be compared and combined, leading to multi-center studies and more rapid development of new medications and devices for inhaled therapies.
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Affiliation(s)
- Beth L Laube
- Professor, Emerita, Johns Hopkins University, Department of Pediatrics, Baltimore, Maryland, USA
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Bennett WD, Clapp PW, Holbrook LT, Zeman KL. Respiratory Tract Deposition of E-Cigarette Particles. Compr Physiol 2022; 12:3823-3832. [PMID: 35959754 DOI: 10.1002/cphy.c210038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Total and regional deposition of inhaled electronic cigarette (E-cig) particles in the respiratory tract (RT) depends on both physical properties of the inhaled particles and biological factors of users, for example, breathing pattern or puff profile, airway anatomy, and regional ventilation. Accurate particle sizing of E-cig aerosols is essential for predicting particle deposition in the RT. Studies using a variety of sizing methods have shown mass median aerodynamic diameters ranging from 0.2 to 1.2 um and secondary count diameters in the ultrafine range (<0.1 μm). Incorporating these particle sizes into a multiple-path particle dosimetry (MPPD) model shows 10% to 45% total lung deposition by mass and 30% to 80% for ultrafine particles depending on the breathing patterns. These predictions are consistent with experimental measures of deposition fraction of submicron and ultrafine particles. While box-mod-type E-cig devices allow for full "direct-lung" inhalations of aerosol, the more recent pod-based, and disposable E-cigs (e.g., JUUL, Puff Bar, Stig) deliver the aerosol as a "mouth-to-lung" puff, or bolus, that is inhaled early in the breath followed to various degrees by further inhalation of ambient air. Measurement of realistic ventilation patterns associated with these various devices may further improve deposition predictions. Finally, while in vivo measures of RT deposition present a challenge, a recent methodology to radiolabel E-cig particles may allow for such measurements by gamma scintigraphy. Supported by NIH/NHLBI R01HL139369. © 2022 American Physiological Society. Compr Physiol 12: 1-10, year.
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Affiliation(s)
- William D Bennett
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Phillip W Clapp
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Landon T Holbrook
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kirby L Zeman
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, USA
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6
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Alapati D, Shaffer TH. Administration of Drugs/Gene Products to the Respiratory System: A Historical Perspective of the Use of Inert Liquids. Front Physiol 2022; 13:871893. [PMID: 35620598 PMCID: PMC9127416 DOI: 10.3389/fphys.2022.871893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
The present review is a historical perspective of methodology and applications using inert liquids for respiratory support and as a vehicle to deliver biological agents to the respiratory system. As such, the background of using oxygenated inert liquids (considered a drug when used in the lungs) opposed to an oxygen-nitrogen gas mixture for respiratory support is presented. The properties of these inert liquids and the mechanisms of gas exchange and lung function alterations using this technology are described. In addition, published preclinical and clinical trial results are discussed with respect to treatment modalities for respiratory diseases. Finally, this forward-looking review provides a comprehensive overview of potential methods for administration of drugs/gene products to the respiratory system and potential biomedical applications.
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Affiliation(s)
- Deepthi Alapati
- Nemours Children’s Health, Wilmington, DE, United States
- Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, United States
- *Correspondence: Deepthi Alapati, ; Thomas H. Shaffer,
| | - Thomas H. Shaffer
- Nemours Children’s Health, Wilmington, DE, United States
- Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
- *Correspondence: Deepthi Alapati, ; Thomas H. Shaffer,
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Steinle H, Weber J, Stoppelkamp S, Große-Berkenbusch K, Golombek S, Weber M, Canak-Ipek T, Trenz SM, Schlensak C, Avci-Adali M. Delivery of synthetic mRNAs for tissue regeneration. Adv Drug Deliv Rev 2021; 179:114007. [PMID: 34710530 DOI: 10.1016/j.addr.2021.114007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023]
Abstract
In recent years, nucleic acid-based therapeutics have gained increasing importance as novel treatment options for disease prevention and treatment. Synthetic messenger RNAs (mRNAs) are promising nucleic acid-based drugs to transiently express desired proteins that are missing or defective. Recently, synthetic mRNA-based vaccines encoding viral proteins have been approved for emergency use against COVID-19. Various types of vehicles, such as lipid nanoparticles (LNPs) and liposomes, are being investigated to enable the efficient uptake of mRNA molecules into desired cells. In addition, the introduction of novel chemical modifications into mRNAs increased the stability, enabled the modulation of nucleic acid-based drugs, and increased the efficiency of mRNA-based therapeutic approaches. In this review, novel and innovative strategies for the delivery of synthetic mRNA-based therapeutics for tissue regeneration are discussed. Moreover, with this review, we aim to highlight the versatility of synthetic mRNA molecules for various applications in the field of regenerative medicine and also discuss translational challenges and required improvements for mRNA-based drugs.
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Affiliation(s)
- Heidrun Steinle
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Josefin Weber
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Sandra Stoppelkamp
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Katharina Große-Berkenbusch
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Sonia Golombek
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Marbod Weber
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Tuba Canak-Ipek
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Sarah-Maria Trenz
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Christian Schlensak
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Meltem Avci-Adali
- University Hospital Tuebingen, Department of Thoracic and Cardiovascular Surgery, Calwerstraße 7/1, 72076 Tuebingen, Germany.
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8
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Wang ST, Bao C, Liu Q, Zhang T, Yang Y, Tian X, Zhu Z, Xu KF. Ga-68 EDTA aerosols in evaluation of inhaled-particle deposition and clearance of obstructive pulmonary diseases: A pilot prospective study compared with Galligas. Eur J Clin Invest 2021; 51:e13620. [PMID: 34076256 PMCID: PMC9286628 DOI: 10.1111/eci.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE 68-gallium (Ga-68) ethylenediaminetetraacetic acid (EDTA) aerosols and Galligas were compared in evaluation of inhaled-particle deposition and clearance in volunteers with or without obstructive pulmonary diseases. METHODS Nonsmoking healthy volunteers, healthy smokers, asthma patients and patients with chronic obstructive pulmonary disease (COPD) were recruited to undergo the dynamic lung ventilation positron emission tomography/computerized tomography (PET/CT) scans within two consecutive days. The inhaled particles were Ga-68-labelled carbon nanoparticles (Galligas, 30-60 nm in size) and Ga-68-labelled EDTA aerosols (1-2 μm in size), respectively. The volunteers' lung function parameters were measured for comparison. RESULTS Central deposition and inhomogeneity of both tracers were negatively correlated with lung function parameters, including the ratio of forced expiratory volume at 1 second to forced vital capacity (FEV1 /FVC). The central or hilum deposition of Galligas, but not 68-gallium (Ga-68) EDTA, was negatively correlated with the maximal expiratory flow at 25%, 50% and 75% of the forced vital capacity. Compared with Galligas, Ga-68 EDTA aerosols were more concentrated in the central region in all groups except for the healthy nonsmokers. Ventilation inhomogeneity was more evident when using Ga-68 EDTA aerosols, especially in patients with COPD and asthma patients. In the healthy smokers, the central region accumulated more Ga-68 EDTA at 30 minutes after inhalation than immediately after inhalation. Ga-68 EDTA cleared faster in lungs than Galligas. CONCLUSIONS Both Galligas and Ga-68 EDTA aerosols can be used for PET/CT lung ventilation scan. However, Ga-68 EDTA aerosols showed more advantages in diagnosis and evaluation of obstructive airway diseases by revealing the inhaled-particle deposition and clearance.
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Affiliation(s)
- Shao-Ting Wang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Cheng Bao
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qingxing Liu
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Tengyue Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yanli Yang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kai-Feng Xu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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9
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Corcoran TE. Measurements of deposited aerosol dose in infants and small children. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:595. [PMID: 33987293 PMCID: PMC8105848 DOI: 10.21037/atm-20-2045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/19/2020] [Indexed: 11/06/2022]
Abstract
Pediatric patients are very dependent on inhaled aerosol medications. There are significant differences in how these aerosols deposit in the lungs of children vs. adults that may affect the efficacy of the therapies. Inefficient aerosol delivery to children, caused by factors such as high mouth and throat deposition during oral inhalation, significant losses within adjunct devices such as masks, and high rates of nasal deposition during cannula delivery, can lead to dosing that is difficult to control. Here we discuss the methods, such as deposition scintigraphy, that are used to assess inhaled dose in vivo and review previous studies where these techniques have been applied to measure dosing in children. This includes studies of nebulizers and metered dose inhalers and delivery through adjuncts such as facemasks and nasal cannulas. We discuss the factors that can lead to inefficient inhaled drug delivery and high levels of mouth and throat deposition in children. Finally, we propose areas of innovation to improve inhaled drug delivery to this population. There is a need for child-specific technologies for inhaled drug delivery. This includes the use of smart devices that can guide pediatric breathing patterns and better engage children during treatments, the use of smaller aerosols which are less likely to deposit in the upper airways after inhalation, and the design of better nasal cannula interfaces for aerosol delivery to infants.
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Affiliation(s)
- Timothy E Corcoran
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Affiliation(s)
- Andrew R. Martin
- 10-324 Donadeo Innovation Center for Engineering, University of Alberta, Alberta, Canada
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11
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Gu W, Darquenne C. Heterogeneity in lobar and near-acini deposition of inhaled aerosol in the mouse lung. JOURNAL OF AEROSOL SCIENCE 2021; 151:105642. [PMID: 32921804 PMCID: PMC7480823 DOI: 10.1016/j.jaerosci.2020.105642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Laboratory animals are often used to derive health risk from environmental exposure or to assess the therapeutic effect of a drug delivered by inhaled therapy. Knowledge of the in-situ distribution of deposited particles on airway and alveolar surfaces is essential in any assessment of these effects. A unique database including both high-resolution lung anatomy and deposition data in four strains of laboratory mice have been recently made publicly available to the research community (https://doi.org/10.25820/9arg-9w56). Using these data, we investigated the effect of particle size on the distribution of deposited particles at the lobar and near-acini level. Analysis was performed on a total of 33 mice where 3, 16 and 14 animals were exposed to 0.5μm, 1μm and 2μm particles, respectively. Ratio of normalized deposition to normalized volume was calculated for each lobe (DV lobe ). At the near-acini level, the skew and standard deviation of the frequency distribution of particle deposition were calculated. Significant deviation above 1 was found for DV ratio in the cranial lobe (DV Cranial ). DV Middle , DV Caudal and DV Accessory were all significantly <1 and lower than DV left (p<0.01). At the near-acini level, skew and standard deviation were positively correlated with particle size and the presence of hot spots (high deposition) were mainly found in the apical region of the lung. These results highlight the uneven distribution of deposited particles in the mouse lung. Thus, depending on the lung sample location, individual analysis to determine overall deposition may either underestimate or overestimate total lung burden, at least for micron-sized particles.
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Affiliation(s)
- W. Gu
- Department of Medicine, University of California, San Diego, USA
| | - C. Darquenne
- Department of Medicine, University of California, San Diego, USA
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12
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Chow MYT, Chang RYK, Chan HK. Inhalation delivery technology for genome-editing of respiratory diseases. Adv Drug Deliv Rev 2021; 168:217-228. [PMID: 32512029 PMCID: PMC7274121 DOI: 10.1016/j.addr.2020.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 12/25/2022]
Abstract
The clustered regulatory interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (CRISPR/Cas9) system has significant therapeutic potentials for lung congenital diseases such as cystic fibrosis, as well as other pulmonary disorders like lung cancer and obstructive diseases. Local administration of CRISPR/Cas9 therapeutics through inhalation can achieve high drug concentration and minimise systemic exposure. While the field is advancing with better understanding on the biological functions achieved by CRISPR/Cas9 systems, the lack of progress in inhalation formulation and delivery of the molecule may impede their clinical translation efficiently. This forward-looking review discussed the current status of formulations and delivery for inhalation of relevant biologics such as genes (plasmids and mRNAs) and proteins, emphasising on their design strategies and preparation methods. By adapting and optimising formulation strategies used for genes and proteins, we envisage that development of inhalable CRISPR/Cas9 liquid or powder formulations for inhalation administration can potentially be fast-tracked in near future.
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Affiliation(s)
- Michael Y T Chow
- Advanced Drug Delivery Group, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rachel Yoon Kyung Chang
- Advanced Drug Delivery Group, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia.
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13
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Dhanani JA, Goodman S, Ahern B, Cohen J, Fraser JF, Barnett A, Diab S, Bhatt M, Roberts JA. Comparative lung distribution of radiolabeled tobramycin between nebulized and intravenous administration in a mechanically-ventilated ovine model, an observational study. Int J Antimicrob Agents 2020; 57:106232. [PMID: 33232733 DOI: 10.1016/j.ijantimicag.2020.106232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/15/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia is common and is treated using nebulized antibiotics. Although adequate pulmonary biodistribution is important for antibiotic effect, there is a lack of data for both intravenous (IV) and nebulized antibiotic administration during mechanical ventilation. OBJECTIVE To describe the comparative pulmonary regional distribution of IV and nebulized technetium-99m-labeled tobramycin (99mTc-tobramycin) 400 mg in a mechanically-ventilated ovine model. METHODS The study was performed in a mechanically-ventilated ovine model. 99mTc-tobramycin 400 mg was obtained using a radiolabeling process. Computed tomography (CT) was performed. Ten sheep were given 99mTc-tobramycin 400 mg via either an IV (five sheep) or nebulized (five sheep) route. Planar images (dorsal, ventral, left lateral and right lateral) were obtained using a gamma camera. Blood samples were obtained every 15 min for 1 h (4 time points) and lung, liver, both kidney, and urine samples were obtained post-mortem. RESULTS Ten sheep were anesthetized and mechanically ventilated. Whole-lung deposition of nebulized 99mTc-tobramycin 400 mg was significantly lower than with IV (8.8% vs. 57.1%, P<0.001). For both administration routes, there was significantly lower deposition in upper lung zones compared with the rest of the lungs. Dorsal deposition was significantly higher with nebulized 99mTc-tobramycin 400 mg compared with IV (68.9% vs. 58.9%, P=0.003). Lung concentrations of 99mTc-tobramycin were higher with IV compared with nebulized administration. There were significantly higher concentrations of 99mTc-tobramycin in blood, liver and urine with IV administration compared with nebulized. CONCLUSIONS Nebulization resulted in lower whole and regional lung deposition of 99mTc-tobramycin compared with IV administration and appeared to be associated with low blood and extra-pulmonary organ concentrations.
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Affiliation(s)
- Jayesh A Dhanani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Critical Care Research Group, The University of Queensland, Brisbane, Australia.
| | - Steven Goodman
- Department of Nuclear Medicine and Specialised PET Services Queensland, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Benjamin Ahern
- School of Veterinary Science, Faculty of Science, University of Queensland, Gatton, Australia
| | - Jeremy Cohen
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Sara Diab
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Manoj Bhatt
- Department of Nuclear Medicine and Specialised PET Services Queensland, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Royal Brisbane & Women's Hospital, Brisbane, Australia
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14
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Abstract
Aerosolized drug inhalation plays an important role in the treatment of respiratory diseases. All of the published in silico, in vivo, and in vitro studies have improved the knowledge of aerosol delivery in the human respiratory system. However, aerosolized magnetic nano-particle (MNP) transport and deposition (TD) for the specific position of the human lung are still unavailable in the literature. Therefore, this study is aimed to provide an understanding of the magnetic nano-particle TD in the targeted region by imposing an external magnetic field for the development of future therapeutics. Uniform aerosolized nano-particle TD in the specific position of the lung airways will be modelled by adopting turbulence k–ω low Reynolds number simulation. The Euler–Lagrange (E–L) approach and the magneto hydrodynamics (MHD) model are incorporated in the ANSYS fluent (18.0) solver to investigate the targeted nano-particle TD. The human physical activity conditions of sleeping, resting, light activity and fast breathing are considered in this study. The aerosolized drug particles are navigated to the targeted position under the influence of external magnetic force (EMF), which is applied in two different positions of the two-generation lung airways. A numerical particle tracing model is also developed to predict the magnetic drug targeting behavior in the lung. The numerical results reveal that nano-particle deposition efficiency (DE) in two different magnetic field position is different for various physical activities, which could be helpful for targeted drug delivery to a specific region of the lung after extensive clinical trials. This process will also be cost-effective and will minimize unwanted side effects due to systemic drug distribution in the lung.
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Yang B, Choi H, Kim SH, Yoon HJ, Lee H. How will nanotechnology lead to better control of asthma? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:515. [PMID: 31807497 DOI: 10.21037/atm.2019.09.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bumhee Yang
- Division of Pulmonology, Center of Lung Cancer, National Cancer Center, Goyang, Korea
| | - Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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16
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Malmlöf M, Nowenwik M, Meelich K, Rådberg I, Selg E, Burns J, Mascher H, Gerde P. Effect of particle deposition density of dry powders on the results produced by an in vitro test system simulating dissolution- and absorption rates in the lungs. Eur J Pharm Biopharm 2019; 139:213-223. [DOI: 10.1016/j.ejpb.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 02/15/2019] [Accepted: 03/03/2019] [Indexed: 11/16/2022]
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17
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Ahmad S, Zafar I, Mariappan N, Husain M, Wei CC, Vetal N, Eltoum IA, Ahmad A. Acute pulmonary effects of aerosolized nicotine. Am J Physiol Lung Cell Mol Physiol 2018; 316:L94-L104. [PMID: 30358437 DOI: 10.1152/ajplung.00564.2017] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Nicotine is a highly addictive principal component of both tobacco and electronic cigarette that is readily absorbed in blood. Nicotine-containing electronic cigarettes are promoted as a safe alternative to cigarette smoking. However, the isolated effects of inhaled nicotine are largely unknown. Here we report a novel rat model of aerosolized nicotine with a particle size (~1 μm) in the respirable diameter range. Acute nicotine inhalation caused increased pulmonary edema and lung injury as measured by enhanced bronchoalveolar lavage fluid protein, IgM, lung wet-to-dry weight ratio, and high-mobility group box 1 (HMGB1) protein and decreased lung E-cadherin protein. Immunohistochemical analysis revealed congested blood vessels and increased neutrophil infiltration. Lung myeloperoxidase mRNA and protein increased in the nicotine-exposed rats. Complete blood counts also showed an increase in neutrophils, white blood cells, eosinophils, and basophils. Arterial blood gas measurements showed an increase in lactate. Lungs of nicotine-inhaling animals revealed increased mRNA levels of IL-1A and CXCL1. There was also an increase in IL-1α protein. In in vitro air-liquid interface cultures of airway epithelial cells, there was a dose dependent increase in HMGB1 release with nicotine treatment. Air-liquid cultures exposed to nicotine also resulted in a dose-dependent loss of barrier as measured by transepithelial electrical resistance and a decrease in E-cadherin expression. Nicotine also caused a dose-dependent increase in epithelial cell death and an increase in caspase-3/7 activities. These results show that the nicotine content of electronic cigarettes may have adverse pulmonary and systemic effects.
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Affiliation(s)
- Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Iram Zafar
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Nithya Mariappan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Maroof Husain
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chih-Chang Wei
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Nilam Vetal
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Isam A Eltoum
- Department of Pathology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
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18
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Alcoforado L, Dornelas de Andrade A, Herraiz JL, Brandão SCS, Barcelar JDM, Fink JB, Venegas JG. Anatomically Based Analysis of Radioaerosol Distribution in Pulmonary Scintigraphy: A Feasibility Study in Asthmatics. J Aerosol Med Pulm Drug Deliv 2018; 31:298-310. [PMID: 29672215 PMCID: PMC6161331 DOI: 10.1089/jamp.2017.1403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Manual analysis of two-dimensional (2D) scintigraphy to evaluate aerosol deposition is usually subjective and has reduced sensitivity to quantify regional differences between central and distal airways. AIMS (1) To present a method to analyze 2D scans based on three-dimensional (3D)-linked anatomically consistent regions of interest (ROIs); (2) to evaluate peripheral-to-central counts ratio (P/C2D) and penetration indices (PIs) for a set of 16 subjects with moderate-to-severe asthma; and (3) to compare the reproducibility of this method against one with manually traced ROIs. METHODS Two-dimensional scans were analyzed using custom software that scaled onto 2D-projections' 3D anatomical features, obtained from population-averaged computed tomography (CT) chest scans. ROIs for a rectangular box (bROI) and an anatomically shaped ROI (aROI) were defined by computer and by manually tracing the standard rectangular box (manual ROI [mROI]). These ROIs were defined five nonconsecutive times for each scan and average value and variability of the P/C2D were estimated. Based on CT estimates of lung and airways, volumes lying under the bROI and aROI, a 2D penetration index (PI2D) and a 3D penetration index (PI3D), were defined as volume-normalized ratios of aerosol deposition in central and peripheral ROIs and in central and distal airways, respectively. RESULTS P/C2D values and their variability, were influenced by the shape and method to define the ROIs: The P/C2D was systematically greater and more variable for mROI versus bROI (p < 0.005). The P/C2D for aROI was higher and its variability lower than those for the bROI (p < 0.001). The PI2D was in average the same for aROI and bROI, and is substantially (∼30 × ) greater than PI3D (p < 0.001). Both PI2D and PI3D, obtained with our analysis, compared well with literature values obtained with two scans (deposition and volume). CONCLUSION Our results demonstrate that 2D scintigraphy can be analyzed using anatomically based ROIs from 3D CT data, allowing objective and enhanced reproducibility values describing the distribution pattern of radioaerosol deposition in the tracheobronchial tree.
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Affiliation(s)
- Luciana Alcoforado
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Joaquin L. Herraiz
- Grupo de Fisica Nuclear, Facultad de Ciencias Fisicas, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Jose G. Venegas
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Address correspondence to:Jose G. Venegas, PhDDepartment of AnesthesiaEdwards 410Massachusetts General Hospital55 Fruit St.Boston, MA 02114
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19
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Alcoforado L, Dornelas de Andrade A, Herraiz JL, Brandão SCS, Barcelar JDM, Fink JB, Venegas JG. Anatomically Based Analysis of Radioaerosol Distribution in Pulmonary Scintigraphy: A Feasibility Study in Asthmatics. J Aerosol Med Pulm Drug Deliv 2018. [DOI: https://doi.org/10.1089/jamp.2017.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Luciana Alcoforado
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Joaquin L. Herraiz
- Grupo de Fisica Nuclear, Facultad de Ciencias Fisicas, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Jose G. Venegas
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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20
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Newman SP. Delivering drugs to the lungs: The history of repurposing in the treatment of respiratory diseases. Adv Drug Deliv Rev 2018; 133:5-18. [PMID: 29653129 DOI: 10.1016/j.addr.2018.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 04/01/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
The repurposing of drug delivery by the pulmonary route has been applied to treatment and prophylaxis of an increasingly wide range of respiratory diseases. Repurposing has been most successful for the delivery of inhaled bronchodilators and corticosteroids in patients with asthma and chronic obstructive pulmonary disease (COPD). Repurposing utilizes the advantages that the pulmonary route offers in terms of more targeted delivery to the site of action, the use of smaller doses, and a lower incidence of side-effects. Success has been more variable for other drugs and treatment indications. Pulmonary delivery is now well established for delivery of inhaled antibiotics in cystic fibrosis (CF), and in the treatment of pulmonary arterial hypertension (PAH). Other inhaled treatments such as those for idiopathic pulmonary fibrosis (IPF), lung transplant rejection or tuberculosis may also become routine. Repurposing has progressed in parallel with the development of new drugs, inhaler devices and formulations.
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21
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Morélot-Panzini C, O'Donnell CR, Lansing RW, Schwartzstein RM, Banzett RB. Aerosol furosemide for dyspnea: Controlled delivery does not improve effectiveness. Respir Physiol Neurobiol 2017; 247:146-155. [PMID: 29031573 DOI: 10.1016/j.resp.2017.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 01/23/2023]
Abstract
Aerosolized furosemide has been shown to relieve dyspnea; nevertheless, all published studies have shown great variability in response. This dyspnea relief is thought to result from the stimulation of slowly adapting pulmonary stretch receptors simulating larger tidal volume. We hypothesized that better control over aerosol administration would produce more consistent dyspnea relief; we used a clinical ventilator to control inspiratory flow and tidal volume. Twelve healthy volunteers inhaled furosemide (40mg) or placebo in a double blind, randomized, crossover study. Breathing Discomfort was induced by hypercapnia during constrained ventilation before and after treatment. Both treatments reduced breathing discomfort by 20% full scale. Effectiveness of aerosol furosemide treatment was weakly correlated with larger tidal volume. Response to inhaled furosemide was inversely correlated to furosemide blood level, suggesting that variation among subjects in the fate of deposited drug may determine effectiveness. We conclude that control of aerosol delivery conditions does not improve consistency of treatment effect; we cannot, however, rule out placebo effect.
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Affiliation(s)
- Capucine Morélot-Panzini
- Pulmonary Division, Beth Israel Deaconess MC, Boston, MA, 02215, USA; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, F-75013, Paris, France.
| | - Carl R O'Donnell
- Pulmonary Division, Beth Israel Deaconess MC, Boston, MA, 02215, USA; Harvard Med School, Boston, MA, 02115, USA
| | - Robert W Lansing
- Pulmonary Division, Beth Israel Deaconess MC, Boston, MA, 02215, USA
| | - Richard M Schwartzstein
- Pulmonary Division, Beth Israel Deaconess MC, Boston, MA, 02215, USA; Harvard Med School, Boston, MA, 02115, USA
| | - Robert B Banzett
- Pulmonary Division, Beth Israel Deaconess MC, Boston, MA, 02215, USA; Harvard Med School, Boston, MA, 02115, USA
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22
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Banzett RB, Schwartzstein RM, Lansing RW, O'Donnell CR. Aerosol furosemide for dyspnea: High-dose controlled delivery does not improve effectiveness. Respir Physiol Neurobiol 2017; 247:24-30. [PMID: 28843675 DOI: 10.1016/j.resp.2017.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
Published studies have shown great variability in response when aerosolized furosemide has been tested as a palliative treatment for dyspnea. We hypothesized that a higher furosemide dose with controlled aerosol administration would produce consistent dyspnea relief. We optimized deposition by controlling inspiratory flow (300-500mL/s) and tidal volume (15% predicted vital capacity) while delivering 3.4μm aerosol from either saline or 80mg of furosemide. We induced dyspnea in healthy subjects by varying inspired PCO2 while restricting minute ventilation. Subjects rated "Breathing Discomfort" on a Visual Analog Scale (BDVAS, 100% Full Scale≡intolerable). At the PETCO2 producing 60% BDVAS pre-treatment, furosemide produced a clinically meaningful reduction of BDVAS (i.e., >20% FS) in 5/11 subjects; saline reduced dyspnea in 3/11 subjects; neither treatment worsened dyspnea in any subject. Furosemide and saline treatment effects were not statistically different. There were no significant adverse events. Higher furosemide dose and controlled delivery did not improve consistency of treatment effect compared with prior studies.
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Affiliation(s)
- Robert B Banzett
- Division of Pulmonary, Critical Care, and Sleep Medicine Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
| | - Richard M Schwartzstein
- Division of Pulmonary, Critical Care, and Sleep Medicine Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert W Lansing
- Division of Pulmonary, Critical Care, and Sleep Medicine Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Carl R O'Donnell
- Division of Pulmonary, Critical Care, and Sleep Medicine Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA; Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
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23
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Davis ES, Sassano MF, Goodell H, Tarran R. E-Liquid Autofluorescence can be used as a Marker of Vaping Deposition and Third-Hand Vape Exposure. Sci Rep 2017; 7:7459. [PMID: 28785072 PMCID: PMC5547159 DOI: 10.1038/s41598-017-07862-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/04/2017] [Indexed: 11/17/2022] Open
Abstract
In the past 5 years, e-cigarette use has been increasing rapidly, particularly in youth and young adults. Due to the novelty of e-cigarettes (e-cigs) and e-cigarette liquids (e-liquids), research on their chemo-physical properties is still in its infancy. Here, we describe a previously unknown and potentially useful property of e-liquids, namely their autofluorescence. We performed an emission scan at 9 excitation wavelengths common to fluorescent microscopy and found (i) that autofluorescence differs widely between e-liquids, (ii) that e-liquids are most fluorescent in the UV range (between 350 and 405 nm) and (iii) fluorescence intensity wanes as the emission wavelength increases. Furthermore, we used the autofluorescence of e-liquids as a marker for tracking e-cig aerosol deposition in the laboratory. Using linear regression analysis, we were able to quantify the deposition of a “vaped” e-liquid onto hard surfaces. Using this technique, we found that every 70 mL puff of an e-cigarette deposited 0.019% e-liquid (v/v) in a controlled environment. Finally, we vaped a surface in the laboratory and used our method to detect e-cig aerosol third-hand exposure. In conclusion, our data suggest that e-cigarette autofluorescence can be used as a marker of e-cigarette deposition.
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Affiliation(s)
- Eric S Davis
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - M Flori Sassano
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Henry Goodell
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
| | - Robert Tarran
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina, Chapel Hill, NC, USA. .,Department of Cell Biology & Physiology, University of North Carolina, Chapel Hill, NC, USA.
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24
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Miyawaki S, Hoffman EA, Lin CL. Numerical simulations of aerosol delivery to the human lung with an idealized laryngeal model, image-based airway model, and automatic meshing algorithm. COMPUTERS & FLUIDS 2017; 148:1-9. [PMID: 28959080 PMCID: PMC5612319 DOI: 10.1016/j.compfluid.2017.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The authors proposed a new method to automatically mesh computed tomography (CT)-based three-dimensional human airway geometry for computational fluid dynamics (CFD)-based simulations of pulmonary gas-flow and aerosol delivery. Traditional methods to construct and mesh realistic geometry were time-consuming, because they were done manually using image-processing and mesh-generating programs. Furthermore, most of CT thoracic image data sets do not include the upper airway structures. To overcome these issues, the proposed method consists of CFD grid-size distribution, an automatic meshing algorithm, and the addition of a laryngeal model along with turbulent velocity inflow boundary condition attached to the proximal end of the trachea. The method is based on our previously developed geometric model with irregular centerlines and cross-sections fitted to CT segmented airway surfaces, dubbed the "fitted-surface model." The new method utilizes anatomical information obtained from the one-dimensional tree, e.g., skeleton connectivity and branch diameters, to efficiently generate optimal CFD mesh, automatically impose boundary conditions, and systematically reduce simulation results. The aerosol deposition predicted by the proposed method agreed well with the prediction by a traditional CT-based model, and the laryngeal model generated a realistic level of turbulence in the trachea. Furthermore, the computational time was reduced by factor of two without losing accuracy by using the proposed grid-size distribution. The new method is well suited for branch-by-branch analyses of gas-flow and aerosol distribution in multiple subjects due to embedded anatomical information.
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Affiliation(s)
- Shinjiro Miyawaki
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, Iowa 52242
| | - Eric A. Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa 52242
- Medicine, University of Iowa, Iowa City, Iowa 52242
- Radiology, University of Iowa, Iowa City, Iowa 52242
| | - Ching-Long Lin
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, Iowa 52242
- Radiology, University of Iowa, Iowa City, Iowa 52242
- Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa 52242
- Corresponding author: (Ching-Long Lin)
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25
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Sá RC, Zeman KL, Bennett WD, Prisk GK, Darquenne C. Regional Ventilation Is the Main Determinant of Alveolar Deposition of Coarse Particles in the Supine Healthy Human Lung During Tidal Breathing. J Aerosol Med Pulm Drug Deliv 2017; 30:322-331. [PMID: 28277885 DOI: 10.1089/jamp.2016.1336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To quantify the relationship between regional lung ventilation and coarse aerosol deposition in the supine healthy human lung, we used oxygen-enhanced magnetic resonance imaging and planar gamma scintigraphy in seven subjects. METHODS Regional ventilation was measured in the supine posture in a 15 mm sagittal slice of the right lung. Deposition was measured by using planar gamma scintigraphy (coronal scans, 40 cm FOV) immediately postdeposition, 1 hour 30 minutes and 22 hours after deposition of 99mTc-labeled particles (4.9 μm MMAD, GSD 2.5), inhaled in the supine posture (flow 0.5 L/s, 15 breaths/min). The distribution of retained particles at different times was used to infer deposition in different airway regions, with 22 hours representing alveolar deposition. The fraction of total slice ventilation per quartile of lung height from the lung apex to the dome of the diaphragm at functional residual capacity was computed, and co-registered with deposition data-apices aligned-using a transmission scan as reference. The ratio of fractional alveolar deposition to fractional ventilation of each quartile (r) was used to evaluate ventilation and deposition matching (r > 1, regional aerosol deposition fraction larger than regional ventilation fraction). RESULTS r was not significantly different from 1 for all regions (1.04 ± 0.25, 1.08 ± 0.22, 1.03 ± 0.17, 0.92 ± 0.13, apex to diaphragm, p > 0.40) at the alveolar level (r22h). For retention times r0h and r1h30, only the diaphragmatic region at r1h30 differed significantly from 1. CONCLUSIONS These results support the hypothesis that alveolar deposition is directly proportional to ventilation for ∼5 μm particles that are inhaled in the supine posture and are consistent with previous simulation predictions that show that convective flow is the main determinant of aerosol transport to the lung periphery.
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Affiliation(s)
- Rui Carlos Sá
- 1 Pulmonary Imaging Laboratory, Department of Medicine, University of California , San Diego, La Jolla, California
| | - Kirby L Zeman
- 2 Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - William D Bennett
- 2 Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - G Kim Prisk
- 1 Pulmonary Imaging Laboratory, Department of Medicine, University of California , San Diego, La Jolla, California.,3 Pulmonary Imaging Laboratory, Department of Radiology, University of California , San Diego, La Jolla, California
| | - Chantal Darquenne
- 1 Pulmonary Imaging Laboratory, Department of Medicine, University of California , San Diego, La Jolla, California
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Pacheco S, Kanou T, Fung SY, Chen K, Lee D, Bai X, Keshavjee S, Liu M. Formulation of hydrophobic therapeutics with self-assembling peptide and amino acid: A new platform for intravenous drug delivery. J Control Release 2016; 239:211-22. [DOI: 10.1016/j.jconrel.2016.08.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/27/2016] [Indexed: 01/21/2023]
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Ilic V, Dunet V, Le Pape A, Buchs M, Kosinski M, Bischof Delaloye A, Gerber S, Prior JO. SPECT/CT study of bronchial deposition of inhaled particles. A human aerosol vaccination model against HPV. Nuklearmedizin 2016; 55:203-8. [PMID: 27440125 DOI: 10.3413/nukmed-0811-16-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/28/2016] [Indexed: 02/01/2023]
Abstract
AIMS Vaccination by aerosol inhalation can be used to efficiently deliver antigen against HPV to mucosal tissue, which is particularly useful in developing countries (simplicity of administration, costs, no need for cold chain). For optimal immunological response, vaccine particles should preferentially be delivered to proximal bronchial airways. We aimed at quantifying the deposition of inhaled particles in central airways and peripheral lung, and to assess administration biosafety. Participants, methods: 20 healthy volunteers (13W/7M, aged 24±4y) performed a 10-min free-breathing inhalation of (99m)Tc-stannous chloride colloid aerosol (450 MBq) in a buffer solution without vaccinal particles using an ultrasonic nebulizer (mass median aerodynamic diameter 4.2 μm) and a double mask inside a biosafety cabinet dedicated to assess environmental particle release. SPECT/CT and whole-body planar scintigraphy were acquired to determine whole-body and regional C/P distribution ratio (central-to-peripheral pulmonary deposition counts). Using a phantom, SPECT sensitivity was calibrated to obtain absolute pulmonary activity deposited by inhalation. RESULTS All participants successfully performed the inhalation that was well tolerated (no change in pulmonary peak expiratory flow rate, p = 0.9). It was environmentally safe (no activity released in the biosafety filter.) 1.3±0.6% (range 0.4-2.6%) of the total nebulizer activity was deposited in the lungs with a C/P distribution ratio of 0.40±0.20 (range 0.15-1.14). CONCLUSION Quantification and regional distribution of inhaled particles in an aerosolized vaccine model is possible using radioactive particles. This will allow optimizing deposition parameters and determining the particles charge for active-particles vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | - John O Prior
- Prof. John O. Prior, PhD MD, Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland, Tel. +41/21/314 43-48, Fax -49,
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Pirozynski M, Sosnowski TR. Inhalation devices: from basic science to practical use, innovative vs generic products. Expert Opin Drug Deliv 2016; 13:1559-1571. [PMID: 27267298 DOI: 10.1080/17425247.2016.1198774] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Inhalation therapy is a convenient method of treating respiratory diseases. The key factors required for inhalation are the preparation of drug carriers (aerosol particles) allowing reproducible dosing during administration. These technical challenges are accomplished with a variety of inhalation devices (inhalers) and medicinal formulations, which are optimized to be easily converted into inhalable aerosols. Areas covered: This review is focused on the most important, but often overlooked, effects, which are required for the reliable and reproducible inhalable drug administration. The effects of patient-related issues that influence inhalation therapy, such as proper selection of inhalers for specific cases is discussed. We also discuss factors that are the most essential if generic inhalation product should be considered equivalent to the drugs with the clinically confirmed efficacy. Expert opinion: Proper device selection is crucial in clinical results of inhalation therapy. The patients' ability to coordinate inhalation with actuation, generation of optimal flow through the device, use of optimal inspiratory volume, all produces crucial effects on disease control. Also the severity of the disease process effects proper use of inhalers. Interchanging of inhalers can produce potentially conflicting problem regarding efficacy and safety of inhalation therapy.
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Affiliation(s)
- Michal Pirozynski
- a Allergy and Pulmonology Department , Postgraduate Center for Medical Education , Warsaw , Poland
| | - Tomasz R Sosnowski
- b Faculty of Chemical and Process Engineering , Warsaw University of Technology , Warsaw , Poland
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Darquenne C, Fleming JS, Katz I, Martin AR, Schroeter J, Usmani OS, Venegas J, Schmid O. Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung. J Aerosol Med Pulm Drug Deliv 2016; 29:107-26. [PMID: 26829187 DOI: 10.1089/jamp.2015.1270] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Development of a new drug for the treatment of lung disease is a complex and time consuming process involving numerous disciplines of basic and applied sciences. During the 2015 Congress of the International Society for Aerosols in Medicine, a group of experts including aerosol scientists, physiologists, modelers, imagers, and clinicians participated in a workshop aiming at bridging the gap between basic research and clinical efficacy of inhaled drugs. This publication summarizes the current consensus on the topic. It begins with a short description of basic concepts of aerosol transport and a discussion on targeting strategies of inhaled aerosols to the lungs. It is followed by a description of both computational and biological lung models, and the use of imaging techniques to determine aerosol deposition distribution (ADD) in the lung. Finally, the importance of ADD to clinical efficacy is discussed. Several gaps were identified between basic science and clinical efficacy. One gap between scientific research aimed at predicting, controlling, and measuring ADD and the clinical use of inhaled aerosols is the considerable challenge of obtaining, in a single study, accurate information describing the optimal lung regions to be targeted, the effectiveness of targeting determined from ADD, and some measure of the drug's effectiveness. Other identified gaps were the language and methodology barriers that exist among disciplines, along with the significant regulatory hurdles that need to be overcome for novel drugs and/or therapies to reach the marketplace and benefit the patient. Despite these gaps, much progress has been made in recent years to improve clinical efficacy of inhaled drugs. Also, the recent efforts by many funding agencies and industry to support multidisciplinary networks including basic science researchers, R&D scientists, and clinicians will go a long way to further reduce the gap between science and clinical efficacy.
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Affiliation(s)
- Chantal Darquenne
- 1 Department of Medicine, University of California , San Diego, La Jolla, California
| | - John S Fleming
- 2 National Institute of Health Research Biomedical Research Unit in Respiratory Disease , Southampton, United Kingdom .,3 Department of Medical Physics and Bioengineering, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Ira Katz
- 4 Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay , Jouy-en-Josas, France .,5 Department of Mechanical Engineering, Lafayette College , Easton, Pennsylvania
| | - Andrew R Martin
- 6 Department of Mechanical Engineering, University of Alberta , Edmonton, Alberta, Canada
| | | | - Omar S Usmani
- 8 Airway Disease Section, National Heart and Lung Institute , Imperial College London and Royal Brompton Hospital, London, United Kingdom
| | - Jose Venegas
- 9 Department of Anesthesia (Bioengineering), MGH/Harvard, Boston, Massachusetts
| | - Otmar Schmid
- 10 Comprehensive Pneumology Center (CPC), Member of the German Center for Lung Research , Munich, Germany .,11 Institute of Lung Biology and Disease, Helmholtz Zentrum München-German Research Center for Environmental Health , Neuherberg, Germany
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Raliya R, Singh Chadha T, Haddad K, Biswas P. Perspective on Nanoparticle Technology for Biomedical Use. Curr Pharm Des 2016; 22:2481-90. [PMID: 26951098 PMCID: PMC4930863 DOI: 10.2174/1381612822666160307151409] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/04/2016] [Indexed: 12/20/2022]
Abstract
This review gives a short overview on the widespread use of nanostructured and nanocomposite materials for disease diagnostics, drug delivery, imaging and biomedical sensing applications. Nanoparticle interaction with a biological matrix/entity is greatly influenced by its morphology, crystal phase, surface chemistry, functionalization, physicochemical and electronic properties of the particle. Various nanoparticle synthesis routes, characterization, and functionalization methodologies to be used for biomedical applications ranging from drug delivery to molecular probing of underlying mechanisms and concepts are described with several examples (150 references).
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Affiliation(s)
| | | | | | - Pratim Biswas
- School of Engineering and Applied Science, Washington University in St. Louis, St. Louis, MO-63130, USA.
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31
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Rowell TR, Tarran R. Will chronic e-cigarette use cause lung disease? Am J Physiol Lung Cell Mol Physiol 2015; 309:L1398-409. [PMID: 26408554 PMCID: PMC4683316 DOI: 10.1152/ajplung.00272.2015] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/22/2015] [Indexed: 12/22/2022] Open
Abstract
Chronic tobacco smoking is a major cause of preventable morbidity and mortality worldwide. In the lung, tobacco smoking increases the risk of lung cancer, and also causes chronic obstructive pulmonary disease (COPD), which encompasses both emphysema and chronic bronchitis. E-cigarettes (E-Cigs), or electronic nicotine delivery systems, were developed over a decade ago and are designed to deliver nicotine without combusting tobacco. Although tobacco smoking has declined since the 1950s, E-Cig usage has increased, attracting both former tobacco smokers and never smokers. E-Cig liquids (e-liquids) contain nicotine in a glycerol/propylene glycol vehicle with flavorings, which are vaporized and inhaled. To date, neither E-Cig devices, nor e-liquids, are regulated by the Food and Drug Administration (FDA). The FDA has proposed a deeming rule, which aims to initiate legislation to regulate E-Cigs, but the timeline to take effect is uncertain. Proponents of E-Cigs say that they are safe and should not be regulated. Opposition is varied, with some opponents proposing that E-Cig usage will introduce a new generation to nicotine addiction, reversing the decline seen with tobacco smoking, or that E-Cigs generally may not be safe and will trigger diseases like tobacco. In this review, we shall discuss what is known about the effects of E-Cigs on the mammalian lung and isolated lung cells in vitro. We hope that collating this data will help illustrate gaps in the knowledge of this burgeoning field, directing researchers toward answering whether or not E-Cigs are capable of causing disease.
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Affiliation(s)
- Temperance R Rowell
- Marsico Lung Institute and Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert Tarran
- Marsico Lung Institute and Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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32
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Sá RC, Zeman KL, Bennett WD, Prisk GK, Darquenne C. Effect of Posture on Regional Deposition of Coarse Particles in the Healthy Human Lung. J Aerosol Med Pulm Drug Deliv 2015; 28:423-31. [DOI: 10.1089/jamp.2014.1189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rui Carlos Sá
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Kirby L. Zeman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William D. Bennett
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - G. Kim Prisk
- Department of Medicine, University of California, San Diego, La Jolla, California
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Chantal Darquenne
- Department of Medicine, University of California, San Diego, La Jolla, California
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33
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Paramjot, Khan NM, Kapahi H, Kumar S, Bhardwaj TR, Arora S, Mishra N. Role of polymer–drug conjugates in organ-specific delivery systems. J Drug Target 2015; 23:387-416. [DOI: 10.3109/1061186x.2015.1016436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Zhu B, Traini D, Young P. Aerosol particle generation from solution-based pressurized metered dose inhalers: a technical overview of parameters that influence respiratory deposition. Pharm Dev Technol 2014; 20:897-910. [DOI: 10.3109/10837450.2014.959176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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35
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Löndahl J, Möller W, Pagels JH, Kreyling WG, Swietlicki E, Schmid O. Measurement techniques for respiratory tract deposition of airborne nanoparticles: a critical review. J Aerosol Med Pulm Drug Deliv 2014; 27:229-54. [PMID: 24151837 PMCID: PMC4120654 DOI: 10.1089/jamp.2013.1044] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/15/2013] [Indexed: 12/14/2022] Open
Abstract
Determination of the respiratory tract deposition of airborne particles is critical for risk assessment of air pollution, inhaled drug delivery, and understanding of respiratory disease. With the advent of nanotechnology, there has been an increasing interest in the measurement of pulmonary deposition of nanoparticles because of their unique properties in inhalation toxicology and medicine. Over the last century, around 50 studies have presented experimental data on lung deposition of nanoparticles (typical diameter≤100 nm, but here≤300 nm). These data show a considerable variability, partly due to differences in the applied methodologies. In this study, we review the experimental techniques for measuring respiratory tract deposition of nano-sized particles, analyze critical experimental design aspects causing measurement uncertainties, and suggest methodologies for future studies. It is shown that, although particle detection techniques have developed with time, the overall methodology in respiratory tract deposition experiments has not seen similar progress. Available experience from previous research has often not been incorporated, and some methodological design aspects that were overlooked in 30-70% of all studies may have biased the experimental data. This has contributed to a significant uncertainty on the absolute value of the lung deposition fraction of nanoparticles. We estimate the impact of the design aspects on obtained data, discuss solutions to minimize errors, and highlight gaps in the available experimental set of data.
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Affiliation(s)
- Jakob Löndahl
- Ergonomics and Aerosol Technology (EAT), Lund University, SE-221 00 Lund, Sweden
| | - Winfried Möller
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Joakim H. Pagels
- Ergonomics and Aerosol Technology (EAT), Lund University, SE-221 00 Lund, Sweden
| | - Wolfgang G. Kreyling
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | | | - Otmar Schmid
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, 85764 Neuherberg, Germany
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36
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Newman S. Improving inhaler technique, adherence to therapy and the precision of dosing: major challenges for pulmonary drug delivery. Expert Opin Drug Deliv 2014; 11:365-78. [PMID: 24386924 DOI: 10.1517/17425247.2014.873402] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The inhaled route has many advantages, but requires the patient to use, and to master the use of, an inhaler device. Poor inhaler technique and non-adherence to therapy lead to a highly variable lung dose in clinical practice, with subsequent loss of clinical efficacy and wastage of economic resources. AREAS COVERED This paper discusses problems of poor inhaler technique, non-adherence to inhaler therapy, other issues relating to the precision of dose delivery, the consequences of these problems and how they can be addressed. EXPERT OPINION The precision of dosing by the pulmonary route can be improved by appropriate choice of inhaler device and by education. It is vital to educate patients about their disease, about the importance of taking prescribed medications and about correct inhaler use. One-on-one sessions with healthcare professionals probably represent the most effective educational method. For some drugs and patient groups, inhalers containing small microprocessors may also be used to control inhalation technique, and hence, to obtain a more reproducible lung dose. As the range of drugs delivered by inhalation increases, the need for correct inhaler technique, adherence to therapy and precise dosing becomes more and more important.
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37
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Manunta MDI, McAnulty RJ, McDowell A, Jin J, Ridout D, Fleming J, Bottoms SE, Tossici-Bolt L, Laurent GJ, Biassoni L, O'Callaghan C, Hart SL. Airway deposition of nebulized gene delivery nanocomplexes monitored by radioimaging agents. Am J Respir Cell Mol Biol 2013; 49:471-80. [PMID: 23614789 DOI: 10.1165/rcmb.2013-0030oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Receptor-targeted nanocomplexes are nonviral vectors developed for gene delivery to the airway epithelium for the treatment of pulmonary disease associated with cystic fibrosis. The present study aimed to optimize the delivery of the nanocomplex by nebulization, and to monitor the in vivo deposition of radiolabeled vector in the airways of a large animal model by γ-camera scintigraphy. Large White weaner pigs were nebulized with nanocomplexes mixed with technetium-99m radiopharmaceuticals. The aerosol deposition scans suggested that the nebulized radiovectors were deposited mainly in the trachea-main bronchi and in the midregion of the lungs. The plasmid biodistribution, assessed by real-time PCR, correlated with the scintigraphy images. The highest plasmid copy numbers were found in the bronchial areas and in the tissues proximal to the main bronchi bifurcation. Immunohistochemistry detected transgene expression in the tracheal and bronchial ciliated epithelium. Histological analysis of lung tissue showed no evidence of inflammation, and no increase in inflammatory cytokines or inflammatory cells was detected in the bronchoalveolar lavage. The deposition of nebulized nanocomplexes coassociated with technetium-99m can be monitored by nuclear medicine techniques. The use of a noninvasive strategy to follow the delivery of the vector could improve the clinical management of patients undergoing cystic fibrosis gene therapy.
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Affiliation(s)
- Maria D I Manunta
- Wolfson Centre for Gene Therapy of Childhood Disease, UCL-Institute of Child Health, University College London, 30 Guilford St., London, United Kingdom
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38
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Abstract
The human body interacts with the environment in many different ways. The lungs interact with the external environment through breathing. The enormously large surface area of the lung with its extremely thin air-blood barrier is exposed to particles suspended in the inhaled air. The particle-lung interaction may cause deleterious effects on health if the inhaled pollutant aerosols are toxic. Conversely, this interaction can be beneficial for disease treatment if the inhaled particles are therapeutic aerosolized drugs. In either case, an accurate estimation of dose and sites of deposition in the respiratory tract is fundamental to understanding subsequent biological response, and the basic physics of particle motion and engineering knowledge needed to understand these subjects is the topic of this article. A large portion of this article deals with three fundamental areas necessary to the understanding of particle transport and deposition in the respiratory tract. These are: (i) the physical characteristics of particles, (ii) particle behavior in gas flow, and (iii) gas-flow patterns in the respiratory tract. Other areas, such as particle transport in the developing lung and in the diseased lung are also considered. The article concludes with a summary and a brief discussion of areas of future research.
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Affiliation(s)
- Akira Tsuda
- Harvard School of Public Health, Boston, Massachusetts
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39
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Newman S, Bennett WD, Biddiscombe M, Devadason SG, Dolovich MB, Fleming J, Haeussermann S, Kietzig C, Kuehl PJ, Laube BL, Sommerer K, Taylor G, Usmani OS, Zeman KL. Standardization of Techniques for Using Planar (2D) Imaging for Aerosol Deposition Assessment of Orally Inhaled Products. J Aerosol Med Pulm Drug Deliv 2012; 25 Suppl 1:S10-28. [DOI: 10.1089/jamp.2012.1su4] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen Newman
- Scientific Consultant, Hunstanton, Norfolk, United Kingdom
| | - William D. Bennett
- Department of Medicine, Department of Pulmonary Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Martyn Biddiscombe
- Nuclear Medicine Department, Royal Brompton Hospital, Sydney Street, London, United Kingdom
| | - Sunalene G. Devadason
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Myrna B. Dolovich
- Faculty of Sciences, Michael de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Fleming
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Philip J. Kuehl
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | - Beth L. Laube
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Glyn Taylor
- Cardiff Scintigraphics and Welsh School of Pharmacy, Cardiff, United Kingdom
| | - Omar S. Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
| | - Kirby L. Zeman
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina
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40
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Conway J. Lung imaging - two dimensional gamma scintigraphy, SPECT, CT and PET. Adv Drug Deliv Rev 2012; 64:357-68. [PMID: 22310158 DOI: 10.1016/j.addr.2012.01.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 01/18/2012] [Accepted: 01/24/2012] [Indexed: 12/17/2022]
Abstract
This review will cover the principles of imaging the deposition of inhaled drugs and some of the state-of-the art imaging techniques being used today. Aerosol deposition can be imaged and quantified by the addition of a radiolabel to the aerosol formulation. The subsequent imaging of the inhaled deposition pattern can be acquired by different imaging techniques. Specifically, this review will focus on the use of two-dimensional planar, gamma scintigraphy, SPECT, CT and PET. This review will look at how these imaging techniques are used to investigate the mechanisms of drug delivery in the lung and how the lung anatomy and physiology have the potential to alter therapeutic outcomes.
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Affiliation(s)
- Joy Conway
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, UK.
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41
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Catanese DJ, Fogg JM, Schrock DE, Gilbert BE, Zechiedrich L. Supercoiled Minivector DNA resists shear forces associated with gene therapy delivery. Gene Ther 2012; 19:94-100. [PMID: 21633394 PMCID: PMC3252587 DOI: 10.1038/gt.2011.77] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/04/2011] [Accepted: 03/09/2011] [Indexed: 02/08/2023]
Abstract
Supercoiled DNAs varying from 281 to 5302 bp were subjected to shear forces generated by aerosolization or sonication. DNA shearing strongly correlated with length. Typical sized plasmids (≥ 3000 bp) degraded rapidly. DNAs 2000-3000 bp persisted ~10 min. Even in the absence of condensing agents, supercoiled DNA <1200 bp survived nebulization, and increased forces of sonication were necessary to shear it. Circular vectors were considerably more resistant to shearing than linear vectors of the same length. DNA supercoiling afforded additional protection. These results show the potential of shear-resistant Minivector DNAs to overcome one of the major challenges associated with gene therapy delivery.
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Affiliation(s)
- D J Catanese
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Pharmacology, Baylor College of Medicine, Houston, TX, USA
| | - J M Fogg
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Pharmacology, Baylor College of Medicine, Houston, TX, USA
| | - D E Schrock
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- University of Texas MD Anderson Cancer Center School of Health Sciences, Houston, TX, USA
| | - B E Gilbert
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - L Zechiedrich
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Pharmacology, Baylor College of Medicine, Houston, TX, USA
- University of Texas MD Anderson Cancer Center School of Health Sciences, Houston, TX, USA
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42
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Huang CW, Pei C, Huang CH. Respiratory deposition model of an inhaled aerosol bolus. Comput Methods Biomech Biomed Engin 2011; 14:915-25. [PMID: 21409658 DOI: 10.1080/10255842.2010.500287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The bolus delivery method is designed to deliver a dose to the desired location in the lung, and it has the advantage of fewer side effects and a more efficient way of delivery. Based upon the lung deposition model developed for continuously inhaling aerosols of constant concentration, a mathematical model of aerosol bolus deposition is proposed. The calculated results show that the recovery depends on the bolus penetration depth, flow rate, particle size, breath holding time and bolus volume. Three sets of published experimental data with different controlling factors (particle size, flow rate and breath holding time) are adopted to make the quantitative comparisons with the calculated results. The predictions and data for the low intrinsic motion particles (∼1 μm) have good agreement, as do the coarse particles in the shallow airways region. For females, the recovery was found to be consistently lower than that for males.
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Affiliation(s)
- Chien-Wen Huang
- Pulmonary Disease Section, Fong-Yuan Hospital, Fong-Yuan City, Taiwan, ROC
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43
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Newman S, Fleming J. Challenges in assessing regional distribution of inhaled drug in the human lungs. Expert Opin Drug Deliv 2011; 8:841-55. [PMID: 21554149 DOI: 10.1517/17425247.2011.577063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Both the total amount of drug deposited in the lungs (whole lung deposition) and the amount deposited in different lung regions (regional lung deposition) are potentially important factors that determine the safety and efficacy of inhaled drugs. Radionuclide imaging is well established for quantifying the whole lung deposition of inhaled drugs, but the assessment of regional lung deposition is less straightforward, because of the complex nature of the lung anatomy. AREAS COVERED This review describes the challenges and problems associated with quantifying regional lung deposition by the two-dimensional (2D) radionuclide imaging method of gamma scintigraphy, and by the three-dimensional (3D) radionuclide imaging methods of single-photon-emission computed tomography (SPECT) and positron-emission tomography (PET). The advantages and disadvantages of each method for assessing regional lung deposition are discussed. EXPERT OPINION Owing to its 2D nature, gamma scintigraphy provides limited information about regional lung deposition. SPECT provides regional lung deposition data in three dimensions, but usually involves a (99m)Tc radiolabel. PET enables the regional lung deposition of radiolabeled drug molecules to be quantified in three dimensions, but poses the greatest logistical and technical difficulties. Despite their more challenging nature, 3D imaging methods should be considered as an alternative to gamma scintigraphy whenever the determination of regional lung deposition of pharmaceutical aerosols is a major study objective.
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44
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Biddiscombe MF, Meah SN, Underwood SR, Usmani OS. Comparing lung regions of interest in gamma scintigraphy for assessing inhaled therapeutic aerosol deposition. J Aerosol Med Pulm Drug Deliv 2011; 24:165-73. [PMID: 21453048 DOI: 10.1089/jamp.2010.0845] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Two-dimensional gamma scintigraphy is an important technique used to evaluate the lung deposition from inhaled therapeutic aerosols. Images are divided into regions of interest and deposition indices are derived to quantify aerosol distribution within the intrapulmonary airways. In this article, we compared the different approaches that have been historically used between different laboratories for geometrically defining lung regions of interest. We evaluated the effect of these different approaches on the derived indices classically used to assess inhaled aerosol deposition in the lungs. Our primary intention was to assess the ability of different regional lung templates to discriminate between central and peripheral airway deposition patterns generated by inhaling aerosols of different particle sizes. METHODS We investigated six methods most commonly reported in the scientific literature to define lung regions of interest and assessed how different each of the derived regional lung indices were between the methods to quantify regional lung deposition. We used monodisperse albuterol aerosols of differing particle size (1.5, 3, and 6 μm) in five mild asthmatic subjects [forced expiratory volume in 1 sec (FEV(1)) 90% predicted] to test the different approaches of each laboratory. RESULTS We observed the areas of geometry used to delineate central (C) and peripheral (P) lung regions of interest varied markedly between different laboratories. There was greater similarity between methods in values of penetration index (PI), defined as P/C aerosol counts normalized by P/C krypton ventilation counts, compared to nonnormalized C/P or P/C aerosol count-ratios. Normalizing the aerosol deposition P/C count-ratios by the ventilation P/C count-ratios, reduced the variability of the data. There was dependence of the regional lung deposition indices on the size of the P region of interest in that, as P increased, C/P count-ratios decreased and P/C count-ratios increased, whereas PI was less affected by variations in the P area. We found particle size, itself, strongly influenced the indices of regional aerosol deposition such that C/P count-ratios increased with increasing particle size for each method and conversely, P/C count-ratios and PI decreased. CONCLUSIONS Different approaches used to determine pulmonary regions of interest and quantify aerosol deposition produce different results. Our research highlights a genuine need for a consensus to standardize the methodology to facilitate data comparison between laboratories on aerosol deposition.
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Affiliation(s)
- Martyn F Biddiscombe
- Nuclear Medicine Department, Royal Brompton Hospital, Sydney Street, London, United Kingdom
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45
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Smith JH, Brooks P, Johnson S, Tompkins SM, Custer KM, Haas DL, Mair R, Papania M, Tripp RA. Aerosol vaccination induces robust protective immunity to homologous and heterologous influenza infection in mice. Vaccine 2011; 29:2568-75. [PMID: 21300100 PMCID: PMC3076080 DOI: 10.1016/j.vaccine.2011.01.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/18/2011] [Accepted: 01/21/2011] [Indexed: 12/17/2022]
Abstract
Live-attenuated influenza vaccine (LAIV) delivered by large droplet intranasal spray is efficacious against infection. However, many of the large droplets are trapped in the external nares and do not reach the target nasal airway tissues. Smaller droplets might provide better distribution yielding similar protection with lower doses. We evaluated 20 and 30 μm aerosol delivery of influenza virus in mice. A 15s aerosol exposure optimally protected against homologous and heterologous influenza infection and induced a robust immune response. These results demonstrate the feasibility of nasal vaccination using aerosolized particles, providing a strategy to improve vaccine efficacy and delivery.
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Affiliation(s)
- Jennifer Humberd Smith
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
| | - Paula Brooks
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
| | - Scott Johnson
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
| | - S. Mark Tompkins
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
| | - Koren M. Custer
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
| | - Debra L. Haas
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
| | - Raydel Mair
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC)*, Atlanta, GA 30333
| | - Mark Papania
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC)*, Atlanta, GA 30333
| | - Ralph A. Tripp
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA 30602
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VanderWeele TJ. Controlled direct and mediated effects: definition, identification and bounds. Scand Stat Theory Appl 2010; 38:551-563. [PMID: 25309023 DOI: 10.1111/j.1467-9469.2010.00722.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Results are given which provide bounds for controlled direct effects when the no-unmeasured-confounding assumptions required for the identification of these effects do not hold. Previous results concerning bounds for controlled direct effects rely on monotonicity relationships between the treatment, mediator and the outcome themselves; the results presented in this paper instead assume that monotonicity relationships hold between the unmeasured confounding variable or variables and the treatment, mediator and outcome. Whereas prior results give bounds that contain the null hypothesis of no direct effect, the results presented here will in many instances yield bounds that do not contain the null hypothesis of no direct effect. For contexts in which a set of variables intercepts all paths between a treatment and an outcome, it is possible to provide a definition for a controlled mediated effect. We discuss the identification of these controlled mediated effects; the bounds for controlled direct effects are applicable also to controlled mediated effects. An example is given to illustrate how the results in the paper can be used to draw inferences about direct and mediated effects in the presence of unmeasured confounding variables.
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Affiliation(s)
- Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, 02115,
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Fleming J, Conway J, Majoral C, Tossici-Bolt L, Katz I, Caillibotte G, Perchet D, Pichelin M, Muellinger B, Martonen T, Kroneberg P, Apiou-Sbirlea G. The use of combined single photon emission computed tomography and X-ray computed tomography to assess the fate of inhaled aerosol. J Aerosol Med Pulm Drug Deliv 2010; 24:49-60. [PMID: 21166585 DOI: 10.1089/jamp.2010.0843] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gamma camera imaging is widely used to assess pulmonary aerosol deposition. Conventional planar imaging provides limited information on its regional distribution. In this study, single photon emission computed tomography (SPECT) was used to describe deposition in three dimensions (3D) and combined with X-ray computed tomography (CT) to relate this to lung anatomy. Its performance was compared to planar imaging. METHODS Ten SPECT/CT studies were performed on five healthy subjects following carefully controlled inhalation of radioaerosol from a nebulizer, using a variety of inhalation regimes. The 3D spatial distribution was assessed using a central-to-peripheral ratio (C/P) normalized to lung volume and for the right lung was compared to planar C/P analysis. The deposition by airway generation was calculated for each lung and the conducting airways deposition fraction compared to 24-h clearance. RESULTS The 3D normalized C/P ratio correlated more closely with 24-h clearance than the 2D ratio for the right lung [coefficient of variation (COV), 9% compared to 15% p < 0.05]. Analysis of regional distribution was possible for both lungs in 3D but not in 2D due to overlap of the stomach on the left lung. The mean conducting airways deposition fraction from SPECT for both lungs was not significantly different from 24-h clearance (COV 18%). Both spatial and generational measures of central deposition were significantly higher for the left than for the right lung. CONCLUSIONS Combined SPECT/CT enabled improved analysis of aerosol deposition from gamma camera imaging compared to planar imaging. 3D radionuclide imaging combined with anatomical information from CT and computer analysis is a useful approach for applications requiring regional information on deposition.
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Affiliation(s)
- John Fleming
- Department of Medical Physics and Bioengineering, Southampton University Hospitals, NHS Trust, Southampton, United Kingdom.
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Zeman KL, Wu J, Bennett WD. Targeting aerosolized drugs to the conducting airways using very large particles and extremely slow inhalations. J Aerosol Med Pulm Drug Deliv 2010; 23:363-9. [PMID: 20863250 DOI: 10.1089/jamp.2008.0711] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The site of deposition in the respiratory tract for aerosolized, inhaled therapeutic drugs depends on both the particles' aerodynamic size and the patient's breathing pattern. METHODS In 21 healthy subjects with normal lung function, we evaluated an extremely slow inhalation of a large 9.5-μm MMAD particle aerosol (ESI-9) for its ability to enhance the delivery of radiolabeled particles ((99m)Tc-labeled sulfur colloid) to the conducting airways. The regional deposition of the large particles (modified Pari-Boy jet nebulizer), inhaled at the extremely low rate of 0.080 Lps for 10 sec, was compared to the deposition of 5-μm MMAD particles inhaled during cyclic resting tidal breathing (TVB-5-) (mean 0.44 L and 0.46 Lps). Gamma scintigraphy gave an estimate of conducting airway deposition (% CAD) as a fraction of all deposited particles by multiplying the percent of activity in both lungs immediately postdeposition relative to the total deposition (i.e., lungs + mouth + esophagus + stomach) times the percent of activity cleared from the lungs over 24 h. RESULTS % CAD for healthy subjects for the ESI-9 and TVB-5 maneuvers was 35% (±8%) and 27% (±11%), respectively, p = 0.004). The amount deposited within the oropharynx was 26% (±7%) and 37% (±11%), respectively, p < 0.001. CONCLUSIONS Higher therapeutic value of a medication delivered to the conducting airways where the primary defect is associated with many diseases, and with fewer losses to the extrathoracic surfaces, may be obtained by using an "extremely slow inhalation and large particle" routine when compared to a normal tidal volume breathing associated with typical nebulizers.
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Affiliation(s)
- Kirby L Zeman
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Goetz SM, Dahmani C, Rudolph C, Weyh T. First Theoretic Analysis of Magnetic Drug Targeting in the Lung. IEEE Trans Biomed Eng 2010; 57:2115-21. [DOI: 10.1109/tbme.2010.2051032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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50
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Yang YT, Chen CT, Yang JC, Tsai T. Spray-dried microparticles containing polymeric micelles encapsulating hematoporphyrin. AAPS JOURNAL 2010; 12:138-46. [PMID: 20101530 DOI: 10.1208/s12248-009-9172-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/22/2009] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to examine the properties of a new pulmonary delivery platform of microparticles containing micelles in which a therapeutic photosensitizing drug, hematoporphyrin (Hp), was encapsulated. Different poloxamers were used to form micellar Hp, and one of these, Pluronic L122-Hp, was subsequently incorporated into lactose microparticles by spray-drying. Spectral and morphological analyses were performed on both micellar Hp, and lactose microparticles containing micellar Hp (lactose-micellar Hp) before and after dissolution of the microparticles in water. Photodynamic activity of the various Hp samples were evaluated in human lung epithelial carcinoma A549 cells using a light-emitting diode (LED) device at a wavelength of 630 +/- 5 nm. No significant difference was observed between micellar Hp and lactose-micellar Hp regarding the generation of singlet oxygen. The mean particle size of the microparticles was 2.3 +/- 0.7 microm which is within the size range for potential lung delivery. The cellular uptake of micellar Hp and lactose-micellar Hp measured on A549 cells was at least twofold higher than those obtained with the Hp at equivalent concentrations. Micellar Hp exhibited higher cytotoxicity than Hp due to reduced formation of Hp aggregates and increased cellar uptake. The spectral properties as well as the photodynamic activity of the micellar Hp was retained when formulated into microparticles by spray-drying. Microparticles containing micelles have the potential for delivering micelle-encapsulated hydrophobic drugs in targeted therapy of pulmonary diseases.
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Affiliation(s)
- Yu-Tsai Yang
- School of Dentistry, Taipei Medical University, Taipei 110, Taiwan, China
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