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Shao J, Talton J, Wang Y, Winner L, Hochhaus G. Quantitative Assessment of Pulmonary Targeting of Inhaled Corticosteroids Using Ex Vivo Receptor Binding Studies. AAPS JOURNAL 2020; 22:39. [PMID: 32002694 DOI: 10.1208/s12248-019-0404-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022]
Abstract
The goal of locally acting inhaled corticosteroids is to achieve distinct pulmonary effects with reduced systemic side effects. The present work using an ex vivo receptor binding model in rats was interested in assessing pulmonary targeting for several commercially available corticosteroids by monitoring receptor occupancies in the lung and systemic organs (liver, kidney, spleen, and brain) after intravenous (IV) injection or intratracheal (IT) instillation of a dry powder administration at a dose of 100 μg/kg. Pulmonary targeting, defined as the difference in cumulative receptor occupancies (AUCE) between the lung and kidney after pulmonary delivery, differed across the investigated corticosteroids (ΔAUCE range, 33 ± 46 to 143 ± 52% *h) with the highest degree found for corticosteroids with high systemic clearance and pronounced lipophilicity (presumably allowing a long pulmonary residence time). Additionally, this study demonstrated differences in the receptor occupancies across systemic organs. Using kidney receptor occupancies as the comparator, liver receptor occupancies were reduced (ΔAUCE range: - 157 ± 43 to 178 ± 42% *h) after IV and IT administration for corticosteroids with high intrinsic clearance, while they were increased for corticosteroid prodrugs due to hepatic activation. Spleen receptor occupancies were increased after IT (ΔAUCE range: 33 ± 35 to 135 ± 28% *h), but not after IV administration. This was especially true for slowly dissolving drugs. Reduced brain uptake was also observed for ciclesonide (CIC) and des-ciclesonide (desCIC), two compounds previously not investigated. In summary, ex vivo receptor binding studies represent a powerful tool to assess the fate of ICSs.
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Affiliation(s)
- Jie Shao
- Department of Pharmaceutics, JHMHC, P3-33, College of Pharmacy, University of Florida, P.O. Box 100494, Gainesville, FL, 32610, USA
| | | | - Yaning Wang
- Department of Pharmaceutics, JHMHC, P3-33, College of Pharmacy, University of Florida, P.O. Box 100494, Gainesville, FL, 32610, USA
| | - Lawrence Winner
- Department of Statistics, University of Florida, Gainesville, FL, USA
| | - Guenther Hochhaus
- Department of Pharmaceutics, JHMHC, P3-33, College of Pharmacy, University of Florida, P.O. Box 100494, Gainesville, FL, 32610, USA.
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2
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Matera MG, Rinaldi B, Calzetta L, Rogliani P, Cazzola M. Pharmacokinetics and pharmacodynamics of inhaled corticosteroids for asthma treatment. Pulm Pharmacol Ther 2019; 58:101828. [PMID: 31349002 DOI: 10.1016/j.pupt.2019.101828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
The differences in the pharmacokinetic (PK) characteristics of inhaled corticosteroids (ICSs) critically influence the profile of each of them, but also the significant differences in glucocorticoid receptor selectivity, potency, and physicochemical properties are critical in defining the pharmacodynamic (PD) profile of an ICS. The PK and PD properties of ICSs used in asthma and the importance of their interrelationship have been reviewed. The differences among the ICSs in PK and PD must be considered when an ICS should be prescribed to an asthmatic patient because a better understanding of the PK/PD interrelationship of ICSs could be important to better fit with the between-patient variability and within-patient repeatability in the response to ICSs that often complicate the therapeutic approach to the asthmatic patient. The role of the device in influencing the PK profile of an ICS must be always considered because it is crucial. Also patient-related factors and disease severity affect pulmonary deposition of ICS.
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Affiliation(s)
- Maria Gabriella Matera
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Naples, Italy
| | - Barbara Rinaldi
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Naples, Italy
| | - Luigino Calzetta
- University of Rome "Tor Vergata", Department of Experimental Medicine, Rome, Italy
| | - Paola Rogliani
- University of Rome "Tor Vergata", Department of Experimental Medicine, Rome, Italy
| | - Mario Cazzola
- University of Rome "Tor Vergata", Department of Experimental Medicine, Rome, Italy.
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3
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Zaidi S, Chen MJ, Lee DT, Neubart E, Ewing P, Miller-Larsson A, Hochhaus G. Fetal Concentrations of Budesonide and Fluticasone Propionate: a Study in Mice. AAPS JOURNAL 2019; 21:53. [PMID: 30993489 DOI: 10.1208/s12248-019-0313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 02/27/2019] [Indexed: 01/01/2023]
Abstract
The study goal was to evaluate the transplacental transfer of two corticosteroids, budesonide (BUD) and fluticasone propionate (FP), in pregnant mice and investigate whether P-glycoprotein (P-gp) might be involved in reducing BUD transplacental transfer. Pregnant mice (N = 18) received intravenously either low (104.9 μg/kg) or high (1049 μg/kg) dose of [3H]-BUD or a high dose of [3H]-FP (1590 μg/kg). In a separate experiment, pregnant mice (N = 12) received subcutaneously either the P-gp inhibitor zosuquidar (20 mg/kg) or vehicle, followed by an intravenous infusion of [3H]-BUD (104.9 μg/kg). Total and free (protein unbound) corticosteroid concentrations were determined in plasma, brain, fetus, placenta, kidney, and liver. The ratios of free BUD concentrations in fetus versus plasma K(fetus, plasma, u, u) 0.42 ± 0.17 (mean ± SD) for low-dose and 0.38 ± 0.18 for high-dose BUD were significantly different from K = 1 (P < 0.05), contrary to 0.87 ± 0.25 for FP, which was moreover significantly higher than that for matching high-dose BUD (P < 0.01). The BUD brain/plasma ratio was also significantly smaller than K = 1, while these ratios for other tissues were close to 1. In the presence of the P-gp inhibitor, K(fetus, plasma, u, u) for BUD (0.59 ± 0.16) was significantly increased over vehicle treatment (0.31 ± 0.10; P < 0.01). This is the first in vivo study demonstrating that transplacental transfer of BUD is significantly lower than FP's transfer and that placental P-gp may be involved in reducing the fetal exposure to BUD. The study provides a mechanistic rationale for BUD's use in pregnancy.
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Affiliation(s)
- Syedsaoud Zaidi
- Departments of Pharmaceutics, JHMHC, P3-33, University of Florida, 100494, Gainesville, Florida, 32610, USA
| | - Mong-Jen Chen
- Departments of Pharmaceutics, JHMHC, P3-33, University of Florida, 100494, Gainesville, Florida, 32610, USA
| | - Daniel T Lee
- Departments of Pharmaceutics, JHMHC, P3-33, University of Florida, 100494, Gainesville, Florida, 32610, USA
| | - Elsa Neubart
- Departments of Pharmaceutics, JHMHC, P3-33, University of Florida, 100494, Gainesville, Florida, 32610, USA
| | - Pär Ewing
- AstraZeneca Gothenburg, 431 83, Mölndal, Sweden
| | | | - Günther Hochhaus
- Departments of Pharmaceutics, JHMHC, P3-33, University of Florida, 100494, Gainesville, Florida, 32610, USA.
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4
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Hemmerling M, Nilsson S, Edman K, Eirefelt S, Russell W, Hendrickx R, Johnsson E, Kärrman Mårdh C, Berger M, Rehwinkel H, Abrahamsson A, Dahmén J, Eriksson AR, Gabos B, Henriksson K, Hossain N, Ivanova S, Jansson AH, Jensen TJ, Jerre A, Johansson H, Klingstedt T, Lepistö M, Lindsjö M, Mile I, Nikitidis G, Steele J, Tehler U, Wissler L, Hansson T. Selective Nonsteroidal Glucocorticoid Receptor Modulators for the Inhaled Treatment of Pulmonary Diseases. J Med Chem 2017; 60:8591-8605. [PMID: 28937774 DOI: 10.1021/acs.jmedchem.7b01215] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A class of potent, nonsteroidal, selective indazole ether-based glucocorticoid receptor modulators (SGRMs) was developed for the inhaled treatment of respiratory diseases. Starting from an orally available compound with demonstrated anti-inflammatory activity in rat, a soft-drug strategy was implemented to ensure rapid elimination of drug candidates to minimize systemic GR activation. The first clinical candidate 1b (AZD5423) displayed a potent inhibition of lung edema in a rat model of allergic airway inflammation following dry powder inhalation combined with a moderate systemic GR-effect, assessed as thymic involution. Further optimization of inhaled drug properties provided a second, equally potent, candidate, 15m (AZD7594), that demonstrated an improved therapeutic ratio over the benchmark inhaled corticosteroid 3 (fluticasone propionate) and prolonged the inhibition of lung edema, indicating potential for once-daily treatment.
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Affiliation(s)
- Martin Hemmerling
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | | | - Karl Edman
- Discovery Sciences, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Stefan Eirefelt
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | - Wayne Russell
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | - Ramon Hendrickx
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Eskil Johnsson
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Carina Kärrman Mårdh
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Markus Berger
- Medicinal Chemistry Berlin, Drug Discovery, Pharmaceuticals, Bayer AG , Berlin 13353, Germany
| | - Hartmut Rehwinkel
- Medicinal Chemistry Berlin, Drug Discovery, Pharmaceuticals, Bayer AG , Berlin 13353, Germany
| | - Anna Abrahamsson
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Jan Dahmén
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | - Anders R Eriksson
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Balint Gabos
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | | | - Nafizal Hossain
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | | | | | - Tina J Jensen
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Anders Jerre
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | | | | | - Matti Lepistö
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Martin Lindsjö
- Pharmaceutical Sciences, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Irene Mile
- AstraZeneca R&D Lund , Scheelevägen 1, Lund, SE 22187, Sweden
| | | | - John Steele
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Ulrika Tehler
- Pharmaceutical Sciences, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Lisa Wissler
- Discovery Sciences, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
| | - Thomas Hansson
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca , Pepparedsleden 1, Mölndal, SE 43183, Sweden
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5
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Edsbäcker S. New techniques for studying airway drug pharmacokinetics for asthma therapeutics. Expert Rev Clin Pharmacol 2016; 10:127-130. [PMID: 27915484 DOI: 10.1080/17512433.2017.1268915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Staffan Edsbäcker
- a Dept of Clinical and Experimental Pharmacology, Laboratory Medicines Unit , Lund University , Lund , Sweden
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6
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Caniga M, Cabal A, Mehta K, Ross DS, Gil MA, Woodhouse JD, Eckman J, Naber JR, Callahan MK, Goncalves L, Hill SE, Mcleod RL, McIntosh F, Freke MC, Visser SA, Johnson N, Salmon M, Cicmil M. Preclinical Experimental and Mathematical Approaches for Assessing Effective Doses of Inhaled Drugs, Using Mometasone to Support Human Dose Predictions. J Aerosol Med Pulm Drug Deliv 2016; 29:362-77. [PMID: 26859446 DOI: 10.1089/jamp.2015.1253] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Michael Caniga
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Antonio Cabal
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Khamir Mehta
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - David S. Ross
- Center for Applied and Computational Mathematics, Rochester Institute of Technology, Rochester, New York
| | - Malgorzata A. Gil
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Janice D. Woodhouse
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Joseph Eckman
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - John R. Naber
- Department of Discovery Pharmaceutical Sciences, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Marissa K. Callahan
- Department of Discovery Pharmaceutical Sciences, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Luciano Goncalves
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Susan E. Hill
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Robbie L. Mcleod
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Fraser McIntosh
- Discovery Research Services Charles River Laboratories, Senneville, Quebec, Canada
| | - Mark C. Freke
- Discovery Research Services Charles River Laboratories, Senneville, Quebec, Canada
| | - Sandra A.G. Visser
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Neil Johnson
- Department of Safety Assessment and Laboratory Animal Sciences, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Michael Salmon
- Department of Biology Discovery, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Milenko Cicmil
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
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7
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Bäckström E, Lundqvist A, Boger E, Svanberg P, Ewing P, Hammarlund-Udenaes M, Fridén M. Development of a Novel Lung Slice Methodology for Profiling of Inhaled Compounds. J Pharm Sci 2016; 105:838-845. [DOI: 10.1002/jps.24575] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 01/11/2023]
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8
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Al-Numani D, Colucci P, Ducharme MP. Rethinking bioequivalence and equivalence requirements of orally inhaled drug products. Asian J Pharm Sci 2015. [DOI: 10.1016/j.ajps.2015.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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9
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The lungs in acute mountain sickness: victim, perpetrator, or both? Am J Med 2014; 127:899-900. [PMID: 24950487 DOI: 10.1016/j.amjmed.2014.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/23/2022]
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10
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Weber B, Hochhaus G. A pharmacokinetic simulation tool for inhaled corticosteroids. AAPS JOURNAL 2012; 15:159-71. [PMID: 23139018 DOI: 10.1208/s12248-012-9420-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/01/2012] [Indexed: 11/30/2022]
Abstract
The pharmacokinetic (PK) behavior of inhaled drugs is more complicated than that of other forms of administration. In particular, the effects of certain physiological (mucociliary clearance and differences in membrane properties in central and peripheral (C/P) areas of the lung), formulation (as it relates to drug deposition and particle dissolution rate), and patient-related factors (lung function; effects on C/P deposition ratio) affect the systemic PKs of inhaled drugs. The objectives of this project were (1) to describe a compartmental model that adequately describes the fate of inhaled corticosteroids (ICS) after administration while incorporating variability between and within subjects and (2) based upon the model, to provide a freely available tool for simulation of PK trials after ICS administration. This compartment model allows for mucociliary removal of undissolved particles from the lung, distinguishes between central and peripheral regions of the lung, and models drug entering the systemic circulation via the lung and the gastrointestinal tract. The PK simulation tool is provided as an extension package to the statistical software R ('ICSpkTS'). It allows simulation of PK trials for hypothetical ICS and of four commercially available ICS (budesonide, flunisolide, fluticasone propionate, and triamcinolone acetonide) in a parallel study design. Simulated PK data and parameters agreed well with literature data for all four ICS. The ICSpkTS package is especially suitable to explore the effect of changes in model parameters on PK behavior and can be easily adjusted for other inhaled drugs.
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Affiliation(s)
- Benjamin Weber
- Department of Pharmaceutics, College of Pharmacy, Center of Pharmacometrics and Systems Pharmacology, University of Florida, 1600 SW Archer Road, P3-33, Gainesville, FL 32610, USA
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11
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Mantell S, Jones R, Trevethick M. Design and application of locally delivered agonists of the adenosine A(2A) receptor. Expert Rev Clin Pharmacol 2012; 3:55-72. [PMID: 22111533 DOI: 10.1586/ecp.09.57] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The broad spectrum anti-inflammatory actions of adenosine A(2A) receptor agonists are well described. The wide distribution of this receptor, however, suggests that the therapeutic potential of these agents is likely to reside in topical treatments to avoid systemic side effects associated with oral administration. Adenosine A(2A) receptor agonists have been assessed as topical agents: GW328267X (GSK; allergic rhinitis and asthma), UK-432097 (Pfizer; chronic obstructive pulmonary disease [COPD]) and Sonedenoson (MRE0094, King Pharmaceuticals; wound healing). All trials failed to achieve effects against the desired clinical end points. This broad-based review will discuss general principles of chemical design of topically applied agents and potential therapeutic topical applications of current adenosine A(2A) receptor agonists. Potential factors contributing to the lack of efficacy in the above clinical trials will be discussed together with design principles, which may influence efficacy in disease states. Our analysis suggests that adenosine A(2A) receptor agonists have a wide therapeutic potential as topical agents in a wide variety of diseases, such as neutrophil-dependent lung diseases (acute lung injury, exacerbations in asthma and COPD), allergic rhinitis, glaucoma and wound repair. Factors that will influence topical activity include formulation, tissue retention, compound potency, receptor kinetics and pharmacokinetics.
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Affiliation(s)
- Simon Mantell
- PC 675, Pfizer Global R&D, Sandwich, Kent, CT13 9NJ, UK.
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Forbes B, Asgharian B, Dailey LA, Ferguson D, Gerde P, Gumbleton M, Gustavsson L, Hardy C, Hassall D, Jones R, Lock R, Maas J, McGovern T, Pitcairn GR, Somers G, Wolff RK. Challenges in inhaled product development and opportunities for open innovation. Adv Drug Deliv Rev 2011; 63:69-87. [PMID: 21144875 DOI: 10.1016/j.addr.2010.11.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/19/2010] [Accepted: 11/25/2010] [Indexed: 11/26/2022]
Abstract
Dosimetry, safety and the efficacy of drugs in the lungs are critical factors in the development of inhaled medicines. This article considers the challenges in each of these areas with reference to current industry practices for developing inhaled products, and suggests collaborative scientific approaches to address these challenges. The portfolio of molecules requiring delivery by inhalation has expanded rapidly to include novel drugs for lung disease, combination therapies, biopharmaceuticals and candidates for systemic delivery via the lung. For these drugs to be developed as inhaled medicines, a better understanding of their fate in the lungs and how this might be modified is required. Harmonized approaches based on 'best practice' are advocated for dosimetry and safety studies; this would provide coherent data to help product developers and regulatory agencies differentiate new inhaled drug products. To date, there are limited reports describing full temporal relationships between pharmacokinetic (PK) and pharmacodynamic (PD) measurements. A better understanding of pulmonary PK and PK/PD relationships would help mitigate the risk of not engaging successfully or persistently with the drug target as well as identifying the potential for drug accumulation in the lung or excessive systemic exposure. Recommendations are made for (i) better industry-academia-regulatory co-operation, (ii) sharing of pre-competitive data, and (iii) open innovation through collaborative research in key topics such as lung deposition, drug solubility and dissolution in lung fluid, adaptive responses in safety studies, biomarker development and validation, the role of transporters in pulmonary drug disposition, target localisation within the lung and the determinants of local efficacy following inhaled drug administration.
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