1
|
Alegrete N, Sousa SR, Peleteiro B, Monteiro FJ, Gutierres M. Local Antibiotic Delivery Ceramic Bone Substitutes for the Treatment of Infected Bone Cavities and Bone Regeneration: A Systematic Review on What We Have Learned from Animal Models. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2387. [PMID: 36984267 PMCID: PMC10056339 DOI: 10.3390/ma16062387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
AIMS the focus of this study is to evaluate if the combination of an antibiotic with a ceramic biomaterial is effective in treating osteomyelitis in an infected animal model and to define which model and protocol are best suited for in vivo experiments of local bone infection treatment. METHODS a systematic review was carried out based on PRISMA statement guidelines. A PubMed search was conducted to find original papers on animal models of bone infections using local antibiotic delivery systems with the characteristics of bone substitutes. Articles without a control group, differing from the experimental group only by the addition of antibiotics to the bone substitute, were excluded. RESULTS a total of 1185 records were retrieved, and after a three-step selection, 34 papers were included. Six manuscripts studied the effect of antibiotic-loaded biomaterials on bone infection prevention. Five articles studied infection in the presence of foreign bodies. In all but one, the combination of an antibiotic with bioceramic bone substitutes tended to prevent or cure bone infection while promoting biomaterial osteointegration. CONCLUSIONS this systematic review shows that the combination of antibiotics with bioceramic bone substitutes may be appropriate to treat bone infection when applied locally. The variability of the animal models, time to develop an infection, antibiotic used, way of carrying and releasing antibiotics, type of ceramic material, and endpoints limits the conclusions on the ideal therapy, enhancing the need for consistent models and guidelines to develop an adequate combination of material and antimicrobial agent leading to an effective human application.
Collapse
Affiliation(s)
- Nuno Alegrete
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- FMUP-Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Susana R. Sousa
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- ISEP-Instituto Superior de Engenharia do Porto, IPP - Instituto Politécnico do Porto, R. Dr. António Bernardino de Almeida 431, 4200-072 Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- ITR-Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Fernando J. Monteiro
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- FEUP-Faculdade de Engenharia, Universidade do Porto, R. Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Manuel Gutierres
- FMUP-Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- CHUSJ-Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| |
Collapse
|
2
|
Tobin E, Brenner S. Nanotechnology Fundamentals Applied to Clinical Infectious Diseases and Public Health. Open Forum Infect Dis 2021; 8:ofab583. [PMID: 34988245 PMCID: PMC8694202 DOI: 10.1093/ofid/ofab583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022] Open
Abstract
Nanotechnology involves the discovery and fabrication of nanoscale materials possessing unique physicochemical properties that are being employed in industry and medicine. Infectious Diseases clinicians and public health scientists utilize nanotechnology applications to diagnose, treat, and prevent infectious diseases. However, fundamental principles of nanotechnology are often presented in technical formats that presuppose an advanced knowledge of chemistry, physics, and engineering, thereby limiting the clinician’s grasp of the underlying science. While nanoscience is technically complex, it need not be out of reach of the clinical practitioner. The aim of this review is to introduce fundamental principles of nanotechnology in an accessible format, describe examples of current clinical infectious diseases and public health applications, and provide a foundation that will aid understanding of and appreciation for this burgeoning and important field of science.
Collapse
Affiliation(s)
- Ellis Tobin
- College of Nanoscale Science and Engineering, State University of New York Polytechnic Institute, Albany, New York, USA
| | - Sara Brenner
- Office of In Vitro Diagnostics and Radiological Health, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
3
|
Liposomes produced by reverse phase evaporation: in vitro and in vivo efficacy of diminazene aceturate against Trypanosoma evansi. Parasitology 2014; 141:761-9. [PMID: 24476993 DOI: 10.1017/s0031182013002114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study aimed to develop and test the in vitro and in vivo effectiveness of diminazene aceturate encapsulated into liposomes (L-DMZ) on Trypanosoma evansi. To validate the in vitro tests with L-DMZ, the efficacy of a commercial formulation of diminazene aceturate (C-DMZ) was also assessed. The tests were carried out in culture medium for T. evansi, at concentrations of 0.25, 0.5, 1, 2 and 3 μg mL(-1) of L-DMZ and C-DMZ. A dose-dependent effect was observed for both formulations (L-DMZ and C-DMZ), with the highest dose-dependent mortality of trypomastigotes being observed at 1 and 3 h after the onset of tests with L-DMZ. The results of in vivo tests showed the same effects in the animals treated with L-DMZ and C-DMZ in single doses of 3.5 mg kg(-1) and for 5 consecutive days (3.5 mg kg(-1) day(-1)). It was possible to conclude that T. evansi showed greater in vitro susceptibility to L-DMZ when compared with C-DMZ. In vivo tests suggest that treatment with the L-DMZ and C-DMZ showed similar efficacy in vivo. The potential of the formulation developed in this study was clearly demonstrated, as it increased the efficacy of the treatment against trypanosomosis, but more studies are needed to increase the effectiveness in vivo.
Collapse
|
4
|
Zhaorigetu S, Rodriguez-Aguayo C, Sood AK, Lopez-Berestein G, Walton BL. Delivery of negatively charged liposomes into the atherosclerotic plaque of apolipoprotein E-deficient mouse aortic tissue. J Liposome Res 2014; 24:182-90. [PMID: 24443972 DOI: 10.3109/08982104.2013.863208] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Liposomes have been used to diagnose and treat cancer and, to a lesser extent, cardiovascular disease. We previously showed the uptake of anionic liposomes into the atheromas of Watanabe heritable hyperlipidemic rabbits within lipid pools. However, the cellular distribution of anionic liposomes in atherosclerotic plaque remains undescribed. In addition, how anionic liposomes are absorbed into atherosclerotic plaque is unclear. We investigated the uptake and distribution of anionic liposomes in atherosclerotic plaque in aortic tissues from apolipoprotein E-deficient (ApoE(-/-)) mice. To facilitate the tracking of liposomes, we used liposomes containing fluorescently labeled non-silencing small interfering RNA. Confocal microscopy analysis showed the uptake of anionic liposomes into atherosclerotic plaque and colocalization with macrophages. Transmission electron microscopy analysis revealed anionic liposomal accumulation in macrophages. To investigate how anionic liposomes cross the local endothelial barrier, we examined the role of clathrin-mediated endocytosis in human coronary artery endothelial cells (HCAECs) treated with or without the inflammatory cytokine tumor necrosis factor (TNF)-α. Pretreatment with amantadine, an inhibitor of clathrin-mediated endocytosis, significantly decreased liposomal uptake in HCAECs treated with or without TNF-α by 77% and 46%, respectively. Immunoblot analysis showed that endogenous clathrin expression was significantly increased in HCAECs stimulated with TNF-α but was inhibited by amantadine. These studies indicated that clathrin-mediated endocytosis is partly responsible for the uptake of liposomes by endothelial cells. Our results suggest that anionic liposomes target macrophage-rich areas of vulnerable plaque in ApoE(-)(/)(-) mice; this finding may lead to the development of novel diagnostic and therapeutic strategies for treating vulnerable plaque in humans.
Collapse
Affiliation(s)
- Siqin Zhaorigetu
- Department of Atherosclerosis Research, Texas Heart Institute , Houston, TX , USA
| | | | | | | | | |
Collapse
|
5
|
Cottenye N, Cui ZK, Wilkinson KJ, Barbeau J, Lafleur M. Interactions between non-phospholipid liposomes containing cetylpyridinium chloride and biofilms of Streptococcus mutans: modulation of the adhesion and of the biodistribution. BIOFOULING 2013; 29:817-827. [PMID: 23826726 DOI: 10.1080/08927014.2013.807505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cetylpyridinium chloride (CPC) is a surfactant that binds strongly to bacteria and bacterial biofilms. In this study, fluorescence-based techniques were used to determine the penetration and adhesion of CPC when it was introduced in liposomes. In spite of a reduced adhesion as compared to pure CPC micelles, CPC-containing liposomes adhered significantly to the biofilms of Streptococcus mutans. In contrast, no binding was observed for liposomes that were composed of phosphatidylcholine-cholesterol. The influence of the charge of the liposome on its adhesion to biofilms was studied using cholesterol (Chol) and cholesterol sulfate (Schol). In spite of similar binding to the biofilms, positively charged CPC/Chol liposomes were located mainly in the core of the biofilm microcolonies, whereas the negatively charged CPC/Schol liposomes were mainly concentrated at their periphery. This effect may be attributed to the different availability of the CPC head group. In summary, this work demonstrates the high potential for tailoring drug nanovectors by modulating sterol selection in order to selectively target and bind biofilms.
Collapse
Affiliation(s)
- Nicolas Cottenye
- Department of Chemistry, Center for Self-Assembled Chemical Structures (CSACS), Université de Montréal, Montréal, QC, Canada
| | | | | | | | | |
Collapse
|
6
|
Gupta V, Gupta N, Shaik IH, Mehvar R, McMurtry IF, Oka M, Nozik-Grayck E, Komatsu M, Ahsan F. Liposomal fasudil, a rho-kinase inhibitor, for prolonged pulmonary preferential vasodilation in pulmonary arterial hypertension. J Control Release 2013; 167:189-99. [PMID: 23353807 DOI: 10.1016/j.jconrel.2013.01.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/11/2013] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
Abstract
Current pharmacological interventions for pulmonary arterial hypertension (PAH) require continuous infusions, multiple inhalations, or oral administration of drugs that act on various pathways involved in the pathogenesis of PAH. However, invasive methods of administration, short duration of action, and lack of pulmonary selectivity result in noncompliance and poor patient outcomes. In this study, we tested the hypothesis that encapsulation of an investigational anti-PAH molecule fasudil (HA-1077), a Rho-kinase inhibitor, into liposomal vesicles results in prolonged vasodilation in distal pulmonary arterioles. Liposomes were prepared by hydration and extrusion method and fasudil was loaded by ammonium sulfate-induced transmembrane electrochemical gradient. Liposomes were then characterized for various physicochemical properties. Optimized formulations were tested for pulmonary absorption and their pharmacological efficacy in a monocrotaline (MCT) induced rat model of PAH. The entrapment efficiency of optimized liposomal fasudil formulations was between 68.1±0.8% and 73.6±2.3%, and the cumulative release at 37°C was 98-99% over a period of 5 days. Compared to intravenous (IV) fasudil, a ~10 fold increase in the terminal plasma half-life was observed when liposomal fasudil was administered as aerosols. The t1/2 of IV fasudil was 0.39±0.12 h. and when given as liposomes via pulmonary route, the t1/2 extended to 4.71±0.72 h. One h after intratracheal instillation of liposomal fasudil, mean pulmonary arterial pressure (MPAP) was reduced by 37.6±5.7% and continued to decrease for about 3 h, suggesting that liposomal formulations produced pulmonary preferential vasodilation in MCT induced PAH rats. Overall, this study established the proof-of-principle that aerosolized liposomal fasudil is a feasible option for a non-invasive, controlled release and pulmonary preferential treatment of PAH.
Collapse
Affiliation(s)
- Vivek Gupta
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, 1300S Coulter, Amarillo, TX-79106, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Annapragada AV, Hoffman E, Divekar A, Karathanasis E, Ghaghada KB. High-resolution CT vascular imaging using blood pool contrast agents. Methodist Debakey Cardiovasc J 2012; 8:18-22. [PMID: 22891106 DOI: 10.14797/mdcj-8-1-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
While the evolution of computed tomography imaging in the last 2 decades has been driven almost exclusively by improvements in the instrumentation and processing algorithms, there have been comparatively modest advances in contrast agent technology.A notable change in the last decade has been the development of blood pool contrast agents based on nanoparticle technology.While not yet ready for clinical use, the stable and uniform opacification provided by these agents in normal vasculature and controlled extravasation in compromised vasculature enables novel techniques for imaging and diagnosis of pathologies. This manuscript presents preclinical examples demonstrating cardiovascular pathologies and tumor characterization by high-resolution computed tomography imaging.
Collapse
Affiliation(s)
- Ananth V Annapragada
- Singleton Department of Pediatric Radiology, Texas Children’s Hospital, Houston, TX, USA
| | | | | | | | | |
Collapse
|
8
|
Chandhok M, Taylor KMG, Craig DQM. Reconstitution of Ambisome injection in one regional health authority. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1994.tb00784.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Ambisome is a lyophilised liposomal formulation of amphotericin B which requires a prolonged and elaborate reconstitution procedure prior to administration by intravenous infusion. In this study a questionnaire survey was used to ascertain the level of usage of Ambisome in hospitals within the North Thames (West) regional health authority, England, and details of the reconstitution procedure employed.
Eight hospitals indicated that they currently had patients being treated with Ambisome or had in the recent past. A number of different guidelines, based on the product's data sheet, were used in the region. Reconstitutions of Ambisome performed in three hospitals during the study period were monitored by the investigator. When possible, samples of the reconstituted product were sized by photon correlation spectroscopy. The observational study suggests that significant deviation from the reconstitution guidelines occurred in practice. However, the sizing data, although indicating that liposome size may increase slightly on storage and be influenced to some extent by the reconstitution procedure, suggest that within limits the final product is not greatly influenced by reconstitution variables.
Collapse
Affiliation(s)
- Mani Chandhok
- Department of Pharmaceutics, School of Pharmacy, University of London, 29–39 Brunswick Square, London WCIN 1AX, England
| | - Kevin M G Taylor
- Department of Pharmaceutics, School of Pharmacy, University of London, 29–39 Brunswick Square, London WCIN 1AX, England
| | - Duncan Q M Craig
- Department of Pharmaceutics, School of Pharmacy, University of London, 29–39 Brunswick Square, London WCIN 1AX, England
| |
Collapse
|
9
|
Walton BL, Leja M, Vickers KC, Estevez-Fernandez M, Sanguino A, Wang E, Clubb FJ, Morrisett J, Lopez-Berestein G. Delivery of negatively charged liposomes into the atheromas of Watanabe heritable hyperlipidemic rabbits. Vasc Med 2010; 15:307-13. [DOI: 10.1177/1358863x10374118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Liposomes have been used as imaging and therapeutic agents in various tissues but only infrequently in the cardiovascular system. We prepared a liposome to target atheromas in a Watanabe heritable hyperlipidemic (WHHL) rabbit model. Liposomes labeled with rhodamine and nanogold were injected intra-arterially into the descending thoracic aortas of WHHL rabbits. The arterial segments of interest were perfusion-fixed and evaluated with immunohistochemistry, light microscopy, and electron microscopy. Deconvolution microscopy showed that rhodamine label was concentrated in the plaque shoulder regions of advanced-stage atheromas; however, rhodamine label was not found in adjacent, non-atherosclerotic aorta. Transmission electron microscopy revealed liposome remnants and the highest concentration of nanogold label in lipid-laden areas of atheromas. Liposomes were concentrated in areas of lipoprotein-associated phospholipase A2 expression. We conclude that modified liposomes can be delivered to the shoulder regions of advanced atheromas in WHHL rabbits and may be useful therapeutically for targeting metabolically active plaque.
Collapse
Affiliation(s)
- Brian L Walton
- Texas Heart Institute at St Luke's Episcopal Hospital, Houston, TX, USA,
| | - Monika Leja
- Section of Cardiology, Department of Medicine, Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Kasey C Vickers
- Section of Atherosclerosis, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Monica Estevez-Fernandez
- Division of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Angela Sanguino
- Division of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Wang
- Department of Cardiovascular Pathology, Texas Heart Institute, Houston, TX, USA
| | - Fred J Clubb
- Department of Cardiovascular Pathology, Texas Heart Institute, Houston, TX, USA
| | - Joel Morrisett
- Section of Atherosclerosis, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Lopez-Berestein
- Division of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
10
|
Gardner DM, Taylor VM, Cedeño DL, Padhee S, Robledo SM, Jones MA, Lash TD, Vélez ID. Association of acenaphthoporphyrins with liposomes for the photodynamic treatment of leishmaniasis. Photochem Photobiol 2010; 86:645-52. [PMID: 20202163 DOI: 10.1111/j.1751-1097.2010.00705.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acenaphthoporphyrins are potential photosensitizers for photodynamic therapy, but their hydrophobicity limits their potential. Liposomes have been widely investigated as delivery vehicles that can transport hydrophobic drugs in biological systems. Here we study the association of acenaphthoporphyrins with liposomes made up of dimyristoyl phosphatidylcholine (DMPC), and to liposomes made up of a mixture of DMPC, cholesterol (Chol) and distearoyl phosphatidylglycerol (DSPG) in a 2:1:0.8 molar ratio to evaluate how liposome composition affects association constants. In liposomes consisting only of DMPC, the smaller monoacenaphthoporphyrin had the largest association constant of 5.5 x 10(4) m(-1) while the larger adj-diacenaphthoporphyrin and opp-diacenaphthoporphyrin (ODP) had smaller association constants at 1.8 x 10(4) and 1.5 x 10(4) m(-1), respectively. The addition of liposomal Chol and DSPG has little effect on the magnitudes of the association constants. Polarization studies show that the acenaphthoporphyrins are driven far into the lipid bilayer to minimize polar-nonpolar interactions. Confocal microscopy confirms that the DMPC liposomes transport the porphyrins into promastigotes of Leishmania tarentolae. The compounds associated with DMPC:Chol:DSPG liposomes are effective in vitro against axenic and intracellular amastigotes of the pathogenic Leishmania panamensis. The effectiveness of the compounds is enhanced upon exposure of cultures to visible light.
Collapse
Affiliation(s)
- Daniel M Gardner
- Department of Chemistry, Illinois State University, Normal, IL, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Hui T, Yongqing X, Tiane Z, Gang L, Yonggang Y, Muyao J, Jun L, Jing D. Treatment of osteomyelitis by liposomal gentamicin-impregnated calcium sulfate. Arch Orthop Trauma Surg 2009; 129:1301-8. [PMID: 19034468 DOI: 10.1007/s00402-008-0782-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Traditional therapy of staphylococcal osteomyelitis is ineffective in producing complete sterilization of infected bones due to the formation of the Staphylococcus aureus biofilms. The aim of this study was to develop a new drug-delivery system of antibiotics for treatment of chronic experimental osteomyelitis. METHODS In the current work, cationic liposomal gentamicin was prepared and impregnated in calcium sulfate (CS), and tested for anti-biofilm activities in vitro and in vivo. RESULTS AND CONCLUSIONS The combination of liposomal gentamicin and CS showed initial burst-release of active liposomal gentamicin and had continuous-release (12 days). Liposomal gentamicin released from CS had the same anti-biofilm activity with the liposomal gentamicin prepared freshly. Meanwhile, both agents were more effective relative to free gentamicin at low drug concentration. Therapeutic trials with antibiotics given intravenously revealed that free gentamicin for 14 days was ineffective in sterilizing bone. Treatment with liposomal gentamicin for 14 days resulted in recovery of 33.3% of treated animals, which was the lower slightly than the result treated with implantation of gentamicin-impregnated CS (66.7%). Complete sterilization of bone tissues on cultures (100% cure) was obtained only in the group of liposomal gentamicin-impregnated CS treated for 14 days. The new drug-delivery system was effective in preventing biofilm infection in a contaminated defect, and it could also be used clinically for bacterial infections in the conditions like plaque formation or in arresting biofilm formation in the implanted devices or dead bone of osteomyelitis.
Collapse
Affiliation(s)
- Tang Hui
- Orthopedic Center, Kunming General Hospital of Chengdu Military Command, Kunming, China
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Kumar C, Himabindu M, Jetty A. Microbial Biosynthesis and Applications of Gentamicin: A Critical Appraisal. Crit Rev Biotechnol 2008; 28:173-212. [DOI: 10.1080/07388550802262197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
13
|
Fresta M, Puglisi G. Association of netilmicin Sulphate to poly(Alkylcyanoacrylate) Nanoparticles: Factors Influencing particle delivery Behaviour. Drug Dev Ind Pharm 2008. [DOI: 10.3109/03639049409050235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Siler-marinkovic S, Mojovic L, Davinic V, Bugarski B. Liposomes as Carriers of Antimicrobial Drugs. Drug Dev Ind Pharm 2008. [DOI: 10.3109/03639049709148497] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
15
|
Sammour OA, Hassan HM. Enhancement of the antibacterial activity of ampicillin by liposome encapsulation. Drug Deliv 2008. [DOI: 10.3109/10717549609029460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Koo EWY, Edelman ER. Cellular effects of antisensec-mycoligodeoxynucleotides are delivery dependent. Drug Deliv 2008; 3:149-54. [DOI: 10.3109/10717549609029444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Richards EM, Apperley JF, Marcus RE. Successful use of liposome encapsulated amphotericin to treat invasive aspergillosis following failure of conventional amphotericin. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 14:127-30. [PMID: 1633682 DOI: 10.1111/j.1365-2257.1992.tb01069.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We describe a case of proven invasive pulmonary aspergillosis in a neutropenic patient in whom disease progression occurred during treatment with conventional amphotericin B despite neutrophil recovery. Treatment with liposomal encapsulated amphotericin B resulted in clinical and radiological improvement and the clearance of aspergillus spores from the sputum.
Collapse
Affiliation(s)
- E M Richards
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | | |
Collapse
|
18
|
Junghanns JU, Buttle I, Müller RH, Araújo IB, Silva AKA, Egito EST, Damasceno BPGL. SolEmuls technology: a way to overcome the drawback of parenteral administration of insoluble drugs. Pharm Dev Technol 2008; 12:437-45. [PMID: 17963143 DOI: 10.1080/10837450701555885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this article, a nanosuspension of AmB was prepared and mixed with the preformed parenteral emulsion Lipofundin and subjected to high-pressure homogenization (SolEmuls technology). Characterization was performed by photon correlation spectroscopy (PCS), laser diffractometry (LD), and zeta potential measurements. Drug incorporation was studied by using light microscopy. The produced emulsions were further investigated by comparing them with the commercially available Fungizone in regard to antifungal efficiency and toxicity. Results suggest that through the SolEmuls process the AmB forms a reservoir, out of which it is released in such a manner that it is more efficient and less toxic than Fungizone.
Collapse
Affiliation(s)
- J-U Junghanns
- Free University of Berlin, Department of Pharmaceutical Technology, Biotechnology and Quality Management, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
19
|
Lincopan N, Borelli P, Fock R, Mamizuka EM, Carmona-Ribeiro AM. Toxicity of an effective amphotericin B formulation at high cationic lipid to drug molar ratio. ACTA ACUST UNITED AC 2006; 58:175-83. [PMID: 16982179 DOI: 10.1016/j.etp.2006.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 07/05/2006] [Indexed: 11/26/2022]
Abstract
Therapeutic activity of an effective and less nephrotoxic amphotericin B (AMB) formulation with dioctadecyldimethylammonium bromide (DODAB) bilayer fragments (named DODAB/AMB) inspired this toxicity survey in mice. At low drug to lipid molar ratios, hepatotoxicity, spleen damage and blood changes in comparison to DOC/AMB (sodium desoxycholate/amphotericin B, Fungizone) are evaluated ultimately showing toxic effects associated to DODAB only. Swiss Webster female mice were given DODAB, DODAB/AMB or DOC/AMB intraperitonially (ip) for 10 consecutive days (0.4 mg/kg/day AMB; 80 mg/kg/day DODAB) and repeated dose-toxicity was evaluated at the end of the treatment period (on day 11) and after a recovery period of 6 months from biochemical and hematological parameters plus histopathological examination of spleen and liver. Both at day 11 and 180, DODAB in the formulation administered ip causes irreversible changes in spleen such as fibrosis and leukocytes infiltration as a consequence of the administration route. Whereas focal necrosis is induced by DODAB in liver at day 180, DOC/AMB causes more severe multifocal necrosis both at day 11 and day 180. In the kidneys, the novel formulation preserves integrity of tubules and glomeruli in contrast to the serious damage caused by DOC/AMB as shown previously. The majority of the toxic effects observed for the novel formulation were due to the DODAB carrier used at 10mg/mL, i.e., at a rather high concentration and further studies should minimize DODAB dose.
Collapse
Affiliation(s)
- Nilton Lincopan
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, CP 26077, Avenida Lineu Prestes 748 - Butantã, CEP 05513-970 São Paulo, Brazil
| | | | | | | | | |
Collapse
|
20
|
Abstract
Fungal infections and leishmaniasis are an important cause of morbidity and mortality in immunocompromised patients. The macrolide polyene antibiotic amphotericin B (AmB) has long been recognized as a powerful fungicidal and leishmanicidal drug. A conventional intravenous dosage form of AmB, AmB- deoxycholate (Fungizone or D-AmB), is the most effective clinically available for treating fungal and parasitic (leishmaniasis) infections. However, the clinical efficacy of AmB is limited by its adverse effects mainly nephrotoxicity. Efforts to lower the toxicity are based on synthesis of AmB analogues such as AmB esters or preparation of AmB-lipid associations in the forms of liposomal AmB (L-AmB or AmBisome), AmB lipid complex (Abelcet or ABLC), AmB colloidal dispersion (Amphocil or ABCD), and intralipid AmB. These newer formulations are substantially more expensive, but allow patients to receive higher doses for longer periods of time with decreased renal toxicity than conventional AmB. Modifications of liposomal surface in order to avoid RES uptake, thus increased targetability has been attempted. Emulsomes and other nanoparticles are special carrier systems for intracellular localization in macrophage rich organs like liver and spleen. Injectable nano-carriers have important potential applications as in site-specific drug delivery.
Collapse
Affiliation(s)
- Suresh P Vyas
- Drug Delivery Research Laboratory, Department of Pharmaceutical Sciences, Dr Hari Singh Gour University, Sagar (M.P), India.
| | | |
Collapse
|
21
|
Lincopan N, Mamizuka EM, Carmona-Ribeiro AM. Low nephrotoxicity of an effective amphotericin B formulation with cationic bilayer fragments. J Antimicrob Chemother 2005; 55:727-34. [PMID: 15761070 DOI: 10.1093/jac/dki064] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Evaluation of nephrotoxicity of a novel amphotericin B (AMB) formulation with dioctadecyldimethylammonium bromide (DODAB) bilayer fragments (DOD/AMB). METHODS Dose-dependent cytotoxicity of DOD/AMB was evaluated in vitro against cultured kidney epithelial cells in culture. For in vivo experiments, Swiss Webster female mice were injected intraperitoneally for 10 consecutive days with 0.4 mg/kg/day AMB in the form of traditional bile salt desoxycholate (DOC)/AMB or DOD/AMB. Body and spleen weight, and biochemical and histopathological data were obtained at days 11 and 180 after injection. RESULTS Nephrotoxicity of the novel formulation was lower than that of Fungizone (DOC/AMB), which is the traditional AMB formulation using DOC. Dose-dependent cytotoxicity of DOD/AMB was lower than that exhibited by DOC/AMB. At day 11, DODAB and DOD/AMB caused loss of body weight and increase in spleen weight, which were not observed for DOC/AMB, although the changes were reversible and weights returned to control values at day 180. Ten days after injection, biochemical parameters for hepatic and renal function remained unaltered. At day 180, renal cortex histopathology revealed leucocytic infiltration and moderate hydropic degeneration of the renal tubules in the DODAB and DOD/AMB groups, in contrast to more severe lesions observed for the DOC/AMB group such as tubular cystic degeneration and glomerular injury, which were absent for the former groups. CONCLUSIONS The DOD/AMB formulation exhibited differential cytotoxicity and low nephrotoxicity, but there were also important aspects of general toxicity that will require evaluation with full-scale toxicity protocols.
Collapse
Affiliation(s)
- Nilton Lincopan
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, CP 66083, Avenida Lineu Prestes 580-Butantã, CEP 05315-970, São Paulo, Brazil
| | | | | |
Collapse
|
22
|
Kadry AA, Al-Suwayeh SA, Abd-Allah ARA, Bayomi MA. Treatment of experimental osteomyelitis by liposomal antibiotics. J Antimicrob Chemother 2004; 54:1103-8. [PMID: 15486079 DOI: 10.1093/jac/dkh465] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Traditional antibiotic therapy of staphylococcal osteomyelitis by a single drug or a drug combination is ineffective in producing complete sterilization of infected bones. The aim of this study was to develop a non-traditional delivery system of antibiotics for treatment of chronic experimental osteomyelitis. METHODS In the current work, ciprofloxacin and vancomycin were encapsulated in a cationic, anionic or neutral liposomal formulation. For prolonged circulation in serum, liposomal dispersions (<100 nm in diameter) were sonicated for different times (20, 40, 60 or 80 s), and tested for antibacterial activities. RESULTS AND CONCLUSIONS Liposomes sonicated for 40 s gave the highest antibacterial activities in vitro. Since cationic liposomes trapped the highest percentage of antibiotics, and enhanced antibacterial activity above that of the free drugs, they were used for therapeutic trials to treat chronic staphylococcal osteomyelitis induced in rabbits. Therapeutic trials with antibiotics given intravenously revealed that, free ciprofloxacin or vancomycin given alone for 14 days was ineffective in sterilizing bone. Combination therapy with free ciprofloxacin and vancomycin for 14 days was more effective. However, this group showed renal dysfunction and severe diarrhoea, which resulted in loss of 33.3% of treated animals. Treatment with liposomal forms of either drug for 7 days was ineffective. Meanwhile, combination therapy in liposomal form for 7 days was more effective. Complete sterilization of bone tissues on cultures (100% cure) was obtained only in the group treated for 14 days with the combination of both drugs in liposomal form. Moreover, liposomal formulations showed much lower nephrotoxicity and a lower incidence of severe diarrhoea than that induced by free drugs.
Collapse
Affiliation(s)
- Ashraf A Kadry
- Microbiology Division, Faculty of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
| | | | | | | |
Collapse
|
23
|
Egger P, Bellmann R, Wiedermann CJ. Determination of amphotericin B, liposomal amphotericin B, and amphotericin B colloidal dispersion in plasma by high-performance liquid chromatography. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 2001; 760:307-13. [PMID: 11530990 DOI: 10.1016/s0378-4347(01)00292-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Amphotericin B is a potent polyene antifungal drug for intravenous treatment of severe infections. It is used as amphotericin B-deoxycholate and in order to reduce amphotericin B toxicity as lipid-formulated complex (liposomal or colloidal dispersion). A sensitive and specific analytical method is presented for the separation of lipid-complexed and plasma protein-bound amphotericin B in human heparinized plasma. This separation, which is required for pharmacokinetic studies, is achieved by solid-phase extraction (SPE) via Bond Elut C18. The protein-bound amphotericin B has a higher affinity to the SPE material and is therefore retained, whereas the lipid-complexed amphotericin B is eluted in the first step. The recovery of the SPE was >75% for high concentrations and >95% for low concentrations. Quantification was performed by reversed-phase HPLC using a LiChrosorb-RP-8 column, UV detection (lambda=405 nm) and a mixture of acetonitrile-methanol-0.010 M NaH2PO4 buffer (41:10:49, v/v) as mobile phase. The retention time for amphotericin B under the given conditions was 6.7 min. The calibration curves were found to be linear (r > or = 0.999) in two different ranges (5.0-0.50 microg/ml and 0.50-0.005 microg/ml). Intra- and inter-day precision and accuracy fulfilled the international requirements. No interference from other drugs (typical broad medication for intensive-care patients) or common plasma components was detected in >400 samples analyzed.
Collapse
Affiliation(s)
- P Egger
- Department of Medicine, Innsbruck University Hospital, Austria
| | | | | |
Collapse
|
24
|
Moreno MA, Frutos P, Ballesteros MP. Lyophilized lecithin based oil-water microemulsions as a new and low toxic delivery system for amphotericin B. Pharm Res 2001; 18:344-51. [PMID: 11442275 DOI: 10.1023/a:1011011215418] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To develop and investigate lecithin based oil-water microemulsions as potential amphotericin B (AmB) delivery systems and to evaluate their in vivo acute toxicity. METHODS AmB was added to the microemulsion and its location was evaluated by partitioning studies and UV-visible spectrophotometric analysis of the drug. Both, non-lyophilized and reconstituted microemulsions were characterised and assessed for their stability. Single-dose acute toxicity of the AmB microemulsion was studied on male albino Webster-derived CD-1 mice and compared with Fungizone. RESULTS The studies performed showed that AmB was intercalated on the oil-water interface of the microemulsion as a complex formed with lecithin molecules. AmB addition did not seem to modify the rheological properties of the original system, but had an effect on its particle size distribution. Lyophilization of the microemulsion led to an oily cake, easily reconstituted and stable at the conditions studied. Single-dose acute toxicity studies proved that the LD50 of AmB microemulsions was of 4 mg kg(-1) of animal weight, compared with 1 mg kg(-1) found for Fungizone. CONCLUSIONS Lyophilized lecithin based oil-water microemulsions appear to be valuable systems for the delivery of AmB in terms of easy and low-cost manufacturing, stability and safety compared with the formulations already in market.
Collapse
Affiliation(s)
- M A Moreno
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Complutense University of Madrid, Spain.
| | | | | |
Collapse
|
25
|
Mahaguna V, Williams RO, Hardin TC. Trends in antifungal research. EXS 2001; 89:55-68. [PMID: 10997282 DOI: 10.1007/978-3-0348-8393-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
With the increasing use of aggressive immunosuppressive therapies in the management of a variety of patient populations, the continuing presence of the AIDS pandemic and the therapeutic advances employed in critical care settings, an increasing number of serious fungal infections are being encountered by today's practicing clinicians. Traditionally, antifungal drug therapy has been delivered by means of intravenous infusion, oral administration, or topical application. Recently, a number of alternative routes of antifungal drug delivery have been developed and investigated, and the traditional means of antifungal administration have been improved to facilitate the therapeutic use of new and reformulated antifungal agents. Organized based on the route of administration, this chapter reviews these advances in antifungal drug delivery.
Collapse
Affiliation(s)
- V Mahaguna
- College of Pharmacy, University of Texas at Austin, USA
| | | | | |
Collapse
|
26
|
Campanhã M, Mamizuka E, Carmona-Ribeiro A. Interactions between cationic liposomes and bacteria: the physical-chemistry of the bactericidal action. J Lipid Res 1999. [DOI: 10.1016/s0022-2275(20)33392-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
27
|
Xiong YQ, Kupferwasser LI, Zack PM, Bayer AS. Comparative efficacies of liposomal amikacin (MiKasome) plus oxacillin versus conventional amikacin plus oxacillin in experimental endocarditis induced by Staphylococcus aureus: microbiological and echocardiographic analyses. Antimicrob Agents Chemother 1999; 43:1737-42. [PMID: 10390232 PMCID: PMC89353 DOI: 10.1128/aac.43.7.1737] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Optimal treatment strategies for serious infections caused by Staphylococcus aureus have not been fully characterized. The combination of a beta-lactam plus an aminoglycoside can act synergistically against S. aureus in vitro and in vivo. MiKasome, a new liposome-encapsulated formulation of conventional amikacin, significantly prolongs serum half-life (t1/2) and increases the area under the concentration-time curve (AUC) compared to free amikacin. Microbiologic efficacy and left ventricular function, as assessed by echocardiography, were compared in animals administered either oxacillin alone or oxacillin in combination with conventional amikacin or MiKasome in a rabbit model of experimental endocarditis due to S. aureus. In vitro, oxacillin, combined with either free amikacin or MiKasome, prevented the bacterial regrowth observed with aminoglycosides alone at 24 h of incubation. Rabbits with S. aureus endocarditis were treated with either oxacillin alone (50 mg/kg, given intramuscularly three times daily), oxacillin plus daily amikacin (27 mg/kg, given intravenously twice daily), or oxacillin plus intermittent MiKasome (160 mg/kg, given intravenously, a single dose on days 1 and 4). The oxacillin-alone dosage represents a subtherapeutic regimen against the infecting strain in the endocarditis model (L. Hirano and A. S. Bayer, Antimicrob. Agents Chemother. 35:685-690, 1991), thus allowing recognition of any enhanced bactericidal effects between oxacillin and either aminoglycoside formulation. Treatment was administered for either 3 or 6 days, and animals were sacrificed after each of these time points or at 5 days after a 6-day treatment course (to evaluate for posttherapy relapse). Left ventricular function was analyzed by utilizing serial transthoracic echocardiography during treatment and posttherapy by measurement of left ventricular fractional shortening. At all sacrifice times, both combination regimens significantly reduced S. aureus vegetation counts versus control counts (P < 0.05). In contrast, oxacillin alone did not significantly reduce S. aureus vegetation counts after 3 days of therapy. Furthermore, at this time point, the two combinations were significantly more effective than oxacillin alone (P < 0.05). All three regimens were effective in significantly decreasing bacterial counts in the myocardium during and after therapy compared to controls (P < 0.05). In kidney and spleen abscesses, all regimens significantly reduced bacterial counts during therapy (P < 0.0001); however, only the combination regimens prevented bacteriologic relapse in these organs posttherapy. By echocardiographic analysis, both combination regimens yielded a significant physiological benefit by maintaining normal left ventricular function during treatment and posttherapy compared with oxacillin alone (P < 0.001). These results suggest that the use of intermittent MiKasome (similar to daily conventional amikacin) enhances the in vivo bactericidal effects of oxacillin in a severe S. aureus infection model and preserves selected physiological functions in target end organs.
Collapse
Affiliation(s)
- Y Q Xiong
- St. John's Cardiovascular Research Center, LAC-UCLA Medical Center, Torrance, California 90509, USA.
| | | | | | | |
Collapse
|
28
|
Harindran J, Chakraborty KK, Naik SR. Preparation, relative toxicity and therapeutic efficacy in mice and rats of liposomal HA-1-92, a new oxohexaene polyene macrolide antibiotic. J Pharm Pharmacol 1999; 51:771-6. [PMID: 10467950 DOI: 10.1211/0022357991773122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
HA-1-92, a new polyene oxohexaene macrolide antibiotic isolated from Streptomyces CDRIL-312, was incorporated into liposomes containing phosphotidyl choline and cholesterol. The liposomal incorporated HA-1-92 considerably decreased toxicity when compared with free HA-1-92 in mice. Liposomal HA-1-92 showed improved pharmacokinetic profiles in rats. When administered to aspergillosis- and cryptococcosis-infected Balb/c mice, liposomal HA-1-92 showed increased antifungal activity, compared with free HA-1-92, with improved survival rate and decreased colony-forming units in lung, liver, spleen and kidney. These results suggest that liposomal HA-1-92 is more effective than free HA-1-92 in controlling experimental aspergillosis and cryptococcosis in Ba1b/c mice.
Collapse
Affiliation(s)
- J Harindran
- Research and Development Division, Hindustan Antibiotics Ltd, Pimpri, Pune, India
| | | | | |
Collapse
|
29
|
Abstract
Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases in the number of immunosuppressed patients, however, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide. In this review, the focus is on the biology of A. fumigatus and the diseases it causes. Included are discussions of (i) genomic and molecular characterization of the organism, (ii) clinical and laboratory methods available for the diagnosis of aspergillosis in immunocompetent and immunocompromised hosts, (iii) identification of host and fungal factors that play a role in the establishment of the fungus in vivo, and (iv) problems associated with antifungal therapy.
Collapse
Affiliation(s)
- J P Latgé
- Laboratoire des Aspergillus, Institut Pasteur, 75015 Paris, France.
| |
Collapse
|
30
|
Paul M, Durand R, Boulard Y, Fusaï T, Fernandez C, Rivollet D, Deniau M, Astier A. Physicochemical characteristics of pentamidine-loaded polymethacrylate nanoparticles: implication in the intracellular drug release in Leishmania major infected mice. J Drug Target 1998; 5:481-90. [PMID: 9783679 DOI: 10.3109/10611869808997874] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This work describes the preparation, the physicochemical properties, the tolerance and the intracellular trafficking of pentamidine loaded nanoparticles. Pentamidine was bound to the polymer by ionic interaction. This interaction involved the carboxylic acid functions of methacrylic acid (10% of the polymer) and the amine groups of the drug. Pentamidine fixation and release were pH dependent. An acidic pH led to a decrease of fixation or a release. At pH 5, which is the pH value of lysosomes and parasitophorous vacuoles, the release reached up to 50%. At this pH value, pentamidine is ionized and therefore can not traverse the biological membranes. Unloaded nanoparticles and pentamidine-loaded nanoparticles were tested in vitro on U937 cells and no cytotoxicity was observed. In vivo, in Leishmania infected mice, no significant weight loss was found. Ultrastructural studies showed the different steps of drug loaded nanoparticles trafficking inside Leismania-infected Küpffer cells. The nanoparticle uptake by macrophagic cells led to the location of nanoparticles inside phagocytosis vacuoles which fused with primary lysosomes to form secondary lysosomes. Ultimate fusion of secondary lysosomes containing nanoparticles with parasitophorous vacuoles was also observed. Nanoparticles were identified close to amastigotes but internalization by the parasite was not observed.
Collapse
Affiliation(s)
- M Paul
- Laboratoire de Pharmacotechnie, Service Pharmacie, CHU H. Mondor, Créteil, France
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Vasilenko IA, Krasnopol'skii YM, Stepanov AE, Shvets VI. Problems and prospects of phospholipid production. Pharm Chem J 1998. [DOI: 10.1007/bf02471879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
32
|
Oh YK, Straubinger RM. Cellular retention of liposome-delivered anionic compounds modulated by a probenecid-sensitive anion transporter. Pharm Res 1997; 14:1203-9. [PMID: 9327449 DOI: 10.1023/a:1012158924547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Drug carriers such as liposomes may enhance the intracellular delivery of therapeutic agents for infectious or neoplastic diseases. However, the mechanisms affecting cellular retention of liposome contents are understood poorly. We tested the hypothesis that retention of anionic compounds may be modulated by a nonspecific probenecid-sensitive anion transport mechanism, and that liposome composition may determine the impact of such transporters on drug retention by cells. METHODS The fluorescent anionic dye hydroxy-pyrene-[1,3,6]-trisulfonate (HPTS) was transferred to the cytoplasm of cultured CV-1 or J774 cells by direct needle-microinjection or by ATP-induced permeabilization of the-plasma membrane, respectively, to investigate whether the cells have anion transport mechanisms capable of extruding HPTS from the cytoplasm. Cellular retention of dye was monitored in the presence and absence of the anion transport inhibitors probenecid or sulfinpyrazone. Liposomes containing HPTS were co-labeled with tetramethylrhodamine-labeled phosphatidylethanolamine (Rho-PE) as a marker of liposome membrane fate, and uptake was investigated using J774 cells. RESULTS Needle-injected HPTS underwent both sequestration in early endocytic vesicles and rapid extrusion into the extracellular medium. Probenecid or sulfinpyrazone reduced the extrusion of HPTS. Thus HPTS is a substrate for a probenecid-sensitive anion transporter in J774 and CV1 cells. After delivery via fluid liposomes composed of phosphatidylglycerol:phosphatidylcholine:cholesterol (3:7:5 mole ratio) and co-labeled with Rho-PE, cell-associated HPTS declined more rapidly than did Rho-PE. Exposure of cells to 5 mM probenecid doubled the quantity of HPTS retained by cells, without changing the retention of the Rho-PE membrane marker. In contrast, the effect of probenecid was negligible when gel-phase liposomes of distearoylphosphatidylglycerol:cholesterol (10:5 mole ratio) were used. CONCLUSIONS Probenecid-sensitive nonspecific anion transporters can mediate the extrusion of model anions delivered via liposomes. However, liposome composition modulates the amount of material subject to extrusion from cells, possibly by altering the endocytic compartment in which liposomes release their contents.
Collapse
Affiliation(s)
- Y K Oh
- Department of Pharmaceutics, University at Buffalo, State University of New York Amherst 14260-1200, USA
| | | |
Collapse
|
33
|
Heinemann V, Bosse D, Jehn U, Kähny B, Wachholz K, Debus A, Scholz P, Kolb HJ, Wilmanns W. Pharmacokinetics of liposomal amphotericin B (Ambisome) in critically ill patients. Antimicrob Agents Chemother 1997; 41:1275-80. [PMID: 9174183 PMCID: PMC163899 DOI: 10.1128/aac.41.6.1275] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The liposomal formulation of amphotericin B (AmBisome) greatly reduces the acute and chronic side effects of the parent drug. The present study describes the pharmacokinetic characteristics of AmBisome applied to 10 patients at a dose of 2.8 to 3.0 mg/kg of body weight and compares them to the pharmacokinetics observed in 6 patients treated with amphotericin B deoxycholate at the standard dose of 1.0 mg/kg. Interpatient variabilities of amphotericin B peak concentrations (Cmax) and areas under concentration-time curves (AUC) were 8- to 10-fold greater for patients treated with AmBisome than for patients treated with amphotericin B deoxycholate. At the threefold greater dose of AmBisome, median Cmaxs were 8.4-fold higher (14.4 versus 1.7 microg/ml) and median AUCs exceeded those observed with amphotericin B deoxycholate by 9-fold. This was in part explained by a 5.7-fold lower volume of distribution (0.42 liters/kg) in AmBisome-treated patients. The elimination of amphotericin B from serum was biphasic for both formulations. However, the apparent half-life of elimination was twofold shorter for AmBisome (P = 0.03). Neither hemodialysis nor hemofiltration had a significant impact on AmBisome pharmacokinetics as analyzed in one patient. In conclusion, the liposomal formulation of amphotericin B significantly (P = 0.001) reduces the volume of drug distribution, thereby allowing for greater drug concentrations in serum. The low toxicity of AmBisome therefore cannot readily be explained by its serum pharmacokinetics.
Collapse
Affiliation(s)
- V Heinemann
- Klinikum Grosshadern, III Medical Clinic, University of Munich, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Abstract
Amphotericin B (AmB), the drug of choice for the treatment of most systemic fungal infections, is marketed under the trademark Fungizone, as an AmB-deoxycholate complex suitable for intravenous administration. The association between AmB and deoxycholate is relatively weak; therefore, dissociation occurs in the blood. The drug itself interacts with both mammalian and fungal cell membranes to damage cells, but the greater susceptibility of fungal cells to its effects forms the basis for its clinical usefulness. The ability of the drug to form stable complexes with lipids has allowed the development of new formulations of AmB based on this property. Several lipid-based formulations of the drug which are more selective in damaging fungal or parasitic cells than mammalian cells and some of which also have a better therapeutic index than Fungizone have been developed. In vitro investigations have led to the conclusion that the increase in selectivity observed is due to the selective transfer of AmB from lipid complexes to fungal cells or to the higher thermodynamic stability of lipid formulations. Association with lipids modulates AmB binding to lipoproteins in vivo, thus influencing tissue distribution and toxicity. For example, lipid complexes of AmB can be internalized by macrophages, and the macrophages then serve as a reservoir for the drug. Furthermore, stable AmB-lipid complexes are much less toxic to the host than Fungizone and can therefore be administered in higher doses. Experimentally, the efficacy of AmB-lipid formulations compared with Fungizone depends on the animal model used. Improved therapeutic indices for AmB-lipid formations have been demonstrated in clinical trials, but the definitive trials leading to the selection of an optimal formulation and therapeutic regimen have not been done.
Collapse
Affiliation(s)
- J Brajtburg
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | | |
Collapse
|
36
|
Ehlers S, Bucke W, Leitzke S, Fortmann L, Smith D, Hänsch H, Hahn H, Bancroff G, Müller R. Liposomal amikacin for treatment of M. avium infections in clinically relevant experimental settings. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1996; 284:218-31. [PMID: 8837382 DOI: 10.1016/s0934-8840(96)80097-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In an effort to optimize rational chemotherapy against M. avium infections in a clinically meaningful context, we tested whether liposome-encapsulated amikacin would effectively reduce the bacterial load in (i) intravenously infected immunodeficient SCID mice, (ii) immunocompetent mice in both early and late stages of intravenous infection, and (iii) immunocompetent mice with pulmonary M. avium infection. Although complete eradication of M. avium was never achieved following intravenous infection, mycobacterial CFUs decreased by 3 to 4 logs in the spleens and livers of mice treated for three weeks with twice-weekly intravenous injections of liposomal amikacin and continued to stay low in the liver, even in the absence of specific immunity. Mice treated in the chronic stage of infection equally benefited from therapy and showed signs of attenuated granulomatous inflammation in the liver. Even moribund mice responded to liposomal amikacin by significantly gaining weight and survived their infected untreated littermates by at least 4 months. In contrast, during pulmonary M. avium infection, treatment with liposome-encapsulated amikacin only resulted in a transient plateau of bacterial proliferation in the lungs, and the infection exacerbated immediately after cessation of therapy.
Collapse
Affiliation(s)
- S Ehlers
- Institut für Medizinische Mikrobiologie und Infektionsimmunologie, Klinikum Benjamin Franklin, FU Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
de Chasteigner S, Cav� G, Fessi H, Devissaguet JP, Puisieux F. Freeze-drying of itraconazole-loaded nanosphere suspensions: a feasibility study. Drug Dev Res 1996. [DOI: 10.1002/(sici)1098-2299(199606)38:2<116::aid-ddr6>3.0.co;2-m] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
38
|
de Chasteigner S, Fessi H, Devissaguet JP, Puisieux F. Comparative study of the association of itraconazole with colloidal drug carriers. Drug Dev Res 1996. [DOI: 10.1002/(sici)1098-2299(199606)38:2<125::aid-ddr7>3.0.co;2-l] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
39
|
Rodrigues J. Primaquine-loaded poly(lactide) nanoparticles: physicochemical study and acute tolerance in mice. Int J Pharm 1995. [DOI: 10.1016/0378-5173(95)04135-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
40
|
Graybill JR, Bocanegra R. Liposomal amphotericin B therapy of murine histoplasmosis. Antimicrob Agents Chemother 1995; 39:1885-7. [PMID: 7486941 PMCID: PMC162848 DOI: 10.1128/aac.39.8.1885] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Liposomal amphotericin B (AmBisome) was compared with amphotericin B deoxycholate for the treatment of disseminated murine histoplasmosis. Liposomal amphotericin B was well tolerated and, milligram for milligram, was as potent as amphotericin B deoxycholate.
Collapse
Affiliation(s)
- J R Graybill
- Department of Medicine, University of Texas Health Science Center at San Antonio, USA
| | | |
Collapse
|
41
|
|
42
|
Poyner E, Alpar H, Almeida A, Gamble M, Brown M. A comparative study on the pulmonary delivery of tobramycin encapsulated into liposomes and PLA microspheres following intravenous and endotracheal delivery. J Control Release 1995. [DOI: 10.1016/0168-3659(95)00017-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Monshipouri M, Rudolph AS. Liposome-encapsulated alginate: controlled hydrogel particle formation and release. J Microencapsul 1995; 12:117-27. [PMID: 7629654 DOI: 10.3109/02652049509015282] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Large unilamellar liposomes of dipalmitoyl phosphatidylcholine have been employed as reaction sites for calcium alginate gelation. Encapsulation of sodium alginate was accomplished by extrusion of phospholipid dispersions through polycarbonate filter of uniform pore size followed by incubation with high concentrations of calcium chloride. The diffusion of calcium into the liposome interior resulted in alginate gelatin within the liposome. Detergent treatment of the liposomes resulted in solubilization of the lipid bilayer with subsequent release of the alginate beads which were measured by laser light scattering and electron microscopy. The release profiles of both the liposomes with entrapped alginate beads and the alginate beads (released by detergent treatment of the liposomes) were determined using cytochrome-c as a marker for release. The release profiles show a rapid release of cytochrome-c over the first 2 for both preparations with slower subsequent release rates for the liposomes with encapsulated alginate beads. The similar early profile may be due to the release of cytochrome-c from bound calcium alginate adsorbed to the outer leaflet of the liposome. This is also supported by calorimetric results which indicate a marked reduction in the enthalpy of the main gel to liquid crystalline phase transition of multilamellar and large unilamellar dispersions of the lipid. This method results in the fabrication of easily controlled, unimodal submicron hydrogel particles which may be used for controlled-release applications.
Collapse
Affiliation(s)
- M Monshipouri
- Department of Biochemistry, Georgetown University, Washington, DC 20007, USA
| | | |
Collapse
|
44
|
Graybill JR. Antifungal drugs and resistance. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1995; 390:217-34. [PMID: 8718616 DOI: 10.1007/978-1-4757-9203-4_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J R Graybill
- Department of Medicine, Audie Murphy V.A. Hospital, San Antonio, TX, USA
| |
Collapse
|
45
|
Le Conte P, Le Gallou F, Potel G, Struillou L, Baron D, Drugeon HB. Pharmacokinetics, toxicity, and efficacy of liposomal capreomycin in disseminated Mycobacterium avium beige mouse model. Antimicrob Agents Chemother 1994; 38:2695-701. [PMID: 7535036 PMCID: PMC188272 DOI: 10.1128/aac.38.12.2695] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Capreomycin was incorporated into multilamellar vesicles of pure dipalmitoylphosphatidylcholine. The pharmacokinetics and nephrotoxicity of capreomycin in the free and liposomal forms were studied in normal mice. The efficacies of the two forms were evaluated by using the Mycobacterium avium complex beige mouse model. Approximately 10(7) viable M. avium cells were injected intravenously. Seven days later, treatment with either liposomal or free capreomycin at 60 or 120 mg/kg of body weight was administered daily for 5 days. Mice were sacrificed 5 days after the end of treatment, and the viable bacteria in liver, spleen, lungs, and blood were counted. After 5 days of treatment with dosages of 60 or 120 mg/kg/day, the level of blood urea nitrogen increased in the group treated with free capreomycin but not in the group treated with liposomal capreomycin. After intravenous injection of 120 mg/kg, liposomes enhanced the diffusion of capreomycin in the spleen, lungs, and kidneys and increased the half-life in serum. The 120-mg/kg dose of liposomal capreomycin significantly reduced the number of viable mycobacteria in the liver, spleen, and blood compared with those in the controls. Although these results are promising, further studies are needed to assess the efficacy of liposomal capreomycin for the treatment of M. avium complex infections.
Collapse
Affiliation(s)
- P Le Conte
- Laboratoire d'Antibiologie Clinique et Expérimentale, Faculté de Médecine, Nantes, France
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Numerous studies performed in the field of antifungal therapy during the last decade have resulted in major developments in new modalities of administering amphotericin B including liposomes or other lipid vehicles. Current data available are very encouraging and several preparations are already commercially available in some countries. An improved therapeutic index has been shown in humans but large comparative trials are still needed to establish the definite role and indications of the various preparations as well as the optimal therapeutic regimens. These studies will make a significant contribution to improving the prognosis of patients predisposed to life threatening invasive fungal infections.
Collapse
Affiliation(s)
- F Meunier
- EORTC Central Office-Data Center, Brussels, Belgium
| |
Collapse
|
47
|
The protective effect of free and membrane-bound cryoprotectants during freezing and freeze-drying of liposomes. J Control Release 1994. [DOI: 10.1016/0168-3659(94)90257-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
48
|
Andrès E, Limacher JM, Bergerat JP. [Pulmonary invasive aspergillosis: value of treatment with intravenous amphotericin B administered in a triglyceride emulsion for parenteral usage]. Rev Med Interne 1994; 15:244-9. [PMID: 8059144 DOI: 10.1016/s0248-8663(94)80028-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pulmonary invasive aspergillosis is a frequent and poor prognosis complication of immuno-deficiency and prolonged neutropenia. Its treatment is usually based on amphotericin B (0.7 to 1 mg/kg/d) given as intravenous infusions for at least 2 months. This therapy is limited by the side-effects of the drug including renal failure, myelosuppression, chills and fever. We present here the case of women with pulmonary invasive aspergillosis treated with a different modality of administration. The amphotericin B was given as a continuous infection at 2 mg/kg/d diluted in Intralipid, a triglyceridic mixture used in parenteral nutrition. Given by this way amphotericin B seems to have a good therapeutic efficiency and a mild toxicity limited to transient reduction in creatinine clearance with increased kaliuria. Other current approaches of invasive aspergillosis include the amphotericin B in liposomes, combination of amphotericin B with 5-fluorouracil and the triazolated compounds.
Collapse
Affiliation(s)
- E Andrès
- Service d'oncologie médicale, CHU de Strasbourg, 1, place de l'Hôpital, France
| | | | | |
Collapse
|
49
|
Meunier F. Current issues on the prophylaxis and the management of fungal infections in leukemic patients. Int J Antimicrob Agents 1994; 4:73-6. [DOI: 10.1016/0924-8579(94)90065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/1993] [Indexed: 10/27/2022]
|
50
|
Abstract
OBJECTIVE To update readers on the clinical management of infections caused by Mycobacterium tuberculosis, to provide a general description of the organism, culture and susceptibility testing, and clinical manifestations of the disease, and to provide several aspects of the treatment of the disease, including historical perspective, current approaches, and research opportunities for the future. DATA SOURCES The current medical literature, including abstracts presented at recent international meetings, is reviewed. References were identified through MEDLINE, MEDLARS II, Current Contents, and published meeting abstracts. STUDY SELECTION Data regarding the epidemiology, clinical manifestations, culture and susceptibility testing, and treatment of tuberculosis are cited. Specific attention has been focused on the clinical management of patients with noncontagious infection and potentially contagious active disease (TB) caused by M. tuberculosis. DATA EXTRACTION Information contributing to the discussion of the topics selected by the authors is reviewed. Data supporting and disputing specific conclusions are presented. DATA SYNTHESIS The incidence of TB is increasing in the US, despite the fact that available technologies are capable of controlling the vast majority of existing cases. Fueling the fire is the problem of coinfection with HIV and M. tuberculosis. Very few drugs are available for the treatment of TB, and few of these approach the potency of isoniazid and rifampin. Preventive therapy of patients exposed to multiple-drug-resistant M. tuberculosis (MDR-TB) is controversial and of unknown efficacy. Treatment of active disease caused by MDR-TB requires up to four times longer, is associated with increased toxicity, and is far less successful than the treatment of drug-susceptible TB. Strategies for the management of such cases are presented. The rising incidence of TB in the US reflects a breakdown in the healthcare systems responsible for controlling the disease, which reflects the past budgetary reductions. Although TB control is one of the most cost-effective public health strategies, funding has been cut repeatedly despite the fact that TB was never eliminated. This has helped to produce the current crisis, including the spread of MDR-TB in many urban areas. The elimination of TB will now take decades longer, cost hundreds of millions of dollars more, and result in vastly higher morbidity and mortality rates than would have occurred with timely, adequate measures. CONCLUSIONS Tremendous effort and far more funding will be required to eliminate TB in the US. The selection of drug therapy must be based on the susceptibility data for each isolate. Multiple-drug therapy must be continued for 6 to > or = 24 months, and patient adherence to prescribed regimens must be verified in all cases of TB. Significant antimycobacterial drug malabsorption has been documented in AIDS patients with TB, and may result in treatment failure. New agents are needed to improve the clinical outcome in patients with MDR-TB.
Collapse
Affiliation(s)
- C A Peloquin
- Infectious Disease Pharmacokinetics Laboratory (IDPL), National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206
| | | |
Collapse
|