Enhanced ileal absorption of a hydrophilic macromolecule, pentosan polysulfate sodium (PPS)

The effect of pentosan polysulfate sodium for improving dyslipidaemia and knee pain in people with knee osteoarthritis: A pilot study

Objective

To evaluate the efficacy and safety of pentosan polysulfate sodium (PPS, Elmiron®) for dyslipidaemia and knee osteoarthritis (OA) related symptoms.

Method

This was a single-arm, open-label, prospective, non-randomised pilot study. People with painful knee OA and a history of primary hypercholesterolemia were included. PPS was taken orally in a dosage of 10 ​mg/kg once every 4 days for 5 weeks for two cycles. There was 5 weeks of no medication between the cycles. The main outcomes included the change in lipidemia levels, the change in knee OA-related symptoms assessed by pain numerical rating scale (NRS) and Knee Osteoarthritis Outcome Score (KOOS), and knee MRI semi-quantitative score. The changes were analysed using paired t-tests.

Results

38 participants were included, with a mean age of 62.2 years. We found a statistically significant decrease in total cholesterol (from 6.23 ​± ​0.74 to 5.95 ​± ​0.77 ​mmol/L; P ​= ​0.01) and low-density lipoprotein (from 4.03 ​± ​0.61 to 3.82 ​± ​0.61 ​mmol/L; P ​= ​0.009) from baseline to week 16. Knee pain NRS was significantly reduced at weeks 6, 16 and 26 from 6.39 ​± ​1.33 to 4.18 ​± ​1.99, 3.63 ​± ​2.28 and 4.38 ​± ​2.55, respectively (P ​< ​0.001). However, there was no significant difference in terms of the primary outcome of triglyceride levels before and after treatment. The most common AEs were positive faecal occult blood tests, followed by headache and diarrhoea.

Conclusion

The findings suggest that PPS has promising effects on improving dyslipidaemia and symptomatic pain relief in people with knee OA.

Repurposing pentosan polysulfate sodium as hyaluronic acid linked polyion complex nanoparticles for the management of osteoarthritis: A potential approach

Osteoarthritis is still a disease burden for pharmaceutical scientists and strategy makers. It is associated with the chronic inflammation of joints especially weight-bearing joints like knee, hip, backbone, and phalanges. NSAIDs that are used for the management of inflammation associated with osteoarthritis have high side effects related to gastric upset, gastric ulcer, and long term treatment associated with liver and kidney damage. Nanotechnology has gained a huge scope for the management of arthritis as it can reach out to the deep inside the cell and alter cellular physiology as desired. The present study hypothesizes the use of polyion complex nanoparticles of hyaluronic acid linked Pentosan polysulfate sodium, a disease-modifying agent for the treatment of osteoarthritis administered through transdermal route. The hypothesis involves the use of drug repurposing as the drug was initially approved for interstitial cystitis, a condition of the urinary bladder associated with pain and swelling. Being very low oral bioavailability and gastric irritation profile, the transdermal route would be beneficial. To overcome the problem associated with the oral route, there is a need for the targeted approach that will particularly reach at inflammatory sites. Thereby transdermal delivery of hyaluronic acid linked Pentosan polysulfate sodium through polyion complex nanoparticle therapy will be a novel therapeutic approach to combat osteoarthritis.

Enhanced bioavailability of poorly absorbed hydrophilic compounds through drug complex/in situ gelling formulation

BCS class III hydrophilic compounds are often associated with low oral bioavailability due to their poor epithelial permeability in the gastrointestinal tract. In this study, we reported an approach of incorporating a drug complex into an in situ gelling muco-adhesive carrier to achieve an improved bioavailability of a poorly absorbed hydrophilic compound. A new molecular entity (RWJ-445167) from Johnson and Johnson was used as a model compound. The compound was first complexed with sodium lauryl sulfate (SLS). The complex was then incorporated into an in situ gelling muco-adhesive carrier Cremophor for formulation characterization and rat pharmacokinetic (PK) studies. The study results showed that RWJ-445167 bound to SLS at a stoichiometric ratio. By complexing with SLS, the compound became lipophilic. The aqueous solubility of RWJ-445167 dropped to 0.58 mg/mL for the complex from 61 mg/mL for the free compound, while the partitioning coefficient of the complex increased to 7.59, compared with 0.05 of the free compound. In the rat PK study, with duodenal administration, the complex in the in situ-gelling formulation achieved 28.24% of bioavailability, compared to 4.26% of the free compound solution. The enhanced bioavailability was also significantly higher than those in the RWJ-445167/SLS physical mixture in Cremophor (14.91%), the complex in non-gelling carrier PEG 400 (9.95%) and the RWJ-445167/SLS physical mixture in PEG 400 carrier (8.60%). The study demonstrates that incorporation of a drug complex into an in situ gelling formulation provides a new approach to improving bioavailability of BCS class III drugs.

Molecular size affects urine excretion of pentosan polysulfate

PURPOSE

In human subjects only a small percent of oral PPS is found in urine. Commercially available PPS is a heterogeneous mixture with varying molecular weights. Our hypothesis was that only the low molecular weight fraction reaches the urine.

MATERIALS AND METHODS

Urine was obtained from patients with IC who were chronically receiving PPS. The amount and molecular size of PPS in the urine were determined by enzyme-linked immunosorbent assay and molecular sieve chromatography. PPS was purified from Elmiron capsules and fractionated into LMW and HMW fractions. Urine recovery of PPS was measured in rabbits after oral or intravenous administration of unfractionated, LMW or HMW PPS.

RESULTS

The median urine PPS level in 34 patients with IC was 1.2 microg/ml (range 0.5 to 27.7). All PPS recovered from IC urine was LMW. After intravenous administration in rabbits the median recovery in urine was 47.2% (range 19.7% to 73.2%) for unfractionated PPS, 74.6% (range 31.4% to 96.3%) for LMW and 3.3% (range 2.5% to 5.0%) for HMW. After oral administration in rabbits the median recovery in urine was 7.4% (range 2.1% to 46.0%) for LMW and 0.10% (range 0.0% to 0.3%) for HMW.

CONCLUSIONS

In patients with IC who are on oral PPS the PPS recovered in the urine is all of LMW. In rabbits the HMW fraction of PPS is recovered in small amounts from urine after intravenous administration and not at all after oral administration.