Intravenous infusion of high doses of liposomes containing NSC 251635, a water-insoluble cytostatic agent. A pilot study with pharmacokinetic data

Nonclinical Testing Evaluation of Liposomes as Drug Delivery Systems

Various marketed drugs, as well as many in-development, have utilized liposomes, vesicles composed of one or more phospholipid bilayers, as a drug delivery system, often with the statement that they are "non-toxic" materials. This paper examined safety testing considerations and reviewed nonclinical packages used to support the safe clinical use and marketing of drugs using a liposomal drug delivery system, including liposome-only study findings. It was found that most experience has come from use of an established drug (especially in the oncology field) in a liposome formulation with known excipients. From this knowledge, it is proposed that the minimal package of studies (using an oncology indication as an example) needed to support clinical entry should include in vivo pharmacology in selected mouse xenograft models, pharmacokinetic characterization showing enhanced kinetics or disposition and including tumor exposure evaluation along with repeat-dose toxicity testing in one species. It was also found that the liposomes used in drug delivery systems are not truly "non-toxic" materials. However, the majority of findings in toxicity testing relate to macrophage processing of large amounts of lipid material, with no human known safety consequence. Of note, however, are cases of hypersensitivity for some PEGylated liposome forms which translate to the clinic.

Complement Activation: A Potential Threat on the Safety of Poly(ethylene glycol)-Coated Nanomedicines

In this issue of ACS Nano, Chen et al. provide in vitro and in vivo evidence for monoclonal anti-poly(ethylene glycol) (anti-PEG) antibody-triggered, complement terminal complex-mediated damage to PEGylated liposomal doxorubicin, entailing the release of the encapsulated drug from the vesicles. These results reveal a new dimension of the potential damage of anti-PEG antibody-mediated complement activation on PEGylated nanomedicines in addition to previous observations on infusion hypersensitivity reactions and the accelerated blood clearance effect. The possibility of a destructive attack of the complement system on the liposome drug carrier may have safety implications in patients displaying high levels of preformed anti-PEG antibodies. In this Perspective, we summarize the experimental and clinical data highlighting the relationships among the above adverse immune phenomena and the options available for reducing the risk of immune damage caused by PEGylated nanomedicines.

Dog-specific hemorrhagic changes induced by liposomal formulations, in the liver and the gallbladder

Although several liposomal drugs, including liposomal doxorubicin, have been approved, the etiology of the pathological responses caused by their physicochemical properties remains unknown. Herein, we investigated the pathological changes in the liver and the gallbladder of dogs following a single injection of liposomal doxorubicin (1 or 2.5 mg/kg) or an empty liposomal formulation (i.e., liposomal formulation without doxorubicin, ca. 21 mg/kg as lipid content). Injection of liposomal doxorubicin or the empty liposomal formulation induced hemorrhagic changes in the liver and the gallbladder. These changes were accompanied by minimal cellular infiltration with no obvious changes in the blood vessels. As there were no differences in the incidence and severity of hemorrhage between the groups administered comparable amounts of total lipid, the physicochemical properties of the liposomal formulation rather than an active pharmacological ingredient, doxorubicin, were associated with the hemorrhagic changes. Furthermore, decreased cytoplasmic granules with low electron density in mast cells beneath the endothelium of the hepatic vein were observed in the liver of dogs treated with liposomal doxorubicin or empty liposomal formulation. Injection of compound 48/80, a histamine releaser induced comparable hemorrhage in dogs, implying that hemorrhage caused by injection of liposomal doxorubicin or the empty liposomal formulation could be attributed to the histamine released from mast cells. The absence of similar hemorrhagic lesions in other species commonly used in toxicology studies (i.e., rats and monkeys), as well as humans, is due to the lack of mast cells beneath the endothelium of the hepatic vein in these species.

Effect of the moist-heat sterilization on fabricated nanoscale solid lipid particles containing rasagiline mesylate

BACKGROUND

Nanoscale solid lipid particles of rasagiline mesylate (RM) were fabricated by microemulsion technique. The nanoscale particle must be sterile for intravenous administration, and several approaches are available for sterilization. However, the selection of sterilization technique for the fabricated RM loaded nanoscale solid lipid particles mainly depends on the nature of the drug that needs to be encapsulated and release pattern of the polymer.

MATERIALS AND METHODS

We have preferred moist heat sterilization, as it is the most convenient and the composition of the carrier and incorporated drug should remain unchanged and the incorporated drug should not leak out of the drug carrier. The physical and chemical stability of RM loaded nanoscale solid lipid particles investigated during sterilization and to determine the average mean particle size, polydispersity index, zeta potential (ZP), transmission electron microscopy (TEM), entrapment efficiency (EE), and drug content after autoclaving.

RESULT

There were no significant changes in the average mean particle size, polydispersity index, ZP, TEM, EE, and drug content of RM loaded nanoscale solid lipid particles after autoclaving (121°C for 20 min [15 lbs]).

CONCLUSION

These observations suggest that the moist heat sterilization by autoclaving is the most suitable method for nanoscale solid lipid formulations.

Activation of complement by therapeutic liposomes and other lipid excipient-based therapeutic products: prediction and prevention

Some therapeutic liposomes and lipid excipient-based anticancer drugs are recognized by the immune system as foreign, leading to a variety of adverse immune phenomena. One of them is complement (C) activation, the cause, or major contributing factor to a hypersensitivity syndrome called C activation-related pseudoallergy (CARPA). CARPA represents a novel subcategory of acute (type I) hypersensitivity reactions (HSR), which is mostly mild, transient, and preventable by appropriate precautions. However, in an occasional patient, it can be severe or even lethal. Because a main manifestation of C activation is cardiopulmonary distress, CARPA may be a safety issue primarily in cardiac patients. Along with an overview of the various types of liposome-immune system interactions, this review updates the experimental and clinical information on CARPA to different therapeutic liposomes and lipid excipient-based (micellar) anticancer drugs, including PEGylated liposomal doxorubicin sulfate (PLD, Doxil®) and paclitaxel (Taxol®). The substantial individual variation of in vitro and in vivo findings reflects an extremely complex immune phenomenon involving multiple, redundant pathways of C activation, signal transduction in allergy-mediating cells and vasoactive mediator actions at the effector cell level. The latest advances in this field include the proposal of doxorubicin-induced shape changes and aggregation of liposomes in Doxil as possible contributing factors to CARPA caused by PLD, and the finding that Doxil-induced immune suppression prevents HSR to co-administered carboplatin, a significant benefit of Doxil in combination chemotherapy with carboplatin. The review evaluates the use of in vitro C assays and the porcine liposome-induced cardiopulmonary distress model for predicting CARPA. It is concluded that CARPA may become a frequent safety issue in the upcoming era of nanomedicines, necessitating its prevention at an early stage of nanomedicine R&D.

The choroidal circulation assessed by laser-targeted angiography

The choroid plays an important role in supplying nutrients to and removing waste products from the outer region of the retina. Abnormal choroidal blood flow can disrupt normal retinal function and lead to alterations in visual function. Visualization of the choriocapillaris in vivo is a great challenge to understanding its normal physiology and involvement in the disease process. Laser-targeted angiography (LTA) is a relatively new method used to visualize and analyze the choroidal circulation. Carboxyfluorescein (CF), encapsulated in heat-sensitive liposomes, is released locally in the choroid through the application of a heat beam provided by an infrared laser. Video angiograms are generated with excitation illumination provided by an argon laser. Obtained images are highly selective to the choriocapillaris and are sharply contrasted against underlying and overlying structures. The images can be obtained repetitively, during which period the circulating liposome concentration is sufficient to generate adequate angiograms. These high-quality images have revealed three distinct phases (filling, plateau, and draining) of the choriocapillaris. In the plateau phase, a cluster of lobules fed by a common arteriole has been uniformly illuminated. This defined cluster area does not change in size while an infrared laser is continuously applied to the same spot, which demonstrates that each cluster is functionally independent and no physiological communication exists between them. Only in posterior regions do the angiograms demonstrate during the filling and draining phases that each lobule is filled from a central spot and drained along a peripheral ring, showing honeycomb flow patterns. The regional differences in choriocapillaris flow patterns revealed by LTA suggests that the choriocapillaris provides a more highly efficient system of outflow in posterior regions than in peripheral regions. LTA is useful in analyzing choroidal circulation in vivo and has the potential for clinical application in the future. Additionally, LTA has a unique capability to image choroidal neovascularization in animal models and it promises potential application in age-related macular degeneration (AMD).

VERTEPORFIN THERAPY OF SUBFOVEAL CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION

PURPOSE

We sought to evaluate the detailed safety profile of photodynamic therapy with verteporfin in patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (ARMD) from the combined analysis of three multicenter, double-masked, placebo-controlled, randomized 24-month clinical trials of similar design (TAP Investigation Studies A and B and the VIP ARMD Trial), and to clarify the adverse reaction information in the current verteporfin product prescription information approved in the United States.

METHODS

Nine hundred forty-eight patients were randomly assigned to verteporfin or placebo. Treatment was administered as described in previous reports. All general entry criteria were similar, so systemic safety results were combined for this analysis. Entry criteria for CNV lesion composition and visual acuity in the two TAP Investigation trials was different from those used in the VIP ARMD trial, so ocular safety results for the treated eye were not combined.

RESULTS

The percentage of patients who experienced at least one ocular or nonocular adverse event, regardless of relationship to therapy, was similar between the verteporfin and placebo groups (92.3 and 89.1%, respectively, P = 0.114). The overall incidence of study eye adverse events was not significantly different between verteporfin and placebo. The only clinically relevant ocular adverse events reported with higher incidence after verteporfin compared with placebo were visual disturbances (22.1 versus 15.5% in TAP [P = 0.054] and 41.7 and 22.8% in VIP [P < 0.001]). Acute severe visual acuity decrease (defined as a visual acuity letter score decrease of at least 20, equivalent to at least four-line decrease, within 7 days of therapy) occurred in 3 patients treated with verteporfin in the TAP Investigation (0.7%) and 11 in the VIP ARMD trial (4.9%). Systemic adverse events with increased incidence after verteporfin compared with placebo, most of which were transient and mild or moderate, were injection site reactions (13.1 versus 5.6%; P < 0.001), photosensitivity reactions (2.4 versus 0.3%; P = 0.016), and infusion-related back pain (2.4 versus 0%; P = 0.004). No clinically relevant difference was observed between the verteporfin and placebo groups in any other adverse event.

CONCLUSION

In 948 ARMD patients, verteporfin therapy had an overall safety profile similar to that for placebo, with a few exceptions. Visual disturbances, including acute severe visual acuity decrease, did not affect the net vision outcome benefits associated with treatment that has been reported previously. This detailed safety profile of verteporfin therapy clarifies the adverse reaction information in the current verteporfin product prescription information.

Complement activation following first exposure to pegylated liposomal doxorubicin (Doxil): possible role in hypersensitivity reactions

BACKGROUND

Pegylated liposomal doxorubicin (Doxil) has been reported to cause immediate hypersensitivity reactions (HSRs) that cannot be explained as IgE-mediated (type I) allergy. Previous in vitro and animal studies indicated that activation of the complement (C) system might play a causal role in the process, a proposal that has not been tested in humans to date.

PATIENTS AND METHODS

Patients with solid tumors (n = 29) treated for the first time with Doxil were evaluated for HSRs and concurrent C activation. HSRs were classified from mild to severe, while C activation was estimated by serial measurement of plasma C terminal complex (SC5b-9) levels. Increases in SC5b-9 were compared in patients with or without reactions, and were correlated with Doxil dose rate.

RESULTS

Moderate to severe HSRs occurred in 45% of patients. Plasma SC5b-9 at 10 min after infusion was significantly elevated in 92% of reactor patients versus 56% in the non-reactor group, and the rise was greater in reactors than in non-reactors. We found significant association between C activation and HSRs, both showing direct correlation with the initial Doxil dose rate.

CONCLUSIONS

C activation may play a key role in HSRs to Doxil. However, low-level C activation does not necessarily entail clinical symptoms, highlighting the probable involvement of further, as yet unidentified, amplification factors.

Adverse reaction characterized by chest pain, shortness of breath, and syncope associated with verteporfin (visudyne)

PURPOSE

To report a serious adverse reaction associated with verteporfin infusion.

DESIGN

Observational case report.

METHODS

Case report of a single individual undergoing photodynamic therapy (PDT) with verteporfin.

RESULTS

A 77-year-old man with long-standing asymptomatic atrial fibrillation, but no known coronary artery disease experienced severe chest and neck pain, shortness of breath, and syncope while undergoing a fourth photodynamic therapy (PDT) treatment with verteporfin. This infusion had been preceded by three prior infusions; the first two were uneventful, and the third was associated with milder, but similar symptoms. Evaluation demonstrated that the chest pain was noncardiac in origin.

CONCLUSION

As verteporfin continues to be used around the world, physicians must be alert to the possibility of serious adverse side effects associated with its use.

Prevention of the hemodynamic effects of iopromide-carrying liposomes in rats and pigs

RATIONALE AND OBJECTIVES

Intravenous injection of liposomes is able to trigger allergy-like reactions that affect the cardiopulmonary system. The mechanism of these effects is still not totally clear. Because prediction of adverse reactions and the consequent exclusion of reactive patients do not seem feasible, prevention might have a considerable impact.

METHODS

Two small, multilamellar liposome batches with the encapsulated contrast agent iopromide, which differed by size and buffer composition, were injected into anesthetized rats (n = 5 per group) and pigs (n = 6 per group). Blood pressure (BP), cardiac output (CO), contractility (dP/dt; in rats), total peripheral resistance (TPR; in rats), pulmonary vascular resistance (in pigs), and pulmonary arterial pressure (PAP; in pigs) were monitored. Saline, mannitol solution, the two buffers, and the contrast medium were used as controls.

RESULTS

Significant changes in hemodynamic parameters were observed not only between liposomes and controls but also between the two liposome preparations. In rats, a significant decrease in BP followed by its normalization and subsequent increase, a decrease in CO followed by an increase, a decrease in TPR, and a decrease in dP/dt followed by an increase were observed. In pigs, the effects were different both in quality and in quantity (more intense) compared with those in rats. In this species, an increase in BP, a decrease in CO, an increase in TPR, and an increase in PAP were found. Pretreatment with acetylsalicylic acid was able to prevent the hemodynamic changes induced by the liposomes.

CONCLUSIONS

Allergy-like side effects induced by liposome injection strongly depend on the size, electric charge, and composition of the particles. The mechanism triggered by liposome injection probably is complex and can be effectively blocked by pretreatment with acetylsalicylic acid.

Comparison of the effects of dimyristoyl and soya phosphatidylcholine liposomes on human fibroblasts

The in vitro effects of prolonged exposure (8 days) of human skin fibroblasts to several concentrations of extruded dimyristoyl (dm-PC) and soya phosphatidylcholine (soya-PC) liposomes were compared. Prepared liposome suspensions were added to the fibroblast culture medium at phospholipid concentrations of 10, 50, 100, 200, and 300 microM. Survival curves and values of 50% inhibitory concentration (IC50) and area under the curve (AUC) were used to compare the response of the fibroblasts to the two types of liposomes. The effect of the incorporation of vitamin E in the liposomal preparations also was determined. Fibroblasts showed greater sensitivity toward the soya-PC liposomes (IC50 = 150 microM) than the dm-PC liposomes (IC50 = 212 microM). The presence of vitamin E in the soya-PC liposomes led to a 1.9-fold increase in the IC50, while dm-PC liposomes containing vitamin E showed an IC50 that was 1.1 times higher than that shown by control vitamin-free liposomes. Soya-PC liposomes containing vitamin E at a molar ratio of 10:0.5 (phospholipid:vitamin) were best tolerated by the fibroblasts (IC50 > 300 microM). It would appear that dm-PC liposomes are better tolerated by fibroblasts than those composed of soya-PC. However, the incorporation of vitamin E into the liposomes seems to reverse this effect, and it is the vitamin-containing soya-PC liposomes that are most compatible with the growth of fibroblasts in culture.

Hemodynamic changes induced by liposomes and liposome-encapsulated hemoglobin in pigs: a model for pseudoallergic cardiopulmonary reactions to liposomes. Role of complement and inhibition by soluble CR1 and anti-C5a antibody

BACKGROUND

Intravenous administration of some liposomal drugs can trigger immediate hypersensitivity reactions that include symptoms of cardiopulmonary distress. The mechanism underlying the cardiovascular changes has not been clarified.

METHODS AND RESULTS

Anesthetized pigs (n=18) were injected intravenously with 5-mg boluses of large multilamellar liposomes, and the ensuing hemodynamic, hematologic, and laboratory changes were recorded. The significant (P<0.01) alterations included 79+/-9% (mean+/-SEM) rise in pulmonary arterial pressure, 30+/-7% decline in cardiac output, 11+/-2% increase in heart rate, 236+/-54% increase in pulmonary vascular resistance, 71+/-27% increase in systemic vascular resistance, and up to a 100-fold increase in plasma thromboxane B2. These changes peaked between 1 and 5 minutes after injection, subsided within 10 to 20 minutes, were lipid dose-dependent (ED50=4. 5+/-1.4 mg), and were quantitatively reproducible in the same animal several times over 7 hours. The liposome-induced rises of pulmonary arterial pressure showed close quantitative and temporal correlation with elevations of plasma thromboxane B2 and were inhibited by an anti-C5a monoclonal antibody (GS1), by sCR1, or by indomethacin. Liposomes caused C5a production in pig serum in vitro through classic pathway activation and bound IgG and IgM natural antibodies. Zymosan- and hemoglobin-containing liposomes and empty liposomes caused essentially identical pulmonary changes.

CONCLUSIONS

The intense, nontachyphylactic, highly reproducible, complement-mediated pulmonary hypertensive effect of minute amounts of intravenous liposomes in pigs represents a unique, unexplored phenomenon in circulation physiology. The model provides highly sensitive detection and study of cardiopulmonary side effects of liposomal drugs and many other pharmaceutical products due to "complement activation-related pseudoallergy" (CARPA).

Toxicity of gamma irradiated liposomes. 2. In vitro effects on cells in culture

In this study, the effects of liposome composition and gamma irradiation on their interactions with cell cultures were studied. The cytotoxicity test and the growth inhibition test clearly revealed toxic effects of liposomes composed of unsaturated phospholipids and gamma irradiation of these preparations enhanced their toxic effects. The murine fibroblast cell-line L 929 was less affected compared to the macrophage cell-line RAW 264 with a higher endocytic capacity. On the other hand, both gamma irradiated and non-irradiated liposomes composed of saturated phospholipids were non-toxic for the cells and irradiation did not affect their drug delivery properties. Hence, it seems that gamma irradiation is appropriate for sterilisation of these liposomes.

Drug retention and stability of solid lipid nanoparticles containing azidothymidine palmitate after autoclaving, storage and lyophilization

Solid lipid nanoparticles (SLNs) were prepared using trilaurine (TL) as the SLN core and phospholipid (PL) as coating. Neutral and negatively charged PLs were used to produce neutral and negatively charged SLNs. An ester prodrug of 3'-azido-3'-deoxythymidine (Zidovudine, AZT), AZT palmitate (AZT-P), was synthesized and incorporated in the SLNs. The stability of SLN formulations containing AZT-P was studied at different temperatures. Drug retention and mean particle diameter of SLNs were determined after autoclaving, during temperature stability testing, and after lyophilization (with or without cryoprotective sugars) and reconstitution. There were no significant changes in the mean diameter and the zeta potential (zeta) of SLNs after autoclaving (121 degrees C for 20 min). The amount of incorporated AZT-P was, however, slightly reduced due to the formation of hydrosoluble AZT. Autoclaved SLNs were stable for a period of 10 weeks at 20 degrees C but an increase in particle size and loss of AZT-P were observed at 4 and 37 degrees C. Trehalose was an effective cryoprotectant for preventing SLN aggregation during lyophilization and subsequent reconstitution. Thermal gravimetric analysis showed that lyophilized preparations contained approximately 1% water. Using appropriate trehalose to lipid ratios, AZT-P retention in the SLNs was 100% after reconstitution. Our results demonstrate that SLNs containing AZT-P can be autoclaved, lyophilized and reconstituted without significant changes in SLN diameter and zeta potential or in the quantity of incorporated prodrug.

Comparative topical anaesthesia of EMLA and liposome-encapsulated tetracaine

BACKGROUND

The eutectic mixture of local anaesthetics (EMLA) provides effective topical anaesthesia after a minimum of 60 to 90 min application. Since liposome-encapsulated tetracaine (LET) can provide rapid dermal penetration, the goal of this study was to compare the local anaesthetic effects of EMLA and LET in human volunteers after 60 min application.

METHODS

After obtaining institutional approval and informed consent, healthy volunteers were recruited in a double blind, crossover, randomized trial. The study creams (0.5 ml EMLA and 0.5 ml LET 5%) were applied randomly to opposite arms for 60 min. The discomfort of i.v. catheterization was assessed using a visual analogue pain score (VAS). Cutaneous side effects of the creams were recorded.

RESULTS

Sixty-one subjects were studied. Twenty-one were excluded because of technical difficulties. Forty subjects completed the study and were included in the data analysis. The mean ( +/- SD) VAS was lower for LET than for EMLA (10.9 +/- 9.0 mm vs 22.7 +/- 17.1 mm, P < 0.001). Erythema secondary to vasodilatation occurred more frequent in the LET group than in the EMLA group (33 vs 3, P < 0.001). One subject with a history of atopy developed a rash at the LET application site.

CONCLUSION

Liposome-encapsulated tetracaine can provide a more effective topical anaesthesia than EMLA for intravenous catheterization after 60 min application. Clinical evaluations are necessary to determine the efficacy and safety of LET in providing topical anaesthesia for various invasive percutaneous procedures in other patient populations.

A submicron lipid emulsion coated with amphipathic polyethylene glycol for parenteral administration of paclitaxel (Taxol)

Paclitaxel is a promising anticancer agent with poor solubility in water and requires a suitable formulation for intravenous administration. Presently paclitaxel is formulated for clinical use in ethanol and Cremophor EL (Diluent 12), a solvent system associated with severe adverse effects. In this study paclitaxel was entrapped in lipid emulsion droplets with triolein as oil core and dipalmitoyl phosphatidylcholine as the principal emulsifier. The emulsion was further stabilized with polysorbate 80 and polyethylene glycol-dipalmitoyl phosphatidylethanolamine. The drug-emulsion droplets (diameter about 40 nm) were physically and chemically stable during several months at 4 degrees C. Lyophilized preparations in 5% glucose were completely restored by distilled water. Studies of the integrity of the drug-emulsion showed a release of the drug from emulsion globules and surface transfer was found to be the major mechanism for cellular uptake. The in-vitro antiproliferative activity of paclitaxel against T-47D cells was retained by the drug-emulsion with an ID50 value of 7 nM compared to 10 and 35 nM for paclitaxel in liposomes and Diluent 12, respectively. Long-circulating submicron lipid emulsions may prove useful, not only for replacement of the more toxic Cremophor EL vehicle, but also by improving the distribution of the drug to the tumour.

Gamma-irradiation of liposomes composed of saturated phospholipids: effect of bilayer composition, size, concentration and absorbed dose on chemical degradation and physical destabilization of liposomes

Liposomes composed of dipalmitoylphosphatidylcholine (DPPC), dipalmitoylphosphatidylglycerol (DPPG), or mixtures of these two phospholipids were exposed to gamma-irradiation in an air environment. Disappearance of the mother compounds was monitored by HPLC analysis. Plotting of the logarithmic values of residual DPPC or DPPG concentration versus irradiation dose resulted in straight lines. The slopes of these lines (overall degradation constants) depended on the type of phospholipids, concentration of the liposomes and the size of the liposomes. Under the chosen conditions, addition of DPPG in DPPC-liposomes did not affect the degradation rate constant of DPPC and vice versa. The presence of phosphate buffer (pH 7.4), pH or presence of sodium chloride did not affect the irradiation damage either. Minor changes were found upon analysis of total fatty acids by GLC and upon measurement of water soluble phosphate compounds. These changes were less pronounced than the changes monitored by HPLC of phospholipids, because the HPLC analysis monitored the overall degradation of the liposomal phospholipids. Thin-layer chromatography/fast atom bombardment mass spectrometry (TLC/FAB-MS) analysis of irradiated and non-irradiated DPPC or DPPG provided information on the structure of several degradation products. Degradation routes which include these degradation products are proposed. Gamma-irradiation neither affected the size of the liposomes nor the bilayer rigidity as determined by dynamic light scattering and fluorescence anisotropy of the probe 1,6-diphenyl-1,3,5-hexatriene (DPH), respectively. However, upon gamma-irradiation, changes in the melting characteristics of the liposomes were found by differential scanning calorimetry (DSC) measurements. The pre-transition melting enthalpy of the liposomal bilayer decreased or disappeared and the main-transition broadened. The changes found in DSC scans correlated qualitatively well with the changes recorded after HPLC analysis of phospholipids.

Autoclaving of liposomes

The attempt was made to study liposome stability and oxidation under the autoclaving conditions. It was shown that after the preliminary air removal from a liposome sample there was no lipid oxidation (malonaldehyde bis(dimethyl acetate) was used as a control) and liposome content leakage during autoclaving. Liposomes with entrapped Intal remain completely intact after autoclaving for 15 min at 120 degrees C.

Absorption of liposome-encapsulated tetracaine versus nonliposome-encapsulated tetracaine from open wounds in rabbits

The plasma tetracaine concentration versus time profiles for liposome-encapsulated tetracaine (LET) versus nonliposome-encapsulated tetracaine (NLET) were determined after topical application to open wounds in six rabbits (three in LET and three in NLET). H3-tetracaine preparations of LET or NLET were applied randomly to uniform dermal lacerations in anesthetized rabbits. Plasma tetracaine concentrations (ng/mL) of arterial blood samples obtained were measured at predetermined intervals (0.25, 0.5, 1.0, 2.0, and 24 hours) by isotope tracer assay. Results (mean +/- standard deviation) showed the peak plasma tetracaine concentration (Cmax) and the time to Cmax were 40.8 +/- 5.1 ng/mL and 40.1 +/- 7.3 minutes for LET, and 117.8 +/- 9.7 ng/mL and 49.1 +/- 50.2 minutes for NLET. Plasma tetracaine concentrations at all samples times were significantly lower for LET versus NLET. Liposome encapsulation of topically applied tetracaine significantly decreases both the peak and overall plasma tetracaine concentrations compared with the nonencapsulated form. The data suggest that liposome encapsulation of topically applied local anesthetics such as a solution of tetracaine, adrenaline, and cocaine, might reduce the potential systemic toxicity caused by rapid absorption of these compounds.

Novel taxol formulations: preparation and characterization of taxol-containing liposomes

Taxol is a promising anticancer agent under investigation for therapy of ovarian, breast, colon, and head and neck cancer. One problem associated with the administration of taxol is its low solubility in most pharmaceutically-acceptable solvents; the formulation used clinically contains Cremophor EL (polyethoxylated castor oil) and ethanol as excipients, which cause serious adverse effects. To eliminate this vehicle and possibly improve the antitumor efficacy of taxol, we have formulated taxol in liposomes of various compositions. Liposome formulations containing taxol and phospholipid in the molar ratio 1:33 were prepared from phosphatidylglycerol (PG) and phosphatidylcholine (PC) (1:9 molar ratio), and were physically and chemically stable for more than 2 months at 4 degrees C, or for 1 month at 20 degrees C. A method of producing taxol-liposomes by lyophilization has been developed, by which large batches can be prepared reproducibly in a 'pharmaceutically rational' manner. Taxol-liposomes retained the growth-inhibitory activity of the free drug in vitro against a variety of tumor cell lines. In mice, taxol-liposomes were well-tolerated when given in bolus doses by both iv and ip routes. The Maximum Tolerated Dose (MTD) was > 200 mg/kg; it exceeded that of free taxol, which had a MTD of 30 mg/kg by iv or 50 mg/kg by ip administration. Free taxol administered in the Cremophor vehicle was toxic at doses > 30 mg/kg, as was the equivalent volume of vehicle without drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipid-associated methylpheophorbide-a (hexyl-ether) as a photodynamic agent in tumor-bearing mice

Liposomes are a potential system for more selective delivery of photosensitizers (PS) to tumors. Pheophorbides are one series of new PS under investigation for use in photodynamic therapy. The pharmacokinetics, anti-tumor response and normal tissue effects of methylpheophorbide-a-(hexyl-ether) (MPH) associated with negatively charged phospholipid vesicles composed of high and low transition temperature lipids were determined in mice. In some preparations monosialoganglioside, which is known to impart long circulation time to liposomes was also included. Normally water-insoluble MPH could be quantitatively incorporated in multilamellar liposomes up to at least 20 mol MPH/mol lipid% for most liposome compositions and sonicated to form clear suspensions. Evidence from electron microscopy and entrapment of aqueous space markers indicated that the particles formed by sonication were not standard liposomes. Anti-tumor responses to light treatment (135 J/cm2, 665 nm argon-dye laser) 24 h after MPH (0.4 mumol/kg) administration were slightly but significantly greater (P < 0.05) for lipid associated MPH compared to MPH solubilized in Tween 80. There were no major differences in tumor uptake and tumor cell photosensitization between lipid or Tween 80 formulations of MPH, whereas, dependent on lipid composition and time after MPH administration, the doses of light required to cause occlusive vascular damage were increased for the lipid formulations. Pharmacokinetic studies showed rapid dissociation between lipids and MPH in vivo. Lipid formulations are useful for solubilizing MPH and may improve the therapeutic effects of this PS.

Enhancement of tissue delivery and receptor occupancy of methylprednisolone in rats by a liposomal formulation

A liposomal formulation of methylprednisolone (L-MPL) was developed to improve localization of this immunosuppressant in lymphatic tissues. Liposomes containing MPL were formulated from a mixture of phosphatydylcholine and phosphatydylglycerol (molar ratio, 9:1) and sized by extrusion through a 0.1-micron membrane. Male Sprague-Dawley rats received a bolus dose of 2 mg/kg of L-MPL or free MPL in solution (control). Samples of blood, spleen, liver, thymus, and bone marrow were collected at intervals over a 66-hr period. Concentrations of MPL in plasma and organs and free cytosolic glucocorticoid receptors (GCR) in spleen and liver were determined. The plasma MPL profiles for free and L-MPL were bi- and triexponential. Although the alpha phase kinetics of both dosage forms were similar, L-MPL showed a substantially slower elimination phase than did free drug. Incorporation of MPL into liposomes caused the following increases: terminal half-life, from 0.48 (MPL) to 30.13 hr (L-MPL); MRT, from 0.42 to 11.95 hr, Vss, from 2.10 to 21.87 L/kg; and AUC, from 339 to 1093 ng x hr/mL. Uptake of liposomes enhanced significantly the delivery of drug to lymphatic tissues and liver; AUC tissue:plasma ratios for spleen increased 77-fold; for liver, 9-fold; and for thymus, 27-fold. The duration of GCR occupancy was extended 10-fold in spleen and 13-fold in liver by the liposomal formulation. Lymphatic tissue selectivity and extended receptor binding of liposome-delivered MPL offer promise for enhanced immunosuppression.

Effect of blood-brain barrier and blood-tumor barrier modification on central nervous system liposomal uptake

In this study of 25 central nervous system (CNS) tumor-bearing rats, the CNS biodistribution of intravenously administered, indium-labeled liposomes was investigated. In 16 animals, the blood-brain barrier and blood-tumor barrier were modified using intracarotid administration of etoposide. In control animals, analysis by autoradiography and well-counting experiments demonstrated uptake of liposomes in the tumor-bearing hemisphere (% injected dose/g tissue = 0.135) with minimal uptake in the non-tumor-bearing hemisphere (% injected dose/g tissue = 0.007), p < 0.01. Unilateral intracarotid etoposide administration enhanced liposome uptake in both hemispheres-0.215 and 0.023 (tumor-bearing and nontumor-bearing), respectively. The presence of meningeal tumor involvement in nontumor-implanted hemispheres increased liposomal uptake 10-fold. These findings may have clinical applicability in designing therapeutic protocols for the treatment of CNS tumors.

Liposomes in the treatment of malignancy: a clinical perspective

Technological advances in liposomal preparation and efficient drug entrapment, along with supportive preclinical studies, have led to a number of recent clinical trials utilizing liposomes as drug carriers in the treatment of human malignancy. Although the results of these trials must be considered preliminary, it is clear that liposomal delivery of chemotherapeutic agents is safe at the doses administered. Aside from minor constitutional symptoms, virtually all toxicity could be attributed to release of the incorporated drug. Myelosuppression tends to be the dose-limiting toxicity with free drug, whereas constitutional symptoms are more likely to occur with encapsulated biologic therapy. Prior to human trials, there was fear that intravenous injection of liposomes could result in pulmonary emboli. No cases of pulmonary embolism secondary to liposome therapy have been recorded. The objective response rate in the patients studied appears to be minimal. This is not surprising, since the overwhelming majority of patients studied had disease that was advanced and previously shown to be refractory to therapy. Subgroups of patients that appear to benefit most include those with breast cancer who were treated with liposomal doxorubicin and those with advanced melanoma treated with liposomal tumor vaccines. Additional phase II and III clinical trials will better define the effectiveness of treatment modalities incorporating liposomes. VI-A. Future directions One of the earliest applications of liposomes may be in the amelioration of drug toxicity. Although not yet proven, the clinical studies reviewed suggest that liposomal delivery of doxorubicin reduces cardiotoxicity without sacrificing antitumor effect. Although similar claims have been made in support of continuous infusion doxorubicin [11], one can avoid unnecessary hospitalization or the bulk and expense of portable infusion devices by a single administration of the liposomal preparation. Liposome encapsulation can markedly alter the biodistribution and pharmacokinetics of well-known chemotherapeutic agents. The effectiveness of liposomal drug delivery in human trials thus far has probably been more closely related to altered pharmacokinetics rather than enhanced drug delivery to tumor or increased tumor responsiveness. As demonstrated by Gabizon [19], increased liposome circulating time in the murine model can be achieved by using small unilamellar vesicles containing a phosphatidylcholine of high phase-transition temperature and a small molar fraction of monosialoganglioside or hydrogenated phosphatidylinositol.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical experience of targeted therapy

Drug targeting (i.e. administration of a drug-carrier conjugate which delivers active drug selectively to a particular tissue) has recently evolved into a new subdiscipline of experimental pharmacy/pharmacology. However, clinical experience with targeted therapy is very limited to date. This review summarizes human studies of targeted therapy. Indications for which drug targeting has been attempted include neoplastic disorders, fungal infections, enzyme replacement, hematologic and immune disorders, and iron storage disease. To date, no single drug targeting system is recommendable for routine clinical use, but present results justify further clinical evaluation in a number of situations.

Separation of liposome-associated doxorubicin from non-liposome-associated doxorubicin in human plasma: implications for pharmacokinetic studies

To characterize the pharmacokinetics of liposome-associated drugs, the fraction of drug circulating in liposome-associated form and the absolute plasma drug levels must be determined. In this report, we describe our methodological approach to quantitate plasma liposome-associated doxorubicin separately from protein-bound and free doxorubicin. The method is based on the affinity of a cation-exchange resin for doxorubicin and the repulsion by the same resin of negatively-charged liposomes. The methodology is technically simple and reproducible, and lends itself to the analysis of multiple plasma samples as required in pharmacokinetic studies. The validity of this approach was confirmed by separation of liposome-associated from non-liposome-associated drug using gel exclusion chromatography.

Liposomes as drug delivery system in the treatment of infectious diseases. Potential applications and clinical experience

Liposomes are microscopic, closed lipid vesicles able to entrap hydrophilic as well as lipophilic compounds. They constitute a versatile drug delivery system. When injected by the intravenous route, liposomes are taken up by macrophages in the liver and in the spleen. Investigation of several animal models of infections has shown that liposome-entrapped anti-infectious drugs are active against infections due to facultative intracellular bacteria, parasites such as Leishmania, viruses such as the one causing Rift valley fever. Liposomes of different lipid compositions, structures and sizes were used for intravenous administration of anti-infectious drugs without inducing toxicity in the tested animals. Clinical experience was obtained with two different liposomal preparations of amphotericin B in the treatment of systemic fungal diseases in cancer patients; these preparations were shown to be effective and very well-tolerated.

Incorporation of chlorpromazine into bilayer liposomes for protection against microsomal metabolism and liver absorption

Chlorpromazine (CPZ) was incorporated into bilayer liposomes carrying negative charges either from phosphatidic acid (PA) or from phosphatidyl inositol (PI). CPZ incorporation was dependent on the amount of negatively charged lipid present in the liposomes. At a concentration of 0.6 mol parts phosphatidic acid as referred to egg phosphatidyl choline (EPC) as matrix lipid, 80 micrograms CPZ/mg EPC were stably incorporated. At the saturation concentration a 1:1 molar complex between the phenothiazine drug and the negatively charged lipid is formed. This lipophilic complex retains the CPZ molecules firmly within the lipid bilayer. In vitro release of CPZ into the medium surrounding the liposomes was found to be a very slow process with release half-times of 30 to 99 hours depending on liposome composition. Microsomal metabolism of liposomally incorporated CPZ was slowed and reduced by 50% as determined by the formation of CPZ-sulfoxide. In single pass liver perfusion experiments it was shown that CPZ absorption is significantly reduced when CPZ is incorporated into liposomes. It is suggested that this protective effect of the liposomes might influence the pharmacological effects of CPZ and reduce its hepatotoxic properties.

The antitumour effect of lipophilic derivatives of 5-fluoro-2'-deoxyuridine incorporated into liposomes

Lipophilic prodrugs of 5-fluoro-2'-deoxyuridine (FUdR), namely 5'-O-palmitoyl-5-fluoro-2'-deoxyuridine (5'-O-palm-FUdR) and 3',5'-O-dipalmitoyl-5-fluoro-2'-deoxyuridine (3',5'-O-dipalm-FUdR), were incorporated into bilayer liposomes. Prodrug incorporation into positively charged liposomes was quantitative and stable, homogeneous bilayer vesicles were obtained. The maximal amounts of prodrug incorporation are 200 micrograms for 5'-O-palm-FUdR and 90 micrograms for 3',5'-O-dipalm-FUdR per mg egg phosphatidylcholine as matrix lipid. The prodrug-liposome preparations were tested in vivo against mammary carcinoma 13/C, Lewis lung carcinoma and L1210 leukaemia and compared to the cytostatic activity of free FUdR and of the prodrugs dissolved in peanut oil. Intraperitoneally administered prodrugs either incorporated into liposomes or dissolved in peanut oil inhibited tumour growth in all animals. The comparison of the doses required for tumour growth inhibition showed that both prodrugs were active at concentrations 20-75 times lower as compared to unmodified FUdR. However, due to the increased toxicity of the prodrug-liposome preparations, the therapeutic index of the parent drug FUdR could not be improved. The cytostatic effect of the prodrug preparations may be explained by altered pharmacokinetic properties of the FUdR derivatives and the additional sustained release action the liposomes are providing. A further increase of the antitumour activity may be obtained by the attachment of tumour-specific antibodies to the surface of such prodrug-containing liposomes.