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Party P, Klement ML, Szabó-Révész P, Ambrus R. Preparation and Characterization of Ibuprofen Containing Nano-Embedded-Microparticles for Pulmonary Delivery. Pharmaceutics 2023; 15:pharmaceutics15020545. [PMID: 36839867 PMCID: PMC9966045 DOI: 10.3390/pharmaceutics15020545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
A fatal hereditary condition, cystic fibrosis (CF) causes severe lung problems. Ibuprofen (IBU), a non-steroidal anti-inflammatory drug, slows the progression of disease without causing significant side effects. Considering the poor water-solubility of the drug, IBU nanoparticles are beneficial for local pulmonary administration. We aimed to formulate a carrier-free dry powder inhaler containing nanosized IBU. We combined high-performance ultra-sonication and nano spray-drying. IBU was dissolved in ethyl acetate; after that, it was sonicated into a polyvinyl alcohol solution, where it precipitated as nanoparticles. Mannitol and leucine were added when producing dry particles using nano-spray drying. The following investigations were implemented: dynamic light scattering, laser diffraction, surface tension measurement, scanning electron microscopy, X-ray powder diffraction, differential scanning calorimetry, Fourier-transform infrared spectroscopy, in vitro dissolution test, and in vitro aerodynamic assessment (Andersen Cascade Impactor). The particle diameter of the IBU was in the nano range. The spray-dried particles showed a spherical morphology. The drug release was rapid in artificial lung media. The products represented large fine particle fractions and proper aerodynamic diameters. We successfully created an inhalable powder, containing nano-sized IBU. Along with the exceptional aerodynamic performance, the ideal particle size, shape, and drug-release profile might offer a ground-breaking local therapy for CF.
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Prados C, Zamarrón E, Girón R, Quintana E, Máiz L, Nieto R, Asensio Ó, Álvarez-Sala R, Quirós S, Martínez-Redondo M, Mangas A, Martínez-Martínez T. ¿Qué supuso el consenso español para el tratamiento de la infección por Pseudomonas aeruginosa en pacientes con fibrosis quística en la infección pulmonar inicial? Med Clin (Barc) 2020; 154:232-235. [DOI: 10.1016/j.medcli.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 11/25/2022]
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Yang Q, Soltis AR, Sukumar G, Zhang X, Caohuy H, Freedy J, Dalgard CL, Wilkerson MD, Pollard HB, Pollard BS. Gene therapy-emulating small molecule treatments in cystic fibrosis airway epithelial cells and patients. Respir Res 2019; 20:290. [PMID: 31864360 PMCID: PMC6925517 DOI: 10.1186/s12931-019-1214-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/11/2019] [Indexed: 12/22/2022] Open
Abstract
Background Several small molecule corrector and potentiator drugs have recently been licensed for Cystic Fibrosis (CF) therapy. However, other aspects of the disease, especially inflammation, are less effectively treated by these drugs. We hypothesized that small molecule drugs could function either alone or as an adjuvant to licensed therapies to treat these aspects of the disease, perhaps emulating the effects of gene therapy in CF cells. The cardiac glycoside digitoxin, which has been shown to inhibit TNFα/NFκB signaling in CF lung epithelial cells, may serve as such a therapy. Methods IB3–1 CF lung epithelial cells were treated with different Vertex (VX) drugs, digitoxin, and various drug mixtures, and ELISA assays were used to assess suppression of baseline and TNFα-activated secretion of cytokines and chemokines. Transcriptional responses to these drugs were assessed by RNA-seq and compared with gene expression in AAV-[wildtype]CFTR-treated IB3–1 (S9) cells. We also compared in vitro gene expression signatures with in vivo data from biopsied nasal epithelial cells from digitoxin-treated CF patients. Results CF cells exposed to digitoxin exhibited significant suppression of both TNFα/NFκB signaling and downstream secretion of IL-8, IL-6 and GM-CSF, with or without co-treatment with VX drugs. No evidence of drug-drug interference was observed. RNA-seq analysis showed that gene therapy-treated CF lung cells induced changes in 3134 genes. Among these, 32.6% were altered by digitoxin treatment in the same direction. Shared functional gene ontology themes for genes suppressed by both digitoxin and gene therapy included inflammation (84 gene signature), and cell-cell interactions and fibrosis (49 gene signature), while genes elevated by both were enriched for epithelial differentiation (82 gene signature). A new analysis of mRNA data from digitoxin-treated CF patients showed consistent trends in expression for genes in these signatures. Conclusions Adjuvant gene therapy-emulating activities of digitoxin may contribute to enhancing the efficacy of currently licensed correctors and potentiators in CF patients.
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Affiliation(s)
- Q Yang
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine- America's Medical School, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - A R Soltis
- Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - G Sukumar
- Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - X Zhang
- Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - H Caohuy
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine- America's Medical School, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - J Freedy
- Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - C L Dalgard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine- America's Medical School, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA.,Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - M D Wilkerson
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine- America's Medical School, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA.,Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA
| | - H B Pollard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University School of Medicine- America's Medical School, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA. .,Collaborative Health Initiative Research Program (CHIRP), The American Genome Center (TAGC), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, 20814, USA.
| | - B S Pollard
- Silver Pharmaceuticals, Rockville, MD, 20854, USA.
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Szabó-Révész P. Modifying the physicochemical properties of NSAIDs for nasal and pulmonary administration. DRUG DISCOVERY TODAY. TECHNOLOGIES 2018; 27:87-93. [PMID: 30103868 DOI: 10.1016/j.ddtec.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
Abstract
This review focuses on nasal and pulmonary delivery of NSAIDs (non-steroidal anti-inflammatory drugs) for fast-onset analgesia, for the potential prevention of Alzheimer's disease (AD), as well as for an add-on treatment in cystic fibrosis (CF) and non-small cell lung cancer (NSCLC). I discuss how the physicochemical properties of NSAIDs can be modified with respect to the biological characteristics of the target site. Innovative technology and/or dosage forms can promote an effective therapy.
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Affiliation(s)
- P Szabó-Révész
- University of Szeged, Institute of Pharmaceutical Technology and Regulatory Affairs, Eötvös u 6, 6720 Szeged, Hungary.
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Sheikh Z, Ong HX, Pozzoli M, Young PM, Traini D. Is there a role for inhaled anti-inflammatory drugs in cystic fibrosis treatment? Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1409110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Zara Sheikh
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Hui Xin Ong
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michele Pozzoli
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Paul M Young
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Daniela Traini
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
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Olveira C, Padilla A, Dorado A, Contreras V, Garcia-Fuentes E, Rubio-Martin E, Porras N, Doña E, Carmona A, Olveira G. Inflammation and Oxidation Biomarkers in Patients with Cystic Fibrosis: The Influence of Azithromycin. Eurasian J Med 2017. [PMID: 28638254 DOI: 10.5152/eurasianjmed.2017.17010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In addition to their antibiotic effect, macrolides appear to modulate the inflammatory response in cystic fibrosis (CF) and could influence oxidative stress. The objective of this study was to assess oxidation biomarkers and levels of inflammation and to determine whether there is an association between these parameters and the intake of macrolides. MATERIALS AND METHODS The subjects included in this cross-sectional study were, on the one hand, clinically stable patients with CF and, on the other, healthy controls. The following serum and plasma inflammatory and oxidative stress biomarkers were measured: interleukin-6 (IL-6), reactive C protein (RCP), tumor necrosis alpha (TNF-α), glutathione peroxidase (GPx), total antioxidant capacity (TAC), catalase (CAT), and superoxide dismutase (SOD), together with markers of lipid peroxidation (8-isoprostanes and thiobarbituric acid reactive substances [TBARS]). Clinical, anthropometric, lung function, radiological, and analytical variables (albumin, prealbumin, vitamins, and zinc) were also recorded. RESULTS We studied 36 adults with CF and 41 controls. No differences were observed in age, gender, or anthropometric variables. The patients had significantly higher levels of IL-6, TNF-α, RCP, TBARS, and isoprostanes, and lower levels of SOD than the controls. Twenty-three of the patients were treated with azithromycin, and they had more severe clinical and radiological parameters than those who were not but nevertheless presented significantly lower levels of TNF-α. No differences were observed in the markers of oxidation. CONCLUSION Inflammation and oxidation biomarkers were increased in patients with CF compared with controls. The use of azithromycin was associated with reduced TNF-α levels and did not influence oxidation parameters.
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Affiliation(s)
- Casilda Olveira
- Pneumology Service, IBIMA (Institute of Biomedical Research in Malaga), Regional University of Málaga, Málaga, Spain
| | - Alicia Padilla
- Pneumology Unit, The Costa del Sol Health Agency, Málaga, Spain
| | - Antonio Dorado
- Pneumology Service, Hospital Regional University of Málaga, Málaga, Spain
| | - Victoria Contreras
- Endocrinology and Nutrition Unit, IBIMA (Institute of Biomedical Research in Malaga), Regional University Hospital of Málaga University, Málaga, Spain
| | - Eduardo Garcia-Fuentes
- Endocrinology and Nutrition Unit, IBIMA (Institute of Biomedical Research in Malaga), Regional University Hospital of Málaga University, Málaga, Spain
| | - Elehazara Rubio-Martin
- Endocrinology and Nutrition Unit, IBIMA (Institute of Biomedical Research in Malaga), Regional University Hospital of Málaga University, Málaga, Spain
| | - Nuria Porras
- Endocrinology and Nutrition Unit, IBIMA (Institute of Biomedical Research in Malaga), Regional University Hospital of Málaga University, Málaga, Spain
| | - Esperanza Doña
- Pneumology Unit, High Resolution Hospital of Benalmádena, Málaga, Spain
| | - Ana Carmona
- Department of Medicine and Dermatology, Málaga University Faculty of Medicine, Málaga, Spain
| | - Gabriel Olveira
- Endocrinology and Nutrition Unit, IBIMA (Institute of Biomedical Research in Malaga), Regional University Hospital of Málaga University, Málaga, Spain.,CIBERDEM (CIBER of Diabetes and Associated Metabolic Diseases)
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7
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Li J, Hao C, Ren L, Xiao Y, Wang J, Qin X. Data Mining of Lung Microbiota in Cystic Fibrosis Patients. PLoS One 2016; 11:e0164510. [PMID: 27741283 PMCID: PMC5065158 DOI: 10.1371/journal.pone.0164510] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/26/2016] [Indexed: 12/18/2022] Open
Abstract
The major therapeutic strategy used to treat exacerbated cystic fibrosis (CF) is antibiotic treatment. As this approach easily generates antibiotic-resistant strains of opportunistic bacteria, optimized antibiotic therapies are required to effectively control chronic and recurrent bacterial infections in CF patients. A promising future for the proper use of antibiotics is the management of lung microbiota. However, the impact of antibiotic treatments on CF microbiota and vice versa is not fully understood. This study analyzed 718 sputum samples from 18 previous studies to identify differences between CF and uninfected lung microbiota and to evaluate the effects of antibiotic treatments on exacerbated CF microbiota. A reference-based OTU (operational taxonomic unit) picking method was used to combine analyses of data generated using different protocols and platforms. Findings show that CF microbiota had greater richness and lower diversity in the community structure than uninfected control (NIC) microbiota. Specifically, CF microbiota showed higher levels of opportunistic bacteria and dramatically lower levels of commensal bacteria. Antibiotic treatment affected exacerbated CF microbiota notably but only transiently during the treatment period. Limited decrease of the dominant opportunistic bacteria and a dramatic decrease of commensal bacteria were observed during the antibiotic treatment for CF exacerbation. Simultaneously, low abundance opportunistic bacteria were thriving after the antibiotic treatment. The inefficiency of the current antibiotic treatment against major opportunistic bacteria and the detrimental effects on commensal bacteria indicate that the current empiric antibiotic treatment on CF exacerbation should be reevaluated and optimized.
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Affiliation(s)
- Jianguo Li
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China
| | - Chunyan Hao
- College of Chemical & Biological Engineering, Taiyuan University of Science & Technology, Taiyuan 030021, China
| | - Lili Ren
- MOH Key Laboratory of System Pathogen Biology and Christophe Mérieux Laboratory, IPB, CAMS-Foundation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yan Xiao
- MOH Key Laboratory of System Pathogen Biology and Christophe Mérieux Laboratory, IPB, CAMS-Foundation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jianwei Wang
- MOH Key Laboratory of System Pathogen Biology and Christophe Mérieux Laboratory, IPB, CAMS-Foundation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xuemei Qin
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China
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Cantón R, Máiz L, Escribano A, Olveira C, Oliver A, Asensio O, Gartner S, Roma E, Quintana-Gallego E, Salcedo A, Girón R, Barrio MI, Pastor MD, Prados C, Martínez-Martínez MT, Barberán J, Castón JJ, Martínez-Martínez L, Poveda JL, Vázquez C, de Gracia J, Solé A. Spanish Consensus on the Prevention and Treatment of Pseudomonas aeruginosa Bronchial Infections in Cystic Fibrosis Patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.arbr.2014.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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9
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Cantón R, Máiz L, Escribano A, Olveira C, Oliver A, Asensio O, Gartner S, Roma E, Quintana-Gallego E, Salcedo A, Girón R, Barrio MI, Pastor MD, Prados C, Martínez-Martínez MT, Barberán J, Castón JJ, Martínez-Martínez L, Poveda JL, Vázquez C, de Gracia J, Solé A. Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients. Arch Bronconeumol 2015; 51:140-50. [PMID: 25614377 DOI: 10.1016/j.arbres.2014.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 09/22/2014] [Indexed: 01/22/2023]
Abstract
Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and "patient-to-patient transmission" of this pathogen.
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Affiliation(s)
- Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, España; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España.
| | - Luis Máiz
- Unidad de Bronquiectasias y Fibrosis Quística, Servicio de Neumología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, España
| | - Amparo Escribano
- Unidad de Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Casilda Olveira
- Unidad de Gestión Clínica de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | - Antonio Oliver
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España; Servicio de Microbiología y Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, España
| | - Oscar Asensio
- Unidad de Neumología y Alergia Pediátrica, Hospital Universitario de Sabadell. Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Silvia Gartner
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Eva Roma
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Esther Quintana-Gallego
- Unidad de Fibrosis Quística, Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Antonio Salcedo
- Unidad de Fibrosis Quística Interhospitalaria Niño Jesús-Gregorio Marañón, Madrid, España
| | - Rosa Girón
- Unidad de Bronquiectasias y Fibrosis Quística, Hospital Universitario La Princesa, Instituto La Princesa de Investigación Sanitaria, Madrid, España
| | - María Isabel Barrio
- Sección de Neumología Pediátrica y Unidad de Fibrosis Quística, Hospital Universitario La Paz, Madrid, España
| | - María Dolores Pastor
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Concepción Prados
- Unidad de Fibrosis Quística y Bronquiectasias, Servicio de Neumología, Hospital Universitario La Paz, Madrid, España
| | | | - José Barberán
- Departamento de Medicina Interna, Hospital Montepríncipe, Universidad CEU San Pablo, Madrid, España
| | - Juan José Castón
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL y Departamento de Biología Molecular, Universidad de Cantabria, Santander, España
| | - José Luis Poveda
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Carlos Vázquez
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Javier de Gracia
- Servicio de Neumología y CIBER en Enfermedades Respiratorias (CibeRES), Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, España
| | - Amparo Solé
- Unidad de Trasplante Pulmonar y Fibrosis Quística, Hospital Universitario y Politécnico la Fe, Valencia, España.
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d'Angelo I, Conte C, La Rotonda MI, Miro A, Quaglia F, Ungaro F. Improving the efficacy of inhaled drugs in cystic fibrosis: challenges and emerging drug delivery strategies. Adv Drug Deliv Rev 2014; 75:92-111. [PMID: 24842473 DOI: 10.1016/j.addr.2014.05.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/23/2014] [Accepted: 05/09/2014] [Indexed: 02/06/2023]
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians associated with early death. Although the faulty gene is expressed in epithelia throughout the body, lung disease is still responsible for most of the morbidity and mortality of CF patients. As a local delivery route, pulmonary administration represents an ideal way to treat respiratory infections, excessive inflammation and other manifestations typical of CF lung disease. Nonetheless, important determinants of the clinical outcomes of inhaled drugs are the concentration/permanence at the lungs as well as the ability of the drug to overcome local extracellular and cellular barriers. This review focuses on emerging delivery strategies used for local treatment of CF pulmonary disease. After a brief description of the disease and formulation rules dictated by CF lung barriers, it describes current and future trends in inhaled drugs for CF. The most promising advanced formulations are discussed, highlighting the advantages along with the major challenges for researchers working in this field.
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Affiliation(s)
- Ivana d'Angelo
- Di.S.T.A.B.i.F., Second University of Napoli, Via Vivaldi 43, 81100 Caserta, Italy
| | - Claudia Conte
- Laboratory of Drug Delivery, Department of Pharmacy, University of Napoli Federico II, Via Domenico Montesano 49, 80131 Napoli, Italy
| | - Maria Immacolata La Rotonda
- Laboratory of Drug Delivery, Department of Pharmacy, University of Napoli Federico II, Via Domenico Montesano 49, 80131 Napoli, Italy
| | - Agnese Miro
- Laboratory of Drug Delivery, Department of Pharmacy, University of Napoli Federico II, Via Domenico Montesano 49, 80131 Napoli, Italy
| | - Fabiana Quaglia
- Laboratory of Drug Delivery, Department of Pharmacy, University of Napoli Federico II, Via Domenico Montesano 49, 80131 Napoli, Italy
| | - Francesca Ungaro
- Laboratory of Drug Delivery, Department of Pharmacy, University of Napoli Federico II, Via Domenico Montesano 49, 80131 Napoli, Italy.
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Smith DJ, Anderson GJ, Bell SC, Reid DW. Elevated metal concentrations in the CF airway correlate with cellular injury and disease severity. J Cyst Fibros 2014; 13:289-95. [DOI: 10.1016/j.jcf.2013.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/01/2013] [Accepted: 12/01/2013] [Indexed: 12/11/2022]
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12
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Shah N, Tan HL, Sebire N, Suri R, Leuven K. The role of endoscopy and biopsy in the management of severe gastrointestinal disease in cystic fibrosis patients. Pediatr Pulmonol 2013; 48:1181-9. [PMID: 23825099 DOI: 10.1002/ppul.22697] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/22/2012] [Indexed: 12/23/2022]
Abstract
There is increasing evidence to suggest the presence of chronic inflammation in the gastrointestinal (GI) tract of cystic fibrosis (CF) patients. Some CF patients continue to have very severe gastrointestinal symptoms despite conventional CF treatment. In our center, these patients are managed in a CF gastroenterology clinic, jointly with a pediatric gastroenterologist. A number have required GI endoscopy and biopsy. The aim of our study was to characterize these patients and determine whether endoscopy and biopsy changed their management. We reviewed all the patients seen in the CF gastroenterology clinic from 2004 to 2009, who had GI endoscopies performed. The GI symptoms these patients were experiencing included abdominal pain, nausea and vomiting, rectal bleeding, failure to thrive, loose stools, and constipation. Twelve patients had GI endoscopies with mucosal biopsies performed. The median [interquartile range (IQR)] age at referral to the CF gastroenterology clinic was 4 years [0.9-8]. Their body mass index (BMI) was 15.2 [13.7-15.5]. Twenty-five percent were homozygous delta F508. Two patients had previously had meconium ileus as neonates requiring surgical intervention. One other patient had needed abdominal surgery for intussusception. Ninty-two percent were pancreatic insufficient, 25% were chronically infected with Pseudomonas aeruginosa and 17% were on regularly 3 monthly intravenous antibiotics. Of the 10 patients who were able to perform spirometry, FEV1 was 101% [67-125] predicted. Nine of the 12 patients had evidence of mucosal inflammation in their biopsies, including duodenitis with eosinophilic infiltrate, chronic non-specific inactive gastritis, enteropathy with partial villous atrophy, and non-specific colitis. Immunosuppressive and anti-inflammatory therapies were commenced in these nine patients, including prednisolone, azathioprine, methotrexate, ketotifen, mesalazine, and sulfasalazine as well as the use of parenteral nutrition and elemental feeds. All the patients clinically responded to therapy. Five of the patients commenced on anti-inflammatory therapy had repeat biopsies 1-5 years following commencement of treatment and all showed histological improvement of the mucosal inflammation. GI endoscopy with mucosal biopsy has a significant role to play in the management of CF children with severe GI disease. In our study, it influenced the management in the majority of patients with severe GI symptoms. Furthermore, if GI mucosal inflammation is identified on biopsy, management with immunomodulatory agents may be clinically beneficial.
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Affiliation(s)
- Neil Shah
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
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Iannitti RG, Carvalho A, Cunha C, De Luca A, Giovannini G, Casagrande A, Zelante T, Vacca C, Fallarino F, Puccetti P, Massi-Benedetti C, Defilippi G, Russo M, Porcaro L, Colombo C, Ratclif L, De Benedictis FM, Romani L. Th17/Treg imbalance in murine cystic fibrosis is linked to indoleamine 2,3-dioxygenase deficiency but corrected by kynurenines. Am J Respir Crit Care Med 2013; 187:609-20. [PMID: 23306541 DOI: 10.1164/rccm.201207-1346oc] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Mutations in the cystic fibrosis (CF) transmembrane conductance regulator affect the innate epithelial immune function of the lung, resulting in exaggerated and ineffective airway inflammation that fails to eradicate pathogenic fungi. The appreciation of whether such fungi are primarily responsible for or a consequence of ineffective airway inflammation is important for future therapeutics development. OBJECTIVES To characterize the impact of the tryptophan/kynurenine pathway on pathogenic airway inflammation preventing effective fungal clearance in CF. METHODS We studied the expression of indoleamine 2,3-dioxygenase (IDO), the first enzyme in the kynurenine pathway of tryptophan degradation, in human and murine CF, the impact of IDO on lung inflammation and immunity in murine CF, and the potential role of tryptophan catabolism in pathogenesis and therapy of fungus-associated lung inflammation. MEASUREMENTS AND MAIN RESULTS IDO was defective in murine and human CF. Genetic and transcriptional regulatory mechanisms contributed to dysfunctional IDO activity that, in turn, correlated with imbalanced Th17/Treg-cell responses to Aspergillus fumigatus in murine CF. Treatments enhancing IDO function or preventing pathogenic Th17-cell activation restored protective immunity to the fungus and improved lung inflammation in murine CF. CONCLUSIONS This study provides a link between tryptophan catabolism and lung immune homeostasis in murine CF, representing a proof-of-concept that targeting pathogenic inflammation via IDO-mimetic drugs may benefit patients with CF.
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Affiliation(s)
- Rossana G Iannitti
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, Perugia, Italy
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Feldman C. The Use of Antiinflammatory Therapy and Macrolides in Bronchiectasis. Clin Chest Med 2012; 33:371-80. [DOI: 10.1016/j.ccm.2012.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hirsch R, Deng H, Laohachai MN. Azithromycin in periodontal treatment: more than an antibiotic. J Periodontal Res 2011; 47:137-48. [PMID: 22050485 DOI: 10.1111/j.1600-0765.2011.01418.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Azithromycin is a macrolide antibiotic used extensively in medicine for the treatment of a wide range of infections such as upper respiratory tract infections, middle ear infections, sexually transmitted infections and trachoma. It is also effective against the most common periodontopathogens. The versatility of the macrolides extends beyond their antibiotic properties as a result of their well-documented immune-modulating/anti-inflammatory effects. Macrolides, including azithromycin, are therefore used to treat diseases not associated with bacteria, such as severe asthma, chronic obstructive pulmonary diseases and, more recently, cystic fibrosis. Azithromycin is concentrated in neutrophils, macrophages and particularly fibroblasts; all of these cells are central players in the pathogenesis of most periodontal diseases. This paper reviews the diverse properties of azithromycin and the clinical periodontal studies of its effects in both the treatment of periodontitis and in resolving drug-related gingival overgrowth. Evidence exists to support the use of a single course of azithromycin in the treatment of advanced periodontal diseases. Azithromycin could have a triple role in the treatment and resolution of periodontal diseases: suppressing periodontopathogens, anti-inflammatory activity and healing through persistence at low levels in macrophages and fibroblasts in periodontal tissues, even after a single course of three tablets. If future periodontal research confirms these properties, it could become a valuable host-modulator in periodontal treatment.
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Affiliation(s)
- R Hirsch
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.
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