Intraosseous delivery of paclitaxel-loaded hydroxyapatitealginate composite beads delaying paralysis caused by metastatic spine cancer in rats

Local Suppression Effect of Paclitaxel-Impregnated Hydroxyapatite/Collagen on Breast Cancer Bone Metastasis in a Rat Model

Introduction

Breast cancer is one of the most frequent primary tumors that cause spinal metastases. Metastasis consequences impair both the patient's overall prognosis and quality of life. We previously developed a porous hydroxyapatite collagen composite (HAp/Col) as an osteoconductive scaffold. HAp/Col is a commercially available artificial bone that is frequently utilized in spinal fusion. Because of its high absorbance capacity, HAp/Col is regarded as a good chemical carrier.

Methods

This study investigated the effect of local administration of paclitaxel combined with HAp/Col scaffold on breast cancer metastasis. High-performance liquid chromatography was used to assess the in vitro release of paclitaxel from HAp/Col. In an in vivo rat model, the inhibitory effects of paclitaxel-impregnated scaffolds on local osteogenesis was examined, and then the local suppression effects on metastatic cancer were investigated.

Results

In vitro testing revealed that roughly 30% of the paclitaxel was released within 96 hours. Paclitaxel-impregnated HAp/Col inhibited local osteogenesis for the first 8 weeks in a rat femur. However, at 12 weeks following surgery, this negative effect appeared to have subsided. In the metastatic model, all rats in the control group reached the humane endpoint 14 days after surgery. On the other hand, the average time to the endpoint in the paclitaxel group was 26.5 days, which was substantially longer than that in the control group. Long-term survivors treated with paclitaxel had no remaining tumor cells in the femoral bone, and osteogenesis was seen surrounding the HAp/Col.

Conclusions

Paclitaxel-impregnated HAp/Col reduced local tumor development and extended the time to the target endpoint in rats with metastases from breast cancer. This study shows that local implantation of paclitaxel-impregnated HAp/Col may be a viable therapeutic option for the management of breast cancer metastases.

Alginate hydrogels functionalized with β-cyclodextrin as a local paclitaxel delivery system

Modification of drug delivery materials with beta-cyclodextrins (β-CyD) is known to increase solubility of poorly water-soluble drugs, protect drugs from degradation and sustain release. In this study, we developed a hydrogel drug delivery system for local paclitaxel delivery using the natural polysaccharide alginate functionalized with β-CyD-moieties. Paclitaxel was chosen due to its ability to form inclusion complexes with cyclodextrins. The rheological and mechanical properties of the prepared hydrogels were characterized, as well as in vitro release of the paclitaxel and in vitro activity on PC-3 prostate cancer cells. Introduction of β-CyD-moieties into the hydrogel reduces the mechanical properties of the gels compared to nonmodified gels. However, gelation kinetics were not markedly different. Furthermore, the β-CyD-modified alginate helped to reduce undesired crystallization of the paclitaxel in the gel and facilitated paclitaxel diffusion out of the gel network. Remarkably, the β-CyD grafted alginate showed increased capacity to complex paclitaxel compared to free HPβ-CyD. Release of both paclitaxel and degradation products were measured from the gels and were shown to have cytotoxic effects on the PC-3 cells. The results indicate that functionalized alginate with β-CyDs has potential as a material for drug delivery systems.

Nanocarrier-based drug delivery systems for bone cancer therapy: a review

Bone cancer is a malignant tumor that originates in the bone and destroys the healthy bone tissues. Of the various types of bone tumors, osteosarcoma is the most commonly diagnosed primary bone malignancy. The standard treatment for primary malignant bone tumors comprises surgery, chemotherapy and radiotherapy. Owing to the lack of proven treatments, different forms of alternative therapeutic approaches have been examined in recent decades. Among the new therapeutic methodologies, nanotechnology-based anticancer therapy has paved the way for new targeted strategies for bone cancer treatment and bone regeneration. They include approaches such as the co-delivery of multiple drug cargoes, the enhancement of their biodistribution and transport properties, normalizing accumulation and the optimization of drug release profiles to overcome shortcomings of the existing therapy. This review examines the standard treatments for osteosarcoma, their lacunae, and the evolving therapeutic strategies based on nanocarrier-mediated combinational drug delivery systems, and future perspectives for osteosarcoma therapy.

Feasibility of local administration of chemotherapeutic drugs as an effective adjuvant therapy in primary, recurrent and metastatic extradural tumours of the spine-review

Present day multimodality treatment with advances in systemic chemotherapy and radiotherapy has increased the survival of patients significantly even in those primary tumours which were once considered to have a poor prognosis. However, local recurrence can severely jeopardise the quality of life and even reduce survival. Hence local recurrence is considered as the worst complication in the management of spinal tumours and the need to achieving adequate local tumour control cannot be overemphasised. Techniques like en bloc resections which significantly reduce the chances of local recurrence are always not possible due to anatomical and technical reasons and sometimes, not feasible in debilitated patients. Local administration of chemotherapeutic drugs has already been recognised as a treatment strategy in the management of bladder and brain tumours. In this literature review, an attempt is made to explore the available evidence in the English literature for local administration of chemotherapeutic drugs in the surgical management of primary, recurrent and metastatic spinal tumours.

Drug-eluting implants for the suppression of metastatic bone disease: current insights

INTRODUCTION

The fixation of impending or pathologic fractures is challenging and their successful management can have a favourable impact on the quality of life of the patient. The progression of the metastatic bone disease can cause significant pain and disability but also could result in the loosening and subsequent failure of the implants. To prevent the additional local growth, postoperative radiotherapy is often recommended, and many patients receive endocrine or chemotherapy.

AREAS COVERED

Several reports support the antineoplastic drugs to bone cement as an adjuvant to improve implant stability as well as to prevent local cancer progression and failure of reconstructive devices used to treat patients with pathologic fractures. The aim of the present review is to present our current understanding on the effect of local delivery of antineoplastic drugs at the bone site.

EXPERT COMMENTARY

Encouraging evidence support the application of bone cement loaded with antineoplastic drugs to fill defects and strengthen the fixation of orthopaedic implants. This is an inexpensive and safe method that can improve implant stability, prevent local cancer progression and failure of reconstructive devices. To fully evaluate its clinical effectiveness randomized clinical studies are needed.

Paclitaxel/hydroxyapatite composite coatings on titanium alloy for biomedical applications

In order to reduce the side effects of chemotherapy, target therapies have been spotlighted. In this study, paclitaxel, the drug for cancer treatment, is electrochemically deposited on Ti alloy as vascular stents for the tumor localized therapy by sustaining drug releasing to achieve the cancer cells apoptosis or the prevention of cancer metastasis. In the experiment, cathodic polarization tests coupled with electrochemical reactions were analyzed to speculate the deposition mechanism, and the field emission scanning electron microscope (FESEM), focused ion beam (FIB) system and Fourier transform infrared spectroscopy (FTIR) to observe the surface morphology and analyze constituent elements. A spectrophotometer (UV visible spectrometer) was used to measure drug loading and release. Finally, MTT Assay was carried out to analyze the cell viability for drug efficacy. It is concluded that paclitaxel can be successfully deposited on the titanium alloy by electrochemical method. Besides, the post-hydroxyapatite coated specimen with high porosity can enhance the drug loading from 395±95μg/cm² to 572±99μg/cm², a lower burst release in the first day, a higher sustaining release rate in a month, and the more complete drug release. All results indicate that the paclitaxel/hydroxyapatite composite coating by the electrochemical deposition method is much more effective and promising.

Engineered in-situ depot-forming hydrogels for intratumoral drug delivery

Chemotherapy is the traditional treatment for intermediate and late stage cancers. The search for treatment options with minimal side effects has been ongoing for several years. Drug delivery technologies that result in minimal or no side effects with improved ease of use for the patients are receiving increased attention. Polymer drug conjugates and nanoparticles can potentially offset the volume of drug distribution while enhancing the accumulation of the active drug in tumors thereby reducing side effects. Additionally, development of localized drug delivery platforms is being investigated as another key approach to target tumors with minimal or no toxicity. Development of in-situ depot-forming gel systems for intratumoral delivery of immuno-oncology actives can enhance drug bioavailability to the tumor site and reduce systemic toxicity. This field of drug delivery is critical to develop given the advent of immunotherapy and the availability of novel biological molecules for treating solid tumors. This article reviews the advances in the field of engineered in-situ gelling platforms as a practical tool for local delivery of active oncolytic agents to tumor sites.

Controlling the biological function of calcium phosphate bone substitutes with drugs

There is a growing interest in bone tissue engineering for bone repair after traumatic, surgical or pathological injury, such as osteolytic tumor or osteoporosis. In this regard, calcium phosphate (CaP) bone substitutes have been used extensively as bone-targeting drug-delivery systems. This localized approach improves the osteogenic potential of bone substitutes by delivering bone growth factors, thus extending their biofunctionality to any pathological context, including infection, irradiation, tumor and osteoporosis. This review briefly describes the physical and chemical processes implicated in the preparation of drug-delivering CaPs. It also describes the impact of these processes on the intrinsic properties of CaPs, especially in terms of the drug-release profile. In addition, this review focuses on the potential influence of drugs on the resorption rate of CaPs. Interestingly, by modulating the resorption parameters of CaP biomaterials, it should be possible to control the release of bone-stimulating ions, such as inorganic phosphate, in the vicinity of bone cells. Finally, recent in vitro and in vivo evaluations are extensively reported.

Intraoperative Near-infrared Fluorescence Imaging with Novel Indocyanine Green-Loaded Nanocarrier for Spinal Metastasis: A Preliminary Animal Study

Marginal resection during resection of a spinal metastasis is frequently difficult because of the presence of important tissues such as the aorta, vena cava, and dura mater, including the spinal cord adjacent to the vertebral body. Thus, there is an urgent need for novel intraoperative imaging modalities with the ability to clearly identify bone metastasis. We have proposed a novel nanocarrier loaded with indocyanine green (ICG) (ICG-lactosome) with tumor selectivity attributable to its enhanced permeation and retention (EPR) effect. We studied its feasibility in intraoperative near-infrared (NIR) fluorescence diagnosis with ICG-lactosome for imaging spinal metastasis. A rat model of subcutaneous mammary tumor and a rat model of spinal metastasis of breast cancer were used. Fluorescence emitted by the subcutaneous tumors and the spinal metastasis were clearly detected for at least 24 h. Moreover, imaging of the dissected spine revealed clear fluorescence emitted by the metastatic lesion in the L6 vertebra while the normal bone lacked fluorescence. This study was the first report on NIR fluorescence imaging of spinal metastasis in vivo. NIR fluorescence imaging with ICG-lactosome could be an effective intraoperative imaging modality for detecting spinal metastasis.

Bioactive silica-based drug delivery systems containing doxorubicin hydrochloride: in vitro studies

This study reports the applicability of sol-gel derived silica and silica-polydimethylsiloxane (silica-PDMS) composites as a potential bioactive implantable drug delivery system for doxorubicin hydrochloride (DOX). These composites also contain calcium chloride (CaCl(2)) and triethylphosphate as precursors of Ca(2+) and (PO(4))(3-) ions. These composites were immersed for 20 days in a simulated body fluid (SBF) at 37°C to study the release rate of the DOX, dissolution of the silica and the formation of hydroxyapatite on the composites' surface. The results show that the release rate of the DOX can be effectively tailored by either the addition of a polydimethylsiloxane (PDMS), or by varying the amount of CaCl(2), where the elution rate of DOX increases with increasing amount of the CaCl(2) precursor. Importantly, irrespective of the amount of CaCl(2), no burst release of DOX has been observed in any of the silica-PDMS system investigated. On the other hand, a slow release of DOX has been observed with a trend that followed a zero (0)-order kinetics for a total of 20 days of elusion. The dissolution of silica in SBF was ca. two-times faster than that of silica-PDMS, with the former reaching an average saturation level of 80 μg/mL whilst the latter reached 46 μg/mL within 20 days. Both the silica and the silica-PDMS composites show bioactivity i.e. they absorb calcium phosphate from SBF. Within 10 days, a ten-fold increase in the concentration of calcium phosphate deposit has been observed on the silica-PDMS relative to the silica. The constant rates of DOX release observed for the silica-PDMS composites indicate that the calcium phosphate deposit do not obstruct controlled release of the drug.

Local drug delivery strategies for cancer treatment: gels, nanoparticles, polymeric films, rods, and wafers

Polymer-based drug delivery depots have been investigated over the last several decades as a means to improve upon the lack of tumor targeting and severe systemic morbidities associated with intravenous chemotherapy treatments. These localized therapies exist in a variety of form factors designed to facilitate the delivery of drug directly to the site of disease in a controlled manner, sparing off-target tissue toxicities. Many of these depots are biodegradable and designed to maintain therapeutic concentrations of drug at the tumor site for a prolonged period of time. Thus a single implantation procedure is required, sometimes coincident with tumor excision surgery, and thereby biodegrading following complete release of the loaded active agent. Even though localized polymer depot delivery systems have been investigated, a surprisingly small subset of these technologies has demonstrated potentially curative preclinical results for cancer applications, and fewer have progressed toward commercialization. The aims of this article are to review the most well-studied and efficacious local polymer delivery systems from the last two decades, to examine the rationale for utilizing drug-eluting polymer implants in cancer patients, and to identify the patient cohorts that could most benefit from localized therapy. Finally, a discussion of the physiological barriers to localized therapy (i.e. drug penetration, transport), technical hurdles, and future outlook of the field is presented.

Photodynamic therapy with indocyanine green injection and near-infrared light irradiation has phototoxic effects and delays paralysis in spinal metastasis

OBJECTIVE

The purpose of this study was to investigate the phototoxic effects of photodynamic therapy (PDT) with indocyanine green (ICG) and near-infrared light irradiation on rat mammary adenocarcinoma cells, and its therapeutic efficacy in a rat model of spinal metastasis.

BACKGROUND DATA

Although PDT has been successfully used as a non-radiation treatment for many malignancies, it has not yet been clinically applied for treating spinal metastasis.

METHODS

For the phototoxicity study, CRL-1666 cells were treated with PDT and cell viability was measured by WST-1 assay. For the efficacy study, 26 female Fischer 344 rats with spinal metastasis in the L6 vertebra were divided into three treatment groups: PDT with local injection of ICG (9 rats), PDT with systemic injection of ICG (10 rats), and no treatment or control (7 rats). Both the PDT groups received near-infrared light irradiation with a total energy of 10 J (1 W for 10 sec). The light was delivered directly through a single silica probe which was set on the left side of the L6 vertebral body. Hindlimb motor function was monitored according to the Basso-Beattie-Bresnahan (BBB) scale. Further, the observation periods were calculated to determine the survival time.

RESULTS

The PDT exerted immediate and persistent phototoxic effects. Furthermore, the PDT with local injection of ICG as well as systemic injection of ICG delayed the deterioration of paralysis and prolonged the observation period.

CONCLUSIONS

PDT with ICG injection and near-infrared light irradiation could be an effective local adjuvant treatment for spinal metastasis.

Polymeric drug delivery systems for localized cancer chemotherapy

Cancer has become one of the most difficult health challenges of our time, accounting for millions of deaths yearly. Systemic chemotherapy is the most common therapeutic approach; however, considerable limitations exist including toxicities to healthy tissues and low achievable drug concentrations at tumor sites. More than 85% of human cancers are solid tumors, which can greatly benefit from localized delivery. This approach allows for high drug concentrations at the target site, lower systemic toxicity, and extended drug exposure which may be beneficial for cell cycle-specific drugs. Polymers have been widely considered in the development of localized delivery systems. This review focuses on both natural and synthetic biodegradable polymers that have been explored for localized chemotherapy, exploring their advantages, disadvantages, and clinical potential while citing examples of their use in pre-clinical development.

Organic-inorganic composites for bone drug delivery

This review paper attempts to provide an overview in the fabrication and application of organic-inorganic based composites in the field of local drug delivery for bone. The concept of local drug delivery exists for a few decades. However, local drug delivery in bone and specially application of composites for delivery of drugs to bone is an area for potential research interest in the recent time. The advantages attained by an organic-inorganic composite when compared to its individual components include their ability to release drug, adopting to the natural environment and supporting local area until complete bone regeneration, which make them carriers of interest for local drug delivery for bone.