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Sharifi SHH, Wu YX, Lavasani SAM, Tano ZE, Ali SN, Gao BM, Saadat S, Piedras P, Nourbakhsh M, Jiang P, Patel RM, Landman J, Clayman RV. Electromotive Drug Administration in the Porcine Renal Pelvis: First Report. J Endourol 2024; 38:77-81. [PMID: 37842848 DOI: 10.1089/end.2023.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Introduction: Electromotive Drug Administration (EMDA) amplifies drug delivery deep into targeted tissues. We tested, for the first time, the ability of EMDA to deliver methylene blue into the urothelium of the renal pelvis. Materials and Methods: In an anesthetized female pig, both proximal ureters were transected two inches distal to the ureteropelvic junction. An 8F dual lumen catheter and a 5F fenestrated catheter with an indwelling silver wire were inserted into both renal pelvises following which methylene blue (0.1%) was infused at a rate of 5 mL/min for 20 minutes. In one pelvis, a 4 mA positive pulsed electrical current was applied to the silver wire. Results: In contrast to the control pelvis, the EMDA side macroscopically exhibited dense homogeneous staining; microscopy revealed penetration of methylene blue into the urothelium/lamina propria. Conclusion: In the porcine renal pelvis, application of EMDA increased the penetration of a charged molecule into the urothelium/lamina propria.
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Affiliation(s)
| | - Yi Xi Wu
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Sohrab Naushad Ali
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Seyedamirvala Saadat
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mahra Nourbakhsh
- Department of Pathology, University of California, Irvine, Orange, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Melgarejo Segura MT, Morales Martínez A, Yáñez Castillo Y, Arrabal Polo MÁ, Gutiérrez Tejero F, Pareja Vílchez M, Arrabal Martín M. Electromotive Drug Administration Chemotherapy with Mitomycin C Versus Bacillus Calmette-Guerin for the Treatment of Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2023; 9:159-166. [PMID: 38993293 PMCID: PMC11181766 DOI: 10.3233/blc-230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND Devices that increase the penetrance of intravesical chemotherapeutics are emerging as alternatives to classical Bacillus Calmette Guérin (BCG) treatment. OBJECTIVE To compare the efficacy of mitomycin C applied with the electromotive drug delivery device (MMC-EMDA) versus BCG in patients with intermediate and high-risk non-muscle-invasive bladder cancer (NMIBC) without carcinoma in situ (CIS). METHODS Prospective non-randomized study in which 47 patients received MMC-EMDA (40 mg of MMC diluted in 50 mg of distilled water at 20 mA for 30 min. Regimen of 6 weekly and then 6 monthly instillations) and 48 patients received BCG (50 mg of OncoCITE® diluted in 50 ml of normal saline for 60 min. Regimen of 6 weekly instillations and then 3 weekly instillations at months 3, 6 and 12). The primary endpoint was the recurrence-free rate (RFR) at 24 months. Secondary endpoints were time to recurrence and progression-free rate (PFR) at 24 months follow-up. RESULTS Baseline patient assessment and mean follow-up time were similar in both groups (MMC-EMDA group: 26.4 months; BCG group: 28.4 months (p = 0.44)). The RFR at 24 months was 80.9% for the MMC-EMDA group and 77.1% for the BCG group (p = 0.969). The mean time to recurrence was 12.5 months in the MMC-EMDA group and 14 months in the BCG group (p = 0.681). At 24 months, PFR was 97.9% in the MMC-EMDA group and 93.8% in the BCG group (p = 0.419). CONCLUSIONS No differences were found between MMC-EMDA and BCG treatments in patients with high-risk and intermediate-risk NMIBC without CIS.
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Affiliation(s)
| | | | | | - Miguel Ángel Arrabal Polo
- Department of Urology, University Hospital SanCecilio, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Complejo Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
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Melgarejo Segura MT, Morales Martínez A, Yáñez Castillo Y, Arrabal Polo MÁ, Gómez Lechuga P, Pareja Vílchez M, Arrabal Martín M. Conductive hyperthermic chemotherapy versus electromotive drug administration of mitomycin C as intravesical adjuvant treatment of patients with intermediate or high-risk non-muscle invasive bladder cancer. Urol Oncol 2023; 41:109.e1-109.e8. [PMID: 36379812 DOI: 10.1016/j.urolonc.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/25/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Devices that increase the penetration of intravesical chemotherapeutic agents have been developed as alternatives to the use of bacillus Calmette-Guérin, in short supply at a time of increasing global incidence of non-muscle invasive bladder cancer (NMIBC). We performed a prospective observational study to compare 2 of these devices in the treatment of patients with high- and intermediate-risk NMIBC. The primary endpoint was the recurrence-free rate. Secondary endpoints were the rate of progression and adverse events. METHODS After undergoing transurethral bladder resection, 98 patients were selected to receive 1 of 2 treatments: hyperthermic intravesical chemotherapy (HIVEC) treatment with 40 mg of mitomycin C (MMC) using Combat BRS System V2.0 at 43 ± 0.5°C and 200 ml/min for 60 minutes (56 patients) or electromotive drug administration (EMDA) with 40 mg of MMC at 20 mA for 30 minutes (42 patients). The treatment schemes were similar: 6 weekly instillations as induction and 6-monthly instillations as maintenance. The recurrence rates were evaluated at 6 and 12 months and the progression rates at 12 months. RESULTS The recurrence-free rate at 12 months was 91,1% in the HIVEC group and 88.1% in the EMDA group (P ≥ 0.05). After the 12-month follow-up, only 1 progression occurred in each treatment group. In terms of adverse events, no significant differences were found between the treatments. CONCLUSIONS HIVEC and EMDA techniques are comparable in terms of recurrence, progression and adverse events at 12 months in the treatment of patients with high- and intermediate-risk NMIBC.
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Bioelectronic medicines: Therapeutic potential and advancements in next-generation cancer therapy. Biochim Biophys Acta Rev Cancer 2022; 1877:188808. [DOI: 10.1016/j.bbcan.2022.188808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022]
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Melgarejo-Segura MT, Morales-Martínez A, Yáñez-Castillo Y, Arrabal-Polo MÁ, Gómez-Lechuga P, Pareja-Vílchez M, Jiménez-Moleón JJ, Martín MA. A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer. Urol Oncol 2022; 41:166-176. [PMID: 36328923 DOI: 10.1016/j.urolonc.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/13/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. OBJECTIVE To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. METHOD A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. RESULTS The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. CONCLUSIONS The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.
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Affiliation(s)
| | | | | | - Miguel Ángel Arrabal-Polo
- Department of Urology, University Hospital San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | | | | | - José Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Wang LL, Zhang B, Zheng MH, Xie YZ, Wang CJ, Jin JY. Matrix Metalloproteinases (MMPs) in Targeted Drug Delivery: Synthesis of a Potent and Highly Selective Inhibitor against Matrix Metalloproteinase- 7. Curr Top Med Chem 2021; 20:2459-2471. [PMID: 32703131 DOI: 10.2174/1568026620666200722104928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/20/2020] [Accepted: 02/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) are a family of zinc endopeptidases that play a key role in both physiological and pathological tissue degradation. MMPs have reportedly shown great potentials in the degradation of the Extracellular Matrix (ECM), have shown great potentials in targeting bioactive and imaging agents in cancer treatment. MMPs could provoke Epithelial to Mesenchymal Transition (EMT) of cancer cells and manipulate their signaling, adhesion, migration and invasion to promote cancer cell aggressiveness. Therefore, targeting and particularly inhibiting MMPs within the tumor microenvironment is an effective strategy for cancer treatment. Based on this idea, different MMP inhibitors (MMPIs) have been developed to manipulate the tumor microenvironment towards conditions appropriate for the actions of antitumor agents. Studies are ongoing to improve the selectivity and specificity of MMPIs. Structural optimization has facilitated the discovery of selective inhibitors of the MMPs. However, so far no selective inhibitor for MMP-7 has been proposed. AIMS This study aims to comprehensively review the potentials and advances in applications of MMPs particularly MMP-7 in targeted cancer treatment approaches with the main focus on targeted drug delivery. Different targeting strategies for manipulating and inhibiting MMPs for the treatment of cancer are discussed. MMPs are upregulated at all stages of expression in cancers. Different MMP subtypes have shown significant targeting applicability at the genetic, protein, and activity levels in both physiological and pathophysiological conditions in a variety of cancers. The expression of MMPs significantly increases at advanced cancer stages, which can be used for controlled release in cancers in advance stages. METHODS Moreover, this study presents the synthesis and characteristics of a new and highly selective inhibitor against MMP-7 and discusses its applications in targeted drug delivery systems for therapeutics and diagnostics modalities. RESULTS Our findings showed that the structure of the inhibitor P3' side chains play the crucial role in developing an optimized MMP-7 inhibitor with high selectivity and significant degradation activities against ECM. CONCLUSION Optimized NDC can serve as a highly potent and selective inhibitor against MMP-7 following screening and optimization of the P3' side chains, with a Ki of 38.6 nM and an inhibitory selectivity of 575 of MMP-7 over MMP-1.
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Affiliation(s)
- Ling-Li Wang
- Centre of Chemical Biology, Department of Chemistry, Yanbian University, Yanji City, Jilin Province, 133002, China,National Demonstration Centre for Experimental Chemistry Education, Department of Chemistry, Yanbian University,
Yanji, Jilin Province, 130002, China
| | - Bing Zhang
- Department of Nephrology, Central Hospital of Jiamusi, Heilongjiang Province 154002, China
| | - Ming-Hua Zheng
- Centre of Chemical Biology, Department of Chemistry, Yanbian University, Yanji City, Jilin Province, 133002, China
| | - Yu-Zhong Xie
- National Demonstration Centre for Experimental Chemistry Education, Department of Chemistry, Yanbian University,
Yanji, Jilin Province, 130002, China,College of Chemistry, Northeast Normal University, Changchun, Jilin Province, 130024, China
| | - Chang-Jiang Wang
- Department of Nephrology, Central Hospital of Jiamusi, Heilongjiang Province 154002, China
| | - Jing-Yi Jin
- National Demonstration Centre for Experimental Chemistry Education, Department of Chemistry, Yanbian University,
Yanji, Jilin Province, 130002, China
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Robinson AJ, Jain A, Sherman HG, Hague RJM, Rahman R, Sanjuan‐Alberte P, Rawson FJ. Toward Hijacking Bioelectricity in Cancer to Develop New Bioelectronic Medicine. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000248] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andie J. Robinson
- Regenerative Medicine and Cellular Therapies, School of Pharmacy University of Nottingham Nottingham NG7 2RD UK
| | - Akhil Jain
- Regenerative Medicine and Cellular Therapies, School of Pharmacy University of Nottingham Nottingham NG7 2RD UK
| | - Harry G. Sherman
- Regenerative Medicine and Cellular Therapies, School of Pharmacy University of Nottingham Nottingham NG7 2RD UK
| | - Richard J. M. Hague
- Centre for Additive Manufacturing, Faculty of Engineering University of Nottingham Nottingham NG8 1BB UK
| | - Ruman Rahman
- Children's Brain Tumour Research Centre, Biodiscovery Institute, School of Medicine University of Nottingham Nottingham NG7 2RD UK
| | - Paola Sanjuan‐Alberte
- Regenerative Medicine and Cellular Therapies, School of Pharmacy University of Nottingham Nottingham NG7 2RD UK
- Department of Bioengineering and iBB‐Institute for Bioengineering and Biosciences, Instituto Superior Técnico Universidade de Lisboa Lisbon 1049‐001 Portugal
| | - Frankie J. Rawson
- Regenerative Medicine and Cellular Therapies, School of Pharmacy University of Nottingham Nottingham NG7 2RD UK
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Intrarectal Electromotive Botulinum Toxin Type A Administration in Children With Intractable Constipation: A Randomized Clinical Trial. Am J Gastroenterol 2020; 115:2060-2067. [PMID: 33009066 DOI: 10.14309/ajg.0000000000000940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection. METHODS From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire. RESULTS After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively). DISCUSSION BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia.
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Van de Sande L, Rahimi‐Gorji M, Giordano S, Davoli E, Matteo C, Detlefsen S, D'Herde K, Braet H, Shariati M, Remaut K, Xie F, Debbaut C, Ghorbaniasl G, Cosyns S, Willaert W, Ceelen W. Electrostatic Intraperitoneal Aerosol Delivery of Nanoparticles: Proof of Concept and Preclinical Validation. Adv Healthc Mater 2020; 9:e2000655. [PMID: 32548967 DOI: 10.1002/adhm.202000655] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/13/2020] [Indexed: 12/21/2022]
Abstract
There is an increasing interest in intraperitoneal delivery of chemotherapy as an aerosol in patients with peritoneal metastasis. The currently used technology is hampered by inhomogenous drug delivery throughout the peritoneal cavity because of gravity, drag, and inertial impaction. Addition of an electrical force to aerosol particles, exerted by an electrostatic field, can improve spatial aerosol homogeneity and enhance tissue penetration. A computational fluid dynamics model shows that electrostatic precipitation (EP) results in a significantly improved aerosol distribution. Fluorescent nanoparticles (NPs) remain stable after nebulization in vitro, while EP significantly improves spatial homogeneity of NP distribution. Next, pressurized intraperitoneal chemotherapy with and without EP using NP albumin bound paclitaxel (Nab-PTX) in a novel rat model is examined. EP does not worsen the effects of CO2 insufflation and intraperitoneal Nab-PTX on mesothelial structural integrity or the severity of peritoneal inflammation. Importantly, EP significantly enhances tissue penetration of Nab-PTX in the anatomical regions not facing the nozzle of the nebulizer. Also, the addition of EP leads to more homogenous peritoneal tissue concentrations of Nab-PTX, in parallel with higher plasma concentrations. In conclusion, EP enhances spatial homogeneity and tissue uptake after intraperitoneal nebulization of anticancer NPs.
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Affiliation(s)
- Leen Van de Sande
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
| | - Mohammad Rahimi‐Gorji
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- IBiTech – bioMMedaGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
| | - Silvia Giordano
- Mass Spectrometry LaboratoryIstituto di Ricerche Farmacologiche Mario Negri IRCCS Via Mario Negri 2 Milan 20156 Italy
| | - Enrico Davoli
- Mass Spectrometry LaboratoryIstituto di Ricerche Farmacologiche Mario Negri IRCCS Via Mario Negri 2 Milan 20156 Italy
| | - Cristina Matteo
- Cancer Pharmacology LaboratoryIstituto di Ricerche Farmacologiche Mario Negri IRCCS Via Mario Negri 2 Milan 20156 Italy
| | - Sönke Detlefsen
- Department of PathologyOdense University Hospital J.B. Winsløws Vej 4 Odense 5000 Denmark
- Department of Clinical ResearchUniversity of Southern Denmark Winsløwsparken 19 Odense 5000 Denmark
| | - Katharina D'Herde
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
| | - Helena Braet
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Laboratory of General Biochemistry and Physical PharmacyFaculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 Ghent 9000 Belgium
| | - Molood Shariati
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Laboratory of General Biochemistry and Physical PharmacyFaculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 Ghent 9000 Belgium
| | - Katrien Remaut
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Laboratory of General Biochemistry and Physical PharmacyFaculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 Ghent 9000 Belgium
| | - Feifan Xie
- Laboratory of Medical Biochemistry and Clinical AnalysisFaculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 Ghent 9000 Belgium
| | - Charlotte Debbaut
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- IBiTech – bioMMedaGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
| | - Ghader Ghorbaniasl
- Department of Mechanical EngineeringVrije Universiteit Brussel (VUB) Pleinlaan 2 Brussels 1050 Belgium
| | - Sarah Cosyns
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
| | - Wouter Willaert
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
| | - Wim Ceelen
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Cancer Research Institute Ghent (CRIG)Ghent University Corneel Heymanslaan 10 Ghent 9000 Belgium
- Department of Human Structure and RepairGhent University Corneel Heymanslaan 10 Ghent 9000 Belgium
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Farrell MR, Ziegelmann MJ, Levine LA. Minimally invasive therapies for Peyronie's disease: the current state of the art. Transl Androl Urol 2020; 9:S269-S283. [PMID: 32257868 PMCID: PMC7108992 DOI: 10.21037/tau.2019.08.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Peyronie's disease (PD) is a relatively common condition that can result in significant penile deformity, sexual dysfunction, and psychological bother. Surgical straightening offers the highest probability of success during the stable phase of the disease. However, for men in the acute phase of PD or for those with less severe deformity who elect to avoid surgery, a variety of non-surgical treatment options are available. Oral therapies, including L-citrulline and pentoxifylline, are most useful as part of a combination regimen rather than as monotherapy. Intralesional therapy with IFN-α2b, verapamil, and collagenase clostridium histolyticum (CCH) can cause significant reduction in penile curvature, yet these results may not be clinically significant for men with more severe curvature. Further investigation into the timing of administration and optimal patient characteristics is required. Penile traction therapy offers a clinically significant improvement in penile length and curvature. However, this has traditionally required hours of daily therapy. Overall, a combination of oral, topical, injection and traction therapies may provide the most significant benefit among the non-surgical modalities for PD.
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Affiliation(s)
- M Ryan Farrell
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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Intraperitoneal aerosolized drug delivery: Technology, recent developments, and future outlook. Adv Drug Deliv Rev 2020; 160:105-114. [PMID: 33132169 DOI: 10.1016/j.addr.2020.10.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/28/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022]
Abstract
Current therapies for patients with peritoneal metastases (PM) are only moderately effective. Recently, a novel locoregional treatment method for PM was introduced, consisting of a combination of laparoscopy with intraperitoneal (IP) delivery of anticancer agents as an aerosol. This 'pressurized intraperitoneal aerosol chemotherapy' (PIPAC) may enhance tissue drug penetration by the elevated IP pressure during CO2 capnoperitoneum. Also, repeated PIPAC cycles allow to accurately stage peritoneal disease and verify histological response to treatment. This review provides an overview of the rationale, indications, and currently used technology for therapeutic IP nebulization, and discusses the basic mechanisms governing aerosol particle transport and peritoneal deposition. We discuss early clinical results in patients with advanced, irresectable PM and highlight the potential of electrostatic aerosol precipitation. Finally, we discuss promising novel approaches, including nebulization of nanoparticles and prolonged release formulations.
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Koh C, Melling CV, Jennings C, Lewis M, Goyal A. Efficacy of electromotive drug administration in delivering botulinum toxin a in children with neuropathic detrusor overactivity-outcomes of a pilot study. J Pediatr Urol 2019; 15:552.e1-552.e8. [PMID: 31326328 DOI: 10.1016/j.jpurol.2019.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intravesical botulinum toxin A (BtA) injection is well established in managing paediatric neuropathic detrusor overactivity (NDO). Electromotive drug administration (EMDA) is a less invasive method, which can be performed in the clinic, using pulsed electrical current for drug delivery via a urethral catheter. Few small studies report good outcomes following BtA via EMDA (BtA/EMDA) into bladders of children with NDO. OBJECTIVE The objective of this study is to assess the efficacy of BtA/EMDA in children with NDO, reduced bladder capacity and compliance. METHODS Twelve children with NDO on baseline urodynamic study were prospectively included. Pre-BtA/EMDA and post-BtA/EMDA results compared the following four parameters: maximal cystometric capacity, bladder compliance, maximal detrusor pressure (pDetmax) during detrusor overactivity and pDetmax at capacity. The Wilcoxon matched-pairs signed-rank test using Graphpad Prism 8 was used for analysis. Secondary outcomes include adverse effects and symptomatic improvement. RESULTS Fourteen episodes of BtA/EMDA were performed. Five patients received 3.3 IU/kg of Botox®, and five received 10 IU/kg (maximum 300 IU). Four patients received 10 IU/kg of Dysport®. Two patients in the Dysport®/EMDA group also received Botox®/EMDA more than six months previously. Thirteen of 14 post-EMDA results were completed and included in the paired analysis. No statistically significant improvements in any cystometric parameters were demonstrated. Eight patients subsequently had intravesical BtA injections with significant improvements in both cystometric parameters and symptoms. Two patients subsequently transitioned to adult services; one was commenced on mirabegron, and one has undergone ileocystoplasty with Mitrofanoff appendicovesicostomy. DISCUSSION Despite some evidence to support BtA/EMDA in children with NDO, the authors were unable to replicate previously published positive cystometric and symptomatic outcomes. In addition, BtA/EMDA performed poorly when compared with conventional intravesical BtA injections. This implies failure of EMDA to deliver BtA correctly to the target tissue. The large size of the BtA molecule or the abnormal bladder wall in NDO could account for the negative results. Thorough preparation and consultation was undertaken before this study with BtA/EMDA, and it is discouraging that the authors were unable to reproduce the positive results of other groups. CONCLUSIONS Although safe and acceptable to most patients, the authors cannot recommend the use of BtA/EMDA for NDO in children at present.
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Affiliation(s)
- C Koh
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK.
| | - C V Melling
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
| | - C Jennings
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
| | - M Lewis
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
| | - A Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
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Sharifi-Rad L, Ladi-Seyedian SS, Nabavizadeh B, Alijani M, Kajbafzadeh AM. Intravesical Electromotive Botulinum Toxin Type A (Dysport) Administration in Children With Myelomeningocele. Urology 2019; 132:210-211. [DOI: 10.1016/j.urology.2019.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/19/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
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