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Gaikwad SS, Morales JO, Lande NB, Catalán-Figueroa J, Laddha UD, Kshirsagar SJ. Exploring paediatric oral suspension development: Challenges, requirements, and formulation advancements. Int J Pharm 2024; 657:124169. [PMID: 38688428 DOI: 10.1016/j.ijpharm.2024.124169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Oral suspension is the most preferred dosage form for the paediatric population because of the difficulties related to solid medications, such as the swallowing limitations, bitter taste, and poor oral bioavailability, which can cause serious impairment to attain a successful treatment. Given the importance of successful therapies, there is a need for safe and effective commercially-available paediatric oral suspension and their characterization. For the latter, it is important to identify safe excipients and preservatives. The paediatric group is a diverse category which includes infants and teenagers, with major pharmacokinetics and pharmacodynamics differences, mainly because of physiological and behavioral variations. Therefore, finding a single formulation for paediatric population remains a challenge, as well asthe formulation of stable-in-time suspension. In addition, drug's dissolving characteristic and permeation, are the main determinants for oral absorption, which are closely related to drug release kinetics from the pharmaceutical form. In this context, drug release profile is an important and limiting step in oral bioavailability, particularly for BCS class II drugs; thus, it is possible to increase bioavailability and minimize adverse effects by changing the release rate of such drugs. This review covers all the aspects for paediatric oral suspension development, and analyses the considerations for excipients selection as a crucial task for effectively choosing a safe and effective pharmaceutical form and correctly dosing paediatric patients.
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Affiliation(s)
- Sachin S Gaikwad
- Department of Pharmaceutics, Sanjivani College of Pharmaceutical Education and Research, Savitribai Phule Pune University, At Sahajanandnagar, Post-Shinganapur, Tal-Kopargaon, Ahmednagar, Maharashtra 423603, India; Department of Pharmaceutics, MET's Institute of Pharmacy, Affiliated to Savitribai Phule Pune University, Bhujbal Knowledge City, Adgaon, Nashik 422003, India.
| | - Javier O Morales
- Department of Pharmaceutical Sciences and Technology, University of Chile. Santiago 8380494, Chile; Advanced Center for Chronic Diseases (ACCDiS), Chile; Center of New Drugs for Hypertension (CENDHY), Chile
| | - Narayan B Lande
- Department of Pharmaceutics, Sanjivani College of Pharmaceutical Education and Research, Savitribai Phule Pune University, At Sahajanandnagar, Post-Shinganapur, Tal-Kopargaon, Ahmednagar, Maharashtra 423603, India
| | - Johanna Catalán-Figueroa
- Food Science Lab, Institute of Research and Postgraduate Studies, Faculty of Medicine and Health Sciences, Universidad Central de Chile, Santiago 8330546, Chile
| | - Umesh D Laddha
- Department of Pharmaceutics, MET's Institute of Pharmacy, Affiliated to Savitribai Phule Pune University, Bhujbal Knowledge City, Adgaon, Nashik 422003, India; Regeron Inc., Chuncheon-si, Gangwon-do 24232, South Korea
| | - Sanjay J Kshirsagar
- Department of Pharmaceutics, MET's Institute of Pharmacy, Affiliated to Savitribai Phule Pune University, Bhujbal Knowledge City, Adgaon, Nashik 422003, India
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Jorge EC, Martínez NN, González MJ, Sánchez SV, Robino L, Morales JO, Scavone P. Gold-, silver- and magnesium-doped zinc oxide nanoparticles prevents the formation of and eradicates bacterial biofilms. Nanomedicine (Lond) 2023. [PMID: 37254888 DOI: 10.2217/nnm-2022-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Aim: This work aimed to synthesize magnesium-doped zinc oxide, silver and gold nanoparticles (Nps) and to evaluate their potential to prevent and eradicate Escherichia coli, Proteus mirabilis, Staphylococcus aureus, Acinetobacter baumannii and Pseudomonas aeruginosa biofilms. Materials & methods: The Nps were synthesized by precipitation and metallic reduction techniques. Physicochemical and biological characterization of Nps was performed. Results: All the Nps tested were able to inhibit the formation of E. coli, P. mirabilis, S. aureus and A. baumannii biofilms. The effects on the eradication of preformed biofilms were variable, although all the Nps tested were able to eradicate A. baumannii biofilms. Conclusion: The observed effects make the Nps suitable for coating surfaces and/or antibiotic carriers with medical interest.
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Affiliation(s)
- Erlen Cruz Jorge
- Departamento de Microbiología, Laboratorio de Biofilms Microbianos, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318 PC 11600, Montevideo, Uruguay
| | - Nicolás Navarro Martínez
- Departamento de Microbiología, Laboratorio de Biofilms Microbianos, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318 PC 11600, Montevideo, Uruguay
- Advanced Center for Chronic Diseases (ACCDiS), Sergio Livingstone 1007, Independencia, PC 8380000, PC Santiago, Chile
- Center of New Drugs for Hypertension (CENDHY), Santos Dumont 964, Independencia, PC 8380000, Santiago, Chile
| | - María José González
- Departamento de Microbiología, Laboratorio de Biofilms Microbianos, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318 PC 11600, Montevideo, Uruguay
| | - Sofía V Sánchez
- Advanced Center for Chronic Diseases (ACCDiS), Sergio Livingstone 1007, Independencia, PC 8380000, PC Santiago, Chile
- Center of New Drugs for Hypertension (CENDHY), Santos Dumont 964, Independencia, PC 8380000, Santiago, Chile
- Departamento de Ciencias y Tecnologías Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, PC 8380000, Santiago, Chile
| | - Luciana Robino
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad del República, Alfredo Navarro 3051, PC 11600 Montevideo, Uruguay
| | - Javier O Morales
- Advanced Center for Chronic Diseases (ACCDiS), Sergio Livingstone 1007, Independencia, PC 8380000, PC Santiago, Chile
- Center of New Drugs for Hypertension (CENDHY), Santos Dumont 964, Independencia, PC 8380000, Santiago, Chile
- Departamento de Ciencias y Tecnologías Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, PC 8380000, Santiago, Chile
| | - Paola Scavone
- Departamento de Microbiología, Laboratorio de Biofilms Microbianos, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318 PC 11600, Montevideo, Uruguay
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Nair VV, Cabrera P, Ramírez-Lecaros C, Jara MO, Brayden DJ, Morales JO. Buccal delivery of small molecules and biologics: Of mucoadhesive polymers, films, and nanoparticles - An update. Int J Pharm 2023; 636:122789. [PMID: 36868332 DOI: 10.1016/j.ijpharm.2023.122789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
Buccal delivery of small and large molecules is an attractive route of administration that has been studied extensively over the past few decades. This route bypasses first-pass metabolism and can be used to deliver therapeutics directly to systemic circulation. Moreover, buccal films are efficient dosage forms for drug delivery due to their simplicity, portability, and patient comfort. Films have traditionally been formulated using conventional techniques, including hot-melt extrusion and solvent casting. However, newer methods are now being exploited to improve the delivery of small molecules and biologics. This review discusses recent advances in buccal film manufacturing, using the latest technologies, such as 2D and 3D printing, electrospraying, and electrospinning. This review also focuses on the excipients used in the preparation of these films, with emphasis on mucoadhesive polymers and plasticizers. Along with advances in manufacturing technology, newer analytical tools have also been used for the assessment of permeation of the active agents across the buccal mucosa, the most critical biological barrier and limiting factor of this route. Additionally, preclinical and clinical trial challenges are discussed, and some small molecule products already on the market are explored.
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Affiliation(s)
- Varsha V Nair
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Pablo Cabrera
- Advanced Center for Chronic Diseases (ACCDiS), Sergio Livingstone 1007, Independencia, Santiago 8380494, Chile; Departamento de Química Farmacológica y Toxicológica, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 8380494, Chile
| | | | - Miguel O Jara
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - David J Brayden
- UCD School of Veterinary Medicine and UCD Conway Institute, Belfield, Dublin D04 V1W8, Ireland
| | - Javier O Morales
- Advanced Center for Chronic Diseases (ACCDiS), Sergio Livingstone 1007, Independencia, Santiago 8380494, Chile; Center of New Drugs for Hypertension (CENDHY), Santiago 8380492, Chile; Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 8380492, Chile.
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Arrua EC, Sanchez SV, Trincado V, Hidalgo A, Quest AFG, Morales JO. Experimental design and optimization of a novel dual-release drug delivery system with therapeutic potential against infection with Helicobacter pylori. Colloids Surf B Biointerfaces 2022; 213:112403. [PMID: 35219219 DOI: 10.1016/j.colsurfb.2022.112403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 12/24/2022]
Abstract
The objective of this study was to develop clarithromycin-loaded lipid nanocarriers and incorporate them into microcapsules for pH-specific localized release of clarithromycin in the Helicobacter pylori microenvironment in order to obtain a gastro-retentive and pH-sensitive formulation. A Plackett-Burman design was applied to identify the effect of 5 factors on 3 responses. Then, a central composite design was applied to estimate the most important factors leading to the best compromise between lower particle size, polydispersity index and particle size changes. The optimized clarithromycin-loaded nanocapsules were employed to generate microcapsules by different methodologies. Nanocarriers and microcapsules were characterized in vitro. Experimental design and conditions were optimized to obtain nanocapsules of around 100 nm by a modified phase inversion-based process. High particle size homogeneity and high stability were achieved. At 4 °C both optimized lipid nanocapsules were stable during at least 365 days, confirming stability under those conditions. Clarithromycin incorporation in the nanocarrier was effective. Both types of microcoating were evaluated regarding their pH sensitivity. Spray drying microcapsules exhibited similar and uncontrolled release profiles at pH 2 and 7.4. Alternatively, when microcoatings were generated using an Encapsulator, release was insignificant at pH 2, while at pH 7.4 release was triggered, and appeared more appropriate to formulate microcapsules that release nanocarriers under pH neutral Helicobacter pylori microenvironment conditions, thereby permitting effective drug delivery in infected locations. The release of clarithromycin from lipid nanocarrier loaded microcapsules was pH-sensitive suggesting that this could be an effective strategy for clarithromycin delivery to the Helicobacter pylori microenvironment. Clarithromycin nanocapsules with and without microcoating showed a high anti-Helicobacter pylori activity in vitro.
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Affiliation(s)
- Eva C Arrua
- Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Universidad de Chile, Chile; Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380492, Chile
| | - Sofía V Sanchez
- Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Universidad de Chile, Chile; Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380492, Chile; Center of New Drugs for Hypertension (CENDHY), Santiago 8380492, Chile
| | - Valeria Trincado
- Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Universidad de Chile, Chile
| | - Antonio Hidalgo
- Laboratory of Cellular Communication, Center for the study of Exercise, Metabolism and Cancer (CEMC), Program in Cell and Molecular Biology, Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Andrew F G Quest
- Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380492, Chile; Laboratory of Cellular Communication, Center for the study of Exercise, Metabolism and Cancer (CEMC), Program in Cell and Molecular Biology, Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Javier O Morales
- Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Universidad de Chile, Chile; Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380492, Chile; Center of New Drugs for Hypertension (CENDHY), Santiago 8380492, Chile.
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Trincado V, Gala RP, Morales JO. Buccal and Sublingual Vaccines: A Review on Oral Mucosal Immunization and Delivery Systems. Vaccines (Basel) 2021; 9:vaccines9101177. [PMID: 34696284 PMCID: PMC8539688 DOI: 10.3390/vaccines9101177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Currently, most vaccines available on the market are for parental use; however, this may not be the best option on several occasions. Mucosal routes of administration such as intranasal, sublingual, and buccal generate great interest due to the benefits they offer. These range from increasing patient compliance to inducing a more effective immune response than that achieved through conventional routes. Due to the activation of the common mucosal immune system, it is possible to generate an effective systemic and local immune response, which is not achieved through parenteral administration. Protection against pathogens that use mucosal entry routes is provided by an effective induction of mucosal immunity. Mucosal delivery systems are being developed, such as films and microneedles, which have proven to be effective, safe, and easy to administer. These systems have multiple advantages over commonly used injections, which are simple to manufacture, stable at room temperature, painless for the patient since they do not require puncture. Therefore, these delivery systems do not require to be administered by medical personnel; in fact, they could be self-administered.
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Affiliation(s)
- Valeria Trincado
- Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Universidad de Chile, Santiago 8380494, Chile;
- Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile
- Center of New Drugs for Hypertension (CENDHY), Santiago 8380494, Chile
| | - Rikhav P. Gala
- Biotechnology Division, Center Mid-Atlantic, Fraunhofer USA, Newark, DE 19702, USA;
| | - Javier O. Morales
- Drug Delivery Laboratory, Departamento de Ciencias y Tecnología Farmacéuticas, Universidad de Chile, Santiago 8380494, Chile;
- Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile
- Center of New Drugs for Hypertension (CENDHY), Santiago 8380494, Chile
- Correspondence:
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Sepúlveda-Rivas S, Leal MS, Pedrozo Z, Kogan MJ, Ocaranza MP, Morales JO. Nanoparticle-Mediated Angiotensin-(1-9) Drug Delivery for the Treatment of Cardiac Hypertrophy. Pharmaceutics 2021; 13:pharmaceutics13060822. [PMID: 34206106 PMCID: PMC8228229 DOI: 10.3390/pharmaceutics13060822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023] Open
Abstract
Ang-(1-9) peptide is a bioactive vasodilator peptide that prevents cardiomyocyte hypertrophy in vitro and in vivo as well as lowers blood pressure and pathological cardiovascular remodeling; however, it has a reduced half-life in circulation, requiring a suitable carrier for its delivery. In this work, hybrid nanoparticles composed of polymeric nanoparticles (pNPs) based on Eudragit® E/Alginate (EE/Alg), and gold nanospheres (AuNS), were developed to evaluate their encapsulation capacity and release of Ang-(1-9) under different experimental conditions. Hybrid pNPs were characterized by dynamic light scattering, zeta potential, transmission and scanning electron microscopy, size distribution, and concentration by nanoparticle tracking analysis. Nanometric pNPs, with good polydispersity index and colloidally stable, produced high association efficiency of Ang-(1-9) and controlled release. Finally, the treatment of neonatal cardiomyocytes in culture with EE/Alg/AuNS 2% + Ang-(1-9) 20% pNPs decreased the area and perimeter, demonstrating efficacy in preventing norepinephrine-induced cardiomyocyte hypertrophy. On the other hand, the incorporation of AuNS did not cause negative effects either on the cytotoxicity or on the association capacity of Ang-(1-9), suggesting that the hybrid carrier EE/Alg/AuNS pNPs could be used for the delivery of Ang-(1-9) in the treatment of cardiovascular hypertrophy.
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Affiliation(s)
- Sabrina Sepúlveda-Rivas
- Medical Technology School, Faculty of Sciences, Universidad Mayor, Camino la Piramide 5750, Huechuraba, Santiago 8580745, Chile;
| | - Matías S. Leal
- Center for Bioinformatics and Integrative Biology, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370146, Chile;
| | - Zully Pedrozo
- Red Para el Estudio de Enfermedades Cardiopulmonares de Alta Letalidad (REECPAL), Santiago 8380453, Chile;
- Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile, Santiago 8380494, Chile;
- Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Marcelo J. Kogan
- Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile, Santiago 8380494, Chile;
- Departamento de Química Farmacológica y Toxicológica, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 8380494, Chile
| | - María Paz Ocaranza
- Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile, Santiago 8380494, Chile;
- División de Enfermedades Cardiovasculares, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
- Center of New Drugs for Hypertension, Universidad de Chile & Pontificia Universidad Católica de Chile, Santiago 8380494, Chile
- Correspondence: (M.P.O.); (J.O.M.)
| | - Javier O. Morales
- Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile, Santiago 8380494, Chile;
- Center of New Drugs for Hypertension, Universidad de Chile & Pontificia Universidad Católica de Chile, Santiago 8380494, Chile
- Departamento de Ciencias y Tecnología Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 8380494, Chile
- Correspondence: (M.P.O.); (J.O.M.)
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Sánchez SV, Navarro N, Catalán-Figueroa J, Morales JO. Nanoparticles as Potential Novel Therapies for Urinary Tract Infections. Front Cell Infect Microbiol 2021; 11:656496. [PMID: 33954121 PMCID: PMC8089393 DOI: 10.3389/fcimb.2021.656496] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Abstract
Urinary tract infection (UTI) is one of the most common reasons for antibiotic treatment. Nevertheless, uropathogens are steadily becoming resistant to currently available therapies. In this context, nanotechnology emerges as an innovative and promising approach among diverse strategies currently under development. In this review we deeply discuss different nanoparticles (NPs) used in UTI treatment, including organic NPs, nanodiamonds, chemical and green synthesized inorganic NPs, and NPs made of composite materials. In addition, we compare the effects of different NPs against uropathogens in vivo and in vitro and discuss their potential impact the in the near future.
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Affiliation(s)
- Sofía V Sánchez
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile.,Center of New Drugs for Hypertension (CENDHY), Santiago, Chile.,Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | - Nicolás Navarro
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile.,Center of New Drugs for Hypertension (CENDHY), Santiago, Chile.,Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | - Johanna Catalán-Figueroa
- Departamento Farmacología, Facultad de Ciencias Químicas, Instituto de Farmacología experimental de Córdoba (IFEC-CONICET), Universidad Nacional de Córdoba, Córdoba, Argentina.,Facultad de Medicina, Escuela de Química y Farmacia, Universidad Católica del Maule, Talca, Chile
| | - Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile.,Center of New Drugs for Hypertension (CENDHY), Santiago, Chile.,Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
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Jara MO, Landin M, Morales JO. Screening of critical variables in fabricating polycaprolactone nanoparticles using Neuro Fuzzy Logic. Int J Pharm 2021; 601:120558. [PMID: 33831482 DOI: 10.1016/j.ijpharm.2021.120558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/16/2021] [Accepted: 03/27/2021] [Indexed: 12/16/2022]
Abstract
In this work, we used the artificial intelligence tool known as neurofuzzy logic (NFL) for fabricating uniform nanoparticles of polycaprolactone by the nanoprecipitation method with a focus on stabilizer selection. The adaptability of NFL assisted the decision-making on different manufacturing and formulation conditions. The nanoprecipitation method can be summarized as mixing a poorly water-soluble polymer solution with water and its consequent precipitation. Although nanoprecipitation seems simple, the process is highly variable to even slight modifications, leading to polydispersity and nanoparticle aggregation. Here, the NFL model established relationships between mixing conditions, different stabilizers and solvents, among other parameters. Seven parameters measured by dynamic light scattering and laser doppler electrophoresis were modelized with high predictability using NFL tool, as a function of the raw materials and operation conditions. The model allowed the principal component analysis to be carried out, showing that the selection of a stabilizer is the most critical parameter for avoiding nanoparticle aggregation. Then, inputs related to fluid dynamics were relevant to tune the characteristics of the stabilized nanoparticles even further. NFL model showed great potential to support pharmaceutical research by finding subtle relationships between several variables, even from incomplete or fragmented data, which is common in pharmaceutical development.
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Affiliation(s)
- Miguel O Jara
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santos Dumont 964, 4to piso, Of. 09, Independencia, 8380494 Santiago, Chile; Molecular Pharmaceutics and Drug Delivery Division, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, 78712 Austin, TX, USA(1)
| | - Mariana Landin
- R+D Pharma Group (GI-1645), Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, and Health Research Institute of Santiago De Compostela (IDIS) Universidade de Santiago de Compostela-Campus Vida, 15782 Santiago de Compostela, Spain
| | - Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santos Dumont 964, 4to piso, Of. 09, Independencia, 8380494 Santiago, Chile; Advanced Center for Chronic Diseases (ACCDiS), 8380494 Santiago, Chile; Center of New Drugs for Hypertension (CENDHY), 8380494 Santiago, Chile.
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Chou WH, Gamboa A, Morales JO. Inkjet printing of small molecules, biologics, and nanoparticles. Int J Pharm 2021; 600:120462. [PMID: 33711471 DOI: 10.1016/j.ijpharm.2021.120462] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/02/2023]
Abstract
During the last decades, inkjet printing has emerged as a novel technology and attracted the attention of the pharmaceutical industry, as a potential method for manufacturing personalized and customizable dosage forms to deliver drugs. Commonly, the desired drug is dissolved or dispersed within the ink and then dispensed in various dosage forms. Using this approach, several studies have been conducted to load hydrophilic or poorly water-soluble small molecules onto the surface of different solid substrates, including films, tablets, microneedles, and smart data-enriched edible pharmaceuticals, using two-dimensional and three-dimensional inkjet printing methods, with high dose accuracy and reproducibility. Furthermore, biological drugs, such as peptides, proteins, growth factors, and plasmids, have also been evaluated with positive results, eliciting the expected biological response; nonetheless, minor changes in the structure of these compounds with significant impaired activity cannot be dismissed. Another strategy using inkjet printing is to disperse drug-loaded nanoscale particles in the ink liquid, such as nanosuspension, nanocomplexes, or nanoparticles, which have been explored with promising results. Although these favorable outcomes, the proper selection of ink constituents and the inkjet printer, the correlation of printing cycles and effectively printed doses, the stability studies of drugs within the ink and the optimal analysis of samples before and after the printing process are the main challenges for inkjet printing, and therefore, this review analyzes these aspects to assess the body of current literature and help to guide future investigations on this field.
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Affiliation(s)
- Wai-Houng Chou
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile; Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile; Center of New Drugs for Hypertension (CENDHY), Santiago 8380494, Chile
| | - Alexander Gamboa
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile; Centro de Investigación Austral Biotech, Facultad de Ciencias, Universidad Santo Tomás, Avenida Ejército 146, Santiago 8320000, Chile
| | - Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile; Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile; Center of New Drugs for Hypertension (CENDHY), Santiago 8380494, Chile.
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Catalan-Figueroa J, García MA, Contreras P, Boisset CB, Gonzalez PM, Fiedler JL, Pérez MF, Morales JO. Poloxamer 188-Coated Ammonium Methacrylate Copolymer Nanocarriers Enhance Loperamide Permeability across Pgp-Expressing Epithelia. Mol Pharm 2020; 18:743-750. [PMID: 33044825 DOI: 10.1021/acs.molpharmaceut.0c00623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Loperamide is a μ-opioid agonist with poor gastrointestinal absorption, mainly because of its modest aqueous solubility and being a P-glycoprotein (Pgp) efflux substrate. Nevertheless, studies associated with therapeutic effects strongly suggest that loperamide holds potential pharmacological advantages over traditional μ-opioid agonists commonly used for analgesia. Thus, in this Communication, we assessed in MDCK-hMDR1 cell lines the effects over loperamide uptake and efflux ratio, when loaded into Eudragit RS (ERS) nanocarriers coated with poloxamer 188 (P188). ERS was chosen for enhancing loperamide aqueous dispersibility and P188 as a potential negative Pgp modulator. In uptake assays, it was observed that Pgp limited the accumulation of loperamide into cells and that preincubation with P188, but not coincubation, led to increasing loperamide uptake at a similar extent of Pgp pharmacological inhibition. On the other hand, the efflux ratio displayed no alterations when Pgp was pharmacologically inhibited, whereas ERS/P188 nanocarriers effectively enhanced loperamide uptake and absorptive transepithelial transport. The latter suggests that loperamide transport across cells is significantly influenced by the presence of the unstirred water layer (UWL), which could hinder the visualization of Pgp-efflux effects during transport assays. Thus, results in this work highlight that formulating loperamide into this nanocarrier enhances its uptake and transport permeability.
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Affiliation(s)
- Johanna Catalan-Figueroa
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.,Department of Biochemistry, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.,Departamento Farmacología, Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | - Mauricio A García
- Departamento de Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago 7820244, Chile
| | - Pilar Contreras
- Departamento de Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago 7820244, Chile
| | - Constanza B Boisset
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile
| | - Pablo M Gonzalez
- Innovation and Biopharmaceutical Evaluation (IBE) Center, Santiago 8441536, Chile
| | - Jenny L Fiedler
- Department of Biochemistry, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile
| | - Mariela F Pérez
- Departamento Farmacología, Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | - Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.,Center of New Drugs for Hypertension (CENDHY), Santiago 8380494, Chile.,Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile
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Gala RP, Morales JO, McConville JT. Preface to advances in thin film technologies in drug delivery. Int J Pharm 2019; 571:118687. [DOI: 10.1016/j.ijpharm.2019.118687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
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12
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Jara MO, Catalan-Figueroa J, Landin M, Morales JO. Finding key nanoprecipitation variables for achieving uniform polymeric nanoparticles using neurofuzzy logic technology. Drug Deliv Transl Res 2019; 8:1797-1806. [PMID: 29288356 DOI: 10.1007/s13346-017-0446-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nanoprecipitation is a simple and fast method to produce polymeric nanoparticles (Np); however, most applications require filtration or another separation technique to isolate the nanosuspension from aggregates or polydisperse particle production. In order to avoid variability introduced by these additional steps, we report here a systematic study of the process to yield monomodal and uniform Np production with the nanoprecipitation method. To further identify key variables and their interactions, we used artificial neural networks (ANN) to investigate the multiple variables which influence the process. In this work, a polymethacrylate derivative was used for Np (NpERS) and a database with several formulations and conditions was developed for the ANN model. The resulting ANN model had a high predictability (> 70%) for NpERS characteristics measured (mean size, PDI, zeta potential, and number of particle populations). Moreover, the model identified production variables leading to polymer supersaturation, such as mixing time and turbulence, as key in achieving monomodal and uniform NpERS in one production step. Polymer concentration and type of solvent, modifiers of polymer diffusion and supersaturation, were also shown to control NpERS characteristics. The ANN study allowed the identification of key variables and their interactions and resulted in a predictive model to study the NpERS production by nanoprecipitation. In turn, we have achieved an optimized method to yield uniform NpERS which could pave way for polymeric nanoparticle production methods with potential in biological and drug delivery applications.
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Affiliation(s)
- Miguel O Jara
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santos Dumont 964, 4to piso, Of. 09, Independencia, 8380494, Santiago, Chile
| | - Johanna Catalan-Figueroa
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santos Dumont 964, 4to piso, Of. 09, Independencia, 8380494, Santiago, Chile
| | - Mariana Landin
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago, 15782, Santiago de Compostela, Spain
| | - Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santos Dumont 964, 4to piso, Of. 09, Independencia, 8380494, Santiago, Chile. .,Advanced Center for Chronic Diseases (ACCDiS), 8380494, Santiago, Chile. .,Pharmaceutical Biomaterial Research Group, Department of Health Sciences, Luleå University of Technology, 97187, Luleå, Sweden.
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Sepúlveda-Rivas S, Fritz HF, Valenzuela C, Santiviago CA, Morales JO. Development of Novel EE/Alginate Polyelectrolyte Complex Nanoparticles for Lysozyme Delivery: Physicochemical Properties and In Vitro Safety. Pharmaceutics 2019; 11:E103. [PMID: 30823628 PMCID: PMC6470925 DOI: 10.3390/pharmaceutics11030103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
The number of biologic drugs has increased in the pharmaceutical industry due to their high therapeutic efficacy and selectivity. As such, safe and biocompatible delivery systems to improve their stability and efficacy are needed. Here, we developed novel cationic polymethacrylate-alginate (EE-alginate) pNPs for the biologic drug model lysozyme (Lys). The impact of variables such as total charge and charge ratios over nanoparticle physicochemical properties as well as their influence over in vitro safety (viability/proliferation and cell morphology) on HeLa cells was investigated. Our results showed that electrostatic interactions between the EE-alginate and lysozyme led to the formation of EE/alginate Lys pNPs with reproducible size, high stability due to their controllable zeta potential, a high association efficiency, and an in vitro sustained Lys release. Selected formulations remained stable for up to one month and Fourier transform-Infrared (FT-IR) showed that the functional groups of different polymers remain identifiable in combined systems, suggesting that Lys secondary structure is retained after pNP synthesis. EE-alginate Lys pNPs at low concentrations are biocompatible, while at high concentrations, they show cytotoxic for HeLa cells, and this effect was found to be dose-dependent. This study highlights the potential of the EE-alginate, a novel polyelectrolyte complex nanoparticle, as an effective and viable nanocarrier for future drug delivery applications.
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Affiliation(s)
- Sabrina Sepúlveda-Rivas
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.
- Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile.
| | - Hans F Fritz
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.
- Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile.
| | - Camila Valenzuela
- Department of Biochemistry and Molecular Biology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.
| | - Carlos A Santiviago
- Department of Biochemistry and Molecular Biology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.
| | - Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.
- Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile.
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Montenegro-Nicolini M, Reyes PE, Jara MO, Vuddanda PR, Neira-Carrillo A, Butto N, Velaga S, Morales JO. The Effect of Inkjet Printing over Polymeric Films as Potential Buccal Biologics Delivery Systems. AAPS PharmSciTech 2018; 19:3376-3387. [PMID: 29934803 DOI: 10.1208/s12249-018-1105-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022] Open
Abstract
The buccal mucosa appears as a promissory route for biologic drug administration, and pharmaceutical films are flexible dosage forms that can be used in the buccal mucosa as drug delivery systems for either a local or systemic effect. Recently, thin films have been used as printing substrates to manufacture these dosage forms by inkjet printing. As such, it is necessary to investigate the effects of printing biologics on films as substrates in terms of their physical and mucoadhesive properties. Here, we explored solvent casting as a conventional method with two biocompatible polymers, hydroxypropyl methylcellulose, and chitosan, and we used electrospinning process as an electrospun film fabrication of polycaprolactone fibers due to its potential to elicit mucoadhesion. Lysozyme was used as biologic drug model and was formulated as a solution for printing by thermal inkjet printing. Films were characterized before and after printing by mechanical and mucoadhesive properties, surface, and ultrastructure morphology through scanning electron microscopy and solid state properties by thermal analysis. Although minor differences were detected in micrographs and thermograms in all polymeric films tested, neither mechanical nor mucoadhesive properties were affected by these differences. Thus, biologic drug printing on films was successful without affecting their mechanical or mucoadhesive properties. These results open way to explore biologics loading on buccal films by inkjet printing, and future efforts will include further in vitro and in vivo evaluations.
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Bejarano J, Navarro-Marquez M, Morales-Zavala F, Morales JO, Garcia-Carvajal I, Araya-Fuentes E, Flores Y, Verdejo HE, Castro PF, Lavandero S, Kogan MJ. Nanoparticles for diagnosis and therapy of atherosclerosis and myocardial infarction: evolution toward prospective theranostic approaches. Theranostics 2018; 8:4710-4732. [PMID: 30279733 PMCID: PMC6160774 DOI: 10.7150/thno.26284] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/29/2018] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular diseases are the leading cause of death worldwide. Despite preventive efforts, early detection of atherosclerosis, the common pathophysiological mechanism underlying cardiovascular diseases remains elusive, and overt coronary artery disease or myocardial infarction is often the first clinical manifestation. Nanoparticles represent a novel strategy for prevention, diagnosis, and treatment of atherosclerosis, and new multifunctional nanoparticles with combined diagnostic and therapeutic capacities hold the promise for theranostic approaches to this disease. This review focuses on the development of nanosystems for therapy and diagnosis of subclinical atherosclerosis, coronary artery disease, and myocardial infarction and the evolution of nanosystems as theranostic tools. We also discuss the use of nanoparticles in noninvasive imaging, targeted drug delivery, photothermal therapies together with the challenges faced by nanosystems during clinical translation.
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Affiliation(s)
- Julian Bejarano
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
| | - Mario Navarro-Marquez
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
| | - Francisco Morales-Zavala
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
| | - Javier O. Morales
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
- Departamento de Ciencias y Tecnología Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 8380494, Chile
- Pharmaceutical Biomaterial Research Group, Department of Health Sciences, Luleå University of Technology, Luleå 97187, Sweden
| | - Ivonne Garcia-Carvajal
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
| | - Eyleen Araya-Fuentes
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
- Departamento de Ciencias Quimicas, Facultad de Ciencias Exactas, Universidad Andres Bello, Republica 275, 8370146, Santiago, Chile
| | - Yvo Flores
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
| | - Hugo E. Verdejo
- Advanced Center for Chronic Diseases (ACCDiS), División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo F. Castro
- Advanced Center for Chronic Diseases (ACCDiS), División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
- Advanced Center for Chronic Diseases (ACCDiS), & Centro de Estudios en Ejercicio, Metabolismo y Cáncer (CEMC), Instituto de Ciencias Biomedicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380492, Chile
- Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marcelo J. Kogan
- Advanced Center for Chronic Diseases (ACCDiS), Facultad Ciencias Químicas y Farmaceuticas, Universidad de Chile, Santiago 8380492, Chile
- Departamento de Química Farmacológica y Toxicológica, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Vuddanda PR, Montenegro-Nicolini M, Morales JO, Velaga S. Effect of surfactants and drug load on physico-mechanical and dissolution properties of nanocrystalline tadalafil-loaded oral films. Eur J Pharm Sci 2017; 109:372-380. [DOI: 10.1016/j.ejps.2017.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 01/18/2023]
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Morales JO, Brayden DJ. Buccal delivery of small molecules and biologics: of mucoadhesive polymers, films, and nanoparticles. Curr Opin Pharmacol 2017; 36:22-28. [PMID: 28800417 DOI: 10.1016/j.coph.2017.07.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 01/28/2023]
Abstract
Buccal delivery of macromolecules (biologics) sets a great challenge for researchers. Although several niche small molecule products have been approved as simple sprays, tablets and oral films, it is not simply a case of adapting existing technologies to biologics. Buccal delivery of insulin has reached clinical trials with two approaches: oromucosal sprays of the peptide with permeation enhancers, and embedded gold nanoparticles in a dissolvable film. However, neither of these approaches have led to FDA approvals likely due to poor efficacy, submaximal peptide loading in the dosage form, and to wide intra-subject variability in pharmacokinetics and pharmacodynamics. It is likely however that printed film designs with lower molecular weight stable biotech payloads including lipophilic glucagon-like 1 (GLP-1) agonists and macrocycles with long half-lives will generate greater efficacy than was achieved to date for insulin.
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Affiliation(s)
- Javier O Morales
- Department of Pharmaceutical Science and Technology, School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile; Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile; Pharmaceutical Biomaterial Research Group, Department of Health Sciences, Luleå University of Technology, Luleå 97187, Sweden.
| | - David J Brayden
- UCD School of Veterinary Medicine and UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
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Morales JO, Fathe KR, Brunaugh A, Ferrati S, Li S, Montenegro-Nicolini M, Mousavikhamene Z, McConville JT, Prausnitz MR, Smyth HDC. Challenges and Future Prospects for the Delivery of Biologics: Oral Mucosal, Pulmonary, and Transdermal Routes. AAPS J 2017; 19:652-668. [DOI: 10.1208/s12248-017-0054-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/01/2017] [Indexed: 12/25/2022]
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Montero-Padilla S, Velaga S, Morales JO. Buccal Dosage Forms: General Considerations for Pediatric Patients. AAPS PharmSciTech 2017; 18:273-282. [PMID: 27301872 DOI: 10.1208/s12249-016-0567-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/03/2016] [Indexed: 01/08/2023] Open
Abstract
The development of an appropriate dosage form for pediatric patients needs to take into account several aspects, since adult drug biodistribution differs from that of pediatrics. In recent years, buccal administration has become an attractive route, having different dosage forms under development including tablets, lozenges, films, and solutions among others. Furthermore, the buccal epithelium can allow quick access to systemic circulation, which could be used for a rapid onset of action. For pediatric patients, dosage forms to be placed in the oral cavity have higher requirements for palatability to increase acceptance and therapy compliance. Therefore, an understanding of the excipients required and their functions and properties needs to be particularly addressed. This review is focused on the differences and requirements relevant to buccal administration for pediatric patients (compared to adults) and how novel dosage forms can be less invasive and more acceptable alternatives.
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Vuddanda PR, Montenegro-Nicolini M, Morales JO, Velaga S. Effect of plasticizers on the physico-mechanical properties of pullulan based pharmaceutical oral films. Eur J Pharm Sci 2017; 96:290-298. [DOI: 10.1016/j.ejps.2016.09.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/27/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
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Montenegro-Nicolini M, Morales JO. Overview and Future Potential of Buccal Mucoadhesive Films as Drug Delivery Systems for Biologics. AAPS PharmSciTech 2017; 18:3-14. [PMID: 27084567 DOI: 10.1208/s12249-016-0525-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/29/2016] [Indexed: 12/13/2022] Open
Abstract
The main route of administration for drug products is the oral route, yet biologics are initially developed as injectables due to their limited stability through the gastrointestinal tract and solubility issues. In order to avoid injections, a myriad of investigations on alternative administration routes that can bypass enzymatic degradation and the first-pass effect are found in the literature. As an alternative site for biologics absorption, the buccal route presents with a number of advantages. The buccal mucosa is a barrier, providing protection to underlying tissue, but is more permeable than other alternative routes such as the skin. Buccal films are polymeric matrices designed to be mucoadhesive properties and usually formulated with permeability enhancers to improve bioavailability. Conventionally, buccal films for biologics are manufactured by solvent casting, yet recent developments have shown the potential of hot melt extrusion, and most recently ink jet printing as promising strategies. This review aims at depicting the field of biologics-loaded mucoadhesive films as buccal drug delivery systems. In light of the literature available, the buccal epithelium is a promising route for biologics administration, which is reflected in clinical trials currently in progress, looking forward to register and commercialize the first biologic product formulated as a buccal film.
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Montenegro-Nicolini M, Miranda V, Morales JO. Inkjet Printing of Proteins: an Experimental Approach. AAPS J 2016; 19:234-243. [DOI: 10.1208/s12248-016-9997-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/22/2016] [Indexed: 12/13/2022]
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Catalan-Figueroa J, Palma-Florez S, Alvarez G, Fritz HF, Jara MO, Morales JO. Nanomedicine and nanotoxicology: the pros and cons for neurodegeneration and brain cancer. Nanomedicine (Lond) 2015; 11:171-87. [PMID: 26653284 DOI: 10.2217/nnm.15.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Current strategies for brain diseases are mostly symptomatic and noncurative. Nanotechnology has the potential to facilitate the transport of drugs across the blood-brain barrier and to enhance their pharmacokinetic profile. However, to reach clinical application, an understanding of nanoneurotoxicity in terms of oxidative stress and inflammation is required. Emerging evidence has also shown that nanoparticles have the ability to alter autophagy, which can induce inflammation and oxidative stress, or vice versa. These effects may increase neurodegenerative processes damage, but on the other hand, they may have benefits for brain cancer therapies. In this review, we emphasize how nanomaterials may induce neurotoxic effects focusing on neurodegeneration, and how these effects could be exploited toward brain cancer treatment.
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Affiliation(s)
- Johanna Catalan-Figueroa
- Department of Pharmaceutical Science & Technology, School of Chemical & Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.,Laboratory of Neuroplasticity & Neurogenetics, School of Chemical & Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile
| | | | - Gonzalo Alvarez
- Department of Pharmaceutical Science & Technology, School of Chemical & Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile
| | - Hans F Fritz
- Department of Pharmaceutical Science & Technology, School of Chemical & Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile
| | - Miguel O Jara
- Department of Pharmaceutical Science & Technology, School of Chemical & Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile
| | - Javier O Morales
- Department of Pharmaceutical Science & Technology, School of Chemical & Pharmaceutical Sciences, University of Chile, Santiago 8380494, Chile.,Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380494, Chile
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Morales JO, Valdés K, Morales J, Oyarzun-Ampuero F. Lipid nanoparticles for the topical delivery of retinoids and derivatives. Nanomedicine (Lond) 2015; 10:253-69. [DOI: 10.2217/nnm.14.159] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Retinoids are lipophilic compounds that are highly used in cosmetics/therapeutics for skin disorders. Conventional formulations are limited by poor water solubility, high chemical/photochemical instability and the irritation of retinoids. Interestingly, lipid nanoparticles enable the administration of retinoids in aqueous media, providing drug stabilization and controlled release. Recently, it has been demonstrated that retinoids in solid lipid nanoparticles, nanostructured lipid carriers, nanoemulsions and nanocapsules can decrease degradation, improve targeting and enhance efficacy for the treatment of skin disorders. This article focuses on the formulation, fabrication, characterization and in vitro/in vivo evaluation of solid lipid nanoparticles, nanostructured lipid carriers, nanoemulsions and nanocapsules loaded with retinoids for skin administration. Furthermore, the incorporation of these lipid nanoparticles into secondary vehicles is discussed.
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Affiliation(s)
- Javier O Morales
- Department of Sciences & Pharmaceutical Technologies, University of Chile, Santos Dumont 964, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Santos Dumont 964, Santiago, Chile
| | - Karina Valdés
- Department of Sciences & Pharmaceutical Technologies, University of Chile, Santos Dumont 964, Santiago, Chile
| | - Javier Morales
- Department of Sciences & Pharmaceutical Technologies, University of Chile, Santos Dumont 964, Santiago, Chile
| | - Felipe Oyarzun-Ampuero
- Department of Sciences & Pharmaceutical Technologies, University of Chile, Santos Dumont 964, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Santos Dumont 964, Santiago, Chile
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Morales JO, Huang S, Williams RO, McConville JT. Films loaded with insulin-coated nanoparticles (ICNP) as potential platforms for peptide buccal delivery. Colloids Surf B Biointerfaces 2014; 122:38-45. [DOI: 10.1016/j.colsurfb.2014.05.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/06/2014] [Accepted: 05/16/2014] [Indexed: 01/16/2023]
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Morales JO, Su R, McConville JT. The influence of recrystallized caffeine on water-swellable polymethacrylate mucoadhesive buccal films. AAPS PharmSciTech 2013; 14:475-84. [PMID: 23456475 PMCID: PMC3666026 DOI: 10.1208/s12249-012-9891-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022] Open
Abstract
The aim of this work was to investigate the influence of particles on the properties of polymethacrylate films intended for buccal delivery. A solvent casting method was used with Eudragit RS and RL (ERS and ERL, respectively) as film-forming rate-controlling polymers, with caffeine as a water-soluble model drug. The physicochemical properties of the model films for a series of formulations with increasing concentrations of caffeine were determined in terms of morphology, mechanical and mucoadhesive properties, drug content uniformity, and drug release and associated kinetics. Typically regarded as non-mucoadhesive polymers, ERS and mainly ERL, were found to be good mucoadhesives, with ERL01 exhibiting a work of mucoadhesion (WoA) of 118.9 μJ, which was about five to six times higher than that observed for commonly used mucoadhesives such as Carbopol(®) 974P (C974P, 23.9 μJ) and polycarbophil (PCP, 17.4 μJ). The mucoadhesive force for ERL01 was found to be significantly lower yet comparable to C974P and PCP films (211.1 vs. 329.7 and 301.1 mN, respectively). Inspection of cross-sections of the films indicated that increasing the concentration of caffeine was correlated with the appearance of recrystallized agglomerates. In conclusion, caffeine agglomerates had detrimental effects in terms of mucoadhesion, mechanical properties, uniformity, and drug release at large particle sizes. ERL series of films exhibited very rapid release of caffeine while ERS series showed controlled release. Analysis of release profiles revealed that kinetics changed from a diffusion controlled to a first-order release mechanism.
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Affiliation(s)
- Javier O. Morales
- />College of Pharmacy, University of Texas at Austin, Austin, Texas 78712 USA
- />School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, 8380494 Chile
| | - Rong Su
- />Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY UK
| | - Jason T. McConville
- />College of Pharmacy, University of Texas at Austin, Austin, Texas 78712 USA
- />Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, New Mexico 87131 USA
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Morales JO, Ross AC, McConville JT. Protein-coated nanoparticles embedded in films as delivery platforms. J Pharm Pharmacol 2013; 65:827-38. [DOI: 10.1111/jphp.12046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/29/2013] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
This work aimed to evaluate the performance of nanoparticle-loaded films based on matrices of polymethacrylates and hydroxypropylmethylcellulose (HPMC) intended for delivery of macromolecules.
Methods
Lysozyme (Lys)-loaded nanoparticles were manufactured by antisolvent co-precipitation. After size, loading efficiency and stability characterization, the selected batch of particles was further formulated into films. Films were characterized for mechanical properties, mucoadhesion, Lys release and activity after manufacture.
Key findings
We found that protein-coated nanoparticles could be obtained in USP phosphate buffer pH 6.8. Particles obtained at pH 6.8 had a z-average of 347.2 nm, a zeta-potential of 21.9 mV and 99.2% remaining activity after manufacture. This formulation was further studied for its application in films for buccal delivery. Films loaded with nanoparticles that contained Eudragit RLPO (ERL) exhibited excellent mechanical and mucoadhesive properties. Due to its higher water-swelling and solubility compared with ERL, the use of HPMC allowed us to tailor the release of Lys from films. The formulation composed of equal amounts of ERL and HPMC revealed a sustained release over 4 h, with Lys remaining fully active at the end of the study.
Conclusions
Mucoadhesive films containing protein-coated nanoparticles are promising carriers for the buccal delivery of proteins and peptides in a stable form.
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Affiliation(s)
- Javier O Morales
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- School of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
| | - Alistair C Ross
- Ferring Controlled Therapeutics Ltd, East Kilbride, Scotland, UK
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Morales JO, Joks GM, Lamprecht A, Ross AC, McConville JT. A design of experiments to optimize a new manufacturing process for high activity protein-containing submicron particles. Drug Dev Ind Pharm 2013; 39:1793-801. [DOI: 10.3109/03639045.2012.737332] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Morales JO, McConville JT. Manufacture and characterization of mucoadhesive buccal films. Eur J Pharm Biopharm 2010; 77:187-99. [PMID: 21130875 DOI: 10.1016/j.ejpb.2010.11.023] [Citation(s) in RCA: 264] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 11/30/2022]
Abstract
The buccal route of administration has a number of advantages including bypassing the gastrointestinal tract and the hepatic first pass effect. Mucoadhesive films are retentive dosage forms and release drug directly into a biological substrate. Furthermore, films have improved patient compliance due to their small size and reduced thickness, compared for example to lozenges and tablets. The development of mucoadhesive buccal films has increased dramatically over the past decade because it is a promising delivery alternative to various therapeutic classes including peptides, vaccines, and nanoparticles. The "film casting process" involves casting of aqueous solutions and/or organic solvents to yield films suitable for this administration route. Over the last decade, hot-melt extrusion has been explored as an alternative manufacturing process and has yielded promising results. Characterization of critical properties such as the mucoadhesive strength, drug content uniformity, and permeation rate represent the major research areas in the design of buccal films. This review will consider the literature that describes the manufacture and characterization of mucoadhesive buccal films.
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Affiliation(s)
- Javier O Morales
- College of Pharmacy, University of Texas at Austin, Austin, TX 78712, USA
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Beal JE, Olson R, Lefkowitz L, Laubenstein L, Bellman P, Yangco B, Morales JO, Murphy R, Powderly W, Plasse TF, Mosdell KW, Shepard KV. Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia. J Pain Symptom Manage 1997; 14:7-14. [PMID: 9223837 DOI: 10.1016/s0885-3924(97)00038-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We studied the effects of long-term (12 months) dronabinol in 94 late-stage acquired immunodeficiency syndrome (AIDS) patients (mean CD4 count of 45/mm3) who previously participated in a 6-week study (placebo versus dronabinol). All patients received dronabinol orally-2.5 mg twice daily (90%) or 2.5 mg once daily (10%). Appetite was measured using a visual analogue scale for hunger (VASH). Dronabinol was associated with consistent improvement in mean appetite. Patients previously treated with dronabinol continued to show improvement in VASH (percent change from baseline of 6-week trial: 48.6-76.1% at each month), whereas those previously treated with placebo exhibited substantial improvement in mean appetite, particularly during the initial 4 months of treatment (48.5-69.9%). Thereafter, dronabinol was associated with a VASH change at least twice baseline. Patients tended toward stable body weight for at least 7 months. Adverse events were primarily related to known central nervous system effects of dronabinol. These data support long-term, safe use of dronabinol for anorexia associated with weight loss in patients with AIDS.
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Affiliation(s)
- J E Beal
- St. John's Hospital, Tulsa, Oklahoma, USA
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Beal JE, Olson R, Laubenstein L, Morales JO, Bellman P, Yangco B, Lefkowitz L, Plasse TF, Shepard KV. Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage 1995; 10:89-97. [PMID: 7730690 DOI: 10.1016/0885-3924(94)00117-4] [Citation(s) in RCA: 314] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effects of dronabinol on appetite and weight were evaluated in 139 patients with AIDS-related anorexia and > or = 2.3 kg weight loss in a multi-institutional study. Patients were randomized to receive 2.5 mg dronabinol twice daily or placebo. Patients rated appetite, mood, and nausea by using a 100-mm visual analogue scale 3 days weekly. Efficacy was evaluable in 88 patients. Dronabinol was associated with increased appetite above baseline (38% vs 8% for placebo, P = 0.015), improvement in mood (10% vs -2%, P = 0.06), and decreased nausea (20% vs 7%; P = 0.05). Weight was stable in dronabinol patients, while placebo recipients had a mean loss of 0.4 kg (P = 0.14). Of the dronabinol patients, 22% gained > or = 2 kg, compared with 10.5% of placebo recipients (P = 0.11). Side effects were mostly mild to moderate in severity (euphoria, dizziness, thinking abnormalities); there was no difference in discontinued therapy between dronabinol (8.3%) and placebo (4.5%) recipients. Dronabinol was found to be safe and effective for anorexia associated with weight loss in patients with AIDS.
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Affiliation(s)
- J E Beal
- St. John's Hospital, Tulsa, Oklahoma, USA
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Abstract
The purpose of this study was to determine the safety and efficacy of home intravenous antibiotic therapy in treating secondary bacterial infections in patients infected with the human immunodeficiency virus (HIV). This study was a subset analysis of 22 patients with HIV, enrolled in two centers of a multicenter, open-label, prospective study. When necessary, patients were stabilized as inpatients, followed by home therapy. Enrolled patients had diagnoses of pneumonia, skin and soft-tissue infections, bacteremia/septicemia, or other infections requiring parenteral therapy. A third-generation cephalosporin, cefotaxime, 1-2 g every 8 hours, was delivered intravenously using an ambulatory delivery system (ADS). Home therapy with cefotaxime/ADS produced a clinical response rate of 95% and bacteriologic response of 88.2%. The requirement for and duration of inpatient therapy was markedly reduced compared with diagnosis-related group (DRG) allotments. In conclusion, home intravenous antibiotic therapy with cefotaxime in patients infected with HIV is effective and safe. It may improve quality of life by reducing the length of hospital stay.
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Affiliation(s)
- J O Morales
- Ashford Presbyterian Community Hospital, San Juan, Puerto Rico 00907
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Abstract
The treatment of bacterial pneumonia commands a large segment of hospital resources, and economic concerns are dictating shorter hospital stays. This study was designed to determine whether outpatient therapy with intravenous (IV) antibiotics (a third-generation cephalosporin, cefotaxime, delivered via an ambulatory delivery system [ADS]) is as effective as traditional hospital management of pneumonia. A subgroup of 62 patients from three centers, with bacterial pneumonia, were enrolled in a multicenter, open-label study of outpatient IV cefotaxime therapy. Doses of cefotaxime were 1 g IV every 12 hours, 1 g IV every 8 hours, or 2 g IV every 8 hours, based on severity of infection. Of 62 patients, 53 (85%) completed the study. All 22 bacteriologically evaluable patients showed eradication of pathogen or clinical cure with no obtainable follow-up culture; no relapses, reinfections, or superinfections were reported. Overall clinical success rate was 94.8% (satisfactory 75.9%; improved 19.0%, n = 58). Average length of hospital stay was 2.3 +/- 4.83 days. In conclusion, clinical success rates with outpatient IV cefotaxime therapy were comparable to previous studies with IV cefotaxime for pneumonia treatment in the hospital. Outpatient IV antibiotic therapy has the potential to significantly reduce length of hospital stay for pneumonia without sacrificing clinical efficacy.
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Affiliation(s)
- J O Morales
- Ashford Presbyterian Community Hospital, San Juan, Puerto Rico 00907
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Abstract
A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.
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Shultz MM, Morales JO, Fishbein PG, Steinberg AJ. Bilateral breast uptake of 99mTc polyphosphate in a patient with metastatic adenocarcinoma. Radiology 1976; 118:377-8. [PMID: 1250972 DOI: 10.1148/118.2.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bilateral breast uptake of 99mTc polyphosphate was found in a patient with metastatic adenocarcinoma from the rectum. The metastatic breast lesion showed no radiographic evidence of calcification.
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Abstract
Combined ultrasound and nuclear medicine procedures in the evaluation of urinary-tract disease are essentially limited to the kidneys. They are useful in the evaluation of patients with masses, renal failure, unilateral nonfunctioning kidney, trauma, and transplants. In our experience the combined use of these techniques has increased diagnostic accuracy and in many cases has obviated the need for more complex procedures associated with higher radiation doses. This is an especially important factor in children and in adults in the childbearing age group. We have achieved success with these modalities because of the constant communication between the referring physicians and the ultrasound and nuclear medicine divisions.
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Shenkin HA, Greenberg J, Bouzarth WF, Gutterman P, Morales JO. Ventricular shunting for relief of senile symptoms. JAMA 1973; 225:1486-9. [PMID: 4740719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Goldberg BB, Clearfield HR, Goodman GA, Morales JO. Ultrasonic determination of ascites. Arch Intern Med 1973; 131:217-20. [PMID: 4566575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Morales JO, Goldberg BB. Telephone transmission of scintiphotographs. J Nucl Med 1972; 13:771-2. [PMID: 5056695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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DiGiulio W, Morales JO. The value of the selenomethionine Se 75 scan in preoperative localization of parathyroid adenomas. JAMA 1969; 209:1873-80. [PMID: 5820075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Morales JO, Beierwaltes WH, Counsell RE, Meier DH. The concentration of radioactivity from labeled epinephrine and its precursors in the dog adrenal medulla. J Nucl Med 1967; 8:800-9. [PMID: 6061766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Haddock L, Tristani FE, Morales JO, Aguiló F. Primary aldosteronism. A study of carbohydrate tolerance and the juxtaglomerular apparatus. Bol Asoc Med P R 1967; 59:435-44. [PMID: 5258113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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