Advances in transdermal insulin delivery

Insulin therapy is necessary to regulate blood glucose levels for people with type 1 diabetes and commonly used in advanced type 2 diabetes. Although subcutaneous insulin administration via hypodermic injection or pump-mediated infusion is the standard route of insulin delivery, it may be associated with pain, needle phobia, and decreased adherence, as well as the risk of infection. Therefore, transdermal insulin delivery has been widely investigated as an attractive alternative to subcutaneous approaches for diabetes management in recent years. Transdermal systems designed to prevent insulin degradation and offer controlled, sustained release of insulin may be desirable for patients and lead to increased adherence and glycemic outcomes. A challenge for transdermal insulin delivery is the inefficient passive insulin absorption through the skin due to the large molecular weight of the protein drug. In this review, we focus on the different transdermal insulin delivery techniques and their respective advantages and limitations, including chemical enhancers-promoted, electrically enhanced, mechanical force-triggered, and microneedle-assisted methods.

Jet injectors: Perspectives for small volume delivery with lasers

Needle-free jet injectors have been proposed as an alternative to injections with hypodermic needles. Currently, a handful of commercial needle-free jet injectors already exist. However, these injectors are designed for specific injections, typically limited to large injection volumes into the deeper layers beneath the skin. There is growing evidence of advantages when delivering small volumes into the superficial skin layers, namely the epidermis and dermis. Injections such as vaccines and insulin would benefit from delivery into these superficial layers. Furthermore, the same technology for small volume needle-free injections can serve (medical) tattooing as well as other personalized medicine treatments. The research dedicated to needle-free jet injectors actuated by laser energy has increased in the last decade. In this case, the absorption of the optical energy by the liquid results in an explosively growing bubble. This bubble displaces the rest of the liquid, resulting in a fast microfluidic jet which can penetrate the skin. This technique allows for precise control over volumes (pL to µL) and penetration depths (µm to mm). Furthermore, these injections can be tuned without changing the device, by varying parameters such as laser power, beam diameter and filling level of the liquid container. Despite the published research on the working principles and capabilities of individual laser-actuated jet injectors, a thorough overview encompassing all of them is lacking. In this perspective, we will discuss the current status of laser-based jet injectors and contrast their advantages and limitations, as well as their potential and challenges.

Characterization of needle-assisted jet injections

Hypodermic injections have been the standard for transcutaneous drug delivery for many years. However, needle phobia, pain, and risks of needle-stick injuries have manifested in poor patient compliance. Needle-free jet injections (NFJI) have been developed to address these drawbacks but the reliability of dose and depth of delivery have been limited by a lack of control over jet parameters, and by variability in the skin's mechanical properties among individuals. Moreover, the device size and cost have been restrained by the high pressure (>20MPa) required to penetrate the skin. Needle-assisted jet injections have been proposed to improve delivery reliability of conventional jet injectors by penetrating the skin with a short needle (<5mm) and thereby allowing jet delivery to a desired injection depth at a reduced pressure. This study characterized needle-assisted jet injections performed after first penetrating the skin with a 1.5mm needle, examining the effect of needle size on jet parameters, and evaluating injection performance in porcine skin. A voice-coil actuated jet injector was modified to incorporate needles of 30G, 31G and 32G. A series of pulse tests was performed to compare jet velocity and injection volume across the needle sizes, where it was found that the jet velocity and injection volume achieved with 32G needles were 13% and 16% lower, respectively, than with 30G. In contrast, there was no significant difference in jet velocity and injection volume between 30G and 31G needles, suggesting that a reduction of 10μm in the mean inner diameter of the 31G needle has minimal impact on jet velocity and injection volume. Injection studies performed in porcine skin revealed that injections driven by fluid pressures ranging between 0.8MPa and 1.4MPa were able to achieve substantial injectate penetration (~10mm) and delivery (~100μL) into subcutaneous fat regardless of needle size, in a period of 40ms. The required pressures are an order of magnitude lower than those used in NFJI, yet still maintain the high-speed nature of jet injection by achieving a delivery rate of 2.25mL/s. The lower pressures required in needle-assisted drug delivery can lead to reduced device size and cost, as well as reduced shear stresses during jet injection and can therefore minimise the potentially adverse effect of shear on the structural integrity of proteins, vaccines and DNA.

Recent advances in mechanical force-assisted transdermal delivery of macromolecular drugs

The transdermal delivery of macromolecular drugs has become one of the focused topics in pharmaceutical research since it enables highly specific and effective delivery, while avoiding the pain and needle phobia associated with injection, or incidences like drug degradation and low bioavailability of oral administration. However, the passive absorption of macromolecular drugs via skin is highly restricted by the stratum corneum owing to high molecular weight. Therefore, various strategies have been extensively developed and conducted to facilitate the transdermal delivery of macromolecular drugs, among which, mechanical force-assisted techniques occupy dominant positions. Such techniques include ultrasound, needle-free jet injection, temporary pressure and microneedles. In this review, we focus on recent transdermal enhancing strategies utilizing mechanical force, and summarize their mechanisms, advantages, limitations and clinical applications respectively.

Effect of geometrical parameters on the fluid dynamics of air-powered needle-free jet injectors

Needle-free jet injectors are non-invasive systems having intradermal drug delivery capabilities. At present, they revolutionize the next phase of drug delivery and therapeutic applications in the medical industry. An efficiently designed injection chamber can reduce the energy consumption required to achieve the maximum penetration depth in skin tissue. In this study, the authors explored the effect of various geometrical parameters using a computational fluid dynamics tool. Peak stagnation pressure during the initial phase of the injection procedure was considered as the quantifier for comparison because of its proportional relationship with the initial penetration depth during the injection process. Peak stagnation pressure indicates the maximum energy transformation that could happen between the microjet and skin tissues for an injection procedure. The results of this study indicated a tradeoff that exists between the attainable density and velocity of the microjet on the skin surface with variation in nozzle diameter; the optimum nozzle diameter was found to be within 200-250 μm under the present conditions. The authors also observed a discrepancy in the peak stagnation pressure value for lower filling ratios with variation in chamber diameter; hence, filling ratio of at least 50% was recommended for such systems. Furthermore, a 150% increase in the peak stagnation pressure was obtained with an angle of entry of 10°. In general, this study could provide valuable insights into the effect of geometrical parameters in the fluid dynamics characteristics of propelled microjets from the nozzle of a needle-free jet injector. Such information could be useful for the design of a mechanically driven needle-free jet injector having limited control over the energizing mechanism.

Small animal jet injection technique results in enhanced immunogenicity of hantavirus DNA vaccines

DNA vaccine evaluation in small animals is hampered by low immunogenicity when the vaccines are delivered using a needle and syringe. To overcome this technical hurdle we tested the possibility that a device developed for human intradermal medicine delivery might be adapted to successfully deliver a DNA vaccine to small animals. Disposable syringe jet injection (DSJI) does not currently exist for small animals. However, a commercialized, human intradermal device used to to administer medicines to the human dermis in a 0.1 mL volume was evaluated in Syrian hamsters. Here, we found that hantavirus DNA vaccines administered to hamsters using DSJI were substantially more immunogenic than the same vaccines delivered by needle/syringe or particle mediated epidermal delivery (gene gun) vaccination. By adjusting how the device was used we could deliver vaccine to either subcutaneous tissues, or through the skin into the muscle. RNA and/or antigen expression was detected in epidermal, subepidermal and fibroblast cells. We directly compared six optimized and non-optimized hantavirus DNA vaccines in hamsters. Optimization, including codon-usage and mRNA stability, did not necessarily result in increased immunogenicity for all vaccines tested; however, optimization of the Andes virus (ANDV) DNA vaccine protected vaccinated hamsters from lethal disease. This is the first time active vaccination with an ANDV DNA vaccine has shown protective efficacy in the hamster model. The adaptation of a human intradermal jet injection device for use as a method of subcutaneous and intramuscular jet injection of DNA vaccines will advance the development of nucleic acid based medical countermeasures for diseases modeled in hamsters.

Optimization of Zika DNA vaccine by delivery systems

In our previous study, we designed and evaluated the efficacy of six DNA vaccine candidates based on the E protein of Zika virus (ZIKV). To optimize the DNA vaccine, we inoculated C57BL/6 and IFNAR1^- mice with the vaccine candidate expressing tandem repeated ZIKV envelope domain III (ED III × 3) doses; 50 μg by intramuscular (IM), jet injection (JET), or electroporation (EP) routes. Results showed that vaccination by all routes induced humoral and cellular immunity. Among them, EP induced robust ZIKV E specific-total IgG and neutralizing antibodies, as well as T cell responses. Additionally, EP showed superior protective efficacy against the ZIKV Brazil strain compared to the IM and JET routes. Finally, in the dose optimization test of EP route, cellular immunity of 50 μg was induced a significant level than other dose groups. These results showed that the EP delivery system enhanced the potential immunogenicity and protective efficacy of DNA vaccines.

Reduction of membrane fouling by innovative method (injection of air jet)

BACKGROUND

One of the most important challenges about the Membrane Bio Reactors is membrane fouling. Fouling has been at the centre of a globe debate for more recent years. It leads to high operational and maintenance costs such as membrane damage and replacement of membrane. Membrane fouling is attributed to the physicochemical interactions between the bio fluid and membrane. In order to decrease the fouling in bioreactors there are common anti fouling strategies such as operation at low flux, Optimization of aeration flow-rate and Physical and chemical cleanings. However, often they are not effective.

METHODOLOGY

This work deal with fouling crisis by a new and innovative method in order to reduce of fouling on membrane surface by injection of parallel air jet on membrane bio reactor. This is a new idea and fundamental study about the influence of wall jet on fouling of membrane surface. This study is included both experimental and numerical investigations. In order to polarize the stream path on the surface of the membrane, four symmetric nozzles were implemented at the bottom of the membrane surface upon the sparger. The changes in the fouling resistance were experimentally measured at five various jet velocities and all of them recorded by a computer system. In addition the effect of air jet velocity and shear stress on fouling resistances was also investigated by computational fluid dynamics at the similar conditions.

RESULTS

It was revealed that the permeate flux and resistance of fouling can be related to shear stress of air flow at the membrane surface. When the velocity of air jets increase, the permeate flux increase too. Also, results illustrate that jet injection can partially remove the cake which was formed on the surface of the membrane.

CONCLUSIONS

Correlations were developed for estimating each resistance of the membrane surface via the shear stress. The resistances of the cake are removed by the jet velocity changes, from 20% in lower jet velocity up to 40% in higher jet velocity.

Dispersion profile of a needle-free jet injection depends on the interfacial property of the medium

Injections into or through the skin are common drug or vaccine administration routes, which can be achieved with conventional needles, microneedles, or needle-free jet injections (NFJI). Understanding the transport mechanism of these injected fluids is critical for the development of effective drug administration devices. NFJI devices are distinct from traditional injection techniques by their route and time scale, which relies on a propelled microjet with sufficient energy to penetrate the skin surface and deliver the drug into the targeted region. The injected fluid interacts with multiple skin tissue layers and interfaces, which implies that the corresponding injection profile is dependent on their mechanical properties. In this study, we address the lack of fundamental knowledge on the impact of these interfaces on the injection profiles of NFJI devices.

Jet or conventional local anaesthesia? A randomized controlled split mouth study

OBJECTIVES

To compare the efficacy, acceptance and preference of conventional infiltration technique with a needleless jet anaesthetic device (Comfort-In).

MATERIALS AND METHODS

Non-fearful healthy adult volunteers, aged 19-40 years, were recruited in the Dental School of Aristotle University of Thessaloniki, Greece. Intact maxillary premolars were selected for local anaesthesia. Both techniques were applied sequentially with 35 min time gap on either buccal side on the same day by the same operator. The quadrant and the order of administration were randomly assigned using an online randomization generator. Immediately after administration, at 1, 3, 5, 10, 15, 20, 25 and 30 min, pulp vitality and soft tissue pain reaction tests were performed. Each participant was asked 6 questions in order to assess acceptance. At the end of the session, at 24 h and 7 days, all participants were asked to report any adverse events and their preference.

RESULTS

In 63 volunteers who were successfully followed, 63 teeth received conventional local infiltration and 63 the Comfort-In. Both techniques presented with similar anaesthetic efficacy at 1, 3, 5, 10 and 15 min, whereas the conventional technique was more efficacious at 20 min (p < 0.005). Both presented similar acceptance apart from higher pain/discomfort during administration of Comfort-In (p = 0.002). Significantly higher preference was reported for the conventional technique immediately after the session, at 24 h and at 7 days (p < 0.0005); 19 (30.2%) reported the presence of ecchymosis or lacerations at the Comfort-In site as opposed to 5 (7.9%) with the conventional method (p < 0.0001).

CONCLUSION

Both techniques showed similar effectiveness. Conventional infiltration was preferred to needleless anaesthesia by non-fearful adult volunteers and was associated with less adverse events.

CLINICAL RELEVANCE

This study enhances the advantages of conventional local anaesthesia.

TRIAL REGISTRATION

ISRCTN17400733.

Degradation study on molecules released from laser-based jet injector

Development of needle-free methods to administer injectable therapeutics has been researched for a few decades. We focused our attention on a laser-based jet injection technique where the liquid-jet actuation mechanism is based on optical cavitation. This study investigates the potential damage to therapeutic molecules which are exposed to nanosecond laser pulses in the configuration of a compact laser-based jet injection device. Implementation of a pulsed laser source at 1574 nm wavelength allowed us to generate jets from pure water solutions and circumvent the need to reformulate therapeutics with absorbing dyes. We performed H1-NMR analysis on exposed samples of Lidocaine and δ-Aminolevulinic acid. We made several tests with linear and plasmid DNA to assess the structural integrity and functional potency after ejection with our device. The tests showed no significant degradation or detectable side products, which is promising for further development and eventually clinical applications.

Effect of orientation angle for needle-free jet injection

In this paper, we report on the delivery efficiency of needle-free jet injections using injectors with typical jet speed vj≈140m/s, orifice diameter do=157μm, and volume V=0.1 mL. The target substrates were either hydrogel tissue phantoms or porcine tissues combined with excised human skin. The novelty of this study is two-fold: First, we investigate the influence of injection angle relative to the skin surface, and second, we also study the influence of the jet path relative to the orientation of muscle fibers. While most commercial jet injectors employ a fitting that would render the device normal to the skin surface, recent studies have proposed oblique injections, which may be beneficial for intradermal or subcutaneous tissue injection. Furthermore, for deeper intramuscular injections, we propose that an angled jet path taking the muscle fiber orientation into account may result in a bolus or dispersion zone that is conducive to increased cellular uptake of the drug.

Efficacy and safety of needle-free jet injector-assisted intralesional treatments in dermatology-a systematic review

Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and safety of these treatments has not been published. The objectives of this study are to evaluate the efficacy and safety of needle-free jet injections for dermatological indications and to provide evidence-based treatment recommendations. An electronic literature search was conducted in April 2022. Two reviewers independently selected studies based on predefined criteria and performed a methodological quality assessment using the Cochrane Collaborations risk-of-bias 2.0 assessment tool and Newcastle-Ottawa Scale. Thirty-seven articles were included, involving 1911 participants. Dermatological indications included scars, alopecia areata, hyperhidrosis, nail diseases, non-melanoma skin cancer, common warts, local anesthesia, and aesthetic indications. Keloids and other types of scars (hypertrophic, atrophic, and burn scars) were investigated most frequently (n = 7). The included studies reported favorable efficacy and safety outcomes for intralesional jet injector-assisted treatment with triamcinolone acetonide/hexacetonide, 5-fluorouracil, bleomycin, or hyaluronic acid. Two high-quality studies showed good efficacy and tolerability of intralesional jet injections with a combination of 5-fluorouracil and triamcinolone acetonide in hypertrophic scars and with saline in boxcar and rolling acne scars. No serious adverse reactions and good tolerability were reported in the included studies. Overall, the methodological quality of the included studies was low. Limited evidence suggests that needle-free jet injector-assisted intralesional treatment is efficacious and safe for hypertrophic and atrophic acne scars. More well-powered RCTs investigating the efficacy and safety of jet injector treatment in dermatology are warranted to make further evidence-based recommendations.

DNA Aβ42 immunization via needle-less Jet injection in mice and rabbits as potential immunotherapy for Alzheimer's disease

Alzheimer's disease (AD) is the most common form of dementia found in the elderly and disease progression is associated with accumulation of Amyloid beta 1-42 (Aβ42) in brain. An immune-mediated approach as a preventive intervention to reduce amyloid plaques without causing brain inflammation is highly desirable for future clinical use. Genetic immunization, in which the immunizing agent is DNA encoding Aβ42, has great potential because the immune response to DNA delivered into the skin is generally non-inflammatory, and thus differs quantitatively and qualitatively from immune responses elicited by peptides, which are inflammatory with production of IFNγ and IL-17 cytokines by activated T cells. DNA immunization has historically been proven difficult to apply to larger mammals. A potential barrier to use DNA immunization in large mammals is the method for delivery of the DNA antigen. We tested jet injection in mice and rabbits and found good antibody production and safe immune responses (no inflammatory cytokines). We found significant reduction of amyloid plaques and Aβ peptides in brains of the DNA Aβ42 immunized 3xTg-AD mouse model. This study was designed to optimize DNA delivery for possible testing of the DNA Aβ42 vaccine for AD prevention in a clinical trial.

Jet injection through microneedles for large volume subcutaneous delivery

Subcutaneous (SC) drug delivery offers several advantages over intravenous (IV) delivery including: self-administration, improved patient experience, and reduced treatment costs. Unfortunately, each SC delivery is currently limited to ∼ 2.25 mL with IV administration required when the delivery volume exceeds this value. In this work, we explore a new technique for large volume subcutaneous drug delivery that uses microneedles to break through the epidermis then forms the liquid drug into many small jets that penetrate past the ends of the microneedles and into the subcutaneous (or muscle) tissue. By performing multiple simultaneous injections, this delivery approach avoids the volume limitations of SC delivery, and thus may be able to greatly increase the volume we can deliver to this space. Here, we present a novel multi-jet prototype that forms seven simultaneous jets through 30G needles that have been shortened to have an exposed length of just ∼ 1mm. The jet speed, shape, and volume of jets formed through these microneedles are measured to assess the consistency of jet production through the microneedles. We then perform jet injections of volumes up to 3.9 mL into ex vivo porcine tissue. The results demonstrate the successful delivery (>95 %) of 3.9 mL in just 0.3 s using jet injection performed through microneedles. This volume is almost double the maximum volume of current autoinjectors and the perceived limit for subcutaneous injection (2.25 mL). We also find that jet speeds of 70 m/s and below do not achieve complete delivery of 3.9 mL with our prototype system, and that the addition of microneedles leads to more consistent large volume delivery than equivalent needle-free injections. These results demonstrate the promise of multi-jet injection through microneedles to accommodate volumes much greater than current autoinjectors, and thus potentially allow patient self-administration in many more delivery applications.

Large volume subcutaneous delivery using multi-orifice jet injection

Needle-free jet injection is an alternative drug delivery technique that uses the liquid drug itself to penetrate through the skin. This technology is not only a promising alternative to hypodermic needles but also has the potential to replace intravenous delivery with rapid, needle-free subcutaneous delivery for large-volume treatments. In this work we propose a parallelised, 'multi-orifice' approach to overcome the volume constraints of subcutaneous tissue. We present a prototype multi-orifice nozzle with up to seven orifices and use this nozzle to perform injections into samples of ex vivo porcine tissue. These injections demonstrated the rapid (<0.15 s) delivery of up to 2 mL into the tissue using both three and seven orifices. Delivery success (measured as the percentage of fluid deposited in the tissue relative to the total volume that left the device) was very similar when using three versus seven injection orifices. A computational fluid dynamic model of multi-orifice jet injection is also presented. This model predicts that jet production is largely unaffected as the spacing between orifices is changed from 3 mm to 48 mm. This finding is supported by measurements of the speed, volume, and shape of the jets produced by the prototype nozzle that showed very similar jets were produced through all seven orifices. These findings demonstrate the feasibility of multi-orifice jet injection for needle-free delivery of large volumes. This promising technique has the potential to improve patient experience and reduce healthcare costs in large volume parenteral delivery applications.

Experimental studies on penetration process of high-speed water-jet into ballistic gelatin

To reveal the penetration mechanism and present the penetration characteristics of high-speed micro-jet with injection volume larger than 0.3 mL into soft tissue, the present study conducted experimental research on high-speed water-jet penetration into ballistic gelatin. The free jet dynamics of an air-powered needle-free injector that can emit up to 1.27 mL of liquid at once and the penetration dynamics were visualized to reveal the details of the penetration process. In the early unstable stage, the jet is emitted in the form of pulses, and the first jet pulse can rapidly generate an initial slender channel in gelatin in a very short time. In the subsequent stable stage, energy input produces dispersion and further increases the penetration depth slowly. Changing the driving pressure by the power source mainly changes the penetration depth increment by dispersion; while changing the nozzle diameter mainly affects the penetration depth in the initial stage. The central position of the dispersion area in the injection direction was firstly defined in the present work and it was found that an approximate linear relationship between this position and the maximum penetration depth exits for different nozzle diameters and driving pressures when injecting the same liquid dose. These research results can provide a basis for a thorough understanding of the penetration characteristics of high-speed micro-jet with injection volume larger than 0.3 mL into soft tissue, as well as the design and operation of the air-powered needle-free injector.

Intra-articular administration of naked plasmid DNA with a guide-equipe jet injector in rat knee joints

Previous studies showed that intradermal delivery of naked plasmid DNA using the needle-free pyro-drive jet injector, Actranza™, significantly enhanced gene expression compared to needle-syringe injections in animals. Here, we targeted intra-articular (IA) tissues, including cartilage in the rat knee joint. In order to accurately deliver the DNA solution to the joint cavity, the Actranza prototype attaching a 30G needle as a guide was used (30G-Acranza). The injection powers are controllable adjusting the amounts of ignition powder (IP) and smokeless powder (SP). Preliminary tests determined an optimal injection site (5 mm depth from the skin surface into the anterior joint cavity with the knee flexed) and injection volume (30 µL). Initial trials with 30G-Actranza-25/40 (IP/SP = 25 mg/40 mg) showed luciferase plasmid (pLuc) expression levels (relative luminescence units, RLU) that were approximately 40 times higher than manual syringe injections 24 h after the administration. Additional Green Fluorescent Protein plasmid (pGFP) experiments detected fluorescence in chondrocytes and cruciate ligament fibroblasts. The higher-powered 30G-Actranza-35/40 further increased pLuc expression compared to syringe injections (∼ 100 times). The expression remained detectable 10 days post-injection, though reduced from day one. Speed-controlled tests indicated that pLuc expression levels increased with injection speed, reaching saturation at 693 µL/s of 30G-Actranza-35/40. Reference data showed transdermal needle-free jet injection favored skin and proximal tissues over IA sites. In conclusion, needle-equipped jet injection effectively transfects naked plasmid DNA into IA tissues like cartilage, synovium, ligaments, and tendons with potential applications for encapsulated tissues such as tumors, broadening prospects for gene therapy, gene editing, and regenerative medicine.