Role of cyclodextrins in ophthalmics

Cyclodextrins are oligosaccharides having outer hydrophilic surface and central hydrophobic cavity. These agents form inclusion complexes with poorly water-soluble drugs; hence they show an important implication for use in ophthalmics because of their applications in solubilising and stabilising the ocular drugs. Most of the drugs being used in ophthalmics were not tailor-made for the eye and considering the poor bioavailability of <1% from the corneal surface, presentation of the drug in a soluble form and at high concentration is important. Provision of a high drug concentration at the corneal surface increases the percent drug permeation indicating the usefulness of cyclodextrins as penetration enhancers. A decrease in irritation potential of some drugs upon incorporation of cyclodextrins is also reported. Polymer-cyclodextrin multicomponent systems further extend the role of cyclodextrins in improving the solubility and bioavilability of ocular drugs. Large hydrophilic cyclodextrins like hydroxypropyl-beta-cyclodextrin and sulphobutylether-beta-cyclodextrin are safe for the use in aqueous eye drop solutions especially since they do not cross the lipophilic cornea. Various aspects about the applications of cyclodextrins in ophthalmics, the formulation considerations and expected toxicity of cyclodextrins (especially if high concentration is used) is discussed in this review. Strategies like use of polymers to reduce the effective concentration of cyclodextrin required without compromising solubility are also included. Further the concept of incorporating the drug-cyclodextrin complexes into liposomes or niosomes for a better targeting of the drug at appropriate tissue destination is discussed as a possible future option.     

Potential of liposomes for the intravitreal injection of therapeutic molecules

Intravitreal administration has been widely used since 20 years and has been shown to improve the treatment of diseases of the posterior segment of the eye with infectious origin or in edematous maculopathies. This route of administration allows to achieve high concentration of drug in the vitreous and avoids the problems resulting from systemic administration. However, two basic problems limit the use of intravitreal therapy. Many drugs are rapidly cleared from the vitreous humor; therefore, to reach and to maintain effective therapy repeated injections are necessary. Repeated intravitreal injections increase the risk of endophthalmitis, damage to lens, retinal detachment. Moreover, some drugs provoke a local toxicity at their effective dose inducing side-effects and possible retinal lesions. In this context, the development and the use of new drug delivery systems for intravitreal administration are necessary to treat chronic ocular diseases. Among them, particulate systems such as liposomes have been widely studied. Liposomes are easily injectable and permit to reduce the toxicity and to increase the residence time of several drugs in the eye. They are also able to protect in vivo poorly-stable molecules from degradation such as peptides and nucleic acids. Some promising results have been obtained for the treatment of retinitis induced by cytomegalovirus in human and more recently for the treatment of uveitis in animal. Finally, the fate of liposomes in ocular tissues and fluids after their injection into the vitreous and their elimination routes begin to be more known.     

Cyclodextrins in drug carrier systems

One of the important characteristics of cyclodextrins is the formation of an inclusion complex with a variety of drug molecules in solution and in the solid state. As a consequence of intensive basic research, exhaustive toxic studies, and realization of industrial production during the past decade, there seem to be no more barriers for the practical application of natural cyclodextrins in the biomedical field. Recently, a number of cyclodextrin derivatives and cyclodextrin polymers have been prepared to obtain better inclusion abilities than parent cyclodextrins. The natural cyclodextrins and their synthetic derivatives have been successfully utilized to improve various drug properties, such as solubility, dissolution and release rates, stability, or bioavailability. In addition, the enhancement of drug activity, selective transfer, or the reduction of side effects has been achieved by means of inclusion complexation. The drug-cyclodextrin complex is generally formed outside of the body and, after administration, it dissociates, releasing the drug into the organism in a fast and nearly uniform manner. In the biomedical application of cyclodextrins, therefore, particular attention should be directed to the magnitude of the stability constant of the inclusion complex. In the case of parenteral application, a rather limited amount of work has been done because the cyclodextrins in the drug carrier systems have to be more effectively designed to compete with various biological components in the circulatory system. However, the works published thus far apparently indicate that the inclusion phenomena of cyclodextrin analogs may allow the rational design of drug formulation and that the combination of molecular encapsulation with other carrier systems will become a very effective and valuable method for the development of a new drug delivery system in the near future.     

Cyclodextrins in nasal drug delivery

Nasal drug delivery is an attractive approach for the systemic delivery of high potency drugs with a low oral bioavailability due to extensive gastrointestinal breakdown and high hepatic first-pass effect. For lipophilic drugs nasal delivery is possible if they can be dissolved in the dosage form. Peptide and protein drugs often have a low nasal bioavailability because of their large size and hydrophilicity, resulting in poor transport properties across the nasal mucosa. Cyclodextrins are used to improve the nasal absorption of these drugs by increasing their aqueous solubility and/or by enhancing their nasal absorption. With several cyclodextrins very efficient nasal drug absorption has been reported, but also large interspecies differences have been found. Studies concerning the safety of cyclodextrins in nasal drug formulations demonstrate the non-toxicity of the cyclodextrins and also clinical data show no adverse effects. Therefore, some cyclodextrins can be expected to become effective and safe excipients in nasal drug delivery.     

Mise en œuvre de procédures d’hygiène et de contrôles physiques et microbiologiques d’environnement au sein d’une unité de radiopharmacie

Preparation of radiopharmaceuticals for injection involves compliance with the regulations for pharmaceutical drugs and radionuclides. The microbiological quality must be ensured, radiation exposure limited, and radioactive contamination of personnel and the environment prevented. Based on work concerning compliance and in accordance with changes in recent regulations, the facilities of the radiopharmacy department of the Louis Mourier Hospital have been optimized. Physical and microbiological controls of equipment and facilities have been implemented to monitor workstations and their environment with respect to microbiological quality. Three hygiene guidelines have also been implemented: improving hygiene practices, personal clothing, practical training on hygiene and its evaluation.     

Modified Doxorubicin for Improved Encapsulation in PVA Polymeric Micelles

Polyvinylalcohol, partially substituted with lipophilic acyl chains, generates polymeric micelles in aqueous phase, containing a hydrophobic core able to encapsulate lipophilic drugs. Two types of polymers were obtained by conjugation of polyvinylalcohol with oleoyl or linoleoyl chains as pendant groups. The polymers, at a substitution degree of ∼1%, are soluble in water and form polymeric micelles whose size increases with polymer concentration. Doxorubicin was hydrophobized, by linking an oleoyl chain via amide bond, to make the drug more similar to the substituted polymers and promote its encapsulation into the inner core of the micelles. The properties of the drug-polymer systems were evaluated in solution by dynamic light scattering technique and correlated to the physicochemical characteristics of the drug and the substituted polymers. Solubilization tests revealed that the similarity of the chain, in both the polymer and the drug, promotes better drug encapsulation in the oleoyl than linoleoyl derivative. The drug-polymer systems are stable in phosphate buffer saline (pH 7.4) at 37°C, and the release of the drug is activated by the presence of the proteolytic enzyme pronase-E. The enzyme activated drug release and the size of the polymeric micelles, compatible with the pore dimensions of the tumor vessels, make these systems interesting for targeting lipophilic drugs to solid tumors, where the proteolytic enzyme concentration strongly raises with respect to the other body compartments.     

Arrêt de la valorisation humanitaire des médicaments non utilisés : enjeux et perspectives

Since the 1970s, drugs unused by French households have been collected for humanitarian aid. In 1993, the Cyclamed^® system was created by pharmacists in order to manage and collect unused drugs. However, experience has shown that in developing countries unused drugs caused more problems than they solved, including: poorly adapted to the needs of the population, poor quality of the collected medicines, interferences with local pharmaceutical policies, misappropriation… As recommended by the World Health Organisation, most of the humanitarian organizations stopped unused drug donations. In France this practice has been forbidden since the 1st of January 2009. Associations that still desire to send unused drugs to developing countries must develop other approaches, such as essential generic medicines or emergency health kits.     

Utility of cyclodextrins in the formulation of genistein: Part 1. Preparation and physicochemical properties of genistein complexes with native cyclodextrins

Isoflavones are suitable guest molecules for inclusion complex formation with cyclodextrins (CDs). The molecular encapsulation with CDs results in a solid, molecularly dispersed form and in a significantly improved aqueous solubility of isoflavones. Genistein, a key isoflavone constituent of Ononidis spinosae radix was found to form a supramolecular, non-covalent inclusion complex with both β-cyclodextrin (β-CD) and γ-cyclodextrin (γ-CD), while it did not form a stable complex with α-CD. The guest genistein was found to spatially located in the less polar cavity of cyclodextrin. The isolated binary genistein/CD complexes appeared novel crystalline lattices. The in vitro dissolution of genistein entrapped into both β- and γ-CD, significantly surpassed that of the plain isoflavone.     

Caractéristiques des infections respiratoires basses chez les sujets âgés

Pneumonia is more frequent among the elderly and is associated with higher rates of hospitalization and death. The diagnosis of pneumonia in the elderly is a clinical challenge because of its non-typical symptoms and because of a poor diagnostic yield of microbiological analysis. Ageing is associated with specific pathogenesis, modifications in lung performance and modifications in oropharyngeal flora. The management relies on empirical therapy, which takes into account the severity of the infectious episode, the presence of additional risk factors, co-morbidities and institutionalization.     

Modified doxorubicin for improved encapsulation in PVA polymeric micelles

Polyvinylalcohol, partially substituted with lipophilic acyl chains, generates polymeric micelles in aqueous phase, containing a hydrophobic core able to encapsulate lipophilic drugs. Two types of polymers were obtained by conjugation of polyvinylalcohol with oleoyl or linoleoyl chains as pendant groups. The polymers, at a substitution degree of approximately 1%, are soluble in water and form polymeric micelles whose size increases with polymer concentration. Doxorubicin was hydrophobized, by linking an oleoyl chain via amide bond, to make the drug more similar to the substituted polymers and promote its encapsulation into the inner core of the micelles. The properties of the drug-polymer systems were evaluated in solution by dynamic light scattering technique and correlated to the physicochemical characteristics of the drug and the substituted polymers. Solubilization tests revealed that the similarity of the chain, in both the polymer and the drug, promotes better drug encapsulation in the oleoyl than linoleoyl derivative. The drug-polymer systems are stable in phosphate buffer saline (pH 7.4) at 37 degrees C, and the release of the drug is activated by the presence of the proteolytic enzyme pronase-E. The enzyme activated drug release and the size of the polymeric micelles, compatible with the pore dimensions of the tumor vessels, make these systems interesting for targeting lipophilic drugs to solid tumors, where the proteolytic enzyme concentration strongly raises with respect to the other body compartments.     

Betamethasone-in-cyclodextrin-in-liposome: the effect of cyclodextrins on encapsulation efficiency and release kinetics

Lipophilic drugs have limited solubility in phospholipid systems, hence maximum entrapment levels in liposomes are known to be low. "Drugs-in-cyclodextrin-in-liposome" systems were previously proposed to overcome this drawback but studies were limited to betaCD and HPbetaCD. In some cases, other cyclodextrins may be more interesting than betaCD or HPbetaCD, such as methylated cyclodextrins. However, these cyclodextrins are known to extract lipid components from the lipid membrane, which may destabilize liposomes. We tested the influence of several cyclodextrins (betaCD, gammaCD, Dimeb, Trimeb, Crysmeb, Rameb, HPbetaCD and HPgammaCD) on the aqueous solubility of betamethasone by phase solubility diagrams and on the encapsulation efficiency in liposomes. The release kinetics of betamethasone was studied using Franz diffusion cells. We showed that release kinetics are directly correlated with encapsulation efficiency, which is closely related to betamethasone concentration in cyclodextrin complex solution. No liposome destruction was observed, even with the testing of methylated cyclodextrins at the highest concentration (40 mM). This can be explained by the fact that these cyclodextrins have a higher affinity for betamethasone than for cholesterol. This was proved by the comparison of phase solubility diagrams of both betamethasone and cholesterol.     

Cyclodextrins as pharmaceutical solubilizers

Cyclodextrins are useful functional excipients that have enjoyed widespread attention and use. The basis for this popularity from a pharmaceutical standpoint, is the ability of these materials to interact with poorly water-soluble drugs and drug candidates resulting in an increase in their apparent water solubility. The mechanism for this solubilization is rooted in the ability of cyclodextrin to form non-covalent dynamic inclusion complexes in solution. Other solubilizing attribute may include the ability to form non-inclusion based complexes, the formation of aggregates and related domains and the ability of cyclodextrins to form and stabilize supersaturated drug solutions. The increase in solubility also can increase dissolution rate and thus improve the oral bioavailability of BCS Class II and IV materials. A number of cyclodextrin-based products have reached the market based on their ability to camouflage undesirable physicochemical properties. This review is intended to give a general background to the use of cyclodextrin as solubilizers as well as highlight kinetic and thermodynamic tools and parameters useful in the study of drug solubilization by cyclodextrins.     

Antitumoral activity of camptothecin-loaded nanoparticles in 9L rat glioma model

Camptothecin (CPT), a plant alkaloid, is a potent anticancer drug in cell culture studies but it is clinically inactive due to rapid hydrolysis under physiological conditions. The drug exists in two forms depending on the pH value, an active lactone form at pH below 5 and an inactive carboxylate form at basic pH and this is a reversible reaction. In this study, nanoparticulate delivery systems were developed with either amphiphilic cyclodextrins, poly(lactide-co-glycolide) or poly-?-caprolactone in order to maintain the active lactone form and prevent the drug from hydrolysis. All nanoparticles were prepared with nanoprecipitation technique. Mean particle sizes were 130–280 nm and surface charges were negative. The encapsulation efficiency was significantly higher for amphiphilic cyclodextrin nanoparticles when compared to polymeric nanoparticles. Nanoparticle formulations based on cyclodextrins showed a controlled release profile extended up to 12 days. 6-O-Capro-β-cyclodextrin (1.44 μg/60 μL CPT) and concentrated 6-O-Capro-β-cyclodextrin (2.88 μg/60 μL CPT) nanoparticles significantly modified the growth or lethality of the 9L gliomas, since the median survival time was 26 days for the untreated group and between 27 and 33 days for amphiphilic cyclodextrin nanoparticle groups. These results indicate that, CPT-loaded amphiphilic cyclodextrin nanoparticles may provide a promising carrier system for the effective delivery of CPT in comparison to polymeric analogues.     

Prise en charge des méningites postopératoires

Postoperative meningitis are rare but severe complications of neurosurgery. Their incidence varies from 0.3 to 1.5% after craniotomy. Aseptic meningitis are twice as more frequent than bacterial meningitis and have a constantly favorable outcome without antibiotic treatment. Physiopathology of aseptic meningitis remains debated between a bacterial origin with a low inoculum or a local inflammatory reaction to blood breakdown products, sutures, tissue breakdown products, etc. Clinical presentation and characteristics of cerebrospinal fluid (CSF) are similar between the two entities. Only negative CSF direct examination and CSF culture in the absence of antibiotic exposure previous to lumbar puncture allows the diagnostic of septic meningitis. There now is a consensus to systematically treat with antibiotics according to local ecology any patient with symptoms suggestive of postoperative meningitis with a CSF yielding more than 100 leukocytes/mm³. Antibiotic should be stop after 72 hours if CSF cultures remain sterile; if culture is positive, empirical treatment should be adapted accordingly. The efficiency of this approach was demonstrated in a prospective study and allowed a significant reduction in the duration of antibiotic treatment in patients with postoperative meningitis with a favorable clinical outcome.     

Properties of poly(lactic-co-glycolic acid) nanospheres containing protease inhibitors: camostat mesilate and nafamostat mesilate

Poly(lactic-co-glycolic acid) (PLGA) nanospheres containing protease inhibitors, camostat mesilate (CM) and nafamostat mesilate (NM), were prepared by the emulsion solvent diffusion methods in water or in oil, and the w/o/w emulsion solvent evaporation method. The average diameter of PLGA nanospheres prepared in the water system were about 150-300 nm, whereas those prepared in the oil system were 500-600 nm. Among the three methods, these drugs were the most efficiently encapsulated up to 60-70% in PLGA nanospheres in the oil system. Other factors that may influence drug encapsulation efficiency and in vitro release such as drug load, molecular weight of polymer were also investigated. Both the CM- and NM-loaded nanospheres prepared in the water system immediately released about 85% of the drug upon dispersed in the release medium while the drug initial burst of nanospheres prepared by the emulsion solvent diffusion in oil method reduced to 30% and 60% for CM and NM, respectively. Poly(aspartic acid) (PAA), a complexing agent for cationic water soluble drugs, showed little effect on the encapsulation efficiency and release behavior for CM and NM. The DSC study and AFM pictures of nanospheres demonstrated that temperature-dependent drug release behavior was ascribable to the glass transition temperature of the polymer, which also affected the morphology of nanospheres upon dispersed in the release medium and influenced the drug release consequently.     

Physical–chemical characterization of binary and ternary systems of ketoprofen with cyclodextrins and phospholipids

Binary and ternary interaction products of ketoprofen (an anti-inflammatory drug very poorly water soluble) with phospholipids (phosphatidylcholine (EPC3) and phosphatidylglycerol (EPG)) and cyclodextrins (β-cyclodextrin and its methylated derivative (MeβCd)), were prepared to evaluate their ability in improving drug dissolution properties. The different binary and ternary drug–carrier(s) systems were obtained by microwave irradiation, in order to investigate the effectiveness of such a newly proposed preparation technology in bringing about effective solid-state interactions among the components. The effect of different experimental conditions such as microwave irradiation power (500 and 750 W) and treatment time (5, 10 and 15 min) on the physicochemical properties of the products has been also assessed. All solid systems were characterized by differential scanning calorimetry (DSC) analysis, supported by X-ray powder diffractometry, and examined for dissolution properties. The study pointed out the better performance of ternary systems than the binary ones and allowed selection of the best drug–phospholipid–Cd combination and of the most effective preparation conditions. In particular drug–EPC3–MeβCd ternary systems obtained by using the greatest microwave irradiation energy and the longest treatment time exhibited complete drug amorphization and allowed achievement after 60 min of almost 80% dissolved drug, with an increase in dissolution efficiency of 10.7 and 1.4 times in comparison with drug alone and the corresponding drug–Cd binary system, respectively. The synergistic effect between cyclodextrin and phospholipid in enhancing the drug dissolution properties has been attributed to the combination of the surfactant properties of phospholipids and the wetting and solubilizing power of cyclodextrins and/or the possible formation of a “multicomponent” complex.     

Recent advances in asymmetric membrane capsule based osmotic pump: a patent overview

Conventional drug delivery systems have little control over their drug release and almost no control over the effective concentration at the target site. This kind of dosing pattern may result in constantly changing, unpredictable plasma concentrations. Drugs can be delivered in a controlled pattern over a long period of time by the process of osmosis. Osmotic devices are the most promising strategy based systems for controlled drug delivery. They are the most reliable controlled drug delivery systems and could be employed as oral drug delivery systems. The present review is concerned with the study of drug release through asymmetric membrane capsule systems. When these systems are exposed to water, low levels of water soluble additive are leached from polymeric material i.e. the semipermeable membrane and the drug releases in a controlled manner over an extended period of time. Drug delivery from this system is not influenced by the different physiological factors within the gut lumen and the release characteristics can be predicted easily from the known properties of the drug and the dosage form. This patent review is useful in the knowledge of asymmetric membrane capsule osmotic pump for its application.     

Effects of cyclodextrins on drug delivery through biological membranes

Cyclodextrins have proven themselves to be useful functional excipients. Cyclodextrin derivatives can be hydrophilic or relatively lipophilic based on their substitution and these properties can give insight into their ability to act as permeability enhancers. Lipophilic cyclodextrins such as the methylated derivatives are thought to increase drug flux by altering barrier properties of the membrane through component extraction or fluidization. The hydrophilic cyclodextrin family also modulate drug flux through membranes but via different mechanisms. The current effort seeks to provide various explanations for these observations based on interactions of hydrophilic cyclodextrins with the unstirred water layer that separates the bulk media from biological membranes such as the gastric mucosa, cornea and reproductive tract. Theories on the serial nature of resistances to drug flux are used to explain why hydrophilic cyclodextrins can enhance drug uptake in some situation (i.e., for lipophilic material) but not in others. In addition, the nature of secondary equilibria and competition between cyclodextrins and rheologically important biopolymers such as mucin are assessed to give a complete picture of the effect of these starch derivatives. This information can be useful not only in understanding the actions of cyclodextrin but also in expanding their application and uses.