Clinical Translation of the National Institutes of Health’s Investments in Nanodrug Products and Devices

The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting biomedical research. The NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to enhance health, lengthen life, and reduce illness and disability. In support of this mission, NIH has invested about $4.4 billion since 2001 in nanotechnology (NT) research. This investment is leading to fundamental changes in understanding biological processes in health and disease, as well as enabling novel diagnostics and interventions for treating disease. NIH scientists are developing molecular agents and methods for earlier and more accurate diagnosis and therapies aimed directly and selectively at diseased cells, and are exploring root causes of common and rare diseases at the nanoscale. Work is also underway to move these research tools and devices into clinical practice. This particular investigative review examines the NIH NT portfolio linked to clinical trials from FY2008 to FY2015 to assess the progress of clinical translation. Among the subset of trials identified, 70% target drug or combination drug-device products used in treating cancer, AIDS, and other various diseases. The review also provides insight into trends observed from studying the clinical research portfolio.     

The impact of the concentration of drug binding plasma proteins on drug distribution according to Øie-Tozer’s model

1.?New equations have been developed from an updated version of Øie-Tozer’s model expressing how the free concentration and volume of distribution change in relation to changes in the concentration of drug binding plasma proteins. This updated model accommodates more than one drug binding plasma protein to contribute to the plasma protein binding.

2.?Demonstrations of the model show that variability in the concentration of one plasma protein has considerably less impact on the free drug concentration and volume of distribution if other plasma proteins contribute to binding, than if they don’t.     

The presenilins as potential drug targets in Alzheimer’s disease

Alzheimer’s disease (AD) is a major neurodegenerative disorder affecting a large proportion of the elderly. Given the increasing life expectancy in developed countries, the generation of new drugs to treat AD represents one of the major challenges for the pharmaceutical industry in the coming decades. Central to the disease is the abnormal processing of amyloid precursor protein (APP) resulting in the release of the β-amyloid peptide (Aβ), the major constituent of plaques in the brains of AD patients. Mis-sense mutations causing AD have been found in the APP gene, and more recently in the presenilin genes. Remarkably, all mutations investigated cause an increased production of a particular form of the Aβ that is more prone to precipitation. Presenilins, which are multi-membrane spanning proteins, appear to specifically regulate the production of Aβ by controlling the intramembranous proteolytic cleavage of APP. Inhibition of presenilin is therefore an obvious drug target, although side-effects caused by interference with the processing of other proteins, including notch, have to be considered.     

Clinical and genetic predictors of diabetes drug’s response

Abstract

Diabetes is a major health problem worldwide. Glycemic control is the main goal in the management of type 2 diabetes. While many anti-diabetic drugs and guidelines are available, almost half of diabetic patients do not reach their treatment goal and develop complications. The glucose-lowering response to anti-diabetic drug differs significantly between individuals. Relatively little is known about the factors that might underlie this response. The identification of predictors of response to anti-diabetic drugs is essential for treatment personalization. Unfortunately, the evidence on predictors of drugs response in type 2 diabetes is scarce. Only a few trials were designed for specific groups of patients (e.g. patients with renal impairment or older patients), while subgroup analyses of larger trials are frequently unreported. Physicians need help in picking the drug which provides the maximal benefit, with minimal side effects, in the right dose, for a specific patient, using an omics-based approach besides the phenotypic characteristics.     

Nanotechnology-based drug delivery of ropinirole for Parkinson’s disease

A new drug delivery system is developed for ropinirole (RP) for the treatment of Parkinson’s disease (PD) consisting of biodegradable poly (D,L-lactide-co-glycolide) (PLGA) nanoparticles (NPs). The formulation selected was prepared with 8?mg RP and 50?mg PLGA 502. This formulation exhibited mean encapsulation efficiency of 74.8?±?8.2%, mean particle size lower than 155?nm, the zeta potential of ?14.25?±?0.43?mV and zero-order in vitro release of RP (14.13?±?0.17?μg/h/10?mg NPs) for 5?d. Daily doses of the neurotoxin rotenone (2?mg/kg) given i.p. to male Wistar rats induced neuronal and behavioral changes similar to those of PD. Once neurodegeneration was established (15?d) animals received RP in saline (1?mg/kg/d for 35?d) or encapsulated within PLGA NPs (amount of NPs equivalent to 1?mg/kg/d RP every 3 d for 35?d). Brain histology and immunochemistry (Nissl-staining, glial fibrillary acidic protein and tyrosine hydroxylase immunohistochemistry) and behavioral testing (catalepsy, akinesia, rotarod and swim test) showed that RP-loaded PLGA NPs were able to revert PD-like symptoms of neurodegeneration in the animal model assayed.     

The National Children’s Study: An Opportunity for Medical Toxicology

The National Children's Study (NCS) is a national longitudinal study that will prospectively investigate the influence of biological, environmental, genetic, and social factors on the health and development of US children. The NCS was mandated by the Children's Health Act of 2000 (Public Law 106-310) and is being implemented by the National Institutes of Health with input from the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency, and other federal departments and agencies. The NCS is a data-driven, evidence-based, community- and participant-informed study. Given its scale and scope, the NCS is an integrated system using several data acquisition strategies intended to provide evidenced-based design of methodologies and protocols. These strategies include the Vanguard Study, the Main Study, and formative research and sub-studies. The Vanguard Study, a pilot study, is currently underway and has been expanded from 7 to 37 study locations. The original study protocols and recruitment strategy have been field tested and revisions are under consideration. The CDC is collaborating with NCS in a pilot study that evaluates biological specimen protocols and will provide results on a broad array of environmental chemical exposures and nutritional indicators for a sample of Vanguard Study participants. This study is an example of the kind of collaborative opportunity that would benefit the NCS. Medical toxicologists have unique training in basic and clinical toxicology and laboratory assessments, and by partnering with study centers, both the NCS design and future NCS research projects could be enhanced.     

New concepts in the drug therapy of Alzheimer’s disease

There are currently four compounds approved for use in the treatment of Alzheimer’s disease (AD). These drugs are all cholinesterase (ChE) inhibitors, which are thought to provide predominantly symptomatic benefits by increasing the level of acetylcholine (ACh) in the synapse. Although there are slight differences in the mechanisms of action of these compounds, it remains to be determined whether any one of them has a significant therapeutic advantage over the others. Several other drugs have also been investigated for their potential use as either symptomatic or disease-modifying agents in the treatment of AD, with mixed results. Current therapeutic research is focused on addressing the underlying pathology of AD, in the hope of arresting or reversing the course of the disease. This review will provide an overview of the ChE inhibitors and other drugs used for treating the symptoms of AD, summarise the results of recent therapeutic trials, discuss directions of future research and outline the current treatment recommendations for AD.     

An overview of late-stage functionalization in today’s drug discovery

ABSTRACT

Introduction: Late-stage functionalization (LSF) can introduce important chemical groups in the very last steps of the synthesis. LSF has the potential to speed up the preparation of novel chemical entities and diverse chemical libraries and have a major impact on drug discovery. Functional group tolerance and mild conditions allows access to new molecules not easily accessible by conventional approaches without the need for laborious de novo chemical synthesis.

Areas Covered: A historical overview of late-stage functionalization and its applicability to drug discovery is provided. Pioneering methodologies that laid the foundations for the field are briefly covered and archetypal examples of their application to drug discovery are discussed. Novel methodologies reported in the past few years mainly stemming from the recent renaissances of photoredox catalysis and radical chemistry are reviewed and their application to drug discovery considered.

Expert opinion: It is envisioned that late-stage functionalization will improve the efficiency and efficacy of drug discovery. There is evidence of the widespread uptake of LSF by the medicinal chemistry community and it is expected that the recent and continuing endeavors of many academic laboratories and pharmaceutical companies will soon have an impact on drug development.     

Pharmacokinetic drug evaluation of opicapone for the treatment of Parkinson’s disease

Introduction: Opicapone (OPC) is a novel, potent, reversible, and purely peripheral third-generation COMT inhibitor, which provides an enhancement in levodopa (L-Dopa) availability. It represents adjunctive therapy for L-Dopa treated patients with PD and motor fluctuations.

Areas covered: The purpose of this study was to evaluate pharmacokinetic of OPC for the treatment of PD.

Expert commentary: Oral OPC exhibits linear, dose-dependent absorption. However, following concomitant ingestion of a high-fat, high-calorie meal, the maximum plasma concentration will be decreased. A once-daily bedtime administration of OPC 1 h after the last daily L-Dopa/AADCi, are considered to avoid any interaction during the L-Dopa absorption phase. There are no clinically relevant effects of age (in adults), renal impairment or race on the pharmacokinetics of OPC. OPC dose adjustment is not needed in patients with mild to moderate chronic hepatic impairment. Opicapone exhibits the lowest potential for cytotoxicity in comparison with other COMT inhibitors. It significantly decreases COMT activity, with half-life of COMT inhibition in human erythrocytes of 61.6 h and increases systemic exposure to L-Dopa. This provides an enhancement in L-Dopa availability that translates into clinical benefit for PD patients in terms of significant decrease of OFF periods and increase in ON-time without troublesome dyskinesia.     

Pharmacokinetic drug evaluation of budesonide in the treatment of Crohn’s disease

Introduction: Crohn’s disease (CD) is a chronic inflammatory disorder that commonly affects the terminal ileum and proximal colon. Although systemic corticosteroids such as prednisone and methylprednisolone are widely used for treatment of CD, these agents have a high incidence of adverse drug reactions due to off-target effects. Budesonide is a locally acting corticosteroid with enhanced formulation properties that offer a superior therapeutic index in comparison to conventional members of the class.

Areas covered: This review focuses on budesonide for the treatment of CD. The pharmacological and pharmacokinetics of the drug are summarized, along with clinical efficacy and safety data. We also indicate the role of budesonide in therapeutic algorithms.

Expert opinion: Budesonide has an important role as an induction therapy in patients with mild to moderately active CD of the ileum and proximal colon. The most distinctive advantage of budesonide over conventional corticosteroids is a substantially reduced risk of corticosteroid-related side effects.     

The use of national reimbursement reports to support formulary decisions of the hospital’s Drug and Therapeutics Committee: a comparative analysis

International Journal of Clinical Pharmacy - Background New therapies that do not reach patients in need, have not achieved their goal. Drug and Therapeutics Committees in hospitals ensure access...     

The movement and translation of drug policy ideas: The case of ‘new recovery’

Introduction'New recovery' can be conceptualised as both a social movement and a broader policy agenda to restructure treatment service systems towards 'recovery-oriented systems of care'. Emerging initially out of the United States, new recovery has gained currency as a policy agenda in other jurisdictions - perhaps most distinctly in the United Kingdom. In 2012, the ideas behind 'new recovery' were debated in the Australian alcohol and other drug field as the Victorian government sought to incorporate recovery principles into policy and service design. This paper uses the policy transfer and policy translation literature to understand how international policy ideas about 'new recovery' were negotiated in the Australian context, focusing specifically on the role of non-government actors in the process.MethodsThis paper draws on an analysis of policy documents, organisational documents and interviews with representatives from the Australian non-government alcohol and other drug sector to consider how new recovery was translated into Victorian drug policy.ResultsThe interactions between organisations and actors — including bureaucrats, governmental agencies and policy entrepreneurs — facilitated the circulation and translation of policy ideas in the Victorian context. Despite this, the analysis suggests that policy transfer was largely a symbolic exercise: overall, some of the key features of new recovery policy from the United States and the United Kingdom, such as encouraging peer-led recovery and mutual aid, were not incorporated in the Victorian policy. NGOs resisted what they considered to be some of the more problematic elements of 'new recovery', and informed the local translation of the policy.DiscussionThe results have implications for understandings of the relationship between social movements, non-government organisations and the state, as well as the dynamics of knowledge transfer in drug policy.     

Pivotal role of nitrogen heterocycles in Alzheimer’s disease drug discovery

Alzheimer’s disease (AD) is a detrimental neurodegenerative disease that progressively worsens with time. Clinical options are limited and only provide symptomatic relief to AD patients. The search for effective anti-AD compounds is ongoing with a few already in Phase III clinical trials, yet to be approved. Heterocycles containing nitrogen are important to biological processes owing to their abundance in nature, their function as subunits of biological molecules and/or macromolecular structures, and their biological activities. The present review discusses previously used strategies, SAR, relevant in vitro and in vivo studies, and success stories of nitrogen-containing heterocyclic compounds in AD drug discovery. Also, we propose strategies for designing and developing novel potent anti-AD small molecules that can be used as treatments for AD.