Advances in the Application of Natural Products and the Novel Drug Delivery Systems for Psoriasis

Psoriasis, an incurable autoimmune skin disease, is one of the most common immune-mediated disorders. Presently, numerous clinical research studies are underway, and treatment options are available. However, these treatments focus on improving symptoms of the disease and fail to achieve a radical cure; they also have certain toxic side effects. In recent years, natural products have increasingly gained attention because of their high efficiency and low toxicity. Despite their obvious therapeutic effects, natural products’ biological activity was limited by their instability, poor solubility, and low bioavailability. Novel drug delivery systems, including liposomes, lipospheres, nanostructured lipid carriers, niosomes, nanoemulsions, nanospheres, microneedles, ethosomes, nanocrystals, and foams could potentially overcome the limitations of poor water solubility and permeability in traditional drug delivery systems. Thus, to achieve a therapeutic effect, the drug can reach the epidermis and dermis in psoriatic lesions to interact with the immune cells and cytokines.

Differential and prognostic value of cardiovascular magnetic resonance derived scoring algorithm in cardiac tumors

OBJECTIVES

To establish a scoring algorithm based on cardiovascular magnetic resonance (CMR) parameters for differentiating between benign and malignant cardiac tumors and for predicting outcome.

METHODS

Patients referred for CMR for suspected cardiac tumors were prospectively enrolled. Tumors were categorized as benign or malignant based on pathology, imaging, and clinical information. The CMR protocol included cine, T1-weighted, T2-weighted, first-pass perfusion, and late gadolinium enhancement (LGE) sequences. Variables independently associated with malignancy in the multivariable logistic analysis were used to construct the scoring algorithm, and receiver operating characteristic analyses were used to assess the ability to discriminate malignant from benign tumors. The ability of the score to predict outcome (all-cause mortality) was also assessed by Kaplan-Meier survival analysis.

RESULTS

Among the 105 enrolled patients, 74 had benign and 31 had malignant tumors. In multivariable analysis, the independent predictors of malignant tumors were invasiveness (odds ratio, OR = 11.4, 2 points), irregular border (OR = 5.8, 1 point), and heterogenous LGE (OR 10.6, 2 points). The area under curves (AUC) of the scoring algorithm was 0.912 (cut-off score of 5) and showed significantly higher AUCs than individual variables (all P < 0.05) in differentiating benign and malignant tumors. After median follow-up of 18.2 months, mortality was significantly higher in patients with a score of 5 than in patients with score ≤ 4.

CONCLUSIONS

The scoring algorithm based on CMR-detected invasiveness, irregularity of border, and heterogenous LGE is an effective method for differentiating malignant from benign cardiac tumors and for predicting outcome.

Cellulose nanocrystals based clove oil Pickering emulsion for enhanced antibacterial activity

An effective antibacterial system was developed by using clove essential oil Pickering emulsion (CO-PE). The carboxymethyl cellulose sodium modified cellulose nanocrystals (CNC) was used as the stabilizer of CO-PE, which were prepared by environmentally friendly approach of homogenization technology. The factors affecting the formation and stability of CO-PE were studied, such as CNC concentration, homogenization pressure, CO concentration and ionic concentration and pH. And the antibacterial performance of CO-PE against E. coli and S. aureus was investigated by determining the minimal inhibitory concentration (MIC). The results showed that 1% CNC stabilized CO-PE exhibited small droplet size and rough surface, and had good stability at high pH values or salt concentration, owing to the presence of CNC on interface of droplet. And the CNC-stabilized CO-PE exhibited higher antimicrobial activity at equivalent CO concentration, which might be attributed to efficiently adhere to bacterial membrane. Therefore, our research would provide new insights for antibacterial application of Pickering emulsions loading essential oils in the food and other industries.

Nose-to-Brain Delivery by Nanosuspensions-Based in situ Gel for Breviscapine

Purpose

Nose-to-brain drug delivery is an effective approach for poorly soluble drugs to bypass the blood–brain barrier. A new drug intranasal delivery system, a nanosuspension-based in situ gel, was developed and evaluated to improve the solubility and bioavailability of the drug and to prolong its retention time in the nasal cavity.

Materials and Methods

Breviscapine (BRE) was chosen as the model drug. BRE nanosuspensions (BRE-NS) were converted into BRE nanosuspension powders (BRE-NP). A BRE nanosuspension in situ gelling system (BRE-NG) was prepared by mixing BRE-NP and 0.5% gellan gum (m/v). First, the BRE-NP were evaluated in terms of particle size and by differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Subsequently, the critical ionic concentration of the gellan gum phase transition, influence of the deacetylated gellan gum (DGG) concentration on the expansion coefficient (S%), water-holding capacity, rheological properties and in vitro release behaviour of the BRE-NG were investigated. The pharmacokinetics and brain distribution of the BRE-NG after intranasal administration were compared with those of the intravenously injected BRE-NP nanosuspensions in rats.

Results

The rheology results demonstrated that BRE-NG was a non-Newtonian fluid with good spreadability and bioadhesion performance. Moreover, the absolute bioavailability estimated for BRE-NG after intranasal administration was 57.12%. The drug targeting efficiency (DTE%) of BRE in the cerebrum, cerebellum and olfactory bulb was 4006, 999 and 3290, respectively. The nose-to-brain direct transport percentage (DTP%) of the cerebrum, cerebellum and olfactory bulb was 0.975, 0.950 and 0.970, respectively.

Conclusion

It was concluded that the in situ gel significantly increased the drug retention time at the administration site. Therefore, the nanosuspension-based in situ gel could be a convenient and effective intranasal formulation for the administration of BRE.

Development and usability test of an intelligent cardiovascular risk elimination application for patients with coronary heart disease

Background

The mortality of coronary heart disease (CHD) can be largely reduced by improving CHD risk factors through facilitating adherence to unhealthy lifestyle modification (UhLM) and secondary preventive medications (SPMs). Current interventions, however, have been unsatisfactory worldwide.

Purpose

To develop an Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination system (iCARE) for facilitating adherence to UhLM and SPMs, and test its usability and feasibility for implementation.

Methods

Based on a set of individualized interventions formulated in our preliminary work, we developed iCARE using mHealth techniques and a user-centred approach, which included 3 phases: (1) identifying patient preferences regarding formats for providing interventions; (2) designing the functions, architecture, and user interface (UI); (3) developing the iCARE using prototyping techniques. Usability test was conducted in patients with acute coronary syndromes and/or underwent percutaneous coronary intervention from January to March 2019 in two University affiliated hospitals in our city. The iCARE was implemented in 4 cardiac units of the same hospitals thereafter.

Results

The iCARE architecture and UI are displayed in Fig 1. Different from most current available mHealth CHD management system, the iCARE has a set of interventions and IF-THEN algorithms triggering interventions to ensure that patients receive individualized recommendations for UhLM and SPMs adherence. To improve effectiveness of iCARE interventions, visualization was used to augment patients' perceptions of risks of non-adherence to UhLM and SPMs, and effectiveness of adopting healthy lifestyles etc. Interventions are triggered by results of initial assessment and health data from daily monitoring. The initial assessment is conducted before patients are discharged, and a health report as well as individualized goals for risk reduction are formulated automatically. Daily diet, physical activities, smoking, medication adherence, blood pressure, blood sugar, and symptoms are monitored either through wearable devices or manual entry. Instant and individualized feedbacks as well as recommended actions are sent to patients automatically. A build-in artificial intelligent Q-A function was also included in iCARE. For the usability test, 88 patients with 71.3% male and mean age of 60 (SD 9.9) were recruited, 87.5% were satisfied with iCARE; 89.5% and 81.4% reported that iCARE was useful and easy to use, respectively. Currently, a total of 201 patients with 83.1% male and mean age of 54 (SD 10.2) were recruited from June 2019 to January 2020, and 46 of them have been followed up for 3 months.

Conclusions

The iCARE has achieved its functions of serving as an individualized and intelligent CHD management tool to improve adherence to UhLM and SPMs. The usability is satisfactory and it is feasible to implement in clinical settings.

Figure 1. The iCARE system. iCARE, Individualized, Intelligent and Integrated Cardiovascular Applicaton for Risk Elimination (iCARE) system, CHD, coronary heart disease.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): National Natural Science Funding of China

Roles of maltodextrin and inulin as matrix formers on particle performance of inhalable drug nanocrystal-embedded microparticles

The objective of this study was to investigate the influence of inulin (IL) and maltodextrin (MD) as matrix formers on the physical properties of drug nanocrystal-embedded microparticles (NEM) during spray-drying and storage. The redispersibility, aerodynamic performance and phase behaviour of NEM/MD and NEM/IL stored at different water activity (a_w) values were evaluated. NEM with 2 g/g (relative to the weight of drug) of IL and MD exhibited the excellent performance after spray-drying. The water activity significantly influenced the redispersibility and aerodynamic performance of NEM/MD and NEM/IL. The NEM/MD presented a higher T_g at all a_w values than did NEM/IL. The moisture-induced collapse of the amorphous glassy matrix of IL and MD could be responsible for the poor redispersibility and aerodynamic performance of NEM/IL and NEM/MD, respectively. The NEM/MD exhibited better aerodynamic performance at high a_w (0.528) than did NEM/IL. Therefore, MD could be an excellent matrix former for inhalable NEM.

[Renal angiomyolipoma with epithelial cysts: a clinicopathological analysis of four cases]

Objective: To investigate the clinicopathological features,diagnosis and differential diagnosis of renal angiomyolipoma with epithelial cysts(AMLEC). Methods: Four cases of renal AMLEC diagnosed between January 2014 and June 2019 at the Department of Pathology,Zhejiang Provincial People's Hospital were subjected to clinicopathological, histological and immunohistochemistry analyses along with a literature review. Results: All the four patients were females and aged from 19 to 52 years (mean 34.5 years). Three cases were accidentally discovered by physical examination, and the medical history was 1 to 6 years. The preoperative imaging Bosniak classification was grade Ⅲ in 3 and grade Ⅳ in 1 case. The maximum diameter of the tumor ranged from 2.5 to 9.0 cm (average 5.0 cm). Histologically, all of the 4 tumors showed three histological components: (1) simple epithelial cysts lined by a layer of cuboidal/low-columnar to occasionally, hobnailcells; (2) a thin, compact subepithelial "cambium-like" layer of cellular, mullerian-like short spindle cell stromas with prominent admixedchronic inflammation; (3) a outermost layer of thick, long-fascicles of smooth muscle-like stromas, often surrounded by dysplastic, tortuous thick-walled blood vessels. There was often a prominent lymphatic channel network in the smooth muscle component forming slit like branched and curvilinear spaces. None of the 4 tumors had fat content.Immunohistochemically, the epithelial cells lining the cysts strongly expressed PAX8 and CK7. The subepithelial "cambium-like" stromas strongly expressed melanocytic markers (HMB45, Melan A, Cathspin K, MiTF) and mullerian markers (ER,PR,CD10), and were negative for smooth-muscle markers(SMA,desmin,calponin). The outermost layer of smooth muscle-like stromas strongly expressed smooth-muscle markers, and were only focally positive for melanocytic and mullerian markers. Follow-up information was obtained in 3 cases, among which no evidence of tumor recurrence or metastasis was found at 3, 5, and 66 months of follow-up, respectively. Conclusions: Renal AMLEC is a rare histological subtype of angiomyolipoma with benign biological behavior, and has characteristic histological and immunophenotypic characteristics.Pathologists should be familiar with the clinicopathological appearances of AMLEC and include it in the differential diagnostic spectrums of renal tumors with biphasic epithelial and mesenchymal features.

A novel CPC composite cement reinforced by dopamine coated SCPP fibers with improved physicochemical and biological properties

Traditional CPC cements have attracted wide attentions in repairing bone defects for injectability, easy plasticity and good osseointegration. However, its further application was limited by poor mechanical properties, long setting time and unsatisfactory biocompatibility. To solve these problems, polydopamine (DOPA) coated strontium-doped calcium polyphosphate (SCPP) fibers were added into CPC cements for the first time. A doping amount at fiber weight fraction of 0%, 1%, 2% and 5% was designed to develop a multifunctional composite fitting for bone tissues' regeneration and reconstruction and the optimum amount was selected through subsequent physicochemical and biological characterizations. The results implied DOPA coating successfully formed stable connections between SCPP fibers and CPC matrix, which simultaneously reinforced biomechanical strength and tenacity (5% SCPP/D/CPC samples exhibited more prominent mechanical property than others). In addition, 5% D/SCPP fibers doped composite cements were characterized as markedly-improved cytocompatibility: Sr²⁺ introduction induced cytoactive and significantly accelerated proliferation, attachment and spreading of osteoblasts. Besides, it also stimulated the secretion of OT, Col-I and ALP from seeded MG63, which was a critical character for further inducing osteogenic process, mineralization and bone tissues formation. The promoted cytocompatibility and improved osteogenesis-related growth factors' secretion could be attributed to constant and controllable release of Sr²⁺ and this deduction was approved by ICP analysis. In addition, Sr doping made this novel cement had a potential efficacy to inhibit aseptic loosening. In a word, present studies all demonstrated 5% SCPP/D/CPC composites could be a potential candidate material employed in bone regeneration and reconstruction for excellent mechanical property and cytocompatibility.

288Thrombotic events in bleeding patients treated with andexanet alpha: an ANNEXA-4 sub-study

Background/Introduction

Andexanet alfa (“andexanet”) was developed as a specific reversal agent for patients with major bleeding while using factor Xa (FXa) inhibitors. While thrombotic events (TEs) have been reported in patients receiving andexanet, the scope, nature, and timing of these events have not been fully characterized.

Purpose

The ANNEXA-4 study was a prospective, single-arm, open-label clinical trial that evaluated the safety and efficacy of andexanet in patients with acute major bleeding. In this secondary analysis, the occurrence of TEs was investigated.

Methods

Patients presenting with acute major bleeding within 18 hours after their last dose of FXa inhibitor were treated with andexanet. Safety outcomes, including TEs (reviewed by an adjudication committee), were evaluated at 30 days.

Results

Among 352 patients treated with andexanet, 34 (9.7%) experienced one or more TEs (Table). Strokes and deep vein thromboses were the most frequent TE types. Compared to patients with arterial TEs, patients with venous TEs were more likely to have been originally anticoagulated for venous thromboembolism. Median time to first TE was 10.5 days (Figure); time to event was shorter for arterial TEs than for venous TEs. TEs were nonfatal for most patients. Subgroups by age, bleed type, baseline anti-fXa activity, FXa inhibitor dose, and andexanet dose were not associated with the occurrence of TEs. Of the 34 TE patients, 26 (76.4%) had TEs before restart of any (full or prophylactic) anticoagulation; all first TEs occurred in patients not receiving oral anticoagulation. No TEs occurred after resumption of oral anticoagulation (N=100).

Table 1. Thrombotic event characteristics Characteristic Result (n/N [%]) TE type   Strokes 14/352 (4.0%)   Deep vein thromboses 13/352 (3.7%)   Myocardial infarctions 7/352 (2.0%)   Pulmonary embolisms 5/352 (1.4%)   Transient ischemic attacks 1/352 (0.3%) Bleed type   Intracranial 23/227 (10.1%)   Gastrointestinal 7/90 (7.8%)   Other 4/35 (11.4%) Arterial TEs   Anticoagulated for AF 17/22 (77.3%)   Anticoagulated for VTE 6/22 (27.3%) Venous TEs   Anticoagulated for AF 11/18 (61.1%)   Anticoagulated for VTE 8/18 (44.4%)   Median time to first TE 10.5 days   Arterial 6 days   Venous 15 days Outcome   Fatal 7/34 (20.6%)   Nonfatal 27/34 (79.4%) AF = atrial fibrillation; n = number of patients with TEs; N = total number of patients for each characteristic; TE = thrombotic event; VTE = venous thromboembolism.

Figure 1. Thrombotic Events Over Time

Conclusions

In patients with FXa inhibitor-associated acute major bleeding treated with andexanet, TEs occurred a rate not unexpected given the high thrombotic risk of the population. No factors predictive of TEs were identified. Resumption of anticoagulation was associated with fewer TEs.

Acknowledgement/Funding

Study funded by Portola Pharmaceuticals, Inc.

Novel redispersible nanosuspensions stabilized by co-processed nanocrystalline cellulose-sodium carboxymethyl starch for enhancing dissolution and oral bioavailability of baicalin

BACKGROUND

To improve the dissolution and bioavailability of poorly soluble drugs, novel nanosuspensions using co-processed nanocrystalline cellulose-sodium carboxymethyl starch (NCCS) as a synergetic stabilizer were first designed.

METHODS

Co-processed NCCS was prepared by means of homogenization. Poorly soluble baicalin (BCA) was used as a model drug. BCA nanosuspension (BCA-NS/NCCS) using co-processed NCCS as a dispersant was prepared via homogenization and further converted into the dried BCA nanosuspension particle (BCA-NP/NCCS) via spray drying. The influence of NCCS on the dispersion efficiency of BCA-NS/NCCS was investigated. Morphology and crystal characteristic of NCCS and BCA-NP were analyzed. The dissolution and bioavailability evaluation were performed to investigate the feasibility of NCCS as a stabilizer for BCA-NS/NCCS and BCA-NP.

RESULTS

The optimum 50% concentration of NCCS (nanocrystalline cellulose [NCC]:sodium carboxymethyl starch [SCS]=60:40) could be mostly beneficial for formation and stability of BCA-NS/NCCS. NCCS could completely prevent aggregation of BCA-NP during spray drying and enhance the redispersibility as well as dissolution of spray-dried BCA-NP, which might be attributed to "brick-concrete"-based barrier effect of NCCS and the swelling capacity of superdisintegrant SCS. The crystal state of NCC and BCA presented in BCA-NP/NCCS remained unchanged during the homogenization. The BCA-NP/NCCS exhibited a fast dissolution rate and significantly enhanced bioavailability of BCA. The AUC(0-∞) of the BCA-NP/NCCS (8,773.38±718.18 µg/L·h) was 2.01 times (P<0.05) as high as that of the crude BCA (4,354.61±451.28 µg/L·h).

CONCLUSION

This study demonstrated that novel surfactant-free nanosuspensions could be prepared using co-processed NCCS as a synergetic stabilizer and also provided a feasible strategy to improve the dissolution and oral bioavailability of poorly soluble drug.

Development and characterization of bladder acellular matrix cross-linked by dialdehyde carboxymethyl cellulose for bladder tissue engineering

In order to address the disadvantage of rapid degradation and serious immune response of bladder acellular matrix (BAM) tissues in clinical application, in this study, oxidized carboxymethyl cellulose (DCMC) was developed to replace glutaraldehyde (GA), a most common synthetic crosslinking reagent in clinical practice, to fix BAM tissues for lower cytotoxicity. The aim of this work was to evaluate feasibility of DCMC as a crosslinking reagent for BAM fixation and developing DCMC fixed-BAM (D-BAM) tissues for tissue engineering. For the preparation of DCMC, the results showed that when DCMC was prepared using a specific concentration of sodium periodate solution (the mass ratio of NaIO₄/CMC is 1 : 1) and a specific reaction time (4 hours), its cytotoxicity was the lowest and its fixation effect was better. The critical crosslinking characteristics and cytocompatibility of optimum D-BAM tissues were also investigated. The results demonstrated that DCMC-fixation (especially 30 mg ml⁻¹ DCMC-fixation) not only formed stable cross-linking bonds but also preserved well the original ultrastructure of the BAM tissues, which simultaneously increased the mechanical strength and capacity of the enzymatic hydrolytic resistance. The DCMC-fixation could also reduce the expression of α-Gal in BAM tissues and preserve the useful growth factors such as GAGs, KGF and TGF-β in bladder tissues. In addition, 30 mg ml⁻¹ D-BAM tissues had excellent cytocompatibility. Moreover, it could stimulate the secretion of PDGF and EGF from seeded bladder transitional epithelial cells (BTECs), which is a critical feature for further re-epithelialization. Its anti-calcification ability was also prominent, which is necessary in bladder repair. The present studies demonstrated that DCMC could be a potential biological crosslinking agent for BAM fixation due to its excellent crosslinking effects, and the D-BAM tissues were suitable to be used as a substitute for the bladder due to their resistance to enzymatic degradation, anticalcification and cytocompatibility.

To address the disadvantage of rapid degradation and serious immune response of bladder acellular matrix tissues in clinical application, oxidized carboxymethyl cellulose was developed to replace commonly used glutaraldehyde, to fix BAM tissues for lower cytotoxicity.

The Shielding Effect of Microcrystalline Cellulose on Drug Nanocrystal Particles During Compaction

To elucidate the compaction behavior of drug nanocrystals based composite particles (NP) during tabletting, the compaction behavior of binary mixtures of microcrystalline cellulose (MCC) and nanocrystal particles was investigated. The force-displacement correlation of mixtures containing different ratios of MCC and micronized NP was studied in order to explain the nature on densification of NP during compaction, and the resultant compaction curves (pressure as function of in-die thickness) were systemically analyzed to elucidate the most important mechanisms of volume reduction for MCC and NP in different stages of compaction. The results showed that the close compaction of individual MCC was relatively quickly achieved, and the drug NP particles could slide into the intrinsic void spaces between MCC microparticles. This was the reason that the particles size of MCC used in this study was significantly larger compared to that of drug NP. This interstitial rearrangement phenomenon of NP occurred on a typical time scale and was strongly dependent on the speed of compaction. This migration behavior occurred on void spaces of MCC inter-particles might be identified as an elastic stress relaxation mechanism and be helpful to dissolution of NP. MCC can effectively shield the NP from significant aggregation during compaction process.

Novel nanocrystal-based solid dispersion with high drug loading, enhanced dissolution, and bioavailability of andrographolide

Objective

The current study sought to design a quickly dissolving, high drug loading nanocrystal-based solid dispersion (NC-SD) in order to improve the dissolution of poorly soluble drugs.

Methods

The NC-SD was prepared by means of combination of homogenization and spray-drying. Polymer hydroxypropylmethylcellulose (HPMC) was used as baseline dispersant for NC-SD of the model drug – andrographolide (AG). Three superdisintegrants cohomogenized with HPMC were used as codispersant for AG-NC-SD and compared to common water-soluble dispersants – mannitol and lactose. The dissolution characterization and oral bioavailability of AG-NC-SD were evaluated.

Results

The AG-NC-SD with the higher concentration of HPMC exhibited fast dissolution due to the enhanced wettability of HPMC. The water-soluble codispersants (mannitol and lactose) did not completely prevent AG-NC from aggregation during spray-drying. To achieve much faster AG release, cohomogenized superdisintegrants at a level of 20% must be used along with 25% HPMC. Compared with water-soluble dispersants like mannitol and lactose, superdisintegrants with high swelling capacity were much more effective dispersants for enhancing fast redispersion/dissolution of AG-NC-SD via a swelling-triggered erosion/disintegration mechanism. Surfactant-free AG-NC-SD with 15% cohomogenized sodium carboxymethyl starch combined with 15% HPMC and 10% lactose enhanced the dissolution further, without comprising drug loading, exhibited a barely compromised dissolution rate compared to precursor NC suspensions (f₂>50), and possessed drug loading up to 67.83%±1.26%. The pharmacokinetics results also demonstrated that the AG-NC-SD significantly improved the bioavailability in vivo of AG (P<0.05), compared with to the coarse AG.

Conclusion

This study illustrates that a quickly dissolving, high drug load, surfactant-free NC-SD can be prepared by using a superdisintegrant as codispersant, and provides a feasible strategy to improve the oral bioavailability of poorly soluble drugs.

[Traditional nasal therapy in Uighur medicine]

Nasal therapy, extensively documented in the ancient Uighur medical literature, is one of the external therapies of Uighur medicine. Based on the relevant records of 14 Uighur medical works, the application, classification, clinical features, and medications characteristics of nasal therapy were preliminarily sorted out. The results show that the nasal therapy can be divided into 7 categories, covering more than 200 kinds of common medicinal herbs, 8 kinds of processing methods and 10 kinds of preparations. Clinically, there is a large number of nasal therapy prescriptions, with flexible administration of prescriptions and medications, significant features of comprehensive therapy, with significance of application for further development.