Encapsulation of drugs in intact erythrocytes: an intravenous delivery system

Erythrocytes as Carriers: From Drug Delivery to Biosensors

Drug delivery using natural biological carriers, especially erythrocytes, is a rapidly developing field. Such erythrocytes can act as carriers that prolong the drug's action due to its gradual release from the carrier; as bioreactors with encapsulated enzymes performing the necessary reactions, while remaining inaccessible to the immune system and plasma proteases; or as a tool for targeted drug delivery to target organs, primarily to cells of the reticuloendothelial system, liver and spleen. To date, erythrocytes have been studied as carriers for a wide range of drugs, such as enzymes, antibiotics, anti-inflammatory, antiviral drugs, etc., and for diagnostic purposes (e.g. magnetic resonance imaging). The review focuses only on drugs loaded inside erythrocytes, defines the main lines of research for erythrocytes with bioactive substances, as well as the advantages and limitations of their application. Particular attention is paid to in vivo studies, opening-up the potential for the clinical use of drugs encapsulated into erythrocytes.

Advances of blood cell-based drug delivery systems

Blood cells, including erythrocytes, leukocytes and platelets are used as drug carriers in a wide range of applications. They have many unique advantages such as long life-span in circulation (especially erythrocytes), target release capacities (especially platelets), and natural adhesive properties (leukocytes and platelets). These properties make blood cell based delivery systems, as well as their membrane-derived carriers, far superior to other drug delivery systems. Despite the advantages, the further development of blood cell-based delivery systems was hindered by limitations in the source, storage, and mass production. To overcome these problems, synthetic biomaterials that mimic blood cell and nanocrystallization of blood cells have been developed and may represent the future direction for blood cell membrane-based delivery systems. In this paper, we review recent progress of the rising blood cell-based drug delivery systems, and also discuss their challenges and future tendency of development.

Influence of the glycocalyx and plasma membrane composition on amphiphilic gold nanoparticle association with erythrocytes

Erythrocytes are attractive as potential cell-based drug carriers because of their abundance and long lifespan in vivo. Existing methods for loading drug cargos into erythrocytes include hypotonic treatments, electroporation, and covalent attachment onto the membrane, all of which require ex vivo manipulation. Here, we characterized the properties of amphiphilic gold nanoparticles (amph-AuNPs), comprised of a ∼2.3 nm gold core and an amphiphilic ligand shell, which are able to embed spontaneously within erythrocyte membranes and might provide a means to load drugs into red blood cells (RBCs) directly in vivo. Particle interaction with RBC membranes occurred rapidly at physiological temperature. We further show that amph-AuNP uptake by RBCs was limited by the glycocalyx and was particularly influenced by sialic acids on cell surface proteoglycans. Using a reductionist model membrane system with synthetic lipid vesicles, we confirmed the importance of membrane fluidity and the glycocalyx in regulating amph-AuNP/membrane interactions. These results thus provide evidence for the interaction of amph-AuNPs with erythrocyte membranes and identify key membrane components that govern this interaction, providing a framework for the development of amph-AuNP-carrying erythrocyte 'pharmacytes' in vivo.

Co-opting biology to deliver drugs

The goal of drug delivery is to improve the safety and therapeutic efficacy of drugs. This review focuses on delivery platforms that are either derived from endogenous pathways, long-circulating biomolecules and cells or that piggyback onto long-circulating biomolecules and cells. The first class of such platforms is protein-based delivery systems--albumin, transferrin, and fusion to the Fc domain of antibodies--that have a long-circulation half-life and are designed to transport different molecules. The second class is lipid-based delivery systems-lipoproteins and exosomes-that are naturally occurring circulating lipid particles. The third class is cell-based delivery systems--erythrocytes, macrophages, and platelets--that have evolved, for reasons central to their function, to exhibit a long life-time in the body. The last class is small molecule-based delivery systems that include folic acid. This article reviews the biology of these systems, their application in drug delivery, and the promises and limitations of these endogenous systems for drug delivery.

Cell-based drug-delivery platforms

Cell systems have recently emerged as biological drug carriers, as an interesting alternative to other systems such as micro- and nano-particles. Different cells, such as carrier erythrocytes, bacterial ghosts and genetically engineered stem and dendritic cells have been used. They provide sustained release and specific delivery of drugs, enzymatic systems and genetic material to certain organs and tissues. Cell systems have potential applications for the treatment of cancer, HIV, intracellular infections, cardiovascular diseases, Parkinson’s disease or in gene therapy. Carrier erythrocytes containing enzymes such us L-asparaginase, or drugs such as corticosteroids have been successfully used in humans. Bacterial ghosts have been widely used in the field of vaccines and also with drugs such as doxorubicin. Genetically engineered stem cells have been tested for cancer treatment and dendritic cells for immunotherapeutic vaccines. Although further research and more clinical trials are necessary, cell-based platforms are a promising strategy for drug delivery.

Encapsulation of concentrated protein into erythrocyte porated by continuous-wave ultrasound

A procedure of continuous-wave ultrasound (US)-induced hemolysis and reseal in solution containing water soluble protein was applied to a method for encapsulating concentrated protein solutions into resealed rat erythrocyte ghosts. To find a condition yielding a higher mean corpuscular concentration of encapsulated protein (MCC), we investigated the value of MCCs for various conditions. Additions of a small amount of plasma, Ca(2+) and Mg(2+) significantly increased MCC, whereas these additives did not alter the degree of hemolysis. It was suggested that plasma protect the molecular damages by the US, and that Ca(2+) and Mg(2+) physically stabilized the lipids of the erythrocyte membrane to fuse and reseal the pore induced by US. A maximal MCC of approximately 50 mg/mL, which is 2.5 times the reported maximum amount encapsulated by the osmotic dialysis method, was obtained without a blood-washing procedure.

Preparation and in vitro evaluation of carrier erythrocytes for RES-targeted delivery of interferon-alpha 2b

Carrier erythrocytes is one of the most promising systemic drug delivery systems investigated in recent decades. In this study, human erythrocytes have been loaded with interferon-alpha 2b (IFN) with the aim to benefit the reticuloendothelial system (RES) targeting potential of the carrier cells. Hypotonic preswelling method was used for drug loading in erythrocytes and the entire loading procedure was evaluated and validated. The loaded amount, entrapment efficiency and cell recovery of the loading procedure were 2906.33+/-588.35IU/0.1ml, 14.53+/-2.94%, and 83.61+/-0.49%, respectively, all being practically feasible. The carrier erythrocytes were characterized in vitro in terms of their drug release kinetics, hematological indices, particle size distribution, SEM analysis, and osmotic and turbulence fragility. IFN release from carrier cells was a relatively rapid process in comparison to the cell lysis kinetics, which is unusual considering the whole body of data published on this delivery system and other protein drugs, so far. All the tested in vitro characteristics showed significant, sometimes notable changes upon drug loading procedure, both with and without the drug.

Preparation and in vitro characterization of carrier erythrocytes for vaccine delivery

Erythrocytes as the most readily available and abundant cells within the body, have been studied extensively for their potential application as drug delivery carriers. In this study, human erythrocytes have been loaded by bovine serum albumin (BSA) as a model antigen/protein using hypotonic preswelling method for targeted delivery of this antigen to antigen-presenting cells (APCs). A series of in vitro tests have been carried out to characterize the carrier cells in vitro, including loading parameters, BSA and hemoglobin release kinetics, hematological indices, particle size distribution, SEM analysis, osmotic and turbulence fragility, and osmotic competency. BSA was loaded in erythrocytes with a loaded amount of 1.98+/-0.009mg with antigen release from carrier cells showing a zero-order kinetic consistent to that of the cell lysis. The apparent cell sizes, measured using laser scattering, were not significantly different from normal erythrocytes, but the real sizes, measured using SEM, and surface topologies were quite different between loaded and unloaded cells. The BSA-loaded cells were remarkably more fragile and less deformable compared to the normal cells. Totally, BSA-loaded erythrocytes seem to be a promising delivery system for reticuloendothelial system (RES) targeting of the antigens.

Applications of carrier erythrocytes in delivery of biopharmaceuticals

Carrier erythrocytes, resealed erythrocytes loaded by a drug or other therapeutic agents, have been exploited extensively in recent years for both temporally and spatially controlled delivery of a wide variety of drugs and other bioactive agents owing to their remarkable degree of biocompatibility, biodegradability and a series of other potential advantages. Biopharmaceuticals, therapeutically significant peptides and proteins, nucleic acid-based biologicals, antigens and vaccines, are among the recently focused pharmaceuticals for being delivered using carrier erythrocytes. In this article, the potential applications of erythrocytes in drug delivery have been reviewed with a particular stress on the studies and laboratory experiences on successful erythrocyte loading and characterization of the different classes of biopharmaceuticals.

Drug, enzyme and peptide delivery using erythrocytes as carriers

Erythrocytes are potential biocompatible vectors for different bioactive substances, including drugs. These can be used successfully as biological carriers of drugs, enzymes and peptides. There are currently diverse methods that permit drug encapsulation in erythrocytes with an appropriate yield. The methods most commonly employed are based on a high-haematocrit dialysis procedure, mainly hypo-osmotic dialysis. Erythrocytes loaded with drugs and other substances allow for different release rates to be obtained. Encapsulation in erythrocytes significantly changes the pharmacokinetic properties of drugs in both animals and humans, enhancing liver and spleen uptake and targeting the reticulo-endothelial system (RES). Amongst other applications, erythrocytes have been used for drug-targeting the RES with aminoglycoside antibiotics; the selective transport to certain organs and tissues of certain antineoplastic drugs, such as methotrexate, doxorubicine, etoposide, carboplatin, etc.; the encapsulation of angiotensin-converting enzyme (ACE) inhibitors, systemic corticosteroids, the encapsulation of new prodrugs with increased duration of action, etc. Erythrocytes are also attractive systems in the sense of their potential ability to deliver proteins and therapeutic peptides. Thus, erythrocytes have been used for the transport of enzymes destined for the correction of metabolic alterations as l-asparaginase, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (AlDH) among others. Erythrocytes have been used successfully as carriers of anti-HIV peptides, such as AZT, nucleoside analogues, antisense oligonucleotides, antineoplastic peptides, erythropoietin, interleukin 3, etc. Amongst other applications, mention may be made of paramagnetic erythrocytes, encapsulation of MRI contrast agents or the study of the metabolism of the red cell. Although erythrocytes have been applied with different uses in human medicine, their deployment is still very limited due to difficulties involving storage, its exposure to contamination and the absence of a validated industrial procedure for its preparation.

Encapsulation of PEG-urease/PEG-AlaDH enzyme system in erythrocyte

No intravenously injectable enzyme preparate containing urease as an alternetive to hemodialysis, hemoperfusion and CAPD systems in patients having chronic renal failure has been encountered in literature. In this study, it has been aimed to convert blood urea to alanine by using PEG-urease/PEG-AlaDH enzyme pair encapsulated within living erythrocyte. In this system, urea is decomposed into NH3 and HCO3- and the ammonia released is converted into alanine by reacting pyruvate under the catalytic action of alaninedehydrogenase. The production of pyruvate and NADH by erythrocyte required in the second stage of the reaction will make the process a feasible and ceaseless one. The success of the system will enable the renal patients with diabetes mellitus. Urease and AlaDH were covalently immobilized on activated PEG. PEG-urease/PEG-AlaDH were encapsulated in erythrocyte (1/1)(v/v) by using slow dialysis methods. The activity of enzyme system, encapsulation yield and hemogram analysis were determined for each sample.

Inhibition of serum angiotensin-converting enzyme in rabbits after intravenous administration of enalaprilat-loaded intact erythrocytes

Encapsulation of drugs in intact erythrocytes, because of the profound characteristics of these natural microspheres, has gained considerable attention in recent years. In this study, the inhibition time courses of serum angiotensin-converting enzyme (ACE) activity after intravenous administration of enalaprilat encapsulated in intact erythrocytes was evaluated and compared with free drug, in a rabbit model. Three groups of animals each received free drug, drug-loaded erythrocytes or sham-encapsulated erythrocytes. Serum ACE activity was determined in each case using the synthetic substrate hippuryl-histidyl-leucine and quantitation of the hippuric acid released by a developed and validated HPLC method. The serum ACE inhibition profiles in the three groups showed that the encapsulated drug inhibited the serum ACE more slowly, more efficiently, over a considerably longer time and in a more reproducible manner, than the free drug or sham-encapsulated erythrocytes. We conclude that the erythrocytes can serve as efficacious slow-release drug carriers for enalaprilat in circulation.

Evaluation of hypotonic preswelling method for encapsulation of enalaprilat in intact human erythrocytes

The hypotonic preswelling method for encapsulation of drugs in intact human erythrocytes was evaluated using enalaprilat as a model peptide-like drug. Several process variables, including volume, concentration, pH, and method of addition of drug solution, type of erythrocyte-suspending medium, temperature, initial packed density of erythrocytes, and individual process steps, were exploited with respect to their effects on the loading parameters (i.e., loaded amount, efficiency of entrapment, and cell recovery). In addition, the probable mechanism by which the erythrocytes were loaded by enalaprilat at the point of lysis was shown to be a simple concentration gradient-based diffusion through membrane openings occurring on hemolysis. Finally, the adopted method was validated, and the results showed a considerable degree of reproducibility and recovery for the entire loading procedure.

Reduction of erythrocyte membrane permeability and protein binding of low-molecular-weight drugs following glycoside derivitization

The permeability of glycosides (salicin, arbutin, glycyrritin, p-nitrophenyl-beta-D-glucopyranoside, p-nitrophenyl-beta-D-galactopyranoside, p-nitrophenyl-beta-D-lactopyranoside, and p-nitrophenyl-beta-D-maltopyranoside) and their aglycons through human erythrocyte membrane was investigated. The transport rate of the glycosides through human erythrocyte membrane was slower than that of their aglycons. Glycosides with a disaccharide did not permeate the erythrocyte membrane; this observation suggests that the introduction of disaccharide to drugs gives rise to a significant decrease in the leakage of drugs through the erythrocyte membrane. The derivatives of glycosides encapsulated in erythrocytes were not released from these erythrocytes into the outer medium. The transport capacity of the glycosides was not influenced by the kind of suspending medium, but that of the aglycons was influenced by the medium. The glycosides bound to human serum albumin more weakly than their aglycons. Particularly, the glycosides were more difficult to displace from 7-anilinocoumarin-4-acetic acid (site III drug) than their aglycons, except for glycyrritin.

Reversible electropermeabilisation of human and rat blood platelets: evaluation of morphological and functional integrity 'in vitro' and 'in vivo'

A high-voltage discharge procedure has been developed for permeabilising the plasma membranes of both human and rat blood platelets. The cells can be resealed by incubation at 37 degrees C, show less than 4% loss of lactate dehydrogenase (LDH) implying minimal cell lysis and also have well maintained morphological and functional integrity. The prototype apparatus used at field strengths between 6 and 8 kV/cm produces membrane pores which allow free diffusion of low molecular weight substances such as adenine nucleotides, inositol phosphate and fluorescent dyes. Two properties, namely Ca2+-induced secretion of granule stored 5-hydroxytryptamine (5HT) and inositol 1,4,5-trisphosphate (IP3)-induced release of intracellularly sequestered 45Ca, which are both well expressed immediately after permeabilisation, are essentially abolished after resealing. The efficiency of permeabilisation and resealing can be simply monitored by shifts in 'apparent platelet volume' using a resistive particle counter (Coulter). Permeabilised platelets show a shift in modal volumes from a control range 4-7 fl to 10-15 fl. Resealing restores these modal volumes to the original control range. Encapsulation of the fluorochrome, Lucifer yellow (Mr 550), during permeabilisation revealed that after resealing greater than 85% of rat platelets, and close to 100% human platelets, contained the encapsulated dye. The initial rates and % aggregation responses of both human and rat platelets to collagen, thrombin and the thromboxane A2-mimetic U46619 remained essentially normal after permeabilisation and resealing further illustrating the maintenance of functional competence following treatment. Resealed rat platelets reinfused into the circulation after labelling with [111In]indium oxine gave survival curves similar to those of control platelets. Therefore, this reversible permeabilisation procedure may allow the use of autologous or heterologous platelets as carrier vehicles for the delivery of drugs and other agents 'in vivo'.

Role of the red blood cell in drug metabolism

Contrary to the belief that the RBC is not metabolically active towards pharmacologically active endogenous and exogenous substances, it is evident that the RBC contains moderate cytochrome P-450-like activity, in addition to the ability to catalyse various other transformations of a range of drugs. The list of drugs for which there is evidence of metabolism by RBC (Table 1) contains examples from several drug classes. However some major classes of drugs which are principally cleared in vivo by metabolism are missing (for example, benzodiazepines). Moreover, there is as yet no evidence for the RBC having the capacity for the more important drug conjugation reactions (glucuronidation, sulphation) although there is evidence of other conjugation reactions (methylation, acetylation, glutathione conjugation). It is conceivable that the RBC could be used as a convenient tissue to add to other metabolism screening procedures used in drug development. Already use has been made of the RBC in identifying fast and slow acetylators. Others have used RBC to identify a possible sex-based difference in drug metabolism. Hopefully, this review has stimulated interest in the ability of the RBC to metabolize drugs and this interest will result in further discoveries.

Rapid analysis of ranitidine in biological fluids and determination of its erythrocyte partitioning

A reversed-phase ion-pair high-performance liquid chromatographic assay is described for the rapid and sensitive quantitation of the H2-receptor antagonist ranitidine in human plasma and urine. The method involves a single-step extraction of the alkalinized sample with methylene chloride and analysis of the evaporated extract on a cyano column. Detection was performed by ultraviolet absorbance monitored at 318 nm. The overall run time of the assay was 5 min at a flow-rate of 2.0 ml/min. The limit of sensitivity was 1 ng/ml ranitidine in human plasma. Urine and plasma samples collected from a subject after administration of an oral dose of 150 mg of ranitidine were analyzed by this method. Furthermore, the procedure was applied to determine the red blood cell partition coefficient of ranitidine in a concentration range up to 10 micrograms/ml.

Encapsulation of thiosulfate: cyanide sulfurtransferase by mouse erythrocytes

Murine carrier erythrocytes, prepared by hypotonic dialysis, were employed in the encapsulation of several compounds including [14C]sucrose, [3H]inulin, and bovine thiosulfate:cyanide sulfurtransferase (rhodanese), a mitochondrial enzyme which converts cyanide to thiocyanate. Approximately 30% of the added [14C]sucrose, [3H]inulin, and rhodanese was encapsulated by predialyzed erythrocytes, and a decrease in the mean corpuscular volume and mean corpuscular hemoglobin was observed. In the encapsulation of rhodanese a recovery of 95% of the erythrocytes was achieved and an 85% equilibrium was established. The addition of potassium cyanide (50 mM) to intact, rhodanese-loaded erythrocytes containing sodium thiosulfate resulted in its metabolism to thiocyanate. These results establish the potential use of erythrocytes as biodegradable drug carrier in drug antagonism.

Therapeutic efficacy of asparaginase encapsulated in intact erythrocytes

Asparaginase has been encapsulated in intact erythrocytes by a gentle loading technique. The loaded cells were found to survive removal by the recticuloendothelial system when returned to the circulation of mice. In addition the enzyme removed all detectable asparagine from the plasma in vivo for at least two weeks after the injection of the loaded cells. In vitro evidence suggested that the asparagine entered the cell and was metabolised by the loaded enzyme in situ. No evidence was found to suggest that the enzyme left the cell. When the encapsulated asparaginase was tested against the 6C3HED tumour in C3H mice the encapsulated preparation was superior to the free enzyme in treating the tumour and was the only treatment to produce 'cured' mice. Encapsulated asparaginase also lowered glutamine levels both in vivo and in vitro. The possibility that LDH virus was responsible for the excellent results obtained with the encapsulated enzyme was investigated and eliminated.

The use of corticosteroids encapsulated in erythrocytes in the treatment of adjuvant induced arthritis in the rat

Corticosteroid esters have been encapsulated into intact erythrocytes and used as an intravenous treatment for adjuvant induced arthritis in the rat. The treatment consisted of injections of the encapsulated steroids with the effects monitored for up to 14 days. On an equivalent weight basis both encapsulated cortisol-21-phosphate and prednisolone-21-sodium hemisuccinate proved superior to the free steroid esters administered in solution by injection.