Accumulation of 99mTc-low-density lipoprotein in human malignant glioma

Lipoprotein Drug Delivery Vehicles for Cancer: Rationale and Reason

Lipoproteins are a family of naturally occurring macromolecular complexes consisting amphiphilic apoproteins, phospholipids, and neutral lipids. The physiological role of mammalian plasma lipoproteins is to transport their apolar cargo (primarily cholesterol and triglyceride) to their respective destinations through a highly organized ligand-receptor recognition system. Current day synthetic nanoparticle delivery systems attempt to accomplish this task; however, many only manage to achieve limited results. In recent years, many research labs have employed the use of lipoprotein or lipoprotein-like carriers to transport imaging agents or drugs to tumors. The purpose of this review is to highlight the pharmacologic, clinical, and molecular evidence for utilizing lipoprotein-based formulations and discuss their scientific rationale. To accomplish this task, evidence of dynamic drug interactions with circulating plasma lipoproteins are presented. This is followed by epidemiologic and molecular data describing the association between cholesterol and cancer.

Lipoprotein-Related and Apolipoprotein-Mediated Delivery Systems for Drug Targeting and Imaging

The integration of lipoprotein-related or apolipoprotein-targeted nanoparticles as pharmaceutical carriers opens new therapeutic and diagnostic avenues in nanomedicine. The concept is to exploit the intrinsic characteristics of lipoprotein particles as being the natural transporter of apolar lipids and fat in human circulation. Discrete lipoprotein assemblies and lipoprotein-based biomimetics offer a versatile nanoparticle platform that can be manipulated and tuned for specific medical applications. This article reviews the possibilities for constructing drug loaded, reconstituted or artificial lipoprotein particles. The advantages and limitations of lipoproteinbased delivery systems are critically evaluated and potential future challenges, especially concerning targeting specificity, concepts for lipoprotein rerouting and design of innovative lipoprotein mimetic particles using apolipoprotein sequences as targeting moieties are discussed. Finally, the review highlights potential medical applications for lipoprotein-based nanoparticle systems in the fields of cardiovascular research, cancer therapy, gene delivery and brain targeting focusing on representative examples from literature.

Synthesis and Evaluation of a Radioiodinated Tracer with Specificity for Poly(ADP-ribose) Polymerase-1 (PARP-1) in Vivo

Interest in nuclear imaging of poly(ADP-ribose) polymerase-1 (PARP-1) has grown in recent years due to the ability of PARP-1 to act as a biomarker for glioblastoma and increased clinical use of PARP-1 inhibitors. This study reports the identification of a lead iodinated analog 5 of the clinical PARP-1 inhibitor olaparib as a potential single-photon emission computed tomography (SPECT) imaging agent. Compound 5 was shown to be a potent PARP-1 inhibitor in cell-free and cellular assays, and it exhibited mouse plasma stability but approximately 3-fold greater intrinsic clearance when compared to olaparib. An (123)I-labeled version of 5 was generated using solid state halogen exchange methodology. Ex vivo biodistribution studies of [(123)I]5 in mice bearing subcutaneous glioblastoma xenografts revealed that the tracer had the ability to be retained in tumor tissue and bind to PARP-1 with specificity. These findings support further investigations of [(123)I]5 as a noninvasive PARP-1 SPECT imaging agent.

Evaluation of the pharmacokinetics of all-trans-retinoic acid (ATRA) in Wistar rats after intravenous administration of ATRA loaded into tributyrin submicron emulsion and its cellular activity on caco-2 and HepG2 cell lines

The pharmacokinetics of all-trans-retinoic acid (ATRA), an anti-cancer drug was highly variable due to its poor aqueous solubility. In this study, we investigated the pharmacokinetics of ATRA in male Wistar rats following intravenous administration of the ATRA loaded tributyrin emulsion. In vitro, the ATRA emulsion was proved binding to apolipoprotein(s). In vivo, the clearance of ATRA was significantly reduced by formulating into the tributyrin emulsion, leading to higher AUCs. Co-administration with 17alpha-ethynylestradiol, a compound known to upregulate the activity of low-density lipoprotein receptors in tissues, significantly increased the K(e), V, and CL of ATRA. The variation of plasma AUCs after administering the ATRA emulsion to the healthy rats was two times less than that after the ATRA solution. The IC(50) in ATRA of the ATRA emulsion for the Caco-2 carcinoma cells was 3.8 microg/mL lower than 6 microg/mL of the ATRA solution. The IC(50) of the emulsion for the HepG2 carcinoma cells was 2.8 microg/mL, while IC(50) was not achieved with the ATRA solution over the test concentration range. The finding indicated that the tributyrin emulsion could be used as a carrier for ATRA and enhances the drug effect by reducing the clearance and increasing the in vitro activity.

Receptor-Targeted Liposomal Delivery of Boron-Containing Cholesterol Mimics for Boron Neutron Capture Therapy (BNCT)

Liposomes have been a main focus of tumor-selective boron delivery strategies in boron neutron capture therapy (BNCT), a binary method for the treatment of cancer that is based on the nuclear reaction between boron atoms and low-energy thermal neutrons. Three novel carboranyl cholesterol derivatives were prepared as lipid bilayer components for the construction of nontargeted and receptor-targeted boronated liposomes for BNCT. A major structural feature of these novel boronated cholesterol mimics is the replacement of the B and the C ring of cholesterol with a carborane cluster. Computational analyses indicated that all three boronated compounds have structural features and physicochemical properties that are very similar to those of cholesterol. One of the synthesized boronated cholesterol mimics was stably incorporated into non-, folate receptor (FR)-, and vascular endothelial growth factor receptor-2 (VEGFR-2)-targeted liposomes. No major differences were found in appearance, size distribution, and lamellarity between conventional dipalmitoylphosphatidylcholine (DPPC)/cholesterol liposomes, nontargeted, and FR-targeted liposomal formulations of this carboranyl cholesterol derivative. FR-targeted boronated liposomes were taken up extensively in FR overexpressing KB cells in vitro, and the uptake was effectively blocked in the presence of free folate. In contrast, a boronated cholesterol mimic incorporated into nontargeted liposomes showed significantly lower cellular uptake. There was no apparent in vitro cytotoxicity in FR overexpressing KB cells and VEGFR-2 overexpressing 293/KDR cells when these were incubated with boronated FR- and (VEGFR-2)-targeted liposomes, respectively, although the former accumulated extensively in KB cells and the latter effectively interacted with VEGFR-2 by causing autophosphorylation and protecting 293/KDR cells from SLT (Shiga-like toxin)-VEGF cytotoxicity.

Evaluation of Tributyrin Lipid Emulsion with Affinity to Low-Density Lipoprotein: Pharmacokinetics in Adult Male Wistar Rats and Cellular Activity on Caco-2 and HepG2 Cell Lines

The tributyrin lipid emulsion was proved to be able to bind to low-density lipoprotein (LDL) in vitro. The aim of this study was to investigate the pharmacokinetics of the emulsion in vivo and the cellular activity in vitro. The pharmacokinetics of tributyrin and its metabolite, butyrate, was evaluated in male Wistar rats after administration with pure tributyrin or tributyrin emulsion. After oral administration, maximal plasma concentration (C(max)), time to reach maximal plasma concentration (T(max)), and elimination half-life (T(1/2)) of butyrate were 87.6 muM and 25.3 and 63.0 min, respectively, for the pure tributyrin compared with 1344.5 microM and 8.5 and 19.8 min for the 10% (v/v) tributyrin emulsion. C(max) and mean residence time of tributyrin were 2.74 microM and 87.9 min and 4.2 microM and 132.0 min for pure tributyrin and 10% emulsion, respectively. The bioavailabilities of the pure tributyrin versus tributyrin emulsion were 15.3 versus 65.7% and 34.9 versus 64.5% calculated from butyrate and tributyrin, respectively. After the rats were treated with 17alpha-ethynylestradiol (an LDL receptor up-regulator), the distribution volumes calculated from both butyrate and tributyrin were significantly increased after oral administration or infusion of the 10% tributyrin emulsion. The increased distribution volume after coadministration with a LDL receptor up-regulator suggested the increased uptake of tributyrin/butyrate by tissues with increased expression of LDL receptors. The selective uptake of the emulsion by the cellular LDL receptors was further confirmed by testing the cellular viability in the presence of competing LDL. The viable cells can reach 92% of control at IC(50) in Caco-2 and 77% in HepG2 incubated with emulsion in the presence of LDL.

Preparation of Tributyrin Emulsion and Characterization of the Binding of the Emulsion Particles to Low‐Density Lipoprotein in vitro

Tributyrin has been shown to be an effective antitumor agent alone or in combination with other chemotherapeutic agents in vitro. Because tributyrin exists as an oil, it could be formulated as an emulsion to facilitate its delivery. The aim of this study was to develop a tributyrin emulsion with affinity to low-density lipoprotein (LDL). The tributyrin emulsion was prepared by sonication. Sizes of the different fractions of the emulsion particles separated by ultracentrifugation were determined. Cholesterol was found to decrease the particle size slightly because of its condensing effect. The emulsion monolayer prepared was proved to bind effectively with LDL in vitro. The dissociation constant and binding maximum to LDL of the emulsion fraction 1 with smaller particle sizes were 0.1236 microM and 0.4140 mmol/mol, and that of the fraction 2 with larger particle sizes were 0.0635 microM and 0.2654 mmol/mol, respectively. These results suggested that the binding ability of tributyrin emulsion depended on the component of the monolayer as well as the size of the emulsion particles. The potential pharmaceutical applications of this tributyrin emulsion are discussed.

Enhanced detection of malignant glioma xenograft by fluorescein-human serum albumin conjugate

OBJECT

During the surgical resection of malignant gliomas, it is important to make clear the border zone between the tumor tissue and normal brain tissue. For this purpose, we conjugated fluorescein and human serum albumin (FLS-HSA) and compared its effectiveness against that of fluorescein-sodium (FLS-Na) alone in detecting human glioma xenografts in SCID mice through a fluorescence microscope.

METHODS

We made FLS-HSA conjugate using carbodiimide as a linking reagent. SCID mice, with U251MG cells transplanted subcutaneously, were prepared as tumor models. The animals were sacrificed 15, 30, 60, 180, 360, or 720 min after the intravenous administration of either the FLS-HSA conjugate or FLS-Na alone (n = 3). Fluorescence images were taken with a digital camera, and the brightness of the tumor and that of the peripheral tissue in each image were quantified. In the group of tumor-bearing mice that received FLS-Na, the fluorescence of tumor tissue disappeared 60 min after the reagent was administered, and there was no significant difference in brightness between the tumor and peripheral tissue at any time point. On the other hand, injection of FLS-HSA revealed relative tumor-selective brightness and sufficient contrast between the tumor and surrounding tissue 60 and 360 min after administration.

CONCLUSION

FLS-HSA has the advantages of specificity and persistence of fluorescence over FLS-Na for the purpose of identifying glioma nodules in xenogenic subcutaneous tumor transplantation models.

Metabolism of a cholesterol-rich microemulsion (LDE) in patients with multiple myeloma and a preliminary clinical study of LDE as a drug vehicle for the treatment of the disease

PURPOSE

Previously we have shown that cholesterol-rich microemulsions that bind to LDL receptors have the ability to concentrate in acute myeloid leukemia cells and in ovarian and breast carcinomas. Thus, LDE may be used as a vehicle for drugs directed against neoplastic cells. Indeed, we subsequently showed that when carmustine is associated with LDE the toxicity of the drug is significantly reduced in patients with advanced cancers. The aim of the present study was to verify whether LDE may be taken up by multiple myeloma cells and whether patients with multiple myeloma respond to treatment with LDE associated with carmustine.

METHODS

A total of 131 consecutive volunteer patients with recently diagnosed multiple myeloma classified as clinical stage IIIA had their plasma lipid profile determined. LDE plasma kinetics were performed in 14 of them. Cell uptake of LDE and the cytotoxicity of carmustine associated with the emulsion were evaluated in a multiple myeloma cell line. A pharmacokinetic study of LDE-carmustine was performed in three patients. Finally, an exploratory clinical study of LDE-carmustine (carmustine dose 180 mg/m(2) body surface every 4 weeks) was performed in seven untreated multiple myeloma patients.

RESULTS

LDL cholesterol was lower in the 131 multiple myeloma patients than in healthy controls and the fractional clearance rate (FCR, in units per minute) in the 14 multiple myeloma patients was twice that in 14 paired healthy control subjects. Moreover, entry of LDE into multiple myeloma cells was shown to be mediated by LDL receptors. Taken together, these findings indicate that LDE may target multiple myeloma. The exploratory clinical study showed that gammaglobulin decreased by 10-70% (mean 36%) after three cycles and by 25-75% (mean 44%) after six cycles. Furthermore, there was amelioration of symptoms in all patients. Cholesterol concentrations increased after treatment, suggesting that the treatment resulted in at least partial destruction of neoplastic cells with receptor upregulation. Side effects of the treatment were negligible.

CONCLUSIONS

Because it targets multiple myeloma and, when associated with an antineoplastic agent, produces therapeutic responses in patients with fewer side effects, LDE has the potential for use as a drug vehicle in the treatment of the disease.

Clinical implementation of 4-dihydroxyborylphenylalanine synthesised by an asymmetric pathway

Boron neutron capture therapy (BNCT) is an experimental therapeutic modality combining a boron pharmaceutical with neutron irradiation. 4-Dihydroxyborylphenylalanine (L-BPA) synthesised via the asymmetric pathway by Malan and Morin [Synlett. 167-168 (1996)] was developed to be the boron containing pharmaceutical in the first series of Finnish BNCT clinical trials. The final product was >98.5% chemically pure L-BPA with L-phenylalanine and L-tyrosine as the residual impurities. The solubility of L-BPA was enhanced by complex formation with fructose (BPA-F). The pH and osmolarity of the BPA-F preparation is in the physiological range. Careful attention was given to the pharmaceutical quality of the BPA-F preparations. Prior to starting clinical trials the acute toxicity of L-BPA was studied in male albino Sprague-Dawley rats. In accordance with earlier studies no adverse effects were observed. After completion of the development work L-BPA solution was administered to brain tumour patients in conjunction with clinical studies for development and testing of BPA-based BNCT. No clinically significant adverse events attributable to the L-BPA i.v. infusions were observed. We conclude that our synthesis development, complementary preclinical and clinical observations justify the safe use of L-BPA up to clinical phase III studies with L-BPA produced by the asymmetric pathway, originally presented by Malan and Morin in 1996.

In vivo fluorescence imaging of the transport of charged chlorin e6 conjugates in a rat orthotopic prostate tumour

Polymeric drug conjugates are used in cancer therapy and, varying their molecular size and charge, will affect their in vivo transport and extravasation in tumours. Partitioning between tumour vasculature and tumour tissue will be of particular significance in the case of photosensitizer conjugates used in photodynamic therapy, where this partitioning can lead to different therapeutic effects. Poly-l-lysine chlorin e6conjugates (derived from polymers of average Mr 5000 and 25000) were prepared both in a cationic state and by poly-succinylation in an anionic state. A fluorescence scanning laser microscope was used to follow the pharmacokinetics of these conjugates in vivo in an orthotopic rat prostate cancer model obtained with MatLyLu cells. Fluorescence was excited with the 454-528 nm group of lines of an argon laser and a 570 nm long pass filter used to isolate the emission. Results showed that the conjugates initially bound to the walls of the vasculature, before extravasating into the tissue, and eventually increasing in fluorescence. The anionic conjugates produced tissue fluorescence faster than the cationic ones, and surprisingly, the larger Mr conjugates produced tissue fluorescence faster than the smaller ones with the same charge. These results are consistent with differences in aggregation state between conjugates.

Oxidized lipoproteins increase reactive oxygen species formation in microglia and astrocyte cell lines

Lipoproteins exist in the central nervous system and surrounding vasculature possibly mediating effects upon cells in the brain during times of oxidative stress or compromised blood-brain barrier. The focus of the present study was to determine the effect of unmodified and oxidatively modified lipoproteins on astrocytes and microglia. Application of oxidized low-density lipoprotein resulted in an increase in DCF fluorescence, which was inhibited by pretreatment with antioxidants, consistent with the formation of reactive oxygen species (ROS). Low-density at concentrations below 20 microg/ml likewise increased ROS formation. Because ROS are associated with numerous astrocyte and microglia activities including proliferation, activation, and cytokine production it is possible that lipoproteins may mediate such effects on glial cells in the central nervous system.

Opposing actions of native and oxidized lipoprotein on motor neuron-like cells

Lipoproteins are present in the central nervous system and surrounding vasculature and possibly mediate effects relevant to neuronal physiology and pathology. To determine the effects of lipoproteins on motor neurons, native low density lipoproteins (LDL) and oxidized LDL (oxLDL) were applied to a motor neuron cell line. Oxidized LDL, but not native LDL, resulted in a dose- and time-dependent increase in reactive oxygen species and neuron death. Oxidized LDL-induced toxicity was attenuated by a calcium chelator, antioxidants, caspase inhibitors, and inhibitors of macromolecular synthesis. In addition to being nontoxic, application of native LDL attenuated reactive oxygen species formation and neuron loss following glucose deprivation injury. Together, these data demonstrate a possible neuroprotective role for unmodified lipoproteins and suggest oxidized lipoproteins may amplify oxidative stress and neuron loss.

Serum cholesterol in cerebral malignancies

Reduced blood cholesterol levels were reported in patients with a variety of malignant peripheral tumors. This fact is likely related to increased cholesterol demand by proliferating tumor cells. The question arises whether this 'tumor-associated hypocholesterolemia' occurs also in patients with brain tumors, and--if it does not--whether its absence can be related to the location of the tumors. We have compared fasting serum total cholesterol levels among three groups of patients: 52 patients with gliomas, 56 patients with symptomatic metastatic brain tumors, and 50 patients harboring malignant tumors of peripheral location but showing no clinical signs of brain metastases. Patients in the last group, despite being--on an average--more age-advanced, had lower total serum cholesterol levels than either the patients with gliomas, or the patients with brain metastases. No difference in the cholesterol levels was found between the two latter groups, and a majority of these patients had borderline or elevated cholesterol levels. This apparent absence of 'tumor-associated hypocholesterolemia' in brain tumor patients may be related to either brain tumors' ability to synthesize cholesterol de novo and their reduced dependence on peripheral cholesterol supply, the existence of brain tumor-blood barrier, effect of medications used to counteract brain edema and seizures, or a combination of these factors.

Lymph flow dynamics in exercising human skeletal muscle as detected by scintography

1. The effects of dynamic and isometric muscle contractions on the lymph flow dynamics in human skeletal muscle were studied with a scintographic method. 2. Radioactively labelled human serum albumin (99mTc-HSA) was injected bilaterally into the vastus lateralis muscles of eight men (n = 16), four of whom had had an endurance training background. The subjects performed 100 submaximal contractions in 10 min as (i) dynamic knee extensions (CONS), (ii) isometric contractions with the knees at full extension (IMExt), or (iii) isometric contractions with knees fixed at 90 deg angle flexion (IMFlex). The exercises were separated by 65 min periods in supine rest. The level of radioactivity at the injection site was monitored by a gamma-camera, and the clearance rate of radioactivity (CR) was calculated as the fractional decrease during the periods of interest (CR unit = % min-1). 3. The clearance rate was low during the rest periods (0.04 +/- 0.05% min-1), though higher in the trained than in the sedentary subjects (0.06 +/- 0.05 vs. 0.03 +/- 0.03% min-1; P = 0.008). Exercise increased the clearance rate three- to sixfold, to 0.16 +/- 0.16% min-1 during CONS, 0.20 +/- 0.15% min-1 during IMExt and 0.09 +/- 0.11% min-1 during IMFlex. There were no differences between the subject subgroups. 4. The higher clearance rate during IMExt than during IMFlex (P = 0.02) demonstrates the importance of muscle deformations on lymph propulsion and experimentally confirms the current concepts of lymph formation and propulsion in voluntarily active skeletal muscle. It is suggested that lymph propulsion by working muscle is most efficient when the muscle is able to shorten close to its minimum length.

Selective boron drug delivery to brain tumors for boron neutron capture therapy

Malignant glioma is one of the most deadly forms of cancer in humans and remains refractory to presently available treatments. Boron neutron capture therapy (BNCT) is a promising therapeutic modality for the treatment of malignant brain tumors. For successful BNCT, a sufficient quantity of boron atoms must be selectively delivered to individual brain tumor cells while at the same time the boron concentration in the normal brain tissue should be kept low to minimize the damage to normal brain tissue. However, the brain entry of drugs is restricted by the blood-brain barrier (BBB), even though the permeability of the pathological area of this barrier may be partially increased due to the present of brain tumors. Therefore, selective delivery of boron to tumor cells across the BBB is a major challenge to the BNCT of brain tumors. This review briefly discusses four main mechanisms responsible for drug transport across the BBB. Brain tumor-localizing boron compounds are described, such as borocaptate sodium, p-boronophenylalanine, boronated porphyrins and boronated nucleosides. Strategies employed to selectively deliver boron drug into brain tumors are reviewed including hyperosmotic BBB modification, biochemical opening of BBB, electropermeabilization and direct intracerebral delivery of boron drugs. Conjugation of boron drugs to macromolecules like monoclonal antibodies and epidermal growth factor are discussed for active tumor targeting. Boron delivery via microparticles such as liposomes, high density lipoproteins and nanoparticles is also covered for their potential utilization in BNCT of brain tumors.

Photodynamic therapy in neurosurgery: a review

Photodynamic therapy (PDT) has been investigated extensively, both experimentally and clinically, as an adjunctive treatment in the neuro-oncological field. It is based on the more selective accumulation of a photosensitizer in malignant than normal tissue with low systemic toxicity. Subsequent light activation induces photo-oxidation, followed by selective tumour destruction via vascular and direct cellular mechanisms. Malignant brain tumours carry a lethal prognosis with a median survival of 15 months despite surgery, radiotherapy and chemotherapy. PDT is therefore a logical therapeutic concept for brain tumours infiltrating into normal brain. In this review, all the available data on patients treated with haematoporphyrin derivative-mediated PDT are critically analysed. Over 310 patients have been reported in the literature suffering from primary or recurrent malignant brain tumours which were treated with PDT following tumour resection in open clinical phase I/II trials. This number includes 58 patients treated at our own institution. Variations in the treatment protocols make evaluation scientifically difficult; however, there is a clear trend of increased median survival after surgical resection and one single photodynamic treatment. PDT is generally well tolerated and side effects consist of moderate increased intracranial pressure and prolonged skin sensitivity to direct sunlight. The current available data indicate that PDT is a safe treatment, which is well tolerated by the patients and yields an improvement in survival of those with malignant brain tumours. Conclusive information can be expected from controlled clinical trials which are currently being designed. The results raise the hope that PDT will be a valuable addition to the armamentarium for the treatment of cerebral malignancies.