Primaquine liposomes in the chemotherapy of experimental murine malaria

Review: Liposomes in the prophylaxis and treatment of infectious diseases

Infectious diseases remain as one of the major burdens among health communities as well as in the general public despite the advances in prevention and treatment. Although vaccination and vector eliminations have greatly prevented the transmission of these diseases, the effectiveness of these strategies is no longer guaranteed as new challenges such as drug resistance and toxicity as well as the missing effective therapeutics arise. Hence, the development of new tools to manage these challenges is anticipated, in which nano technology using liposomes as effective nanostructure is highly considered. In this review, we concentrate on the advantages of liposomes in the drug delivery system and the development of vaccine in the treatment of three major infectious diseases; tuberculosis (TB), malaria and HIV.

Current challenges and nanotechnology-based pharmaceutical strategies for the treatment and control of malaria

Malaria is one of the prevalent tropical diseases caused by the parasitic protozoan of the genus Plasmodium spp. With an estimated 228 million cases, it is a major public health concern with high incidence of morbidity and mortality worldwide. The emergence of drug-resistant parasites, inadequate vector control measures, and the non-availability of effective vaccine(s) against malaria pose a serious challenge to malaria eradication especially in underdeveloped and developing countries. Malaria treatment and control comprehensively relies on chemical compounds, which encompass various complications, including severe toxic effects, emergence of drug resistance, and high cost of therapy. To overcome the clinical failures of anti-malarial chemotherapy, a new drug development is of an immediate need. However, the drug discovery and development process is expensive and time consuming. In such a scenario, nanotechnological strategies may offer promising alternative approach for the treatment and control of malaria, with improved efficacy and safety. Nanotechnology based formulations of existing anti-malarial chemotherapeutic agents prove to exceed the limitations of existing therapies in relation to optimum therapeutic benefits, safety, and cost effectiveness, which indeed advances the patient's compliance in treatment. In this review, the shortcomings of malaria therapeutics and necessity of nanotechnological strategies for treating malaria were discussed.

Liposomes for malaria management: the evolution from 1980 to 2020

Malaria is one of the most prevalent parasitic diseases and the foremost cause of morbidity in the tropical regions of the world. Strategies for the efficient management of this parasitic infection include adequate treatment with anti-malarial therapeutics and vaccination. However, the emergence and spread of resistant strains of malaria parasites to the majority of presently used anti-malarial medications, on the other hand, complicates malaria treatment. Other shortcomings of anti-malarial drugs include poor aqueous solubility, low permeability, poor bioavailability, and non-specific targeting of intracellular parasites, resulting in high dose requirements and toxic side effects. To address these limitations, liposome-based nanotechnology has been extensively explored as a new solution in malaria management. Liposome technology improves anti-malarial drug encapsulation, bioavailability, target delivery, and controlled release, resulting in increased effectiveness, reduced resistance progression, and fewer adverse effects. Furthermore, liposomes are exploited as immunological adjuvants and antigen carriers to boost the preventive effectiveness of malaria vaccine candidates. The present review discusses the findings from studies conducted over the last 40 years (1980-2020) using in vitro and in vivo settings to assess the prophylactic and curative anti-malarial potential of liposomes containing anti-malarial agents or antigens. This paper and the discussion herein provide a useful resource for further complementary investigations and may pave the way for the research and development of several available and affordable anti-malarial-based liposomes and liposomal malaria vaccines by allowing a thorough evaluation of liposomes developed to date for the management of malaria.

Promising nanomaterials in the fight against malaria

For more than one hundred years, several treatments against malaria have been proposed but they have systematically failed, mainly due to the occurrence of drug resistance in part resulting from the exposure of the parasite to low drug doses. Several factors are behind this problem, including (i) the formidable barrier imposed by the Plasmodium life cycle with intracellular localization of parasites in hepatocytes and red blood cells, (ii) the adverse fluidic conditions encountered in the blood circulation that affect the interaction of molecular components with target cells, and (iii) the unfavorable physicochemical characteristics of most antimalarial drugs, which have an amphiphilic character and can be widely distributed into body tissues after administration and rapidly metabolized in the liver. To surpass these drawbacks, rather than focusing all efforts on discovering new drugs whose efficacy is quickly decreased by the parasite's evolution of resistance, the development of effective drug delivery carriers is a promising strategy. Nanomaterials have been investigated for their capacity to effectively deliver antimalarial drugs at local doses sufficiently high to kill the parasites and avoid drug resistance evolution, while maintaining a low overall dose to prevent undesirable toxic side effects. In recent years, several nanostructured systems such as liposomes, polymeric nanoparticles or dendrimers have been shown to be capable of improving the efficacy of antimalarial therapies. In this respect, nanomaterials are a promising drug delivery vehicle and can be used in therapeutic strategies designed to fight the parasite both in humans and in the mosquito vector of the disease. The chemical analyses of these nanomaterials are essential for the proposal and development of effective anti-malaria therapies. This review is intended to analyze the application of nanomaterials to improve the drug efficacy on different stages of the malaria parasites in both the human and mosquito hosts.

Receptor-mediated hepatocyte-targeted delivery of primaquine phosphate nanocarboplex using a carbohydrate ligand

Primaquine phosphate is a drug of choice for the treatment of malarial relapse. However, poor drug concentration in the hepatocytes and dose-related toxicity pose severe limitations. We report a nanocarboplex of primaquine phosphate by a simple in situ process using dextran sulphate as a carbohydrate polymer and pullulan as an asialoglycoprotein receptor ligand. Our aim was to preferentially enhance accumulation of the nanocarboplex in the hepatocytes. The in situ pullulan-anchored primaquine nanocarboplex was prepared by simple addition of a solution of dextran sulphate and pullulan with stabilizer to a measured quantity of primaquine phosphate in a vial, followed by shaking to obtain the primaquine phosphate nanocarboplex ready for injection. The nanocarboplex was characterized and evaluated in vivo for pharmacokinetics and biodistribution in the rat model. Specific uptake by hepatocytes in the liver was also quantified. Increase in t ½ with significant uptake in the RES organ was observed. More importantly, anchoring pullulan favored high liver uptake and preferential accumulation in the hepatocytes with a hepatocytes/nonparenchymal cells ratio of 75:25. The in situ primaquine phosphate nanocarboplex anchored with pullulan provides both a significant technological advantage and the desired targeting to the hepatocytes.

Design, synthesis and evaluation of antimalarial potential of polyphosphazene linked combination therapy of primaquine and dihydroartemisinin

Various polymer drug conjugates (13-16) such as primaquine and dihydroartemisinin conjugated 2-propoxy substituted polyphosphazenes (13), primaquine and dihydroartemisinin conjugated 4-acetamidophenoxy substituted polyphosphazenes (14), primaquine and dihydroartemisinin conjugated 4-formyl substituted polyphosphazenes (15) and primaquine and dihydroartemisinin conjugated 4-aminoethylbenzoate substituted polyphosphazenes (16) were synthesized using substituted polyphosphazenes as polymer and primaquine and dihydroartemisinin as combination antimalarial pharmacophores and formulated to nanoparticles to achieve novel controlled combined drug delivery approach for radical cure of malaria. The polymeric backbone was suitably substituted to impart different physicochemical properties. The polymer-drug conjugates were characterized by IR, (1)H NMR, (31)P NMR and their molecular weights were determined by Gel Permeation Chromatography. The thermal properties of the conjugates (13-16) were studied by DSC and TGA. The conjugates (13-16) were then formulated to nanoparticles formulations to increase their uptake by hepatocytes and to achieve targeted drug delivery. The nanoparticle formulations were characterized by Zeta Sizer and their morphology were studied by TEM (Transmission Electron Microscopy) imaging. The nanoparticles formulations exhibited biphasic in vitro drug release profile, the initial burst release followed by a sustained release owing to the non-fickian diffusion during first step release and fickian diffusion during second step release. In vivo antimalarial efficacy was tested using Plasmodium berghei (NK65 resistant strain) infected swiss albino mice at different doses. The combination therapy exhibited promising antimalarial efficacy at lower doses in comparison to the standard drug combination. Further, this combination therapy provided protection over 35days without any recrudescence, thus proving to be effective against resistant malaria. The study provides an alternative combination regimen found to be effective in the treatment of resistant malaria.

Curcuminoids-loaded liposomes in combination with arteether protects against Plasmodium berghei infection in mice

Curcuminoids are poorly water-soluble compounds with promising antimalarial activity. To overcome some of the drawbacks of curcuminoids, we explored the potential of liposomes for the intravenous delivery of curcuminoids in a model of mouse malaria. The curcuminoids-loaded liposomes were formulated from phosphatidylcholine (soy PC) by the thin-film hydration method. Antimalarial activity of curcuminoids-loaded liposomes alone and in combination with α/β arteether when administered intravenously, was evaluated in Plasmodium berghei infected mice. Animals treated with curcuminoids-loaded liposomes showed lower parasitemia and higher survival when compared to control group (no treatment). Importantly, the combination therapy of curcuminoids-loaded liposomes (40 mg/kg body wt) along with α/β arteether (30 mg/kg body wt) was able to not only cure infected mice but also prevented recrudescence. These data suggest that curcuminoids-loaded liposomes may show promise as a formulation for anti-malarial therapy.

Nanotechnology applied to the treatment of malaria

Despite the fact that we live in an era of advanced technology and innovation, infectious diseases, like malaria, continue to be one of the greatest health challenges worldwide. The main drawbacks of conventional malaria chemotherapy are the development of multiple drug resistance and the non-specific targeting to intracellular parasites, resulting in high dose requirements and subsequent intolerable toxicity. Nanosized carriers have been receiving special attention with the aim of minimizing the side effects of drug therapy, such as poor bioavailability and the selectivity of drugs. Several nanosized delivery systems have already proved their effectiveness in animal models for the treatment and prophylaxis of malaria. A number of strategies to deliver antimalarials using nanocarriers and the mechanisms that facilitate their targeting to Plasmodium spp.-infected cells are discussed in this review. Taking into account the peculiarities of malaria parasites, the focus is placed particularly on lipid-based (e.g., liposomes, solid lipid nanoparticles and nano and microemulsions) and polymer-based nanocarriers (nanocapsules and nanospheres). This review emphasizes the main requirements for developing new nanotechnology-based carriers as a promising choice in malaria treatment, especially in the case of severe cerebral malaria.

In vitroandin vivoevaluation of albumin-encapsulated primaquine diphosphate prepared by nebulization into heated oil

Nebulization of an aqueous mixture of primaquine diphosphate and albumin into heated vegetable oil produces spherical particles with an average size of 6 microm. The microparticles are relatively stabile in buffers of pH 7.2 and 4.5 and completely degrade when exposed to proteolytic enzymes such as trypsin. Pharmacokinetic evaluation of the albumin-encapsulated primaquine diphosphate shows significantly higher levels in mouse liver tissue relative to free drug 2-48 h post-IP administration. Higher AUC (2.8x), lower steady-state volume of distribution (10x) and slower half-life (2.5x) relative to an equivalent dose of free primaquine diphosphate suggest liver targeting and sustained release of the drug from the microparticles.

Formulation, antimalarial activity and biodistribution of oral lipid nanoemulsion of primaquine

Primaquine (PQ) is one of the most widely used antimalarial and is the only available drug till date to combat relapsing form of malaria especially in case of Plasmodium vivax and Plasmodium ovale. Primaquine acts specifically on the pre-erythrocytic schizonts which are concentrated predominantly in the liver and causes relapse after multiplication. However application of PQ in higher doses is limited by severe tissue toxicity including hematological and GI related side effects which are needed to be minimized. Lipid nanoemulsion has been widely explored for parenteral delivery of drugs. Primaquine when incorporated into oral lipid nanoemulsion having particle size in the range of 10-200 nm showed effective antimalarial activity against Plasmodium bergheii infection in swiss albino mice at a 25% lower dose level as compared to conventional oral dose. Lipid nanoemulsion of primaquine exhibited improved oral bioavailability and was taken up preferentially by the liver with drug concentration higher at least by 45% as compared with the plain drug.

Recent advances in antimalarial drug development

Malaria caused by protozoa of the genus Plasmodium, because of its prevalence, virulence, and drug resistance, is the most serious and widespread parasitic disease encountered by mankind. The inadequate armory of drugs in widespread use for the treatment of malaria, development of strains resistant to commonly used drugs such as chloroquine, and the lack of affordable new drugs are the limiting factors in the fight against malaria. These factors underscore the continuing need of research for new classes of antimalarial agents, and a re-examination of the existing antimalarial drugs that may be effective against resistant strains. This review provides an in-depth look at the most significant progress made during the past 10 years in antimalarial drug development.

Targeting primaquine into liver using chylomicron emulsions for potential vivax malaria therapy

Primaquine (PQ) exerts a broad spectrum of activities against various stages of parasitic malaria. It remains as the only drug that destroys late hepatic stages and latent tissue forms of Plasmodium vivax and Plasmodium ovale. However, systems that can target PQ to liver hepatocytes, where malarial sporozoites reside, are needed to minimize the dose-limiting severe toxicities and side-effects caused by PQ. Recently, a reconstituted artificial chylomicron emulsion was generated using commercially available lipids and was shown to be preferentially taken up by liver hepatocytes following intravenous injection. We proposed to target PQ to hepatocytes by incorporating it into this chylomicron emulsion. We have shown that lipophilized PQ can be readily incorporated into the chylomicron emulsion. The PQ remained inside the emulsion without significant release. Moreover, PQ incorporated inside the emulsion was more stable than free PQ when incubated in serum. Finally, when intravenously injected into mice, the PQ-incorporated chylomicron emulsion led to significantly enhanced accumulation of PQ in liver, when compared to the injection of free PQ. This emulsion could be developed into a promising delivery system to target PQ into hepatocytes for vivax malaria therapy.

8-Quinolinamines conjugated with amino acids are exhibiting potent blood-schizontocidal antimalarial activities

Alanine, lysine, ornithine and valine conjugated to primaquine and other 8-quinolinamine antimalarials were prepared for blood-schizontocidal antimalarial activity evaluation. The analogues were examined in vivo against Plasmodium berghei (drug-sensitive strain) and Plasmodium yoelii nigeriensis (highly virulent multi-drug-resistant strain) infected mice models. N(1)-[4-(5-Butoxy-4-ethyl-6-methoxy-8-quinolylamino)pentyl]-(2S)-2,6-diaminohexanamide (20) which showed curative activity at 5mg/kg in the P. berghei test emerged as the most effective compound. N(1)-[4-(4-Ethyl-5-hexoxy-6-methoxy-8-quinolylamino)pentyl]-(2S)-2,6-diaminohexanamide (22) exhibited curative activity at 50mg/kg against P. yoelii nigeriensis in mice and emerged as the most potent analogue against multi-drug resistant strain. The results of this study represent development of highly potent 8-quinolinamines for antimalarial drug development.

Preparation of beta-artemether liposomes, their HPLC-UV evaluation and relevance for clearing recrudescent parasitaemia in Plasmodium chabaudi malaria-infected mice

Egg phosphatidylcholine-cholesterol liposome formulations containing the antimalarial drug beta-artemether have been prepared and analyzed for their encapsulating capacity, chemical stability, leakage, in vitro release and their therapeutic efficiency against Plasmodium chabaudi infection. A HPLC-UV analysis of beta-artemether liposomes without derivatisation was achieved. A good linearity of y=4437.7 x+469.01 (R(2)=0.9999) with a detection limit of 2 microg ml(-1) was reached. Prior to this, liposomal formulations composed of different molar ratios of EPC-CHOL were prepared to select beta-artemether crystal-free liposome preparations. The formulation corresponding to 4:3 and a total concentration of 300 mg lipids ml(-1) buffer (pH 7.2), which could incorporate as much as 1.5 mg beta-artemether was selected for therapy. A trapping efficiency of nearly 100% was reached, the drug being located in the lipid bilayers. A dialysis test demonstrated that the drug could be reversibly released from the liposomes, reaching equilibrium within 24 h. After 3 months storage at 4 degrees C, no leakage of beta-artemether had occurred indicating a high stability of the liposomes. These liposomes were used to treat mice infected with the virulent rodent malaria parasite Plasmodium chabaudi chabaudi, with a 100% cure by clearing the recrudescent parasitaemia.

Effect of surface charge of small unilamellar liposomes on uptake and transfer of carboxyfluorescein across the perfused human term placenta

We aim to investigate the effect of surface charge of small unilamellar liposomes on transfer and uptake of a low molecular weight, hydrophilic and polar molecule carboxyfluorescein in an in vitro model of perfused human term placenta. Carboxyfluorescein-encapsulated neutral liposomes were prepared by using an equimolar concentration of lecithin and cholesterol. Anionic and cationic liposomes were prepared by adding dicetylcholine and stearylamine, respectively. Size distribution, encapsulation efficiency, and stability of liposomes in blood-based medium were determined. The transfer kinetics of free carboxyfluorescein and liposomally encapsulated carboxyfluorescein were studied in a dually perfused isolated lobule of human term placenta. The concentration of carboxyfluorescein was measured fluorometrically. The maternal to fetal transfer and placental uptake of free carboxyfluorescein was 1.6 +/- 0.1% and 4.2 +/- 0.1% of the initial dose, respectively. This constitutes the control data. The placental transfer of carboxyfluorescein was significantly increased by neutral (2.5 +/- 0.1%; p < 0.01) and anionic liposomes (3.1 +/- 0.2%; p < 0.001), whereas cationic liposomes prevented its transfer (0.4 +/- 0.1%; p < 0.001). The placental uptake of neutral (14.9 +/- 2.3%; p < 0.001) and anionic liposomes (21.1 +/- 1.2%; p < 0.001) were significantly higher than the cationic liposomes (2.3 +/- 0.6%) and control group (p < 0.001). The placental uptake of cationic liposomes was comparable with the control data. These results indicate that placental uptake of small unilamellar liposomes depends upon their surface charge, and transfer of carboxyfluorescein is enhanced by anionic and impeded by cationic liposomes.

Characterization, in vitro and in vivo studies on primaquine diphosphate liposomes

In this study, several Primaquine diphosphate (PQ) liposomal formulations containing phospholipid, charge inducer and with or without cholesterol in molar ratios of 7:1:(2) and 10:1:(4) were investigated. Gel state (DPPC:CHEMS:CHOL and PL-100H:CHEMS:CHOL) and liquid-crystalline state (PL-100:CHEMS:CHOL and PL-90G:CHEMS:CHOL) liposomes were prepared. The film method followed by sonication and extrusion through polycarbonate membrane was used. Particle size distribution, percentage of entrapped active substance, content of phospholipid and bilayer type and composition were determined. Lamellarity was determined by 31P-NMR technique. In vitro release of PQ was investigated at 37 degrees C, 35 rpm and in Tris (pH: 7.4) buffer. In vitro release and its fit to kinetic models were investigated. Liposomes were labelled by 99mTc and injected intravenously to Swiss Albino mice.

Erythrocyte based delivery system of primaquine: in vitro characterization

Primaquine phosphate, an antimalarial drug, was loaded in erythrocytes by the process of endocytosis. The encapsulation of 0.1-0.15 mg of drug ml-1 of packed erythrocytes was achieved. The loaded cells attained spherical shape and exhibited higher osmotic fragility and lower resistance to turbulence shock as compared with normal cells. Glutaraldehyde treatment stabilized the cells which were noted to be resistant to the osmotic and turbulence shocks. In vitro release of drug and haemoglobin was also retarded upon treatment of loaded erythrocytes with glutaraldehyde. The studies suggest the potentiality of primaquine-loaded, glutaraldehyde-treated erythrocytes as an intravenous drug delivery system for casual prophylaxis and radical cure of malaria.

Chloroquine blood levels after administration of the liposome-encapsulated drug in relation to therapy of murine malaria

In a previous report (P. A. M. Peeters, C. W. E. M. Huiskamp, W. M. C. Eling, and D. J. A. Crommelin. Parasitology, 1989, in press) an increase in therapeutic and prophylactic potential was found when chloroquine (CQ) was encapsulated in fluid-state liposomes (lipCQ) and tested in Plasmodium berghei-infected mice in comparison to intraperitoneal (i.p.) administration of the free drug. In this study, the same model was used to demonstrate that encapsulation of CQ into gel-state liposomes further increased the preventive and therapeutic effect considerably. CQ determinations in whole blood, plasma, and red blood cells (RBC) after i.p. administration of fluid- or gel-state lipCQ revealed a prolonged availability of the drug in comparison to administration of free CQ. The CQ concentrations were related to the CQ levels needed for prevention or therapy of Plasmodium berghei infections in mice.

Chloroquine containing liposomes in the chemotherapy of murine malaria

In this study, the advantage of the use of chloroquine (CQ) containing liposomes (lipCQ) over free CQ in the chemotherapy of murine malaria (Plasmodium berghei) was demonstrated. The maximum permissible dose per intraperitoneal injection was 0.8 and 10 mg for CQ and lipCQ, respectively. An increase in therapeutic and prophylactic efficacy of lipCQ in comparison with free CQ at a 0.8 mg CQ dose level was found. It was possible to obtain 100% efficacy (injection at day 5 after infection; parasitaemia 4-8%) with one single intraperitoneal injection of 6 mg lipCQ. Moreover, the ability to increase the doses of CQ per injection after liposome encapsulation allowed successful treatment of infections with CQ-resistant Plasmodium berghei which could not be cured by a 7-day course with the maximum tolerable dose of free CQ of 0.8 mg/mouse/day.

Therapeutic efficacy of liposome-entrapped rifampin against Mycobacterium avium complex infection induced in mice

Liposome-entrapped rifampin (RFP) was examined for therapeutic efficacy against experimental infection induced in mice by the Mycobacterium avium complex. Intraperitoneal injections (once daily, six times weekly) of liposome-entrapped RFP led to a greater reduction in bacterial growth in the lungs and spleen of infected mice than did free RFP alone. Liposome-entrapped RFP given to mice via the intramuscular or subcutaneous route failed to show such an increased therapeutic efficacy. RFP entrapped in the lipid layer of liposomal vesicles exhibited a level of therapeutic activity similar to that seen with RFP encapsulated in the inner solute of the vesicles. Entrapment of RFP in liposomal vesicles increased incorporation of the drug into host peritoneal macrophages and increased the activity of the agent against M. avium complex phagocytosed into the macrophages.

In vitro lysis of the bloodstream forms of Trypanosoma brucei gambiense by stearylamine-bearing liposomes

Cytolytic activity of liposomes consisting of stearylamine and phosphatidylcholine (SA/PC-liposomes) was examined in vitro against the bloodstream forms of Trypanosoma brucei gambiense. More than 99% of the cells (2 X 10(6)/ml) were killed within 30 min by treatment with 15 mol% SA/PC-liposomes (100 microM total lipids). As few as 1.2 X 10(12) liposomes per ml (equivalent to 2 nM liposome) showed trypanocidal activity. Fluorescence microscopy of cells treated with the dansylated SA/PC-liposomes suggested that the liposomes bound to and accumulated on the cell surface, eventually damaging the plasma membrane. SA/PC-liposomes showed no significant hemolysis when incubated with human and mouse erythrocytes under conditions that killed greater than 99.9% of the T. b. gambiense trypomastigotes. Human leukocytes were also shown to be less susceptible to SA/PC-liposomes than T. b. gambiense. These results may point to a new direction in strategy for therapy of African trypanosomiasis.

Liposomes as drug delivery system in the treatment of infectious diseases. Potential applications and clinical experience

Liposomes are microscopic, closed lipid vesicles able to entrap hydrophilic as well as lipophilic compounds. They constitute a versatile drug delivery system. When injected by the intravenous route, liposomes are taken up by macrophages in the liver and in the spleen. Investigation of several animal models of infections has shown that liposome-entrapped anti-infectious drugs are active against infections due to facultative intracellular bacteria, parasites such as Leishmania, viruses such as the one causing Rift valley fever. Liposomes of different lipid compositions, structures and sizes were used for intravenous administration of anti-infectious drugs without inducing toxicity in the tested animals. Clinical experience was obtained with two different liposomal preparations of amphotericin B in the treatment of systemic fungal diseases in cancer patients; these preparations were shown to be effective and very well-tolerated.

Liposome-encapsulated ampicillin against Listeria monocytogenes in vivo and in vitro

In an experimental infection caused by Listeria monocytogenes in mice a considerable enhancement (90-fold) of the therapeutic activity of ampicillin resulting from liposomal encapsulation was observed. The mechanism by which liposomes improved the therapeutic index of ampicillin in this infection appeared to be an increased delivery of the antibiotic to the site of infection, i.e. the liver and spleen. Substantial amounts of liposomal ampicillin were recovered from isolated Kupffer cells, the target cells of L. monocytogenes after intravenous inoculation. In addition, in studies on the survival of L. monocytogenes within murine peritoneal macrophages in vitro it was found that liposomal encapsulation of ampicillin resulted in an increased availability of the antibiotic for the intracellular bacteria: liposomal ampicillin killed 90% of the intracellular bacteria, whereas a similar concentration of free ampicillin plus empty liposomes had no effect upon the intracellular bacteria.

Preparation and use of liposomes in the treatment of microbial infections

The potential application of liposomes to drug delivery has been apparent since 1965, when these phospholipid vesicles were first described by Bangham. Since then, experiments on animals have shown that liposome encapsulation can dramatically alter the distribution of drugs in the body and their rate of clearance. These pharmacokinetic differences, as well as other less well-understood effects, can result in reduced toxicity and enhanced efficacy of the encapsulated drug. The vast majority of studies on the therapeutic use of liposomes have involved the delivery of drugs used in cancer chemotherapy and metabolic storage diseases, but there is now more literature on the use of liposomes for the delivery of antimicrobial drugs and immunomodulating agents. This review briefly discusses the general properties of liposomes and the rationale for their use in antimicrobial drug delivery and immunomodulation, as well as the encapsulation of specific agents and the effect of encapsulation on the treatment of infectious diseases.

Liposomes in treatment of infectious diseases

In reviewing the literature about the potential of liposomes in the therapy of infections caused by protozoa, bacteria, fungi and viruses, it can be concluded that liposomal encapsulation may improve the therapeutic index of anti-infectious drugs. The improved therapeutic index may be a result of a reduction in drug toxicity and/or an enhanced drug delivery at the intracellular site of infection. Furthermore, attention is paid to the therapeutic utility of liposome-encapsulated immunomodulators in treatment of infections.

Effect of liposome-entrapped ampicillin on survival of Listeria monocytogenes in murine peritoneal macrophages

The effect of liposomal encapsulation of ampicillin on the antibacterial activity against intracellular Listeria monocytogenes was studied by comparing survival of L. monocytogenes within peritoneal mouse macrophages in the presence of free ampicillin alone or in combination with liposome-entrapped ampicillin. In the presence of 50 micrograms of free ampicillin per ml of the incubation medium, intracellular growth of L. monocytogenes was still observed, although less as compared with intracellular growth in the absence of ampicillin. At a concentration of 50 micrograms of free ampicillin plus 100 micrograms of liposome-entrapped ampicillin per ml, 99% of the intracellular bacteria were killed. On the other hand, a concentration of 150 micrograms of free ampicillin per ml plus empty liposomes only inhibited intracellular bacterial growth, and the bacteria were not killed. In addition, empty liposomes at a concentration of 1 mumol of lipid per ml had no effect on intracellular bacterial growth. In broth, liposome-entrapped ampicillin at a concentration of 100 micrograms/ml was not bactericidal for L. monocytogenes, indicating that significant leakage of ampicillin from the liposomes with subsequent killing of the bacteria by the free drug did not occur. Therefore, we concluded that liposomal encapsulation of ampicillin results in an increased availability of the antibiotic for the intracellular bacteria.

Liposomes as drug carriers in leishmaniasis and malaria

Experimental studies suggest that liposomes could substantially improve the performance of anti-leishmanial drugs in the chemotherapy of visceral leishmaniasis. In this article, Carl Alving discusses the potential for overcoming resistance to antimonial drugs; for 'buffering' the toxicity of drugs, and for drug delivery under conditions where hospitalization is impossible or inconvenient. Liposomes can also be used experimentally to reduce the toxicity and increase the efficacy of parenterally-administered primaquine in the treatment of sporozoite-induced murine malaria.

Mouse Lewis lung carcinoma and hepatoma ascites treatment by combination of liposome chemotherapy and non-specific immunotherapy

Liposomes have been used as biological carriers of anti-tumor drugs, and their potential use has been tested in mouse Lewis lung carcinoma and hepatoma ascites tumor models. Ara-C3 given by the intraperitoneal i.p. route either at 35 mg/kg in a single dose or at 2.5 mg/kg/dose with 5 doses/day for 3 days had no effect on the average survival time of i.v. implanted LLC. However, the same single dose of Ara-C encapsulated in positively charged MLV significantly improved the average survival time of LLC-bearing mice. MTX was chosen as a test drug for the treatment of hepatoma ascites. Non-encapsulated MTX given at either 3 or 30 mg/kg by the i.p. route had little effect on the average survival of i.p.-implanted hepatoma ascites. However, MTX encapsulated in SUV at a 3 mg/kg dose by the i.p. route significantly improved the average survival time of tumor-bearing mice. A combination of chemotherapy and non-specific immunotherapy has also been tested with these 2 tumor models. Two non-specific microbial immune stimulators, Bacillus Calmette Guérin (BCG) and Corynebacterium parvum (CP) were tested by both the i.v. and i.p. routes. A combination of BCG therapy with non-encapsulated anti-tumor drugs was not effective for either of the tumor models. A combination of BCG therapy with liposome therapy appeared to improve the average survival time of LLC-bearing mice. In particular, BCG treatment by the i.p. route in combination with liposome therapy resulted in a 20% long-term survival rate among treated mice. However, BCG therapy by either route in combination with SUV encapsulated MTX therapy had no effect on the average survival time of hepatoma ascites-bearing mice. Immunostimulation with CP at a given dose appears to be superior to BCG therapy for both tumor models. In the treatment of LLC, injection of CP by either the i.v. or i.p. route appears to be equally effective in combination with liposome therapy. However, for the treatment of hepatoma ascites, CP was only effective by the i.p. route, in combination with liposome therapy.

Studies on the kinetics of uptake and distribution of free and liposome-entrapped primaquine, and of sporozoites by isolated perfused rat liver

The kinetics of uptake and the distribution of free primaquine differed markedly from that of liposome-entrapped primaquine. The uptake of the liposome-entrapped drug (LPQ) was gradual, reaching a plateau of 60% of the initial load after 20 minutes of perfusion. However, clearance of the free drug was almost immediate, reaching its maximum uptake of 44% within five minutes. Some interactions also seen between liposomes and malarial sporozoites. In mixed perfusions the removal of LPQ was enhanced whilst the uptake of sporozoites remained normal. Liposome uptake was significantly lower in livers obtained from silica-treated animals, in which Küpffer cell numbers are depleted. Further, analysis of the radioactive content of hepatocyte and Küpffer cell fractions following perfusion with 3H and 14C labelled liposomes suggested that the vesicles were concentrated in the latter cell type.

The disposition of free and liposomally encapsulated antimalarial primaquine in mice

Plasma clearance, urinary excretion and tissue distribution of radiolabeled free (FPQ) and liposome-entrapped Primaquine (LPQ) in mice were monitored for 2 hr following intravenous administration. FPQ is eliminated very rapidly from the plasma and excreted predominantly in the urine, probably largely in a metabolized form. In decreasing order of magnitude, pronounced accumulation of label occurs in the liver, kidneys, lungs and skeletal muscle. Less than 1 per cent of the total initial dose is recovered in other tissues. Partial erythrocytic sequestration results in drug levels higher and more persistent in blood cells than in the plasma. Compared to the free drug form, Primaquine entrapped within negatively charged liposomes of the cholesterol-rich multilamellar type exhibits a prolonged plasmatic half-life and, within the observation period, excretion is 8-fold reduced. Liver accumulation of label is doubled, accounting for close to 50% of the injected dose; splenic uptake is tripled, while accumulation in the lungs, kidneys, heart and brain is drastically reduced. These differences in pharmacodynamic behaviour may explain why liposomal entrapment leads to diminished acute Primaquine toxicity.