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Verco J, Johnston W, Frost M, Baltezor M, Kuehl PJ, Lopez A, Gigliotti A, Belinsky SA, Wolff R, diZerega G. Inhaled Submicron Particle Paclitaxel (NanoPac) Induces Tumor Regression and Immune Cell Infiltration in an Orthotopic Athymic Nude Rat Model of Non-Small Cell Lung Cancer. J Aerosol Med Pulm Drug Deliv 2019; 32:266-277. [PMID: 31347939 PMCID: PMC6781259 DOI: 10.1089/jamp.2018.1517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: This study evaluated the antineoplastic and immunostimulatory effects of inhaled (IH) submicron particle paclitaxel (NanoPac®) in an orthotopic non-small cell lung cancer rodent model. Methods: Male nude rats were whole body irradiated, intratracheally instilled with Calu-3 cancer cells and divided into six treatment arms (n = 20 each): no treatment (Group 1); intravenous nab-paclitaxel at 5.0 mg/kg once weekly for 3 weeks (Group 2); IH NanoPac at 0.5 or 1.0 mg/kg, once weekly for 4 weeks (Groups 3 and 4), or twice weekly for 4 weeks (Groups 5 and 6). Upon necropsy, left lungs were paraffin embedded, serially sectioned, and stained for histopathological examination. A subset was evaluated by immunohistochemistry (IHC), anti-pan cytokeratin staining AE1/AE3+ tumor cells and CD11b+ staining dendritic cells, natural killer lymphocytes, and macrophage immune cells (n = 2, Group 1; n = 3 each for Groups 2–6). BCL-6 staining identified B lymphocytes (n = 1 in Groups 1, 2, and 6). Results: All animals survived to scheduled necropsy, exhibited no adverse clinical observations due to treatment, and gained weight at the same rate throughout the study. Histopathological evaluation of Group 1 lung samples was consistent with unabated tumor growth. Group 2 exhibited regression in 10% of animals (n = 2/20). IH NanoPac-treated groups exhibited significantly higher tumor regression incidence per group (n = 11–13/20; p < 0.05, χ2). IHC subset analysis revealed tumor-nodule cluster separation, irregular borders between tumor and non-neoplastic tissue, and an increased density of infiltrating CD11b+ cells in Group 2 animals (n = 2/3) and in all IH NanoPac-treated animals reviewed (n = 3/3 per group). A single animal in Group 4 and Group 6 exhibited signs of pathological complete response at necropsy with organizing stroma and immune cells replacing areas presumed to have previously contained adenocarcinoma nodules. Conclusion: Tumor regression and immune cell infiltration were observed in all treatment groups, with an increased incidence noted in animals receiving IH submicron particle paclitaxel treatment.
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Affiliation(s)
- James Verco
- US Biotest, Inc., San Luis Obispo, California
| | | | - Michael Frost
- Western Diagnostic Services Laboratory, Santa Maria, California
| | | | | | - Anita Lopez
- Lovelace Biomedical, Albuquerque, New Mexico
| | | | | | | | - Gere diZerega
- US Biotest, Inc., San Luis Obispo, California.,NanOlogy, LLC, Fort Worth, Texas
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Hertel SP, Winter G, Friess W. Protein stability in pulmonary drug delivery via nebulization. Adv Drug Deliv Rev 2015; 93:79-94. [PMID: 25312674 DOI: 10.1016/j.addr.2014.10.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 08/22/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
Protein inhalation is a delivery route which offers high potential for direct local lung application of proteins. Liquid formulations are usually available in early stages of biopharmaceutical development and nebulizers are the device of choice for atomization avoiding additional process steps like drying and enabling fast progression to clinical trials. While some proteins were proven to remain stable throughout aerosolization e.g. DNase, many biopharmaceuticals are more susceptible towards the stresses encountered during nebulization. The main reason for protein instability is unfolding and aggregation at the air-liquid interface, a problem which is of particular challenge in the case of ultrasound and jet nebulizers due to recirculation of much of the generated droplets. Surfactants are an important formulation component to protect the sensitive biomolecules. A second important challenge is warming of ultrasound and vibrating mesh devices, which can be overcome by overfilling, precooled solutions or cooling of the reservoir. Ultimately, formulation development has to go hand in hand with device evaluation.
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Kuzmov A, Minko T. Nanotechnology approaches for inhalation treatment of lung diseases. J Control Release 2015; 219:500-518. [PMID: 26297206 DOI: 10.1016/j.jconrel.2015.07.024] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/16/2015] [Accepted: 07/21/2015] [Indexed: 02/08/2023]
Abstract
Local administration of therapeutics by inhalation for treatment of lung diseases has the ability to deliver drugs, nucleic acids and peptides specifically to the site of their action and therefore enhance the efficacy of the treatment, limit the penetration of nebulized therapeutic agent(s) into the bloodstream and consequently decrease adverse systemic side effects of the treatment. Nanotechnology allows for a further enhancement of the treatment efficiency. The present review analyzes modern therapeutic approaches of inhaled nanoscale-based pharmaceutics for the detection and treatment of various lung diseases.
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Affiliation(s)
- Andriy Kuzmov
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway 08854, USA
| | - Tamara Minko
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway 08854, USA; Rutgers Cancer Institute of New Jersey, New Brunswick 08903, USA.
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Le Noci V, Tortoreto M, Gulino A, Storti C, Bianchi F, Zaffaroni N, Tripodo C, Tagliabue E, Balsari A, Sfondrini L. Poly(I:C) and CpG-ODN combined aerosolization to treat lung metastases and counter the immunosuppressive microenvironment. Oncoimmunology 2015; 4:e1040214. [PMID: 26451303 DOI: 10.1080/2162402x.2015.1040214] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 12/29/2022] Open
Abstract
The immunostimulatory ability of synthetic oligonucleotides containing CpG motifs (CpG-ODN), agonists of Toll-like receptor 9 (TLR9), can be harnessed to promote antitumor immunity by their application at the tumor site to stimulate local activation of innate immunity; however, particularly in the lung, tumor-associated immunosuppression can subvert such antitumor innate immune responses. To locally maintain continuous activation of innate subpopulations while inhibiting immunosuppressive cells, we evaluated aerosol delivery CpG-ODN combined with Poly(I:C), a TLR3 agonist able to convert tumor-supporting macrophages to tumoricidal effectors, in the treatment of B16 melanoma lung metastases in C57BL/6 mice. Aerosolization of CpG-ODN with Poly(I:C) into the bronchoalveolar space reduced the presence of M2-associated arginase- and IL-10-secreting macrophages in tumor-bearing lungs and increased the antitumor activity of aerosolized CpG-ODN alone against B16 lung metastases without apparent signs of toxicity or injury of the bronchial-bronchiolar structures and alveolar walls. Moreover, CpG-ODN/Poly(I:C) aerosol combined with dacarbazine, a therapeutic agent used in patients with inoperable metastatic melanoma able to exert immunostimulatory effects, led to a significant increase in antitumor activity as compared to treatments with aerosolized CpG-ODN/Poly(I:C) or dacarbazine alone. This effect was related to an enhanced recruitment and cytotoxic activity of tumor-infiltrating NK cells in the lung. Our results point to aerosol delivery as a convenient approach for repeated applications of immunostimulants in patients with lung metastases to maintain a continuous local activation of innate immune cells while suppressing polarization of tumor-infiltrating macrophages to an M2 phenotype.
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Affiliation(s)
- Valentino Le Noci
- Dipartimento di Scienze Biomediche per la Salute; Università degli Studi di Milano ; Milan, Italy
| | - Monica Tortoreto
- Molecular Pharmacology Unit; Fondazione IRCCS Istituto Nazionale dei Tumori ; Milan, Italy
| | - Alessandro Gulino
- Dipartimento PRO.SA.MI; Unità di Immunologia dei Tumori; Universita degli Studi di Palermo ; Palermo, Italy
| | - Chiara Storti
- Molecular Targeting Unit; Fondazione IRCCS Istituto Nazionale dei Tumori ; Milan, Italy
| | - Francesca Bianchi
- Dipartimento di Scienze Biomediche per la Salute; Università degli Studi di Milano ; Milan, Italy
| | - Nadia Zaffaroni
- Molecular Pharmacology Unit; Fondazione IRCCS Istituto Nazionale dei Tumori ; Milan, Italy
| | - Claudio Tripodo
- Dipartimento PRO.SA.MI; Unità di Immunologia dei Tumori; Universita degli Studi di Palermo ; Palermo, Italy
| | - Elda Tagliabue
- Molecular Targeting Unit; Fondazione IRCCS Istituto Nazionale dei Tumori ; Milan, Italy
| | - Andrea Balsari
- Dipartimento di Scienze Biomediche per la Salute; Università degli Studi di Milano ; Milan, Italy ; Molecular Targeting Unit; Fondazione IRCCS Istituto Nazionale dei Tumori ; Milan, Italy
| | - Lucia Sfondrini
- Dipartimento di Scienze Biomediche per la Salute; Università degli Studi di Milano ; Milan, Italy
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Gore M, Bellmunt J, Eisen T, Escudier B, Mickisch G, Patard J, Porta C, Ravaud A, Schmidinger M, Schöffski P, Sternberg C, Szczylik C, De Nigris E, Wheeler C, Kirpekar S. Evaluation of treatment options for patients with advanced renal cell carcinoma: Assessment of appropriateness, using the validated semi-quantitative RAND corporation/University of California, Los Angeles methodology. Eur J Cancer 2012; 48:1038-47. [DOI: 10.1016/j.ejca.2012.02.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 12/18/2022]
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Gemcitabine-loaded chitosan microspheres. Characterization and biological in vitro evaluation. Biomed Microdevices 2011; 13:799-807. [DOI: 10.1007/s10544-011-9550-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muriel C, Esteban E, Corral N, Fonseca PJ, Luque M, Berros JP, Fernández Y, Blay P, Fra J, Villanueva N, Sanmamed M, Pardo P, Izquierdo M, Vieitez JM, Estrada E, Lacave ÁJ. Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias. Clin Transl Oncol 2010; 12:562-7. [DOI: 10.1007/s12094-010-0554-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Llarena Ibarguren R. [Treatment of metastatic renal cancer: current validity of immunotherapy]. Actas Urol Esp 2009; 33:584-92. [PMID: 19658313 DOI: 10.1016/s0210-4806(09)74193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the significance and effects of conventional immunotherapy for management of disseminated renal cancer. MATERIALS AND METHODS Historical data from studies conducted with cytokines, interferon, and interleukin are reviewed, their combinations are evaluated, and the different relevant studies available are compared. DISCUSSION While diverse, results are poor in terms of objective response and its duration. Historical series using interleukin-2 achieved, despite severe side effects, disease remissions, some of them complete. CONCLUSIONS Currently, after the advent of new drugs, use of conventional immunotherapy may be indicated for specific patients with a good general condition undergoing previous nephrectomy for a clear cell carcinoma at least 12 months before occurrence of metastasis in a single organ, preferably the lung, and with normal levels of hemoglobin, calcium, and lactate dehydrogenase, looking for that small percentage of stable and sustained responses.
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Shaker MA, Younes HM. Interleukin-2: Evaluation of Routes of Administration and Current Delivery Systems in Cancer Therapy. J Pharm Sci 2009; 98:2268-98. [DOI: 10.1002/jps.21596] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Diaz D, Chara L, Chevarria J, Carballido J, Esteban E, Navas V, Monserrat J, Prieto A, de la Hera A, Alvarez-Mon M. Inhaled IL-2 induces systemic immunomodulation in patients with renal cell carcinoma and lung metastasis. Cancer Immunol Immunother 2009; 58:235-45. [PMID: 18592236 PMCID: PMC11030678 DOI: 10.1007/s00262-008-0546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
The peripheral blood lymphocytes of eight patients with metastatic renal cell carcinoma, and of eight healthy volunteers were analyzed by four-color flow cytometry to characterize the immunophenotypic alterations manifested, determine the prevalence of lymphocyte apoptosis, and detect evidence of the systemic effect of inhaled IL-2. The T, B and NK lymphocytes of untreated patients were found to have undergone profound changes characterized by an increase in susceptibility to both spontaneous and mitogen-induced ex vivo apoptosis, a modified distribution of the main lymphocyte populations in the peripheral blood, and alterations in activation status. An increase in the proportion of regulatory T cells was also seen in these patients. Treatment with inhaled IL-2, however, normalized the rate of apoptosis in all the lymphocyte subpopulations studied, as well as their distribution and activation status. These findings demonstrate that inhaled IL-2 has systemic immunomodulatory effects.
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Affiliation(s)
- David Diaz
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Luis Chara
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Julio Chevarria
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Joaquin Carballido
- Urology Department, Clínica Universitaria Puerta de Hierro, Madrid, Spain
| | - Emilio Esteban
- Oncology Department, Hospital Central de Asturias, Oviedo, Spain
| | - Victor Navas
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Jorge Monserrat
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Alfredo Prieto
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Antonio de la Hera
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
| | - Melchor Alvarez-Mon
- CNB-CSIC R&D Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain
- Immune System Diseases and Oncology Service, University Hospital “Príncipe de Asturias”, Alcalá de Henares, Madrid, Spain
- Departamento de Medicina, Universidad de Alcalá, Carretera Madrid-Barcelona, Km 33.600, Alcalá de Henares, 28871 Madrid, Spain
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Den Otter W, Jacobs JJL, Battermann JJ, Hordijk GJ, Krastev Z, Moiseeva EV, Stewart RJE, Ziekman PGPM, Koten JW. Local therapy of cancer with free IL-2. Cancer Immunol Immunother 2008; 57:931-50. [PMID: 18256831 PMCID: PMC2335290 DOI: 10.1007/s00262-008-0455-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 01/14/2008] [Indexed: 12/30/2022]
Abstract
This is a position paper about the therapeutic effects of locally applied free IL-2 in the treatment of cancer. Local therapy: IL-2 therapy of cancer was originally introduced as a systemic therapy. This therapy led to about 20% objective responses. Systemic therapy however was very toxic due to the vascular leakage syndrome. Nevertheless, this treatment was a break-through in cancer immunotherapy and stimulated some interesting questions: Supposing that the mechanism of IL-2 treatment is both proliferation and tumoricidal activity of the tumor infiltrating cells, then locally applied IL-2 should result in a much higher local IL-2 concentration than systemic IL-2 application. Consequently a greater beneficial effect could be expected after local IL-2 application (peritumoral = juxtatumoral, intratumoral, intra-arterial, intracavitary, or intratracheal = inhalation). Free IL-2: Many groups have tried to prepare a more effective IL-2 formulation than free IL-2. Examples are slow release systems, insertion of the IL-2 gene into a tumor cell causing prolonged IL-2 release. However, logistically free IL-2 is much easier to apply; hence we concentrated in this review and in most of our experiments on the use of free IL-2. Local therapy with free IL-2 may be effective against transplanted tumors in experimental animals, and against various spontaneous carcinomas, sarcomas, and melanoma in veterinary and human cancer patients. It may induce rejection of very large, metastasized tumor loads, for instance advanced clinical tumors. The effects of even a single IL-2 application may be impressive. Not each tumor or tumor type is sensitive to local IL-2 application. For instance transplanted EL4 lymphoma or TLX9 lymphoma were not sensitive in our hands. Also the extent of sensitivity differs: In Bovine Ocular Squamous Cell Carcinoma (BOSCC) often a complete regression is obtained, whereas with the Bovine Vulval Papilloma and Carcinoma Complex (BVPCC) mainly stable disease is attained. Analysis of the results of local IL-2 therapy in 288 cases of cancer in human patients shows that there were 27% Complete Regressions (CR), 23% Partial Regressions (PR), 18% Stable Disease (SD), and 32% Progressive Disease (PD). In all tumors analyzed, local IL-2 therapy was more effective than systemic IL-2 treatment. Intratumoral IL-2 applications are more effective than peritumoral application or application at a distant site. Tumor regression induced by intratumoral IL-2 application may be a fast process (requiring about a week) in the case of a highly vascular tumor since IL-2 induces vascular leakage/edema and consequently massive tumor necrosis. The latter then stimulates an immune response. In less vascular tumors or less vascular tumor sites, regression may require 9-20 months; this regression is mainly caused by a cytotoxic leukocyte reaction. Hence the disadvantageous vascular leakage syndrome complicating systemic treatment is however advantageous in local treatment, since local edema may initiate tumor necrosis. Thus the therapeutic effect of local IL-2 treatment is not primarily based on tumor immunity, but tumor immunity seems to be useful as a secondary component of the IL-2 induced local processes. If local IL-2 is combined with surgery, radiotherapy or local chemotherapy the therapeutic effect is usually greater than with either therapy alone. Hence local free IL-2 application can be recommended as an addition to standard treatment protocols. Local treatment with free IL-2 is straightforward and can readily be applied even during surgical interventions. Local IL-2 treatment is usually without serious side effects and besides minor complaints it is generally well supported. Only small quantities of IL-2 are required. Hence the therapy is relatively cheap. A single IL-2 application of 4.5 million U IL-2 costs about 70 Euros. Thus combined local treatment may offer an alternative in those circumstances when more expensive forms of treatment are not available, for instance in resource poor countries.
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Affiliation(s)
- Willem Den Otter
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands.
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