Corticosteroid delivery using oral mucosa equivalents for the treatment of inflammatory mucosal diseases

Janus LAAM-loaded electrospun fibrous buccal films for treating opioid use disorder

The opioid crisis has claimed approximately one million lives in the United States since 1999, underscoring a significant public health concern. This surge in opioid use disorder (OUD) fatalities necessitates improved therapeutic options. Current OUD therapies often require daily clinical visits, leading to poor patient compliance and high costs to the health systems. Levo-alpha-acetylmethadol (LAAM) is a long-lasting OUD drug, and the thrice-weekly oral LAAM solution can offer better patient compliance compared to the traditional daily methadone therapies. However, LAAM is FDA-approved but withdrawn from the market. As part of the NIH HEAL Initiative, we aim to reintroduce LAAM back to the market to improve OUD therapeutic options by developing a novel Janus LAAM-loaded fibrous buccal film (LFBF) formulation made of a drug-containing electrospun fibrous layer and a backing layer. The buccal administration of LFBF exhibited superior transmucosal delivery of LAAM to systemic circulation with a nearly 4-fold higher drug bioavailability than the conventional oral LAAM solution in rabbits. Furthermore, upon buccal administration in an opioid-dependent rat model, the LFBF significantly decreased fentanyl choice in the fentanyl-dependent rats, while the conventional oral LAAM solution did not at the same dose. Both the buccal film and oral solution of LAAM reduced somatic withdrawal signs in the experimental animals. These findings highlight the buccal delivery of LAAM using electrospun fibers as a promising strategy with improved drug bioavailability. Furthermore, it sheds light on future clinical applications aiming for enhanced treatment outcomes in the battle against the current opioid crisis.

An advanced in silico model of the oral mucosa reveals the impact of extracellular spaces on chemical permeation

Accurately predicting the permeation of chemicals through human epithelial tissues is crucial for pharmaceutical therapeutic design and toxicology. Current mathematical models of multi-layered stratified squamous epithelium such as those in the oral cavity use simplistic 'bricks and mortar' geometries that do not fully account for the complex cellular architecture that may affect chemical permeation in these tissues. Here we aimed to develop a new, advanced mechanistic mathematical model of the human epithelium that more accurately represents chemical tissue permeation. Using measurements of cell size and tortuosity from micrograph images of both human oral (buccal) and tissue-engineered buccal mucosa along with mechanistic mathematical modelling, we show that the convoluted geometry of the extracellular spaces within the epithelium significantly impacts chemical permeation. We next developed an advanced histologically and physiologically-relevant in silico model of buccal mucosal chemical permeation using partial differential equations, fitted to chemical permeation from in vitro assay data derived from tissue-engineered buccal mucosal models and chemicals with known physiochemical properties. Our novel in silico model can predict epithelial permeation kinetics for chemicals with different physicochemical properties in the absence or presence of permeability enhancers. This in vitro - in silico approach constitutes a step-change in the modelling of chemical tissue permeation and has the potential to expedite pharmaceutical innovation by improved and more rapid screening of chemical entities whilst reducing the need for in vivo animal experiments.

Formulation and Evaluation of Triamcinolone Acetonide-Loaded Oral Disintegrated Film with Different Polymers via Solvent Casting Method

Objectives

The study aimed to investigate the effect of different polymers and plasticizers on oral disintegrating films (ODFs) containing triamcinolone acetonide (TA), a glucocorticosteroid indicated for the treatment of oral wounds.

Materials and Methods

Thirteen different formulations with the same amount of polymer and plasticizer were prepared by solvent casting. Briefly, the solutions containing polymer, plasticizer, and other ingredients were poured into Petri dishes and kept at room temperature for 20 hours to obtain ODFs. Physical properties of ODFs such as visual appearance, weight and thickness uniformity, pH, mechanical durability (tensile strength, elongation at break and folded insurance), and disintegration time were assessed and drug content analysis was performed on ODFs.

Results

Suitable ODFs were produced with hydroxypropyl methylcellulose (HPMC), polyvinyl alcohol, carboxymethylcellulose, gelatin, and pectin, while film integrity was not achieved with polyethyleneglycol 4000 (PEG 4000), chitosan and starch. Glycerin made ODFs more transparent, reduced their thickness, and improved their mechanical properties. On the other hand, PEG 400 reduced the weight variation. Regarding drug content, PEG-containing gelatin-based ODF (ODF10) and pectin-based ODF (ODF12) complied with pharmacopeial limits. In addition, all ODFs except HPMC-based ODFs had an appropriate pH range.

Conclusion

When all features were evaluated together in terms of the applicability of an ODF to the patient, the most convenient formulation was found to be gelatin-based with PEG 400 ODF (ODF10). In short, patients will benefit from ease of application and transportation and effective therapy with correct dosing with the development of ODF forms of TA for which there are no preparations except for cream, gel, and pomade forms for topical use in Türkiye.

Rationale for the Use of Topical Calcineurin Inhibitors in the Management of Oral Lichen Planus and Mucosal Inflammatory Diseases

Oral lichen planus (OLP) is a chronic inflammatory condition that affects the mucous membranes of the oral cavity and is characterized by a T-cell-mediated autoimmune response. It presents a therapeutic challenge due to its relapsing nature, causing significantly decreased quality of life and, in some cases, increasing the risk of malignant transformation. While topical corticosteroids have long been the first-line therapy for OLP, their long-term use is associated with adverse effects, such as mucosal atrophy and candidiasis. This has driven interest in alternative therapies, particularly topical calcineurin inhibitors (TCIs), such as tacrolimus, which offer a steroid-sparing approach. This review explores the pathophysiological basis of OLP, examines the role of TCIs in its treatment, and evaluates emerging therapies, with a specific focus on the use of a topical liposomal formulation of tacrolimus. These formulations aim to achieve high local drug concentrations while minimizing systemic absorption. OLP is a complex and multifactorial disease that requires a multifaceted approach to management. While current therapies provide symptomatic relief, there is a need for more effective and safer treatment options. Emerging therapies, including advanced drug delivery systems, biologics, and alternative therapies, hold promise for improving the management of OLP. Future research should focus on identifying novel therapeutic targets and developing strategies that can achieve sustained remission with minimal side effects.

A Tissue-Engineered Model of T-Cell-Mediated Oral Mucosal Inflammatory Disease

T-cell-mediated oral mucocutaneous inflammatory conditions, including oral lichen planus, are common, but development of new treatments aimed at relieving symptoms and controlling oral lichen planus progression is hampered by the lack of experimental models. In this study, we developed a tissue-engineered oral mucosal equivalent containing polarized T-cells to replicate oral lichen planus pathogenesis. Peripheral blood CD4+ and CD8+ T-cells were isolated, activated, and polarized into T helper 1 and cytotoxic T cells. Oral mucosal equivalents were constructed by culturing oral keratinocytes on an oral fibroblast-populated hydrogel to produce a stratified squamous epithelium. Oral mucosal equivalent stimulated with IFN-γ and TNF-α or medium from T helper 1 cells caused increased secretion of inflammatory cytokines and chemokines. A model of T-cell-mediated inflammatory disease was developed by combining oral mucosal equivalent on top of a T helper 1 and cytotoxic T-cell-containing hydrogel, followed by epithelial stimulation with IFN-γ and TNF-α. T-cell recruitment toward the epithelium was associated with increased secretion of T-cell chemoattractants CCL5, CXCL9, and CXCL10. Histological assessment showed tissue damage associated with cleaved caspase-3 and altered laminin-5 expression. Treatment with inhibitors directed against Jak, KCa3.1 channels, or clobetasol in solution and through a mucoadhesive patch prevented cytokine and chemokine release and tissue damage. This disease model has potential to probe for mechanisms of pathogenesis or as a test platform for novel therapeutics or treatment modalities.

What can we learn from treatments of oral lichen planus?

Oral lichen planus (OLP), a T-lymphocyte-mediated disease of the oral mucosa, has a complex pathogenesis that involves a number of factors. The disease is characterized by recurrent episodes and requires continuous follow up, and there is no curative treatment available. Erosive lichen planus, among others, has a risk of malignant transformation and requires standardized treatment to control its progression. Different clinical subtypes of oral lichen planus require appropriate treatment. Pharmacological treatments are the most widely available and have the greatest variety of options and a number of novel pharmacological treatments are presented as highlights, including JAK enzyme inhibitors. The second is photodynamic therapy, which is the leading physiological treatment. In addition, periodontal treatment and psychological treatment should not be neglected. In this review, we briefly discuss the most recent developments in therapies for oral lichen planus after summarizing the most widely used clinical treatments, aiming to provide different proposals for future clinical treatment.

Electrospun fiber-based immune engineering in regenerative medicine

Immune engineering, a burgeoning field within regenerative medicine, involves a spectrum of strategies to optimize the intricate interplay between tissue regenerative biomaterials and the host tissue. These strategies are applied across different types of biomaterials and various disease models, which encompasses finely modulating the immune response at the levels of immune cells and factors, aiming to mitigate adverse effects like fibrosis and persistent inflammation that may arise at the injury site and consequently promote tissue regeneration. With the continuous progress in electrospinning technology, the immunoregulatory capabilities of electrospun fibers have gained substantial attention over the years. Electrospun fibers, with their extracellular matrix-like characteristics, high surface-area-to-volume ratio, and reliable pharmaceutical compound capacity, have emerged as key players among tissue engineering materials. This review specifically focuses on the role of electrospun fiber-based immune engineering, emphasizing their unique design strategies. Notably, electrospinning actively engages in immune engineering by modulating immune responses through four essential strategies: (i) surface modification, (ii) drug loading, (iii) physicochemical parameters, and (iv) biological grafting. This review presents a comprehensive overview of the intricate mechanisms of the immune system in injured tissues while unveiling the key strategies adopted by electrospun fibers to orchestrate immune regulation. Furthermore, the review explores the current developmental trends and limitations concerning the immunoregulatory function of electrospun fibers, aiming to drive the advancements in electrospun fiber-based immune engineering to its full potential.

Evaluation of therapeutic effects of nanofibrous mat containing mycophenolate mofetil on oral lichen planus: In vitro and clinical trial study

Objectives

Recently, topical drug delivery system has gained increasing interest in the treatment of oral lesions. Lichen planus is a chronic inflammatory disease affecting mucous membranes and skin. The current study aimed to fabricate a drug delivery system containing mycophenolate mofetil for the treatment of oral lichen planus lesions.

Methods

Firstly, a nanofibrous mat containing mycophenolate mofetil, zinc oxide nanoparticles, and aloe vera was designed and fabricated. The antimicrobial, cytocompatibility, anti-inflammatory, and antioxidative characteristics of fabricated scaffolds were evaluated. Then, this nanofibrous mat was applied to 12 patients suffering from bilateral erythematous/erosive Oral Lichen planus (OLP) lesions for 2 weeks. The treatment outcomes, including oral symptoms and lesion size, were compared with the routine topical treatment of these lesions; Triamcinolone ointment.

Results

The characterization of nanofibrous mat approved the successful fabrication of scaffolds. The fabricated nanofibers showed notable antimicrobial activity. The amounts of TNF 𝛼, IL6, and reactive oxygen species (ROS) of stimulated human gingival fibroblasts were decreased after exposure to NFs/Myco/Alv/ZnO scaffolds. The clinical trial results demonstrated the same therapeutic effects compared to the commercial ointment, while the symptoms of patients were significantly improved in the mats group.Significance. Considering the successful results of this study, the application of nanofibrous mat can be a promising product for improving treatment outcomes of OLP.

3D printed mucoadhesive orodispersible films manufactured by direct powder extrusion for personalized clobetasol propionate based paediatric therapies

The aim of this work is the development and production by Direct Powder Extrusion (DPE) 3D printing technique of novel oral mucoadhesive films delivering Clobetasol propionate (CBS), useful in paediatric treatment of Oral Lichen Planus (OLP), a rare chronic disease. The DPE 3D printing of these dosage forms can allow the reduction of frequency regimen, the therapy personalization, and reduction of oral cavity administration discomfort. To obtain suitable mucoadhesive films, different polymeric materials, namely hydroxypropylmethylcellulose or polyethylene oxide blended with chitosan (CS), were tested and hydroxypropyl-β-cyclodextrin was added to increase the CBS solubility. The formulations were tested in terms of mechanical, physico-chemical, and in vitro biopharmaceutical properties. The film showed a tenacious structure, with drug chemical-physical characteristics enhancement due to its partial amorphization during the printing stage and owing to cyclodextrins multicomponent complex formation. The presence of CS enhanced the mucoadhesive properties leading to a significant increase of drug exposure time on the mucosa. Finally, the printed films permeation and retention studies through porcine mucosae showed a marked retention of the drug inside the epithelium, avoiding drug systemic absorption. Therefore, DPE-printed films could represent a suitable technique for the preparation of mucoadhesive film potentially usable for paediatric therapy including OLP.

Oral Mucosa Models to Evaluate Drug Permeability

Due to its numerous advantages, such as excellent drug accessibility, rapid absorption, and bypass of first-pass metabolism, the route of drug administration that involves crossing the oral mucosa is highly favored. As a result, there is significant interest in investigating the permeability of drugs through this region. The purpose of this review is to describe the various ex vivo and in vitro models used to study the permeability of conveyed and non-conveyed drugs through the oral mucosa, with a focus on the most effective models. Currently, there is a growing need for standardized models of this mucosa that can be used for developing new drug delivery systems. Oral Mucosa Equivalents (OMEs) may provide a promising future perspective as they are capable of overcoming limitations present in many existing models.

Polymeric Micelles Enhance Mucosal Contact Time and Deposition of Fluocinolone Acetonide

This study used polymeric micelles to improve quality by increasing drug solubility, extending mucosal drug retention time, enhancing mucoadhesiveness, and promoting drug permeation and deposition. Fluocinolone acetonide (FA) was loaded into polymeric micelles (FPM), which were composed of poloxamer 407 (P407), sodium polyacrylate (SPA), and polyethylene glycol 400, and their physicochemical properties were examined. Small-angle X-ray scattering (SAXS) revealed a hexagonal micellar structure at all temperatures, and the concentrations of P407 and SPA were shown to significantly affect the solubility, mucoadhesion, release, and permeation of FPMs. The proportion of P407 to PEG at a ratio of 7.5:15 with or without 0.1% w/v of SPA provided suitable FPM formulations. Moreover, the characteristics of FPMs revealed crystalline states inside the micelles, which was consistent with the morphology and nano-hexagonal structure. The results of ex vivo experiments using focal plane array (FPA)-based Fourier transform infrared (FTIR) imaging showed that the FPM with SPA penetrated quickly through the epithelium, lamina propria, and submucosa, and remained in all layers from 5-30 min following administration. In contrast, the FPM without SPA penetrated and passed through all layers. The FPM with extended mucoadhesion, improved drug-mucosal retention time, and increased FA permeation and deposition were successfully developed, and could be a promising innovation for increasing the efficiency of mouth rinses, as well as other topical pharmaceutical and dental applications.

Immune mechanisms in oral lichen planus

Oral lichen planus (OLP) is a T-cell-mediated inflammatory disease of the oral mucosa that has been extensively researched over many years but as yet the mechanisms of pathogenesis are still not fully understood. Whilst the specific etiologic factors driving OLP remain ambiguous, evidence points to the development of a chronic, dysregulated immune response to OLP-mediating antigens presented by innate immune cells and oral keratinocytes leading to increased cytokine, chemokine and adhesion molecule expression. These molecules recruit T-cells and mast cells to the diseased site and orchestrate a complex interplay between cells that culminates in keratinocyte cell death, mucosal basement membrane destruction and long-term chronicity of the disease. The main lymphocytes involved are thought to be CD8+ cytotoxic and CD4+ Th1 polarised T-cells although recent evidence indicates the involvement of other Th subsets such as Th9, Th17 and Tregs, suggesting that a more complex immune cell relationship exists during the disease process. This review provides an overview of the immune mechanisms at play in OLP pathogenesis with particular emphasis on the role of the different Th subsets and how these recent discoveries may guide research toward identifying potential therapeutic targets.

Immunoresponsive Tissue-Engineered Oral Mucosal Equivalents Containing Macrophages

Macrophages play a key role in orchestrating the host immune response toward invading organisms or non-self molecules in the oral mucosa. Three-dimensional (3D) oral mucosal equivalents (OME) containing oral fibroblasts and keratinocytes are used extensively to mimic the human oral mucosa where they have been employed to examine innate immune responses to both bacterial and fungal pathogens as well as to biomaterials. Although the presence of immune cells is critical in generating an immune response, very few studies have incorporated leukocytes into OME, and to date, none have contained primary human macrophages. In this study, we report the generation of an immunocompetent OME to investigate immune responses toward bacterial challenge. Primary human monocyte-derived macrophages (MDM) were as responsive to bacterial lipopolysaccharide (LPS) challenge when cultured within a 3D hydrogel in terms of proinflammatory cytokine (IL-6, CXCL8, and TNF-α) gene expression and protein secretion compared with culture as two-dimensional monolayers. MDM were incorporated into a type 1 collagen hydrogel along with oral fibroblasts and the apical surface seeded with oral keratinocytes to generate an MDM-containing OME. Full-thickness MDM-OME displayed a stratified squamous epithelium and a fibroblast-populated connective tissue containing CD68-positive MDM that could be readily isolated to a single-cell population for further analysis by collagenase treatment followed by flow cytometry. When stimulated with LPS, MDM-OME responded with increased proinflammatory cytokine secretion, most notably for TNF-α that increased 12-fold when compared with OME alone. Moreover, this proinflammatory response was inhibited by pretreatment with dexamethasone, showing that MDM-OME are also amenable to drug treatment. Dual-labeled immunofluorescence confocal microscopy revealed that MDM were the sole source of TNF-α production within MDM-OME. These data show functional activity of MDM-OME and illustrate their usefulness for investigations aimed at monitoring the immune response of the oral mucosa to pathogens, biomaterials, and for tissue toxicity and anti-inflammatory drug delivery studies.