Lack of nephrotoxicity with the administration of amphotericin B in a lipid emulsion

Onconephrology: The intersections between the kidney and cancer

Onconephrology is a new subspecialty of nephrology that recognizes the important intersections of kidney disease with cancer. This intersection takes many forms and includes drug-induced nephrotoxicity, electrolyte disorders, paraneoplastic glomerulonephritis, and the interactions of chronic kidney disease with cancer. Data clearly demonstrate that, when patients with cancer develop acute or chronic kidney disease, outcomes are inferior, and the promise of curative therapeutic regimens is lessened. This highlights the imperative for collaborative care between oncologists and nephrologists in recognizing and treating kidney disease in patients with cancer. In response to this need, specific training programs in onconephrology as well as dedicated onconephrology clinics have appeared. This comprehensive review covers many of the critical topics in onconephrology, with a focus on acute kidney injury, chronic kidney disease, drug-induced nephrotoxicity, kidney disease in stem cell transplantation, and electrolyte disorders in patients with cancer.

Acute kidney injury in hematopoietic stem cell transplantation

PURPOSE OF REVIEW

Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality.

RECENT FINDINGS

Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD). In addition, engraftment syndrome/cytokine storm, transplant-associated thrombotic microangiopathy (TA-TMA), and less common infections with specific renal manifestations, such as BK and adenovirus nephritis, may lead to kidney injury. There has been significant advancement in the understanding of TA-TMA in particular, especially the role of the complement system in its pathophysiology. The role of early dialysis has been explored in the pediatric population, but not well studied in adult HSCT recipients SUMMARY: This review provides an update on the risk factors, causes, and treatment approaches to HSCT-associated AKI.

Parenteral formulation of larotaxel lipid microsphere tackling poor solubility and chemical instability

The purpose of this study was to develop a parenteral larotaxel lipid microsphere (LTX-LM) and evaluate its stability. The preformulation study showed that LTX possessed poor solubility (0.057 μg/mL in aqueous phase) and chemical instability. LM was selected as the drug carrier due to its higher drug-loading capacities, higher physicochemical stability and reduced irritation and toxicity. High speed shear mixing and high-pressure homogenization were employed to prepare the LTX-LM. Particle size distribution (PSD), zeta-potential, drug content and entrapment efficiency (EE) were taken as indexes to optimize formulations. The dissolution studies were performed using a ZRS-8G dissolution apparatus according to the paddle method. Degradation kinetics test, freezing and thawing test and long term stability test were combined to evaluate the physicochemical stability of LTX-LM. From the degradation kinetics results, the shelf lives (T90%) of LTX in LM at 25 and 4°C (165, 555 days) were about 20 times as long as those in aqueous phase (200, 676 h), which were dramatically prolonged. The activation energies in aqueous solution and in LM calculated from the slopes were 41.93 and 42.25 kJ/mol. And its frequency factors (A) were 4.9 × 10(3)/s and 2.3 × 10(2)/s, respectively. Freezing and thawing test showed the PSD of LTX-LM became larger and wider increasing from 166.9 ± 53.2 nm to 257.4 ± 85.5 nm with more freeze-thaw cycles. From the long term stability test results, all the parameters changes were in qualified range.

Parenteral emulsions stabilized with a mixture of phospholipids and PEG-660-12-hydroxy-stearate: evaluation of accelerated and long-term stability

Different emulsion formulations were prepared using phospholipids (Lipoid S57) and PEG-660-12-hydroxy-stearate (Solutol HS15) as single emulsifiers or in mixtures. The accelerated stability after autoclaving, freezing and centrifugation was investigated. The long-term stability was also studied at different temperatures (4, 20, and 37 degrees C) for 8 months. Emulsion stabilized with phospholipids displayed a stable behavior after the autoclaving and centrifugation, but it broke down after the freezing process. In mixture with Solutol HS15, however, the emulsion showed appropriate shelf stability at different temperatures for 8 months. A change in the particle size of the emulsion prepared only with Solutol HS15 was observed after centrifugation (slight) and after autoclaving (marked). In contrast to phospholipid emulsion, this emulsion (with only Solutol HS15) was less prone to breaking down after the freezing, as no complete phase separation was observed. The results obtained using an emulsifier mixture revealed that a combination of an anionic surfactant (phospholipids) and non-ionic surfactant (PEG-660-12-hydroxy-stearate) improves the emulsion's stability, compared to the emulsion's stability prepared using only a single emulsifier. However, no direct correlation could be found between the accelerated and the long-term stability data.

A new lipid emulsion formulation with high antimicrobial efficacy using chitosan

The antimicrobial activity of chitosan in lipid emulsions as well as in aqueous solutions was investigated. Two types of long-chained chitosan were used differing in the molecular weights, degree of the deacetylation and their viscosity: type I, mol. weight 8.7 x 10(4) g/mol, 92% degree of deacetylation and a viscosity of 14 mPa s, type II, mol. weight of 5.32 x 10(5) g/mol, 73% degree of deacetylation and a viscosity of 461 mPa s. In order to assess the pH optimum of the antimicrobial activity of the biopolymer, suspensions of the microorganisms Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans and Aspergillus niger were incubated at different pH-values in lactic acid solution (1% w/v) containing different concentrations of chitosan up to 1.5% (w/v). Emulsion formulations containing either 0.25%, 0.5% or no chitosan, respectively, were inoculated with the same microorganisms and were incubated at 25 degrees C. The aqueous solutions as well as the emulsions were examined for microbial counts on agar plates after different periods of incubation. After 24 h of incubation in aqueous solutions only the cfu numbers of the bacteria were reduced. Both types of chitosan revealed a pH optimum of their antibacterial activity at pH 5.0-5.1 for P. aeruginosa, and at pH 5.3 for S. aureus. In addition, chitosan with a mol. weight of 8.7 x 10(4) g/mol, high degree of deacetylation and low viscosity showed a higher antimicrobial activity than the other chitosan type of this study. It was found that lipid emulsions containing 0.5% chitosan (type I) conformed to the requirements of the preservation efficacy test for topical formulations according to the European Pharmacopoeia while the emulsion without chitosan and a lactic acid solution with and without the biopolymer did not conform. In hemolysis studies on human erythrocytes, the hemolytic activity of the lipid emulsions with chitosan was assessed. These emulsions showed a negligible hemolytic behavior. The results indicate a use of chitosan as antimicrobial preservative in emulsion formulations for mucosal as well for parenteral applications.

Trends in antifungal research

With the increasing use of aggressive immunosuppressive therapies in the management of a variety of patient populations, the continuing presence of the AIDS pandemic and the therapeutic advances employed in critical care settings, an increasing number of serious fungal infections are being encountered by today's practicing clinicians. Traditionally, antifungal drug therapy has been delivered by means of intravenous infusion, oral administration, or topical application. Recently, a number of alternative routes of antifungal drug delivery have been developed and investigated, and the traditional means of antifungal administration have been improved to facilitate the therapeutic use of new and reformulated antifungal agents. Organized based on the route of administration, this chapter reviews these advances in antifungal drug delivery.