Ultrasound-guided intratumoral delivery of doxorubicin from in situ forming implants in a hepatocellular carcinoma model

Synthesis and in vitro evaluation of cross-linked tragacanthin nanofibers as implants for delivery of cisplatin to hepatocellular carcinoma

There is growing interest in the use of electrospun polymeric nanofibers in drug delivery systems due to their remarkable surface-to-volume ratio, which enhances the processes of drug loading, specific cell binding and proliferation. The preferred polymers for drug delivery must be biocompatible and biodegradable. Gum tragacanth is one of the materials of choice for drug delivery. This work aimed at cross-linking the tragacanthin, the water-soluble fraction of gum tragacanth, with glutaraldehyde, synthesis of the cross-linked nanofibers and evaluating their properties to encapsulate and deliver a drug using caffeine as a model drug in the first place. The nanofibers were then loaded with cisplatin and evaluated against HepG2 cell line. The drug-loaded nanofibers (dia. 0.841 μm) were prepared by electrospinning using glutaraldehyde as the cross-linker and glycerol as a plasticizer and characterized by scanning electron microscopy, Fourier transform-infrared spectroscopy, electronic spectroscopy, 1HNMR, powder X-ray diffraction analysis, and thermogravimetric analysis. They released the encapsulated drugs in a sustained manner at pH 7.4 over 4.5 days (∼275 h with ∼80 % release) following Higuchi (cisplatin) and Hixon-Crowell (caffeine) kinetics. In a cytotoxicity assay against HepG2 cell line the cisplatin-loaded nanofibers exhibited enhanced activity compared to that with the standard cisplatin and in the caspase activity assay it activated caspase 3 to a higher extent and 8 and 9 to double the extent (4-fold) of cisplatin, suggesting a higher apoptotic activity by the nanoformulation than the standard cisplatin. Thus, nanoformulation appeared to be a potential candidate for treating hepatocellular carcinoma as an implant.

Drug-Eluting Porous Embolic Microspheres for Trans-Arterial Delivery of Dual Synergistic Anticancer Therapy for the Treatment of Liver Cancer

Blockage of blood supply while administering chemotherapy to tumors, using trans-arterial chemoembolization (TACE), is the most common treatment for intermediate and advanced-stage unresectable Hepatocellular carcinoma (HCC). However, HCC is characterized by a poor prognosis and high recurrence rates (≈30%), partly due to a hypoxic pro-angiogenic and pro-cancerous microenvironment. This study investigates how modifying tissue stress while improving drug exposure in target organs may maximize the therapeutic outcomes. Porous degradable polymeric microspheres (MS) are designed to obtain a gradual occlusion of the hepatic artery that nourishes the liver, while enabling efficient drug perfusion to the tumor site. The fabricated porous MS are introduced intrahepatically and designed to release a combination therapy of Doxorubicin (DOX) and Tirapazamine (TPZ), which is a hypoxia-activated prodrug. Liver cancer cell lines that are treated with the combination therapy under hypoxia reveal a synergic anti-proliferation effect. An orthotopic liver cancer model, based on N1-S1 hepatoma in rats, is used for the efficacy, biodistribution, and safety studies. Porous DOX-TPZ MS are very effective in suppressing tumor growth in rats, and induction tissue necrosis is associated with high intratumor drug concentrations. Porous particles without drugs show some advantages over nonporous particles, suggesting that morphology may affect the treatment outcomes.

Integration of Real-Time Image Fusion in the Robotic-Assisted Treatment of Hepatocellular Carcinoma

Simple Summary

Hepatocellular carcinoma is one of the leading causes of cancer-related deaths worldwide. An image fusion system is developed for the robotic-assisted treatment of hepatocellular carcinoma, which is not only capable of imaging data interpretation and reconstruction, but also automatic tumor detection. The optimization and integration of the image fusion system within a novel robotic system has the potential to demonstrate the feasibility of the robotic-assisted targeted treatment of hepatocellular carcinoma by showing benefits such as precision, patients safety and procedure ergonomics.

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide, with its mortality rate correlated with the tumor staging; i.e., early detection and treatment are important factors for the survival rate of patients. This paper presents the development of a novel visualization and detection system for HCC, which is a composing module of a robotic system for the targeted treatment of HCC. The system has two modules, one for the tumor visualization that uses image fusion (IF) between computerized tomography (CT) obtained preoperatively and real-time ultrasound (US), and the second module for HCC automatic detection from CT images. Convolutional neural networks (CNN) are used for the tumor segmentation which were trained using 152 contrast-enhanced CT images. Probabilistic maps are shown as well as 3D representation of HCC within the liver tissue. The development of the visualization and detection system represents a milestone in testing the feasibility of a novel robotic system in the targeted treatment of HCC. Further optimizations are planned for the tumor visualization and detection system with the aim of introducing more relevant functions and increase its accuracy.

In situ forming implants exposed to ultrasound enhance therapeutic efficacy in subcutaneous murine tumors

In situ forming implants (ISFIs) allow for a high initial intratumoral concentration and sustained release of the chemotherapeutic. However, clinical translation is impeded primarily due to limited drug penetration from the tumor/boundary interface and poor intratumoral drug retention. Therapeutic ultrasound (TUS) has become a popular approach for improving drug penetration of transdermal devices and increasing cellular uptake of nanoparticles. These effects are driven by the mechanical and thermal bioeffects associated with TUS. In this study, we characterize the released drug penetration, retention, and overall therapeutic response when exposing ISFI to the combination of the mechanical and thermal effects of TUS (C-TUS). ISFIs were intratumorally injected into subcutaneous murine tumors then exposed to C-TUS (exposure: 5 min, duty factor: 0.33, frequency: 3 MHz, intensity: 2.2 W/cm2, pulse duration: 2 ms, pulse repetition frequency: 165 Hz, effective radiating area: 5 cm2, energy delivered: 896 J, time average intensity: 0.88 W/cm2). Tumors treated with the combination of ISFI + C-TUS demonstrated a 2.5-fold increase in maximum drug penetration and a 3-fold increase in drug retention at 5- and 8-days post-injection, respectively, compared to ISFIs without TUS exposure. These improvements in drug penetration and retention translated into an enhanced therapeutic response. Mice treated with ISFI + C-TUS showed a 62.6% reduction in tumor progression, a 50.0% increase in median survival time, and a 26.6% increase in necrotic percentage compared to ISFIs without TUS exposure. Combining intratumoral ISFIs with TUS may be beneficial for addressing some long-standing challenges with local drug delivery in cancer treatment and may serve as a viable noninvasive method to improve the poor clinical success of local drug delivery systems.

Improving Treatment Efficacy of In Situ Forming Implants via Concurrent Delivery of Chemotherapeutic and Chemosensitizer

P-glycoprotein (Pgp), a member of the ATP-binding cassette family, is one of the major causes of multidrug resistance in tumors. Current clinical treatments to overcome MDR involve the co-delivery of a Pgp inhibitor and a chemotherapeutic. A concern for this treatment that has led to varied clinical trial success is the associated systemic toxicities involving endogenous Pgp. Local drug delivery systems, such as in situ forming implants (ISFIs), alleviate this problem by delivering a high concentration of the drug directly to the target site without the associated systemic toxicities. ISFIs are polymeric drug solutions that undergo a phase transition upon injection into an aqueous environment to form a solid drug eluting depot allowing for a high initial intratumoral drug concentration. In this study, we have developed an ISFI capable of overcoming the Pgp resistance by co-delivering a chemotherapeutic, Doxorubicin (Dox), with a Pgp inhibitor, either Pluronic P85 or Valspodar (Val). Studies investigated in vitro cytotoxicity of Dox when combined with either Pgp inhibitor, effect of the inhibitors on release of Dox from implants in PBS, in vivo Dox distribution and retention in a subcutaneous flank colorectal murine tumor, and therapeutic response characterized by tumor growth curves and histopathology. Dox + Val showed a 4-fold reduction in the 50% lethal dose (LD₅₀) after 48 hours. Concurrent delivery of Dox and Val showed the greatest difference at 16 days post injection for both Dox penetration and retention. This treatment group had a 5-fold maximum Dox penetration compared to Dox alone ISFIs (0.53 ± 0.22 cm vs 0.11 ± 0.11 cm, respectively, from the center of the ISFI). Additionally, there was a 3-fold increase in normalized total intratumoral Dox intensity with the Dox + Val ISFIs compared to Dox alone ISFIs (0.54 ± 0.11 vs 0.18 ± 0.09, respectively). Dox + Val ISFIs showed a 2-fold reduction in tumor growth and a 27.69% increase in necrosis 20 days post-injection compared to Dox alone ISFIs. These findings demonstrate that co-delivery of Dox and Val via ISFI can avoid systemic toxicity issues seen with clinical Pgp inhibitors.

Local penetration of doxorubicin via intrahepatic implantation of PLGA based doxorubicin-loaded implants

Doxorubicin (DOX) is widely used in the chemotherapy of a wide range of cancers. However, intravenous administration of DOX causes toxicity to most major organs which limits its clinical application. DOX-loaded drug delivery system could provide a continuous sustained-release of drugs and enables high drug concentrations at the target site, while reducing systemic toxicity. Additionally, local chemotherapy with DOX may be a promising approach for lowering post-surgical recurrence of cancer. In this study, the sustained-release DOX-loaded implants were prepared by melt-molding method. The implants were characterized with regards to drug content uniformity, micromorphology and drug release profiles. Furthermore, differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) analyses were carried out to investigate the drug-excipient compatibility. To determine the local penetration of DOX in liver, the minipigs received intrahepatic implantation of DOX-loaded implants by abdominal surgery. UPLC-MS/MS method was used to detect the concentration of DOX in liver tissues. Our results suggested that DOX-loaded implants delivered high doses of drug at the implantation site for a prolonged period and provided valuable information for the future clinical applications of the DOX-loaded implants.

Serum biomolecules unable to compete with drug refilling into cyclodextrin polymers regardless of the form

Polymers that are refillable and sustain local release will have a great impact in both preventing and treating local cancer recurrence as well as addressing non-resectable diseases. Polymerized cyclodextrin (pCD) disks, which reload drugs into molecular "pockets" in vivo through affinity interactions, have been previously shown to localize doxorubicin (Dox) to treat glioblastoma multiforme. However, one concern is whether drug refilling is influenced by competition from local biomolecules. In addition the impact of the polymer form on drug refilling is unknown. Herein, different pCD formulations were synthesized from γ-cyclodextrin (γ-CD) and were compared in vitro using competitive drug filling/refilling assays. Data reveal that affinity-based drug refilling occurs as a function of both the polymer form and the sustained release polymeric liquid (SRPL) dilution factor, pointing to the surface/volume ratio, as well as the CD pocket density, and the effects of the distance between pocket. In vitro refilling experiments with cholesterol demonstrated no interference with Dox filling of the CD polymer, while the presence of albumin only slightly reduced Dox filling of pCD-γ-MP (microparticle) and pCD-γ-SRPL forms, but not pCD-γ-disks. Moreover, whole serum competition did not inhibit filling or refilling of pCD-γ-MP with Dox at multiple concentrations and filling times, which indicates that this polymer (re)filling is primarily driven by affinity-based interactions that can overcome the physiological conditions which may limit other drug delivery approaches. This was supplemented by isolating variables through docking simulations and affinity measurements. These results attest to the efficiency of in vivo or in situ polymer filling/refilling in the presence of competitive biological molecules achieved partially through high affinity drug to polymer interactions.

Multimodality imaging-guided local injection of eccentric magnetic microcapsules with electromagnetically controlled drug release

BACKGROUND

In the past decade, trackable smart drug delivery systems have played important roles in the treatment of many diseases such as cancer because the drug carriers can be visualized through their distinct physical properties. However, it is still difficult to achieve precise drug delivery because such systems usually rely on a single imaging system.

AIM

This study aimed to present a novel type of multimodality imaging-guided strategy to visualize the drug carriers of eccentric magnetic microcapsule (EMM) designed for potential treatment of hepatocellular carcinoma (HCC).

METHOD AND RESULTS

The EMMs were prepared by using a three-phase microfluidic device. The as-prepared EMMs embedded with Fe₃O₄ nanoparticles are magnetic, with high density and acoustic impedance, allowing for visualization by magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US) imaging during local injection. The release of drug from these EMMs can be further controlled by an external electromagnetic field (EMF). As a proof of concept, we demonstrated the process of multimodality imaging to guide local injection and the controlled release of doxorubicin (DOX) from the EMMs in a phantom. We showed that the release rate of DOX was directly correlated to the strength of the EMF. In addition, we cocultured green fluorescent protein (GFP)-transfected HeLa cancer cells with the DOX-loaded EMMs and documented their apoptosis by DOX following the release triggered by EMF.

CONCLUSION

The results suggest that these EMMs serve both as contrast agents that can be visualized by multimodality imaging techniques and as smart drug delivery systems, with great potential for precision medicine.

Increasing Distribution of Drugs Released from In Situ Forming PLGA Implants Using Therapeutic Ultrasound

One of the challenges in developing sustained-release local drug delivery systems is the limited treatment volume that can be achieved. In this work, we examine the effectiveness of using low frequency, high intensity ultrasound to promote the spatial penetration of drug molecules away from the implant/injection site boundary upon release from injectable, phase inverting poly(lactic acid-co-glycolic acid) (PLGA) implants. Fluorescein-loaded PLGA solutions were injected into poly(acrylamide) phantoms, and the constructs were treated daily for 14 days with ultrasound at 2.2 W/cm2 for 10 min. The 2D distribution of fluorescein within the phantoms was quantified using fluorescence imaging. Implants receiving ultrasound irradiation showed a 1.7-5.6 fold increase (p < 0.05) in fluorescence intensity and penetration distance, with the maximum increase observed 5 days post-implantation. However, this evidence was not seen when the same experiment was also carried out in phosphate buffer saline (pH 7.4). Results suggest an active role of ultrasound in local molecular transport in the phantom. An increase of fluorescein release and penetration depth in phantoms can be accomplished through brief application of ultrasound. This simple technique offers an opportunity to eventually enhance the therapeutic efficacy and broaden the application of local drug delivery systems.