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Gerde P, Sjöberg CO, Bäckroos H, Englund J, Wangheim M, Litorp H. Regional lung targeting with a fluticasone/salmeterol aerosol using a bolus breath hold method of the PreciseInhale® system: A first evaluation in humans. Eur J Pharm Sci 2024; 196:106742. [PMID: 38460609 DOI: 10.1016/j.ejps.2024.106742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND In development of inhaled drugs- and formulations the measured concentration in the systemic circulation is often used as a surrogate for local dosimetry in the lungs. To further elucidate regional differences in the fate of drugs in the lungs, different aerodynamic sizes of aerosols have been used to target major airway regions. An alternative approach to achieve regional targeting of aerosols, is to use a defined aerosol bolus together with a bolus breath hold strategy. A small volume of test aerosol is intercalated and stopped at different penetration depths, to achieve increased drug deposition at chosen lung locations. Drug permeation from the lung regions is then investigated by repeatedly sampling venous blood from the systemic circulation. The PreciseInhale® (PI) exposure platform was developed to allow generation of aerosols from different sources, including clinical inhalers, into a holding chamber, for subsequent use with alternative exposure modules in vitro and in vivo. In the current first-in-human study was investigated the feasibility of a new clinical exposure module added to the PI system. By extracting aerosol puffs from a medical inhaler for subsequent delivery to volunteers, it was possible to administer whole lung exposures, as well as regional targeting exposures. METHODS Aerosols containing 250 µg/25 µg fluticasone propionate (FP)/salmeterol xinafoate (SMX) were automatically actuated and extracted from the pressurized Metered Dose Inhaler (pMDI) Evohaler Seretide forte into the PI system's holding chamber, then administered to the healthy volunteers using controlled flowrate and volume exposure cycles. Two main comparisons were made by measuring the systemic PK response: I. One label dose directly from the inhaler to the subject was compared to the same dose extracted from the pMDI into the PI system and then administered to the subject. II A small aerosol bolus at a penetration level in the central airways was compared to a small aerosol bolus at a penetration level in the peripheral lung. RESULTS AND CONCLUSIONS When one inhaler dose was administered via the PI system, the absorbed dose, expressed as AUC24, was approximately twice as high and the CV was less than half, compared to direct inhalation from the same pMDI. Bolus breath hold targeting of drugs from the same aerosol mixture to the peripheral lung and the central airways showed a difference in their appearance in the systemic circulation. Normalized to the same deposited dose, SMX had a 57 % higher Cmax in the peripheral lung compared to the central airways. However, from 6 to 24 h after dosing the systemic concentrations of SMX from both regions were quite similar. FP had parallel concentrations curves with a 23 % higher AUC24 in the peripheral lung with no noticeable elevation around Cmax. The permeability of these two substances from similar sized aerosols was indeed higher in the thinner air/blood barriers of the peripheral lung compared to the central airways, but differences as measured on the venous side of the circulation were not dramatic. In conclusion, the PI system provided better control of actuation, aspiration, and dispensation of aerosols from the clinical inhaler and thereby delivered higher quality read outs of pharmacokinetic parameters such as tmax, Cmax, and AUC. Improved performance, using PI system, can likely also be employed for studying regional selectivity of other responses in the lungs, for use in drug development.
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Affiliation(s)
- Per Gerde
- Inhalation Sciences AB, Novum, Hälsovägen 7, Huddinge SE-141 57, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden.
| | - Carl-Olof Sjöberg
- Inhalation Sciences AB, Novum, Hälsovägen 7, Huddinge SE-141 57, Sweden; Flexura AB, Vitmåravägen 50, Upplands Väsby SE-194 60, Sweden
| | - Helen Bäckroos
- Inhalation Sciences AB, Novum, Hälsovägen 7, Huddinge SE-141 57, Sweden
| | - Joakim Englund
- Clinical Trial Consultants AB, Dag Hammarskjölds väg 10B, Uppsala SE-752 37, Sweden
| | - Marit Wangheim
- Clinical Trial Consultants AB, Dag Hammarskjölds väg 10B, Uppsala SE-752 37, Sweden
| | - Helena Litorp
- Clinical Trial Consultants AB, Dag Hammarskjölds väg 10B, Uppsala SE-752 37, Sweden; Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Stockholm, Sweden
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Ranjbar H, Farajollahi A, Rostami M. Targeted drug delivery in pulmonary therapy based on adhesion and transmission of nanocarriers designed with a metal-organic framework. Biomech Model Mechanobiol 2023; 22:2153-2170. [PMID: 37624467 DOI: 10.1007/s10237-023-01756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023]
Abstract
With the recent increase in lung diseases, especially with the onset of the coronavirus pandemic, the design of a highly efficient and optimal targeted drug delivery system for the lungs is crucial in inhaler-based delivery systems. This study aimed to design a magnetic field-assisted targeted drug delivery system to the lungs using three types of metal-organic frameworks (MOFs) and nanoliposomes. The optimization of the system was based on three main parameters: the surface density of the nanocarriers' (NCs) adherence to each of the lung branches, the amount of drug transferred to each branch, and the toxicity based on the rate of nanocarrier delivery to the branches. The study investigated the effect of increasing the diameter of the drug carriers and the amount of drug loaded onto the NCs in improving drug delivery to targeted areas of the lung. Results showed that the presence of a magnetic field significantly increased the adhesion of NCs to the targeted branches. The application of a magnetic field and the type of drug carrier had a significant effect on drug delivery downstream of the lung and reduced drug toxicity. The study found that Fe3O4@UiO-66 (iron-oxide nanoparticle attached to the surface of UiO-66, a type of MOF) and Fe3O4@PAA/AuNCs/ZIF-8 carriers, (iron-oxide nanoparticle attached to a hybrid structure composed of three different materials: poly (acrylic acid) (PAA), gold nanoclusters (AuNCs), and zeolitic imidazolate framework-8 (ZIF-8)), had the greatest drug delivery rate in diameters above 200 nm and less than 200 nm, respectively.
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Affiliation(s)
- Hamed Ranjbar
- School of Mechanical Engineering, University of Tabriz, Tabriz, Iran
| | | | - Mohsen Rostami
- Department of Engineering, University of Imam Ali, Tehran, Iran
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Liu H, Ma S, Hu T, Ma D. Computational investigation of flow characteristics and particle deposition patterns in a realistic human airway model under different breathing conditions. Respir Physiol Neurobiol 2023:104085. [PMID: 37276915 DOI: 10.1016/j.resp.2023.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
Airborne particle pollution causes a range of respiratory and cardiovascular disorders by entering the human respiratory system through the breathing process. The administration of pharmaceutical particles by inhalation is another effective way to treat pulmonary illnesses. Studying particle deposition in the respiratory system during human breathing is crucial to maintaining human health. This necessity served as the impetus for this work, which aims to investigate how the airflow and particles' deposition are influenced by constant inhalation and circulatory breathing, particle diameter, and changes in airflow rate. The focus of this paper is to compare the particle deposition results of circulatory respiration with constant respiration. Based on computed tomography (CT) scan pictures, a precise human airway model from the mouth cavity to the fifth-generation bronchi was created. Flow fields and particle deposition inside the respiratory tract were examined at varied breathing rates (30, 60, and 90L/min of constant and circulatory breathing) and varying haled particle sizes (5 and 10 μm). The results showed that the oropharyngeal area is often where the majority of particles are deposited. The particle distribution fraction is more significant in the bronchial area than the oropharyngeal region due to lower inhalation velocities and smaller particle sizes. For particles with a diameter of 5µm, constant respiration and circulatory respiration have virtually identical particle distribution fractions in each region. For particles with a diameter of 10µm, the particle distribution fraction for circulatory respiration is slightly higher than for constant respiration in the bronchial region as the flow rate increases. For both constant and circulatory respiration, particles are deposited more in the right lung and less in the left. These results contribute to further research on respiratory diseases caused by inhaled particles and guide inhalation therapy for better treatment outcomes.
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Affiliation(s)
- Huanxi Liu
- School of Mechanical Engineering, Shandong University, Jinan, PR China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture at Shandong University, Ministry of Education, Jinan, PR China; National Demonstration Center for Experimental Mechanical Engineering Education at Shandong University, Jinan, PR China
| | - Songhua Ma
- School of Mechanical Engineering, Shandong University, Jinan, PR China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture at Shandong University, Ministry of Education, Jinan, PR China; National Demonstration Center for Experimental Mechanical Engineering Education at Shandong University, Jinan, PR China.
| | - Tianliang Hu
- School of Mechanical Engineering, Shandong University, Jinan, PR China; Key Laboratory of High Efficiency and Clean Mechanical Manufacture at Shandong University, Ministry of Education, Jinan, PR China; National Demonstration Center for Experimental Mechanical Engineering Education at Shandong University, Jinan, PR China
| | - Dedong Ma
- Qilu Hospital of Shandong University, Jinan, PR China; Key Laboratory of Otorhinolaryngology, National Health Commission - Shandong University, Jinan, PR China
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Ebrahimi S, Shamloo A, Alishiri M, Mofrad YM, Akherati F. Targeted pulmonary drug delivery in coronavirus disease (COVID-19) therapy: A patient-specific in silico study based on magnetic nanoparticles-coated microcarriers adhesion. Int J Pharm 2021; 609:121133. [PMID: 34563616 PMCID: PMC8459545 DOI: 10.1016/j.ijpharm.2021.121133] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 01/06/2023]
Abstract
Since the beginning of the COVID-19 pandemic, nearly most confirmed cases develop respiratory syndromes. Using targeted drug delivery by microcarriers is one of the most important noteworthy methods for delivering drugs to the involved bronchi. This study aims to investigate the performance of a drug delivery that applies microcarriers to each branch of the lung under the influence of a magnetic field. The results show that by changing the inlet velocity from constant to pulsatile, the drug delivery performance to the lungs increases by ∼31%. For transferring the microcarriers to the right side branches (LUL and LLL), placing the magnet at zero height and ∼30° angle yields the best outcome. Also, the microcarriers' delivery to branch LUL improves by placing the magnet at LUL-LLL bifurcation and the angle of ∼30°. It was observed that dense (9300[kgm3]) microcarriers show the best performance for delivering drugs to LLL and RLL&RML branches. Also, low-density (1000[kgm3]) microcarriers are best for delivering drugs to LUL and RUL branches. The findings of this study can improve our understanding of different factors, such as inlet velocity, the magnet's position, and the choice of microcarrier - that affect drug delivery to the infected parts of the lung.
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Affiliation(s)
- Sina Ebrahimi
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amir Shamloo
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Mojgan Alishiri
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | | | - Fatemeh Akherati
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Artzy-Schnirman A, Arber Raviv S, Doppelt Flikshtain O, Shklover J, Korin N, Gross A, Mizrahi B, Schroeder A, Sznitman J. Advanced human-relevant in vitro pulmonary platforms for respiratory therapeutics. Adv Drug Deliv Rev 2021; 176:113901. [PMID: 34331989 PMCID: PMC7611797 DOI: 10.1016/j.addr.2021.113901] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 02/08/2023]
Abstract
Over the past years, advanced in vitro pulmonary platforms have witnessed exciting developments that are pushing beyond traditional preclinical cell culture methods. Here, we discuss ongoing efforts in bridging the gap between in vivo and in vitro interfaces and identify some of the bioengineering challenges that lie ahead in delivering new generations of human-relevant in vitro pulmonary platforms. Notably, in vitro strategies using foremost lung-on-chips and biocompatible "soft" membranes have focused on platforms that emphasize phenotypical endpoints recapitulating key physiological and cellular functions. We review some of the most recent in vitro studies underlining seminal therapeutic screens and translational applications and open our discussion to promising avenues of pulmonary therapeutic exploration focusing on liposomes. Undeniably, there still remains a recognized trade-off between the physiological and biological complexity of these in vitro lung models and their ability to deliver assays with throughput capabilities. The upcoming years are thus anticipated to see further developments in broadening the applicability of such in vitro systems and accelerating therapeutic exploration for drug discovery and translational medicine in treating respiratory disorders.
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Affiliation(s)
- Arbel Artzy-Schnirman
- Department of Biomedical, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | - Sivan Arber Raviv
- Department of Chemical, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | | | - Jeny Shklover
- Department of Chemical, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | - Netanel Korin
- Department of Biomedical, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | - Adi Gross
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | - Boaz Mizrahi
- Department of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | - Avi Schroeder
- Department of Chemical, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | - Josué Sznitman
- Department of Biomedical, Technion - Israel Institute of Technology, 32000 Haifa, Israel.
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Islam MS, Larpruenrudee P, Saha SC, Pourmehran O, Paul AR, Gemci T, Collins R, Paul G, Gu Y. How severe acute respiratory syndrome coronavirus-2 aerosol propagates through the age-specific upper airways. Phys Fluids (1994) 2021; 33:081911. [PMID: 34552312 PMCID: PMC8450910 DOI: 10.1063/5.0061627] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/24/2021] [Indexed: 05/22/2023]
Abstract
The recent outbreak of the COVID-19 causes significant respirational health problems, including high mortality rates worldwide. The deadly corona virus-containing aerosol enters the atmospheric air through sneezing, exhalation, or talking, assembling with the particulate matter, and subsequently transferring to the respiratory system. This recent outbreak illustrates that the severe acute respiratory syndrome (SARS) coronavirus-2 is deadlier for aged people than for other age groups. It is evident that the airway diameter reduces with age, and an accurate understanding of SARS aerosol transport through different elderly people's airways could potentially help the overall respiratory health assessment, which is currently lacking in the literature. This first-ever study investigates SARS COVID-2 aerosol transport in age-specific airway systems. A highly asymmetric age-specific airway model and fluent solver (ANSYS 19.2) are used for the investigation. The computational fluid dynamics measurement predicts higher SARS COVID-2 aerosol concentration in the airway wall for older adults than for younger people. The numerical study reports that the smaller SARS coronavirus-2 aerosol deposition rate in the right lung is higher than that in the left lung, and the opposite scenario occurs for the larger SARS coronavirus-2 aerosol rate. The numerical results show a fluctuating trend of pressure at different generations of the age-specific model. The findings of this study would improve the knowledge of SARS coronavirus-2 aerosol transportation to the upper airways which would thus ameliorate the targeted aerosol drug delivery system.
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Affiliation(s)
- Mohammad S. Islam
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney (UTS), 15 Broadway, Ultimo, New South Wales 2007, Australia
- Authors to whom correspondence should be addressed: and
| | - Puchanee Larpruenrudee
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney (UTS), 15 Broadway, Ultimo, New South Wales 2007, Australia
| | - Suvash C. Saha
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney (UTS), 15 Broadway, Ultimo, New South Wales 2007, Australia
- Authors to whom correspondence should be addressed: and
| | - Oveis Pourmehran
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia and Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Akshoy Ranjan Paul
- Department of Applied Mechanics, Motilal Nehru National Institute of Technology Allahabad, Prayagraj 211004, Uttar Pradesh, India
| | | | - Richard Collins
- Biomechanics International, Cranberry Township, Pennsylvania 16066, USA
| | - Gunther Paul
- James Cook University, Australian Institute of Tropical Health and Medicine, Townsville, Queensland 4810, Australia
| | - Yuantong Gu
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane 4000, Australia
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Nicolaou L, Checkley W. Differences between cigarette smoking and biomass smoke exposure: An in silico comparative assessment of particulate deposition in the lungs. Environ Res 2021; 197:111116. [PMID: 33823195 PMCID: PMC8187290 DOI: 10.1016/j.envres.2021.111116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 05/29/2023]
Abstract
Cigarette smoking and biomass smoke are the two main environmental risk factors of chronic obstructive pulmonary disease (COPD) worldwide. However, it remains unclear why these exposures result in two different disease phenotypes. In this study, we assessed the lung deposition from biomass and cigarette smoke exposures and examined whether differences due to inherently different particle size distributions and inhalation conditions may contribute to the differences between biomass- and tobacco-related COPD phenotypes. Using high-fidelity three-dimensional computational fluid-particle dynamics in a representative upper airway geometry, coupled to one-dimensional models of the lower airways, we computed total deposited doses and examined regional deposition patterns based on exposure data from a randomized control trial in Peru and from the literature for biomass and mainstream cigarette smoke, respectively. Our results showed that intrathoracic deposition was higher in cigarette smoking, with 36.8% of inhaled biomass smoke particles and 57.7% of cigarette smoke particles depositing in the intrathoracic airways. We observed higher fractions of cigarette smoke particles in the last few airway generations, which could explain why cigarette smoking is associated with more emphysema than biomass smoke exposure. Mean daily deposited dose was two orders of magnitude higher in cigarette smoking. Lobar distributions of the deposited dose also differed, with the left lower and right upper lobes receiving the highest doses of biomass and cigarette smoke particles, respectively. Our findings suggest that the differences between biomass- and tobacco-related COPD could, at least in part, be due to differences in total and regional lung deposition of biomass and cigarette smoke.
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Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA.
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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Huang F, Zhu Q, Zhou X, Gou D, Yu J, Li R, Tong Z, Yang R. Role of CFD based in silico modelling in establishing an in vitro-in vivo correlation of aerosol deposition in the respiratory tract. Adv Drug Deliv Rev 2021; 170:369-385. [PMID: 32971228 DOI: 10.1016/j.addr.2020.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/02/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022]
Abstract
Effective evaluation and prediction of aerosol transport deposition in the human respiratory tracts are critical to aerosol drug delivery and evaluation of inhalation products. Establishment of an in vitro-in vivo correlation (IVIVC) requires the understanding of flow and aerosol behaviour and underlying mechanisms at the microscopic scale. The achievement of the aim can be facilitated via computational fluid dynamics (CFD) based in silico modelling which treats the aerosol delivery as a two-phase flow. CFD modelling research, in particular coupling with discrete phase model (DPM) and discrete element method (DEM) approaches, has been rapidly developed in the past two decades. This paper reviews the recent development in this area. The paper covers the following aspects: geometric models of the respiratory tract, CFD turbulence models for gas phase and its coupling with DPM/DEM for aerosols, and CFD investigation of the effects of key factors associated with geometric variations, flow and powder characteristics. The review showed that in silico study based on CFD models can effectively evaluate and predict aerosol deposition pattern in human respiratory tracts. The review concludes with recommendations on future research to improve in silico prediction to achieve better IVIVC.
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Affiliation(s)
- Fen Huang
- School of Energy and Environment, Southeast University, Nanjing 210096, China; Department of Chemical Engineering, Monash University, Clayton, Vic 3800, Australia
| | - Qixuan Zhu
- School of Materials Science and Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Xudong Zhou
- Department of Chemical Engineering, Monash University, Clayton, Vic 3800, Australia
| | - Dazhao Gou
- School of Materials Science and Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jiaqi Yu
- Institute for Process Modelling and Optimization, JITRI, Suzhou 215000, China
| | - Renjie Li
- Institute for Process Modelling and Optimization, JITRI, Suzhou 215000, China
| | - Zhenbo Tong
- School of Energy and Environment, Southeast University, Nanjing 210096, China.
| | - Runyu Yang
- School of Materials Science and Engineering, University of New South Wales, Sydney, NSW 2052, Australia.
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Heller-Algazi M, Nof E, Das P, Bhardwaj S, Kassinos SC, Sznitman J. In silico optimization of targeted aerosol delivery in upper airways via Inhaled Volume Tracking. Clin Biomech (Bristol, Avon) 2020; 80:105138. [PMID: 32798812 DOI: 10.1016/j.clinbiomech.2020.105138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the widespread use of aerosol inhalation as a drug delivery method, targeted delivery to the upper airways remains an ongoing challenge in the quest for improved clinical response in respiratory disease. METHODS Here, we examine in silico flow and particle dynamics when using an oral Inhaled Volume Tracking manoeuvre. A short pulsed aerosol bolus is injected during slow inhalation flow rates followed by clean air, and a breath-hold is initiated once it reaches the desired depth. We explore the fate of a broad particle size range (1-40 μm) for both upright and supine positions. FINDINGS Our findings illustrate that despite attempts to mitigate dispersion using slower flow rates, the laryngeal jet disperses the aerosol bolus and thus remains a hurdle for efficient targeted delivery. Nevertheless, we show a decrease in extra-thoracic deposition; large aerosols in the range of 10-30 μm potentially outperform existing inhalation methods, showing deposition fractions of up to 80% in an upright orientation. INTERPRETATION The improved deposition during Inhaled Volume Tracking shows promise for clinical applications and could be leveraged to deliver larger payloads to the upper airways.
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Abstract
INTRODUCTION Since 1968, inhaled chemotherapy has been evaluated and has shown promising results up to phase II but has not yet reached the market. This is due to technological and clinical challenges that require to be overcome with the aim of optimizing the efficacy and the tolerance of drug to re-open new developments in this field. Moreover, recent changes in the therapeutic standard of care for treating the patient with lung cancer also open new opportunities to combine inhaled chemotherapy with standard treatments. AREAS COVERED Clinical and technological concerns are highlighted from the reported clinical trials made with inhaled cytotoxic chemotherapies. This work then focuses on new pharmaceutical developments using dry powder inhalers as inhalation devices and on formulation strategies based on controlled drug release and with sustained lung retention or based on nanomedicine. Finally, new clinical strategies are described in regard to the impact of the immunotherapy on the patient's standard of care. EXPERT OPINION The choice of the drug, inhalation device, and formulation strategy as well as the position of inhaled chemotherapy in the patient's clinical care are crucial factors in optimizing local tolerance and efficacy as well as in its scalability and applicability in clinical practice.
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Affiliation(s)
- Nathalie Wauthoz
- Unit of Pharmaceutics and Biopharmaceutics, Université Libre De Bruxelles, Brussels, Belgium
| | - Rémi Rosière
- Unit of Pharmaceutics and Biopharmaceutics, Université Libre De Bruxelles, Brussels, Belgium
| | - Karim Amighi
- Unit of Pharmaceutics and Biopharmaceutics, Université Libre De Bruxelles, Brussels, Belgium
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Ruzycki CA, Murphy B, Nathoo H, Finlay WH, Martin AR. Combined in Vitro-in Silico Approach to Predict Deposition and Pharmacokinetics of Budesonide Dry Powder Inhalers. Pharm Res 2020; 37:209. [PMID: 32995953 DOI: 10.1007/s11095-020-02924-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE A combined in vitro - in silico methodology was designed to estimate pharmacokinetics of budesonide delivered via dry powder inhaler. METHODS Particle size distributions from three budesonide DPIs, measured with a Next Generation Impactor and Alberta Idealized Throat, were input into a lung deposition model to predict regional deposition. Subsequent systemic exposure was estimated using a pharmacokinetic model that incorporated Nernst-Brunner dissolution in the conducting airways to predict the net influence of dissolution, mucociliary clearance, and absorption. RESULTS DPIs demonstrated significant in vitro differences in deposition, resulting in large differences in simulated regional deposition in the central conducting airways and the alveolar region. Similar but low deposition in the small conducting airways was observed with each DPI. Pharmacokinetic predictions showed good agreement with in vivo data from the literature. Peak systemic concentration was tied primarily to the alveolar dose, while the area under the curve was more dependent on the total lung dose. Tracheobronchial deposition was poorly correlated with pharmacokinetic data. CONCLUSIONS Combination of realistic in vitro experiments, lung deposition modeling, and pharmacokinetic modeling was shown to provide reasonable estimation of in vivo systemic exposure from DPIs. Such combined approaches are useful in the development of orally inhaled drug products.
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Affiliation(s)
- Conor A Ruzycki
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Brynn Murphy
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Hafeez Nathoo
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.
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Poh W, Ab Rahman N, Ostrovski Y, Sznitman J, Pethe K, Loo SCJ. Active pulmonary targeting against tuberculosis (TB) via triple-encapsulation of Q203, bedaquiline and superparamagnetic iron oxides (SPIOs) in nanoparticle aggregates. Drug Deliv 2020; 26:1039-1048. [PMID: 31691600 PMCID: PMC6844420 DOI: 10.1080/10717544.2019.1676841] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Tuberculosis (TB) has gained attention over the past few decades by becoming one of the top ten leading causes of death worldwide. This infectious disease of the lungs is orally treated with a medicinal armamentarium. However, this route of administration passes through the body’s first-pass metabolism which reduces the drugs’ bioavailability and toxicates the liver and kidneys. Inhalation therapy represents an alternative to the oral route, but low deposition efficiencies of delivery devices such as nebulizers and dry powder inhalers render it challenging as a favorable therapy. It was hypothesized that by encapsulating two potent TB-agents, i.e. Q203 and bedaquiline, that inhibit the oxidative phosphorylation of the bacteria together with a magnetic targeting component, superparamagnetic iron oxides, into a poly (D, L-lactide-co-glycolide) (PDLG) carrier using a single emulsion technique, the treatment of TB can be a better therapeutic alternative. This simple fabrication method achieved a homogenous distribution of 500 nm particles with a magnetic saturation of 28 emu/g. Such particles were shown to be magnetically susceptible in an in-vitro assessment, viable against A549 epithelial cells, and were able to reduce two log bacteria counts of the Bacillus Calmette-Guerin (BCG) organism. Furthermore, through the use of an external magnet, our in-silico Computational Fluid Dynamics (CFD) simulations support the notion of yielding 100% deposition in the deep lungs. Our proposed inhalation therapy circumvents challenges related to oral and respiratory treatments and embodies a highly favorable new treatment regime.
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Affiliation(s)
- Wilson Poh
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Nurlilah Ab Rahman
- Lee Kong Chian School of Medicine and School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Yan Ostrovski
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Kevin Pethe
- Lee Kong Chian School of Medicine and School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Say Chye Joachim Loo
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore.,Singapore Centre for Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore, Singapore
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13
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Nof E, Heller-Algazi M, Coletti F, Waisman D, Sznitman J. Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate. J R Soc Interface 2020; 17:20190516. [PMID: 31910775 PMCID: PMC7014802 DOI: 10.1098/rsif.2019.0516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We investigate respiratory flow phenomena in a reconstructed upper airway model of an intubated neonate undergoing invasive mechanical ventilation, spanning conventional to high-frequency ventilation (HFV) modes. Using high-speed tomographic particle image velocimetry, we resolve transient, three-dimensional flow fields and observe a persistent jet flow exiting the endotracheal tube whose strength is directly modulated according to the ventilation protocol. We identify this synthetic jet as the dominating signature of convective flow under intubated ventilation. Concurrently, our in silico wall shear stress analysis reveals a hitherto overlooked source of ventilator-induced lung injury as a result of jet impingement on the tracheal carina, suggesting damage to the bronchial epithelium; this type of injury is known as biotrauma. We find HFV advantageous in mitigating the intensity of such impingement, which may contribute to its role as a lung protective method. Our findings may encourage the adoption of less invasive ventilation procedures currently used in neonatal intensive care units.
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Affiliation(s)
- Eliram Nof
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Metar Heller-Algazi
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Filippo Coletti
- Department of Aerospace Engineering and Mechanics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Dan Waisman
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel.,Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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14
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Zhao J, Feng Y, Fromen CA. Glottis motion effects on the particle transport and deposition in a subject-specific mouth-to-trachea model: A CFPD study. Comput Biol Med 2020; 116:103532. [DOI: 10.1016/j.compbiomed.2019.103532] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/27/2022]
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15
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Poorbahrami K, Mummy DG, Fain SB, Oakes JM. Patient-specific modeling of aerosol delivery in healthy and asthmatic adults. J Appl Physiol (1985) 2019; 127:1720-1732. [PMID: 31513445 DOI: 10.1152/japplphysiol.00221.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The magnitude and regional heterogeneity of airway obstructions in severe asthmatics is likely linked to insufficient drug delivery, as evidenced by the inability to mitigate exacerbations with inhaled aerosol medications. To understand the correlation between morphometric features, airflow distribution, and inhaled dosimetry, we perform dynamic computational simulations in two healthy and four asthmatic subjects. Models incorporate computed tomography-based and patient-specific central airway geometries and hyperpolarized 3He MRI-measured segmental ventilation defect percentages (SVDPs), implemented as resistance boundary conditions. Particles [diameters (dp) = 1, 3, and 5 μm] are simulated throughout inhalation, and we record their initial conditions, both spatially and temporally, with their fate in the lung. Predictions highlight that total central airway deposition is the same between the healthy subjects (26.6%, dp = 3 μm) but variable among the asthmatic subjects (ranging from 5.9% to 59.3%, dp = 3 μm). We found that by preferentially releasing the particles during times of fast or slow inhalation rates we enhance either central airway deposition percentages or peripheral particle delivery, respectively. These predictions highlight the potential to identify with simulations patients who may not receive adequate therapeutic dosages with inhaled aerosol medication and therefore identify patients who may benefit from alternative treatment strategies. Furthermore, by improving regional dose levels, we may be able to preferentially deliver drugs to the airways in need, reducing associated adverse side effects.NEW & NOTEWORTHY Although it is evident that exacerbation mitigation is unsuccessful in some asthmatics, it remains unclear whether or not these patients receive adequate dosages of inhaled therapeutics. By coupling MRI and computed tomography data with patient-specific computational models, our predictions highlight the large intersubject variability, specifically in severe asthma.
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Affiliation(s)
- Kamran Poorbahrami
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts
| | - David G Mummy
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sean B Fain
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica M Oakes
- Department of Bioengineering, Northeastern University, Boston, Massachusetts
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