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Arroyo-Currás N, Ortega G, Copp DA, Ploense KL, Plaxco ZA, Kippin TE, Hespanha JP, Plaxco KW. High-Precision Control of Plasma Drug Levels Using Feedback-Controlled Dosing. ACS Pharmacol Transl Sci 2018; 1:110-118. [PMID: 32219207 PMCID: PMC7088981 DOI: 10.1021/acsptsci.8b00033] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 08/29/2018] [Indexed: 12/30/2022]
Abstract
By, in effect, rendering pharmacokinetics an experimentally adjustable parameter, the ability to perform feedback-controlled dosing informed by high-frequency in vivo drug measurements would prove a powerful tool for both pharmacological research and clinical practice. Efforts to this end, however, have historically been thwarted by an inability to measure in vivo drug levels in real time and with sufficient convenience and temporal resolution. In response, we describe a closed-loop, feedback-controlled delivery system that uses drug level measurements provided by an in vivo electrochemical aptamer-based (E-AB) sensor to adjust dosing rates every 7 s. The resulting system supports the maintenance of either constant or predefined time-varying plasma drug concentration profiles in live rats over many hours. For researchers, the resultant high-precision control over drug plasma concentrations provides an unprecedented opportunity to (1) map the relationships between pharmacokinetics and clinical outcomes, (2) eliminate inter- and intrasubject metabolic variation as a confounding experimental variable, (3) accurately simulate human pharmacokinetics in animal models, and (4) measure minute-to-minute changes in a drug's pharmacokinetic behavior in response to changing health status, diet, drug-drug interactions, or other intrinsic and external factors. In the clinic, feedback-controlled drug delivery would improve our ability to accurately maintain therapeutic drug levels in the face of large, often unpredictable intra- and interpatient metabolic variation. This, in turn, would improve the efficacy and safety of therapeutic intervention, particularly for the most gravely ill patients, for whom metabolic variability is highest and the margin for therapeutic error is smallest.
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Affiliation(s)
- Netzahualcóyotl Arroyo-Currás
- Department
of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States,E-mail: . Tel.: (410) 955-3569
| | - Gabriel Ortega
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States,CIC
bioGUNE, Bizkaia Technology Park, Ed. 801A, 48160, Derio, Spain
| | - David A. Copp
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States
| | - Kyle L. Ploense
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States
| | - Zoe A. Plaxco
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States
| | - Tod E. Kippin
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States
| | - João P. Hespanha
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States
| | - Kevin W. Plaxco
- ‡Department of Chemistry and Biochemistry, §Center for Bioengineering, ⊥Center for Control,
Dynamical Systems, and Computation, #Department of Psychological and Brain Sciences, and ∇The Neuroscience
Research Institute and Department of Molecular, Cellular, and Developmental
Biology, University of California Santa
Barbara, Santa
Barbara, California 93106, United States,E-mail: . Tel.: (805) 893-5558
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Ter Boo GJA, Arens D, Metsemakers WJ, Zeiter S, Richards RG, Grijpma DW, Eglin D, Moriarty TF. Injectable gentamicin-loaded thermo-responsive hyaluronic acid derivative prevents infection in a rabbit model. Acta Biomater 2016; 43:185-194. [PMID: 27435965 DOI: 10.1016/j.actbio.2016.07.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 04/01/2016] [Revised: 07/08/2016] [Accepted: 07/15/2016] [Indexed: 01/10/2023]
Abstract
UNLABELLED Despite the use of systemic antibiotic prophylaxis, the surgical fixation of open fractures with osteosynthesis implants is associated with high infection rates. Antibiotic-loaded biomaterials (ALBs) are increasingly used in implant surgeries across medical specialties to deliver high concentrations of antibiotics to the surgical site and reduce the risk of implant-associated infection. ALBs which are either less or not restricted in terms of spatial distribution and which may be applied throughout complex wounds could offer improved protection against infection in open fracture care. A thermo-responsive hyaluronic acid derivative (hyaluronic acid-poly(N-isopropylacrylamide) (HApN)) was prepared by a direct amidation reaction between the tetrabutyl ammonium (TBA) salt of hyaluronic acid and amine-terminated poly(N-isopropylacrylamide) (pN). The degree of grafting, and gelation properties of this gel were characterized, and the composition was loaded with gentamicin. The rheological- and release properties of this gentamicin-loaded HApN composition were tested in vitro and its efficacy in preventing infection was tested in a rabbit model of osteosynthesis contaminated with Staphylococcus aureus. The gentamicin-loaded HApN composition was able to prevent bacterial colonization of the implant site as shown by quantitative bacteriology. This finding was supported by histopathological evaluation of the humeri samples where no bacteria were found in the stained sections. In conclusion, this gentamicin-loaded HApN hydrogel effectively prevents infection in a complex wound, simulating a contaminated fracture treated with plating osteosynthesis. STATEMENT OF SIGNIFICANCE Fracture fixation after trauma is associated with high infection rates. Antibiotic loaded biomaterials (ALBs) can provide high local concentrations without systemic side effects. However, the currently available ALBs have limited accessibility to contaminated tissues in open fractures because of predetermined shape. Thus, a novel thermo-responsive hyaluronan based hydrogel with control over gelation temperature is reported. The efficacy of this gentamicin loaded hyaluronan derivative is demonstrated in an in vivo fracture model in the presence of fracture fixation hardware. The bacterial burden is cleared in all of the inoculated rabbits in the presence of the ALB. Thus, the proposed injectable thermo-responsive hyaluronan presents an effective ALB for the prevention of infection.
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Affiliation(s)
- Gert-Jan A Ter Boo
- AO Research Institute Davos, Davos, Switzerland; MIRA Institute for Biomedical Technology and Technical Medicine, Department of Biomaterials Science and Technology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | | | | | | | | | - Dirk W Grijpma
- MIRA Institute for Biomedical Technology and Technical Medicine, Department of Biomaterials Science and Technology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - David Eglin
- AO Research Institute Davos, Davos, Switzerland
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Pericás JM, Zboromyrska Y, Cervera C, Castañeda X, Almela M, Garcia-de-la-Maria C, Mestres C, Falces C, Quintana E, Ninot S, Llopis J, Marco F, Moreno A, Miró JM. Enterococcal endocarditis revisited. Future Microbiol 2015; 10:1215-40. [PMID: 26118390 DOI: 10.2217/fmb.15.46] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.
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Affiliation(s)
- J M Pericás
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Y Zboromyrska
- Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Cervera
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - X Castañeda
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - M Almela
- Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Garcia-de-la-Maria
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - C Mestres
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Falces
- Cardiology Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Quintana
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - S Ninot
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Llopis
- Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - F Marco
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology Service, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
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Moreillon P, Wilson WR, Leclercq R, Entenza JM. Single-dose oral amoxicillin or linezolid for prophylaxis of experimental endocarditis due to vancomycin-susceptible and vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 2007; 51:1661-5. [PMID: 17353251 PMCID: PMC1855552 DOI: 10.1128/aac.00744-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Endocarditis prophylaxis following genitourinary or gastrointestinal procedures targets Enterococcus faecalis. Prophylaxis recommendations advocate oral amoxicillin (2 g in the United States and 3 g in the United Kingdom) in moderate-risk patients and intravenous amoxicillin (2 g) or vancomycin (1 g) plus gentamicin in high-risk patients. While ampicillin-resistant (or amoxicillin-resistant) E. faecalis is still rare, there is a concern that these regimens might fail against vancomycin-resistant and/or aminoglycoside-resistant isolates. The present study tested oral linezolid as an alternative. Rats with catheter-induced aortic vegetations were given prophylaxis simulating human pharmacokinetics of oral amoxicillin (2- to 3-g single dose), oral linezolid (600 mg, single or multiple oral doses every 12 h), or intravenous vancomycin (1-g single dose). Rats were then inoculated with the minimum inoculum infecting 90% of the animals (90% infective dose [ID(90)]) or with 10 times the ID(90) of the vancomycin-susceptible E. faecalis strain JH2-2 or the vancomycin-resistant (VanA phenotype) E. faecalis strain UCN41. Amoxicillin was also tested with two additional vancomycin-susceptible E. faecalis strains, 309 and 1209. Animals were sacrificed 3 days later. All the tested bacteria were susceptible to amoxicillin and gentamicin. Single-dose amoxicillin provided 100% protection against all four isolates at both the ID(90) and 10 times the ID(90). In contrast, linezolid required up to four consecutive doses to provide full protection against the vancomycin-resistant isolate. Vancomycin protected only against the vancomycin-susceptible strain. The high efficacy of single-dose oral amoxicillin suggests that this regimen could be used for prophylaxis in both moderate-risk and high-risk patients without additional aminoglycosides. Linezolid appears to be less reliable, at least against the vancomycin-resistant strain.
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Affiliation(s)
- Philippe Moreillon
- Department of Fundamental Microbiology, Biophore Building, University of Lausanne, CH-1015 Lausanne, Switzerland
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