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Szebeni J. Evaluation of the Acute Anaphylactoid Reactogenicity of Nanoparticle-Containing Medicines and Vaccines Using the Porcine CARPA Model. Methods Mol Biol 2024; 2789:229-243. [PMID: 38507008 DOI: 10.1007/978-1-0716-3786-9_23] [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] [Indexed: 03/22/2024]
Abstract
A small fraction, up to 10%, of people treated intravenously with state-of-the-art nanoparticulate drugs or diagnostic agents develop an acute infusion reaction which can be severe or even lethal. Activation of the complement (C) system can play a causal, or contributing role in these atypical, "pseudoallergic" reactions, hence their name, C activation-related pseudoallergy (CARPA). Intravenous (i.v.) administration of the human reaction-triggering (very small) dose of a test sample in pigs triggers a symptom tetrad (characteristic hemodynamic, hematological, skin, and laboratory changes) that correspond to the major human symptoms. Quantitating these changes provides a highly sensitive and reproducible method for assessing the risk of CARPA, enabling the implementation of appropriate preventive measures. Accordingly, the porcine CARPA model has been increasingly used for the safety evaluation of therapeutic and diagnostic nanomedicines and, recently, mRNA-lipid nanoparticle vaccines. This chapter provides details of the experimental procedure followed upon using the model.
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Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, Budapest, Hungary
- SeroScience LCC, Budapest, Hungary
- Translational Nanobioscience Research Center, Sungkyunkwan University, Suwon, Korea
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Szebeni J, Storm G, Ljubimova JY, Castells M, Phillips EJ, Turjeman K, Barenholz Y, Crommelin DJA, Dobrovolskaia MA. Applying lessons learned from nanomedicines to understand rare hypersensitivity reactions to mRNA-based SARS-CoV-2 vaccines. Nat Nanotechnol 2022; 17:337-346. [PMID: 35393599 DOI: 10.1038/s41565-022-01071-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/04/2022] [Indexed: 05/24/2023]
Abstract
After over a billion of vaccinations with messenger RNA-lipid nanoparticle (mRNA-LNP) based SARS-CoV-2 vaccines, anaphylaxis and other manifestations of hypersensitivity can be considered as very rare adverse events. Although current recommendations include avoiding a second dose in those with first-dose anaphylaxis, the underlying mechanisms are unknown; therefore, the risk of a future reaction cannot be predicted. Given how important new mRNA constructs will be to address the emergence of new viral variants and viruses, there is an urgent need for clinical approaches that would allow a safe repeated immunization of high-risk individuals and for reliable predictive tools of adverse reactions to mRNA vaccines. In many aspects, anaphylaxis symptoms experienced by the affected vaccine recipients resemble those of infusion reactions to nanomedicines. Here we share lessons learned over a decade of nanomedicine research and discuss the current knowledge about several factors that individually or collectively contribute to infusion reactions to nanomedicines. We aim to use this knowledge to inform the SARS-CoV-2 lipid-nanoparticle-based mRNA vaccine field.
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Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
- SeroScience LCC, Budapest, Hungary
- Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc, Hungary
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
- Department of Biomaterials Science and Technology, University of Twente, Enschede, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Mariana Castells
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keren Turjeman
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yechezkel Barenholz
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Daan J A Crommelin
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA.
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Shi D, Beasock D, Fessler A, Szebeni J, Ljubimova JY, Afonin KA, Dobrovolskaia MA. To PEGylate or not to PEGylate: Immunological properties of nanomedicine's most popular component, polyethylene glycol and its alternatives. Adv Drug Deliv Rev 2022; 180:114079. [PMID: 34902516 PMCID: PMC8899923 DOI: 10.1016/j.addr.2021.114079] [Citation(s) in RCA: 133] [Impact Index Per Article: 66.5] [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: 08/27/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 01/03/2023]
Abstract
Polyethylene glycol or PEG has a long history of use in medicine. Many conventional formulations utilize PEG as either an active ingredient or an excipient. PEG found its use in biotechnology therapeutics as a tool to slow down drug clearance and shield protein therapeutics from undesirable immunogenicity. Nanotechnology field applies PEG to create stealth drug carriers with prolonged circulation time and decreased recognition and clearance by the mononuclear phagocyte system (MPS). Most nanomedicines approved for clinical use and experimental nanotherapeutics contain PEG. Among the most recent successful examples are two mRNA-based COVID-19 vaccines that are delivered by PEGylated lipid nanoparticles. The breadth of PEG use in a wide variety of over the counter (OTC) medications as well as in drug products and vaccines stimulated research which uncovered that PEG is not as immunologically inert as it was initially expected. Herein, we review the current understanding of PEG's immunological properties and discuss them in the context of synthesis, biodistribution, safety, efficacy, and characterization of PEGylated nanomedicines. We also review the current knowledge about immunological compatibility of other polymers that are being actively investigated as PEG alternatives.
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Key Words
- Poly(ethylene)glycol, PEG, immunogenicity, immunology, nanomedicine, toxicity, anti-PEG antibodies, hypersensitivity, synthesis, drug delivery, biotherapeutics
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Affiliation(s)
- Da Shi
- Nanotechnology Characterization Lab, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick MD, USA
| | - Damian Beasock
- University of North Carolina Charlotte; Charlotte, NC, USA
| | - Adam Fessler
- University of North Carolina Charlotte; Charlotte, NC, USA
| | | | | | | | - Marina A. Dobrovolskaia
- Nanotechnology Characterization Lab, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick MD, USA;,Corresponding author:
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Estapé Senti M, de Jongh CA, Dijkxhoorn K, Verhoef JJF, Szebeni J, Storm G, Hack CE, Schiffelers RM, Fens MH, Boross P. Anti-PEG antibodies compromise the integrity of PEGylated lipid-based nanoparticles via complement. J Control Release 2021; 341:475-486. [PMID: 34890719 DOI: 10.1016/j.jconrel.2021.11.042] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 06/11/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/18/2022]
Abstract
PEGylation of lipid-based nanoparticles and other nanocarriers is widely used to increase their stability and plasma half-life. However, either pre-existing or de novo formed anti-PEG antibodies can induce hypersensitivity reactions and accelerated blood clearance through binding to the nanoparticle surfaces, leading to activation of the complement system. In this study, we investigated the consequences and mechanisms of complement activation by anti-PEG antibodies interacting with different types of PEGylated lipid-based nanoparticles. By using both liposomes loaded with different (model) drugs and LNPs loaded with mRNA, we demonstrate that complement activation triggered by anti-PEG antibodies can compromise the bilayer/surface integrity, leading to premature drug release or exposure of their mRNA contents to serum proteins. Anti-PEG antibodies also can induce deposition of complement fragments onto the surface of PEGylated lipid-based nanoparticles and induce the release of fluid phase complement activation products. The role of the different complement pathways activated by lipid-based nanoparticles was studied using deficient sera and/or inhibitory antibodies. We identified a major role for the classical complement pathway in the early activation events leading to the activation of C3. Our data also confirm the essential role of amplification of C3 activation by alternative pathway components in the lysis of liposomes. Finally, the levels of pre-existing anti-PEG IgM antibodies in plasma of healthy donors correlated with the degree of complement activation (fixation and lysis) induced upon exposure to PEGylated liposomes and mRNA-LNPs. Taken together, anti-PEG antibodies trigger complement activation by PEGylated lipid-based nanoparticles, which can potentially compromise their integrity, leading to premature drug release or cargo exposure to serum proteins.
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Affiliation(s)
- Mariona Estapé Senti
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; CDL Research, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Caroline A de Jongh
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kim Dijkxhoorn
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johan J F Verhoef
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary; SeroScience LCC, Budapest, Hungary; Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc, Hungary
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Surgery, Nanomedicine Translational Programme, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, University of Singapore, Singapore
| | - C Erik Hack
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Raymond M Schiffelers
- CDL Research, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcel H Fens
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Peter Boross
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Szebeni J, Kozma G, Meszaros T, Urbanics R. Pseudo-anaphylaxis to PEGylated nanomedicines in a porcine model. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
In this issue of ACS Nano, Chen et al. provide in vitro and in vivo evidence for monoclonal anti-poly(ethylene glycol) (anti-PEG) antibody-triggered, complement terminal complex-mediated damage to PEGylated liposomal doxorubicin, entailing the release of the encapsulated drug from the vesicles. These results reveal a new dimension of the potential damage of anti-PEG antibody-mediated complement activation on PEGylated nanomedicines in addition to previous observations on infusion hypersensitivity reactions and the accelerated blood clearance effect. The possibility of a destructive attack of the complement system on the liposome drug carrier may have safety implications in patients displaying high levels of preformed anti-PEG antibodies. In this Perspective, we summarize the experimental and clinical data highlighting the relationships among the above adverse immune phenomena and the options available for reducing the risk of immune damage caused by PEGylated nanomedicines.
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Affiliation(s)
- Alberto Gabizon
- Nano-oncology Research Center, Shaare Zedek Medical Center and The Hebrew University-Faculty of Medicine, Jerusalem 9103102, Israel
- Lipomedix Pharmaceuticals Ltd., Jerusalem 9139102, Israel
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, Budapest 1089, Hungary
- Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc 3515, Hungary
- SeroScience Ltd., Budapest 1125, Hungary
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Kozma GT, Shimizu T, Ishida T, Szebeni J. Anti-PEG antibodies: Properties, formation, testing and role in adverse immune reactions to PEGylated nano-biopharmaceuticals. Adv Drug Deliv Rev 2020; 154-155:163-175. [PMID: 32745496 DOI: 10.1016/j.addr.2020.07.024] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [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: 06/12/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022]
Abstract
Conjugation of polyethylene glycols (PEGs) to proteins or drug delivery nanosystems is a widely accepted method to increase the therapeutic index of complex nano-biopharmaceuticals. Nevertheless, these drugs and agents are often immunogenic, triggering the rise of anti-drug antibodies (ADAs). Among these ADAs, anti-PEG IgG and IgM were shown to account for efficacy loss due to accelerated blood clearance of the drug (ABC phenomenon) and hypersensitivity reactions (HSRs) entailing severe allergic symptoms with occasionally fatal anaphylaxis. In addition to recapitulating the basic information on PEG and its applications, this review expands on the physicochemical factors influencing its immunogenicity, the prevalence, features, mechanism of formation and detection of anti-PEG IgG and IgM and the mechanisms by which these antibodies (Abs) induce ABC and HSRs. In particular, we highlight the in vitro, animal and human data attesting to anti-PEG Ab-induced complement (C) activation as common underlying cause of both adverse effects. A main message is that correct measurement of anti-PEG Abs and individual proneness for C activation might predict the rise of adverse immune reactions to PEGylated drugs and thereby increase their efficacy and safety.
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Affiliation(s)
- Gergely Tibor Kozma
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University Medical School, Budapest, Hungary; SeroScience Ltd, Budapest, Hungary
| | - Taro Shimizu
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, 1-78-1, Sho-machi, Tokushima 770-8505, Japan
| | - Tatsuhiro Ishida
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, 1-78-1, Sho-machi, Tokushima 770-8505, Japan
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University Medical School, Budapest, Hungary; SeroScience Ltd, Budapest, Hungary; Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc, Hungary.
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9
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Bavli Y, Winkler I, Chen BM, Roffler S, Cohen R, Szebeni J, Barenholz Y. Doxebo (doxorubicin-free Doxil-like liposomes) is safe to use as a pre-treatment to prevent infusion reactions to PEGylated nanodrugs. J Control Release 2019; 306:138-148. [PMID: 31176656 DOI: 10.1016/j.jconrel.2019.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/20/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
The increasing use in the last decade of PEGylated nanodrugs such as Doxil® has seen a rise in the number of associated occurrences of hypersensitivity reactions (HSRs). These reactions (also called infusion reactions or IR), can range from harmless symptoms to life-threatening reactions. Current means to prevent IR include the prophylactic use of antihistamines and steroids, but they cannot ensure total prevention. We previously showed that an intravenous injection of doxorubicin-free Doxil-like PEGylated nano-liposomes (Doxebo) prior to Doxil treatment suppresses Doxil-induced complement activation-related pseudoallergy (CARPA) in pigs, a model of human hypersensitivity reactions to Doxil. However, in order to use Doxebo to prevent Doxil-induced IR, we have to prove its safety and that it does not affect Doxil's performance. Here we show that Doxebo itself does not have toxic effects on the host or tumor, and it does not interfere with Doxil's antitumor activity in mice. Blood, microscopic and macroscopic organ evaluation of rats after repeated administration confirm the lack of intrinsic adverse effect of Doxebo. Likewise, the repeated injection of Doxebo before Doxil did not impact Doxil's pharmacokinetics in plasma and therefore does not cause accelerated blood clearance (ABC). Taken together with our previous publications, these data suggest that the injection of Doxebo prior to Doxil administration can help protect against Doxil-induced IR without adversely affecting treatment efficacy and safety.
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Affiliation(s)
- Yaelle Bavli
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University - Hadassah Medical School, Jerusalem, Israel
| | | | - Bing Mae Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Steve Roffler
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Rivka Cohen
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University - Hadassah Medical School, Jerusalem, Israel
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Department of Pathophysiology, Semmelweis University, Budapest, Hungary; SeroScience Ltd, Cambridge, MA, United States
| | - Yechezkel Barenholz
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University - Hadassah Medical School, Jerusalem, Israel.
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Piecha D, Dezsi L, Moore C, Pethő A, Rosivall L, Canaud B, Szebeni J, Steppan S. SP539PORCINE CARPA MODEL TO STUDY HYPERSENSITIVITY-LIKE REACTIONS DURING DIALYSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dorothea Piecha
- Fresenius Medical Care Deutschland GmbH, Bad Homburg vor der Höhe, Germany
| | | | - Christoph Moore
- Fresenius Medical Care Deutschland GmbH, Bad Homburg vor der Höhe, Germany
| | - Akos Pethő
- Semmelweis University, Budapest, Hungary
| | | | - Bernard Canaud
- Fresenius Medical Care Deutschland GmbH, Bad Homburg vor der Höhe, Germany
| | | | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, Bad Homburg vor der Höhe, Germany
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Banerjee S, Sengupta J, Aljarilla AI, Setaro F, Makinen P, Wu L, Holappa L, de la Escosura A, Martinelli C, Trohopoulos P, Ylä-Herttuala S, Urbanics R, Szebeni J, Torres T, Krol S. Human serum albumin nanoparticles loaded with phthalocyanine dyes for potential use in photodynamic therapy for atherosclerotic plaques. PRNANO 2019. [DOI: 10.33218/prnano2(2).190411.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Diseases caused by obstruction or rupture of vulnerable plaques in the arterial walls such as cardiovascular infarction or stroke are the leading cause of death in the world. In the present work, we developed human serum albumin nanoparticles loaded by physisorption with zinc phthalocyanine, TT1, mainly used for industrial application as near-infrared photosensitizer and compared these to HSA NPs loaded with the well-known silicone phthalocyanine (Pc4). The use of NIR light allows for better tissue penetration, while the use of nanoparticles permits high local concentrations. The particles were characterized and tested for toxicity and stability as well as for their potential use as a contrast agent and NIR photosensitizer for photodynamic therapy in cardiovascular disease. We focused on the distribution of the nanoparticles in RAW264.7 macrophage cells and atherosclerotic mice. The nanoparticles had an average size of 120 nm according to dynamic light scattering, good loading capacity for zinc phthalocyanine, and satisfying stability in 50% (v/v) fetal bovine serum for 8 hours and in an aqueous environment at 4°C for 4–6 weeks. Under light irradiation we found a high production of singlet oxygen and the products showed no dark toxicity in vitro with macrophages (the target cells in vulnerable plaques), but at a low g/mL nanoparticle concentration killed efficiently the macrophages upon LED illumination. Injection of the contrast agent in atherosclerotic mice led to a visible fluorescence signal of zinc phthalocyanine in the atherosclerotic plaque at 30 minutes and in the lungs with a fast clearance of the nanoparticles. Zinc phthalocyanine loaded human serum albumin nanoparticles present an interesting candidate for the visualization and potentially photodynamic treatment of macrophages in atherosclerotic plaques.
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Affiliation(s)
- Subhadeep Banerjee
- aFIRC Institute of Molecular Oncology Foundation, IFOM-IEO-Campus, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tomas Torres
- CIUDAD UNIVERSITARIA DE CANTOBLANCO IMDEA Nanoscience
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12
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Mohamed M, Abu Lila AS, Shimizu T, Alaaeldin E, Hussein A, Sarhan HA, Szebeni J, Ishida T. PEGylated liposomes: immunological responses. Sci Technol Adv Mater 2019; 20:710-724. [PMID: 31275462 PMCID: PMC6598536 DOI: 10.1080/14686996.2019.1627174] [Citation(s) in RCA: 246] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 05/10/2023]
Abstract
A commonly held view is that nanocarriers conjugated to polyethylene glycol (PEG) are non-immunogenic. However, many studies have reported that unexpected immune responses have occurred against PEG-conjugated nanocarriers. One unanticipated response is the rapid clearance of PEGylated nanocarriers upon repeat administration, called the accelerated blood clearance (ABC) phenomenon. ABC involves the production of antibodies toward nanocarrier components, including PEG, which reduces the safety and effectiveness of encapsulated therapeutic agents. Another immune response is the hypersensitivity or infusion reaction referred to as complement (C) activation-related pseudoallergy (CARPA). Such immunogenicity and adverse reactivities of PEGylated nanocarriers may be of potential concern for the clinical use of PEGylated therapeutics. Accordingly, screening of the immunogenicity and CARPA reactogenicity of nanocarrier-based therapeutics should be a prerequisite before they can proceed into clinical studies. This review presents PEGylated liposomes, immunogenicity of PEG, the ABC phenomenon, C activation and lipid-induced CARPA from a toxicological point of view, and also addresses the factors that influence these adverse interactions with the immune system.
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Affiliation(s)
- Marwa Mohamed
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
- Department of Pharmaceutics, Minia University, Minia, Egypt
| | - Amr S. Abu Lila
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
- Department of Pharmaceutics, College of Pharmacy, Hail University, Hail, Saudi Arabia
| | - Taro Shimizu
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Eman Alaaeldin
- Department of Pharmaceutics, Minia University, Minia, Egypt
| | - Amal Hussein
- Department of Pharmaceutics, Minia University, Minia, Egypt
| | | | - Janos Szebeni
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
- SeroScience LCC., Cambridge, MA, USA
| | - Tatsuhiro Ishida
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
- CONTACT Tatsuhiro Ishida Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, 1-78-1, Sho-machi, Tokushima770-8505, Japan
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13
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Szebeni J, Simberg D, González-Fernández Á, Barenholz Y, Dobrovolskaia MA. Roadmap and strategy for overcoming infusion reactions to nanomedicines. Nat Nanotechnol 2018; 13:1100-1108. [PMID: 30348955 PMCID: PMC6320688 DOI: 10.1038/s41565-018-0273-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [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: 04/16/2018] [Accepted: 09/03/2018] [Indexed: 05/20/2023]
Abstract
Infusion reactions (IRs) are complex, immune-mediated side effects that mainly occur within minutes to hours of receiving a therapeutic dose of intravenously administered pharmaceutical products. These products are diverse and include both traditional pharmaceuticals (for example biological agents and small molecules) and new ones (for example nanotechnology-based products). Although IRs are not unique to nanomedicines, they represent a hurdle for the translation of nanotechnology-based drug products. This Perspective offers a big picture of the pharmaceutical field and examines current understanding of mechanisms responsible for IRs to nanomedicines. We outline outstanding questions, review currently available experimental evidence to provide some answers and highlight the gaps. We review advantages and limitations of the in vitro tests and animal models used for studying IRs to nanomedicines. Finally, we propose a roadmap to improve current understanding, and we recommend a strategy for overcoming the problem.
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Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
- SeroScience Ltd, Budapest, Hungary
- Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc, Hungary
| | - Dmitri Simberg
- Translational Bio-Nanosciences Laboratory, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - África González-Fernández
- Immunology, Centro de Investigaciones Biomédicas (CINBIO), Centro de Investigación Singular de Galicia, Instituto de Investigación Sanitaria Galicia Sur (IIS-GS), University of Vigo, Vigo, Spain
| | - Yechezkel Barenholz
- Department of Biochemistry, Institute for Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA.
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Børresen B, Henriksen JR, Clergeaud G, Jørgensen JS, Melander F, Elema DR, Szebeni J, Engelholm SA, Kristensen AT, Kjær A, Andresen TL, Hansen AE. Theranostic Imaging May Vaccinate against the Therapeutic Benefit of Long Circulating PEGylated Liposomes and Change Cargo Pharmacokinetics. ACS Nano 2018; 12:11386-11398. [PMID: 30372038 DOI: 10.1021/acsnano.8b06266] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The enhanced permeability and retention (EPR) effect increases tumor accumulation of liposomal chemotherapy and should, in theory, increase anticancer effects and lower toxicity. Unfortunately, liposomal chemotherapy has generally not met the expected potential, perhaps because the EPR effect is not ubiquitous. PET imaging using radiolabeled liposomes can identify cancers positive for the EPR effect. In the current study, we show in clinical canine cancer patients that repeated imaging with radiolabeled liposomes (64Cu-liposome) induces the accelerated blood clearance (ABC) phenomenon. This was observed even with very long intervals between PEGylated liposome injections, which contradict previous reporting in experimental animal models. The induction of ABC may be devastating for the theranostic use of liposomal imaging, as this could vaccinate patients against therapeutic efficacy. To investigate and solve this important problem, an additional study part was designed in which rats were subjected to repeated liposomal administrations, including stealth 64Cu-liposome PET imaging and Caelyx chemotherapy. Most importantly, it was found that, by increasing the lipid dose at the first injection or by supplying a small predose before the second 64Cu-liposome injection, ABC could be prevented. Importantly, signs of liposome tracer breakdown with subsequent renal excretion were observed. These findings highlight the importance of the ABC phenomenon for liposomal predictive imaging in a clinically relevant setting and show that carefully planned application is central to avoid potential detrimental effects on patient benefit.
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Affiliation(s)
- Betina Børresen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences , University of Copenhagen , 1870 Frederiksberg C , Denmark
| | - Jonas R Henriksen
- DTU Nanotech, Department of Micro- and Nanotechnology, Center for Nanomedicine and Theranostics , Technical University of Denmark , 2800 Kgs. Lyngby , Denmark
| | - Gael Clergeaud
- DTU Nanotech, Department of Micro- and Nanotechnology, Center for Nanomedicine and Theranostics , Technical University of Denmark , 2800 Kgs. Lyngby , Denmark
| | - Jennifer S Jørgensen
- DTU Nanotech, Department of Micro- and Nanotechnology, Center for Nanomedicine and Theranostics , Technical University of Denmark , 2800 Kgs. Lyngby , Denmark
| | - Fredrik Melander
- DTU Nanotech, Department of Micro- and Nanotechnology, Center for Nanomedicine and Theranostics , Technical University of Denmark , 2800 Kgs. Lyngby , Denmark
| | - Dennis R Elema
- DTU Nutech, Center for Nuclear Technologies , Technical University of Denmark , 4000 Roskilde , Denmark
| | - Janos Szebeni
- Nanomedicine Research and Education Center , Semmelweis University , Budapest 1085 , Hungary
| | - Svend Aage Engelholm
- Department of Radiotherapy , Copenhagen University Hospital , 2100 Copenhagen Ø , Denmark
| | - Annemarie T Kristensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences , University of Copenhagen , 1870 Frederiksberg C , Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark and Cluster for Molecular Imaging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Copenhagen , 2200 Copenhagen N , Denmark
| | - Thomas L Andresen
- DTU Nanotech, Department of Micro- and Nanotechnology, Center for Nanomedicine and Theranostics , Technical University of Denmark , 2800 Kgs. Lyngby , Denmark
| | - Anders E Hansen
- DTU Nanotech, Department of Micro- and Nanotechnology, Center for Nanomedicine and Theranostics , Technical University of Denmark , 2800 Kgs. Lyngby , Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark and Cluster for Molecular Imaging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Copenhagen , 2200 Copenhagen N , Denmark
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15
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Zamboni WC, Szebeni J, Kozlov SV, Lucas AT, Piscitelli JA, Dobrovolskaia MA. Animal models for analysis of immunological responses to nanomaterials: Challenges and considerations. Adv Drug Deliv Rev 2018; 136-137:82-96. [PMID: 30273617 DOI: 10.1016/j.addr.2018.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 08/27/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 12/19/2022]
Abstract
Nanotechnology provides many solutions to improve conventional drug delivery and has a unique niche in the areas related to the specific targeting of the immune system, such as immunotherapies and vaccines. Preclinical studies in this field rely heavily on the combination of in vitro and in vivo methods to assess the safety and efficacy of nanotechnology platforms, nanoparticle-formulated drugs, and vaccines. While certain types of toxicities can be evaluated in vitro and good in vitro-in vivo correlation has been demonstrated for such tests, animal studies are still needed to address complex biological questions and, therefore, provide a unique contribution to establishing nanoparticle safety and efficacy profiles. The genetic, metabolic, mechanistic, and phenotypic diversity of currently available animal models often complicates both the animal choice and the interpretation of the results. This review summarizes current knowledge about differences in the immune system function and immunological responses of animals commonly used in preclinical studies of nanomaterials. We discuss challenges, highlight current gaps, and propose recommendations for animal model selection to streamline preclinical analysis of nanotechnology formulations.
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Affiliation(s)
- William C Zamboni
- UNC Eshelman School of Pharmacy, UNC Lineberger Comprehensive Cancer Center, Carolina Center of Cancer Nanotechnology Excellence, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University and SeroScience Ltd, Nagyvárad tér 4, 1089 Budapest, Hungary; Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc, Hungary
| | - Serguei V Kozlov
- Laboratory of Animal Sciences Program, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Andrew T Lucas
- UNC Eshelman School of Pharmacy, UNC Lineberger Comprehensive Cancer Center, Carolina Center of Cancer Nanotechnology Excellence, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph A Piscitelli
- UNC Eshelman School of Pharmacy, UNC Lineberger Comprehensive Cancer Center, Carolina Center of Cancer Nanotechnology Excellence, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, United States.
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Cicha I, Matuszak J, Sekita A, Baeuerle T, Dezsi L, Szebeni J, Lyer S, Alexiou C, Unterweger H. P6481Novel dextran-coated ultrasmall superparamagnetic iron oxide nanoparticles (USPIOs) - a safe contrast agent for magnetic resonance imaging of atherosclerosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I Cicha
- University Hospital Erlangen, Section of Exp. Oncology and Nanomedicine, Erlangen, Germany
| | - J Matuszak
- University Hospital Erlangen, Section of Exp. Oncology and Nanomedicine, Erlangen, Germany
| | - A Sekita
- University Hospital Erlangen, Section of Exp. Oncology and Nanomedicine, Erlangen, Germany
| | - T Baeuerle
- University Hospital Erlangen, Institute of Radiology, Preclinical Imaging Platform Erlangen, Erlangen, Germany
| | - L Dezsi
- Semmelweis University, Nanomedicine Research and Education Center, Budapest, Hungary
| | - J Szebeni
- Semmelweis University, Nanomedicine Research and Education Center, Budapest, Hungary
| | - S Lyer
- University Hospital Erlangen, Section of Exp. Oncology and Nanomedicine, Erlangen, Germany
| | - C Alexiou
- University Hospital Erlangen, Section of Exp. Oncology and Nanomedicine, Erlangen, Germany
| | - H Unterweger
- University Hospital Erlangen, Section of Exp. Oncology and Nanomedicine, Erlangen, Germany
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17
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Zare A, Pourfathollah AA, Pourpak Z, Szebeni J, Ghaffari SMR, Kardar GA. Peptide-based Vaccines Derived from FcεRI Beta Subunit Can Reduce Allergic Response in Mice Model. Iran J Allergy Asthma Immunol 2017; 16:289-297. [PMID: 28865408] [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] [Subscribe] [Scholar Register] [Accepted: 08/12/2017] [Indexed: 06/07/2023]
Abstract
Current therapeutic approaches in allergic diseases especially asthma generally focus on using immunological strategies. According to the importance of FceRI in controlling allergic response we used two extracellular regions of Fc epsilon receptor I (FceRI) beta subunit peptides to design two peptide-based vaccines. Probably these peptides vaccines by triggering the immune response to FceRI can reduce the allergic symptoms through blocking the IgE specific receptor. Two extracellular parts of FceRI beta subunit were made by peptide synthesizer and conjugated with keyhole limpet Hemocyanin. These conjugated peptides were used and evaluated as therapeutic vaccines in allergic airway inflammation mouse model. Total IgE and anti ovalbumin specific IgE were measured in mice serum and compared in vaccinated and unvaccinated allergic mice. Histamine, prostaglandin D2 (PGD2), IL-4 and IL-13 were measured in bronchoalveolar lavage (BAL) fluid of vaccinated allergic mice versus unvaccinated and histopathologic examination were performed in studied groups. After vaccination of mice with each of the peptide vaccines the specific antibodies titer increased significantly in vaccinated groups versus unvaccinated. In histopathologic study, lavage eosinophil percentage and peribronchial inflammation in lung sections of vaccinated groups was decreased (p<0.05). Also the allergic components including total IgE, anti ovalbumin specific IgE, histamine, PGD2, IL-4, and IL-13 showed substantial decline in vaccinated allergic mice. Thus targeting the extracellular regions of FceRI beta subunit by peptide-based vaccines and induction of specific antibodies against them can reduce allergic responses in allergic mice model.
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Affiliation(s)
- Ahad Zare
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Akbar Pourfathollah
- Department of Immunology Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Pourpak
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary
| | | | - Gholam Ali Kardar
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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18
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Wibroe PP, Anselmo AC, Nilsson PH, Sarode A, Gupta V, Urbanics R, Szebeni J, Hunter AC, Mitragotri S, Mollnes TE, Moghimi SM. Bypassing adverse injection reactions to nanoparticles through shape modification and attachment to erythrocytes. Nat Nanotechnol 2017; 12:589-594. [PMID: 28396605 DOI: 10.1038/nnano.2017.47] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 02/27/2017] [Indexed: 05/18/2023]
Abstract
Intravenously injected nanopharmaceuticals, including PEGylated nanoparticles, induce adverse cardiopulmonary reactions in sensitive human subjects, and these reactions are highly reproducible in pigs. Although the underlying mechanisms are poorly understood, roles for both the complement system and reactive macrophages have been implicated. Here, we show the dominance and importance of robust pulmonary intravascular macrophage clearance of nanoparticles in mediating adverse cardiopulmonary distress in pigs irrespective of complement activation. Specifically, we show that delaying particle recognition by macrophages within the first few minutes of injection overcomes adverse reactions in pigs using two independent approaches. First, we changed the particle geometry from a spherical shape (which triggers cardiopulmonary distress) to either rod- or disk-shape morphology. Second, we physically adhered spheres to the surface of erythrocytes. These strategies, which are distinct from commonly leveraged stealth engineering approaches such as nanoparticle surface functionalization with poly(ethylene glycol) and/or immunological modulators, prevent robust macrophage recognition, resulting in the reduction or mitigation of adverse cardiopulmonary distress associated with nanopharmaceutical administration.
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Affiliation(s)
- Peter Popp Wibroe
- Nanomedicine Laboratory, Centre for Pharmaceutical Nanotechnology and Nanotoxicology, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen Ø, Denmark
| | - Aaron C Anselmo
- Department of Chemical Engineering and Center for Bioengineering, University of California at Santa Barbara, Santa Barbara, California 93106, USA
| | - Per H Nilsson
- Department of Immunology, Oslo University Hospital Rikshospitalet, 0372 Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, 0372 Oslo, Norway
- Linnaeus Centre for Biomaterials Chemistry, Linnaeus University, 391 82 Kalmar, Sweden
| | - Apoorva Sarode
- Department of Chemical Engineering and Center for Bioengineering, University of California at Santa Barbara, Santa Barbara, California 93106, USA
| | - Vivek Gupta
- College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, New York 11439, USA
| | - Rudolf Urbanics
- Nanomedicine Research and Education Center, Semmelweis University, Budapest &SeroScience Ltd, Budapest, Hungary
| | - Janos Szebeni
- Nanomedicine Research and Education Center, Semmelweis University, Budapest &SeroScience Ltd, Budapest, Hungary
| | - Alan Christy Hunter
- Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Samir Mitragotri
- Department of Chemical Engineering and Center for Bioengineering, University of California at Santa Barbara, Santa Barbara, California 93106, USA
| | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital Rikshospitalet, 0372 Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, 0372 Oslo, Norway
- Reserach Laboratory, Nordland Hospital, 8092 Bodø, Norway
- K.G. Jebsen TREC, University of Tromsø, 9037 Tromsø, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Seyed Moein Moghimi
- Nanomedicine Laboratory, Centre for Pharmaceutical Nanotechnology and Nanotoxicology, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen Ø, Denmark
- Nano-Science Center, University of Copenhagen, Universitetsparken 5, DK-2100 Copenhagen Ø, Denmark
- School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK
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Szebeni J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Rampton D, Weiss G, Folkersen J. Hypersensitivity to intravenous iron: classification, terminology, mechanisms and management. Br J Pharmacol 2015; 172:5025-36. [PMID: 26265306 DOI: 10.1111/bph.13268] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 12/19/2022] Open
Abstract
Intravenous (IV) iron therapy is widely used in iron deficiency anaemias when oral iron is not tolerated or ineffective. Administration of IV-iron is considered a safe procedure, but severe hypersensitivity reactions (HSRs) can occur at a very low frequency. Recently, new guidelines have been published by the European Medicines Agency with the intention of making IV-iron therapy safer; however, the current protocols are still non-specific, non-evidence-based empirical measures which neglect the fact that the majority of IV-iron reactions are not IgE-mediated anaphylactic reactions. The field would benefit from new specific and effective methods for the prevention and treatment of these HSRs, and the main goal of this review was to highlight a possible new approach based on the assumption that IV-iron reactions represent complement activation-related pseudo-allergy (CARPA), at least in part. The review compares the features of IV-iron reactions to those of immune and non-immune HSRs caused by a variety of other infused drugs and thus make indirect inferences on IV-iron reactions. The process of comparison highlights many unresolved issues in allergy research, such as the unsettled terminology, multiple redundant classifications and a lack of validated animal models and lege artis clinical studies. Facts and arguments are listed in support of the involvement of CARPA in IV-iron reactions, and the review addresses the mechanism of low reactogenic administration protocols (LRPs) based on slow infusion. It is suggested that consideration of CARPA and the use of LRPs might lead to useful new additions to the management of high-risk IV-iron patients.
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Affiliation(s)
- J Szebeni
- Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.,Department of Nanobiotechnology and Regenerative Medicine, Miskolc University, Miskolc, Hungary
| | - S Fishbane
- Hofstra North Shore-LIJ School of Medicine, New York, NY, USA
| | - M Hedenus
- Department for Internal Medicine, Sundsvalls Hospital, Sundsvall, Sweden
| | - S Howaldt
- Research Institute for IBD, HaFCED GmbH & Co. KG, Hamburg, Germany
| | - F Locatelli
- Department of Nephrology, Alessandro Manzoni Hospital, Lecco, Italy
| | - S Patni
- Birmingham Heartlands Hospital, Birmingham, UK
| | - D Rampton
- Barts and the London School of Medicine and Dentistry, London, UK
| | - G Weiss
- Department for Internal Medicine VI, Medical University of Innsbruck, Innsbruck, Austria
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20
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Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Szebeni J, Weiss G. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica 2015; 99:1671-6. [PMID: 25420283 DOI: 10.3324/haematol.2014.111492] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Intravenous iron is widely used for the treatment of iron deficiency anemia when oral iron is inappropriate, ineffective or poorly tolerated. Acute hypersensitivity reactions during iron infusions are very rare but can be life-threatening. This paper reviews their frequency, pathogenesis and risk factors, and provides recommendations about their management and prevention. Complement activation-related pseudo-allergy triggered by iron nanoparticles is probably a more frequent pathogenetic mechanism in acute reactions to current formulations of intravenous iron than is an immunological IgE-mediated response. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases. Early pregnancy is a contraindication to iron infusions, while old age and serious co-morbidity may worsen the impact of acute reactions if they occur. Management of iron infusions requires meticulous observation, and, in the event of an adverse reaction, prompt recognition and severity-related interventions by well-trained medical and nursing staff.
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Affiliation(s)
- David Rampton
- Barts and the London School of Medicine and Dentistry, London, UK
| | | | - Steven Fishbane
- Hofstra North Shore-LIJ School of Medicine, New York, NY, USA
| | | | - Stefanie Howaldt
- Research Institute for IBD, HaFCED GmbH&Co. KG, Hamburg, Germany
| | | | | | - Janos Szebeni
- Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary
| | - Guenter Weiss
- Department for Internal Medicine VI, Medical University of Innsbruck, Austria
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21
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Szebeni J, Storm G. Complement activation as a bioequivalence issue relevant to the development of generic liposomes and other nanoparticulate drugs. Biochem Biophys Res Commun 2015; 468:490-7. [PMID: 26182876 DOI: 10.1016/j.bbrc.2015.06.177] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 01/09/2023]
Abstract
Liposomes are known to activate the complement (C) system, which can lead in vivo to a hypersensitivity syndrome called C activation-related pseudoallergy (CARPA). CARPA has been getting increasing attention as a safety risk of i.v. therapy with liposomes, whose testing is now recommended in bioequivalence evaluations of generic liposomal drug candidates. This review highlights the adverse consequences of C activation, the unique symptoms of CARPA triggered by essentially all i.v. administered liposomal drugs, and the various features of vesicles influencing this adverse immune effect. For the case of Doxil, we also address the mechanism of C activation and the opsonization vs. long circulation (stealth) paradox. In reviewing the methods of assessing C activation and CARPA, we delineate the most sensitive porcine model and an algorithm for stepwise evaluation of the CARPA risk of i.v. liposomes, which are proposed for standardization for preclinical toxicology evaluation of liposomal and other nanoparticulate drug candidates.
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Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Semmelweis University, Budapest & SeroScience Ltd, Budapest, Hungary.
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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22
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Bedocs P, Capacchione J, Potts L, Chugani R, Weiszhar Z, Szebeni J, Buckenmaier CC. Hypersensitivity reactions to intravenous lipid emulsion in swine: relevance for lipid resuscitation studies. Anesth Analg 2015; 119:1094-101. [PMID: 25126705 DOI: 10.1213/ane.0000000000000396] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Reports in the recent experimental literature have provided contradicting results in different animal species regarding the efficacy of IV lipid emulsion (ILE) in the reversal of cardiovascular and central nervous system symptoms of local anesthetic and other lipophilic drug overdoses. In particular, ILE seemed to be effective in rats, rabbits, dogs, and humans, but not in swine, for which it not only failed to reverse the adverse effects of anesthetics, but the animals also developed a generalized cutaneous mottling or a dusky appearance immediately after ILE, suggestive of another type of toxicity. The latter symptoms arise in complement (C) activation-related pseudoallergy, a hypersensitivity reaction to particulate drugs and agents. METHODS Ten Yorkshire swine (15-20 kg) were sedated with ketamine and anesthetized with isoflurane. ILE 1.5 and 5 mL/kg 20% was administered via the ear vein while pulmonary arterial pressure, systemic arterial blood pressure, electrocardiogram, and end-tidal CO2 were recorded continuously. Thromboxane was measured in blood collected at baseline and 2 and 10 minutes after injections. Complement activation by lipid emulsion was also assessed in vitro with soluble terminal complement complex (SC5b-9) and sheep red blood cell assays. RESULTS Significant increases were observed in the pulmonary pressure (median [interquartile range]) within minutes after the administration of ILE, both at doses 1.5 and 5 mL/kg (15 [12-16.5] to 18.5 [16-20] mm Hg, P = 0.0058 and 15.5 [13-17.25] to 39.5 [30.5-48.5], respectively). The systemic arterial blood pressure increased, and the heart rate decreased after both injections. Thromboxane B2 concentration (median [interquartile range]) in the blood plasma increased from a baseline of 617.3 [412.4-920] to 1132 [597.9-1417] pg/mL (P = 0.0055) and from 1276 [1200-2581] to 4046 [2946-8442] pg/mL (P = 0.0017) after the administration of 1.5 and 5 mL/kg ILE, respectively. Intralipid did not cause in vitro complement activation in human serum. CONCLUSIONS ILE causes clinically significant hemodynamic changes in pigs, in concert with significant increases in the plasma thromboxane concentration. However, the in vitro tests did not confirm involvement of the complement system in human sera, leaving the underlying mechanism of these findings in doubt. Nonetheless, the observed hemodynamic and biochemical effects of ILE serve as a caveat that the pig is not an ideal model for the study of interventions involving ILE.
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Affiliation(s)
- Peter Bedocs
- From the *Defense and Veterans Center for Integrative Pain Management; †Department of Anesthesiology, Uniformed Services University; ‡Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland; §Washington University in St. Louis, St. Louis, Missouri; ∥Seroscience Ltd.; ¶Nanomedicine Research and Education Center, Semmelweis University Budapest, Budapest; and #Department of Nanobiotechnology, Institute of Theoretical Health Sciences, Miskolc University, Miskolc, Hungary
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Kokeny G, Foss A, Karetnick M, Szebeni J, Nemeth A, Fazekas K, Czirok S, Rosivall L, Mozes M. FP301STRAIN-DEPENDENT RENAL COMPLEMENT EXPRESSION IN KIDNEY FIBROSIS OF TGF-ß TRASGENIC MICE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv174.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fülöp TG, Józsi M, Metselaar J, Storm G, Rosivall L, Szebeni J. The possible role of factor H in complement activation-related pseudoallergy (CARPA): a failed attempt to correlate blood levels of FH with liposome-induced hypersensitivity reactions in patients with autoimmune disease. European Journal of Nanomedicine 2015. [DOI: 10.1515/ejnm-2015-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractFactor H (FH) is a natural inhibitor of the alternative pathway (AP) of complement (C) activation, an abundant protein in blood whose reduced level has been associated with proneness for increased C activation. There are also 5 FH-related proteins (FHR), which have different impacts on C function. After brief outlines of the C system and its activation via the AP, this review focuses on FH and FHR, collecting data from the literature that suggest that reduced levels or function of FH is associated with C activation-related hypersensitivity reactions (HSRs), called C activation related pseudoallergy (CARPA). Based on such observations we initiated the measurement of FH in the blood of patients with inflammatory bowel disease (IBD) and rheumatoid arthritis (RA), and examined the correlation between FH levels and HSRs following i.v. administration of PEGylated liposomal prednisolone phosphate (PLPP). ELISA assay of FH was conducted on plasma samples before treatment, immediately after treatment and at follow-up visits up to 7 weeks, and an attempt was made to correlate the FH levels obtained with the presence or absence of HSR that occurred in five of twenty patients. However, the initial data presented here on three reactive and three non-reactive patients showed FH levels >600 μg/mL, while the normal range of FH is 2–300 μg/mL. This unexpected outcome of the test led us to realize that the ELISA we used was based on antibodies raised against the short consensus repeats (SCR) in FH, which are also present in FHR. Thus the kit cannot distinguish these proteins and we most likely measured the combined levels of FH and FHR. These initial data highlighted an unforeseen technical problem in assessing FH function when using a FH ELISA that cross reacts with FHR, information that helps in further studies exploring the role of FH in CARPA.
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Scripture CD, Szebeni J, Loos WJ, Figg WD, Sparreboom A. Comparative in vitro properties and clinical pharmacokinetics of paclitaxel following the administration of Taxol® and Paxene®. Cancer Biol Ther 2014; 4:555-60. [PMID: 15917657 DOI: 10.4161/cbt.4.5.1664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 11/19/2022] Open
Abstract
PURPOSE Taxol contains paclitaxel formulated in Cremophor EL-P (CrEL-P) and ethanol. Paxene is similar to Taxol, except for the use of Cremophor EL (CrEL) and the addition of citric acid. Here, we investigated the physicochemical properties and clinical pharmacokinetics of the two paclitaxel formulations. EXPERIMENTAL DESIGN The size and modality of distribution of CrEL-P and CrEL micelles was determined by dynamic-light scattering. The effect of vehicle composition on the fraction unbound paclitaxel in vitro was determined by equilibrium dialysis. Paclitaxel pharmacokinetics were studied in 61 cancer patients receiving Taxol and 26 patients receiving Paxene. Comparative pharmacokinetics of CrEL-P and CrEL were obtained in 14 and 6 patients, respectively. RESULTS The size of micelles present in Taxol was slightly smaller (9 to 13%) than those present in Paxene. Surface tension and critical micellar concentration were also similar for the two formulations, with mean values of 37.0 and 38.1 mN/m and 0.0387 and 0.0307 mg/mL, respectively. The fraction unbound paclitaxel was not significantly different for Taxol and Paxene (p > 0.05). Over the tested dose range, the mean clearance of paclitaxel decreased from 45.1 to 16.9 L/h for Taxol, and from 50.7 to 16.4 L/h for Paxene (p > 0.05). Concentrations of the excipient following the administration of CrEL-P or CrEL were also similar. CONCLUSION The differences in formulation between Taxol and Paxene do not significantly affect micelle formation and/or quantitative aspects of the vehicle-paclitaxel interaction in vitro and in vivo.
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Affiliation(s)
- Charity D Scripture
- Clinical Pharmacology Research Core, National Cancer Institute, Bethesda, MD, USA
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26
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Szebeni J. Complement activation-related pseudoallergy: A stress reaction in blood triggered by nanomedicines and biologicals. Mol Immunol 2014; 61:163-73. [DOI: 10.1016/j.molimm.2014.06.038] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
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Szebeni J, Jiskoot W. Immunological Issues with Nanomedicines: Immunogenicity, Hypersensitivity, Accelerated Clearance and Immune Suppression. Frontiers in Nanobiomedical Research 2014. [DOI: 10.1142/9789814520652_0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Semmelweis University, Budapest and Department of Nanobiotechnology and Regenerative Medicine, Miskolc University, Miskolc, Hungary
| | - Wim Jiskoot
- Division of Drug Delivery Technology, Leiden Academic Centre for Drug Research, Leiden University, P. O. Box 9502, 2300 RA Leiden, The Netherlands
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Szebeni J, Mészáros T, Weiszhár Z, Schneider T, Rosivall L, Rosta A, Urbanics R. Prediction of hypersensitivity reactions to anticancer drugs and monoclonal antibodies by testing complement activation in vitro. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Moghimi SM, Wibroe PP, Szebeni J, Hunter AC. Surfactant-mediated complement activation in beagle dogs. Int Immunopharmacol 2013; 17:33-4. [DOI: 10.1016/j.intimp.2013.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
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30
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van den Hoven JM, Nemes R, Metselaar JM, Nuijen B, Beijnen JH, Storm G, Szebeni J. Complement activation by PEGylated liposomes containing prednisolone. Eur J Pharm Sci 2013; 49:265-71. [DOI: 10.1016/j.ejps.2013.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 02/28/2013] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
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31
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Szebeni J, Muggia F, Gabizon A, Barenholz Y. Activation of complement by therapeutic liposomes and other lipid excipient-based therapeutic products: prediction and prevention. Adv Drug Deliv Rev 2011; 63:1020-30. [PMID: 21787819 DOI: 10.1016/j.addr.2011.06.017] [Citation(s) in RCA: 284] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 06/30/2011] [Indexed: 10/18/2022]
Abstract
Some therapeutic liposomes and lipid excipient-based anticancer drugs are recognized by the immune system as foreign, leading to a variety of adverse immune phenomena. One of them is complement (C) activation, the cause, or major contributing factor to a hypersensitivity syndrome called C activation-related pseudoallergy (CARPA). CARPA represents a novel subcategory of acute (type I) hypersensitivity reactions (HSR), which is mostly mild, transient, and preventable by appropriate precautions. However, in an occasional patient, it can be severe or even lethal. Because a main manifestation of C activation is cardiopulmonary distress, CARPA may be a safety issue primarily in cardiac patients. Along with an overview of the various types of liposome-immune system interactions, this review updates the experimental and clinical information on CARPA to different therapeutic liposomes and lipid excipient-based (micellar) anticancer drugs, including PEGylated liposomal doxorubicin sulfate (PLD, Doxil®) and paclitaxel (Taxol®). The substantial individual variation of in vitro and in vivo findings reflects an extremely complex immune phenomenon involving multiple, redundant pathways of C activation, signal transduction in allergy-mediating cells and vasoactive mediator actions at the effector cell level. The latest advances in this field include the proposal of doxorubicin-induced shape changes and aggregation of liposomes in Doxil as possible contributing factors to CARPA caused by PLD, and the finding that Doxil-induced immune suppression prevents HSR to co-administered carboplatin, a significant benefit of Doxil in combination chemotherapy with carboplatin. The review evaluates the use of in vitro C assays and the porcine liposome-induced cardiopulmonary distress model for predicting CARPA. It is concluded that CARPA may become a frequent safety issue in the upcoming era of nanomedicines, necessitating its prevention at an early stage of nanomedicine R&D.
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Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Bay Zoltan Foundation for Applied Research and Semmelweis University Medical School, Budapest, Hungary.
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Merkel OM, Urbanics R, Bedocs P, Rozsnyay Z, Rosivall L, Toth M, Kissel T, Szebeni J. In vitro and in vivo complement activation and related anaphylactic effects associated with polyethylenimine and polyethylenimine-graft-poly(ethylene glycol) block copolymers. Biomaterials 2011; 32:4936-42. [PMID: 21459440 DOI: 10.1016/j.biomaterials.2011.03.035] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/12/2011] [Indexed: 01/19/2023]
Abstract
Complement activation by polymeric gene and drug delivery systems has been overlooked in the past. As more reports appear in the literature concerning immunogenicity of polymers and their impact on gene expression patterns, it is important to address possible immune side effects of polymers, namely complement activation. Therefore, in this study the activity of low and high molecular weight poly(ethylene imine) and two PEGylated derivatives to induce complement activation were investigated in human serum. These in vitro results revealed that PEI 25 kDa caused significant and concentration dependent complement activation, whereas none of the other polymers induced such effects at their IC(50) concentrations determined by MTT-assays. To verify these in vitro results, additionally, studies were carried out in a swine model after intravenous administration, showing complement activation-related pseudoallergy (CARPA), reflected in symptoms of transient cardiopulmonary distress. Injections of PEI 25 kDa or PEI(25k)-PEG(2k)(10) at a dose of 0.05 and 0.1 mg/kg caused strong reactivity, while PEI 5 kDa and with PEI(25k)-PEG(20k)(1) were also reactogenic at 0.1 mg/kg. It was found that PEI 25 kDa caused both self- and cross-tolerance, whereas the PEG-PEIs were neither self- nor cross-reactively tachyphylactic. As a result of this study, it was shown that PEGylation of polycations with PEG of 20 kDa or higher molecular weight may be favorable. However, potential safety concerns in the development of PEI-based polymeric carriers for drugs and nucleic acids and their translation from bench to bedside need to be taken into consideration for human application.
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Affiliation(s)
- Olivia M Merkel
- Department of Pharmaceutics and Biopharmacy, Philipps Universität Marburg, Ketzerbach 63, 35032 Marburg, Germany
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33
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Szebeni J. [Nanomedicine: application of nanotechnology in medicine. Opportunities in neuropsychiatry]. Neuropsychopharmacol Hung 2011; 13:15-24. [PMID: 21451188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
One of the most popular, most intensely expanding borderline of science and technology today is nanomedicine, the utilization of nanotechnology in medicine. The long lists of innovative medicinal and other products, astonishing market and scientometric indicators and the broad scale of promising therapeutic and diagnostic opportunities support the view that nanomedicine heralds the future of medicine. The goals of this review are to provide a comprehensive overview of the field, to compile the nanomedicines and other medical products that are on the market, and to address in more detail the most successful trend, targeted pharmacotherapy. Various nanocarriers (liposomes, micelles, polymer-conjugates, polymerosomes, dendrimers, aptamers and carbon nanotubes) will be presented, along with their targeting ligands, with special emphasis on liposomal doxorubicin (Doxil), the prototype of long-circulating, targeted chemotherapeutic nanomedicine. Nanotechnology holds great promises for the field of neuropsychiatric pharmacotherapy as well, mainly through the introduction of pharmaceutical agents passing the blood-brain barrier. The review presents some of the approaches and examples of these attempts.
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Affiliation(s)
- Janos Szebeni
- Nanomedicina Kutató és Oktató Központ, Hungary; Semmelweis Egyetem, Bay Zoltán Alkalmazott Kutatási Közalapítvány, Budapest, Hungary.
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Epstein-Barash H, Gutman D, Markovsky E, Mishan-Eisenberg G, Koroukhov N, Szebeni J, Golomb G. Physicochemical parameters affecting liposomal bisphosphonates bioactivity for restenosis therapy: Internalization, cell inhibition, activation of cytokines and complement, and mechanism of cell death. J Control Release 2010; 146:182-95. [DOI: 10.1016/j.jconrel.2010.03.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 03/14/2010] [Indexed: 11/15/2022]
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35
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Racz Z, Nagy E, Rosivall L, Szebeni J, Hamar P. Sugar-free, glycine-stabilized intravenous immunoglobulin prevents skin but not renal disease in the MRL/lpr mouse model of systemic lupus. Lupus 2010; 19:599-612. [PMID: 20167630 DOI: 10.1177/0961203309355299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intravenous immunoglobulin (IVIG) has a therapeutic potential in many autoimmune diseases. Based on its immune modulating and complement inhibiting effects, IVIG has been tested in systemic lupus erythematosus (SLE), but due to osmotic tubular injury caused by immunoglobulin-stabilizing sugar components, lupus nephritis had been accelerated in some patients, thus IVIG use in SLE has been abandoned. The availability of non-sugar-stabilized IVIG raised the possible re-evaluation of IVIG for SLE. We investigated high-dose, long-term non-sugar-stabilized IVIG treatment on skin and renal SLE manifestations in the MRL/lpr mouse model. Animals were treated once a week with glycine-stabilized IVIG or saline (0.2 ml/ 10 g BW) from 6 weeks until they were humanely killed at 5 months of age. IVIG diminished macroscopic cutaneous lupus compared with saline treated mice. Histology and complement-3 immunostaining also demonstrated a significant reduction of skin disease after IVIG treatment. However, renal histology and function were similar in both groups. Compared with typical osmotic tubular damage induced by 5% sucrose and 10% maltose (used for IVIG stabilization), we did not observe any osmotic tubular injury in the glycine-stabilized IVIG treated mice. Our data demonstrate a beneficial effect of IVIG on skin lupus without renal side-effects. Deeper understanding of the organ-specific pathomechanism may aid an individualized SLE therapy.
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Affiliation(s)
- Z Racz
- Institute of Pathophysiology, Semmelweis Medical University, Nagyvarad ter 4., Budapest 1089, Hungary
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36
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Moein Moghimi S, Hamad I, Bünger R, Andresen TL, Jørgensen K, Hunter AC, Baranji L, Rosivall L, Szebeni J. Activation of the Human Complement System by Cholesterol-Rich and PEGylated Liposomes—Modulation of Cholesterol-Rich Liposome-Mediated Complement Activation by Elevated Serum LDL and HDL Levels. J Liposome Res 2008; 16:167-74. [PMID: 16952871 DOI: 10.1080/08982100600848801] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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: 10/24/2022]
Abstract
Intravenously infused liposomes may induce cardiopulmonary distress in some human subjects, which is a manifestation of "complement activation-related pseudoallergy." We have now examined liposome-mediated complement activation in human sera with elevated lipoprotein (LDL and HDL) levels, since abnormal or racial differences in serum lipid profiles seem to modulate the extent of complement activation and associated adverse responses. In accordance with our earlier observations, cholesterol-rich (45 mol% cholesterol) liposomes activated human complement, as reflected by a significant rise in serum level of S-protein-bound form of the terminal complex (SC5b-9). However, liposome-induced rise of SC5b-9 was significantly suppressed when serum HDL cholesterol levels increased by 30%. Increase of serum LDL to levels similar to that observed in heterozygous familial hypercholesterolemia also suppressed liposome-mediated SC5b-9 generation considerably. While intravenous injection of cholesterol-rich liposomes into pigs was associated with an immediate circulatory collapse, the drop in systemic arterial pressure following injection of liposomes preincubated with human lipoproteins was slow and extended. Therefore, surface-associated lipoprotein particles (or apolipoproteins) seem to lessen liposome-induced adverse haemodynamic changes, possibly as a consequence of suppressed complement activation in vivo. PEGylated liposomes were also capable of activating the human complement system, and the presence of surface projected methoxypoly(ethylene glycol) chains did not interfere with generation of C3 opsonic fragments. We also show that poly(ethylene glycol) is not responsible for PEGylated liposome-mediated complement activation. The net anionic charge on the phosphate moiety of the phospholipid-mPEG conjugate seemed to play a critical role in activation of both the classical and alternative pathways of the complement system.
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Affiliation(s)
- S Moein Moghimi
- Molecular Targeting and Polymer Toxicology, School of Pharmacy, University of Brighton, Brighton, UK.
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38
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Hamad I, Hunter A, Szebeni J, Moghimi S. Poly(ethylene glycol)s generate complement activation products in human serum through increased alternative pathway turnover and a MASP-2-dependent process. Mol Immunol 2008; 46:225-32. [DOI: 10.1016/j.molimm.2008.08.276] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 08/26/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
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39
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Szebeni J, Bedocs P, Toth M, Rosivall L, Cohen R, Barenholz Y. New desensitization method for complement-mediated hypersensitivity reactions. Mol Immunol 2008. [DOI: 10.1016/j.molimm.2008.08.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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40
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Szebeni J, Baranyi L, Savay S, Lutz HU, Jelezarova E, Bunger R, Alving CR. The Role of Complement Activation in Hypersensitivity to Pegylated Liposomal Doxorubicin (Doxil®). J Liposome Res 2008. [DOI: 10.3109/08982100009031112] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Bedocs P, Baranyi L, Szebeni J, Bunger R. Adenosine contributes to complement‐activation‐related paradoxical bradycardia. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.737.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter Bedocs
- APGUniformed Services University of the Health SciencesBethesdaMD
- Semmelweis UniversityBudapestHungary
| | - Lajos Baranyi
- APGUniformed Services University of the Health SciencesBethesdaMD
| | - Janos Szebeni
- NanomedicineBay Zoltan Nanotechnology InstituteMiskolcHungary
- NanotechnologySemmelweis UniversityHungaryBudapestHungary
| | - Rolf Bunger
- APGUniformed Services University of the Health SciencesBethesdaMD
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42
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Romberg B, Metselaar JM, Baranyi L, Snel CJ, Bünger R, Hennink WE, Szebeni J, Storm G. Poly(amino acid)s: Promising enzymatically degradable stealth coatings for liposomes. Int J Pharm 2007; 331:186-9. [PMID: 17145145 DOI: 10.1016/j.ijpharm.2006.11.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/03/2006] [Accepted: 11/06/2006] [Indexed: 11/29/2022]
Abstract
Poly(amino acid)s (PAAs) were evaluated as coating polymers for long-circulating liposomes. The pharmacokinetics of PAA-coated liposomes were assessed in rats. Prolonged circulation times were obtained, comparable to those reported for poly(ethylene glycol) (PEG)-liposomes. Besides, the enzymatic degradability of PAAs was studied. PAAs - in free as well as liposome-associated form - are degradable by proteases, which is beneficial for reducing the risks of accumulation in vivo. Furthermore, complement activation by PAA-liposomes was evaluated in vitro and in vivo. Like other liposome types, they appear to activate the complement system. However, a role of endotoxin contamination of the PAA-liposome formulations used cannot be excluded in our complement activation studies.
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Affiliation(s)
- Birgit Romberg
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands.
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43
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Moghimi SM, Hamad I, Andresen TL, Jørgensen K, Szebeni J. Methylation of the phosphate oxygen moiety of phospholipid‐methoxy(polyethylene glycol) conjugate prevents PEGylated liposome‐mediated complement activation and anaphylatoxin production. FASEB J 2006; 20:2591-3. [PMID: 17065229 DOI: 10.1096/fj.06-6186fje] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [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: 01/10/2023]
Abstract
Methoxy(polyethylene glycol), mPEG, -grafted liposomes are known to exhibit prolonged circulation time in the blood, but their infusion into a substantial percentage of human subjects triggers immediate non-IgE-mediated hypersensitivity reactions. These reactions are strongly believed to arise from anaphylatoxin production through complement activation. Despite the general view that vesicle surface camouflaging with mPEG should dramatically suppress complement activation, here we show that bilayer enrichment of noncomplement activating liposomes [dipalmitoylphosphatidylcholine (DPPC) vesicles] with phospholipid-mPEG conjugate induces complement activation resulting in vesicle recognition by macrophage complement receptors. The extent of vesicle uptake, however, is dependent on surface mPEG density. We have delineated the likely structural features of phospholipid-mPEG conjugate responsible for PEGylated liposome-induced complement activation in normal as well as C1q-deficient human sera, using DPPC vesicles bearing the classical as well as newly synthesized lipid-mPEG conjugates. With PEGylated DPPC vesicles, the net anionic charge on the phosphate moiety of phospholipid-mPEG conjugate played a key role in activation of both classical and alternative pathways of complement and anaphylatoxin production (reflected in significant rises in SC5b-9, C4d, and C3a-desarg levels in normal human sera as well as SC5b-9 in EGTA-chelated/Mg2+ supplemented serum), since methylation of the phosphate oxygen of phospholipid-mPEG conjugate, and hence the removal of the negative charge, totally prevented complement activation. To further corroborate on the role of the negative charge in complement activation, vesicles bearing anionic phospholipid-mPEG conjugates, but not the methylated phospholipid-mPEG, were shown to significantly decrease serum hemolytic activity and increase plasma thromboxane B2 levels in rats. In contrast to liposomes, phospholipid-mPEG micelles had no effect on complement activation, thus suggesting a possible role for vesicular zwitterionic phospholipid head-groups as an additional factor contributing to PEGylated liposome-mediated complement activation. Our findings provide a rational conceptual basis for development of safer vesicles for site-specific drug delivery and controlled release at pathological sites.
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Affiliation(s)
- S Moein Moghimi
- Molecular Targeting and Polymer Toxicology Group, School of Pharmacy, University of Brighton, Cockcroft Bldg., Lewes Rd., Brighton BN2 4GJ, UK.
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44
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Bodo M, Szebeni J, Baranyi L, Savay S, Pearce FJ, Alving CR, Bünger R. Cerebrovascular involvement in liposome-induced cardiopulmonary distress in pigs. J Liposome Res 2005; 15:3-14. [PMID: 16194924 DOI: 10.1081/lpr-64523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/03/2022]
Abstract
Intravenous administration of liposomes, including Doxil, can cause severe life-threatening hemodynamic changes in pigs. The reaction is due to complement activation, and it is characterized by massive pulmonary hypertension, systemic hypotension, and severe cardiac abnormalities including falling cardiac output, tachy-or bradycardia with arrhythmia. There were no data suggesting the involvement of cerebrovascular changes in this reaction; however, clinical observations allowed this hypothesis. Here we measured the accompanying changes during liposome infusion by monitoring pulsatile electrical impedance (rheoencephalogram- REG) on the skull (n=24 pigs, 57 trials, 19 types of liposomes). A transient but significant decrease of REG pulse amplitudes followed the injection of liposomes (78.43% in the total sample, and 91.66% in the Doxil subgroup; P=0.003, n=12), indicating the involvement of cerebrovascular reaction during liposome infusion.
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Affiliation(s)
- Michael Bodo
- Department of Resuscitative Medicine, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910-7500, USA.
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45
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Abstract
Self-assembling amphiphilic lipids or polymers have been successfully used in pharmacotherapy as drug solvents or carriers, improving the bioavailability of water-insoluble drugs. This review focuses on an unusual hypersensitivity reaction (HSR) caused by a micellar (Cremophor EL, CrEL) and a monomeric block copolymer (poloxamer 188) representative of these systems. The HSRs, also referred to as anaphylactoid or pseudoallergic, are thought to arise as a consequence of complement (C) activation in blood. However, considering that C activation involves the deposition of multiple C and other (immune) proteins on the activator surface, the mechanism by which small, 8-25 nm CrEL micelles or individual poloxamer 188 molecules activate C is not straightforward. Observations on enlarged lipoproteins and de novo formation of abnormally large lipoprotein-like structures in plasma exposed to CrEL or poloxamer 188 raise the possibility that lipoprotein transformation might play a crucial role in C activation by these amphiphilic emulsifiers. Lipoproteins, furthermore, can also provide a negative feedback control on C activation, as suggested by the inhibition of poloxamer 188-induced C activation in the presence of excess exogenous lipoproteins, and the attenuation of liposome-induced and C activation-related hypotension in pigs by precoating the vesicles with lipoproteins. Thus, lipoproteins may be essential in the induction, and they may also play a complex modulatory role in C activation-related pseudoallergy caused amphiphilic drug solvents and carriers.
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Affiliation(s)
- Janos Szebeni
- Department of Vaccine Production and Delivery, Division of Retrovirology, Walter Reed Army Institute of Research and Henry Jackson Foundation for Military Medical Research, Silver Spring, MD, USA.
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46
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Szebeni J. Complement activation-related pseudoallergy: a new class of drug-induced acute immune toxicity. Toxicology 2005; 216:106-21. [PMID: 16140450 DOI: 10.1016/j.tox.2005.07.023] [Citation(s) in RCA: 411] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 07/18/2005] [Accepted: 07/28/2005] [Indexed: 02/06/2023]
Abstract
A major goal in modern pharmacotechnology is to increase the therapeutic index of drugs by using nanoparticulate vehicle systems in order to ensure slow release or targeted delivery of drugs. With all great benefits, however, these innovative therapies can carry a risk for acute immune toxicity manifested in hypersensitivity reactions (HSRs) that do not involve IgE but arises as a consequence of activation of the complement (C) system. These anaphylactoid reactions can be distinguished within the Type I category of HSRs as "C activation-related pseudoallergy" (CARPA). Drugs and agents causing CARPA include radiocontrast media (RCM), liposomal drugs (Doxil, Ambisome and DaunoXome) and micellar solvents containing amphiphilic lipids (e.g., Cremophor EL, the vehicle of Taxol). These agents activate C through both the classical and the alternative pathways, giving rise to C3a and C5a anaphylatoxins that trigger mast cells and basophils for secretory response that underlies HSRs. Pigs provide a useful model for liposome-induced CARPA as minute amounts of reactogenic lipomes cause C activation with consequent dramatic cardiovascular and laboratory abnormalities that mimic some of the human symptoms. Consistent with the causal role of C activation in liposome-induced HSRs, a recent clinical study demonstrated correlation between the formation of C terminal complex (SC5b-9) in blood and the presence of HSRs in patients treated with liposomal doxorubicin (Doxil). Overall, the CARPA concept may help in the prediction, prevention and treatment of the acute immune toxicity of numerous state-of-the-art drugs.
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Affiliation(s)
- Janos Szebeni
- Department of Vaccine Production and Delivery, Division of Retrovirology, Walter Reed Army Institute of Research and Henry Jackson Foundation for Military Medical Research, Silver Spring, MD, USA.
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Scripture CD, Szebeni J, Figg WD, Sparreboom A. Comparative in vitro properties and pharmacokinetics of paclitaxel following the administration of Taxol and Paxene. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. D. Scripture
- National Cancer Institute, Bethesda, MD; Walter Reed Army Institute of Research, Silver Springs, MD
| | - J. Szebeni
- National Cancer Institute, Bethesda, MD; Walter Reed Army Institute of Research, Silver Springs, MD
| | - W. D. Figg
- National Cancer Institute, Bethesda, MD; Walter Reed Army Institute of Research, Silver Springs, MD
| | - A. Sparreboom
- National Cancer Institute, Bethesda, MD; Walter Reed Army Institute of Research, Silver Springs, MD
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48
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Bodo M, Szebeni J, Baranyi L, Savay S, Pearce FJ, Alving CR, Bünger R. Cerebrovascular Involvement in Liposome - Induced Cardiopulmonary Distress in Pigs. J Liposome Res 2005. [DOI: 10.1081/lpr-200064523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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49
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Moghimi SM, Hunter AC, Dadswell CM, Savay S, Alving CR, Szebeni J. Causative factors behind poloxamer 188 (Pluronic F68, Flocor™)-induced complement activation in human sera. Biochim Biophys Acta Mol Basis Dis 2004; 1689:103-13. [PMID: 15196591 DOI: 10.1016/j.bbadis.2004.02.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 02/17/2004] [Accepted: 02/18/2004] [Indexed: 10/26/2022]
Abstract
Poloxamer 188 is a complex polydisperse mixture of non-ionic macromolecules. Adverse non-IgE-mediated hypersensitivity reactions occur in some individuals following intravenous injection of poloxamer 188-based pharmaceuticals, presumably via complement activation. Here we have delineated potential causal chemical and biological interactive factors behind poloxamer 188-induced complement activation in human serum specimens. We identified the molecular constituents inherent in poloxamer 188 preparations and studied their effect on generation of the two complement split products, SC5b-9 and Bb. Poloxamer 188 activated complement at sub-micellar concentrations and the results indicated the potential involvement of all three known complement activation pathways. The poloxamer-induced rise of SC5b-9 in human sera was abolished in the presence of a recombinant truncated soluble form of complement receptor type 1, thus confirming the role of C3/C5 convertases in the activation process. Poloxamer 188-mediated complement activation is an intrinsic property of these macromolecules and was independent of the degree of sample polydispersity, as opposed to other non-polymeric constituents. Poloxamer 188 preparations also contained unsaturated chains of diblock copolymers capable of generating SC5b-9 in human sera; this effect was terminated following the removal of double bonds by catalytic hydrogenation. By quasi-elastic light scattering, we established interaction between poloxamer and lipoproteins; interestingly, poloxamer-induced rise in SC5b-9 was significantly suppressed when serum HDL and LDL cholesterol levels were increased above normal to mimic two relevant clinical situations. This observation was consistent with previously reported data from patients with abnormal or elevated lipid profiles where no or poor complement activation by poloxamer 188 occurred. Our findings could provide the basis of novel approaches to the prevention of poloxamer-mediated complement activation.
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Affiliation(s)
- S Moein Moghimi
- Molecular Targeting and Polymer Toxicology Group, School of Pharmacy and Biomolecular Sciences, University of Brighton, Lewis Road, Brighton BN2 4GJ, UK.
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Abstract
Although intravenous use of radiocontrast media (RCM) for a variety of radiographic procedures is generally safe, clinically significant acute hypersensitivity reactions still occur in a significant percentage of patients. The mechanism of these anaphylactoid, or "pseudoallergic," reactions is complex, involving complement activation, direct degranulation of mast cells and basophils, and modulation of enzymes and proteolytic cascades in plasma. In this review, basic information on different RCMs and their reactogenicity is summarized and updated, and the prevalence, pathomechanism, prediction, prevention, treatment, and economic impact of hypersensitivity reactions are discussed. Particular attention is paid to the in vitro and in vivo evidence supporting complement activation as an underlying cause of RCM reactions.
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Affiliation(s)
- Janos Szebeni
- Department of Membrane Biochemistry, Walter Reed Army Institute of Research, 501 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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