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Yildiz Pekoz A, Akbal Dagistan O, Fael H, Culha M, Erturk A, Basarir NS, Sahin G, Serhatli M, Cakirca G, Tekin S, Sen LS, Sevim M, Mulazimoglu Durmusoglu L, Yegen BC. Pulmonary delivery of favipiravir inhalation solution for COVID-19 treatment: in vitro characterization, stability, in vitro cytotoxicity, and antiviral activity using real time cell analysis. Drug Deliv 2022; 29:2846-2854. [PMID: 36062490 PMCID: PMC9448368 DOI: 10.1080/10717544.2022.2118398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Favipiravir, an RNA-dependent RNA polymerase (RdRp) inhibitor, is used to treat patients infected with influenza virus and most recently with SARS-CoV-2. However, poor accumulation of favipiravir in lung tissue following oral administration has required an alternative method of administration that directly targets the lungs. In this study, an inhalation solution of favipiravir at a concentration of 2 mg mL-1 was developed and characterized for the first time. The chemical stability of inhaled favipiravir solution in two different media, phosphate buffer saline (PBS) and normal saline (NS), was investigated under different conditions: 5 ± 3 °C, 25 ± 2 °C/60% RH ± 5% RH, and 40 ± 2 °C/75% RH ± 5% RH; in addition to constant light exposure. As a result, favipiravir solution in PBS revealed superior stability over 12 months at 5 ± 3 °C. Antiviral activity of favipiravir was assessed at the concentrations between 0.25 and 3 mg mL-1 with real time cell analyzer on Vero-E6 that were infected with SARS-CoV-2/B.1.36. The optimum concentration was found to be 2 mg mL-1, where minimum toxicity and sufficient antiviral activity was observed. Furthermore, cell viability assay against Calu-3 lung epithelial cells confirmed the biocompatibility of favipiravir at concentrations up to 50 μM (7.855 mg mL-1). The in vitro aerodynamic profiles of the developed inhaled favipiravir formulation, when delivered with soft-mist inhaler indicated good lung targeting properties. These results suggest that favipiravir solution prepared with PBS could be considered as a suitable and promising inhalation formulation for pulmonary delivery in the treatment of patients with COVID-19.
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Affiliation(s)
- Ayca Yildiz Pekoz
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Türkiye
| | - Ozlem Akbal Dagistan
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Türkiye
| | - Hanan Fael
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Türkiye
| | - Meltem Culha
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Türkiye
| | - Aybige Erturk
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Türkiye.,Faculty of Pharmacy, Department of Pharmaceutical Technology, Istinye University, Istanbul, Türkiye
| | - Nur Sena Basarir
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Türkiye
| | - Gokben Sahin
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Trakya University, Istanbul, Türkiye
| | - Muge Serhatli
- Medical Biotechnology (Marmara Research Center (MRC)), TUBITAK Marmara Research Center-MRC, Life Sciences, Kocaeli, Türkiye
| | - Gamze Cakirca
- Medical Biotechnology (Marmara Research Center (MRC)), TUBITAK Marmara Research Center-MRC, Life Sciences, Kocaeli, Türkiye.,Molecular Biology and Genetics, Institute of Natural and Applied Sciences, Gebze Technical University, Kocaeli, Türkiye
| | - Saban Tekin
- Medical Biotechnology (Marmara Research Center (MRC)), TUBITAK Marmara Research Center-MRC, Life Sciences, Kocaeli, Türkiye.,Hamidiye Faculty of Medicine, Department of Basic Medical Sciences, Medical Biology, University of Health Sciences, Istanbul, Türkiye
| | - Leyla Semiha Sen
- School of Medicine, Basic Medical Sciences, Department of Physiology, Marmara University, Istanbul, Türkiye
| | - Mustafa Sevim
- School of Medicine, Basic Medical Sciences, Department of Physiology, Marmara University, Istanbul, Türkiye
| | | | - Berrak C Yegen
- School of Medicine, Basic Medical Sciences, Department of Physiology, Marmara University, Istanbul, Türkiye
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Bilgin H, Marku M, Yilmaz SS, Karahasan Yagci A, Sili U, Can B, Can Sarinoglu R, Mulazimoglu Durmusoglu L, Haklar G, Sirikci O, Eksioglu Demiralp E. The effect of immunization with inactivated SARS-CoV-2 vaccine (CoronaVac) and/or SARS-CoV-2 infection on antibody levels, plasmablasts, long-lived-plasma-cells, and IFN-γ release by natural killer cells. Vaccine 2022; 40:2619-2625. [PMID: 35339303 PMCID: PMC8930391 DOI: 10.1016/j.vaccine.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We evaluated the antibody response, natural killer cell response and B cell phenotypes in healthcare workers (HCW) who are vaccinated with two doses of CoronaVac with or without documented SARS-CoV-2 infection and unvaccinated HCWs with SARS-CoV-2 infection. METHODS HCWs were divided into four groups: vaccine only (VO), vaccine after SARS-CoV-2 infection (VAI), SARS-CoV-2 infection only (IO), and SARS-CoV-2 infection after vaccine (IAV). Anti-SARS-CoV-2 spike protein (Anti-S) antibodies were measured by Elecsys Anti-SARS-CoV-2 S ELISA kit. Memory B cells (CD19+CD27+), plasmablast B cells (CD19+CD138+) and long-lived plasma cells (LLPC; CD138+CD19-) were measured by flow cytometry in 74 patients. Interferon gamma (IFN-γ) release by natural killer (NK) cells were measured by NKVue Test (NKMAX, Republic of Korea) in 76 patients. RT-PCR was performed with Bio-speedy® COVID-19 qPCR detection kit, Version 2 (Bioexen LTD, Istanbul, Turkey). RESULTS The Anti-S antibodies were detectable in all HCWs (n: 224). The median Anti-S titers (BAU/mL) was significantly higher in VAI (620 25-75% 373-1341) compared to VO (136, 25-75% 85-283) and IO (111, 25-75% 54-413, p < 0.01). VAI group had significantly lower percentage of plasmablasts (2.9; 0-8.7) compared to VO (6.8; 3.5-12.0) and IO (9.9; 4.7-47.5, p < 0.01) (n:74). Percentage of LLPCs in groups VO, VAI and IO was similar. There was no difference of IFN-γ levels between the study groups (n: 76). CONCLUSION The antibody response was similar between uninfected vaccinated HCWs and unvaccinated HCWs who had natural infection. HCWs who had two doses of CoronaVac either before or after the natural SARS-CoV-2 infection elicited significantly higher antibody responses compared to uninfected vaccinated HCWs. The lower percentages of plasmablasts in the VAI group may indicate their migration to lymph nodes and initiation of the germinal center reaction phase. IFN-γ response did not differ among the groups.
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Affiliation(s)
- Huseyin Bilgin
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Marisa Marku
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Sultan Seval Yilmaz
- Marmara University, School of Medicine, Department of Biochemistry, Istanbul, Turkey
| | | | - Uluhan Sili
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Baris Can
- Marmara University, School of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Rabia Can Sarinoglu
- Marmara University, School of Medicine, Department of Microbiology, Istanbul, Turkey
| | | | - Goncagul Haklar
- Marmara University, School of Medicine, Department of Biochemistry, Istanbul, Turkey
| | - Onder Sirikci
- Marmara University, School of Medicine, Department of Biochemistry, Istanbul, Turkey,Corresponding author at: Fevzi Cakmak Mah Muhsinyazicioglu Cad No: 10 Marmara University Pendik Hospital, 34899 Istanbul, Turkey
| | - Emel Eksioglu Demiralp
- Istanbul Memorial Şişli Hospital, Tissue Typing and Immunology Laboratory, Istanbul, Turkey
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Haliloglu M, Bilgili B, Bilginer H, Kasapoglu US, Sayan I, Aslan MS, Durmusoglu LM, Cinel I. A new scoring system for early diagnosis of ventilator-associated pneumonia: LUPPIS. Arch Med Sci 2020; 16:1040-1048. [PMID: 32863992 PMCID: PMC7444718 DOI: 10.5114/aoms.2020.97965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/05/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Clinical Pulmonary Infection Score (CPIS) based on chest X-ray has been developed to facilitate clinical diagnosis of ventilator-associated pneumonia (VAP); however, this scoring system has a low diagnostic performance. We developed the Lung Ultrasound and Pentraxin-3 Pulmonary Infection Score (LUPPIS) for early diagnosis of VAP and evaluated the performance of this new scoring system. MATERIAL AND METHODS In a prospective study of 78 patients with suspected VAP, we assessed the detection accuracy of LUPPIS for pneumonia in adult patients. We also evaluated the diagnostic performance of pentraxin-3 (PTX-3) findings of infection. On the day of the study, lung ultrasound was performed, PTX-3 levels were determined, and an endotracheal aspirate was obtained for Gram staining and culture. RESULTS No significant differences were found between groups with respect to age, mechanical ventilation time, APACHE II score, or SOFA score (p > 0.05). Procalcitonin and PTX-3 levels were significantly higher in the VAP (+) group (p < 0.001 and p < 0.001, respectively). The threshold for LUPPIS in differentiating VAP (+) patients from VAP (-) patients was > 7. In predicting VAP, LUPPIS > 7 (sensitivity of 84%, specificity of 87.7%) was superior to CPIS > 6 (sensitivity of 40.1%, specificity of 84.5%). CONCLUSIONS LUPPIS appears to provide better results in the prediction of VAP compared to CPIS, and the importance of lung ultrasound and PTX-3 is emphasized, which is a distinctive property of LUPPIS.
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Affiliation(s)
- Murat Haliloglu
- Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
| | - Beliz Bilgili
- Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
| | - Huseyin Bilginer
- Department of Infectious Disease, School of Medicine, Marmara University, Istanbul, Turkey
| | - Umut Sabri Kasapoglu
- Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ismet Sayan
- Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
| | - Melek Suzer Aslan
- Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Ismail Cinel
- Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
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