1
|
Yeshwante SB, Hanafin P, Miller BK, Rank L, Murcia S, Xander C, Annis A, Baxter VK, Anderson EJ, Jermain B, Konicki R, Schmalstig AA, Stewart I, Braunstein M, Hickey AJ, Rao GG. Pharmacokinetic Considerations for Optimizing Inhaled Spray-Dried Pyrazinoic Acid Formulations. Mol Pharm 2023; 20:4491-4504. [PMID: 37590399 PMCID: PMC10868345 DOI: 10.1021/acs.molpharmaceut.3c00199] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a leading cause of death with 1.6 million deaths worldwide reported in 2021. Oral pyrazinamide (PZA) is an integral part of anti-TB regimens, but its prolonged use has the potential to drive the development of PZA-resistant Mtb. PZA is converted to the active moiety pyrazinoic acid (POA) by the Mtb pyrazinamidase encoded by pncA, and mutations in pncA are associated with the majority of PZA resistance. Conventional oral and parenteral therapies may result in subtherapeutic exposure in the lung; hence, direct pulmonary administration of POA may provide an approach to rescue PZA efficacy for treating pncA-mutant PZA-resistant Mtb. The objectives of the current study were to (i) develop novel dry powder POA formulations, (ii) assess their feasibility for pulmonary delivery using physicochemical characterization, (iii) evaluate their pharmacokinetics (PK) in the guinea pig model, and (iv) develop a mechanism-based pharmacokinetic model (MBM) using in vivo PK data to select a formulation providing adequate exposure in epithelial lining fluid (ELF) and lung tissue. We developed three POA formulations for pulmonary delivery and characterized their PK in plasma, ELF, and lung tissue following passive inhalation in guinea pigs. Additionally, the PK of POA following oral, intravenous, and intratracheal administration was characterized in guinea pigs. The MBM was used to simultaneously model PK data following administration of POA and its formulations via the different routes. The MBM described POA PK well in plasma, ELF, and lung tissue. Physicochemical analyses and MBM predictions suggested that POA maltodextrin was the best among the three formulations and an excellent candidate for further development as it has: (i) the highest ELF-to-plasma exposure ratio (203) and lung tissue-to-plasma exposure ratio (30.4) compared with POA maltodextrin and leucine (75.7/16.2) and POA leucine salt (64.2/19.3) and (ii) the highest concentration in ELF (CmaxELF: 171 nM) within 15.5 min, correlating with a fast transfer into ELF after pulmonary administration (KPM: 22.6 1/h). The data from the guinea pig allowed scaling, using the MBM to a human dose of POA maltodextrin powder demonstrating the potential feasibility of an inhaled product.
Collapse
Affiliation(s)
- Shekhar B Yeshwante
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Patrick Hanafin
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Brittany K Miller
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Laura Rank
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Sebastian Murcia
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Christian Xander
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Ayano Annis
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Victoria K Baxter
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Elizabeth J Anderson
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Brian Jermain
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Robyn Konicki
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Alan A Schmalstig
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Ian Stewart
- Technology Advancement and Commercialization, RTI International, Research Triangle Park, North Carolina 27709, United States
| | - Miriam Braunstein
- Department of Microbiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Anthony J Hickey
- Technology Advancement and Commercialization, RTI International, Research Triangle Park, North Carolina 27709, United States
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Gauri G Rao
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| |
Collapse
|
2
|
Perrin J, Wippich F, Sherina V, Dvornikov D, Lupar K, Melhem MM, Hanafin P, Waight J, Yu J, Yadavilli S, Poeckel D, Bergamini G. Abstract 6647: Dostarlimab shows dose-dependent immune activation of the tumor microenvironment in a patient-derived NSCLC explant model similar to pembrolizumab. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
The ability to more faithfully mimic the tumor microenvironment (TME) of cancer patients offers a wide range of possibilities for non-clinical evaluation of anti-cancer therapeutics, including guidance for patient selection, dose, and combinations. We have established a patient-derived tumor explant (PDE) model to monitor immune activation within a structurally preserved TME, following ex vivo incubation with immune check point inhibitors (ICI). When testing anti-PD-1 agents, such as dostarlimab and pembrolizumab, in a cohort of NSCLC explants from stage I-III treatment-naïve patients, we observed that approximately half demonstrate release of inflammatory cytokines after two days incubation. Interestingly, responsive tumors presented with a high level of PD-L1 expression (high TPS), had elevated TMB, and were highly infiltrated by CD8+ T cells at baseline, in line with tumor baseline characteristics predictive of clinical response to anti-PD-1. When testing a dose-range of dostarlimab and pembrolizumab comparable potencies were observed when measuring cytokine release after treatment of the NSCLC explants. In conclusion, we describe here an in vitro patient-derived NSCLC model that mirrors the heterogeneity of patients’ response for anti-PD-1 agents observed in clinical settings, representing a valuable tool for comparative analysis of novel ICI assets and combinations, such as the CD226 axis members. Importantly, this system is also amenable to extensive multi-omics and genetics-based analyses, providing the opportunity to better identify predictive or pharmacodynamic characteristics within patient tumors.
Citation Format: Jessica Perrin, Frank Wippich, Valeriia Sherina, Dmytro Dvornikov, Katharina Lupar, Murad M. Melhem, Patrick Hanafin, Jeremy Waight, Jong Yu, Sapna Yadavilli, Daniel Poeckel, Giovanna Bergamini. Dostarlimab shows dose-dependent immune activation of the tumor microenvironment in a patient-derived NSCLC explant model similar to pembrolizumab [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6647.
Collapse
|
3
|
Yeshwante SB, Hanafin P, Miller BK, Rank L, Murcia S, Xander C, Annis A, Baxter VK, Anderson EJ, Jermain B, Konicki R, Schmalstig AA, Stewart I, Braunstein M, Hickey AJ, Rao GG. Pharmacokinetic considerations for optimizing inhaled spray-dried pyrazinoic acid formulations. bioRxiv 2023:2023.04.01.534965. [PMID: 37066292 PMCID: PMC10103941 DOI: 10.1101/2023.04.01.534965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis ( Mtb ), remains a leading cause of death with 1.6 million deaths worldwide reported in 2021. Oral pyrazinamide (PZA) is an integral part of anti-TB regimens, but its prolonged use has the potential to drive development of PZA resistant Mtb . PZA is converted to the active moiety pyrazinoic acid (POA) by the Mtb pyrazinamidase encoded by pncA , and mutations in pncA are associated with the majority of PZA resistance. Conventional oral and parenteral therapies may result in subtherapeutic exposure in the lung, hence direct pulmonary administration of POA may provide an approach to rescue PZA efficacy for treating pncA- mutant PZA-resistant Mtb . The objectives of the current study were to i) develop novel dry powder POA formulations ii) assess their feasibility for pulmonary delivery using physicochemical characterization, iii) evaluate their pharmacokinetics (PK) in the guinea pig model and iv) develop a mechanism based pharmacokinetic model (MBM) using in vivo PK data to select a formulation providing adequate exposure in epithelial lining fluid (ELF) and lung tissue. We developed three POA formulations for pulmonary delivery and characterized their PK in plasma, ELF, and lung tissue following passive inhalation in guinea pigs. Additionally, the PK of POA following oral, intravenous and intratracheal administration was characterized in guinea pigs. The MBM was used to simultaneously model PK data following administration of POA and its formulations via the different routes. The MBM described POA PK well in plasma, ELF and lung tissue. Physicochemical analyses and MBM predictions suggested that POA maltodextrin was the best among the three formulations and an excellent candidate for further development as it has: (i) the highest ELF-to-plasma exposure ratio (203) and lung tissue-to-plasma exposure ratio (30.4) compared with POA maltodextrin and leucine (75.7/16.2) and POA leucine salt (64.2/19.3); (ii) the highest concentration in ELF ( Cmac ELF : 171 nM) within 15.5 minutes, correlating with a fast transfer into ELF after pulmonary administration ( k PM : 22.6 1/h). The data from the guinea pig allowed scaling, using the MBM to a human dose of POA maltodextrin powder demonstrating the potential feasibility of an inhaled product. Table of Contents TOC/Abstract Graphic
Collapse
|
4
|
Nang S, Lin Y, Hanafin P, Wang J, Chen K, Yu H, Wickremasinghe H, Bergen P, Chang R, Rao G, Chan H, Li J. 81: PHARMACOKINETICS/PHARMACODYNAMICS OF ANTI-PSEUDOMONAL PHAGE: LEVERAGING PRECLINCAL MODELS OF INFECTION AND MECHANISM-BASED MODELLING. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00360-5] [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: 12/23/2022] Open
|
5
|
Hanafin S, Cosgrove J, Hanafin P, Lynch C, Brady AM. Co-worker relationships and their impact on nurses in Irish public healthcare settings. Br J Nurs 2022; 31:394-399. [PMID: 35404651 DOI: 10.12968/bjon.2022.31.7.394] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article presents the findings of a secondary analysis of data arising from a quantitative study of 3769 nurses on co-worker relationships and their impact on nurses working in public healthcare settings in Ireland. The overall findings from this analysis suggest moderate to high levels of satisfaction with co-worker relationships, with an average scale mean of 77%. Statistically significant lower scale means were identified in respect of nurses whose basic nursing qualification was awarded in a country outside the EU, among students and among those working in the west of Ireland. Respondents intending to leave the healthcare workforce reported significantly lower scores (74%) on this index compared with those intending to stay (79%). Significant positive correlations between co-worker relationships and workplace engagement (0.233), job satisfaction (0.225), organisational commitment (0.221) and perception of managers (0.259) were identified. These findings have implications for the retention of nurses working in Irish public healthcare services.
Collapse
Affiliation(s)
- Sinéad Hanafin
- Visiting Research Fellow, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Jude Cosgrove
- Chief Executive Officer, Educational Research Centre, Dublin, Ireland
| | - Patrick Hanafin
- Research Associate, Research Matters, Thurles Chamber Enterprise Centre, Technological University of the Shannon, Thurles, Ireland
| | - Ciaran Lynch
- Research Associate, Research Matters, Thurles Chamber Enterprise Centre, Technological University of the Shannon, Thurles, Ireland
| | - Anne-Marie Brady
- Professor of Nursing and Chronic Illness, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| |
Collapse
|
6
|
Abstract
This paper presents the findings from an analysis of survey data which was collected from public health nurses (N = 136) as part of a larger study with more than 4000 nurses and midwives in Ireland. The purpose of the study was to examine the prevalence of burnout using the Oldenburg Burnout Inventory and to compare relationships between burnout, demographic and work characteristics across this group of nurses. Younger PHNs were most likely to report feeling burnout (68%) compared with those aged 51 or over (47%) who reported the lowest levels. PHNs whose highest level of qualification was a primary degree were least likely to report feeling burnout (31%) compared with those who held a Masters / Doctoral degree (54.5%). PHNs who reported working on a fixed-term full-time contract were most likely to report feeling burnout (70%) compared with those who were on a permanent part-time contract (49%). Quantitative analysis, using both descriptive and inferential statistics, was carried out and the findings show that PHNs reported moderate levels of burnout. The findings also show that burnout among PHNs is strongly correlated with the physical demands placed on individuals during work, having constant time pressures, too much being expected of individuals, the work environment being too demanding and dissatisfaction with the physical conditions.
Collapse
Affiliation(s)
- Sinead Hanafin
- Visiting Research Fellow, School of Nursing and Midwifery, Trinity College Dublin
| | - Jude Cosgrove
- Chief Executive Officer, Educational Research Centre, Dublin
| | - Patrick Hanafin
- Research Associate, Research Matters, Thurles Chamber Enterprise Centre, Limerick Institute of Technology
| | - Anne-Marie Brady
- Professor of Nursing and Chronic Illness, School of Nursing and Midwifery, Trinity College Dublin
| | - Ciaran Lynch
- Research Associate, Research Matters, Thurles Chamber Enterprise Centre, Limerick Institute of Technology
| |
Collapse
|
7
|
|
8
|
Lee E, Gibbs JP, Emery MG, Block G, Wasserman SM, Hamilton L, Kasichayanula S, Hanafin P, Somaratne R, Egbuna O. Influence of Renal Function on Evolocumab Exposure, Pharmacodynamics, and Safety. Clin Pharmacol Drug Dev 2019; 8:281-289. [PMID: 30676701 PMCID: PMC6590207 DOI: 10.1002/cpdd.650] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/03/2018] [Indexed: 12/31/2022]
Abstract
We evaluated the pharmacokinetics, pharmacodynamics, and safety of evolocumab, a fully human monoclonal antibody against proprotein convertase subtilisin kexin type 9 (PCSK9), in an open‐label, parallel‐design study in participants with normal renal function (n = 6), severe renal impairment (RI; n = 6), or end‐stage renal disease (ESRD) receiving hemodialysis (n = 6) who received a single 140‐mg dose of evolocumab. The effects of evolocumab treatment on low‐density lipoprotein cholesterol (LDL‐C) lowering and unbound PCSK9 concentrations were similar in the normal renal function group and the renally impaired groups. Geometric mean Cmax and AUClast values in the severe RI and ESRD hemodialysis groups compared with the normal renal function group were lower but within 37% of the normal renal function group (Jonckheere‐Terpstra trend test; Cmax, P = .23; AUClast, P = .22) and within 26% after adjusting for body weight (mean body weight was approximately 9% higher in the renally impaired groups compared with the normal renal function group). No correlations were observed between exposure and baseline creatinine clearance. No adverse event was determined by the investigators to be related to evolocumab, and there were no trends indicative of clinically important effects on laboratory variables or vital signs. Overall, there were no meaningful differences in evolocumab exposure, as assessed by Cmax and AUClast, in patients with severe RI and ESRD hemodialysis compared with patients with normal renal function, and LDL‐C‐lowering effects were similar across groups. These results support the use of evolocumab without dose adjustment in patients who have severe RI or ESRD.
Collapse
|
9
|
Abstract
Employing insights from Italian sexual difference theory on law and rights, this article examines how both the text of the Italian Abortion Law of 1978 and its operation reveal the contradictions within liberal rights discourse on reproductive freedom. The Act itself contains traces of both Roman Catholic and liberal pluralist worldviews and has, since its introduction, been the site of conflict over competing notions of citizenship and legal identity. This article explores the impact of the Act's paradoxical nature on its operation against the background of the complex debates within the different strands of feminist theory in Italy over the question of reproductive freedom.
Collapse
|
10
|
Hanafin P. Reproductive rights and the Irish Constitution: from the sanctity of life to the sanctity of autonomy? Eur J Health Law 1996; 3:179-188. [PMID: 11654765 DOI: 10.1007/bf02731853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|