Exploring the potential of black cumin derived nanovesicles for miRNA drug delivery

Liposomes is a non-viral vector drug delivery system. Nevertheless, the existing commercial liposomes are quite expensive and not always affordable, particularly in developing countries. To address this challenge, plant-derived nanoparticles offer a cost-effective alternative while maintaining similar drug delivery capabilities. Hence, this study aimed to explore the potential of nanovesicles derived from black cumin (Nigella sativa) as a miRNA delivery system. Gradient sucrose-centrifugation was utilized to separate the nanovesicles derived from black cumin. Subsequently, these isolated nanovesicles, originating from black cumin, underwent centrifugation at a speed of 11,000 rpm. The miRNAs were encapsulated within these nanovesicles through the ethanol injection method. Morphological examinations of the nanovesicles derived from black cumin and DOTAP, as the positive control, were conducted using TEM and SEM. Furthermore, the cytotoxicity of the nanovesicles derived from black cumin was evaluated through the MTT assay on the MCF-7 cell line. Lastly, the process of internalization for both the black cumin-derived nanovesicles and DOTAP was visualized using a confocal microscope. Results demonstrated the successful isolation of nanovesicles from black cumin using the sucrose gradient method. These particles exhibited a spherical shape with diameters ranging from 100 nm to 200 nm, featuring a negative surface charge. When MCF-7 cells were exposed to black cumin-derived nanovesicles at a concentration of 12 mg/mL, cell viability reached 89.8 %, showing no significant difference compared to the positive control (p > 0.05). Furthermore, the MCF-7 cell line effectively internalized the black cumin-derived nanovesicles after a 45-minute incubation period. Notably, the encapsulation of miRNA within these nanovesicles demonstrated an impressive entrapment efficiency of 76.4 %. Subsequent transfection of miRNA-loaded black cumin-derived nanovesicles resulted in a substantial inhibition of MCF-7 cell viability, reducing it to 67 % after 48 h of treatment. These findings underscore the potential of black cumin-derived nanovesicles as potential nanovectors for the encapsulation and delivery of miRNA within drug delivery systems, offering a cost-effective and accessible solution for advanced drug delivery technologies, particularly in developing country.

Azithromycin-loaded liposomes and niosomes for the treatment of skin infections: Influence of excipients and preparative methods on the functional properties

The aim of this study was to develop azithromycin (AZT)-loaded liposomes (LP) and niosomes (NS) useful for the treatment of bacterial skin infections and acne. LP based on phosphatidylcholine from egg yolk (EPC) or from soybean lecithin (SPC), and NS composed of sorbitan monopalmitate (Span 40) or sorbitan monostearate (Span 60) were prepared through the thin film hydration (TFH) and the ethanol injection (EI) methods. The formulations were subsequently characterized for their physico-chemical and functional properties. Vesicles prepared through TFH showed higher average sizes than the corresponding formulations obtained by EI. All the vesicles presented adequate encapsulation efficiency and a negative ζ potential, which assured good stability during the storage period (except for LP-SPC). Formulations prepared with TFH showed a more prolonged AZT release than those prepared through EI, due to their lower surface area and multilamellar structure, as confirmed by atomic force microscopy nanomechanical characterization. Finally, among all the formulations, NS-Span 40-TFH and LP-EPC-TFH allowed the highest drug accumulation in the skin, retained the antimicrobial activity and did not alter fibroblast metabolism and viability. Overall, they could ensure to minimize the dosing and the administration frequency, thus representing promising candidates for the treatment of bacterial skin infections and acne.

Preventing Complications During Mapping and Ablation of Left Ventricular Summit Arrhythmias

The left ventricular summit is a site of origin for idiopathic ventricular arrhythmias. With advancements in mapping and ablation techniques, sites previously considered inaccessible can now be approached. Anatomical knowledge of the 3-dimensional landmarks of this space is important, as critical structures reside within its boundaries and are potentially liable to collateral injury during ablation. This article reviews reported complications from ablation of ventricular arrhythmias arising from the left ventricular summit and its vicinity and discusses the pros and cons of different ablation technique and the role of an individualized anatomical approach to reduce procedural related complications and improve outcomes.

Continuous processing of paclitaxel polymeric micelles

A continuous polymeric micelle processing platform was successfully developed, which eliminated batch-to-batch variation in critical quality attributes (for example, size and polydispersity that are typically associated with batch processing). A continuous precipitation process was achieved via coaxial turbulent jet in co-flow technology allowing precise control of particle size with average particle size in the range 15 to 70 nm and low polydispersity. Critical relationships between material attributes (e.g., block copolymer design), process parameters (e.g., polymer concentration, organic to aqueous flow rate ratios, and temperature), and critical quality attributes (e.g., size and polydispersity) of the polymeric micelles were realized via multiple designs of experiments studies. Both polymer molecular weight and concentration were shown to influence the micelle polydispersity index. Notably, higher molecular weight polymer required higher processing temperatures to produce monodispersed particles and were generally of larger size. Using optimized conditions, paclitaxel polymeric micelles that are qualitatively and quantitatively equivalent to commercial Genexol PM were produced, exhibiting comparable quality attributes including particle size, size distribution, morphology, drug loading, release characteristics, and stability. Lastly, a dynamic light scattering method was adapted to determine the critical micelle concentration and aggregation number of the block copolymers, providing useful information about the raw material.

Impact of the mucoadhesive lyophilized wafer loaded with novel carvedilol nano-spanlastics on biochemical markers in the heart of spontaneously hypertensive rat models

The purpose of this investigation was to encapsulate carvedilol, a model beta-blocker antihypertensive into nano-spanlastics, followed by incorporation into 1% CMC wafer to afford a mucoadhesive buccal drug delivery system, targeting to sidestep the first-pass metabolism, improving the drug absorption and pharmacological effect, achieving non-invasive buccal delivery for treating hypertension. Carvedilol-loaded nano-spanlastics were rendered by ethanol injection technique, using 2³ factorial design. The effect of formulation variables was investigated on nano-spanlastic characteristics. The optimal nano-spanlastic formulation (S2; containing 20% Brij 97) exhibited particle size (239.8 ± 5 nm), entrapment efficiency (98. 16 ± 1.44%), deformability index (8.74 ± 0.42 g), and the flux after 24 h (J_max) (22.5 ± 0.25 (μg/cm²/h) with enhancement ratio 2.87 as well as excellent stability after storage. Permeation study verified the preeminence of the S2 formula. A confocal laser scanning microscope showed deep penetration of S2 through sheep buccal mucosa formula compared to rhodamine B solution. S2-based wafer showed acceptable characters (pH, swelling, drug content, residence time, and release rate). In vivo studies (pharmacodynamic study and biochemical evaluation) showed considerable improvement in blood pressure, the profile of the lipid, oxidant stress biomarkers, and cardiac markers. Histopathological studies revealed the superiority of S2 wafer in the protection of heart tissues over Carvid®. The results achieved indicate that nano-spanlastic-based wafer offers a promising improving trans-buccal carvedilol delivery system. Graphical abstract.

Management of Low-Risk Papillary Thyroid Cancer

The incidence of thyroid cancer has increased, mainly due to the incidental finding of low-risk papillary thyroid cancers (PTC). These malignancies grow slowly, and are unlikely to cause morbidity and mortality. New understanding about the prognosis of tumor features has led to reclassification of many tumors within the low-risk thyroid category, and to the development of a new one "very low-risk tumors." Alternative less aggressive approaches to therapy are now available including active surveillance and minimally invasive interventions. In this narrative review, we have summarized the available evidence for the management of low-risk PTC.

Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder

OBJECTIVE

This study sought to evaluate the safety and efficacy of ultrasound-guided (US-guided) percutaneous microwave (MW) ablation combined with percutaneous ethanol injection (PEI) to treat liver tumours adjacent to the gallbladder.

MATERIALS AND METHODS

A total of 136 patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder, who underwent ultra-sonographically-guided percutaneous MW ablation, which was combined with PEI in 132 patients, were retrospectively assessed. The patient population characteristics, tumour features, local tumour progression and treatment were compared and analysed. The safety and efficacy of the therapy were assessed by clinical data and imaging in follow-up examinations.

RESULTS

All patients were completely treated with two sessions; 120 patients underwent one session, 16 patients underwent two sessions. The primary technique was effective in 95.6% of the cases, according to the computed tomography (CT) or magnetic resonance imaging (MRI) in the one-month follow-up (132 of 138 sessions). PEI and other therapies were performed in the patients who had been incompletely treated (all six patients underwent PEI, and some underwent other therapies, including one transcatheter arterial chemoembolisation (TACE), one liver transplantation and two liver resections). There was a median follow-up period of 30.1 months and a range of 4 to 68 months. None of the patients had major complications. There were no treatment-related deaths. Twenty-six patients died of primary disease progression that was not directly attributable to MW ablation (19.1%, 26/136). Local tumour progression was noted in five patients (3.7%, 5/136), who had completely ablated tumours at follow-up. The patients with locally progressing tumours underwent additional therapy (three patients underwent PEI, one patient TACE, and one liver resection).

CONCLUSION

Ultrasound-guided percutaneous MW ablation, in combination with percutaneous ethanol injection and thermal monitoring, is a safe and effective treatment for HCC adjacent to the gallbladder.

Management of recurrent cervical papillary thyroid cancer

Papillary thyroid cancer is one of the most common endocrine malignancies, and it is often associated with an excellent prognosis. However, it has been shown to recur in the lymph nodes in the neck. The management of these lymph nodes remains controversial, and current treatment strategies include observation, surgery, radioactive iodine ablation, and percutaneous ethanol injection. These various treatment modalities are discussed in this article.

2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer

Cervical ultrasound scanning (US) is considered a key examination, by all major thyroid and endocrine specialist societies for the postoperative follow-up of thyroid cancer patients to assess the risk of recurrence. Neck US imaging is readily available, non-invasive, relatively easy to perform, cost-effective, and can guide diagnostic and therapeutic procedures with low complication rates. Its main shortcoming is its operator-dependency. Because of the pivotal role of US in the care of thyroid cancer patients, the European Thyroid Association convened a panel of international experts to review technical aspects, indications, results, and limitations of cervical US in the initial staging and follow-up of thyroid cancer patients. The main aim is to establish guidelines for both a cervical US scanning protocol and US-guided diagnostic and therapeutic procedures in patients with thyroid cancer. This report presents (1) standardization of the US scanning procedure, techniques of US-guided fine-needle aspiration, and reporting of findings; (2) definition of criteria for classification of malignancy risk based on cervical US imaging characteristics of neck masses and lymph nodes; (3) indications for US-guided fine-needle aspiration and for biological in situ assessments; (4) proposal of an algorithm for the follow-up of thyroid cancer patients based on risk stratification following histopathological and cervical US findings, and (5) discussion of the potential use of US-guided localization and ablation techniques for locoregional thyroid metastases.

Preparation and in-vitro Evaluation of an Antisense-containing Cationic Liposome against Non-small Cell Lung Cancer: a Comparative Preparation Study

The current methods for treatment of cancers are inadequate and more specific methods such as gene therapy are in progress. Among different vehicles, cationic liposomes are frequently used for delivery of genetic material. This investigation aims to prepare and optimize DOTAP cationic liposomes containing an antisense oligonuclotide (AsODN) against protein kinase C alpha in non-small cells lung cancer (NSCLC). To perform this investigation, two different methods of ethanol injection and thin film hydration were used to prepare AsODN-loaded DOTAP liposomes. The formulated liposomes were then evaluated for their morphology, particle size, zeta potential and encapsulation efficiency, and the best formulation was chosen. In-vitro growth inhibitory effect of encapsulated ODN on A549 cells were evaluated by MTT and colonogenic assay. The physical and serum stability of liposomal ODN were also evaluated. Thin film hydration method resulted in large liposomes that required downsizing by extrusion with an encapsulation efficiency of 13%. Ethanol injection, in a single step gave liposomes with a small size of 115 nm and an encapsulation efficiency of around 90% which were physically stable for 6 months. The optimized liposome could protect oligonucleotides from degradation by nuclease. Cell studies showed a 20% sequence-specific inhibition of cell growth in MTT assay and revealed an LC50 of 103 nM in colonogenic studies. In conclusion, ethanol injection was able to provide suitable liposomes from the permanently charged DOTAP. Also the resulted liposomes were able to inhibit the growth of lung cancer cells.

Endoscopic treatment of duodenal bleeding caused by direct hepatocellular carcinoma invasion with an ethanol injection

We report a case of a man who developed duodenal bleeding caused by direct hepatocellular carcinoma (HCC) invasion, which was successfully treated with endoscopic ethanol injection. A 57-year-old man with known HCC was admitted for melena and exertional dyspnea. He had been diagnosed with inoperable HCC a year ago. Urgent esophagogastroduodenoscopy (EGD) showed two widely eroded mucosal lesions with irregularly shaped luminal protruding hard mass on the duodenal bulb. Argon plasma coagulation and Epinephrine injection failed to control bleeding. We injected ethanol via endoscopy to control bleeding two times with 14 cc and 15 cc separately without complication. Follow-up EGD catched a large ulcer with necrotic and sclerotic base but no bleeding evidence was present. He was discharged and he did relatively well during the following periods. In conclusion, Endoscopic ethanol injection can be used as a significantly effective and safe therapeutic tool in gastrointestinal tract bleeding caused by HCC invasion.

A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thoracoscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC).

METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied energy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L).

RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G.

CONCLUSION: These results suggest that EI-RFA, under general anesthesia, may be effective for the treatment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain-free condition for the patients.

Combined TACE and PEI for palliative treatment of unresectable hepatocellular carcinoma

AIM: To assess whether the effectiveness of a combination of transarterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the treatment of unresectable hepatocellular carcinoma (HCC) is superior to TACE alone a randomized controlled trial was performed.

METHODS: The effect of combination therapy on long-term survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs, randomly allocated to TACE-PEI (27 pts) or TACE alone (25 pts).

RESULTS: The cumulative survival rate of the TACE group was 75.8% at 6 mo, 62.9% at 12 mo, and 18.0% at 24 mo and of the TACE-PEI group 76.9%, 61.5%, and 38.7%, respectively. Comparison of overall survival in both groups showed no statistically significant difference. Regarding the patients with HCCs Okuda stage I (n = 26), the median survival of the TACE-PEI group was significantly longer (>24 mo, median not yet reached in the study period) compared to the TACE group (18.4 mo [range 11.6-21.7 mo]; p = 0.04). TACE-PEI reduced the relative risk for mortality to 0.4 (95%CI 0.15-0.96) compared to patients who received TACE alone. Median survival in patients with HCCs Okuda stage II or III was 5.0 mo in the TACE group (1.7 mo-not defined) compared to 10.4 mo in the TACE-PEI group.

CONCLUSION: The combination TACE-PEI improved survival time compared to TACE alone. Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably.