Enhanced topical paromomycin delivery for cutaneous leishmaniasis treatment: Passive and iontophoretic approaches

Conventional treatments for cutaneous leishmaniasis, a neglected vector-borne infectious disease, can frequently lead to serious adverse effects. Paromomycin (PAR), an aminoglycoside antibiotic, has been suggested for the topical treatment of disease-related lesions, but even when formulated in high drug-loading dosage forms, presents controversial efficacy. The presence of five ionizable amino groups hinder its passive cutaneous penetration but make PAR an excellent candidate for iontophoretic delivery. The objective of this study was to verify the feasibility of using iontophoresis for cutaneous PAR delivery and to propose a topical passive drug delivery system that could be applied between iontophoretic treatments. For this, in vitro iontophoretic experiments evaluated different application durations (10, 30, and 360 min), current densities (0.1, 0.25, and 0.5 mA/cm2), PAR concentrations (0.5 and 1.0 %), and skin models (intact and impaired porcine skin). In addition, 1 % PAR hydrogel had its penetration profile compared to 15 % PAR ointment in passive transport. Results showed iontophoresis could deliver suitable PAR amounts to dermal layers, even in short times and with impaired skin. Biodistribution assays showed both iontophoretic transport and the proposed hydrogel delivered higher PAR amounts to deeper skin layers than conventional ointment, even though applying 15 times less drug. To our knowledge, this is the first report of PAR drug delivery enhancement by iontophoresis. In summary, the association of iontophoresis with a topical application of PAR gel seems appropriate for improving cutaneous leishmaniasis treatment.

Lychnophora ericoides Mart. (Brazilian arnica) ethanol extract accelerates the skin wound healing process: Evidence for its mechanism of action

BACKGROUND

Lychnophora ericoides Mart, also known as the Brazilian arnica or fake arnica, belongs to the Asteraceae family. Leaves and roots are used in alcoholic and hydroalcoholic preparations for the treatment of wounds, inflammation, and pain.

PURPOSE

The present study aimed to investigate the effects of L. ericoides ethanolic extract (EELE) on cutaneous wound healing and the mechanisms of action involved.

METHODS

A total of 72 C57BL/6 mice were randomly divided into four groups of six animals each. An excisional wound was made in the dorsal region of each mouse. The test groups were topically treated with the vehicle, a positive control commercial reference drug, EELE ointment (5%), and EELE ointment (10%). The treatments were applied over 14 days. The wound area was measured every two days to verify the wound closure kinetics. On days 3, 7, and 14 the wound tissue samples were processed for Hematoxylin and Eosin, Masson-Trichrome, and Toluidine blue staining. The expression of renin-angiotensin system (RAS) components, the vascular growth factor-A (VEGF-A), the basic fibroblast growth factor (FGF-2), and type I collagen genes were evaluated. Phytochemical analyses were performed using HPLC-DAD and HPLC-MS/MS.

RESULTS

The EELE (10%) significantly reduced the wound area compared to the treatments used for the other groups. Histological analysis demonstrated that wounds treated with L. ericoides for 14 days developed improved anatomical skin features, healed with hair follicles and sebaceous glands, increased collagen production and angiogenesis, and decreased the number of mast cells at the injury site. Real-time PCR data demonstrated that groups treated with EELE (10%) showed increased Type I collagen, VEGF-A, FGF-2, and AT1R and decreased ACE II and receptor MAS. The healing action of L. ericoides may be related to the presence of phenolic compounds, such as phenolic acids, chlorogenic acid derivatives, and C-glycoside flavonoids.

CONCLUSION

Topical treatment with EELE increases important factors for wound healing: FGF, VEGF, collagen formation, and the expression of the proliferative axis of the renin-angiotensin system. For the first time, the present study shows the healing action of L. ericoides at the molecular level in an animal model. This process can be used as an alternative therapy for wound healing and the development of herbal therapy.

Development and evaluation of colloidal modified nanolipid carrier: application to topical delivery of tacrolimus

Low solubility of tacrolimus in carrier matrix and subsequent poor in vivo bioavailability was overcome by constructing modified nanolipid carrier (MNLC) as a novel approach. The aim of this study was to develop MNLC with enhanced drug solubility in carrier lipid matrix using lipophilic solubilizers for topical delivery. Comprehensive characterization of tacrolimus-loaded MNLC (T-MNLC) was carried out for particle size, morphology, and rheology. Lipid modification resulted in the formation of less perfect crystals offering space to accommodate the dissolved drug leading to high entrapment efficiency of 96.66%. Compatibility and mixing behavior of carrier constituents was evaluated using DSC, FT-IR, and (1)H NMR. T-MNLC displayed sufficient stability that could be attributed to possibility to reduce total lipid concentration in carrier. T-MNLC-enriched gels showed significantly higher in vitro drug release, skin permeation, and in vivo bioavailability with dermatopharmacokinetic approach in guinea pigs compared to commercial ointment, Protopic® as reference. Penetration-enhancing effect was confirmed using gamma scintigraphy in vivo in rats. Radioactivity remained localized in skin at the application site avoiding unnecessary biodisposition to other organs with prospective minimization of toxic effects. Skin irritation studies showed T-MNLC to be significantly less irritating than reference. Research work could be concluded as successful development of novel T-MNLC using lipophilic solubilizers to increase the encapsulation efficiency of colloidal lipid carriers with advantage of improved performance in terms of stability and skin localization.

In Vivo and in Vitro Evaluations of Water-Absorption Properties of Various Ointments

The water-absorption properties of various vehicles were evaluated in rats whose stratum corneum had been stripped off over the application site. Polyethylene glycol (PEG) applied to the site effectively absorbed the exudate, but other applied ointments absorbed little exudate or water. By the PEG ointment, the exudate was absorbed continuously and extensively, and a linear relationship was obtained between the amount of water absorbed and the square root of time. To establish an acceptable alternative in vitro method for the design of a suitable ointment for treating skin ulcers with exudate, in vitro evaluations were performed by three methods: the Franz cell method, the cellulose membrane diffusion method and the spontaneous water uptake method. The membrane diffusion method, and the spontaneous water uptake method appeared to be acceptable alternatives to the in vivo method in evaluating the water absorption of ointments. It is a simple and useful method for preliminary formulation studies of ointments for the treatment of skin ulcers with exudate.

Ex vivo skin absorption of terpenes from Vicks VapoRub ointment

BACKGROUND

The pharmaceutical market offers a wide range of inhalant drug products applied on the skin that contain essential oils and/or their isolated compounds, i.e. terpenes. Because there are few data concerning the skin penetration of terpenes, especially from complex carriers, the goal of this study was to determine the ex vivo skin absorption kinetics of chosen terpenes, namely eucalyptol, menthol, camphor, alpha-pinene, and beta-pinene, from the product Vicks VapoRub.

MATERIAL/METHODS

Human cadaver skin was placed in a flow-through diffusion chamber and the product was applied for 15, 30, and 60 min. After the application time the skin was separated into layers using a tape-stripping technique: three fractions of stratum corneum and epidermis with dermis, and terpenes amounts in the samples were determined by gas-chromatography.

RESULTS

The investigated terpenes showed different absorption characteristics related to their physicochemical properties and did not permeate through the skin into the acceptor fluid. Eucalyptol had the largest total accumulation in the stratum corneum and in the epidermis with dermis, while alpha-pinene penetrated into the skin in the smallest amount.

CONCLUSIONS

The short time in which saturation of the stratum corneum with the terpenes occurred and the high accumulation of most of the investigated terpenes in the skin layers proved that these compounds easily penetrate and permeate the stratum corneum and that in vivo they may easily penetrate into the blood circulation.

Intraocular ophthalmic ointment following clear corneal phacoemulsification: Clinical implications

We report 4 cases of apparent ophthalmic ointment in the anterior chamber after sutureless clear corneal phacoemulsification and posterior chamber intraocular lens implantation. The cases, as well as previous literature, indicate that ointment for topical use can be well tolerated in the eye, although glaucoma and uveitis can be potential negative outcomes. Possible risk factors, some of which may be related to current rates of endophthalmitis after clear corneal cataract surgery, and methods to prevent intraocular ophthalmic ointment after cataract surgery are discussed.

Surgical removal of intraocular antibiotic ointment after routine cataract phacoemulsification

We report surgical removal of a droplet of intraocular chloramphenicol ointment in a 70-year-old man who had routine small-incision phacoemulsification. A spherical droplet of ointment adherent to the intraocular lens was noted 2 months postoperatively. The source was considered to be the immediate postoperative conjunctival fornix chloramphenicol ointment. Gonioscopy revealed tiny droplets adherent to the peripheral iris and angle. The droplet was surgically explanted using a minimally traumatic technique with a lens glide and ophthalmic viscosurgical device through an enlarged clear corneal incision and sent intact for laboratory biochemical analysis. The patient maintained good vision without evidence of uveitis or secondary glaucoma at 1 year of follow-up. This uncommon case also raises issues about the need for immediate postoperative antibiotic ointment for endophthalmitis prophylaxis and phacoemulsification thermal wound effects on the integrity of self-sealing clear corneal incisions.

Skin penetration and metabolism of topical glucocorticoids in reconstructed epidermis and in excised human skin

PURPOSE

To investigate pharmacokinetic differences between the nonhalogenated double ester prednicarbate (PC) and the fluorinated monoester betamethasone 17-valerate (BM17V) their metabolism in human keratinocytes and fibroblasts as well as their permeation and biotransformation in reconstructed epidermis and excised human skin was compared. Special attention was given to the 17-monoesters because of their high receptor affinity and antiproliferative effects.

METHODS

Glucocorticoid penetration was determined using Franz diffusion cells, quantifying metabolite concentrations by HPLC. Chemical stability and reactivity of the monoesters was determined by molecular modeling analysis.

RESULTS

PC accumulated in the stratum corneum. A considerable amount of penetrating PC was hydrolyzed by viable keratinocytes to prednisolone 17-ethylcarbonate (PI7EC), P17EC permeated the skin very rapidly when compared to BM17V. Overall P17EC concentrations in viable tissue were low. Inside of the acceptor fluid, but not within the tissue, P17EC was converted to the more stable prednisolone 21-ethylcarbonate (P21EC).

CONCLUSIONS

The inactivation of highly potent, but also cell toxic, 17-monoesters to almost inactive 21-congeners seen with isolated cell monolayers appears less important in the skin. In vitro determination of the dermal 17-monoesters concentrations may allow the prediction of the atrophogenic risk in man. BM17V levels exceeding P17EC concentration about 6-fold may contribute to its lower tolerance when compared to PC.

HPLC-fluorescence determination of unconjugated estrogens in pharmaceuticals

A fluorimetric liquid chromatographic method (lambda(ex) = 280 nm; lambda(em) = 312 nm) was developed for measurements of unconjugated estrogens (estradiol and estriol) in pharmaceutical dosage forms using a reversed-phase column with water acetonitrile at different composition as mobile phase. The in vitro release profiles of three different estradiol transdermal therapeutic systems were determined through a medical-grade silicone rubber subdermal implant material membrane, using a modified Franz diffusion apparatus at 37 degrees C in presence of PEG 400. The HPLC method possesses advantages of rapidity, simplicity and accuracy.

The effect of some ointment bases on the systemic absorption of tobramycin from various wound surfaces of burned patients

Three kinds of 0.2 per cent tobramycin ointment were prepared with tobramycin and 3 ointment bases (cream, polyethylene glycol and hydrophilic petrolatum), and applied to the various wound surfaces of 5 burned patients. The systemic absorptions of tobramycin were compared with the values of the tentative AUC (area under the curve of tobramycin blood level, micrograms.h/ml.g) until 12 hours after the applications, by determining tobramycin level in blood. Similar values of AUC from the cream and polyethylene glycol ointments were obtained, while that of hydrophilic petrolatum ointment was very low. The systemic absorption of tobramycin from the polyethylene glycol ointment was studied when the ointment was applied to the wound surfaces of 7 patients with partial-thickness burn, 9 patients with full-thickness burn and 6 patients with burn ulcer. The mean values of the tentative AUC of patients with partial-thickness burn, full-thickness burn and burn ulcer were found to be 0.06, 0.03 and 0.15, respectively. These results showed that cream and polyethylene glycol bases should be used carefully as a vehicle of tobramycin ointments because of the rapid systemic absorption of tobramycin from human burn wounds, especially burn ulcer.