Disposable Dosators Intended for Dry Powder Delivery to Mice

Dry powder inhalers offer numerous advantages for delivering drugs to the lungs, including stable solid-state drug formulations, device portability, bolus metering and dosing, and a propellant-free dispersal mechanism. To develop pharmaceutical dry powder aerosol products, robust in vivo testing is essential. Typically, initial studies involve using a murine model for preliminary evaluation before conducting formal studies in larger animal species. However, a significant limitation in this approach is the lack of suitable device technology to accurately and reproducibly deliver dry powders to small animals, hindering such models' utility. To address these challenges, disposable syringe dosators were developed specifically for intrapulmonary delivery of dry powders in doses appropriate for mice. These dosators load and deliver a predetermined amount of powder obtained from a uniform bulk density powder bed. This discrete control is achieved by inserting a blunt needle to a fixed depth (tamping) into the powder bed, removing a fixed quantity each time. Notably, this dosing pattern has proven effective for a range of spray-dried powders. In experiments involving four different model spray-dried powders, the dosators demonstrated the ability to achieve doses within the range of 30 to 1100 µg. The achieved dose was influenced by factors such as the number of tamps, the size of the dosator needle, and the specific formulation used. One of the key benefits of these dosators is their ease of manufacturing, making them accessible and cost-effective for delivering dry powders to mice during initial proof-of-concept studies. The disposable nature of the dosators facilitates use in animal procedure rooms, where cleaning and refilling reusable systems and weighing materials is inconvenient. Thus, developing disposable syringe dosators has addressed a significant hurdle in murine dry powder delivery for proof-of-concept studies, enabling researchers to conduct more accurate and reproducible preliminary studies in small animal models for pulmonary drug delivery.

Preparation Strategies of the Anti-Mycobacterial Drug Bedaquiline for Intrapulmonary Routes of Administration

Mycobacterium tuberculosis (M.tb) has infected one-quarter of the world's population and led to the deaths of 1.6 million individuals in 2021 according to estimates from the World Health Organization. The rise in prevalence of multidrug-resistant and extensively drug-resistant M.tb strains coupled with insufficient therapies to treat such strains has motivated the development of more effective treatments and/or delivery modalities. Bedaquiline, a diarylquinoline antimycobacterial agent, effectively targets mycobacterial ATP synthase but may lead to systemic complications upon oral delivery. Targeted delivery of bedaquiline to the lungs represents an alternative strategy to harness the sterilizing benefits of the drug against M.tb while mitigating off-target side effects. Two pulmonary delivery modalities were developed herein, including dry powder inhalation and liquid instillation. Despite bedaquiline's poor water solubility, spray drying was performed in predominantly aqueous conditions (≥80%) to avoid a closed-loop, inert system. Aerosols of spray-dried bedaquiline with L-leucine excipient outperformed spray-dried bedaquiline alone, demonstrating superior fine particle fraction metrics (~89% of the emitted dose below <5 µm), suitable for inhalation therapies. Furthermore, the use of a 2-hydroxypropyl-β-cyclodextrin excipient allowed a molecular dispersion of bedaquiline in an aqueous solution for liquid instillation. Both delivery modalities were successfully administered to Hartley guinea pigs for pharmacokinetic analysis and were well-tolerated by the animals. Intrapulmonary liquid delivery of bedaquiline led to adequate serum absorption and appropriate peak serum concentrations of the drug. The liquid formulation was superior in systemic uptake compared to the powder formulation. The predominant route via which M.tb bacilli enter the body is aerosol droplets that are deposited onto airway surfaces. For this reason, we believe that further studies should focus on inhalation or intrapulmonary therapies that target the site of entry and primary site of infection for M.tb.

Nanoformulated Remdesivir with Extremely Low Content of Poly(2-oxazoline) - Based Stabilizer for Aerosol Treatment of COVID-19

The rise of the novel virus SARS-CoV2 which causes the disease known as COVID-19 has led to a global pandemic claiming millions of lives. With no clinically approved treatment for COVID-19, physicians initially struggled to treat the disease, and a need remains for improved anti-viral therapies in this area. We conceived early in the pandemic that an inhalable formulation of the drug remdesivir which directly targets the virus at the site of infection could improve therapeutic outcomes in COVID-19. We developed a set of requirements that would be conducive to rapid drug approval: 1) try to use GRAS reagents 2) minimize excipient concentration and 3) achieve a working concentration of 5 mg/mL remdesivir to obtain a deliverable dose which is 5-10% of the IV dose. In this work, we discovered that Poly(2-oxazoline) block copolymers can stabilize drug nanocrystal suspensions and provide suitable formulation characteristics for aerosol delivery while maintaining anti-viral efficacy. We believe POx block copolymers can be used as a semi-ubiquitous stabilizer for the rapid development of nanocrystal formulations for new and existing diseases. This article is protected by copyright. All rights reserved.

Optimization and Scale Up of Spray Dried CPZEN-45 Aerosol Powders for Inhaled Tuberculosis Treatment

PURPOSE

Tuberculosis (TB) remains one of the most serious diseases caused by a single organism. Multiple (MDR) and extensively (XDR) drug resistant disease poses a threat to global health and requires new drugs and/or innovative approaches to treatment. A number of drugs have been proposed as inhaled therapy for TB, frequently prepared by spray drying. CPZEN-45 is a novel anti-tubercular drug that has poor oral bioavailability but has shown promise when administered via inhalation.

METHODS

Excipient-free CPZEN-45 HCl has been spray dried into a powder with physicochemical characteristics, aerodynamic particle size distribution, and delivered dose suitable for consideration as an inhaled product.

RESULTS

The mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD) of the powder delivered using a RS01 inhaler were 2.62 ± 0.04 μm and 1.76 ± 0.09, respectively. Additionally, the powder was physically and chemically stable after storage at ambient conditions for >1.5 years with particle size similar to freshly manufactured product. Overages in spray dried powder were recycled the powder and resprayed into drug product likewise resulting in negligible change in quality thus allowing for further preclinical characterization as necessary. CPZEN-45 was scaled up using pilot-scale manufacturing equipment where the density of the powder was increased to facilitate larger delivered doses without affecting the aerodynamic performance properties.

CONCLUSION

The spray dried powders were suitable for pharmacokinetics, efficacy and preclinical toxicology studies. The final method of manufacture may be used directly for CGMP particle manufacture to support IND and Phase I clinical trials and beyond.

A SPLUNC1 Peptidomimetic Inhibits Orai1 and Reduces Inflammation in a Murine Allergic Asthma Model

Orai1 is a plasma membrane Ca2+ channel that mediates store operated Ca2+ entry (SOCE) and regulates inflammation. Short palate lung and nasal epithelial clone 1 (SPLUNC1) is an asthma gene modifier which inhibits Orai1/SOCE via its C-terminal α6 region. SPLUNC1 levels are diminished in asthma patient airways. Thus, we hypothesized that inhaled α6 peptidomimetics could inhibit Orai1 and reduce airway inflammation in a murine asthma model. To evaluate α6-Orai1 interactions, we used fluorescent assays to measure Ca2+ signalling, Förster resonance energy transfer (FRET), fluorescent recovery after photobleaching, immunostaining, total internal reflection (TIRF) microscopy and Western blotting. To test whether α6 peptidomimetics inhibited SOCE and decreased inflammation in vivo, wild-type and SPLUNC1-/- mice were exposed to house dust mite (HDM) extract ± α6 peptide. We also performed nebulization, jet milling and scanning electron microscopy to evaluate α6 for inhalation. SPLUNC1-/- mice had an exaggerated response to HDM. In bronchoalveolar lavage (BAL)-derived immune cells, Orai1 levels increased after HDM exposure in SPLUNC1-/- but not wild-type mice. Inhaled α6 reduced Orai1 levels in mice regardless of genotype. In HDM-exposed mice, α6 dose-dependently reduced eosinophilia and neutrophilia. In vitro, α6 inhibited SOCE in multiple immune cell types and α6 could be nebulized or jet milled without loss of function. These data suggest that α6 peptidomimetics may be a novel, effective anti-inflammatory therapy for asthma patients.

Designing inhalable metal organic frameworks for pulmonary tuberculosis treatment and theragnostics via spray drying

Inhalable metal organic framework (MOF) aerosols have been developed via spray drying as a therapy for multi-drug resistant (MDR) tuberculosis (TB). The CuPOA₂ (pyrazinoate acid) MOFs can be tailored to exhibit a respirable mass median aerodynamic diameter (MMAD) of 2.6 μm. This method is repeated to manufacture Gd_0.1Cu_0.9(POA)₂ MOFs for inhalable theragnostics.

Development and Characterization of a Dry Powder Formulation for Anti-Tuberculosis Drug Spectinamide 1599

PURPOSE

Human tuberculosis (TB) is a global health problem that causes nearly 2 million deaths per year. Anti-TB therapy exists, but it needs to be administered as a cocktail of antibiotics for six months. This lengthy therapy results in low patient compliance and is the main reason attributable to the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis.

METHODS

One alternative approach is to combine anti-TB multidrug therapy with inhalational TB therapy. The aim of this work was to develop and characterize dry powder formulations of spectinamide 1599 and ensure in vitro and in vivo delivered dose reproducibility using custom dosators.

RESULTS

Amorphous dry powders of spectinamide 1599 were successfully spray dried with mass median aerodynamic diameter (MMAD) = 2.32 ± 0.05 μm. The addition of L-leucine resulted in minor changes to the MMAD (1.69 ± 0.35 μm) but significantly improved the inhalable portion of spectinamide 1599 while maintaining amorphous qualities. Additionally, we were able to demonstrate reproducibility of dry powder administration in vitro and in vivo in mice.

CONCLUSIONS

The corresponding systemic drug exposure data indicates dose-dependent exposure in vivo in mice after dry powder intrapulmonary aerosol delivery in the dose range 15.4 - 32.8 mg/kg.

A Spray-Dried Combination of Capreomycin and CPZEN-45 for Inhaled Tuberculosis Therapy

Tuberculosis (TB) remains the single most serious infectious disease attributable to a single-causative organism. A variety of drugs have been evaluated for pulmonary delivery as dry powders: capreomycin sulfate has shown efficacy and was safely delivered by inhalation at high doses to human volunteers, whereas CPZEN-45 is a new drug that has also been shown to kill resistant TB. The studies here combine these drugs-acting by different mechanisms-as components of single particles by spray-drying, yielding a new combination drug therapy. The spray-dried combination powder was prepared in an aerodynamic particle size range suitable for pulmonary delivery. Physicochemical storage stability was demonstrated for a period of 6 months. The spray-dried combination powders of capreomycin and CPZEN-45 have only moderate affinity for mucin, indicating that delivered drug will not be bound by these mucins in the lung and available for microbicidal effects. The pharmacokinetics of disposition in guinea pigs demonstrated high local concentrations of drug following direct administration to the lungs and subsequent systemic bioavailability. Further studies are required to demonstrate the in vivo efficacy of the combination to confirm the therapeutic potential of this novel combination.

Effect of Morphology on the Electrical Resistivity of Silver Nanostructure Films

The relatively high temperatures (>200 °C) required to sinter silver nanoparticle inks have limited the development of printed electronic devices on low-cost, heat-sensitive paper and plastic substrates. This article explores the change in morphology and resistivity that occurs upon heating thick films of silver nanowires (of two different lengths; Ag NWs), nanoparticles (Ag NPs), and microflakes (Ag MFs) at temperatures between 70 and 400 °C. After heating at 70 °C, films of long Ag NWs exhibited a resistivity of 1.8 × 10^-5 Ω cm, 4000 times more conductive than films made from Ag NPs. This result indicates the resistivity of thick films of silver nanostructures is dominated by the contact resistance between particles before sintering. After sintering at 300 °C, the resistivity of short Ag NWs, long Ag NWs, and Ag NPs converge to a value of (2-3) × 10^-5 Ω cm, while films of Ag MFs remain ∼10× less conductive (4.06 × 10^-4 Ω cm). Thus, films of long Ag NW films heated at 70 °C are more conductive than Ag NP films sintered at 300 °C. Adding 10 wt % nanowires to a film of nanoparticles results in a 400-fold improvement in resistivity.

How Copper Nanowires Grow and How To Control Their Properties

Scalable, solution-phase nanostructure synthesis has the promise to produce a wide variety of nanomaterials with novel properties at a cost that is low enough for these materials to be used to solve problems. For example, solution-synthesized metal nanowires are now being used to make low cost, flexible transparent electrodes in touch screens, organic light-emitting diodes (OLEDs), and solar cells. There has been a tremendous increase in the number of solution-phase syntheses that enable control over the assembly of atoms into nanowires in the last 15 years, but proposed mechanisms for nanowire formation are usually qualitative, and for many syntheses there is little consensus as to how nanowires form. It is often not clear what species is adding to a nanowire growing in solution or what mechanistic step limits its rate of growth. A deeper understanding of nanowire growth is important for efficiently directing the development of nanowire synthesis toward producing a wide variety of nanostructure morphologies for structure-property studies or producing precisely defined nanostructures for a specific application. This Account reviews our progress over the last five years toward understanding how copper nanowires form in solution, how to direct their growth into nanowires with dimensions ideally suited for use in transparent conducting films, and how to use copper nanowires as a template to grow core-shell nanowires. The key advance enabling a better understanding of copper nanowire growth is the first real-time visualization of nanowire growth in solution, enabling the acquisition of nanowire growth kinetics. By measuring the growth rate of individual nanowires as a function of concentration of the reactants and temperature, we show that a growing copper nanowire can be thought of as a microelectrode that is charged with electrons by hydrazine and grows through the diffusion-limited addition of Cu(OH)2(-). This deeper mechanistic understanding, coupled to an understanding of the structure-property relationship of nanowires in transparent conducting films, enabled the production of copper nanowires that can be coated from solution to make films with properties that rival the dominant transparent conductor, indium tin oxide. Finally, we show how copper nanowires can be coated with Zn, Sn, In, Ni, Co, Ag, Au, and Pt to protect them from oxidation or enable their use as transparent electrocatalysts.

Synthesis and Purification of Silver Nanowires To Make Conducting Films with a Transmittance of 99%

Metal nanowire (NW) networks have the highest performance of any solution-coatable alternative to ITO, but there is as yet no published process for producing NW films with optoelectronic performance that exceeds that of ITO. Here, we demonstrate a process for the synthesis and purification of Ag NWs that, when coated from an ink to create a transparent conducting film, exhibit properties that exceed that of ITO. The diameter, and thus optoelectronic performance, of Ag NWs produced by a polyol synthesis can be controlled by adjusting the concentration of bromide. Ag NWs with diameters of 20 nm and aspect ratios up to 2000 were obtained by adding 2.2 mM NaBr to a Ag NW synthesis, but these NWs were contaminated by nanoparticles. Selective precipitation was used to purify the NWs, resulting in a transmittance improvement as large as 4%. At 130.0 Ω sq(-1), the transmittance of the purified Ag NW film was 99.1%.

Effects of length dispersity and film fabrication on the sheet resistance of copper nanowire transparent conductors

Development of thin-film transparent conductors (TC) based on percolating networks of metal nanowires has leaped forward in recent years, owing to the improvement of nanowire synthetic methods and modeling efforts by several research groups. While silver nanowires are the first commercially viable iteration of this technology, systems based on copper nanowires are not far behind. Here we present an analysis of TCs composed of copper nanowire networks on sheets of polyethylene terephthalate that have been treated with various oxide-removing post treatments to improve conductivity. A pseudo-2D rod network modeling approach has been modified to include lognormal distributions in length that more closely reflect experimental data collected from the nanowire TCs. In our analysis, we find that the copper nanowire TCs are capable of achieving comparable electrical performance to silver nanowire TCs with similar dimensions. Lastly, we present a method for more accurately determining the nanowire area coverage in a TC over a large area using Rutherford Backscattering Spectrometry (RBS) to directly measure the metal content in the TCs. These developments will aid research and industry groups alike in the characterization of nanowire based TCs.

Metal nanowire networks: the next generation of transparent conductors

There is an ongoing drive to replace the most common transparent conductor, indium tin oxide (ITO), with a material that gives comparable performance, but can be coated from solution at speeds orders of magnitude faster than the sputtering processes used to deposit ITO. Metal nanowires are currently the only alternative to ITO that meets these requirements. This Progress Report summarizes recent advances toward understanding the relationship between the structure of metal nanowires, the electrical and optical properties of metal nanowires, and the properties of a network of metal nanowires. Using the structure-property relationship of metal nanowire networks as a roadmap, this Progress Report describes different synthetic strategies to produce metal nanowires with the desired properties. Practical aspects of processing metal nanowires into high-performance transparent conducting films are discussed, as well as the use of nanowire films in a variety of applications.

Copper nanowire networks with transparent oxide shells that prevent oxidation without reducing transmittance

Transparent conducting films of solution-synthesized copper nanowires are an attractive alternative to indium tin oxide due to the relative abundance of Cu and the low cost of solution-phase nanowire coating processes. However, there has to date been no way to protect Cu nanowires with a solution-phase process that does not adversely affect the optoelectric performance of Cu nanowire films. This article reports that the electrodeposition of zinc, tin, or indium shells onto Cu nanowires, followed by oxidation of these shells, enables the protection of Cu nanowire films against oxidation without decreasing film performance.

Solution-processed copper-nickel nanowire anodes for organic solar cells

This work describes a process to make anodes for organic solar cells from copper-nickel nanowires with solution-phase processing. Copper nanowire films were coated from solution onto glass and made conductive by dipping them in acetic acid. Acetic acid removes the passivating oxide from the surface of copper nanowires, thereby reducing the contact resistance between nanowires to nearly the same extent as hydrogen annealing. Films of copper nanowires were made as oxidation resistant as silver nanowires under dry and humid conditions by dipping them in an electroless nickel plating solution. Organic solar cells utilizing these completely solution-processed copper-nickel nanowire films exhibited efficiencies of 4.9%.

Role of MIBI breast scintigraphy in evaluation of palpable breast lesions

The sensitivity and specificity of MIBI breast scintigraphy, conventional mammography and ultrasound in differentiating malignant and benign palpable breast lesions was compared in 48 women. MIBI breast scintigraphy had a sensitivity of 97% a specificity of 69%, a positive predictive value of 87.5% and a negative predictive value of 91.7%. Ultrasound and mammography had comparable results with accuracy rates of approximately 93%. We conclude that MIBI breast scintigraphy may have a complementary role in the evaluation of palpable breast lesions, but is not specific enough to replace current imaging modalities.

Superior vena cava syndrome: an oncologic complication

OBJECTIVES

To review the clinical presentation, pathophysiology, diagnosis, treatment, and nursing care of superior vena cava syndrome (SVCS).

DATA SOURCES

Journal articles, research studies, and book chapters relating to complications of lung cancer and SVCS.

CONCLUSION

Lung cancer is the most common malignancy associated with SVCS. The onset of symptoms may be gradual or rapid. Treatment of SVCS is based on the etiology and histologic diagnosis.

IMPLICATIONS FOR NURSING PRACTICE

Major considerations in the nursing care of patients with SVCS include recognition of high-risk patients, facilitation and coordination of diagnostic procedures, assessment of respiratory, cardiac and neurologic systems, administration of therapy, provision of emotional and psychosocial support, and patient education.

Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy, ultrasound and conventional mammography

Axillary lymph node status is important in the staging of breast carcinoma. To evaluate the accuracy of technetium-99m sestamibi breast scintigraphy in detecting metastatic axillary lymph nodes as compared with other accepted imaging modalities, we performed 99mTc-sestamibi breast scintigraphy, conventional mammography and ultrasound in 36 patients with primary untreated breast carcinoma. With histopathology as the gold standard, 99mTc-sestamibi breast scintigraphy was found to yield true-positive results in 7 of 11 cases (64%) of axillary lymph node metastases and true-negative results in 18 of 20 cases (90%); it has an accuracy of 81%, a positive predictive value of 77.8% and a negative predictive value of 81.8%.

Case report: perinephric-splenic fistula--a complication of percutaneous perinephric abscess drainage

A case of acute perinephric abscess due to chronic parenchymal disease and calculi is presented. During percutaneous drainage a reno-splenic vein communication developed acutely. The aetiology and treatment complications of perinephric abscesses are reviewed.

Vascularized iliac crest grafts: evaluation of viability status with marrow scintigraphy

Forty-three vascularized iliac crest grafts in the femoral neck region in 38 patients were assessed with marrow scintigraphy. Twenty grafting procedures had been performed for treatment of fractures, 16 for nontraumatic osteonecrosis, and seven for focal bone lesions. Scintiscans were obtained preoperatively and in the early and late postoperative period. Anterior images of the hips were obtained 30 minutes after intravenous injection of 4 mCi (148 MBq) of technetium-99m tin colloid by using a gamma camera with a low-energy, general-purpose collimator. The viable graft was detected as an area of tracer uptake corresponding to the configuration of the graft on radiographs. Marrow scintigraphy at 12 weeks showed that 24 grafts were viable, 11 were nonviable, and eight were indeterminate. Early and late results concurred in 36 of 43 (84%) grafts. Nonviable grafts occurred most frequently in fractures in the elderly. In seven patients who subsequently required total hip replacement, six grafts were nonviable while one was indeterminate at 12 weeks. Results indicate that marrow scintigraphy is useful in the treatment of patients with vascularized iliac crest bone grafts.

Staging bone scintigraphy in nasopharyngeal carcinoma

Bone scintigraphy was performed on 163 new cases of nasopharyngeal carcinoma without clinical evidence of distant metastases. Among the 10 abnormal bone scans one patient had radiographic skeletal metastases corresponding to the areas of increased tracer uptake. Two patients with abnormal bone scans subsequently developed radiographic metastases at the site of abnormal tracer uptake. The detection rate of asymptomatic skeletal metastases on presentation was thus 1.8% (3/163), and the predictive value of an abnormal scan for metastases 30% (3/10). Bone scintigraphy is not justified as a routine staging investigation for nasopharyngeal carcinoma, although it can be considered for a subset of patients considered at high risk of distant metastases.