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and the associated side effects are expected to be minimal. Thus, functionalized nanoparticles are of potential value in improving therapeutic index of drugs intended for the back of the eye diseases.
11.3.5 Intracellular Trafficking
Nanosystems might offer unique opportunities in targeting subcellular organelles, in addition to cell surface receptors as discussed above. In this respect, nanosystems are expected to be superior to other delivery systems including microparticles and implants, which have a dimension that is close to or larger than cell size. Intracellular targeting is particularly relevant for poorly permeable molecules including protein and nucleic acid drugs. Protein drugs might have different targets within a cell beyond cell surface receptors. For instance, antioxidant proteins might be most desirable in the mitochondria of the cell, while transcription factors might exert their effects in the cell nucleus. With respect to nucleic acid drugs, while delivery of siRNAs is desired in the cytoplasm of the cell, delivery of genes for protein overex­pression is desired in the nucleus. Due to their large size and susceptibility to enzymatic degradation, intracellular targeting of macromolecules requires special delivery systems. Due to their small size and amenability for surface functionalization, nano­systems can potentially enhance cell entry as well as intracellular targeting of mac­romolecules. In cultured retinal pigment epithelial cells, the mass, number, and surface area uptake of carboxylate-modified polystyrene particles increases with a decrease in particle size in the range of 2,000–20 the dose in 3 h for 20 nm particles (Aukunuru and Kompella 2002). The percent uptake for nanoparticles in this study remained about the same in the concentration range of 50–500 mg/ml. Similarly, in conjunctival epithelial cells, nanoparticle uptake increases with a decrease in particle size (Qaddoumi et may enter the cells through various mechanisms including adsorptive endocytosis, fluid phase endocytosis, phagocytosis, and receptor-mediated endocytosis.
PLGA nanoparticles (~100 nm) are endocytosed conjunctival epithelial cells largely by mechanisms independent of clathrin and caveolin-1-mediated pathways (Qaddoumi et al. 2003). Nanoparticles that enter the cell by clathrin-mediated endocytosis form early endosomes (pH 6.3–6.8), which later become late endo­somes (Le Roy and Wrana reach the more acidic lysosomes for degradation. This mechanism of uptake will likely degrade and inactivate the drug or nanoparticles, unless they are resistant to lysosomal enzymes or escape endosomes at an early stage. Some evidence exists for the ability of PLGA nanoparticles to escape endosomes (Prabha and Labhasetwar
2004). Alternatively, nanoparticles that enter the cell by a caveolae-mediated
mechanism form caveosomes, which are neutral in pH and may not destroy drug/ nanoparticles. Caveosomes traffic their contents to microtubules for transport to the golgi and endoplasmic reticulum instead of lysosomes. Interestingly, albumin nano­particles enter retinal pigment epithelial cells via caveolae-mediated endocytosis
2005). Eventually, the endosomes and the nanoparticles
nm, with the uptake being 19% of
al. 2004). Nanosystems
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(Mo et al. 2007). Chitosan nanoparticles of ~200 nm and a positive surface charge were shown to bind to the outside of the cell membrane of alveolar epithelial (A549) cells and internalize primarily via adsorptive endocytosis and in part by clathrin­mediated endocytosis (Huang et al. 2002).
Gene delivery by nanoparticles requires entry into the nucleus. Polyethylenimine­amine DNA (PEI-DNA) nanocomplexes of ~150 nm in size were able to enter microtubules by an active motor-protein-driven transport on microtubules for trans­port toward the nucleus (Suh et al. 2004). These nanoparticles entered the perinu­clear space within minutes after transfection. Nanoparticles fabricated with different materials appear to undergo different intracellular trafficking mechanisms. For instance, cationic liposomes behave differently than PEI–DNA complexes. Cationic liposomes synthesized with dioleoylphosphatidylethanolamine (DOPE) and 3b(N­(2-hydroxyethylaminoethane) carbamoyl)-cholestene (HyC-Chol) lipids were transported along microtubules toward lysosomes after entering the cell and were primarily destroyed within the lysosome before the drug could enter the cytoplasm (Hasegawa et
al. 2001). The size of these liposomes was not given in the above
study, which may also be a major contributor to intracellular trafficking.
Small cationic DNA–protamine complexes of ~120 nm behaved similarly to the HIV-TAT protein that is responsible for the cellular entry of the virus, HIV (Park et al. 2003). The protamine–DNA nanocomplexes had efficient intracellular uptake in the nucleus and the cytoplasm on a similar timescale to that of HIV-TAT protein. The mechanism by which the TAT-HIV protein allows cellular and nuclear entry is unknown, but there is evidence that cationic charge is a major player in uptake. Incorporation of nuclear localization signals on nanoparticle surface is a useful approach for nuclear targeting. Gold nanoparticles were functionalized with nuclear localization signal peptides derived from the SV40 virus T protein (M1), HIV-TAT protein (M2), adenoviral NLS protein (M3), and a synthetic peptide with a nuclear binding site and lysine amino acids (M4) (Tkachenko et al. 2004). The peptide­conjugated gold nanoparticles were fabricated by ligating commercially available 20 nm gold nanoparticles with BSA conjugated to one of three peptides, resulting in a final size of 24 nm. The intracellular location of these four conjugated gold nanoshells was investigated in three cell lines: HeLa, 3T3/NIH, and HepG2. In vitro, the M1-conjugated gold nanoparticles were found in clusters in the cytoplasm (most likely in endosomes) and they accumulated on the outside of the nuclear membrane of all cell types after 3 h. Gold nanoparticles conjugated with the M2 peptide were found only in the cytoplasm of HeLa and HepG2 cells after 3 h, but were not found in any compartment in the 3T3/NIH cells. The M3 peptide-conjugated gold nanoparticles were found in the nucleus of HeLa cells and were able to escape the endosome, but were only found in the cytoplasm of 3T3/NIH cells and were absent in HepG2 cells after 3 h. The M4 peptide-conjugated nanoparticles were found in the nucleus of HeLa and HepG2 cells, but only in the cytoplasm of 3T3/NIH cells after 3 h. Cytoplasm and nuclear trafficking of these gold nanoshells is largely dictated by the structure of the peptide and cell type. However, cationic charge is playing a role in cytoplasm and nuclear uptake. Thus, by careful selection of nano­systems and functionalizing ligands, intracellular trafficking and organelle targeting can be controlled.
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11.4 Alternative Approaches to Improve Ocular Therapeutics
Although there are several benefits to using nanotechnology including small-scaled interactions, improved drug permeability, and sustained release, major disadvan­tages such as rapid elimination by renal systems may counteract the advantages of nanosystems. Kompella et al. compared the release profiles of budesonide PLA nanoparticles and microparticles and found that microparticles had a much more prolonged release profile of 6 weeks of only 23% of the initial drug loading concen­tration compared to nanoparticle release profile of 2 weeks of 50% initial drug loading concentration (Kompella et al. 2003). Due to the prolonged retention of microparticles, these may be more efficacious in sustaining the delivery ocular therapeutics.
Delivery devices other than nanoparticles such as ocular implants are rapidly entering the ocular pharmaceutical market as they provide several advantages over nanosystems. For example, Retisert®, a nonbiodegradable implant comprised of fluocinolone acetonide (active ingredient) in a silicone/polyvinyl alcohol polymer coating situated on a polyvinyl suture strut can effectively release fluocinolone ace­tonide for up to 34 months in the treatment of noninfectious uvetis. Currently, no nanotechnology delivery vehicle is capable of sustaining release up to a few years. The disadvantage of the Retisert system is that it must be inserted and removed by a surgeon; however, patients are not subjected to monthly injections or costly doctor visits. Currently, injectable nondegradable systems such as IluvienTM are under development for sustained drug delivery over a few years. The use of biodegradable implants composed of polymer gels or other biologically related compounds may provide for sustained release in years without the need to remove the implant. However, it will be a challenge to control the rate of implant degradation to allow for controlled release of the drug over a long period of time. Ozurdex®, a biodegrad­able intravitreal implant of dexamethasone, was approved in 2009 for the treatment of macular edema and has shown to persist drug levels for up to 6 months. However, biodegradable implants will degrade over time unlike nonbiodegradable implants and do not provide zero-order drug release, which limits the degree of sustained release. For treatment of certain indications, a 6-month drug profile may be suffi­cient to fully treat the disease. For other chronic diseases such as diabetic retinopathy or choroidal neovascularization, long-term implants will be more beneficial and will have higher rates of patient compliance.
Implantable, refillable delivery devices are also under investigation as possible alternatives to traditional ocular implants and other particles (Saati et These devices are inherently at an advantage because they can be refilled once every so many years by a relatively noninvasive procedure that can be completed in a doctor’s office. Further, this device may include a mechanical device that can readily calculate the amount of drug that is needed in the nearby tissue by measuring drug levels. The device is then able to dispense the drug at precisely the amount calcu­lated. A possible disadvantage of this system is that mechanical failure may occur and make inaccurate decisions for drug dosage times and levels. The system may be
al. 2009).
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Fig. 11.5 Ocular routes of administration for delivery of drug to the posterior segment of the eye including topical administration directly on the corneal surface, intravitreal injection (into the vit­reous humor), retrobulbar injection (in the orbital space behind the eye globe), suprachoroidal injection (below the sclera and above the choroid), sub-Tenon injection (below Tenon’s capsule), and subconjunctival injection (below the conjunctiva)
engineered such that it can keep a record of the dosing scheme, which can be reviewed by the physician.
Another approach to improve drug penetration, retention time and ultimately, efficacy, is to use alternative sites of injection (see Fig. 11.5 for a schematic depic­tion of various routes of ocular administration). This will allow for the drug to be directly injected into the target tissue or within close proximity to the target tissue. Suprachoroidal injection has received recent attention due to its ability to deliver drug to the posterior segment of the eye using a technique that is less invasive to the globe than intravitreal injection. However, the safety and efficacy of this approach has yet to be established.
Thus, several alternatives to nanoparticles exist and selection of any delivery system depends on several factors including the disease state, the drug, and patient­related factors.
11.5 Conclusion
Recent advances in nanotechnology are providing several innovative delivery sys­tems with a nanodimension. Although the rate of drug release is typically more rapid from such systems when compared to larger microparticles and implants, nanosystems offer some unique advantages. Nanosystems can potentially address
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some limitations that exist with current ocular therapeutics such as poor residence time, poor permeability across barriers, poor bioavailability, and poor patient compliance. Nanosystems might be particularly beneficial for poorly permeable, poorly soluble, or labile therapeutic agents. They might allow effective noninvasive delivery of drug molecules to the back of the eye. However, alternative approaches to enhance drug efficacy such as microparticles and implants may offer the advan­tage of more prolonged drug delivery compared to nanoparticles, which might be beneficial for some well-permeable therapeutic agents. The development and design of drug delivery devices will be ultimately dictated by the drug properties, disease properties, and patient convenience.
Acknowledgements This work was supported by the NIH grants R01EY018940, R01EY017533, and RC1EY020361.
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Chapter 12
https://t.me/med1917
Hydrogels for Ocular Posterior Segment Drug Delivery
Gauri P. Misra, Thomas W. Gardner, and Tao L. Lowe
Abstract This chapter discusses emerging hydrogel technology for drug delivery
to the back of the eye to treat retinal diseases. The review includes design, charac­terization and optimization of hydrogels, and advantages and disadvantages of intravitreally and subconjunctivally administrated hydrogels for retinal therapy. Future direction of hydrogel technology for targeted and sustained delivery of drugs to the retina for individualized medicine is also laid out.
12.1 Introduction
The ocular posterior segment, which includes mainly retina, choroid, and optic nerves, plays a vital role in maintaining good vision. Any damage to the back of the eye, especially to the retina, due to disease or disorder leads to vision loss. The major retinal diseases that require better treatment approaches include macular edema, age-related macular degeneration (AMD), diabetic retinopathy, retinitis pigmentosa, cytomegalovirus retinitis, uveitis, retinal detachment, ocular melanoma, and retino­blastoma. Many therapeutic agents including antivascular endothelial growth factor, anti-inflammatory, and neuroprotective drugs/agents have attracted growing interest for the treatments of these retinal diseases (Janoria et al. 2007; Gilhotra and Mishra
2008; Hironaka et al. 2009; Lee and Robinson 2009). These therapeutic agents can be
administrated to the retina via topical, intravitreal, subconjunctival, and systemic routes.
T.L. Lowe (*) Department of Pharmaceutical Sciences, School of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA
Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis,
TN 38163, USA e-mail: tao.lowe@jefferson.edu
U.B. Kompella and H.F. Edelhauser (eds.), Drug Product Development for the Back of the Eye, AAPS Advances in the Pharmaceutical Sciences Series 2, DOI 10.1007/978-1-4419-9920-7_12, © American Association of Pharmaceutical Scientists, 2011
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