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Textbook Drug Delivery An Integrated Clinical and Engineering Approach 1St Edition Yitzhak Rosen Ebook All Chapter PDF
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Edited by
Yitzhak Rosen
Pablo Gurman
Noel M. Elman
The material in this book, whether related to medicine or any other topic, should be verified as to its
accuracy, currency, and preciseness by the reader. It should in no way replace any advice given by a medical
professional or any other professional. None of the information provided here should be a substitute for
additional reading, advice, experience, or other relevant information in any topic discussed in this book.
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v
vi Contents
Index....................................................................................................................... 573
http://taylorandfrancis.com
Foreword
This book is a comprehensive overview in the much needed area of drug delivery.
It addresses a critical unmet need, the approach of integrating the clinical and engi-
neering disciplines for drug delivery optimization and advancement. This integra-
tion is a must, requires a patient-oriented approach, and is a key foundation in drug
delivery development.
Furthermore, the book focuses on important advances and discusses how an inte-
grated approach was used for these advances. It consists of 21 chapters, starting
with a thorough introduction to drug delivery and pharmacokinetics, followed by
diverse clinical examples of this integration. The book discusses the following areas
and their advances: oral and intrathecal drug delivery; insulin delivery and artificial
pancreas; micro- and nanotechnology for drug delivery, including applications of
micro- and nanotechnology in vaccines; inflammatory diseases; airway diseases and
the use of nanoparticles as tracking systems; biomaterial-based delivery systems,
including chitosan and microsponges; gene delivery, cancer drug delivery with a
focus on stem cells; cardiac drug delivery; intravitreal drug delivery; and drug deliv-
ery in obstetrics and gynecology as well as an important chapter on FDA regulation
of drug delivery systems.
As an experienced clinician and discoverer of a new autoimmune syndrome
(ASIA Syndrome), developer of novel therapeutics, publisher of numerous papers
and books, and editor in chief of two journals on autoimmunity (Autoimmunity
Reviews IF-7.95 and Journal of Autoimmunity IF 8.4), it is my hope that all clinicians
and engineers involved in advancing drug delivery will find in this book a useful
resource. Therefore, I give this book the highest recommendation.
ix
http://taylorandfrancis.com
Acknowledgments
We, as editors, take this opportunity to acknowledge all the contributors, editorial
staff, family, and friends for greatly assisting us in making this important book pub-
lication a reality.
xi
http://taylorandfrancis.com
Editors
Yitzhak Rosen, MD, is a graduate of the Tel Aviv University
of Medicine. He completed an internal medicine residency
at Coney Island Hospital and is currently a fellow at the
Cardiovascular Division of SUNY Downstate Medical Center
in Brooklyn, New York. He has worked as a research scientist
at the Institute for Soldier Nanotechnologies, Massachusetts
Institute of Technology (MIT). He is also the president and
CEO of Superior NanoBioSystems LLC, a biomedical com-
pany. He has served in the Israel Defense Forces (IDF) as a medical officer and
physician in militarily active areas. He completed a medical internship at the Rabin
Medical Center and has worked at the Oncology Institutes of both the Rabin and
the Sheba Medical Centers in Israel. He has invented a microfluidic chip platform,
funded by the Defense Advanced Research Projects Agency (DARPA), for effecting
extremely rapid blood typing and cross-matching for mass casualties in collaboration
with the MEMS and Nanotechnology Exchange. In addition, he is the inventor of
several medical ultrasound technologies.
xiii
xiv Editors
focused on developing technologies for biotech, biomed, and public health appli-
cations. In addition, he was appointed an Innovation Fellow at Massachusetts
General Hospital. Dr. Elman’s research focus is on rapid translation from idea
conceptualization to experimental realization. He earned his bachelor’s and mas-
ter’s degrees in electrical engineering at Cornell University, and his PhD degree
in electrical engineering at Tel Aviv University. He performed postdoctoral stud-
ies at MIT, investigating several micro- and nanodevices for therapeutics and
diagnostics.
Contributors
Lissa Nurrul Abdullah Maximiliano L. Cacicedo
Cancer Science Institute of Singapore Nanobiomaterials Laboratory
National University of Singapore Institute of Applied Biotechnology
Singapore (CINDEFI, UNLP-CONICET-CCT
La Plata)
Sharifa Al-Zahrani Department of Chemistry
School of Pharmacy School of Sciences
Queen’s University Universidad Nacional de La Plata
Belfast, United Kingdom La Plata, Argentina
xv
xvi Contributors
INEB
Institute of Biomedical Engineering
University of Porto
Porto, Portugal
Contributors xix
CONTENTS
Overview.....................................................................................................................2
Drug Delivery: Routes of Administration................................................................... 2
Oral Route..............................................................................................................2
Sublingual Route....................................................................................................3
Rectal Route...........................................................................................................3
Parenteral Routes...................................................................................................3
Miscellaneous Routes............................................................................................ 3
Drug Elimination....................................................................................................4
Key Concepts in Pharmacodynamics.......................................................................... 4
Therapeutic Window..............................................................................................4
Drug Delivery Systems: Pharmaceutical Systems versus Drug Delivery Devices..... 4
Drug Delivery Systems: Clinical Applications........................................................... 5
Diabetes and Insulin Delivery Systems.................................................................. 5
Cancer and Antineoplastic Drug Delivery Systems............................................... 6
Epilepsy and Benzodiazepines Drug Delivery Systems........................................ 7
Other Examples of Drug Delivery Systems................................................................ 8
Novel Approaches in Drug Delivery........................................................................... 8
Gene Delivery: DNA and RNA as Payloads for Drug Delivery............................ 8
Cell Delivery..........................................................................................................8
Novel Targets in Drug Delivery: Cancer Stem Cell Delivery..................................... 8
Novel Delivery Modalities Based on the Carrier: Micro and Nanosystems.......... 9
Summary..................................................................................................................... 9
References................................................................................................................. 10
1
2 Drug Delivery
OVERVIEW
Drug delivery is a broad and active area of research involving a multidisciplinary
approach whose integrative aim is to assist in reaching the optimization of drug
efficacy by effective delivery of the active drug component to its target tissue
while minimizing toxicity. The purpose of this chapter in particular and the book
as a whole is to address clinical and engineering integration approaches for drug
delivery systems. The clinical aspect involves understanding the unmet need and
the clinical implications involved. It also requires understanding the individual
clinical and biological differences of patients. Moreover, generating clinical and
biological data is critical for drug delivery as this data can delineate the opti-
mized pathway for a particular drug and its delivery system. In addition, patho-
physiology of disease can affect drug delivery; for example, inflammation may
greatly alter the disposition of a medication, thereby modifying its efficacy, such
as drug penetration to a particular tissue [1–3]. The engineering aspect, on the
other hand, involves either the manipulation of the physicochemical properties of
the active ingredient or formulation (pharmaceutical engineering) or the fabrica-
tion of devices based on mechanical engineering principles in order to achieve a
desired pharmacokinetic–pharmacodynamics profile of the active principle (drug
delivery devices).
Integration of clinical and engineering principles involves a constant interaction
between these two disciplines, and therefore, this book is intended for both the drug
delivery engineer and the clinician. This chapter briefly discusses the rudimentary
foundations of pharmacology that must be considered when designing drug delivery
systems and provides clinical examples where drug delivery systems are playing a
critical role. In addition, a brief description of novel approaches in drug delivery will
be described to illustrate the fast development of this field.
Oral Route
A drug that is given through the oral route must first go through what is known as
the first-pass effect or first-pass metabolism. In the first-pass effect, the drug is first
partially metabolized in the gut wall; then it enters the portal venous system into the
liver where it is further metabolized before reaching the systemic circulation and
receptor target sites. The first-pass effect alters the bioavailability of the drug before
it reaches its receptor target sites. This explains why different routes for the same
drug require different doses for the same drug to have the same efficacy [1,2].
An Introduction to Key Concepts in Drug Delivery 3
The oral route is the most commonly preferred route for drug administration.
Other routes are considered when problematic circumstances arise in which the oral
route cannot be used. These include the following:
1. When the patient has nausea or vomiting and cannot tolerate oral medication
2. When the patient is unconscious and/or has limited swallowing ability
3. When the drug is inactivated by digestive enzymes or acidic gastric fluid or
metabolized by gastrointestinal (GI) flora
4. When there is overall poor drug absorption occurring due to an edematous
GI tract that is seen in fluid overload states [1,2]
Sublingual Route
With the sublingual route, the drug avoids the first-pass effect and thus avoids altera-
tion in its bioavailability by being absorbed directly into the systemic vascular sys-
tem. This allows a very rapid delivery of the active compound, such as sublingual
nitroglycerin for cardiac chest pain [1,2].
Rectal Route
Drugs administered by the rectal route have a bioavailability of approximately 50%,
and even this approximation may greatly vary due to the intricate venous drainage
system of the rectum. The superior portion of the rectum has veins draining into the
liver whereas the distal portion of the rectum has veins draining straight into the
vena cava, thus bypassing the first-pass effect [1,2].
Parenteral Routes
Parenteral routes include intravenous, intramuscular, and subcutaneous. Their key
advantages include administration to unconscious patients and to patients with poor
enteral absorption. These routes provide a quick onset of action and 100% bioavailabil-
ity; therefore, no dose adjustment is required. Their disadvantage is the need for trained
personnel, a short duration of action, risk of infection, and dermal irritation [1,2].
Miscellaneous Routes
The inhalation route is used for respiratory diseases, such as asthma and COPD.
Intranasal and intrathecal routes are used for a drugs whose target site is the brain but
which are unable to penetrate the blood–brain barrier. Topical routes are used for local
effect on areas of skin. Intradermal routes are used for sustained release of a drug, for
example, pain management drugs, such as the fentanyl patch. Liposomes, biodegrad-
able microspheres, and various polymer conjugates are also typical components that
can be used for sustained delivery. The ocular route is utilized as well; for example,
beta blocker eye drops are commonly used for the management of elevated intraocular
pressure, and these drops can actually even affect the heart rate as they can reach other
targets outside their local use. Target delivery involves delivering the drug to a targeted
4 Drug Delivery
tissue while overcoming many of the host’s biological barriers. This may be done using
a combination of encapsulating nanoparticles and monoclonal antibodies [3].
Drug Elimination
Drug elimination occurs by embolization by the liver as discussed previously. Drugs
are also eliminated in the kidneys where they get filtered into the urine. Some drugs
get eliminated through other means, such as from the lungs, but the liver and kidney
are the most common organs responsible for drug metabolism and excretion [1,2].
Therapeutic Window
Drugs require a certain minimum concentration to have a desired effect. This is
called the minimum effective dose. However, drugs can also have undesired effects
that occur if the concentration gets too high. The minimum toxic dose is the mini-
mum dose of a drug that will cause an undesired effect. The therapeutic window is
the dosage range between minimum effective dose and minimum toxic dose. Drugs
with a small therapeutic window must be cautiously administered and have frequent
concentration monitoring to avoid toxic doses [1,2].
improving its efficacy and safety. This can be done by controlling the rate, time, and
place of release of the drug in the body [4]. Drug delivery formulations refer to the
application of pharmaceutical principles to modify the active principle or its excip-
ients to improve drug pharmacokinetics, pharmacodynamics, or both. Improved
efficacy (pharmacodynamics) can be achieved by improving the interaction of the
drug with its target (cell receptors), and rate, time, and place of released can be
improved, for example, through the use of microscale and nanoscale carriers, such
as liposomes, nanocapsules, magnetic nanoparticles, dendrimers, and other type of
transporters.
Drug delivery devices, on the other hand, encompasses a wide range of systems
that differ in their complexity, form factor, mechanical components, and materials.
Drug delivery devices range from pumps designed to control the rate at which a
drug is administered or released to the bloodstream and iontophoretic transdermal
patches that increase the permeability of the skin to improve drug absorption to
simple syringes or polymeric tubes to allow the passage of the drug from a reservoir
to the circulatory system (catheters).
versus inhaled, which had an absolute mean of reduction in HA1c of 0.55% in the
subcutaneous group (pittas). A study by Rosenstock et al. compared TI to Aspart
with similar and noninferior decreases in HA1c, the parameter that is used by clini-
cians to determine 3-month cumulative glucose levels [9].
Besides common side effects of hypoglycemia and throat pain/irritation cough
(25%–35% of patients), studies have shown significant side effects, such as increased
incidence of bronchospasm in patients with chronic lung disease. In addition, further
long-term study will be required due to its association with increased incidence of
lung cancer as post-marketing studies have shown to have a fourfold increased risk
of primary lung cancers [7].
chemotherapeutic agents. Subia et al. attached folate to SF protein loaded with doxo-
rubicin in vivo against breast cancer cells [14].
Technological advances such as these continue. Silk protein, due to its bioavail-
ability and nontoxic properties, shows great promise to the field of drug delivery and
for much broader applications for future health care [15].
Cell Delivery
Recently, it became possible to deliver genetically engineered cells as a therapeutic
modality for a variety of clinical conditions. Genetic engineering of cells involves
the modification of a cell product to express a desired therapeutic protein. These
modified cells are then injected into the patient, allowing the production of a pro-
tein product in vivo. Further encapsulation of cells in special capsules prevents the
implanted cells from being rejected by the immune system once implanted in the
human body.
A product based on encapsulated genetically engineered cells for the treatment of
ocular disorders of the posterior chamber was recently developed and is now under-
going clinical trials [22].
„De pastor kreeg een gedacht. Koster! riep hij, ’k en kan [75]ik volstrekt in
de kerke niet gaan, ge zult gij moeten de kruiskes geven.
„De koster, die zijnen pastor gewend was, verstond dat nog al wel.
„Ge weet wat ge moet zeggen, binst dat ge de kruiskes geeft: Memento,
homo! quia pulvis es et in pulverum reverteris (Herinner, mensch! dat gij
stof zijt en in stof zult wederkeeren).
„De pastor herhaalde ’t latijn, maar de koster en verstond het nog niet.
„Ja, Mijnheer Pastor, zei de koster, en hij trok de kerke binnen, peinzende
in zijn eigen dat ze toch aardige dingen zeggen aan de menschen in ’t
latijn.
„En hij begon maar kruiskes te geven en te herhalen dat hij schuimde:
„De menschen keken wat aardig en dat wierd beklapt en besproken als zij
buiten de kerke kwamen.
„Onverdiend!”
Hier voren (op bladzijde 70) heb ik reeds met een enkel woord
vermeld de verzen van eenen Vlaming uit den ouden tijd, waarin al
de spotnamen van Vlaamsche steden en dorpen zijn opgenoemd.
Op dat hoogst merkwaardige stuk wil ik hier nader terug komen.
Sommigen van deze oude namen leven nog heden in den mond des
volks. De H e e r e n van Gent, de K i n d e r e n van Yperen, de
P a s t e i - e t e r s van Kortrijk, de M a k e l - e t e r s van
Dendermonde, de W i t v o e t e n van Aalst, en anderen zijn nog
heden ten dage zoo goed bekend als tijdens Eduwaert den Dene.
Daarentegen zijn de rijke en machtige P o o r t e r s van Brugge uit
de zestiende eeuw in onze negentiende eeuw tot Z o t t e n
vernederd, zijn de oude L e d i g g a n g e r s van Oudenaarde thans
B o o n e n k n o o p e r s , de H u i d e v e t t e r s van Geeraartsbergen
thans B e r g k r u i p e r s , de K a n d e e l e t e r s van Meenen thans
Ta a r t e b a k k e r s , de R o o m e t e r s van Moerbeke thans
S m e e r k o e k e t e r s (de hedendaagsche lieden van Meenen en
van Moerbeke zijn toch liefhebbers van lekkernij gebleven, zoo als
hunne oud-eeuwsche voorvaders reeds waren); de
V a c h t p l u k k e r s van Poperinge heeten thans K e i k o p p e n , de
O v e r m o e d i g e n van Ronse zijn tot Z o t t e n ,
V l i e g e n v a n g e r s en S l e k k e n t r e k k e r s geworden, en de
zestiende-eeuwsche B u e t e r - e t e r s van Diksmude thans, min
hoffelijk, tot B o t e r - k o p p e n .
Uit een taalkundig oogpunt zijn eenigen van deze namen zeer
merkwaardig; b.v. de D a r y n c b a r n e r s van ’t Land van den Vrijen
van Brugge (eene gouw in ’t Noorden van West-Vlaanderen), die in ’t
hedendaagsche Hollandsche Nederduitsch T u r f b r a n d e r s
zouden moeten genoemd worden. Darync, Darink, Daring,
hedendaags in West-Vlaanderen als dèring of derring uitgesproken,
is de oorspronkelijke vorm van ons hedendaagsch Noord-
Nederlandsche woord derrie.—Verder de H u d e v e t t e r s
(Lederbereiders) van Geeraartsbergen, de D r o o g h a e r t s
(Droogscheerders) van Werveke, de T h o o l n a e r s (Tollenaars of,
zoo als de verbasterde Hollanders zeggen, „Douanen”) van
Rupelmonde, enz.
Daar zijn nog oudere Vlaamsche spotnamen bekend, dan dezen van
1560. In de Anzeiger für Kunde der Teutschen Vorzeit, jaargang
1835, bladzijde 299 vindt men een lijstje van die namen
medegedeeld, ’t welk volgens de meening van sommige geleerden
tusschen de jaren 1347 en 1414 moet zijn opgesteld. Deze
middeleeuwsche spotnamen zijn in hoofdzaak de zelfden als die
men in „den langhen Adieu” vindt opgesomd. Sommigen echter
wijken in meerdere of mindere mate af van de namen in dat [81]rijm
voorkomende. Zoo heeten in dit middeleeuwsche lijstje de
ingezetenen van Poperingen V a c h t p l o t e r s , terwijl Eduwaert
de Dene ze V a c h t p l u c k e r s noemt; die van Meenen
P e l s m a k e r s , tegenover de C a n d e e l e t e r s van de Dene; die
van Werveke V e r w a t e n l i e d e n , tegenover de
D r o o g h a e r t s van de Dene; die van Deinse G a r e n c o e p e r s
tegenover de C a e r d e m a e c k e r s van de Dene. En er worden in
het oude lijstje ook eenigen genoemd, die de Dene niet heeft; bij
voorbeeld de W a f e l e t e r s van Bethune, de U t r e c h t s c h e
V l a m i n g e n van de Vier-Ambachten, de P l a t t e G e s e l l e n
van Sleedingen (hedendaags Sleidinge), de D a n s e r s van
Everghem, de S c i p h e e r e n van der Sluus, de T u u s c h e r s van
Theemsche (hedendaags Temseke), en anderen.
De Engelschman J o h n B u l l , de Franschman J e a n
P o t a g e e n zijn wijf M a r i a n n e , J a n t j e - K a a s de Hollander
(door Vlamingen en Brabanders zoo genoemd) en de Duitsche
M i c h e l of H a n s - M i c h e l zijn overbekend. Overbekend is ook in
onze dagen de spotnaam R o o i n e k en R o o i b a a i t j i e , dien
onze Zuid-Afrikaansche stamgenooten den Engelschman geven. De
Hollanders in ’t bijzonder hebben ook nog eenen bijzonderen
spotnaam voor den Duitscher, dien ze M o f noemen. Naar den
oorsprong van dezen naam is door velen vruchteloos gezocht.
Opmerkelijk is het dat de Duitschers, die langs onze oostelijke
grenzen wonen, dien spotnaam M o f (zij zeggen M u f ) wederkeerig
op de Nederlanders toepassen, en ons H o l l a n d e r - M u f
noemen; zie Ten Doornkaat Koolman, Wörterbuch der
Ostfriesischen Sprache, waar almede eene verklaring van dit woord
Muf of Mof te vinden is. De Nederlanders noemen geheel
Duitschland wel M o f f r i k a , maar de Duitschers zelven geven dien
naam M u f f r i k a in ’t bijzonder aan eene kleine gouw, langs onze
grenzen zich uitstrekkende, aan het zoogenoemde Nedersticht van
Munster, tusschen Oost-Friesland en Bentheim gelegen, en de
stadjes Meppen en Lingen met omstreken omvattende.
Opmerkelijk is het, dat men dit woord P o e p als spotnaam ook hier
en daar elders in de Nederlanden terug vindt. De ingezetenen van
Deventer toch dragen bij de andere Overijsselaars en bij de
Gelderschen in hunne nabuurschap ook dezen naam. En ook de
Zeeuwen noemen hunne Vlaamsche en Brabantsche naburen
P o e p e n . Zoo hoorde ik in 1869 door een paar burgers van Goes
zeggen, van een gezelschap boeren en boerinnen uit de polders van
Zandvliet bij Antwerpen, die door ’t stadje Goes ronddwaalden: „’t
zijn maar P o e p e n ,” eenigszins minachtender wijze, juist zoo als
de Friezen spreken van de Duitschers. Volgens van Dale (zelf een
Zeeuwsche Vlaming), Nieuw Woordenboek der Nederlandsche taal,
is p o e p een scheldnaam dien de bewoners van Zuid-Beveland aan
de bewoners van Zeeuwsch-Vlaanderen geven. En volgens De Bo’s
Westvlaamsch Idioticon noemt men in West-Vlaanderen „iemand die
weinig verstand of weinig moed heeft,” een „dwazerik” dus, of een
„lafaard”, een „p o e p g a a i .”
In der daad, de stad Dokkum dagteekent reeds uit zeer ouden tijd;
reeds ten jare 754 verkondigde Sint-Bonifacius daar het Evangelie.
Het Dokkumer taai, eene soort van grof Sint-Nicolaasgebak, is in
geheel Friesland vermaard. En wat de Dokkumer garnaten
(garnalen) aangaat, daar moet men maar niet te luide van spreken,
als er Dokkumers bij zijn (zie bladzijde 21 en vervolgens). [87]
Zeer aardig kenschetsend zijn deze twee rijmkes, van een
Utrechtsch en van een Noordbrabantsch dorp:
Neêr-Langbroek,
Die schrale hoek!
Daar wonen niets dan edellui
En bedellui,
Ridders
En broodbidders;
Daar staan anders niet als kasteelen en nesten,
Sterkenburg is het beste.
Loon-op-Zand,
Licht volk, licht land;
Ze schooien den kost.
En ze stelen den brand. 16
De Bressianen
Zijn hanen,
Maar voor Schoondijke
Moeten ze wijken,
En komen die van de Groe,
Dan houden ze beter hun deuren maar toe!
[88]
Van groote ingenomenheid met zich zelven getuigt het volgende rijm
van sommige Noordhollandsche steden, dat bij de
Monnikendammers in zwang is:
Ten slotte kan ik nog een zeer bijzonder rijm hier mede deelen, dat
betrekking heeft op de Friesche eilandenreeks die zich uitstrekt
tusschen de Weser en het Marsdiep, en dat door mij is
opgeschreven uit den mond van eenen Frieschen schipperszoon,
die met de tjalk van zijnen vader wel oostwaarts naar Emden,
Bremen en Hamburg, en wel zuidwaarts naar Amsterdam,
Rotterdam, Dordrecht en Antwerpen voer. Het rijm is niet in de
eigenlijke Friesche taal opgesteld, maar in het zoogenoemde Stad-
Friesch of „Stêdsk”, dat is Oud-Dietsch met Friesche woorden en
woordvormen vermengd, en met eenen Frieschen mond
uitgesproken.
Wrangero de skoone,
Spikeroog de krone,
Langeroog is ’n butterfat
En Baltrum is ’n sangat.
En de Norderneyers frete har mar half sat
Juust dat is ’n rooverland;
En Borkum is ’n tooverland;
Rottumeroog is ’n klein land,
Mar Skiermonnikoog is sterk bemand:
De Amelander skalken
Hewwe stolen drie balken,
Avons in ’e maneskijn,
Daarom sal ’t har wapen sijn. [89]
Skilingen het ’n hooge toren,
Flielan het siin naam ferloren,
Tessel is mar ’n seegat,
De Helderse T r a a n b o k k e n segge dat.
Dit is het einde van mijn opstel over spotnamen, spotrijmen, enz.
Mogen anderen hierin aanleiding vinden dit belangrijke onderwerp
nog eens beter en uitvoeriger te behandelen. [90]
[Inhoud]