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Full Chapter Respiratory Delivery of Biologics Nucleic Acids and Vaccines 2Nd Edition Harry Perlstadt PDF
Full Chapter Respiratory Delivery of Biologics Nucleic Acids and Vaccines 2Nd Edition Harry Perlstadt PDF
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Absorption and Utilization of Amino Acids : Volume II
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Series Editor
Claudio Salomon
National University of Rosario, Rosario, Argentina
Founding Editor
Robin Zavod
Chicago College of Pharmacy, Midwestern University, Downers Grove, IL,
USA
Hideyuki Sato
Email: h.sato@u-shizuoka-ken.ac.jp
Abstract
Pharmaceutical peptides have gradually become more attractive
therapeutic molecules than small-molecule drugs, since pharmaceutical
peptides are more selective and effective, and have fewer side effects,
compared to small-molecule drugs. Generally, owing to their poor oral
absorbability and gastrointestinal stability, peptides are mainly
administered via intravenous and intramuscular routes, which
adversely affects patient compliance. Pulmonary characteristics, such
as large surface area, abundant capillary network, thin membrane with
adequate permeability for macromolecules, reduced enzymatic
degradation, and lack of first-pass metabolism, facilitate the use of
inhalable formulations to achieve local and systemic actions. Precise
control of powder properties and appropriate design of respirable
particles to stabilize target peptides are necessary for their efficient
pulmonary delivery. This chapter discusses the strategies for
formulation and efficient delivery of peptide-loaded dry powders.
Keywords Dry powders – Particle design – Peptides – Pulmonary
delivery
1 Introduction
Recent advances in formulation development, such as drug engineering
and recombinant DNA technology, facilitate the efficient formulation
and delivery of medium and high molecular weight compounds such as
peptides, nucleic acids, antibodies, and proteins, which have specific
and potent pharmacological actions owing to their high target
selectivity. In 2019, eight biologic drugs were among the top 10 global
sales [10]. Recently, middle molecular weight drugs with a molecular
weight of about 500–6000 Da, peptides and nucleic acids, have
attracted significant interest as they are relatively easy to design,
synthesize, and control, compared with proteins and antibodies.
However, similar to other biologics, the oral bioavailability of peptides
is poor, owing to their molecular size, degradation by digestive enzymes
in the gastrointestinal (GI) tract, low permeability through the
epithelial barriers in the GI tract, and first-pass metabolism. Thus, most
peptide drugs are administered via the parenteral routes, like
subcutaneous, intramuscular, or intravenous injections. Parenteral
administration has several limitations, such as pain, risk of injury at the
injection site, difficulties with self-administration, cold chain storage,
production of needles, syringes, and other waste materials that are
difficult to dispose of. To overcome these drawbacks, safe, effective, and
non-invasive routes and drug delivery technologies are being
developed.
Pulmonary delivery can offer rapid absorption of drugs and higher
systemic exposure because of the extensive vascularization in the lung,
high tissue permeability of epithelial cells, relatively low activity of
metabolic enzymes, and large pulmonary surface area [57], leading to
several advantages over conventional, non-invasive administration
routes in the treatment of systemic diseases. The pulmonary
administration system can deliver a larger amount of drug directly to a
local disease site with minimal systemic exposure. There have been
many reports on achieving efficacious drug delivery to the disease site
for the treatment of asthma, chronic obstructive pulmonary disease,
and respiratory infections [28]. Therefore, pulmonary delivery is a
viable option for effective and safe delivery of therapeutic peptides for
topical and systemic actions, depending on the target disease. Thus,
much attention has been paid to develop and investigate pulmonary
delivery systems for therapeutic peptides. For the systemic actions,
pulmonary delivery of metabolic hormones, including insulin,
calcitonin, growth hormones, somatostatin, thyroid-stimulating
hormone, and follicle-stimulating hormone, to humans and
experimental animals has been reported [1]. For the treatment of
respiratory diseases like asthma, chronic obstructive pulmonary
diseases, and cystic fibrosis and lung infections, applications of
vasoactive intestinal peptide analogues, neuropeptide Y, cyclosporine A,
and colistin have been investigated [7, 16, 79]. However, difficulty in
particle design and formulation strategies limits the practical
applications of pulmonary delivery of therapeutic peptides. Generally,
for orally inhaled particles, aerodynamic particle size between 1 and
5 μm ensures efficient delivery of inhaled particles [13]. Particles with
aerodynamic diameters larger than 10 μm are deposited in the
extrathoracic sites, such as the mouth, pharynx, and larynx, and particle
sizes between 5–10 μm are deposited in the tracheobronchial tree.
Particles that are too small cannot adhere to the surface of the
respiratory tract because they are removed from the respiratory tract
by exhaled airflow. Compared with conventional small-molecule drugs,
therapeutic peptides tend to be at risk of degradation and deactivation,
owing to their poor stability against chemical and physical stress
during the production process and storage [28]. In addition, even after
reaching the respiratory site, some physiological factors cause their
degradation/denaturalization and elimination from the target site [30].
Thus, along with the precise control of particle size, the selection of
appropriate excipients and formulation design are key considerations
for the successful pulmonary delivery of therapeutic peptides.
There are three commonly used systems for inhalation medication:
nebulizers, metered dose inhalers, and dry powder inhalers (DPIs).
Among these, DPIs are the most commonly used inhalation devices in
adults patients due to a lot of practical advantages including ease of
use, portability, and relatively high pulmonary delivery efficiency [70].
Additionally, considering the chemical stability of peptides,
powderization would be one of the options to stabilize the target
molecule, since the presence of water could accelerate the degradation
of peptides. Thus, this chapter mainly focuses on the physicochemical
and biological challenges of therapeutic peptides and particle
design/formulation strategies for DPIs to achieve efficient peptide
delivery by oral inhalation.
Factor Comment
pH Solution pH can influence the charge state of dissolved peptide
depending on the isoelectric point (pI), changing the dispersion
state by electric repulsion.
Physical stress Physical stresses in manufacturing process can alter molecular
(heat, pressure, interactions including electrostatic force, hydrophobic
and shear stress) interactions, hydrogen bonding, van der Waals forces, and local
peptide interactions, possibly changing the folding state and
causing aggregations.
Oxidative stress Amino acids with reactive side chain in a peptide (histidine,
methionine, cysteine, tyrosine, and tryptophan) can be
Factor Comment
potentially damaged by reaction with any of a number of
reactive oxygen species during formulation process and storage.
Excipient Buffering agents and salts have potential to influence on peptide
stability due to changing pH and ionic strength of peptide
solution. Some excipients like surfactants and antioxidants can
stabilize peptide.
2.1 pH
Generally, the pH can influence the aggregation and chemical
degradation of peptides. Electrostatic interactions are known to play a
major role in stabilizing the dispersion state. More specifically, a higher
net charge can contribute to the suppression of the aggregation
potential of peptides owing to the electronic repulsion between peptide
molecules [60]. Additionally, the ionic strength and nature of the
cations and anions in solution, and the presence of polyelectrolytes also
have the potential to affect the rate and extent of aggregation. To
estimate the effect of solution conditions on aggregation, the isoelectric
point of peptides, where net charges are essentially zero, is useful
information [38], suggesting the importance of selecting suitable
excipients for stabilizing target peptides in the formulation process and
subsequent products. When the solution pH is significantly different
from the isoelectric point, the protein becomes highly charged,
resulting in electric repulsions.
2.2 Temperature
During the pharmaceutical process, active ingredients experience
physical stress, such as thermal stress, pressure, and shear stress.
Temperature affects the structural stability of peptides via molecular
interactions, conformational stability (secondary structure), solubility,
and chemical degradation. Electrostatic forces, hydrophobic
interactions, hydrogen bonding, van der Waals forces, and local peptide
interactions are responsible for the free energy of the folding state.
Temperature plays a crucial role in reaction kinetics because rate
constants increase exponentially with temperature, i.e., the rate of
aggregation increases at high temperatures because of the rise in global
molecular mobility (kinetic energy) [6]. Therefore, an increase in
temperature accompanies an increase in the probability and number of
collisions with sufficient energy to overcome the activation energies for
the reaction, possibly leading to the acceleration of aggregation
formation. Consequently, they may compromise their therapeutic
efficacy and cause potential safety concerns. The lyophilization/freeze-
drying technique is a very common method to increase both chemical
and physical stability [18] and reduce the thermal stress for
solidification. However, in some cases, these processes result in
conformational changes in peptides, leading to increased aggregation
after reconstitution in water, depending on their physicochemical
characteristics. Considering these points, the thermal stress during
drying and evaporation conditions should be carefully selected to
minimize the risk of aggregation, and even using freeze-drying, the
possible changes in conformational changes and redispersibility of the
peptide should be evaluated by spectroscopic analysis such as circular
dichroism spectroscopy.
3 Biological Barriers
Active ingredients can act in the mucus layer or on pathogens for
topical pharmacological actions in the respiratory tract, whereas for
systemic delivery, target drugs have to permeate the bronchial mucus
layer and alveolar epithelial cells to enter systemic circulation (Fig. 1).
The thickness of the mucus layer is between 5 and 55 μm depending on
the depth of the site in the respiratory tract [29] and varies depending
on the physiological conditions [27], resulting in the difficulty of
sufficient delivery of target peptides in obstructive diseases, which
causes increases in mucus production and viscosity of mucus. Thus,
controlling diffusiveness within the mucus layer by mucoadhesive and
mucopenetrating properties of the formulation could contribute to the
enhanced and/or sustained absorbability from the lung (described in
detail in Sect. 5.1 Adjusting mucodiffusiveness). Although pulmonary
mucus is not a significant barrier for macromolecules with sizes less
than 10 nm (−500 kDa), aggregates of peptides and nano/microparticle
formulations (>10 nm) could be trapped by the mucus layer owing to
the mesh-like structure of the mucus layer. They are transported from
the deep lung to the pharynx by mucociliary clearance and are removed
via phagocytosis by macrophages.
Table 3 Excipients for using stabilization of peptide and proteins during spray-
drying process
Category Excipient Characteristic Reference
Sugars Glucose, fructose, maltose, sucrose, Water replacement [14, 19, 21,
trehalose, inulin, dextran theory contributes 66]
to the stabilization
of peptide by
molecular
interactions.
Entrapping peptide
into the glassy
matrix structure of
excipients,
stabilizing included
molecules by
restricting mobility.
Polyols Glycerol, mannitol, sorbitol Water replacement
theory contributes
to the stabilization
of peptide by
molecular
interactions.
Entrapping peptide
into the glassy
matrix structure of
excipients,
stabilizing included
molecules by
restricting mobility.
Amino Alanine, arginine, aspartic acid, Forming hydrogen [2, 15, 25,
acids glycine, histidine, leucine, bonding with 26, 32]
isoleucine, lysine, phenylalanine, proteins and
proline peptides.
Inhibition of the
aggregation of
peptides by
competing with
adsorption at the
air–liquid interface.
Improved inhalation
performance and
moisture protection
Category Excipient Characteristic Reference
by hydrophobic
amino acids.
Surfactants Polysorbate 20, polysorbate 80, Inhibition of the [11, 43, 44]
dipalmitoylphosphatidylcholine, aggregation of
sodium glycocholate peptides and
assisting in the
refolding by
preventing
adsorption at the
air–liquid interface.
Sugars and polyols are typically used as pharmaceutical excipients
to improve the flowability and stability of peptides. Sucrose, mannitol,
lactose, trehalose, sorbitol, and inulin are common excipients used for
the production of peptide-loaded particles [21]. These sugars and
polyols can theoretically stabilize the included peptides based on two
theories: (i) water replacement theory and (ii) vitrification theory (Fig.
2). Water replacement theory suggests that during the
solidification/powderization process, these excipients can form
hydrogen bonds with active ingredients by replacing the hydrated
water of protein/peptide, leading to the entrapment of macromolecules
into the matrix structure of excipients. This may reduce the chance of
hydrolysis by removing surrounding water. Vitrification theory
suggests that entrapment of target macromolecules into the glass-
forming matrix former can contribute to the restriction of mobility in a
rigid structure, resulting in the stabilization of highly structured
proteins and peptides. Glassy excipients with a high glass transition
temperature can act as physical barriers to improve thermostability.
Non-reducing sugars, including trehalose and sucrose, are preferable,
and the combined use of sugars, polyols, and other stabilizing
excipients can stabilize proteins and peptides during the manufacturing
process.
Fig. 2 Vitrification and water replacement theories of peptide stabilization by
sugars and polyols
Amino acids are highly biocompatible and this class of compounds
have a wide range of chemical and physicochemical properties,
including hydrophilic, hydrophobic, neutral, cationic, anionic, and
antioxidant effects [32]. Amino acids with relatively small sizes,
including glycine, alanine, leucine, isoleucine, histidine, and arginine,
are typically used as stabilizers in DPI formulations. They can form
hydrogen bonds with proteins and peptides, possibly leading to
stabilization during powderization. Additionally, they can inhibit the
aggregation of peptides by competing with adsorption at the air-liquid
interface. The application of hydrophobic amino acids, L-leucine and
phenylalanine, can also reduce moisture-induced degradation and
improve the inhalation performance of dry powders by acting as
dispersibility enhancers. L-leucine can enhance the aerosolization
efficiency of spray-dried powders by reducing their surface
cohesiveness. Surfactants such as polysorbate 20, polysorbate 80, and
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V. Persons who tell an artist that he is equal to Claude, or a writer
that he is as great as Bacon, do not add to the satisfaction of their
hearers, but pay themselves a left-handed compliment, by supposing
that their judgment is equivalent to the suffrage of posterity.
VI. A French artist advised young beginners against being too fond
of a variety of colours, which might do very well on a smaller scale,
but when they came to paint a large picture they would find they had
soon lavished all their resources. So superficial writers may deck out
their barren round of common-places in the finest phrases
imaginable; but those who are accustomed to work out a subject by
dint of study, must not use up their whole stock of eloquence at once,
they must bring forward their most appropriate expressions as they
approach nearer to the truth, and raise their style with their
thoughts. A good general keeps his reserve, the élite of his troops, to
charge at the critical moment.
VII. ‘Procrastination is the thief of time.’ It is singular that we are
so often loth to begin what gives us great satisfaction in the progress,
and what, after we have once begun it, we are as loth to leave off. The
reason is, that the imagination is not excited till the first step is taken
or the first blow is struck. Before we begin a certain task, we have
little notion how we shall set about it, or how we shall proceed: it is
like attempting something of which we have no knowledge, and
which we feel we are incapable of doing. It is no wonder, therefore,
that a strong repugnance accompanies this seeming inaptitude: it is
having to make bricks without straw. But after the first effort is over,
and we have turned our minds to the subject, one thing suggests
another, our ideas pour in faster than we can use them, and we
launch into the stream which bears us on with ease and pleasure to
ourselves. The painter who did not like to mix his colours or begin on
a new canvas in the morning, sees the light close in upon him with
unwilling eyes; and the essayist, though gravelled for a thought, or at
a loss for words at the outset of his labours, winds up with alacrity
and spirit.
VIII. Conversation is like a game at tennis, or any other game of
skill. A person shines in one company who makes no figure in
another—just as a tolerably good cricketer, who might be an
acquisition to a country club, would have his wicket struck down at
the first bowl at Lord’s-ground. The same person is frequently dull at
one time and brilliant at another: sometimes those who are most
silent at the beginning of an entertainment are most loquacious at
the end. There is a run in the luck both in cards and conversation.
Some people are good speakers but bad hearers: these are put out,
unless they have all the talk to themselves. Some are best in a tête-à-
tête; others in a mixed company. Some persons talk well on a set
subject, who can hardly answer a common question, still less pay a
compliment or make a repartee. Conversation may be divided into
the personal or the didactic: the one resembles the style of a lecture,
the other that of a comedy. There are as many who fail in
conversation from aiming at too high a standard of excellence, and
wishing only to utter oracles or jeux-d’esprit, as there are who expose
themselves from having no standard at all, and saying whatever
comes into their heads. Pedants and gossips compose the largest
class. Numbers talk on without paying any attention to the effect
they produce upon their audience: some few take no part in the
discourse but by assenting to everything that is said, and these are
not the worst companions in the world. An outcry is sometimes
raised against dull people, as if it were any fault of theirs. The most
brilliant performers very soon grow dull, and we like people to begin
as they end. There is then no disappointment nor false excitement.
The great ingredient in society is good-will. He who is pleased with
what he himself has to say, and listens in his turn with patience and
good-humour, is wise and witty enough for us. We do not covet those
parties where one wit dares not go, because another is expected. How
delectable must the encounter of such pretenders be to one another!
How edifying to the bye-standers!
IX. It was well said by Mr. Coleridge, that people never improve by
contradiction, but by agreeing to differ. If you discuss a question
amicably you may gain a clear insight into it; if you dispute about it
you only throw dust in one another’s eyes. In all angry or violent
controversy, your object is not to learn wisdom, but to prove your
adversary a fool; and in this respect, it must be admitted, both
parties usually succeed.
X. Envy is the ruling passion of mankind. The explanation is
obvious. As we are of infinitely more importance in our own eyes
than all the world beside, the chief bent and study of the mind is
directed to impress others with this self-evident but disputed
distinction, and to arm ourselves with the exclusive signatures and
credentials of our superiority, and to hate and stifle all that stands in
the way of, or obscures, our absurd pretensions. Each individual
looks upon himself in the light of a dethroned monarch, and the rest
of the world as his rebellious subjects and runaway slaves, who
withhold the homage that is his natural due, and burst the chains of
opinion he would impose upon them: the madman in Hogarth (sooth
to say), with his crown of straw and wooden sceptre, is but a type and
common-place emblem of every-day life.
XI. It has been made a subject of regret that in forty or fifty years’
time (if we go on as we have done) no one will read Fielding. What a
falling off! Already, if you thoughtlessly lend Joseph Andrews to a
respectable family, you find it returned upon your hands as an
improper book. To be sure, people read ‘Don Juan’; but that is in
verse. The worst is, that this senseless fastidiousness is more owing
to an affectation of gentility than to a disgust at vice. It is not the
scenes that are described at an alehouse, but the alehouse at which
they take place that gives the mortal stab to taste and refinement.
One comfort is, that the manners and characters which are objected
to as low in Fielding have in a great measure disappeared or taken
another shape; and this at least is one good effect of all excellent
satire—that it destroys ‘the very food whereon it lives.’ The generality
of readers, who only seek for the representation of existing models,
must therefore, after a time, seek in vain for this obvious
verisimilitude in the most powerful and popular works of the kind;
and will be either disgusted or at a loss to understand the
application. People of sense and imagination, who look beyond the
surface or the passing folly of the day, will always read Tom Jones.
XII. There is a set of critics and philosophers who have never read
anything but what has appeared within the last ten years, and to
whom every mode of expression or turn of thought extending beyond
that period has a very odd effect. They cannot comprehend how
people used such out-of-the-way phrases in the time of Shakspeare;
the style of Addison would not do now—even Junius, they think,
would make but a shabby thread-bare figure in the columns of a
modern newspaper—all the riches that the language has acquired in
the course of time, all the idiomatic resources arising from study or
accident, are utterly discarded—sink under-ground: and all that is
admired by the weak or sought after by the vain, is a thin surface of
idle affectation and glossy innovations. Even spelling and
pronunciation have undergone such changes within a short time,
that Pope and Swift require a little modernizing to accommodate
them to ‘ears polite;’ and that a bluestocking belle would be puzzled
in reciting Dryden’s sounding verse with its occasional barbarous,
old-fashioned accenting, if it were the custom to read Dryden aloud
in those serene, morning circles. There is no class more liable to set
up this narrow superficial standard, than people of fashion, in their
horror of what is vulgar and ignorance of what really is so; they have
a jargon of their own, but scout whatever does not fall in with it as
Gothic and outré; the English phrases handed down from the last age
they think come east of Temple-bar, and they perform a sedulous
quarantine against them. The Times, having found it so written in
some outlandish depêche of the Marquis of Wellesley’s, chose as a
mark of the haute literature, to spell dispatch with an e, and for a
long time he was held for a novice or an affected and absolute writer
who spelt it otherwise. The Globe, with its characteristic good sense
and sturdiness of spirit has restored the old English spelling in
defiance of scandal. Some persons who were growing jealous that the
author of Waverley had eclipsed their favourite luminaries may
make themselves easy; he himself is on the wane with those whose
opinions ebb and flow with the ‘inconstant moon’ of fashion, and has
given way (if Mr. Colburn’s advertisements speak true, ‘than which
what’s truer?’) to a set of titled nonentities. Nothing solid is to go
down, or that is likely to last three months; instead of the standing
dishes of old English literature we are to take up with the nicknacks
and whipt syllabubs of modern taste; are to be occupied with a
stream of titlepages, extracts, and specimens, like passing figures in a
camera obscura, and are to be puzzled in a mob of new books as in
the mob of new faces in what was formerly the narrow part of the
Strand.
XIII. Never pity people because they are ill-used. They only wait
the opportunity to use others just as ill. Hate the oppression and
prevent the evil if you can; but do not fancy there is any virtue in
being oppressed, or any love lost between the parties. The
unfortunate are not a jot more amiable than their neighbours,
though they give themselves out so, and our pity takes part with
those who have disarmed our envy.
XIV. The human mind seems to improve, because it is continually
in progress. But as it moves forward to new acquisitions and
trophies, it loses its hold on those which formerly were its chief boast
and employment. Men are better chemists than they were, but worse
divines; they read the newspapers, it is true, but neglect the classics.
Everything has its turn. Neither is error extirpated so much as it
takes a new form and puts on a more artful disguise. Folly shifts its
ground, but finds its level: absurdity is never left without a
subterfuge. The dupes of dreams and omens in former times, are
now the converts to graver and more solemn pieces of quackery. The
race of the sanguine, the visionary, and the credulous, of those who
believe what they wish, or what excites their wonder, in preference to
what they know, or can have rationally explained, will never wear
out; and they only transfer their innate love of the marvellous from
old and exploded chimeras to fashionable theories, and the terra
incognita of modern science.
XV. It is a curious speculation to take a modern belle, or some
accomplished female acquaintance, and conceive what her great-
great-grandmother was like, some centuries ago. Who was the Mrs.
—— of the year 200? We have some standard of grace and elegance
among eastern nations 3000 years ago, because we read accounts of
them in history; but we have no more notion of, or faith in, our own
ancestors than if we had never had any. We cut the connexion with
the Druids and the Heptarchy; and cannot fancy ourselves (by any
transformation) inmates of caves and woods, or feeders on acorns
and sloes. We seem engrafted on that low stem—a bright, airy, and
insolent excrescence.
XVI. There is this advantage in painting, if there were no other,
that it is the truest and most self-evident kind of history. It shows
that there were people long ago, and also what they were, not in a
book darkly, but face to face. It is not the half-formed clay, the old-
fashioned dress, as we might conceive; but the living lineaments, the
breathing expression. You look at a picture by Vandyke, and there
see as in an enchanted mirror, an English woman of quality two
hundred years ago, sitting in unconscious state with her child playing
at her feet, and with all the dove-like innocence of look, the grace and
refinement that it is possible for virtue and breeding to bestow. It is
enough to make us proud of our nature and our countrywomen; and
dissipates at once the idle, upstart prejudice that all before our time
was sordid and scarce civilised. If our progress does not appear so
great as our presumption has suggested, what does it signify? With
such models kept in view, our chief object ought to be not to
degenerate; and though the future prospect is less gaudy and
imposing, the retrospect opens a larger and brighter vista of
excellence.
XVII. I am by education and conviction inclined to republicanism
and puritanism. In America they have both; but I confess I feel a
little staggered in the practical efficacy and saving grace of first
principles, when I ask myself, ‘Can they throughout the United
States, from Boston to Baltimore, produce a single head like one of
Titian’s Venetian nobles, nurtured in all the pride of aristocracy and
all the blindness of popery?’ Of all the branches of political economy,
the human face is perhaps the best criterion of value.
COMMON SENSE
The Atlas.]
[October 11, 1829.
The Atlas.]
[January 31, 1830.
The Atlas.]
[February 14, 1830.