Abraham Sheela A, Waterhouse Dawn N, Mayer Lawrence D, Cullis Pieter R, Madden Thomas D, Bally Marcel B
Cambridge Institute for Medical Research, Addenbrooke's Hospital, Cambridge, UK.
Methods Enzymol. 2005;391:71-97. doi: 10.1016/S0076-6879(05)91004-5.
Doxorubicin is the best known and most widely used member of the anthracycline antibiotic group of anticancer agents. It was first introduced in the 1970s, and since that time has become one of the most commonly used drugs for the treatment of both hematological and solid tumors. The therapy-limiting toxicity for this drug is cardiomyopathy, which may lead to congestive heart failure and death. Approximately 2% of patients who have received a cumulative (lifetime) doxorubicin dose of 450-500 mg?m(2) will experience this condition. An approach to ameliorating doxorubicin-related toxicity is to use drug carriers, which engender a change in the pharmacological distribution of the drug, resulting in reduced drug levels in the heart. Examples of these carrier systems include lipid-based (liposome) formulations that effect a beneficial change in doxorubicin biodistribution, with two formulations approved for clinical use. Drug approval was based, in part, on data suggesting that beneficial changes in doxorubicin occurred in the absence of decreased therapeutic activity. Preclinical (animal) and clinical (human) studies showing that liposomes can preferentially accumulate in tumors have provided a rationale for improved activity. Liposomes represent ideal drug delivery systems, as the microvasculature in tumors is typically discontinuous, having pore sizes (100-780 nm) large enough for liposomes to move from the blood compartment into the extravascular space surrounding the tumor cells. Liposomes, in the size range of 100-200 nm readily extravasate within the site of tumor growth to provide locally concentrated drug delivery, a primary role of liposomal formulation. Although other liposomal drugs have been prepared and characterized due to the potential for liposomes to improve antitumor potency of the encapsulated drug, the studies on liposomal doxorubicin have been developed primarily to address issues of acute and chronic toxicity that occur as a consequence of using this drug. It is important to recognize that research programs directed toward the development of liposomal doxorubicin occurred concurrently with synthetic chemistry programs attempting to introduce safer and more effective anthracycline analogues. Although many of these drugs are approved for use, and preliminary liposomal formulations of these analogues have been prepared, doxorubicin continues to be a mainstay of drug cocktails used in the management of most solid tumors. It will be of great interest to observe how the approved formulations of liposomal doxorubicin are integrated into combination regimes for treatment of cancer. In the meantime, we have learned a great deal about liposomes as drug carriers from over 20 years of research on different liposomal doxorubicin formulations, the very first of which were identified in the late 1970s. This chapter will discuss the various methods for encapsulation of doxorubicin into liposomes, as well as some of the important interactions between the formulation components of the drug and how this may impact the biological activity of the associated drug. This review of methodology, in turn, will highlight research activities that are being pursued to achieve better performance parameters for liposomal formulations of doxorubicin, as well as other anticancer agents being considered for use with lipid-based carriers.
多柔比星是蒽环类抗生素抗癌药中最知名且应用最广泛的成员。它于20世纪70年代首次被引入,自那时起已成为治疗血液系统肿瘤和实体瘤最常用的药物之一。该药物的治疗限制性毒性是心肌病,这可能导致充血性心力衰竭和死亡。接受多柔比星累积(终身)剂量达450 - 500 mg/m²的患者中,约2%会出现这种情况。改善多柔比星相关毒性的一种方法是使用药物载体,它会引起药物药理学分布的改变,从而降低心脏中的药物水平。这些载体系统的例子包括基于脂质的(脂质体)制剂,其对多柔比星的生物分布产生有益变化,有两种制剂已获临床应用批准。药物获批部分基于这样的数据,即多柔比星出现有益变化时治疗活性并未降低。临床前(动物)和临床(人体)研究表明脂质体可优先在肿瘤中蓄积,这为活性改善提供了理论依据。脂质体是理想的药物递送系统,因为肿瘤中的微血管通常是不连续的,其孔径(100 - 780 nm)大到足以使脂质体从血液进入肿瘤细胞周围的血管外间隙。大小在100 - 200 nm范围内的脂质体很容易在肿瘤生长部位外渗,以提供局部集中的药物递送,这是脂质体制剂的主要作用。尽管由于脂质体有提高包封药物抗肿瘤效力的潜力,已制备并表征了其他脂质体药物,但关于脂质体多柔比星的研究主要是为了解决使用该药物导致的急性和慢性毒性问题。必须认识到,针对脂质体多柔比星开发的研究项目与试图引入更安全、更有效蒽环类类似物的合成化学项目是同时进行的。尽管这些药物中有许多已获批使用,且已制备了这些类似物的初步脂质体制剂,但多柔比星仍然是用于治疗大多数实体瘤的药物组合中的主要药物。观察已获批的脂质体多柔比星制剂如何融入癌症治疗的联合方案中将非常有趣。与此同时,通过对不同脂质体多柔比星制剂20多年的研究,我们对脂质体作为药物载体有了很多了解,其中最早的制剂是在20世纪70年代末确定的。本章将讨论将多柔比星包封到脂质体中的各种方法,以及药物制剂成分之间的一些重要相互作用,以及这可能如何影响相关药物的生物活性。这种方法学综述反过来将突出为实现脂质体多柔比星制剂以及其他考虑与基于脂质的载体一起使用的抗癌药物更好的性能参数而正在进行的研究活动。
Methods Enzymol. 2005
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