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通过干粉吸入剂配方共同递送高剂量两性霉素B和伊曲康唑用于治疗严重真菌性肺部感染。

Co-Delivery of a High Dose of Amphotericin B and Itraconazole by Means of a Dry Powder Inhaler Formulation for the Treatment of Severe Fungal Pulmonary Infections.

作者信息

Celi Salomé S, Fernández-García Raquel, Afonso-Urich Andreina I, Ballesteros M Paloma, Healy Anne Marie, Serrano Dolores R

机构信息

Departamento de Farmacia Galénica y Tecnología Alimentaria, Facultad de Farmacia, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain.

Facultad de Farmacia, Instituto Universitario de Farmacia Industrial, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain.

出版信息

Pharmaceutics. 2023 Nov 8;15(11):2601. doi: 10.3390/pharmaceutics15112601.


DOI:10.3390/pharmaceutics15112601
PMID:38004579
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10675812/
Abstract

Over the past few decades, there has been a considerable rise in the incidence and prevalence of pulmonary fungal infections, creating a global health problem due to a lack of antifungal therapies specifically designed for pulmonary administration. Amphotericin B (AmB) and itraconazole (ITR) are two antifungal drugs with different mechanisms of action that have been widely employed in antimycotic therapy. In this work, microparticles containing a high dose of AmB and ITR (20, 30, and 40% total antifungal drug loading) were engineered for use in dry powder inhalers (DPIs) with an aim to improve the pharmacological effect, thereby enhancing the existing off-label choices for pulmonary administration. A Design of Experiment (DoE) approach was employed to prepare DPI formulations consisting of AmB-ITR encapsulated within γ-cyclodextrin (γ-CD) alongside functional excipients, such as mannitol and leucine. In vitro deposition indicated a favourable lung deposition pattern characterised by an upper ITR distribution (mass median aerodynamic diameter (MMAD) ~ 6 µm) along with a lower AmB deposition (MMAD ~ 3 µm). This offers significant advantages for treating fungal infections, not only in the lung parenchyma but also in the upper respiratory tract, considering that spp. can cause upper and lower airway disorders. The in vitro deposition profile of ITR and larger MMAD was related to the higher unencapsulated crystalline fraction of the drug, which may be altered using a higher concentration of γ-CD.

摘要

在过去几十年中,肺部真菌感染的发病率和患病率显著上升,由于缺乏专门用于肺部给药的抗真菌疗法,这已成为一个全球性的健康问题。两性霉素B(AmB)和伊曲康唑(ITR)是两种作用机制不同的抗真菌药物,已广泛应用于抗真菌治疗。在这项工作中,设计了含有高剂量AmB和ITR(总抗真菌药物载量为20%、30%和40%)的微粒,用于干粉吸入器(DPI),旨在提高药理效果,从而增加现有的肺部给药的非标签选择。采用实验设计(DoE)方法制备了DPI制剂,该制剂由包裹在γ-环糊精(γ-CD)中的AmB-ITR以及功能性辅料(如甘露醇和亮氨酸)组成。体外沉积显示出良好的肺部沉积模式,其特征是ITR在上部的分布(质量中位空气动力学直径(MMAD)约为6 µm)以及AmB在下部的沉积(MMAD约为3 µm)。考虑到 spp. 可导致上、下呼吸道疾病,这不仅对治疗肺实质真菌感染,而且对上呼吸道真菌感染都具有显著优势。ITR的体外沉积曲线和较大的MMAD与药物较高的未包裹结晶部分有关,使用更高浓度的γ-CD可能会改变这一情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/7a4e0de67d91/pharmaceutics-15-02601-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/5b206c0e8671/pharmaceutics-15-02601-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/010bc6528d96/pharmaceutics-15-02601-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/32ec1abe2b0d/pharmaceutics-15-02601-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/2f8992edb5f4/pharmaceutics-15-02601-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/7a4e0de67d91/pharmaceutics-15-02601-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/5b206c0e8671/pharmaceutics-15-02601-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/010bc6528d96/pharmaceutics-15-02601-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/32ec1abe2b0d/pharmaceutics-15-02601-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/2f8992edb5f4/pharmaceutics-15-02601-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/60e8/10675812/7a4e0de67d91/pharmaceutics-15-02601-g005.jpg

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[1]
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Molecules. 2023-10-8

[2]
Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality.

World J Transplant. 2023-9-18

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Med Mycol. 2023-8-2

[4]
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Mycoses. 2023-10

[5]
Effect of Amphotericin B on the Thermodynamic Properties and Surface Morphology of the Pulmonary Surfactant Model Monolayer during Respiration.

Molecules. 2023-6-18

[6]
Amphotericin B-Silver Hybrid Nanoparticles Help to Unveil the Mechanism of Biological Activity of the Antibiotic: Disintegration of Cell Membranes.

Molecules. 2023-6-10

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Molecules. 2023-5-30

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Front Genet. 2023-5-9

[9]
Targeting lung macrophages for fungal and parasitic pulmonary infections with innovative amphotericin B dry powder inhalers.

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[10]
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