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Respiratory delivery of favipiravir-tocilizumab combination through mucoadhesive protein-lipidic nanovesicles: prospective therapeutics against COVID-19.

ABSTRACT: Coronavirus disease 19 (COVID-19) is the prime global health concern of the year 2020. Infecting more than 112 million individuals so far, this pandemic has already reported more than 2.4 million deaths around the world. With such high infectivity and mortality, effective treatment intervention is the need of the hour. The integration of medical science with nanotechnology may solve the current problem by exploring collective benefits. In this manuscript, we theoretically proposed the duo-combination of an approved antiviral i.e. favipiravir along with an immunomodulator i.e. tocilizumab loaded in protein-lipid nanovesicles as an effective anti-COVID-19 therapeutic. This proposed nanomedicine delivered through the respiratory mode may enhance the effectiveness of the antiviral and help in restricting the virus and associated complications, utilizing both anti-viral activity and immunomodulation in COVID-19 patients. This proposed nanomedicine could be an effective treatment modality for the severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) infected patients.

SUBMITTER: Thakur V

PROVIDER: S-EPMC7966910 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Respiratory delivery of favipiravir-tocilizumab combination through mucoadhesive protein-lipidic nanovesicles: prospective therapeutics against COVID-19.

Thakur Vikram V Ratho Radha Kanta RK Panda Jiban Jyoti JJ

Virusdisease 20210317 1

Coronavirus disease 19 (COVID-19) is the prime global health concern of the year 2020. Infecting more than 112 million individuals so far, this pandemic has already reported more than 2.4 million deaths around the world. With such high infectivity and mortality, effective treatment intervention is the need of the hour. The integration of medical science with nanotechnology may solve the current problem by exploring collective benefits. In this manuscript, we theoretically proposed the duo-combin ...[more]

PMID: 33748347

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Project description:This study was aimed to synthesize polymeric excipients with improved mucoadhesive, cohesive and in situ-gelling properties to assure a prolonged retention time of dosage forms at a given target site, thereby achieving an increased uptake and improved oral bioavailability of certain challenging therapeutic agents such as peptides and proteins. Accordingly, poly(acrylic acid)-cysteine-2-mercaptonicotinic acid (PAA-cys-2MNA) conjugates were synthesized by the oxidative S-S coupling of PAA-cys (100-, 250- and 450 kDa) with 2-mercaptonicotinic acid (2MNA). Unmodified PAAs, PAAs-cys (thiomers) and PAA-cys-2MNA (100-, 250- and 450 kDa) conjugates were compressed into tablets to perform disintegration tests, mucoadhesion studies and rheological measurements. Moreover, cytotoxicty of the polymers was determined using Caco-2 cells. The resulting PAA-cys-2MNA (100-, 250- and 450 kDa) conjugates displayed 113.5 ± 12.7, 122.7 ± 12.2 and 117.3 ± 4.6 μmol/g of 2-mercaptonicotinic acid, respectively. Due to the immobilization of 2MNA, the PAA-cys-2MNA (pre-activated thiomers) conjugates exhibit comparatively higher swelling properties and disintegration time to the corresponding unmodified and thiolated polymers. On the rotating cylinder, tablets based on PAA-cys-2MNA (100-, 250- and 450 kDa) conjugates displayed 5.0-, 5.4- and 960-fold improved mucoadhesion time in comparison to the corresponding unmodified PAAs. Results achieved from tensile studies were found in good agreement with the results obtained by rotating cylinder method. The apparent viscosity of PAA-cys-2MNA (100-, 250- and 450 kDa) conjugates was improved 1.6-, 2.5- and 206.2-fold, respectively, in comparison to the corresponding unmodified PAAs. Moreover, pre-activated thiomers/mucin mixtures showed a time dependent increase in viscosity up to 24 h, leading to 7.0-, 18.9- and 2678-fold increased viscosity in comparison to unmodified PAAs (100-, 250- and 450 kDa), respectively. All polymers were found non-toxic over Caco-2 cells. Thus, on the basis of achieved results the pre-activated thiomers seem to represent a promising generation of mucoadhesive polymers which are safe to use for prolonged residence time of drug delivery systems to target various mucosa.

Project description:IntroductionThe administration of systemic corticosteroids is a key strategy for improving COVID-19 outcomes. However, evidence is lacking on combination therapies of antiviral agents and systemic corticosteroids. The objective of this study was to investigate the efficacy and safety of the combination therapy of favipiravir and methylprednisolone in preventing respiratory failure progression in patients with COVID-19 and non-critical respiratory failure.MethodsWe conducted a multicenter, open-label, single-arm phase II study. The patients received favipiravir 3600 mg on the first day, followed by 1600 mg for a total of 10-14 days. Methylprednisolone was administered intravenously at 1 mg/ideal body weight (IBW)/day from days 1 to 5, followed by 0.5 mg/IBW/day from days 6 to 10 if clinically indicated. The primary endpoint was the proportion of patients requiring mechanical ventilation (MV) (including noninvasive positive pressure ventilation) or those who met the criteria for tracheal intubation within 14 days of the study treatment initiation (MVCTI-14).ResultsSixty-nine patients were enrolled and underwent the study treatment. Of them, the MVCTI-14 proportion was 29.2% (90% confidence interval 20.1-39.9, p = 0.200). The proportion of patients who required MV or who died within 30 days was 26.2%, and 30-day mortality was 4.9%. The most significant risk factor for MVCTI-14 was a smoking history (odds ratio 4.1, 95% confidence interval 1.2-14.2). The most common grade 3-4 treatment-related adverse event was hyperglycemia, which was observed in 21.7%.ConclusionThe MVCTI-14 proportion did not reach a favorable level in the clinical trial setting with the threshold of 35%. However, the proportion of MV or death within 30 days was 26.6%, which might be close to the findings (28.1%) of the RECOVERY trial, which showed the efficacy of dexamethasone for patients with COVID-19 and non-critical respiratory failure. Further evaluation of this combination therapy is needed.Clinical trial registrationJapan Registry of Clinical Trials (jRCT) identifier jRCTs041200025.

Project description:OBJECTIVE: Sensorineural hearing loss leads to the progressive degeneration of spiral ganglion cells (SGC). Next to postoperative fibrous tissue growth, which should be suppressed to assure a close nerve-electrode interaction, the density of healthy SGC is one factor that influences the efficiency of cochlear implants (CI), the choice of treatment for affected patients. Rolipram, a phosphodiesterase-4 inhibitor, has proven neuroprotective and anti-inflammatory effects and might also reduce SGC degeneration and fibrosis, but it has to pass the cellular membrane to be biologically active. METHODS: Lipidic nanocapsules (LNC) can be used as biodegradable drug carriers to increase the efficacy of conventional application methods. We examined the biological effects of rolipram and LNC's core encapsulated rolipram on SGC and dendritic cell (DC) tumor necrosis factor-? (TNF-?) production in vitro and on SGC survival in systemically-deafened guinea pigs in vivo. RESULTS: Our results prove that rolipram does not have a beneficial effect on cultured SGC. Incorporation of rolipram in LNC increased the survival of SGC significantly. In the DC study, rolipram significantly inhibited TNF-? in a dose-dependent manner. The rolipram-loaded LNC provided a significant cytokine inhibition as well. In vivo data do not confirm the in vitro results. CONCLUSION: By transporting rolipram into the SGC cytoplasm, LNC enabled the neuroprotective effect of rolipram in vitro, but not in vivo. This might be due to dilution of test substances by perilymph or an inadequate release of rolipram based on differing in vivo and in vitro conditions. Nevertheless, based on in vitro results, proving a significantly increased neuronal survival when using LNC-rolipram compared to pure rolipram and pure LNC application, we believe that the combination of rolipram and LNC can potentially reduce neuronal degeneration and fibrosis after CI implantation. We conclude that rolipram is a promising drug that can be used in inner ear therapy and that LNC have potential as an inner ear drug-delivery system. Further experiments with modified conditions might reveal in vivo biological effects.

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Respiratory delivery of favipiravir-tocilizumab combination through mucoadhesive protein-lipidic nanovesicles: prospective therapeutics against COVID-19.

Publications

Respiratory delivery of favipiravir-tocilizumab combination through mucoadhesive protein-lipidic nanovesicles: prospective therapeutics against COVID-19.

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