Background and Purpose. Iontophoresis is a process that uses bipolar electric fields to propel molecules across intact skin and into underlying tissue. The purpose of this study was to describe and experimentally examine an iontophoresis drug delivery model. Subjects and Methods. A mechanistic model describing delivery was studied in vitro using agarose gels and was further tested in vivo by evaluation of cutaneous vasoconstriction following iontophoresis in human volunteers. Results. In vitro cathodic iontophoresis at 4 mA and 0.1 mA each delivered dexamethasone/dexamethasone phosphate (DEX/DEX-P) from a 4-mg/mL donor solution to a depth of 12 mm following a 40 mA·minute stimulation dosage. Delivery of DEX/DEX-P to at least the depths of the vasculature in humans was confirmed by observation of cutaneous vasoconstriction. This cutaneous vasoconstriction was longer lasting and greater in magnitude when using low-current, long-duration (∼0.1 mA) iontophoresis compared with equivalent dosages delivered by higher-current, shorter-duration (1.5-4.0 mA) iontophoresis. Discussion and Conclusion. From data gathered with the gel model, the authors developed a model of a potential mechanism of drug depot formation following iontophoresis. The authors believe this drug depot formation to be due to exchange of drug ions for chloride ions as the ionic current carriers. Furthermore, diffusion, not magnitude of current, appears to govern the depth of drug penetration. Although the authors did not address the efficacy of the drug delivered, the results of human experiments suggest that current magnitude and duration should be considered as factors in treating musculoskeletal dysfunctions with iontophoresis using DEX/DEX-P at a concentration of 4 mg/mL. [Anderson CR, Morris RL, Boeh SD, et al. Effects of iontophoresis current magnitude and duration on dexamethasone deposition and localized drug retention.

Les traitements des pathologies de l’oreille interne par voie locale se développent en alternative aux traitements par voie générale peu efficaces et responsables de nombreux effets secondaires. Dans ce travail, nous avons développé une formulation originale constituée de liposomes dispersés au sein d’un gel d’acide hyaluronique pour la libération prolongée d’un corticoïde dans l’oreille interne après administration locale dans l’oreille moyenne. D'abord, une étude physicochimique approfondie a permis d'identifier les paramètres clés de formulation qui ont un impact sur les propriétés du gel de liposomes en termes de caractéristiques rhéologiques, de seringabilité, de stabilité, de microstructure et enfin de diffusion des liposomes dans le gel. Ensuite, le gel de liposomes contenant la dexamethsone phosphate a été évalué in vivo chez le cobaye. L'administration locale du gel de liposomes a abouti à une libération prolongée du corticoïde dans l'oreille interne, sans aucun effet négatif sur la fonction auditive. L’évaluation de l’efficacité thérapeutique de la formulation pour le traitement de la surdité secondaire à un traumatisme sonore et pour la préservation de l’audition durant l’implantation cochléaire a montré des résultats préliminaires très prometteurs. / Local, rather than systemic drug delivery is being developed to treat inner ear diseases. In this work, we developed an original drug delivery system based on liposomes dispersed within a hyaluronic acid gel for the sustained delivery of a corticoid to the inner ear after local administration in the middle ear. First, a thorough physicochemical study allowed to identify the key formulation parameters that impact the liposomal gel properties in terms of rheological behavior, syringeability, stability, microstructure and diffusion of liposomes within the gel. Then, the liposomal gel containing dexamethsone phosphate was evaluated in vivo in guinea pig. The local administration of the liposomal gel in the middle ear resulted in a sustained release of the corticoid in the inner ear without any negative effect on the hearing function. Promising preliminary data were obtained regarding the therapeutic efficacy of the formulation for hearing recovery after acoustic trauma and for hearing preservation during cochlear implantation.

In this thesis, two potential applications of transdermal iontophoresis in the field of sports medicine were studied: (1) the local delivery of dexamethasone phosphate (Dex-Phos), a corticosteroid used to treat musculoskeletal inflammation, and (2) the extraction of systemic amino acids (AAs), potential biological markers of fatigue in athletes. The iontophoretic delivery of Dex-Phos was studied, in vitro, in order to evaluate the effects of competing ions and electroosmosis, and identify the optimal conditions for its delivery. The iontophoretic extraction of AAs from the skin was first studied in vitro, before evaluating the method in a group of human volunteers. Dex-Phos was best delivered by iontophoresis from the cathode in absence of background electrolyte in the drug solution. In this situation, the delivery of Dex-Phos is limited principally by the competition with counter-ions (mainly Na+) present subdermally and the small mobility of the drug inside the membrane. The accumulation of Cl-, released by the Ag/AgCl cathode in the drug solution during current passage, can also reduce Dex-Phos delivery. The extraction of zwitterionic AAs from the skin during iontophoresis was highly influenced by their presence in the outermost layer of the skin, the stratum corneum (SC). In the pig skin model, the amount of the AAs extracted during a short extraction period (1 hour) correlated with their abundance in the SC. Once this ‘reservoir’ was emptied (after ~3 hours of iontophoresis), the subdermal compartment could be sampled, suggesting that the method could be used to monitor systemic levels of AAs. The experiments in human volunteers revealed, however, that a 4-hour iontophoretic extraction period was insufficient to deplete the AAs SC ‘reservoir’. It follows that the method can be used to evaluate the abundance of AAs in the SC, but is unpractical for the clinical monitoring of their systemic levels.