The drug development process, especially for anti-cancer therapies, continues to be highly inefficient. The current preclinical drug evaluation paradigm of human monolayer in vitro culture followed by small animal in vivo models results in a roughly 90% failure rate in clinical trials involving actual cancer patients. Our hypothesis then, is that there is a clear need for engineered, 3D, healthy and tumor tissue models capable of recapitulating patient physiology and disease, allowing for more accurate preclinical evaluation of anti-cancer drugs. Our hope, is that tissue engineering can provide us with valuable new insights into drug responses, over what we can currently achieve with existing models. Here, we present a new multi-tissue organs-on-a-chip microfluidic platform, Inter-Organ, designed to allow more comprehensive recapitulation of the disease seen in patients. We developed bioengineered tissues of primary and metastatic tumors across three cancer types, and integrated them into the Inter-Organ platform alongside healthy tissues like cardiac muscle known to cause failures in clinical trials for off-target drug toxicities. Overall, the development of these new cancer models and their culture in the Inter-Organ platform allowed us to more accurately predict the success of various drugs in clinical trials than existing models could. Finally, this tissue engineering approach allowed us to explore the relationships between specific constituents of the tumor microenvironment, recapitulate complex cancer processes like metastasis previously only done in small animal models, and identify new potential diagnostic and therapeutic targets.

Eczema or dermatitis is the most common dermatological condition accounting for one-third of all diagnoses in the total population surveyed in South Africa. The prevalence of seborrhoeic dermatitis, extreme photodermatitis and severe psoriasis has increased markedly over the last decade and this increase may be ascribed to the HIV epidemic, first diagnosed in South Africa in 1982. Potent innovator corticosteroids, such as clobetasol 17-propionate (CP) that are used to treat skin disorders, are expensive and there is therefore a need for the production of generic topical corticosteroid products. Formulation and manufacturing processes can be challenging aspects for formulation scientists to produce a robust product that will elicit an appropriate and desirable pharmacokinetic-pharmacodynamic profile. Laboratory scale CP creams were manufactured using different concentrations of Gelot® 64 and propylene glycol in order to establish a composition that would produce a formulation, with similar physical and chemical characteristics and in vitro release profile as an innovator product, Dermovate®. These formulations were assessed in terms of their viscosity, spreadability, pH, content uniformity and in vitro release characteristics using a Franz diffusion cell apparatus. A formulation containing 3% w/w Gelot® 64 and 46% v/v propylene glycol (CPLS-02) was found to exhibit similar viscosity and spreadability characteristics and released CP in a manner similar to Dermovate®. The mechanism of drug release was evaluated using mathematical models such as zero order, first order and Higuchi models. In addition, the in vitro release profiles were characterised by use of difference (f1) and similarity (f2 and Sd) factors. A scale-up formulation with the same % w/w composition as the laboratory scale was also investigated following manufacture using a Wintech® cream/ointment mixer. A Central Composite Design approach was used to investigate the effect of process variables on the performance of the scale-up cream formulations. The homogenisation speed, anchor speed, homogenisation time and cooling time were the process variables investigated. Thirty scale-up batches were manufactured and analysed in terms of their viscosity, spreadability, pH, % drug content and cumulative % drug released per unit area over 72 hours. Model fitting using Design-Expert® software was undertaken and revealed that a correlation between the process variables and the cream responses was most suitably described by quadratic polynomial relationships. The homogenisation speed had the most significant effect on the quality of the scale-up formulations, whereas the anchor speed had a secondary effect on the measured responses, for the formulations investigated. The qualitative interpretation and statistical analysis of the in vitro release data from the scale-up formulations using ANOVA and the f1, f2 and Sd factors revealed that one scale-up batch (CPSU-04), for which the process variables were a homogenisation speed of 1900 rpm, an anchor speed of 35 rpm, a homogenisation time of 100 minutes and a cooling time of 100 minutes, released CP at a similar rate and extent to Dermovate®. A diffusion-controlled mechanism appeared to be predominant in these formulations. A human skin blanching study, using both visual and chromameter assessments, was performed to establish whether batch CPSU-04 was bioequivalent to Dermovate®. The bioequivalence of the selected scale-up formulation to Dermovate® was confirmed, following the calculation of a 90% CI.

Background: A post-exposure regrowth model utilizing the well-tried Bactec radiometric system, which would simulate in vivo situations at the site of invasive disease, was developed to measure drug activity against multiplying Mycobacterium tuberculosis. Aims: The aims of this dissertation were to (a) construct a radiometric model simulating drug efficacy relating to the combined bactericidal activity and delays in regrowth due to the action of anti¬tuberculosis (TB) agents, (b) compare the killing kinetics of drugs singly and in combinations by the time-kill curve method, with the radiometrically-determined regrowth model, and (c) assess whether the Bactec radiometric regrowth model could predict likely bactericidal activities of drugs. Design and methods: Drug concentrations in the time-kill curve method were in a range of achievable drug concentrations at the site of infection and in multiples of the minimal inhibitory concentration (MIC), (1x, 2x or 3x, and 8x). Exposure times of 6h, 24h, 48h and 72h were used and these were based on pharmacokinetic data reflecting likely periods of in vivo exposure in TB lesions. Standardized inocula of approximately 106CFU/mi of actively multiplying M. tuberculosis strains were used. The same concentrations, exposure times and bacterial concentrations were used for the assessment of radiometrically-determined post-exposure regrowth times of M. tuberculosis. Growth times were recorded as the number of days required to reach a predetermined growth index (GI) level in the Bactec system, and were expressed as T400 readings in days. Simple linear regression and a mathematical logistic model were used to assess whether the radiometric post-exposure regrowth model could predict the bactericidal activity of the drugs. For drug combination studies, 1MIC of isoniazid (INH) and rifampicin (RMP) were used singly and in combination while 2MIC of ethambutol (EMB), streptomycin (SM), ofloxacin (OFL) and amikacin (AMK) were used in combinations studies. Colony counts at Oh and following 24h exposures were performed and regrowth patterns were determined using the T400 method. M. tuberculosis H37Rv was tested and subsequently resistant strains. Results: INH and RMP were highly bactericidal while EMS showed moderate activity in the time-kill curve method. The three drugs produced the best curves, showing longer regrowth times and markedly depressed rates of regrowth in the Sactec post-exposure regrowth model. Using simple linear regression, a linear relationship between bacterial survivors and the radiometric regrowth times, T400, was achieved for all drugs tested. Even better agreement was found when control-related regrowth times, (T-C) 400, were used in the analysis. Conditions compromising the linear relationsbip in the radiometric regrowth model, for OFL and less markedly EMS and AMK, were likely postantibiotic effects (PAEs) brought on by the short exposure time (6h), and drug carry-over effects due to concentrations ≥ 8 MIC for INH, RMP and 8M (10x and 20x MICs). The mathematical logistic model showed good correlation between bactericidal activity and regrowth for INH and RMP but not for EMB, SM, OFL and AMK. Drug combination effects in the two techniques depended on the criteria used to describe synergy. Generally, it was found in drug combination experiments that the drugs did not influence each other to a meaningful extent. Discussion and conclusions: For prediction of bactericidal activity, interpretation of the radiometrically-determined regrowth model needs to accommodate PAEs and the effect of subinhibitory concentrations. The validity of the mathematical logistic model is not clear. Technical aspects of future studies such as better organism dispersal, need to be improved to achieve a more reliable evaluation based on the logistic model. For drug combination studies, the radiometric regrowth model yielded findings that were difficult to interpret in relation to published data, reinforcing the need for the use of internationally standardized techniques which would give statistically reliable data. The radiometrically-determined regrowth model showed good discrimination between the standard activities of anti- TB agents, correlating with clinical efficacy. It is simple to perform and could prove to be useful for the screening of candidate anti- TB drugs. Improved technical stringency and the evaluation of poorly active control drugs, are however needed before proof of validity of the model can be established. / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2007. / Medical Microbiology / unrestricted

One of the primary contributing factors to the escalating costs of health care is the high cost of innovator pharmaceutical products. As a consequence, health authorities in various countries and in particular in the developing world have identified generic prescribing and generic substitution as possible strategies to contain the escalating costs of health care provision. There is therefore a need for formulation scientists in developing countries to invest more time in the research and development of generic formulations. Clobetasol 17-propionate (CP) generic cream formulations containing 0.05% w/w of the drug were manufactured and characterized using in vitro testing. Formulation development studies were preceded by the development and validation of an RP-HPLC with UV detection for the quantitation and characterization of CP in innovator and generic cream formulations during formulation development and assessment studies. Furthermore the in vitro release ates of CP release from innovator and generic cream formulations were monitored using a validated in vitro release test method developed in these studies. The formulation of CP cream products was accomplished using a variety of commercially available mixed primary emulsifiers, such as Estol® 1474, Ritapro® 200, Emulcire® 61 WL and Gelot® 64. Successful formulations were selected based on their ability to remain physically stable immediately after manufacture and for 24 hours after storage at room temperature (22°C). Estol® 1474 was found to produce an unstable cream and was therefore not investigated further. The other three emulgents produced stable creams, but only the in vitro release profile of CP from a cream manufactured to contain Gelot® 64 was found to be statistically similar to that of the innovator formulation. Therefore the cream containing Gelot® 64 was selected as the most appropriate prototype generic cream formulation and was characterized in vitro in terms of CP content, viscosity, pH and in vitro release rate. Data generated from these studies were compared to those of the innovator product, Dermovate® cream, using statistical methods. The CP content, pH and in vitro release rate data of the CP formulation were similar to those of the innovator product, however the intrinsic viscosity of Dermovate® cream was almost three (3) times greater than the intrinsic viscosity of the test formulation developed using Gelot® 64. The CP cream formulation developed in these studies was stored for 4 weeks at 40 ± 2°C and 25 ± 5% RH in an incubator and the formulation was found to be stable. A formulation has been developed and assessed and found to be suitable for use as a topical semi-solid dosage form for CP.

Conventional solid dosage forms often lead to fluctuations which exceed the maximum safe therapeutic level and/or decline below the minimum effective level. It is recognised that many drugs for chronic administration should be administered on a schedule that maintains plasma drug concentration within the therapeutic window. Research in controlled release dosage forms aims at designing a system with a zero-order input (eg, ideally to deliver 8.33% of the dose per hour over a 12 hour duration), producing steady state plasma drug levels. Oral dministration of drugs prepared as a controlled release formulation is extremely popular, and has attracted the attention of pharmaceutical scientists during the last decade. This has been due to the simultaneous convergence of various factors (eg, discovery of novel polymers and devices, better understanding of formulation and physiological constraints, expiration of existing patents, prohibitive cost of developing new drug entities), involved in the development of these delivery systems. Controlled release oral products can be formulated as single or multiple unit dosage forms and the relative merits of multiple unit forms with their own rate controlling systems are well established. This work describes the development of a relatively inexpensive multiple-unit capsule dosage form of theophylline containing coated mini-tablets for drug delivery throughout the gastrointestinal tract. Preformulation studies on theophylline anhydrous included solubility and dissolution rate determinations. Techniques including X-ray powder diffraction, differential scanning colorimetry and infrared spectroscopy provided no evidence of true polymorphism after recrystallisation from various solvents. However, scanning electron micrographs showed the effects of solvent polarity and cooling rate on the size and shape of recrystallised particles. Theophylline granules were manufactured by using various binders and were film coated by fluidised bed technology with various proportions of ethylcellulose, containing varying amounts of PEG 1540. In vitro release rates were dependent upon coating thickness and the proportion of PEG, which, being water soluble, created pores in the coating during dissolution studies as observed by a scanning electron microscope. However, substantial proportions of the drug remained unreleased from the granules. In order to overcome the problems of drug retention, plain granules were used and theophylline mini-tablets (3 mm diameter, weighing 15 - 20 mg) were manufactured and film coated with various Eudragits ® and other polymeric mixtures (soluble and insoluble). In vitro dissolution profiles from samples enclosed in hard gelatin capsules were determined using the USPXXI paddle apparatus in test media at pH 1.2 (HCI), pH 5.4 and 7.4 (phosphate buffers) at 37'C. Monitoring of in vitro theophylline release over 12 h, under identical hydrodynamic conditions, showed that the dissolution rate at pH 1.2 is substantially greater (95% of total drug content released in < 10 h) than that in phosphate buffers. The maximum release after 12 h was approximately 20 and 30% of total drug content of the tablet at pH 5.4 and 7.4, respectively. However, in vivo bioavailability after oral administration of tablets to rabbits corresponded to over 95% of total drug, compared with the same dose administered intravenously. The retarded drug release during in vitro dissolution in phosphate buffer was attributed to a possible interaction of phosphate ions with theophylline molecules at the tablet core-coat interface. These findings indicate that both rate and extent of theophylline release from the slow release coated mini-tablets are highly sensitive to phosphate buffers. The data also emphasise the usefulness of an animal model for assessment of in vivo drug release and subsequent absorption during the development of modified release dosage forms. Mini-tablets were subjected to isothermal and cyclic stresses to reach conditions for up to 6 months at different temperatures and relative humidity. The film integrity was maintained but ageing of the coating occurred which impeded dissolution. Reduced drug release was temperature related while the effect of relative humidi% was insignific~t. Encapsulated mini-tablets (uncoated and coated with Eudragit RL and RS 2% w/w) equivalent to a 300 mg dose, were evaluated both in vitro and in vivo using beagle dogs. The pharmacokinetic parameters from single and multiple dose studies showed several advantages over Theo-Dur® 300 mg tablets. Precise dosage titration is possible by careful adjustment of the number of encapsulated mini-tablets. This multiple unit mini-tablet delivery system will allow for greater flexibility in dosage adjustment compared to the currently available preparations, allowing individualised fine dose titration in those patients requiring therapeutic drug monitoring. The developmentof the multiple unit mini-tablet formulation appears to provide an optimal dosage form with maximum flexibility in respect of dose, duration range and ease of production.

Drug metabolism is a specialised subset of xenobiotic metabolism, pertaining to the breakdown and elimination of pharmaceutical drugs. The enzymes involved in these pathways are the cytochrome P450 family of isozymes. Metabolism is an important factor in determining the pharmacological effects of drugs. The main aim of this study was to develop a system whereby the major metabolites of drugs can be produced in vitro. An in vitro system was developed and optimised using commercially prepared microsomes from rat liver and coumarin (by monitoring its conversion to 7-hydroxycoumarin) as a model. The optimum running conditions for the incubations were 50 μM coumarin, 50 μg protein/ml microsomes, 1 mM NADP⁺, 5 mM G6P and 1U/ml G6PDH incubated for 30 minutes at 38℃. The HPLC method for the detection of coumarin and 7-hydroxycoumarin was also validated with respect to linearity, reproducibility, precision, accuracy and lower limits of detection and quantification. The system developed was then tested using microsomes prepared from fresh bovine liver on these ten drugs of interest in doping control in horse racing: diazepam, nordiazepam, oxazepam, promazine, acepromazine, chlorpromazine, morphine, codeine, etoricoxib and lumiracoxib. The bovine liver microsomes were prepared using differential centrifugation and had activity on a par with the commercial preparations. This in vitro system metabolised the drugs and produced both phase I and II metabolites, similar to those observed in humans and horses in vivo. For example, the major metabolites of the benzodiazepine drug, diazepam, nordiazepam, temazepam and oxazepam as well as the glucuronidated phase II products were all found after incubations with the bovine liver microsomes. The metabolism of the drugs was also investigated in silico using the computational procedure, MetaSite. MetaSite was able to successfully predict known metabolites for most of the drugs studied. Differences were observed from the in vitro incubations and this is most likely due to MetaSite using only human cytochrome P450s for analysis.

The human skin blanching assay (HSBA) is a well-researched and validated method for the bioequivalence assessment of topical corticosteroids. Traditionally, visual assessment of skin blanching has been used. Such testing methods are not conducive for interlaboratory comparisons. Regulatory bodies prefer less subjective methods of analysis. The FDA released guidelines on the assessment of bioequivalence for topical corticosteroids that recommends the use of a chromameter as a reliable method to measure skin blanching although the use of visual assessment with acceptable validation is also provided for. However, the FDA does not elucidate on the manipulation and handling of the chromameter during skin blanching measurements. The purpose of this project was several fold, which included investigations to standardize the manipulation and handling of a chromameter. In particular, measures to avoid skin whitening resulting from the effects of pressure on the skin during chromameter use were investigated. Other methods of analysis should surpass or at least be comparable to the HSBA if such methods are to be used for the assessment of topical corticosteroids. Microdialysis is a relatively new technique for assessing the rate at which drug penetrates the skin. The advantage of using this method is that there are fewer restrictions for selection of an appropriate study population unlike those required for the HSBA where one has to be both a ‘responder’ and a ‘detector’ for their results to be used in data analysis. Microdialysis was investigated by initially conducting experiments in which microdialysis probes were embedded into topical formulations containing mometasone furoate (MF) and the initial results revealed that relatively low drug was released from the formulations. These results indicated that should microdialysis be applied to measure the in vivo release of MF from such topical formulations following application to the skin, even lower concentrations of MF would likely result in the dialysate, necessitating the need for ultra-high sensitive methods of analysis. Typically, the availability of an appropriate analytical technique such as liquid chromatography coupled with mass spectrometry (LCMS) would be a pre-requisite for such in vivo studies. However, only high-pressure liquid chromatography (HPLC) and other less sensitive equipment was available in the laboratories. The study objectives were therefore focussed on in vitro assessment of the release of MF from topical formulations using microdialysis and Franz cells. In addition, the in vivo release of MF was also studied using the HSBA. Data obtained from the microdialysis experiments were compared with the data obtained from the Franz cell diffusion studies in order to provide information on the pharmaceutical availability of MF from the various topical MF dosage forms. Subsequently, pharmaceutical equivalence was investigated from the comparative pharmaceutical availability data using statistical analysis. An additional objective was to attempt to correlate in vitro with in vivo data (IVIVC) to establish a model that could be used to assess safety and efficacy of generic topical drug products. The in vivo data obtained from the HSBA were processed according to the FDA requirements and these pharmacodynamic data were subsequently compared with the microdialysis and Franz cell results. In summary the objectives of this project were: 1. To develop a system to improve the reproducibility of the use of a Minolta® chromameter and compare this with the standard/normal manipulation and handling of such instruments. 2. To develop and validate an HPLC method for the analysis of MF for use with in vitro diffusion studies using microdialysis and Franz cells. 3. To conduct a comparative HSBA on proprietary MF topical creams from two different countries in accordance with the FDA guidance. 4. To assess the pharmaceutical equivalence of topical formulations containing MF using Franz diffusion cells and in vitro microdialysis. 5. To compare the in vivo data obtained from the HSBA with those obtained in vitro using microdialysis and Franz cells.

One of the main control mechanism used by employment, school facilities or addictology services is testing for addictive substances. This tool is very important for diagnostic institutes and other organizations providing care and basic needs for entrusted children and adolescents in institutional and protective education. Main purpose of mentioned institutions is to ensure health and safety of their wards, maintain supervision of their school attendance and supervision of their compliance with internal regulations of the school and the institution. Main goal of the study is to map the versions of the standard process across all diagnostic institutes in the Czech Republic, compare these versions with legislative and afterward create recommendations and proposals, which could lead to change or make the work of employees in institutional education more effective. Study was conducted in a form of qualitative research, which was carried out through a series of interviews. The interviews were based on semi-structured type. All of the respondents gave their consent for creating a recording of their interview. For the study recordings were transcribed and edited. Furthermore, an analysis of legislation and internal regulations of diagnostic institutes was performed. The main research questions focused on...

Robert J. Taylor and Herbert A. David developed a new experimental approach in the screening of prospective drugs to be used in the treatment of cancer. The procedure is a sequential one, where the allocation of patients to drugs is based upon the performance of the drugs in immediately previous periods. Taylor further developed a computer program to study the effectiveness of the procedure by means of simulated trials. The purpose of this paper has been to study the sequential allocation procedure further by means of simulation in the form of a factorial experiment. Of primary concern has been the behavior of different weighting functions operating under varying experimental conditions. Response variables have been studied as a means for evaluating the effectiveness of the procedure. The results of this experiment are comparable with the findings originally presented by Taylor and David. / Master of Science

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2004. / Includes bibliographical references (p. 59-61). / Published findings report that it takes approximately eight years to bring a novel drug to market at an average cost of $800 million. Over the last ten years, the Food and Drug Administration (FDA) has helped to reduce the time from filing a new drug application (NDA) to granting marketing approval (i.e. the approval phase). However, there has been no alteration in the time required to progress from an investigational new drug application (IND) to an NDA filing (i.e. the clinical phase) over this same period. Since approval times began to decrease upon the initiation of the Prescription Drug User Fee Act (PDUFA), in this thesis I analyze the impact of PDUFA and calculate its benefits to companies. Due to the importance of getting new drugs to the market faster, I also investigate why there has been no significant change in the time required to test a drug clinically, and attempt to identify steps that could be taken to improve the clinical trial process. To investigate this, I evaluated ways in which the FDA and industry can work together to reduce clinical development times, without compromising safety. The results from this study show that PDUFA has had a significant impact on reducing approval times. More importantly, I determined that the direct costs of PDUFA are small in irmlparison to its benefits. In addition, my analysis of the early clinical phases (pre-clinical to Phase II) of drug benefits. In addition, my analysis of the early clinical phases (pre-clinical to Phase II) of drug development has revealed potential steps both the FDA and industry can take to facilitate a more efficient process for assessing the safety and efficacy of drugs. Thus, this study represents an important step towards improving the development of medicines for the world. / by Matthew W. Strobeck. / S.M.