Cetirizine, an H1-antihistamine, is prescribed for allergic disorders. It exists as a racemic mixture, with levocetirizine being the active enantiomer. The central nervous system side-effects of H1-antihistamines are caused by their penetration into the brain. In this thesis the plasma pharmacokinetics, transport across the blood-brain barrier (BBB) and H1 receptor occupancy of cetirizine enantiomers was investigated in vivo in guinea pigs. The transport across the BBB was quantified using the microdialysis technique. Stereoselective brain distribution was investigated by measuring both unbound and total concentrations in plasma and brain. The time aspects of the H1 receptor occupancy of levocetirizine was studied in the brain and the periphery. The plasma pharmacokinetics of cetirizine was stereoselective with clearance and volume of distribution of levocetirizine being approximately half that of dextrocetirizine. This was mainly due to the differences in plasma protein binding of the enantiomers. The stereoselectivity in brain distribution indicated by the partition coefficient Kp (total AUC ratio brain to plasma) was caused by stereoselective plasma protein binding. The transport across the BBB measured in this thesis by the unbound partition coefficient Kp,uu (unbound AUC ratio brain to plasma) was the same for the two enantiomers. Binding within the brain was also not significantly different. The H1 receptor occupancy of levocetirizine in brain lagged behind the plasma concentrations whereas it was not delayed with respect to the brain concentrations. This indicates that the delayed brain H1 receptor occupancy of levocetirizine is caused by a slow transport across the BBB. In summary, the results of this thesis emphasize the importance of measuring both the unbound and total concentrations in blood and brain to characterize stereoselective brain distribution. The thesis also emphasize the importance of taking local brain pharmacokinetics into consideration in understanding pharmacokinetic-pharmacodynamic relationships of drugs with central activity.

The use of catanionic drug-surfactant mixtures was proven to be an efficient novel method of obtaining prolonged drug release from gels. It was shown that various commonly used drug compounds are able to form catanionic mixtures together with oppositely charged surfactants. These mixtures exhibited interesting phase behaviour, where, among other structures, vesicles and large worm-like or branched micelles were found. The size of these aggregates makes them a potential means of prolonging the drug release from gels, as only monomer drugs in equilibrium with larger aggregates were readily able to diffuse through the gel. When the diffusion coefficient for drug release from the formulation based upon a catanionic mixture was compared to that obtained for the drug substance and gel alone, the coefficient was some 10 to 100 times smaller. The effects of changes in the pH and ionic strength on the catanionic aggregates was also investigated, and this method of prolonging the release was found to be quite resilient to variations in both. Although the phase behaviour was somewhat affected, large micelles and vesicles were still readily found. The drug release was significantly prolonged even under physiological conditions, that is, at a pH of 7.4 and an osmolality corresponding to 0.9% NaCl. Surfactants of low irritancy, capric and lauric acid, may successfully be used instead of the more traditional surfactants, such as sodium lauryl sulfate (SDS), and prolonged release can still be obtained with ease. Some attempts to deduce the release mechanism from the proposed systems have also been made using transient current measurements, dielectric spectroscopy, and modelling of the release using the regular solution theory. In these studies, the previous assumptions made concerning the mechanism responsible for the release were confirmed to a large extent. Only small amounts of the drug existed in monomer form, and most seemed to form large catanionic aggregates with the oppositely charged surfactant.

There are today strong incentives for an increased understanding of material properties and manufacturing processes to facilitate the development of new technologies in the pharmaceutical industry. The purpose of this thesis was to suggest methods requiring a low sample amount for characterization of technical properties of powders. Compression analysis was used to evaluate the formulation relevance of some compression equations. Using the mechanics of single granules to estimate powder functionality was part of this work. It was concluded that the formability of granular solids and the plasticity of single granules could be determined with compression analysis by using the Kawakita model for single components and binary mixtures of ductile granules. Further on, the fragmentation propensity of solid particles could be estimated from compression analysis by using the Shapiro equation, enabling indicators of both the fragmentation and the deformation propensity of particles to be derived in one single compression test. The interpretations of the compression parameters were only valid if the influence of particle rearrangement was negligible for the overall compression profile. An index indicating the extent of particle rearrangement was developed and a classification system of powders into groups dependent on the incidence of particle rearrangement was suggested as tools to enable rational interpretations of compression parameters. The application of compression analysis was demonstrated by investigating the relevance of the mechanics of granular solids for their tableting abilities. The plasticity of single gran-ules was suggested to influence both the rate of compactibility and the mode of deformation, and consequently the maximal tablet strength. The degree of granule bed deformation was shown to be a potential in line process indicator to describe the tableting forming ability. This thesis contributes to a scheme, suitable in formulation work and process control, to describe manufacturability of powders for an enhanced tablet formulation technology.

The interactions between antimicrobial peptides and phospholipid membranes were investigated, in terms of lipid headgroup variations and the role of cholesterol, as well as peptide composition and structure. Also strategies for increasing proteolytic stability were evaluated. The interactions were studied on model membranes in the form of liposomes and supported bilayers, through a combination of ellipsometry, fluorescence spectroscopy, circular dichroism, dynamic light scattering, electrophoresis, electron cryomicroscopy, and bacterial/cell culture experiments. The findings showed that membrane tolerance against the lytic activity of melittin, was increased on anionic membranes by electrostatic arrest in the headgroup region, and was reduced by hydration repulsion. The presence of cholesterol caused a reduction in melittin adsorption, while at the same time reducing membrane tolerance per adsorbed peptide. Differences in membrane leakage mechanisms were also attributed to cholesterol, where large scale structural effects contributed to the leakage, while other membranes followed the pore formation model. Substituting specific amino acids for tryptophan on an LL-37 derivative, was shown to increase stability against bacterial proteases, while at the same time significantly increasing antibacterial properties. These substitutions, as well as terminal modifications, increased adsorption and membrane lytic properties in a way that was less dependent on electrostatics. Furthermore, by comparing short cationic peptides with oligotryptophan end-tagged versions, the lytic mechanism of end-tagged peptides, and the different contributions of arginine and lysine to membrane adsorption and disruption were demonstrated. This thesis is a contribution to the development of antimicrobial peptides as therapeutic alternatives to conventional antibiotics.

Biological function is mainly carried out by a dynamic population of proteins which may be used as markers for disease diagnosis, prognosis, and as a guide for effective treatment. In analogy to genomics, the study of proteins is called proteomics and it is generally performed by two-dimensional gel electrophoresis and mass spectrometric methods. However, gel based proteomics is methodologically restricted from the low mass region which includes important endogenous peptides. Furthermore, the study of endogenous peptides, peptidomics, is compromised by protein fragments produced post mortem during conventional sample handling. In this thesis nanoflow liquid chromatography and mass spectrometry have been used together with improved methods for sample preparation to semi-quantitatively monitor peptides in brain tissue. The proteolysis of proteins and rise of fragments in the low mass region was studied in a time-course study up to ten minutes, where a potential marker for sample quality was found. When rapidly denatured brain tissue was analyzed, the methods enabled detection of hundreds of peptides and identifications of several endogenous peptides not previously described in the literature. The identification process of endogenous peptides has been improved by creating small targeted sequence collections from existing databases. In applications of the MPTP model for Parkinson’s disease the protein and peptide expressions were compared to controls. Several proteins were significantly changed belonging to groups of mitochondrial, cytoskeletal, and vesicle associated proteins. In the peptidomic study, the levels of the small protein PEP-19 was found to be significantly decreased in the striatum of MPTP administered animals. Using imaging mass spectrometry the spatial distribution of PEP-19 was found to be predominant in the striatum and the levels were concordantly decreased in the parkinsonian tissue as verified by immunoblotting.

The number of poorly water-soluble drug substances in the pharmaceutical pipeline is increasing, and thereby also the need to design effective drug delivery systems providing high bioavailability. One favourable formulation approach is preparation of solid dispersions, where dispersing a poorly water-soluble drug in a water-soluble polymer matrix improves the dissolution behaviour and the bioavailability of the drug. However, in order to take full advantage of such formulations the impact of material properties on their performance needs to be investigated.   An experimental toolbox has been designed, and applied, for analysing the processes which govern the behaviour of solid pharmaceutical formulations in general, and that of solid dispersions in particular. For the purpose of monitoring multifaceted phenomena in situ during tablet dissolution, nuclear magnetic resonance (NMR) spectroscopy and NMR imaging are superior to many other techniques, both on macroscopic and molecular levels. The versatility of NMR with its isotope and chemical selectivity allows one to follow the influence of the original tablet properties on polymer mobilisation, drug migration and water penetration selectively. Mapping these processes on relevant time scales in dissolving tablets highlighted the gel layer inhomogeneity below the originally dry tablet surface as a key factor for drug release kinetics.   Furthermore, NMR relaxometry has been shown to provide novel information about the particle size of the drug and its recrystallisation behaviour within swelling solid dispersions. The NMR experiments have been complemented and supported by investigation of the crystalline state, the powder morphology and the surface composition of the dry solid dispersions. These experiments have been performed by X-ray photoelectron spectroscopy (XPS),  scanning electron microscopy (SEM), powder X-ray diffraction (pXRD), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and dynamic contact angle (DAT) measurements.   The methods presented in this thesis provide a new avenue towards better understanding of the behaviour of solid dispersions, which in turn may result in more effective distribution of promising drug candidates despite their low water-solubility. / En allt större andel av de läkemedelssubstanser som idag är av intresse för den farmaceutiska industrin är svårlösliga i vatten. För att trots detta erhålla hög biotillgänglighet måste man utveckla beredningsformer som medger effektiv frisättning av den aktiva substansen. En lovande sådan beredningsform utgörs av fasta dispersioner, där den svårlösliga substansen finfördelas i en vattenlöslig polymer. För att utnyttja dessa dispersioners potential fullt ut måste dock materialegenskapernas inverkan på deras beteende kartläggas i större utsträckning än vad som tidigare gjorts.   En uppsättning experimentella metoder har i detta arbete utvecklats och använts för att analysera de processer som styr beteendet hos fasta läkemedelsberedningar i allmänhet, och fasta dispersioner i synnerhet. För observation av sådana processer in situ, under pågående tablettupplösning, är NMR-spektroskopi (kärnmagnetisk resonans-spektroskopi) och NMR-avbildning överlägsna många andra tekniker, både på makroskopisk och på molekylär nivå. NMR är en mångsidig metod med både isotop- och kemisk selektivitet. Genom att utnyttja dessa möjligheter kan de enskilda sambanden mellan den ursprungliga tablettens materialegenskaper och polymermobilisering, vatteninträngning och den aktiva substansens migrering följas separat. Kartläggning av dessa processer, på relevanta tidsskalor i tabletter under upplösning, påvisar att gellagrets inhomogenitet inuti den ursprungliga tabletten har stor betydelse för frisättningskinetiken.   Vidare visar sig NMR-relaxometri ge värdefull information om den aktiva substansens partikelstorlek och dess omkristallisationsbeteende i fasta dispersioner under svällning och upplösning. NMR-experimenten kompletteras med oberoende karakterisering av det kristallina tillståndet, pulvermorfologin och ytsammansättningen hos de torra fasta dispersionerna. Dessa experiment utförs med hjälp av XPS (röntgen-fotoelektronspektroskopi), SEM (elektronmikroskopi), pXRD (pulver-röntgendiffraktion), DCS (differentiell kalorimetri), FTIR (infraröd Fourier transform spektroskopi) och DAT (dynamisk kontaktvinkel) mätningar.   De metoder som presenteras i den här avhandlingen pekar mot nya vägar att nå djupare förståelse för beteendet hos fasta dispersioner, vilket i sin tur kan leda till att fler lovande läkemedelssubstanser kan distribueras effektivt trots begränsad vattenlöslighet. / QC 20100915

Multipel skleros (MS) är en kronisk, neurologisk sjukdom som drabbar centrala nervsystemet (CNS). Sjukdomen är autoimmun där kroppens eget immunförsvar angriper nervvävnaden, framför allt myelin, och därefter uppstår en inflammatorisk reaktion. Nerverna i det centrala nervsystemet påverkar många olika funktioner och eftersom myelinet som omsluter nervfibrerna blir inflammerat på olika ställen, både i hjärnan och i ryggmärgen, uppkommer olika typer av symptom. Symptomen för MS kan skilja sig mycket från en individ till en annan, och från skov till skov. Om McDonald-kriterierna uppfylls, som bygger på att minst två separata CNS-lesioner skilda i rum och med minst en månads intervall påvisas utan en tydlig anledning, ställs diagnosen MS. Individer med MS producerar autoreaktiva T-celler som deltar i bildningen av inflammatoriska lesioner längs myelinskidan, men det finns även CNS-celler som gliaceller och astrocyter, som deltar i inflammationsprocessen. Vävnadstypen HLA-DR2 är förknippad med ökad risk att få MS. Den vanligaste och den milda formen av MS, skovvis förlöpande MS, bromsas med immunmodulerande läkemedel som interferon beta, fingolimod, m.fl. Syftet med det här litteraturarbetet var att utreda den kliniska effekten av fingolimod, den första orala behandlingen mot MS, på möjliga skador som förekommer på grund av MS. Studierna som granskades i detta arbete hämtades från Pubmed. Resultatet visar att fingolimod har klinisk effekt vid MS, men det behövs fler studier för att undersöka säkerhetsprofilen mer ingående. I en studie under två år reducerades den årliga skovfrekvensen från 0.4 till mindre än hälften av detta. I en annan två-årig studie, där fingolimod jämfördes med interferon-beta 1a, fanns det en signifikant större reduktion i den årliga skovfrekvensen i fingolimodgruppen (årlig skovfrekvens < 0,20) än i interferongruppen (årlig skovfrekvens 0,33). Majoriteten av patienterna (>70 %) förblev skovfria med fingolimodbehandlingen i båda studierna. Det fanns inga studier där fingolimod kombinerades med annan MS-behandling, vilket skulle vara intressant att se i framtiden. / Multiple sclerosis (MS) is a chronic neurological disease that affects the nerves within the central nervous system (CNS). The disease is autoimmune where the body's own immune system attacks nerve tissue, especially myelin, causing an inflammatory reaction. The nerves of the central nervous system serve many different functions and since the myelin surrounding the nerve fibers becomes inflamed at different places, both in the brain and the spinal cord, a variety of symptoms result. Symptoms of MS can differ greatly from one individual to another, as well as from relapse to relapse. If the McDonald criteria, which are based on at least two separate CNS lesions separated in space and at least one month apart demonstrated without a clear reason, are fulfilled a diagnosis of MS is set. Individuals with MS produce autoreactive T cells involved in the formation of inflammatory lesions along the myelin sheath, but CNS cells, glial cells and astrocytes, also participate in the inflammatory process. Tissue type HLA-DR2 is associated with increased risk of developing MS. The most common and mild form of MS, relapsing-remitting MS, can be slowed down with immunomodulatory drugs such as interferon beta, fingolimod, etc. The aim of this literature study was to investigate the clinical efficacy of fingolimod, the first oral therapy for MS, on the possible damage that occurs due to MS. The studies examined in this work were taken from Pubmed. The results demonstrate that fingolimod has clinical efficacy in MS, but more studies are needed to investigate the safety profile in more detail. In a study over two years the annualized relapse rate was reduced from 0.4 to less than half of this. In another two-year study in which fingolimod was compared with interferon-beta 1a, there was a significantly greater reduction in the annualized relapse rate in the fingolimod group (annualized relapse rate <0.20) than in interferon group (annualized relapse rate 0.33). The majority of patients (>70 %) remained relapse-free with fingolimod treatment in both studies. There were no studies that combined fingolimod with other MS treatments, which would be interesting to see in the future.

Ultra-stable cystine knotted microproteins, in which two disulfides and their connecting backbones form a circle that is penetrated by the third disulfide bonds, have attracted high interest due to their resistance to degradation in vitro and potential for the development of peptide drugs. This thesis gives new insights into engineering of that framework of microproteins, including approaches to their chemical synthesis, backbone engineering, structural and biological evaluations. Synthetic and oxidative folding approaches for bracelet cyclotides, a family of cyclic cystine knotted microproteins, was developed using a model peptide, cycloviolacin O2. Following assembly of the peptide chain, protected peptide was generated by mild cleavage that was subsequently thioesterified and cyclized in solution. The cyclic peptide was oxidatively folded under optimized conditions containing co-solvent and non-ionic detergent affording native cycloviolacin O2 as a major product. To gain further insights into the heterogeneity, efficiency and kinetics of cyclotides’ oxidative folding, the intermediates that accumulate in oxidative refolding pathways of all cyclotide subfamilies: Möbius, bracelet and the hybrid cyclotides were quantitatively determined under four different folding conditions. The results were used for defining major folding pathways, which indicated that Möbius cyclotides might accumulate heterogeneous folding intermediates with one-, two- and three-disulfides, whereas bracelet tend to accumulate a homogenous intermediate with three-disulfides, depending on the buffer systems used. Furthermore, to probe the internal factors contributing to inefficiency of oxidative folding, as well as undesired bioactivities of bracelet cyclotides (e.g., cytotoxic activity), polymer-hybridized cyclotides were designed by replacing non-conserved residues with small isosteric polymers. The designed hybrid analogs in which hybridization involved replacement of loop 3 with isosteric polymers showed improved synthetic and oxidative folding properties. The cytoxicity of a model hybrid designed with replacement of loop 3 and 5 exhibited no cytotoxic activity at concentration of 128-fold relative to that of native peptide. Furthermore, 1D and 2D 1H NMR analysis of this hybrid showed that it had well structured fold.

Cefuroxime is a renally eliminated antibiotic used against a variety of different bacterial infections. The pharmacokinetics (PK) for cefuroxime was studied in 97 hospitalized patients using population analysis. To be able to measure cefuroxime in human serum a new sensitive analytical method was developed using mass spectrometry detection. The method was validated and shown to be sensitive and selective. Cystatin C was found to be a better covariate for cefuroxime clearance compared to the traditionally used creatinine clearance (CLcr). This relation might be useful when designing dosing strategies for cefuroxime and other renally eliminated drugs. The time-courses of the biomarkers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and body temperature were studied for the first 72 hours of cefuroxime treatment and was related to the duration of illness previous treatment with cefuroxime and to time to step-down of treatment. When duration of illness was short, CRP and SAA were showed increasing levels. None of the biomarkers could be used to differentiate between early or late step-down of therapy. By use of known PK and pharmacodynamic (PD) principles, dosing strategies based on CLcr for cefuroxime were estimated using minimization of a risk function. The risk function was constructed with the aim to expose patients to cefuroxime concentration above minimum inhibitory concentration (MIC) for 50 % of the dosing interval and to minimize the amount of drug administered in excess to reach the aim. Based on evaluation using wild type MIC distributions for Escherichia coli and Streptococcus pneumoniae improved dosing strategies were selected. In vitro experiments were performed exposing Streptococcus pyogenes to constant concentration of benzylpenicillin, cefuroxime, erythromycin, moxifloxacin or vancomycin. A semi-mechanistic PK/PD model characterizing the time-course of the antibacterial effect was developed using all data simultaneously. Internal validation showed the model being predictive and robust.

Paclitaxel (Taxol®) is now widely used against breast, ovarian and non-small-cell lung cancer. Anticancer agents generally have narrow therapeutic indices, often with myelosuppression (mainly neutropenia) as dose-limiting side effect. A further complicating factor is that paclitaxel when given as Taxol® has a nonlinear pharmacokinetic (PK) behaviour in plasma. Identifying risk groups more sensitive to chemotherapy due to either a PK or pharmacodynamic (PD) interindividual variability is of importance. The aim of the thesis was to develop predictive mechanism-based PK and PD models applicable for paclitaxel. PK and PK/PD models were developed for patient data from studies with relatively frequent sampling or sparse sampling schedules. Population analyses were performed using the software NONMEM. A pharmacokinetic model describing unbound, total plasma and blood concentrations of paclitaxel from known binding mechanisms was developed and validated. The nonlinear PK in plasma could to a large extent be explained by the micelle forming vehicle Cremophor EL (CrEL) and the unbound drug showed linear PK. Besides a binding component directly proportional to concentrations of CrEL, the model included both linear and nonlinear binding components in plasma and blood. Further, relations between the PK parameters and different demographic factors, including polymorphisms in the cytochrome P450s involved in paclitaxel metabolism, were investigated. A semi-physiological PD model for chemotherapy-induced myelosuppression was developed and applied to different anticancer drugs. The model included a self-renewal for proliferating cells, transit compartments describing the delay in observed myelosuppression and a feedback parameter reflecting the effect on the bone marrow from growth factors that can result in an overshoot in white blood cells. The system-related parameters estimated showed consistency across drugs and the difference in the drug-related parameter reflected the relative bone marrow toxicity of the drugs. Relations between demographic factors and the PD parameters were identified. The developed mechanism-based models promote a better understanding of paclitaxel PK and PD and may be used as tools in dosing individualisation and in development of dosing strategies for new administration forms and new drugs in the same area.