名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成25年3月25日 水谷武史氏の博士論文として提出された

Class of 2017 Abstract / Objectives: Milk protein allergy is estimated to affect 1.2% to as much as 17% of people of all ages. Advair® Diskus® (FP/SX) utilizes lactose as an excipient which limits the utility of this product for this population. Furthermore, Advair® Diskus® is formulated as an interactive physical mixture via a micronization process. Alternatively, spray dried engineering achieves narrow particle size distribution, allowing greater deposition in the targeted respiratory bronchioles. The purpose of this dry powder inhaler (DPI) study was to conduct an in vitro comparative analysis of the aerodynamic performance of a co-spray dried lactose-free formulation of FP/SX with a mannitol excipient as a molecular mixture versus the Advair® Diskus® 250/50 (FP/SX) interactive physical mixture product. Methods: Utilizing mannitol as an excipient, a co-spray dried FP/SX powder was prepared using the Buchi Mini-Spray Dryer B-290 under closed system configuration. The resulting feed solution was spray dried at pump rates of 25%, 50%, and 100% with all other parameters remaining constant (aspiration, atomization rate, nitrogen gas rate). The primary outcome measure, aerodynamic performance, was assessed using the Copley Next-Generation Impactor (NGI). NGI data for the DPIs was used to calculate mass median aerodynamic diameter (MMAD), geometric standard deviation (GSD), and fine particle fraction (FPF) of each powder, including the Advair® Diskus®. Residual water content was quantified by Karl Fischer titration. Particle characteristics were visualized by scanning electron microscopy. Results: FPF, MMAD, and GSD were calculated from NGI data; Wolfram Alpha software was used to calculate MMAD and GSD. T-test regression was used for comparative analysis of spray-dried and Advair® Diskus® powders. MMAD for each spray dried sample was analyzed using a t-test regression against the MMAD values from the Advair® Diskus®. Using aerodynamic analysis studies triplicated for each powder, there was no significant difference between the spray dried powder and Advair® Diskus® for MMAD and GSD (p-values >0.05). The 50% and 100% pump rate samples had similar FPF to the Advair® Diskus® (p-values >0.05). However, the 25% pump rate sample had a significantly improved FPF compared to the Advair® Diskus® (p <0.01). Conclusions: A co-spray-dried lactose-free formulation of FP/SX with a mannitol excipient demonstrated similar aerodynamic performance to the Advair® Diskus® which consists of a physical mixture of two drugs with lactose. Of significance, 25% pump rate spray-dry conditions demonstrated an improved FPF compared to the Advair® Diskus®.

The upregulation of the inducible nitric oxide synthase (iNOS) and nitric oxide (NO) production have been implicated in inflammatory pathologies. Although research has revealed that glucocorticoids (GCs) such as dexamethasone and hydrocortisone inhibit iNOS expression and NO production, it remains unclear how these compounds attenuate iNOS expression and function. In response, this thesis has compared the effects of nonselective GCs (i.e., dexamethasone and hydrocortisone) with a selective GC namely, fluticasone propionate (fluticasone) to identify the precise GC actions that regulate the iNOS pathway. Additional investigations were performed to distinguish the GC and non-GC actions using receptor antagonists. Since the effects of GCs on upstream signalling pathways remain vague, further studies were conducted to investigate whether fluticasone regulates the p38 mitogen-activated protein kinases or protein kinase B (Akt) pathways, both of which have been reported to be critical for the induction of iNOS. All experiments were conducted using primary cultures of rat aortic smooth muscle cells (RASMCs). The cells were activated with bacterial LPS (100 μg/mL) and interferon-gamma (IFN-γ, 100 U/mL) to induce iNOS and NO. Nitrite levels in cellular supernatants were quantified by the Griess assay, and expressions of iNOS, phospho-p38 (P-p38), and phospho-Akt (P-Akt) were investigated by western blotting. Dexamethasone (0.1-10.0 μM) inhibited iNOS expression and NO production in a concentration dependent manner that was significant at higher concentrations (0.3-10.0 μM). Hydrocortisone (0.01-10.0 μM) also inhibited iNOS expression and NO production in a concentration dependent manner which was significant at the higher concentrations (0.1-10.0 μM). By contrast, fluticasone (0.1 nM-3.0 μM) inhibited NO production and iNOS expression only partially (~50%), and the effects were significant at 1 nM-3 μM. RU-486 (10 μM), a GC receptor (GCR) blocker, was able to reverse the inhibitions caused by dexamethasone, hydrocortisone, and fluticasone, though eplerenone (0.1-10.0 μM), the mineralocortocoid receptor blocker, had no effect. Fluticasone also inhibited the phosphorylation of p38 and Akt in activated RASMCs. The inhibitions were reversed upon incubation with RU-486 (10 μM) for 1 h prior to the addition of fluticasone. The partial inhibition of iNOS and NO by fluticasone suggests that the actions of dexamethasone and hydrocortisone were not restricted solely to GCR and that other receptors or pathways, if not both, might regulate iNOS and NO in RASMCs. In conclusion, the nonselective GCs (i.e., dexamethasone and hydrocortisone) showed a full inhibition of iNOS expression and function, whereas fluticasone only partially inhibited both processes. The inhibitions were reversed by RU-486, but not eplerenone, which strongly suggests a GC-mediated response to all three compounds investigated. Regarding fluticasone, mechanistic studies revealed that the GC can regulate key signalling pathways associated with the induction of iNOS. More specifically, fluticasone reduced the phosphorylation of p38 and Akt, thereby suggesting that its actions can be mediated by suppressing these kinase pathways, which are widely reported to critically regulate iNOS expression and function.

No / Luticasone propionate is a synthetic glucocorticoid with potent anti-inflammatory activity that has been used effectively in the treatment of chronic asthma. The present work reports a vibrational spectroscopic study of fluticasone propionate and gives proposed molecular assignments on the basis of ab initio calculations using BLYP density functional theory with a 6-31G* basis set and vibrational frequencies predicted within the quasi-harmonic approximation. Several spectral features and band intensities are explained. This study generated a library of information that can be employed to aid the process monitoring of fluticasone propionate.

L’asthme sévère de l’enfant est une pathologie respiratoire chronique dont le traitement est difficile. L’épithélium bronchique à l’interface de l’organisme et de l’environnement, est un pivot central dans la maladie asthmatique. Le but de ce travail a donc été d’étudier l’épithélium bronchique de l’enfant asthmatique sévère.Dans un premier temps, j’ai développé un modèle de reproduction d’épithélium bronchique in vitro obtenu à partir de cellules épithéliales bronchiques issues de biopsies bronchiques d’enfants asthmatiques sévères. J’ai comparé ces épithélia obtenus chez l’enfant à ceux obtenus chez l’adulte. Nous avons spécifiquement étudié un marqueur inflammatoire important dans l’asthme sévère, le TSLP. J'ai montré 2 isoformes de TSLP ayant un rôle contraire, anti inflammatoire et proinflammatoire. Dans un deuxième temps, j’ai mis au point un modèle d’exacerbation d’asthme viro-induite. J’ai utilisé le modèle de culture et soumis les cellules à une stimulation Poly I:C. Les différentes cytokines sécrétées lors d’une exacerbation asthmatique virale ont été retrouvées augmentées dans notre modèle : CXCL8, CXCL10, CCL2, CXCL9 et RANTES. Enfin, j’ai étudié le propionate de fluticasone dans le modèle d’exacerbation asthmatique. Nous avons montré que l’effet de la fluticasone est différent entre les cellules épithéliales bronchiques issues de témoins et celles issues d’asthme sévère. Le modèle de stimulation viro-induite a permis d’étudier l’effet des corticoïdes inhalés sur l’épithélium bronchique et va permettre d’étudier les voies mécanistiques en jeu dans les exacerbations viro-induites, de tester d’autres molécules et proposer d’autres pistes thérapeutiques. / Severe childhood asthma is a chronic respiratory disease difficult to control despite treatment. Bronchial epithelium, at the interface between the body and the environment, is a central pivot in the asthmatic disease. The aim of this study was to examine the bronchial epithelium of severe asthmatic children. Initially, I developed a bronchial epithelium in vitro reproduction model obtained from bronchial epithelial cells from bronchial biopsies of severe asthmatic children. I compared these epithelia obtained in children with those obtained in adults. We specifically studied an important inflammatory marker in severe asthma,TSLP. I have highlighted the presence of two isoforms of TSLP which have an opposite role, anti-inflammatory for the short form and the long form for proinflammatory.Secondly, I developed an asthma exacerbation model of virus-induced. I used the culture model and challenged bronchial cells with poly I:C to. Different cytokines secreted upon viral asthma exacerbation were found increased in our model: CXCL8, CXCL 10, CCL2, RANTES and CXCL9.Finally, I have studied fluticasone propionate in the exacerbation asthmatic model. I studied cells from asthmatic and from non asthmatic children. Interestingly, we have shown that the effect of fluticasone is different between bronchial epithelial cells from non asthmatic children and those from severe asthma.The model of virus-induced stimulation was used to study the effect of inhaled corticosteroids on bronchial epithelium and will allow studying the mechanistic pathways involved in virus-induced exacerbations, testing other molecules and propose other therapeutic approaches.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fluticasone propionate (FP) is a synthetic glucocorticoid with potent anti-inflammatory activity that has been effectively used for the treatment of seasonal and allergic perennial rhinitis, minimizing systemic activity. In the present study, the methods were developed and validaded for assessment of FP in pharmaceutical products. The analysis by reversed-phase liquid chromatography were performed using Shim-pack CLC-ODS column (150 x 4.6 mm), maintained at 35 °C. The mobile phase was consisted of acetonitrile/ methanol/ 0.01M phosphate buffer pH 4 (35:35:30), run at flow rate of 1 mL/min and using photodiode array detection at 240 nm. The chromatographic separation was obtained within 8 minutes and it was linear in the concentration range of 0.05-150 μg/mL (r2 = 0,9999). The method was successfully applied for the determination of FP in creams and nasal sprays pharmaceutical formulations. The micellar electrokinetic chromatography was also developed and validaded. The analyses were performed on a fused-silica capillary (50 μm i.d.; effective length, 40 cm) and background electrolyte consisted of 25 mM borate and 25mM SDS solution at pH 9. The capillary temperature was maintained at 35 °C and the applied voltage was 20 kV. The injection was performed using the hydrodynamic mode at 50 mbar for 6 s, with detection at 238 nm. The electrophoretic separation was obtained with migration time of 5.6 and 5.1 minutes for the FP and prednisolone acetate (internal standard), respectively, and with run time of 7 minutes. The method was linear in the concentration range of 2-80 μg/mL (r2 = 0.9956). The procedures were validated evaluating parameters such as the specificity, linearity, precision, accuracy, and robustness, limit of detection and limit of quantitation, whose results have met the requirements recommended. The proposed methods were used for the analysis of pharmaceutical products, demonstrating nonsignificative difference of the results (P > 0.05). Then, the procedures contribute to improve the quality control, assuring the safety and therapeutic efficacy of pharmaceutical formulations. / O propionato de fluticasona (PF) é um glicocorticóide sintético com potente atividade antiinflamatória utilizado efetivamente no tratamento de rinites alérgicas sazonais e perenes, minimizando a atividade sistêmica. No presente trabalho foram desenvolvidos e validados métodos para avaliação de PF em produtos farmacêuticos. As análises por cromatografia líquida em fase reversa foram realizadas utilizando coluna Shim-pack CLC-ODS (150 x 4,6 mm), mantida à 35ºC. A fase móvel foi composta de acetonitrila/ metanol/ tampão fosfato 0,01M pH 4 (35:35:30), eluída na vazão de 1 mL/min e detecção no ultravioleta a 240 nm. A separação cromatográfica foi obtida no tempo de 8 minutos, sendo linear na faixa de concentração de 0,05-150 μg/mL (r2 = 0,9999). O método foi aplicado para análise de PF em cremes e sprays nasais. Paralelamente, desenvolveu-se e validou-se método por cromatografia eletrocinética micelar. Executaram-se as análises utilizando capilar de sílica (comprimento efetivo de 40 cm e diâmetro de 50 μm) e solução eletrolítica composta de borato 25 mM e SDS 25 mM, pH 9. O capilar foi mantido a temperatura de 35ºC, e aplicada voltagem de 20 kV. O tempo de injeção foi de 6 s com pressão de 50 mbar e detecção no UV a 238 nm. Realizou-se a separação eletroforética com tempo de migração de 5,6 e 5,1 minutos para o PF e acetato de prednisolona (padrão interno), respectivamente, com tempo de corrida de 7 minutos. O método foi linear na faixa de 2-80 μg/mL (r2 = 0,9956). Os procedimentos foram validados, avaliando-se os parâmetros de especificidade, linearidade, precisão, exatidão, robustez, limite de detecção e quantificação, cujos resultados cumpriram os requisitos preconizados. Os métodos propostos foram utilizados para análise de produtos farmacêuticos, demonstrando que não há diferenças significativas dos resultados (P > 0,05). Assim, os procedimentos pesquisados contribuem para aprimorar o controle da qualidade, garantindo a segurança e eficácia terapêutica das formulações farmacêuticas.

It has always been a challenge to imitate the lung environment, therefore there is a constant development of standardized in vitro dissolution methods for inhaled products. Dissolution in vitro has been considered as an important parameter, because low solubility determines the bioavailability of inhaled drugs. The in vitro dissolution data generated by the dissolution test experiment can be correlated with in vivo pharmacokinetic data through in vitro-in vivo correlation (IVIVC), because a completed predictive IVIVC model is very useful for drug formulation design and manufacturing changes after approval. The aim of this study was to investigate the effect of the membrane on the dissolution profile of orally inhaled drugs with different solubility, Budesonide (BUD) and Fluticasone propionate (FP) in the different pore sizes of the membrane 8.0 μm, 3.0 μm and 0.4 μm. The method in this study builds on previous dissolution methods, a Transwell® setup to dissolve the drugs with a small amount of dissolution medium, which mimics more the limited lung fluid capacity in vivo. In order to collect the dose from the drugs, Andersen Cascade Impact was used. The dissolution rate of BUD was first in the ranking in all of the pore sizes in the membrane.

Today, orally inhaled drugs found on the market suffer from variable and discontinuous pulmonary drug release which lowers efficacy and patience compliance. This is usually a consequence of the poor understanding of the interaction and dissolution behavior of drug particles in the lung environment. Thus, the aim of this project was to investigate the effect of the dissolution medium on dissolution profiles for the well-known orally inhaled drug budesonide (BD) and fluticasone propionate (FP), in order to assess the importance of a proper selection of dissolution media for in vitro dissolution methods. In order to achieve this a modified Andersen Cascade Impactor was used to simulate deposition of particles onto filters. The dissolution was measured using a Transwell set up with polycarbonate membranes that can hold the filters with the deposited drug on it. Different media were prepared, from simple to more biorelevant. The samples taken during the dissolution experiments were analyzed quantitatively using UPLC-UV and the experimental data was processed by fitting to the Weibull function. The aim of this project was successfully achieved and the dissolution media that worked best for both BD and FP was PBS with the addition of 0.5% SDS. On the other hand, the dissolution media that performed the least for both BD and FP was the simulated lung fluid (SLF) with presence of 0.02% (w/v) DPPC. This may be due to the fact that DPPC forms liposomal aggregates which probably results in the media becoming more viscous and hence the dissolution time becomes slower.