Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 6 uppsatser.

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Advancements in nanoparticle drug delivery of anticancer agents require mathematical models capable of predicting in vivo formulation performance from in vitro characterization studies. Such models must identify and incorporate the physicochemical properties of the therapeutic agent and nanoparticle driving in vivo drug release. This work identifies these factors for two nanoparticle formulations of anticancer agents using an approach which develops mechanistic mathematical models in conjunction with experimental studies. A non-sink ultrafiltration method was developed to monitor liposomal release kinetics of the anticancer agent topotecan. Mathematical modeling allowed simultaneous determination of drug permeability and interfacial binding to the bilayer from release data. This method also quantified the effects of topotecan dimerization and surface potential on total amount of drug released from these liposomal formulations. The pH-sensitive release of topotecan from unilamellar vesicles was subsequently evaluated with this method. A mechanistic model identified three permeable species in which the zwitterionic lactone form of topotecan was the most permeable. Ring-closing kinetics of topotecan from its carboxylate to lactone form were found to be rate-limiting for topotecan drug release in the neutral pH region. Models were also developed to non-invasively analyze release kinetics of actively-loaded liposomal formulations of topotecan in vivo. The fluorescence excitation spectra of released topotecan were used to observe release kinetics in aqueous solution and human plasma. Simulations of the intravesicular pH in the various release media indicated accelerated release in plasma was a consequence of increased intravesicular pH due to ammonia levels in the plasma instead of alterations in bilayer integrity. Further studies were performed to understand the roles of dimerization, ion-pairing, and precipitation on loading and release kinetics obtained from actively-loaded topotecan. Extension of this type of modeling for other types of nanoparticles was illustrated with doxorubicin-conjugated polymeric micelles. Mathematical modeling of experimental studies monitoring doxorubicin release identified conjugation stability during storage, hydrazone hydrolysis kinetics, and unconjugated doxorubicin partitioning affected micellar doxorubicin release. This work identifies several of the key parameters governing drug release from these liposomal and micellar nanoparticles and lays the framework for future development of in vivo release models for these formulations.

The aim of this study was to investigate the molecular interactions of the anti-cancer drug Doxorubicin (DOX) with poly(methacrylic acid) grafted starch nanoparticles (PMAA-g-St). In order to fully understand the DOX/PMAA-g-St system, we conducted in-depth studies on DOX dimer dissociation and DOX/PMAA-g-St binding interactions using various techniques such as isothermal titration calorimetry (ITC), dynamic light scattering (DLS), and fluorescence and absorption spectroscopy. Based on our experimental results, we developed a quantitative thermodynamic model with relevant parameters such as dissociation constant, Kd, as well as enthalpy of binding, ΔH, in order to explain DOX/PMAA-g-St interactions. In addition, we also studied the effect of environmental factors such as pH and NaCl on DOX self-association and DOX/PMAA-g-St complex formation. In conclusion, the combination of results obtained from various techniques as well as the multispecies equilibrium model, enables us to interpret quantitatively the data of drug loading onto and release from polymeric nanoparticles.

Gene delivery for therapeutic purposes is quickly emerging as the best potential treatment option for inherited genetic diseases and cancer. Viral gene carriers have been the choice for this purpose due to their high efficiency, but harmful immunogenic and oncogenic host reactions have limited their in vivo use. Cationic polymers provide a safe alternative to viral carriers as they can be engineered to reduce immunogenic and toxic responses and serve therapeutic purposes in the body. Due to their strong positive charge, they are able to compact the negatively charged nucleotides to small nano-sized particles appropriate for cellular uptake. Additionally, they efficiently encapsulate the highly sensitive nucleotides, and protect them against degradation by the nucleases present at the physiological milieu. In this thesis work, I have used a novel approach for gene delivery by combining the critical properties of a cationic polymer (i.e., nucleotide condensing ability) with that of a fatty acid (i.e., lipid membrane compatibility). The resulting lipid modified polymer increased delivery of our gene of interest into target cells and resulted in increased siRNA delivery for cancer gene therapy. / Biomedical Sciences

Introdução: A curcumina é um polifenol presente no rizoma da espécie Curcuma longa L. que tem sido usado há séculos como medicamento anti-inflamatório na medicina asiática. A síndrome nefrótica é classicamente tratada com corticosteroides, uma potente classe antiinflamatória e imunossupressora. O tratamento pode trazer sérios efeitos adversos. Objetivos: Este estudo foi desenhado para avaliar o efeito anti-inflamatório e antiproteinúrico da C. longa na forma de droga vegetal, na lesão renal induzida pela doxorrubicina. Desenho do estudo: Trata-se de um estudo experimental in vivo. Métodos: O efeito anti-inflamatório e anti-proteinúrico da C. longa foi avaliado utilizando-se 4 grupos de ratos Wistar: dois grupos com lesão renal induzida por doxorrubicina (3,5 mg/kg) em dose única endovenosa, sendo um alimentando-se de ração padrão e outro com ração misturada a C. longa (5 mg/g de ração). Outros dois grupos controles sem lesão renal foram alimentados, sendo um com ração padrão e outro com C. longa. Foram coletadas amostras de urina para dosagem de albuminúria a cada 2 semanas. Após 8 semanas os animais foram anestesiados e coletado sangue para dosagem no plasma de creatinina, albumina, sódio, potássio, colesterol e osmolalidade. Nas amostras de urina foram dosados albuminúria, sódio, potássio, osmolalidade e os mediadores inflamatórios proteína quimiotática para monócitos-1 e fator de transformação do crescimento beta urinário. Foi coletado tecido renal para realização de microscopia de luz e de imuno-histoquímica para desmina, vimentina e células ED-1 positivas. Resultados: Após a 8a semana de acompanhamento, o tratamento com C. longa atenuou o aumento do MCP-1 urinário, do TGF-? urinário, da imunomarcação para desmina, vimentina e células ED-1+ nos ratos com lesão renal induzida. Conclusão: Os resultados sugerem que o uso de C. longa em um modelo experimental de lesão renal por doxorrubicina, por 8 semanas, não reduz a albuminúria, mas leva a diminuição dos mediadores inflamatórios renais MCP-1 e TGF-? urinário, além de imunomarcação para desmina, vimentina e células ED-1+ no tecido renal. / Background: Curcumin is a polyphenol present in the rhizome of the species Curcuma longa L., which has been used for centuries as an anti-inflammatory remedy in Asian medicine. Nephrotic syndrome is classically treated with corticosteroids, a potent antiinflammatory and immunosuppressive class. The treatment can cause serious adverse effects. Objectives: This study was designed to evaluate the anti-inflammatory and antiproteinuric effects of C. longa, as powdered dried rhizomes, in renal injury induced by doxorubicin. Study design: This is an in vivo experimental study. Methods: The antiinflammatory and anti-proteinuric effects of C. longa were evaluated in four groups of Wistar rats: two groups with intravenous doxorubicin-induced kidney injury (3.5 mg/kg), one fed with standard food and another with standard food mixed with C. longa (5 mg/g food). Two other control groups without kidney injury were fed, one with standard and one with C. longa-mixed food. Urine samples were collected for albuminuria every 2 weeks. After 8 weeks, the animals were anesthetized and blood was collected for measurement of plasma creatinine, albumin, sodium, potassium, cholesterol and osmolality. In the urine samples, measurements of albuminuria, sodium, potassium, osmolality and inflammatory mediators as monocyte chemoattractant protein-1 and transforming growth factor beta were done. Renal tissue was collected for light microscopy and immunohistochemistry for desmin, vimentin and ED-1 positive cells. Results: After the 8th week of follow-up, treatment with C. longa attenuated the increase of urinary MCP-1, urinary TGF-?, and immunostaining for desmin, vimentin and ED-1+ cells in rats with doxorubicin-induced kidney injury. Conclusion: The results suggest that the use of C. longa in an experimental model of nephrotic syndrome for 8 weeks does not reduce albuminuria, but there is a decrease in the inflammatory mediators urinary MCP- 1, urinary TGF-?, and immunostaining for desmin, vimentin and ED-1+ cells.

O prognóstico de pacientes portadores de sarcomas de partes moles (SPM) avançados é reservado. Aumentar o benefício de quimioterapia é necessário, sendo, uma das estratégias, quimioterapia em dose densa, a qual demonstrou benefício em câncer de mama. Por outro lado, a busca de um marcador prognóstico é importante para uma melhor seleção de pacientes que se beneficiariam de protocolo de tratamento mais intensivo. A ezrina é uma proteína que liga o citoesqueleto celular a proteínas de membrana, está associada a invasão celular e metástase e sua hiperexpressão tem sido associada a um pior prognóstico em sarcomas de partes moles. O objetivo deste estudo foi avaliar o papel de quimioterapia com dose densa em pacientes portadores de SPM de alto grau, avançados. O desfecho primário foi taxa de resposta e os secundários foram sobrevida global (SG), sobrevida livre de progressão (SLP), perfil de toxicidade, qualidade de vida e controle de dor. Avaliou-se também a expressão de ezrina por imunohistoquímica como marcador de prognóstico, com o intuito de estratificação da população que poderia se beneficiar mais desta abordagem intensificada. Neste estudo de fase II prospectivo, vinte e um pacientes foram incluídos. A idade mediana foi 37 anos (23-60) e extremidades inferiores foram o sítio primário mais comum. Sarcoma sinovial, leiomiossarcoma e sarcoma sem outras especificações foram as histologias mais frequentes. O protocolo consistiu de seis ciclos seqüenciais de doxorubicina 30mg/m2 D1-3 e ifosfamida 2,5g/m2 D1-5 a cada 14 e 21 dias, respectivamente, seguidos por sete dias de suporte hematopoiético. As intensidades de dose medianas de doxorrubicina e ifosfamida foram, respectivamente, 42mg/m2/semana e 3,63g/m2/semana (93% e 87% do planejado, respectivamente) e 15 pacientes (71%) receberam todo o tratamento. Toxicidades graus 3 e 4 foram observadas em 19 pacientes e em 77/105 ciclos, neutropenia febril em 6 ciclos (5 pacientes) e reduções da fração de ejeção de ventrículo esquerdo de pelo menos 10% em três pacientes. Não houve toxicidade renal provavelmente pela adminsitração da ifosfamida em duas horas. A resposta foi avaliada pelos critérios de RECIST, com três respostas parciais, totalizando uma taxa de resposta de 14%. Seis respostas deveriam ser observadas para que o estudo completasse a inclusão de todos os pacientes programados. Como não se atingiu a taxa de resposta prevista, o protocolo foi fechado. Três mortes precoces foram observadas com suspeita de toxicidade. Após seguimento mediano de 11 meses, a SLP e a SG medianas foram 8,1 e 20,1 meses respectivamente. Pacientes com sarcoma sinovial e idade inferior a 45 anos apresentaram maior sobrevida na análise univariada. A expresão de ezrina foi positiva em 10 pacientes (47%) e houve tendência a uma correlação direta entre sua expressão e sobrevida mais longa (p=0,1191). Todos os pacientes com histologia sinovial foram positivos para ezrina (teste de Fischer, p= 0,0325). Este esquema de quimioterapia sequencial com dose densa de doxorubicina e ifosfamida foi tóxico, a taxa de resposta foi baixa em um grupo de pacientes com doença avançada e não pode ser empregado na prática clínica diária fora de protocolo de pesquisa / Advanced soft tissue sarcoma (STS) patients have a dismal prognosis. Efforts to increase benefit from chemotherapy are needed and dose-dense chemotherapy could be an option, since this approach has demonstrated survival benefit in breast cancer. On the other hand, the identification of a prognostic marker is essential to stratify which patients could benefit most from intensified strategies. Ezrin is a member of the ERM (ezrin, radixin, moesin) cytoeskeleton-associated protein family associated with invasion and metastasis, and has been pointed as important prognostic marker in sarcomas. The objective of this study was to explore the role of dose-dense doxorubicin- and ifosfamide-based chemotherapy in advanced high grade STS patients. Primary endpoint was response rate and secondary endpoints were overall survival (OS), progression free survival (PFS), toxicity profile, quality of life and pain control evaluation. Tumor ezrin immunoreactivity was an exploratory endpoint as a predictor of response to chemotherapy and as a prognostic factor in this population, trying to find which patients could benefit most from this intensified strategy. This prospective, single arm, phase II study included 21 advanced STS patients. Median age was 37 years (23-60y) and lower limbs were the most frequent primary site. Synovial, leiomyo and unclassified sarcoma were the most common histologies. Protocol consisted of 6 cycles of sequential dose-dense doxorubicin 30 mg/m2 D1-3 and ifosfamide 2.5 g/m2 D1-5 every 14 and 21 days, respectively, followed by seven days of hematopoietic support. The median doxorubicin and ifosfamide dose-intensities were, respectively, 42 mg/m2/week and 3.63 g/m2/week (93% and 87% of planned, respectively) and 15 patients (71%) received all cycles. Grade 3/4 toxicities occurred in 19 patients and 77/105 cycles, febrile neutropenia in 5 patients (six cycles) and three LVEF drops of at least 10%, one symptomatic. No renal toxicity was observed what could occurred due to the two-hour-schedule of ifosfamide. Responses were evaluated by RECIST criteria and three patients presented partial response (response rate of 14%). Six responses were necessary to the inclusion of the target population, however, this was not observed and the study was closed. Three deaths were probably related to toxicity. After a median follow-up was 11 months, PFS and OS were 8.1 months and 20.1 months, respectively. Patients with synovial sarcoma and those younger than 45y presented better survival at univariate analysis. Ezrin expression was positive in 10 patients (47%) and a trend was observed for a correlation between positive ezrin expression and longer survival (p= 0.1191). There was a statistically significant correlation between positive ezrin expression and synovial hystology (Fishers exact test, p= 0.0325). This sequential dosedense doxorubicin/ifosfamide-based chemotherapy protocol was toxic, response rate was low in advanced STS patients and can not be considered for routine practice outside clinical trials

Les sphéroïdes multicellulaires tumoraux (SMT) constituent un outil prometteur dans le domaine de l’étude biologique des tumeurs. Le but de la thèse était de développer une technique de la formation de SMT et de démontrer la disponibilité de ces sphéroïdes comme modèle in vitro 3D pour tester l’efficacité de principes actifs anticancéreux ainsi que celle de formulations de délivrance de médicaments. L'effet d’auto-assemblage de cellules induit par une addition des peptides RGD cycliques a été étudié pour 16 lignées cellulaires de différentes origines. Le peptide cyclique RGDfK et sa modification avec le cation triphenylphosphonium (TPP) ont permis de mettre en évidence l’induction de formation de sphéroïdes. Les sphéroïdes ont été employés comme modèles pour évaluer la cytotoxicité de principes actifs antitumoraux (doxorubicine, curcumine, temozolomide) et un certain nombre de formulations nano- et micrométriques (microréservoirs, nano-émulsions et micelles). / Multicellular tumor spheroids (MTS) are a promising tool in tumor biology. The aim of the Thesis was to develop a novel highly reproducible technique for MTS formation, and to demonstrate the availability of these spheroids as 3D in vitro model to test anticancer drugs and drug delivery vehicles. Cell self-assembly effect induced by an addition of cyclic RGD-peptides directly to monolayer cultures was studied for 16 cell lines of various origin. Cyclo-RGDfK peptide and its modification with triphenylphosphonium cation (TPP) were found to induce spheroid formation. The spheroids were used as a model to evaluate the cytotoxicity of antitumor drugs (doxorubicin, curcumin, temozolomide) and a number of nano- and micro- formulations (microcontainers, nano-emulsions and micelles).

L‘intérêt de développer de nouvelles applications de la nanotechnologie pharmaceutique dans les soins de santé augmente année après année. Le rôle des nanosystèmes est devenu évident, surtout après que certains d'entre eux aient contribué à des solutions révolutionnaires dans des maladies graves. Dans notre projet, nous avons cherché à synthétiser des nanoparticules (NPs) intelligentes capables de livrer, de façon sélective, des agents anticancéreux. Les NPs ont été synthétisées afin de cibler des cellules cérébrales atteintes par le glioblastome multiforme (GBM), un cancer du cerveau présentant un mauvais pronostic et un taux de survie médian très faible. À cet effet, nous avons planifié de synthétiser et analyser ces nanoparticules et également d’étudier les preuves de concept de leur efficacité. Tout d'abord, nous avons sélectionné avec soin, la procédure de formulation ainsi que les polymères avant d’optimiser les caractéristiques physico-chimiques des nanogels (NGs) formulés à base de chitosane. Après l'optimisation de la taille, du PdI et du potentiel de surface des NGs, nous avons synthétisés des NGs chargés en substance active. Deux molécules thérapeutiques ont été retenues La première était la doxorubicine HCl (DOX) qui est trop hydrophile pour passer la BHE, bien qu’ayant démontré une efficacité in vitro contre le GBM. Le deuxième médicament était le témozolomide (TMZ) qui est déjà utilisé dans le traitement de GBM, comme adjuvant à la radiothérapie, après l’intervention chirurgicale. Les méthodes d'analyses ont ensuite été développées pour déterminer l’efficacité du taux d'encapsulation (EE%) et l'efficacité de chargement de médicament (DLE%) des deux médicaments. Pour la préparation des nanogels théranostiques, nous avons suivi les mêmes procédures après l’addition de l’agent de contraste USPIO, durant la synthèse des NGs. Ensuite, nous avions besoin d’assurer la qualité de nos NGs lors du stockage à long terme. Pour atteindre cet objectif, nous avons développé une procédure de lyophilisation en utilisant différents sucres de nature et de concentrations variables. Les sucres ont été ajoutés pour cryoprotéger les NGs contre les contraintes mécaniques et physiques mises en jeu lors de la lyophilisation. Les sucres qui ont démontré des résultats satisfaisants avec NGs vides ont été utilisés, par la suite, dans la cryoprotection des NGs chargées de médicament au cours de leur lyophilisation. Finalement, nous avons étudié la libération de la DOX à partir des NGs chargées avant et après lyophilisation. Cette étude, en particulier avait deux objectifs. Le premier était de comparer l'effet de la lyophilisation sur le comportement de la libération de DOX des NGs, en observant l’impact de cette procédure sur la cinétique de libération Le deuxième but de l'étude de relargage était de tester la capacité des NGs à libérer leur contenu à trois pH différents : 5.8 (pH intracellulaire des cellules tumorales), 6.8 (espace interstitiel de la tumeur) et 7.4 (plasma sanguin). / The interest in developing new applications of nanotechnology in the pharmaceutical health care increases year after year. The role of nanosystems became clearer, especially after some of them contributed to revolutionary solutions in serious diseases. In our project, we sought to synthesize ‘intelligent’ nanoparticles (NPs) capable of selectively delivering anticancer agents. NPs were synthesized to target brain cells affected by glioblastoma multiforme (GBM), a brain cancer with a poor prognosis and a very low rate of median survival. To this end, we planned to synthesize and analyze these nanoparticles and also to study the proof-of-concept of their efficiency. First, we carefully selected the formulation process and the polymers prior to optimize physicochemical characteristics of the nanogels (NGs) formulated with chitosan. After optimization of the NGs size, PDI and surface potential, we synthesized NGs loaded with active substances. Two therapeutic molecules were selected. First we chose doxorubicin HCl (DOX) which is too hydrophilic to cross the BBB, whereas demonstrating in vitro efficacy against GBM. The second drug was temozolomide (TMZ), already used in the treatment of GBM as an adjuvant to radiotherapy after surgery. Analytical methods were then developed to determine the encapsulation efficiency (EE %) and drug loading efficiency (DLE %) of both drugs. For the preparation of theranostic nanogels, we followed the same procedures after the addition of the USPIO contrast agent during the NGs synthesis. Next, we needed to ensure the quality of our NGs during long-term storage. To achieve this goal, we developed a freeze-drying process using different kind of sugar cryoprotectants at varying concentrations, in order to protect NGs against mechanical and physical stresses at play during freeze-drying. Most promising sugars used with unloaded NGs were subsequently used to cryoprotect DOX-loaded NGs. Finally, we studied the release of DOX from DOX-loaded NGs before and after freeze-drying. This study in particular had two objectives. The first was to compare the effect of the freeze-drying process on the behavior of the DOX-loaded NGs, observing the impact of this procedure on the release kinetics. The second purpose of the release study was to test the ability of NGs to release their contents at three different pH: 5.8 (intracellular pH of tumor cells), 6.8 (interstitial space of the tumor) and 7.4 (blood plasma).

Abstract In the present study, some of the difficulties in the treatment of the most common malignant lymphoma, diffuse large B-cell lymphoma (DLBCL), were evaluated. Some patients develop local or central nervous system (CNS) relapse after first-line treatment. The treatment of relapsed disease is challenging and despite all efforts, some patients die of the disease. Chemoresistant disease also remains challenging because some patients suffer from refractory disease of a progressive nature. The antioxidant enzymes peroxiredoxins (Prxs) and thioredoxin-1 (Trx) were evaluated as prognostic and predictive markers of DLBCL. High cytoplasmic expression of Prx VI was found to correlate with poor prognosis in patients with DLBCL. Trx knockdown in lymphoma cell culture revealed a possible predictive role of Trx. Trx knockdown sensitized cells to doxorubicin, a widely used chemotherapeutic agent in treatment schemas of DLBCL. Etoposide, another widely used chemotherapeutic agent, on the other hand, killed more native DLBCL cells than did doxorubicin. Patients with high Trx expression at the diagnostic stage of the disease benefitted from etoposide-containing high-dose chemotherapy and autologous stem cell transplantation and did not develop post-transplantation relapses which Trx-negative patients did. Antithrombin III (AT III) in cerebrospinal fluid has been suggested to be a biomarker in previous studies of CNS lymphoma. In the present study, AT III was evaluated in patients with CNS lymphoma and with neurological diseases. High concentrations of AT III in cerebrospinal fluid reflected the magnitude of blood-brain barrier leakage and because of this, AT III should not be used as a biomarker in clinical practice. / Tiivistelmä Tutkimuksessa arvioitiin osaa yleisimmän pahanlaatuisen imukudossyövän eli lymfooman, diffuusin suurisoluisen B-solulymfooman, hoidon haasteista. Osa potilaista saa ensilinjan hoidon jälkeen joko paikallisen tai aivoston alueen taudin uusiutuman. Uusiutuneen taudin hoito on haasteellista, ja hoitoyrityksistä huolimatta osa potilaista kuolee tautiinsa. Solunsalpaajille resistentti tauti on myös yksi haastavista hoitotilanteista, ja osa potilaista kärsiikin hoitojen läpi etenevästä taudista. Antioksidatiivisia entsyymejä, kuten peroksiredoksiineja ja tioredoksiinia, arvioitiin ennusteellisina ja ennakoivina merkkiaineina diffuusissa suurisoluisessa B-solulymfoomassa. Peroksiredoksiini VI:n korkea sytosolinen ilmaantuvuus korreloi tavallista huonompaan diffuusin suurisoluisen B-solulymfooman ennusteeseen. Tioredoksiinin hiljentäminen lymfoomasoluviljelyssä paljasti sen mahdollisen ennakoivan merkityksen hoitoon liittyvässä päätöksenteossa. Solut herkistyivät tiodredoksiinin hiljentämisen vuoksi doksorubisiinille, jota käytetään laajalti diffuusin suurisoluisen B-solulymfooman solunsalpaajahoidoissa. Etoposidi, joka on huomattavasti myrkyllisempi solunsalpaaja, päinvastoin tappoi enemmän tavallisia diffuusia suurisoluisia B-solulymfoomaa edustavia soluja kuin doksorubisiini. Potilaat, joilla oli korkea tioredoksiinin määrä taudin diagnostisessa vaiheessa, hyötyivät etoposidia sisältävästä korkea-annoshoidosta sekä autologisesta kantasolusiirrosta. Näille potilaille ei kehittynyt kantasolusiirron jälkeisiä taudin uusiutumia kuin taas niitä kehittyi potilaille, joilla oli tioredoksiini negatiivinen. Antitrombiini III:a on ehdotettu soveltuvaksi aikaisempien tutkimusten perusteella aivoston lymfooman merkkiaineeksi aivo-selkäydinnesteestä. Tässä tutkimuksessa antitrombiini III:n määrää mitattiin potilailta, joilla oli aivoston lymfooma tai neurologinen sairaus. Korkeat konsentraatiot antitrombiini III:a aivo-selkäydinnesteessä kuitenkin vain heijastivat veri-aivoesteen vuotamisen määrää, ja näin ollen antitrombiini III:a ei tulisi käyttää kliinisessä käytössä.