The venom of the Eastern coral snake Micrurus fulvius can cause respiratory paralysis in the bitten patient, which is attributable to -neurotoxins (-NTx). The aim of this work was to study the biodistribution and lymphatic tracking by molecular imaging of the main -NTx of M. fulvius venom. -NTx was bioconjugated with the chelator diethylenetriaminepenta-acetic acid (DTPA) and radiolabeled with the radionuclide Gallium-67. Radiolabeling efficiency was 60%-78%; radiochemical purity 92%; and stability at 48 h 85%. The median lethal dose (LD50) and PLA(2) activity of bioconjugated -NTx decreased 3 and 2.5 times, respectively, in comparison with native -NTx. The immune recognition by polyclonal antibodies decreased 10 times. Biodistribution of -NTx-DTPA-Ga-67 in rats showed increased uptake in popliteal, lumbar nodes and kidneys that was not observed with Ga-67-free. Accumulation in organs at 24 h was less than 1%, except for kidneys, where the average was 3.7%. The inoculation site works as a depot, since 10% of the initial dose of -NTx-DTPA-Ga-67 remains there for up to 48 h. This work clearly demonstrates the lymphatic system participation in the biodistribution of -NTx-DTPA-Ga-67. Our approach could be applied to analyze the role of the lymphatic system in snakebite for a better understanding of envenoming.

Over the last several years, injectable drugs have been a growing area for the treatment of various therapeutic conditions and they are projected to comprise an even larger proportion among the drugs that will be available in the years to come. The injectable drugs are administered by various routes such as intramuscular (IM), intravenous (IV), subcutaneous (SC) and others, however, the majority of these drugs are administered subcutaneously. Even though subcutaneous delivery has been utilized for a number of years, very little is known about the processes governing the absorption of macromolecules from the interstitial space; and the resulting impact of these processes on the bioavailability (BA) and pharmacokinetic (PK) profiles. Also, there is no established In vitro - In vivo correlation (IVIVC) for subcutaneously administered immediate release (IR) peptide based drugs in a biorelevant manner. The contribution of IVIVC in drug development of orally administered drugs is very well known. For oral drugs, the in vivo process of drug absorption is often rate limited by the rate at which drug dissolves in the gastrointestinal tract. This can be simulated by measuring the rate of dissolution in an in vitro apparatus, which can be correlated with the in vivo absorption rate to produce an IVIVC. This research program involved efforts to develop biorelevant IVIVC methods and model for subcutaneously administered peptide based drugs. The in vivo component of this Program involves the use of clinical data from a bioequivalence (BE) study of Iplex™ [(IGF-I (Insulin like growth factor-I)/IGFBP-3 (Insulin like growth factor binding protein-3)], administered subcutaneously, that was conducted at the Center for Drug Studies (CDS), VCU School of Pharmacy in the year 2005 (Barr et. al., 2005). The PK parameters for Increlex™ (IGF-I) are calculated from the clinical data obtained from another study (Rabkin et. al., 1996). Literature research and molecular modeling research formed the basis of our hypotheses that unbound and bound IGF-I are absorbed from the blood capillaries and lymphatic capillaries respectively and that simulation of these physiologic variables is possible with the use of the modified Hanson Microette® device. The Hanson Microette® device is a vertical diffusion cell system that has been modified to simulate the pores in the capillaries with the use of a synthetic membrane. The flow and composition of circulatory fluid was simulated by the use of modified Hanks balanced salts solution (HBSS). A validated RP-HPLC (reversed-phase high performance liquid chromatography) method has been used for the analysis of IGF-1/IGFBP-3 in the in vitro samples. The in vitro permeation/release results gave the in vitro component to conduct IVIVC analysis. The General Electric (GE) healthcare sourced polycarbonate nucleopore track etched membranes were the only set of membranes that resulted in significant permeation in the in vitro experiments. IVIVC results demonstrated high inter and intra-membrane variability for the membranes (available from today’s technology) that were used to simulate the in vivo membrane characteristics. Currently, there are no validated biorelevant IVIVC methods for SC formulations. The methods described here are the basis for future in vitro method development that will be of significant value for (a) predicting the in vivo performance of SC formulations based on the in vitro data, and (b) provide a reproducible in vitro method as the basis of developing an IVIVC for other subcutaneously administered drugs. This will provide an important tool for both development and regulation of this growing class of drugs.

<p>The subcutaneous injection has emerged as a common approach for self-administration of biotherapeutics due to the patient comfort and cost-effectiveness. However, the available knowledge about transport and absorption of these agents after subcutaneous injection is limited. Here we aim to find drug distribution in the tissue and lymphatic uptake after subcutaneous (SC) injection. In the first part of the study, a mathematical framework to study the subcutaneous drug delivery from injection to lymphatic uptake is presented. A three-dimensional poroelastic model is exploited to find the biomechanical response of the tissue by taking into account tissue deformation during the injection. The results show that including tissue deformability noticeably changes tissue poromechanical response due to the significant dependence of interstitial pressure on tissue deformation. Moreover, the importance of the amount of lymph fluid at the injection site and injection rate on the drug uptake to lymphatic capillaries is highlighted. Finally, the variability of lymphatic uptake due to uncertainty in parameters, including tissue poromechanical and lymphatic absorption parameters, is evaluated. It is found that interstitial pressure due to injection is the major contributing factor in short-term lymphatic absorption, while the amount of lymph fluid at the site of injection determines the long-term absorption of the drug. Finally, it is shown that the lymphatic uptake results are consistent with experimental data available in the literature.</p><p>In the second part, drug transport and distribution in different tissue layers are studied. A single-layer model of the tissue as a base study was first explored. During injection, the difference between the permeability of the solvent and solute results in a higher drug concentration proportional to the inverse of the permeability ratio. Then the effects of layered tissue properties with primary layers, including epidermis, dermis, subcutaneous, and muscle layers, on tissue biomechanical response to injection and drug transport are studied. The drug distributes mainly in the SQ layer due to its lower elastic moduli. Finally, the effect of secondary tissue elements like the deep fascia layer and the network of septa fibers inside the SQ tissue is investigated. The Voronoi algorithm is exploited to create random geometry of the septa network. It is shown how drug molecules accumulate around these tissue components as observed in experimental SC injection. Next, the effect of injection rate on drug concentration is studied. Higher injection rates slightly increase the drug concentration around septa fibers. Finally, it is demonstrated that the concentration-dependent viscosity increases the concentration of biotherapeutics in the direction of septa fibers.</p><p>In the third part of this thesis, a poro-hyperelastic model of the tissue is exploited to find the biomechanical response of the tissue together with a transport model based on an advection-diffusion equation in large-deformation poro-hyperelastic Media. The process of mAbs transport to the lymphatic system is explored. This process has two major parts. First, the initial phase, where mAbs are dispersed in the tissue as a result of momentum exerted by injection. This stage last for only a few minutes after the injection. Then there is the second stage, which can take tens of hours, and as a result, monoclonal antibodies (mAbs) molecules are transported from the subcutaneous layer towards initial lymphatics in the dermis to enter the lymphatic system. In third chapter, both stages are studied. The process of plume formation, interstitial pressure, and velocity development is explored. Then the effect of the injection device, injection site, and sensitivity of long-term lymphatic uptake due to variability in permeability, diffusivity, viscosity, and binding of mAbs are investigated. Then the results are used to find an equivalent lymphatic uptake coefficient that is widely used in pharmacokinetic (PK) models to study the absorption of mAbs. We show that the injection rate is the least, and the injection site is the most important parameter in the uptake of mAbs. Injection depth and mAbs dose also significantly alter lymphatic absorption. Finally, the computational model is validated against experimental studies available in the literature.</p>