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Στόχος της παρούσας εργασίας είναι η ακινητοποίηση λιποσωμάτων με εγκλωβισμένη Tobramycin σε επιχρυσωμένες μεταλλικές επιφάνειες, με σκοπό την παρασκευή αντιμικροβιακών ενδοπροθέσεων του ουροποιητικού, που αποδεσμεύουν φάρμακο με ελεγχόμενο ρυθμό. / The aim of this study is to covalently link liposomes on metallic surfaces, as a method to prepare antimicrobial controlled (release) drug-eluting stents, using Tobramycin (TOB) as an anti-microbial drug. As a preliminary step for immobilization of TOB, different types of liposomes were constructed and evaluated for TOB loading efficiency, size distribution and ζ-potential. TOB concentrations were measured by a chemiluminescence immunoassay (ADVIA Centaur, Siemens), after modulating the technique as required for the specific samples. Results show that extruded DRV liposomes with similar sizes (mean diameter) with that of SUV liposomes (~95 nm), have 4 times higher drug loading efficiency.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 298-336).

Yes / Background: Chronic infections with Pseudomonas aeruginosa are a leading cause of morbidity in patients with cystic fibrosis (CF). The aim of tobramycin inhalation therapy in CF patients with chronic pulmonary infection is to deliver high amounts of drug directly to the site of infection. TOBI® is a tobramycin nebulizer solution (300 mg/5 ml) approved by FDA for maintenance therapy for patient with CF. The 20% tobramycin sulfate solution was reported as the optimal and maximal concentration. Methods: Nebulization of high strength tobramycin solution (20% tobramycin sulfate) (HSTS) has been assessed in this study by using different selected high performance nebulizer delivery systems: two different designs of jet nebulizers, and three new nebulizers based on vibrating mesh technology. The aerosol particle size distribution and output characteristics were measured for in vitro performance assessment of the nebulizer systems. The methodology was adapted from the current European standard, EN 13544-1:2001E. Results: The particle size distribution characteristic measurements showed that all tested nebulizers may be suitable for inhalation of HSTS. The mean (SD) of highest percentage of fine particles (<5 mm) was 77.64 (2.3) % for Sidestream®, at flow rate 16 L/min. The highest respirable inhaled mass was for Pari LC Plus® combined with PariBoyN® compressor, with mean (SD) 90.85 (8.6) mg. The mean (SD) of highest drug wastage percentage was 63.9 (3.9) % for Sidestream® jet nebulizer combined with compressed air cylinder at flow rate 16 L/min, while the lowest was 2.3 (0.26) % for NE-U22 Omron® (high frequency). Conclusions: The HSTS can be nebulized by all tested nebulisers but the high frequency NE-U22 Omron® and Aeroneb Go® are more efficient. When the HSTS compared to TOBI®, the respirable inhaled dose was increased to more than 73%.

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

Device associated infections are a growing problem in the field of orthopaedics and dentistry. Bacteria adhering to implant surfaces and subsequent biofilm formation are challenging to treat with systemic administered antibiotics. Functionalization of implant surfaces with therapeutic coatings that are capable of inhibiting bacterial adhesion are therefore considered as a straight forward strategy to treat and prevent implant related infections. In this thesis, the use of crystalline, arc deposited TiO2 and biomimetic hydroxyapatite (HA) coatings were evaluated with respect to their potential as antibacterial surface modifications for bone-anchored implants. UV light induced photocatalysis of anatase dominated TiO2 coated surfaces was shown to provide a bactericidal effect against S. epidermidis under clinically relevant illumination times and doses. Major parts of the drug release work carried out was based on biomimetic HA (HA-B) coated fixation pins. The analysis of the coating characteristics revealed that the nanoporous structure of HA-B coatings in addition to the chemical composition and surface charge are essential parameters that influence the drug carrier performance. Loading by adsorption was demonstrated to be a feasible approach to quickly incorporate antibiotics. The controlled release of antibiotics was shown to facilitate bactericidal effects against S. aureus over application-relevant time periods, even when exposed to biomechanical forces during insertion into bone model materials. Antibiotic incorporation during coating growth was shown to promote somewhat longer drug release time periods than those obtained using adsorption loading. In summary, functionalization of implant surfaces with bioactive and biocompatible coatings is a promising concept to impact the clinical success for bone-anchored applications. The additional feature of optional, on-demand antibacterial properties of these coatings through either on-site drug release or photocatalytic antibacterial treatment is advantageous for the prevention and effective treatment of devices-associated infections. Both strategies provide an immediate response to the implant contamination by bacteria and are believed to contribute towards minimizing the origin of post-surgical infections, while at the same time improving the interfacial stability between implant and bone.

Tobramycin disposition following airway administration was evaluated by meta-analysis of human data in the literature and, experimentally, using a realistic ex vivo model, the isolated perfused rat lung preparation (IPRL). Pulmonary bioavailability of inhaled tobramycin in published studies was re-evaluated separately for CF and healthy adults, with the drug’s intrinsic pharmacokinetic (PK) parameters obtained from intravenous (IV) studies in the literature. While large variations in tobramycin’s clearance precluded accurate assessment of its bioavailability, the results were indicative of substantial pulmonary absorption, in spite of its hydrophilic and poly cationic properties. To explore its disposition kinetics and mechanisms following airway administration, tobramycin absorption was investigated as a function of dose in the IPRL. The cumulative fraction of the administered tobramycin dose reaching the perfusate versus time, was bi-exponential and dose-dependent, unlike that of the marker solutes fluorescein and mannitol, both of which showed first-order and dose-independent kinetics. A kinetic model that incorporated lung tissue binding (or sequestration) alongside passive absorption was employed successfully to describe the aminoglycoside’s disposition in the IPRL following airway administration. Tobramycin’s absorption was fast with the first-order absorption rate constants (0.065-0.070 min-1) close to those seen with fluorescein (0.076 min-1), but a dose-, and concentration-dependent slow onset tissue binding prolonged its presence in the rat lung. Binding was confirmed by independent dynamic dialysis experiments using sliced lung prepared from the intact IPRL, immediately following airway administration using an identical technique as that used in tobramycin absorption studies. Dosing solution osmolality and pH had negligible effects on the drug’s disposition in the IPRL, when these were investigated over experimental ranges that could be used clinically. While tobramycin itself was found to accelerate mannitol’s absorption, and thus affect airway epithelial integrity when administered at high doses, the effect was undetectable at a dose level in rat lungs that was believed to produce airway concentrations corresponding to those in human patients using TOBI®. These findings may partly explain the apparent success of inhaled tobramycin therapy in the treatment of pulmonary infections.

Este trabalho propõe estudos sobre a caracterização do comportamento térmico dos aminoglicosídeos estreptomicina e tobramicina, que são antibióticos bactericidas, utilizados no combate a microorganismos patogênicos, que agem interrompendo a síntese de proteínas. Após a caracterização espectroscópica dos analitos, foram realizadas medidas termogravimétricas, em atmosfera de ar e nitrogênio, que possibilitaram a determinação da estabilidade térmica do fármaco e o reconhecimento das etapas de decomposição. A calorimetria exploratória diferencial forneceu informações a respeito de processos físicos com variação de entalpia. Os gases envolvidos foram analisados usando termogravimetria acoplada à espectroscopia vibracional na região do infravermelho (TG-FTIR), possibilitando a proposta de um mecanismo para sua decomposição térmica. Intermediários de decomposição térmica foram caracterizados por CG-MS e o conjunto de todas essas informações forneceu um possível mecanismo para o comportamento térmico dessas drogas. Também foi sintetizado, caracterizado e analisado por TG, DSC e TG-FTIR, o complexo de tobramicina com o íon Cu+2. / A study regarding the thermal behavior characterization of the aminoglycosides streptomycin and tobramycin which are bactericidal antibiotics is presented. These antibiotics are widely against pathogenic microorganisms and act by interrupting the synthesis of proteins. Thermogravimetric measurements were performed under air and nitrogen conditions. To evaluate thermal stability of the drugs and their decomposition steps. A differential scanning calorimetry provided information on physical processes with enthalpy change. Evolved gas analysis was performed using thermogravimetry coupled to infrared spectroscopy (TG-FTIR), and was used to characterize the gases released during the thermal heating of the samples. Decomposition intermediates were characterized by CG-MS and the set of all these resultsallowed the proposition of a mechanism for the thermal behavior of drugs. The complex of tobramycin with the Cu+2 ion was also synthesized, characterized and analyzed by TG, DSC and TG-FTIR.

Objetivo: Avaliar a influência da infecção por Pseudomonas aeruginosa formadora de biofilme na penetração pulmonar da tobramicina através da modelagem populacional dos dados de plasma e microdialisado em animais sadios e infectados. Metodologia: A pneumonia foi desenvolvida através de inoculação de P. aeruginosa (cepa PA14) pela via intratraqueal (109 UFC/mL) a ratos Wistar. Sete dias após a inoculação os animais infectados (n = 5) receberam tobramicina 10 mg/kg i.v. bolus. Animais saudáveis (n = 6) foram utilizados como controle. As concentrações livres pulmonares foram coletadas por microdiálise (sonda CMA/20). As sondas de microdiálise foram calibradas in vitro através de diálise e retrodiálise e in vivo utilizando retrodiálise. A ligação da tobramicina às proteínas plasmáticas foi determinada por microdiálise. As concentrações do fármaco nas amostras foram determinadas por cromatografia líquida em tandem com espectrometria de massas (CLAE-EM/EM) utilizando metodologia validada. Os parâmetros farmacocinéticos foram determinados por abordagem não-compartimental (Phoenix®) e modelagem populacional (popPK) (Monolix®). Resultados e Discussão: A recuperação relativa (RR) das sondas foi independente da concentração de tobramicina e inversamente proporcional ao fluxo de perfusão. A RR determinada in vivo foi de 27,64 % ± 7,70 para animais sadios e 24,47 % ± 1,66 para animais infectados. A ligação às proteínas plasmáticas foi de 11,3 ± 1,9%. A infecção com formação de biofilme não alterou a farmacocinética plasmática da tobramicina, entretanto reduziu em cerca de 70% a penetração pulmonar do fármaco. As concentrações plasmáticas e teciduais foram simultaneamente descritas por um modelo farmacocinético populacional de dois compartimentos, tanto em animais sadios como infectados. A infecção, utilizada como covariável categórica, permitiu descrever as alterações no volume do compartimento periférico e na constante de eliminação do compartimento central devido à infecção. Conclusões: As concentrações plasmáticas da tobramicina, utilizadas para ajuste posológico, superestimam as concentrações ativas no pulmão infectado. O modelo popPK descrito permite a previsão das concentrações livres pulmonares da tobramicina em pulmão infectado, podendo auxiliar na otimização da terapia de pneumonias com P. aeruginosa formadora de biofilme. / Objective: To evaluate the influence of biofilm-forming Pseudomonas aeruginosa infection on tobramycin lung penetration by population pharmacokinetic modeling of plasma and microdialysate data in healthy and infected rats. Methodology: The infection was developed by intratracheal inoculation (109 CFU/mL) of P. aeruginosa (PA14 strain) to Wistar rats. In order to determine plasma and tissue concentrations, seven days after the inoculation the infected animals (n = 5) received tobramycin 10 mg/kg i.v. bolus dose via femoral vein. A healthy group (n = 6) was used as control. Free lung concentrations were determined in microdialysate samples obtained using CMA/20 probes. Microdialysis probes were calibrated in vitro by dialysis and retrodialysis and in vivo by retrodialysis. Tobramycin plasma protein binding was determined by microdialysis. Plasma and tissue concentrations were quantified by a developed and validated liquid chromatography in tandem with mass spectrometry (LC-MS/MS) method. Compartmental and non-compartmental analyses were carried out by Monolix™ and Phoenix™ software, respectively. Results and Discussion: Microdialysis probes relative recovery was independent of the tobramycin concentration and is inversely proportional to the perfusion flow rate investigated. The in vivo probe recovery was 27.64 % ± 7.70 (healthy rats) and 24.47 % ± 1.66 (infected rats). The plasma protein binding was 11.3 ± 1.9%. The biofilm-forming lung infection did not alter tobramycin plasma pharmacokinetics, however, reduced lung penetration in about 70%. The plasma and tissue concentrations-time profiles were simultaneously described by a two compartment popPK model in healthy and infected animals. The infection process, used as categorical covariate allowed describing the changes observed in the volume of the peripheral compartment and in constant rate of elimination from the central compartment. Conclusions: Tobramycin plasma concentrations, used for dosing adjustments, overestimate active concentrations in infected lung. The described popPK model allows predicting free tobramycin lung concentrations in infected lung and could be useful to optimize the treatment of pneumonia caused by biofilm-forming P. aeruginosa with this drug.

Este trabalho propõe estudos sobre a caracterização do comportamento térmico dos aminoglicosídeos estreptomicina e tobramicina, que são antibióticos bactericidas, utilizados no combate a microorganismos patogênicos, que agem interrompendo a síntese de proteínas. Após a caracterização espectroscópica dos analitos, foram realizadas medidas termogravimétricas, em atmosfera de ar e nitrogênio, que possibilitaram a determinação da estabilidade térmica do fármaco e o reconhecimento das etapas de decomposição. A calorimetria exploratória diferencial forneceu informações a respeito de processos físicos com variação de entalpia. Os gases envolvidos foram analisados usando termogravimetria acoplada à espectroscopia vibracional na região do infravermelho (TG-FTIR), possibilitando a proposta de um mecanismo para sua decomposição térmica. Intermediários de decomposição térmica foram caracterizados por CG-MS e o conjunto de todas essas informações forneceu um possível mecanismo para o comportamento térmico dessas drogas. Também foi sintetizado, caracterizado e analisado por TG, DSC e TG-FTIR, o complexo de tobramicina com o íon Cu+2. / A study regarding the thermal behavior characterization of the aminoglycosides streptomycin and tobramycin which are bactericidal antibiotics is presented. These antibiotics are widely against pathogenic microorganisms and act by interrupting the synthesis of proteins. Thermogravimetric measurements were performed under air and nitrogen conditions. To evaluate thermal stability of the drugs and their decomposition steps. A differential scanning calorimetry provided information on physical processes with enthalpy change. Evolved gas analysis was performed using thermogravimetry coupled to infrared spectroscopy (TG-FTIR), and was used to characterize the gases released during the thermal heating of the samples. Decomposition intermediates were characterized by CG-MS and the set of all these resultsallowed the proposition of a mechanism for the thermal behavior of drugs. The complex of tobramycin with the Cu+2 ion was also synthesized, characterized and analyzed by TG, DSC and TG-FTIR.