Stability of liposomal doxorubicin formulations: problems and prospects.
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Chemistry, Pharmaceutical↗
Biomedical subjects
A Gabizon
Publications and source records attributed to A Gabizon.
Tailoring liposomes for cancer drug delivery: from the bench to the clinic.
Sterically stabilized liposomes with prolonged circulation times, also referred to as 'Stealth', accumulate in significant amounts in transplanted tumors. Morphological studies carried out with colloidal-gold labeled liposomes show that liposomes can extravasate and localize in the extracellular space of tumors implanted in mice, a phenomenon which is apparently related to the increased permeability of the tumor microvasculature. When these long-circulating liposomes are loaded with doxorubicin, the drug circulates in liposome-associated form and is cleared very slowly from plasma. The drug levels in the heart muscle are drastically diminished, while those in the tumor tissue are significantly raised by liposome encapsulation. Doxorubicin in Stealth liposomes was also shown to have reduced toxicity and greater therapeutic efficacy than free doxorubicin in a mouse tumor model. We conclude that properly formulated liposomes with long residence times in circulation offer a promising tool to improve the therapeutic index of cancer chemotherapeutic agents.
Animals↗
The role of surface charge and hydrophilic groups on liposome clearance in vivo.
The effect of negative surface charge and hydrophilic groups on liposome clearance from blood was investigated in mice using liposome-entrapped 67gallium-deferoxamine as a label. The presence of negatively-charged lipids may retard or accelerate liposome clearance. Physicochemical features contributing to optimal retardation of liposome clearance include a hydrophilic carbohydrate moiety and a sterically hindered negatively-charged group. The relevance of the negative charge steric effect is suggested by the finding that phosphatidylinositol phosphate (PIP) and trisialoganglioside (GT1) are less effective than phosphatidylinositol (PI) and monosialoganglioside (GM1), respectively, in retarding liposome clearance. The need for negative charge in addition to the carbohydrate group for optimal effect on retardation of clearance is indicated by the observation that asialoganglioside (AGM1) is less effective than GM1 in this respect. The negative charge effect is observed with liposome bilayers having both low and high temperature phase-transitions. Increasing the molar fraction of negatively-charged lipid (hydrogenated PI derived from soya) from 23 to 41% resulted in a dramatic acceleration of liposome clearance. The clearance-accelerating effect of the high negative charge was specifically directed to the liver with selective reduction of spleen uptake. Increasing liposome size also had an accelerating effect on clearance but in this case it was accompanied by a non-specific concomitant increase of both liver and spleen uptake.
Animals↗
Sterically stabilized liposomes: improvements in pharmacokinetics and antitumor therapeutic efficacy.
The results obtained in this study establish that liposome formulations incorporating a synthetic polyethylene glycol-derivatized phospholipid have a pronounced effect on liposome tissue distribution and can produce a large increase in the pharmacological efficacy of encapsulated antitumor drugs. This effect is substantially greater than that observed previously with conventional liposomes and is associated with a more than 5-fold prolongation of liposome circulation time in blood, a marked decrease in uptake by tissues such as liver and spleen, and a corresponding increased accumulation in implanted tumors. These and other properties described here have expanded considerably the prospects of liposomes as an effective carrier system for a variety of pharmacologically active macromolecules.
Animals↗
Sterically stabilized liposomes: a hypothesis on the molecular origin of the extended circulation times.
Therapeutic applications of intravenously injected liposomes have been limited by their rapid clearance from the bloodstream and their uptake by the macrophage cells of the liver and spleen (RES). Recently, however, liposomes which substantially evade the rapid uptake by the RES have been introduced. Since these liposomes exhibit dramatically different pharmacokinetics and biodistribution, new therapeutic opportunities have appeared. These include enhanced efficacy of antineoplastic agents against tumors, sites of inflammation, and targeting ligand-coupled liposomes to extravascular targets. Despite extensive experimental work, the mechanism underlying the ability of liposomes to avoid the rapid uptake by the RES is still not fully understood. Our approach is an alternative to seeking the answers in complex differential interactions of liposomes with various components of blood. We believe that the effect can be easily explained, at least in qualitative terms, by the fundamental principles of colloid stability. In this communication, we propose that steric stabilization of liposomes is responsible for their prolonged circulation times. We propose that stabilization results from local surface concentration of highly hydrated groups that sterically inhibit both electrostatic and hydrophobic interactions of a variety of blood components at the liposome surface.
Animals↗
Pharmacokinetic and imaging studies in patients receiving a formulation of liposome-associated adriamycin.
Pharmacokinetic and imaging studies in 19 patients receiving liposome-entrapped adriamycin (L-ADM) were carried out within the framework of a Phase I clinical trial (Gabizon et al., 1989a). The formulation of L-ADM tested consisted of 0.2 microM-extruded multilamellar vesicles composed of egg phosphatidylcholine, egg-derived phosphatidyl-glycerol (PG), cholesterol, and ADM intercalated in the fluid lipid bilayer. Plasma clearance of total drug extracted from the plasma after L-ADM infusion followed a biexponential curve with a pattern similar to that reported for free ADM. The plasma concentration of drug circulating in liposome-associated from was also measured in a subgroup of seven patients. Liposome-associated drug was found to be rapidly cleared from plasma. Its ratio to non-liposome-associated drug appeared to correlate with liver reserve, with highest ratios in patients with normal liver function. Liposome clearance, as measured by the plasma concentration of PG in three patients was slower than the clearance of liposome-associated ADM, suggesting that liposomes lose part of their drug payload during circulation. To learn about the liposome organ distribution, imaging studies were carried out with 111Indium-deferoxamine labelled liposomes of the same composition. Liposomes were cleared predominantly by liver and spleen and to a lesser extent by bone marrow in seven out of nine patients. In two patients with active hepatitis and severe liver dysfunction, there was minimal liver uptake and increased spleen and bone marrow uptake. Except for one hepatoma patient, intrahepatic and extrahepatic tumours were not imaged by liposomes, suggesting that liposome uptake is restricted to cells of the reticulo-endothelial system (RES).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The influence of physical characteristics of liposomes containing doxorubicin on their pharmacological behavior.
We have investigated the behavior of two populations of doxorubicin (DXR)-containing phospholipid vesicles with regard to various physical and pharmacological parameters. DXR-containing liposomes were prepared by ultrasonic irradiation, the lipid composition being phosphatidylglycerol (or phosphatidylserine), phosphatidylcholine and cholesterol. The vesicles were fractionated into oligolamellar vesicles (OLV) and small unilamellar vesicles (SUV) by preparative differential ultracentrifugation (150,000 x g for 1 h). Unentrapped DXR was removed by gel exclusion chromatography. OLV and SUV liposomes differed in size (mean diameters, 247 +/- 113 nm and 61 +/- 16 nm, respectively) and number of lamellae (two for OLV, one for SUV). Drug entrapment per unit of lipid was three to 5-fold higher in OLV than in SUV. In both liposome populations more than 95% of the entrapped drug was membrane-associated. Physical studies on these two vesicle populations revealed higher motional restriction and greater susceptibility to iodide-mediated fluorescence collisional quenching of DXR in the small vesicles. OLV showed superior stability in the presence of plasma as determined by the fraction of DXR retained by the vesicles. It was also found that the tissue distribution of DXR in SUV follows a pattern different from that of DXR in OLV and resembling that of soluble DXR. In accordance with these differences in patterns of tissue distribution, animal studies demonstrated that DXR in OLV is significantly less toxic than DXR in SUV and more effective in a tumor model with predominant involvement of the liver. These results indicate that vesicle size and/or number of lamellae play an important role in optimizing liposome-mediated delivery of DXR, and that oligolamellar liposomes are distinctively superior to small unilamellar liposomes when fluid phase formulations (Tm less than 37 degrees C) with bilayer-associated DXR are considered.
Animals↗
Effect of liposome composition and other factors on the targeting of liposomes to experimental tumors: biodistribution and imaging studies.
We have examined the distribution of radiolabeled liposomes in tumor-bearing mice after i.v. injection. Two mouse tumors (B16 melanoma, J6456 lymphoma) and a human tumor (LS174T colon carcinoma) inoculated i.m., s.c., or in the hind footpad were used in these studies. When various liposome compositions with a mean vesicle diameter of approximately 100 nm were compared using a radiolabel of gallium-67-deferoxamine, optimal tumor localization was obtained with liposomes containing a phosphatidylcholine of high phase-transition temperature and a small molar fraction of monosialoganglioside or hydrogenated phosphatidylinositol (HPI). At 24 h after injection, average values of tumor uptake higher than 10% of the injected dose per g and liver-to-tumor ratios close to 1 were reproducibly obtained. Increasing the molar fraction of HPI from 9% to 41% of the total phospholipid resulted in enhancement of liver uptake and decrease of tumor uptake. Methodological aspects that influence vesicle size appear to affect significantly liposome localization in the tumor. However, varying the phospholipid dose within a 10-fold range caused only minor changes in the percent of injected dose recovered in the tumor. A high uptake by tumors was also observed using other radiolabels [[3H]inulin and indium-111-labeled bleomycin (111In-Bleo)] in monosialoganglioside- and HPI-containing liposomes. In the case of 111In-Bleo, encapsulation in liposomes resulted in approximately 20- to 40-fold increase in tumor accumulation of the radiolabel at 24 h after injection. The marked localization of liposomes in the mouse footpad inoculated with tumor as opposed to the contralateral mock-injected footpad was also documented by imaging experiments with gallium-67-deferoxamine and 111In-Bleo-labeled liposomes. These results support the contention that some glycolipid-containing liposomes previously shown to have long circulating half-lives accumulate significantly in a variety of tumors and are promising tools for the delivery of anti-tumor agents.
Animals↗
Optimization and upscaling of doxorubicin-containing liposomes for clinical use.
This work describes the optimization of a doxorubicin (DXR)-containing liposome formulation and its upscaling for human therapy. Multilamellar vesicles (MLV) composed of egg phosphatidylcholine, egg-derived phosphatidylglycerol, cholesterol, and the drug were prepared in 0.9% sterile, pyrogen-free NaCl by five different hydration methods. The optimal hydration was shown to be the formation of a thin lipid film with high surface area. Alternative hydration methods based on freeze-drying techniques of the lipids in tertiary butanol or based on "alcohol" premixing procedures of the dry DXR-lipid mixture showed smaller DXR loading capacities and lower DXR incorporation per phospholipid. Maximal DXR entrapment was obtained at a molar concentration of phosphatidylglycerol of 30 mol % of total phospholipid. This and previous studies led to a final lipid composition of phosphatidylcholine:phosphatidylglycerol:cholesterol in a molar ratio of 7:3:4. Oligolamellar DXR-liposomes with an average diameter in the range 0.3-0.5 microM were prepared from DXR-MLV by extrusion through polycarbonate membranes using moderate pressures (up to 100 psi). At this size range, maximal entrapment of DXR per phospholipid was obtained. The extrusion process also ensures the sterilization of the final product. Free DXR was removed from liposome-associated DXR (L-DXR) by the use of a cation-exchange resin. The L-DXR formulation was shown to have reasonable stability on storage at 4 degrees C.
Chemistry, Pharmaceutical↗
Liposomes designed to avoid the reticuloendothelial system.
Recent work has revealed some new and important characteristics of liposomes: Inclusion of certain glycolipids within liposomes composed of phosphatidylcholine or sphingomyelin and cholesterol drastically prolongs the circulation time and reduces their uptake by liver and spleen. Concomitantly, their accumulation in several implanted tumors is substantially increased. These studies suggest that controlling the circulation time of liposomes and limiting their non-specific uptake by the Reticuloendothelial system (RES) opens up new opportunities for achieving specific targeting to tumors in vivo, with both diagnostic and therapeutic possibilities.
Animals↗
Pharmacokinetics and tissue distribution of doxorubicin encapsulated in stable liposomes with long circulation times.
We have previously reported on liposome formulations with reduced uptake by the reticuloendothelial system, prolonged circulation time, and enhanced accumulation in transplanted tumors. One of these formulations, consisting of hydrogenated phosphatidylinositol (HPI), hydrogenated phosphatidylcholine (HPC), and cholesterol (Chol) (HPI-HPC-Chol), and a control formulation, consisting of phosphatidylglycerol (PG), phosphatidylcholine (PC), and Chol (PG-PC-Chol), were loaded with doxorubicin (DXR) and injected intravenously into BALB/c mice for pharmacokinetic studies. Although both formulations were similar in vesicle size, fraction of negatively charged lipid, and drug-to-lipid ratio, there were striking pharmacokinetic differences. DXR was cleared much faster in PG-containing liposomes than in HPI-containing liposomes. Liposome-associated drug was detectable in plasma up to 5 hours after injection in the case of PG-PC-Chol and as late as 72 hours after injection in the case of HPI-HPC-Chol. In agreement with the plasma clearance curves, peak drug concentrations in the liver were observed at 1/2, 5, and 24 hours after injection for free DXR, DXR in PG-PC-Chol, and DXR in HPI-HPC-Chol, respectively. Both types of liposomes reduced considerably the amount of drug accumulating in the heart compared with that accumulating after injection of free DXR.
Animals↗
Separation of liposome-associated doxorubicin from non-liposome-associated doxorubicin in human plasma: implications for pharmacokinetic studies.
To characterize the pharmacokinetics of liposome-associated drugs, the fraction of drug circulating in liposome-associated form and the absolute plasma drug levels must be determined. In this report, we describe our methodological approach to quantitate plasma liposome-associated doxorubicin separately from protein-bound and free doxorubicin. The method is based on the affinity of a cation-exchange resin for doxorubicin and the repulsion by the same resin of negatively-charged liposomes. The methodology is technically simple and reproducible, and lends itself to the analysis of multiple plasma samples as required in pharmacokinetic studies. The validity of this approach was confirmed by separation of liposome-associated from non-liposome-associated drug using gel exclusion chromatography.
Doxorubicin↗
Systemic administration of doxorubicin-containing liposomes in cancer patients: a phase I study.
A clinical study was designed to evaluate the tolerance of cancer patients to liposome-associated doxorubicin (L-DXR). The liposomes used contain phosphatidylglycerol, phosphatidylcholine, cholesterol, and DXR intercalated in the lipid bilayer, and have a mean size in the range of 0.3-0.5 microns. Thirty-two patients, most of them with primary or metastatic liver cancer refractory to conventional therapy, were entered into the study. A total of 69 courses of therapy was administered by intravenous infusion of a suspension of L-DXR (0.5-2.0 mg DXR/ml) in physiologic saline at an approximate rate of 2 ml/min given on a 3-week intermittent schedule. The L-DXR and phospholipid doses were escalated from 20 mg/m2 and 0.3 g/m2 to 120 mg/m2 and 3.2 g/m2 respectively. Treatment was generally well tolerated and acute toxic effects such as nausea and vomiting were mild and infrequent. Chills and fever (greater than 38.0 degrees C) were observed in three patients during infusion of L-DXR and in seven patients 6-12 h after the end of infusion. Median WBC nadir counts were 2700, 2300 and 700/microliters at 85, 100 and 120 mg/m2 respectively. All three patients receiving 120 mg/m2 developed grade 4 leukopenia and fever requiring intravenous antibiotics, and, in two of them, severe stomatitis (grades 3 and 4) was observed. Significant hair loss was apparent in all patients receiving doses higher than 50 mg/m2. The maximal tolerated dose of L-DXR appears to be 120 mg/m2, with leukopenia and stomatitis being the dose-limiting factors. While the subacute toxicity of L-DXR appears to be qualitatively similar to that of free DXR, its tolerance exceeds the recommended dose of free DXR (75 mg/m2) in the standard 3-weekly schedule.
Adult↗
Liposomes as a drug delivery system in cancer chemotherapy.
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Animals↗
Liposome formulations with prolonged circulation time in blood and enhanced uptake by tumors.
The rapid clearance of circulating liposomes from the bloodstream, coupled with their high uptake by liver and spleen, has thus far been an obstacle to any attempts at targeting to tumors. We have assessed the impact of liposome composition on their clearance from the circulation in normal and tumor-bearing mice and on their uptake by tumors and various normal tissues. By selective changes in lipid composition, while maintaining a mean particle diameter of approximately equal to 100 nm, we have achieved up to a 60-fold increase in the fraction of recovered dose present in blood 24 hr after i.v. injection. Concomitantly, there was a decrease by a factor of 4 of the recovered dose localizing in the liver and spleen, the major organs of the reticuloendothelial system. Parallel experiments in tumor-bearing mice demonstrated a 25-fold increase of the liposome concentration in the tumor when formulations with long and short blood residence time were compared. The most favorable results were obtained with liposomes containing a small molar fraction of a negatively charged glycolipid, such as monosialoganglioside or phosphatidylinositol, and a solid-phase neutral phospholipid as the bulk component. The bio-distribution of such formulations is of considerable therapeutic potential in cancer for increasing the concentration of cytotoxic agents in tumors while minimizing the likelihood of toxicity to the reticuloendothelial system.
Animals↗
Alteration of blood-brain-CSF barrier in experimental meningeal carcinomatosis. A morphologic and adriamycin-penetration study.
An experimental model of meningeal carcinomatosis has been produced by subarachnoid inoculation of B16 melanoma cells into C57BL mice. Injection of 10(3) viable cells was sufficient to cause 100% tumor incidence and death within a median survival time of 17 days. The tumor infiltrated diffusely the meninges of the brain and spinal cord and filled the ventricular system. Electron microscopic study of the leptomeningeal tumor revealed newly formed microvessels with fenestrated endothelium. The integrity of the blood-brain barrier was studied by the extravasation of the Evans blue and the Horseradish peroxidase tracers. Barrier disruption became evident from the seventh day on, using Evans blue. Electron microscopy study showed peroxidase activity in the luminal and abluminal sides of the meningeal microvessels, and within the tight junctions. Similar findings were noted in cortical capillaries adjacent to the meningeal tumor. Brain concentrations of Adriamycin (ADR) following administration of an intravenous dose of either 10 mg/kg or 50 mg/kg were measured on days 0 to 14 after tumor inoculation. A significant increase in mean +/- SEM content of whole brain ADR was observed only with the 50 mg/kg dose in days 7 to 14 (0.69 +/- 0.02 micrograms/g wet tissue weight) as compared to tumor-free controls (0.43 +/- 0.01, p less than 0.05). Our study suggests that barrier alteration in meningeal carcinomatosis allows extravasation of tracer solutes. Still, in order to achieve a significant increase in a water soluble drug penetration through the disrupted barrier, a high-dose drug regimen is required.
Animals↗
Targeting of liposomes to tumor cells in vivo.
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Animals↗
Comparative long-term study of the toxicities of free and liposome-associated doxorubicin in mice after intravenous administration.
The toxicities of free doxorubicin (F-DOX) and liposome-associated doxorubicin (L-DOX) were investigated in inbred BALB/c and outbred Sabra mice treated iv with 5, 7.5, and 10 mg doxorubicin (DOX)/kg body weight every 2 weeks up to 8 injections and observed for 6 months. Sonicated liposomes containing phosphatidylcholine, phosphatidylglycerol, and cholesterol were used. The lethal effect was reduced in mice treated with L-DOX as compared to mice treated with F-DOX. At a dose of 7.5 mg DOX/kg, 100% of mice receiving the L-DOX survived a cumulative dose of 60 mg/kg administered over 98 days, while 92% of mice receiving the F-DOX died. Two distinct patterns of death were observed: an acute phase type occurring early after injection of high doses of DOX and apparently related to gastrointestinal toxicity and a delayed phase type requiring a long latency after initial drug exposure and characterized by a complex pattern of abnormalities. Delivery of DOX by liposomes effectively protected against both types of lethal effects. Reduced toxicity of L-DOX resulted in reduced body and organ weight losses, reduced severity of pathologic changes, and fewer blood biochemical alterations. The pathological damage to the heart muscle found in mice treated with L-DOX was less severe than with F-DOX, and in some cases it was reversible. Nephrotoxicity was extremely frequent and severe among F-DOX-treated mice, while it was totally insignificant among L-DOX-treated mice. Hyperlipidemia, hypoglycemia, and glycogen-depleted hepatocytes were characteristic findings in mice treated with F-DOX. Altogether, the data obtained in this study indicate that liposomes significantly diminish the toxicity of DOX with the use of an intermittent schedule of chemotherapy. In addition to changes in tissue distribution as a mechanism of reduced toxicity, it is proposed that DOX associated with liposomal lipids interacts less efficiently than the free drug with target intracellular phospholipids.
Alkaline Phosphatase↗