Expression of the Sonic hedgehog pathway in squamous cell carcinoma of the skin and the mucosa of the head and neck.

BACKGROUND: Activation of the hedgehog pathway may contribute to carcinogenesis. This study characterizes the expression pattern in squamous cell carcinoma of the skin and the head and neck. METHODS: Tissue microarrays were constructed with samples of squamous cell carcinoma of the skin and the head and neck. All tissue samples were immunohistochemically stained for 7 Hedgehog pathway molecules. RESULTS: Significant (p < .0001) overexpression of all evaluated molecules could be observed in the tumor samples compared with healthy control tissues. Expression of Gli-2 showed significant upregulation and that of Smoothened and Patched significant downregulation in head and neck compared with skin carcinoma. High expression of Sonic hedgehog correlates significantly (p = .001) with poor overall survival in patients with head and neck cancer. CONCLUSIONS: Hedgehog signaling is differentially regulated in squamous cell carcinomas of the skin and the head and neck. Sonic hedgehog expression may serve as a prognostic factor in patients with head and neck cancer.

Leishmaniasis in the tongue of an immunocompetent man.

A 49-year-old immunocompetent white man had a painful ulcer (1.5 cm in diameter) on the left ventrolateral surface of a grossly enlarged tongue. The ulcer was present for two months. Impaired swallowing resulted in substantial weight loss and fatigue. Histopathologic analysis of a punch biopsy specimen indicated numerous Leishman Donovan bodies within macrophages. A polymerase chain reaction confirmed the presence of L. donovani. Therapy with two cycles of liposomal amphotericin B over a three-month period was administered. Four months after discharge, the ulcer had healed completely and the tongue returned to its normal size and function.

In vivo evaluation of a nasal insulin delivery system based on thiolated chitosan.

The aim of this study was the preparation and in vivo evaluation of a nasal insulin delivery system based on thiolated chitosan. 2-Iminothiolane was covalently attached to chitosan. The resulting conjugate (chitosan-TBA) exhibited 304.9 +/- 63.5 micromol thiol groups per gram polymer. Microparticles were prepared via a new precipitation-micronization technique. The microparticulate delivery system comprised insulin, reduced glutathione and chitosan-TBA (Chito-TBA/Ins) or unmodified chitosan (Chito/Ins) and control microparticles were composed of insulin and mannitol (Mannitol/Ins). Due to a hydration process the size of Chito-TBA/Ins and Chito/Ins microparticles increased in phosphate buffer pH 6.8 2.6- and 2.2-fold, respectively. Fluorescent-labeled insulin-loaded chitosan-TBA microparticles showed a controlled release over 4 h. Chito-TBA/Ins administered nasally to rats led to an absolute bioavailability of 6.9 +/- 1.5%. The blood glucose level decreased for more than 2 h and the calculated absolute pharmacological efficacy was 4.9 +/- 1.4%. Chito/Ins, in comparison, displayed a bioavailability of 4.2 +/- 1.8% and a pharmacological efficacy of 0.7 +/- 0.6%. Mannitol/Ins showed a bioavailability of 1.6 +/- 0.4% and no reduction of the blood glucose level at all. According to these findings microparticles comprising chitosan-TBA seem to have substantial higher potential for nasal insulin administration than unmodified chitosan.

Oral heparin delivery: design and in vivo evaluation of a stomach-targeted mucoadhesive delivery system.

Low molecular weight heparin (LMWH) is an agent of choice in the anti-coagulant therapy and prophylaxis of thrombosis and coronary syndromes. However, the therapeutic use is partially limited due to a poor oral bioavailability. It was therefore the aim of this study to design and evaluate a highly efficient stomach-targeted oral delivery system for LMWH. In order to appraise the influence of the molecular weight on the oral bioavailability, mini-tablets comprising 3 kDa (279 IU) and 6 kDa (300 IU) LMWH, respectively, were generated and tested in vivo in rats. The potential of the test formulations based on thiolated polycarbophil, was evaluated in comparison to hydroxyethylcellulose (HEC) as control carrier matrix. The plasma levels of LMWH after oral versus subcutaneous administration were determined in order to calculate the relative bioavailability. With the delivery system containing 3 kDa LMWH (279 IU) a relative bioavailability of 19.1% was achieved, offering a significantly (p < 0.05) better bioavailability than the control system displaying a relative bioavailability of 8.1% The 6 kDa LMWH (300 IU) formulation displayed a relative bioavailability of 10.7% in contrast to the control displaying a relative bioavailability of 2.1%. In conclusion, these results suggest that mucoadhesive thiolated polymers are a promising tool for the non-invasive stomach-targeted systemic delivery of LMWH as model for a hydrophilic macromolecular polysaccharide.

Nasal delivery of human growth hormone: in vitro and in vivo evaluation of a thiomer/glutathione microparticulate delivery system.

It was the aim of this study to develop and evaluate a nasal microparticulate delivery system for human growth hormone (hGH) based on the thiomer polycarbophil-cysteine (PCP-Cys) in combination with the permeation mediator glutathione (GSH). Microparticles were prepared by dissolving PCP-Cys/GSH/hGH (7.5:1:1.5), PCP/hGH (8.5:1.5), and mannitol/hGH (8.5:1.5) in demineralized water, followed by lyophilization and micronization. Particles were evaluated with regard to size distribution and swelling behavior using a laser diffraction particle size analyzer. The release of fluorescence-labelled hGH from microparticles was determined in Franz diffusion chambers. In vivo studies in rats were performed comparing the nasal bioavailability achieved by PCP-Cys/GSH/hGH microparticles with that of unmodified PCP/hGH microparticles and mannitol/hGH powder. PCP-Cys/GSH/hGH and PCP/hGH microparticles showed a comparable size distribution (80% in the range of 4.8-23 microm) and swelled to almost fourfold size in phosphate-buffered saline (PBS). Both formulations exhibited almost identical sustained drug release profiles. The intranasal administration of the PCP-Cys/GSH/hGH microparticulate formulation resulted in a relative bioavailability of 8.11+/-2.15%, which represents a 3-fold and 3.3-fold improvement compared to that of PCP/hGH microparticles and mannitol/hGH powder, respectively. The study suggests that the PCP-Cys/GSH/hGH nasal microparticulate formulation might represent a promising novel tool for the systemic delivery of hGH.

Thiomers: potential excipients for non-invasive peptide delivery systems.

In recent years thiolated polymers or so-called thiomers have appeared as a promising alternative in the arena of non-invasive peptide delivery. Thiomers are generated by the immobilisation of thiol-bearing ligands to mucoadhesive polymeric excipients. By formation of disulfide bonds with mucus glycoproteins, the mucoadhesive properties of these polymers are improved up to 130-fold. Due to formation of inter- and intramolecular disulfide bonds within the thiomer itself, dosage forms such as tablets or microparticles display strong cohesive properties resulting in comparatively higher stability, prolonged disintegration times and a more controlled release of the embedded peptide drug. The permeation of peptide drugs through mucosa can be improved by the use of thiolated polymers. Additionally some thiomers exhibit improved inhibitory properties towards peptidases. The efficacy of thiomers in non-invasive peptide delivery could be demonstrated by various in vivo studies. Tablets comprising a thiomer and pegylated insulin, for instance, resulted in a pharmacological efficacy of 7% after oral application to diabetic mice. Furthermore, a pharmacological efficacy of 1.3% was achieved in rats by oral administration of calcitonin tablets comprising a thiomer. Human growth hormone in a thiomer-gel was applied nasally to rats and led to a bioavailability of 2.75%. In all these studies, formulations comprising the corresponding unmodified polymer had only a marginal or no effect. According to these results drug carrier systems based on thiomers seem to be a promising tool for non-invasive peptide drug delivery.

Thiomers in noninvasive polypeptide delivery: in vitro and in vivo characterization of a polycarbophil-cysteine/glutathione gel formulation for human growth hormone.

This study was aimed at investigating the potential of a new polycarbophil-cysteine (PCP-Cys)/glutathione (GSH) gel formulation to enhance the permeation of the model drug human growth hormone (hGH) across nasal mucosa in vitro and in vivo. The aqueous nasal gel contained PCP-Cys, GSH, and hGH in a final concentration of 0.3%, 0.5%, and 0.6% (m/v), respectively. In vitro permeation studies were performed in Ussing chambers on freshly excised bovine nasal mucosa using fluorescence-labeled dextran (molecular mass: 4.3 kDa; FD-4) and hGH (FITC-hGH). The release profile of FITC-hGH from the gel formulation and an unmodified PCP control formulation was determined. Furthermore, in vivo studies in rats were performed comparing the PCP-Cys/GSH/hGH gel with PCP/hGH control gel and physiological saline. The permeation of FD-4 and FITC-hGH across the nasal mucosa was improved two-fold and three-fold, respectively, in the presence of PCP-Cys/GSH. The PCP-Cys/GSH/hGH gel and the PCP/hGH control gel showed the same biphasic and matrix-controlled drug release. The nasal administration of the PCP-Cys/GSH/hGH gel formulation to rats resulted in a significantly increased and prolonged hGH plasma concentration-time profile versus unmodified PCP gel and physiological saline. According to these results, PCP-Cys gels might represent a promising new strategy for systemic nasal polypeptide delivery.

Synthesis and in vitro characterization of a poly(acrylic acid)-homocysteine conjugate.

It was the aim of this study to improve our knowledge on thiolated polymers by the synthesis and in vitro characterization of a poly(acrylic acid)-homocysteine conjugate. Mediated by a carbodiimide, homocysteine was therefore covalently attached to poly(acrylic acid) via the formation of an amide bond. The isolated conjugate displayed 930 micromol +/- 83 micromol sulfur atoms per gram polymer. Of these thiol groups, 80.1% were oxidized to disulfide bonds during the coupling reaction. In aqueous solutions the conjugate was rapidly oxidized by the formation of disulfide bonds at pH 8, whereas it remained stable at pH 7 and below during the observation period of 4 hours. Due to the immobilization of thiol groups on the polymer, the mucoadhesive and cohesive properties of poly(acrylic acid) were strongly improved. Furthermore, the thiolated polymer exhibited a significantly (p < 0.05) improved permeation enhancing effect in comparison to the unmodified polymer. Because of these features the poly(acrylic acid)-homocysteine conjugate seems to represent a promising novel tool, which might be useful in particular for aqueous formulations based on thiomers.

Preparation and characterisation of thiolated poly(methacrylic acid)-starch compositions.

The development of mucoadhesive polymer systems, which start swelling in the intestine after oral administration without an enteric coating, might be the key for drug delivery systems exhibiting a prolonged intestinal residence time. The preparation and characterisation of such polymeric excipients was therefore the aim of this study. A poly(methacrylic acid)-cysteine conjugate (thiolated PMAA) exhibiting 747.8+/-30.9 micromol thiol groups per gram polymer was co-precipitated with starch at pH 3. The resulting thiolated PMAA-starch composition consisting of 24% thiolated PMAA and 76% starch was lyophilised and analysed with regard to its swelling behaviour as well as to its cohesive and mucoadhesive properties. Results demonstrated that the thiolated PMAA-starch composition does not swell at all in a simulated gastric fluid. In contrast, a 4- and 6-fold increase in weight by water uptake was observed at pH 5 and 7, respectively. Disintegration studies demonstrated improved cohesive properties due to the immobilisation of thiol groups on PMAA, which are involved in the formation of stabilising inter- and/or intrachain disulfide bonds. Tensile studies demonstrated a total work of adhesion of 90.2+/-15.2 and 27.5+/-2.9 microJ for thiolated PMAA-starch and PMAA-starch, respectively. These results were confirmed by mucoadhesion studies utilising the rotating cylinder method. Thiolated PMAA-starch represents therefore a promising novel mucoadhesive excipient, which might provide a prolonged residence time of various delivery systems in the intestine.

Thiolated polymers: evidence for the formation of disulphide bonds with mucus glycoproteins.

Disulphide bonds between thiolated polymers (thiomers) and cysteine-rich subdomains of mucus glycoproteins are supposed to be responsible for the enhanced mucoadhesive properties of thiomers. This study set out to provide evidence for these covalent interactions using poly(acrylic acid)-cysteine conjugates of 2 and 450 kDa (PAA2-Cys, PAA450-Cys) displaying 402.5-776.0 micromol thiol groups per gram polymer. The effect of the disulphide bond breaker cysteine on thiomer-mucin disulphide bonds was monitored by (1) mucoadhesion studies and (2) rheological studies. Furthermore, (3) diffusion studies and (4) gel filtration studies were performed with thiomer-mucus mixtures. The addition of cysteine significantly (P<0.01) reduced the adhesion of thiomer tablets to porcine mucosa and G'/G" values of thiomer-mucin mixtures, whereas unthiolated controls were not influenced. These results indicate the cleavage of disulphide bonds between thiomer and mucus glycoproteins. Diffusion studies demonstrated that a 12.8-fold higher concentration of the thiomer (PAA2-Cys) remains in the mucin gel than the corresponding unmodified polymer. Gel filtration studies showed that PAA2-Cys was able to form disulphide bonds with mucin glycoproteins resulting in an altered elution profile of the mucin/PAA2-Cys mixture in comparison to mucin alone or mucin/PAA2 mixture. According to these results, the study provides evidence for the formation of covalent bonds between thiomer and mucus glycoproteins.

Improvement in the in situ gelling properties of deacetylated gellan gum by the immobilization of thiol groups.

The rheological properties of an in situ crosslinking thiolated deacetylated gellan gum were examined in vitro. Mediated by a carbodiimide, L-cysteine was covalently bound to deacetylated gellan gum (DGG). The deacetylated gellan gum-cysteine (DGG-Cys) conjugate displayed 216.53 +/- 59.54 micromol thiol groups per gram polymer (means +/- SD, n = 3). The thiolated polymer was capable of forming inter- and/or intramolecular disulfide bonds in aqueous solution (1.5%; m/m) at pH 7. After 6 h of incubation at room temperature, storage modulus, loss modulus, and complex viscosity increased 300-, 6.4-, and 26.6-fold, respectively, relative to the unthiolated polymer. Loss tangent of DGG-Cys was <1, indicating a gel, whereas the corresponding unmodified polymer had a loss tangent of >1, indicating a fluid. Frequency sweep measurements demonstrated an increase in crosslinking of the thiolated polymer as a function of time. DGG-Cys appeared to be superior to the unmodified polymer also in the presence of physiological cation concentrations found (e.g., in tear fluid and nasal secretion), which is referred to rheological properties. The polymer generated within this study represents a promising novel excipient for various drug delivery systems in which in situ gelling properties are favorable.