Non-Invasive Drug Delivery through Respiratory Routes

Version	Summary	Created by	Modification	Content Size	Created at	Operation
1		Yuan-Lu Cui	--	3526	2022-09-28 04:02:18	\|
2	format change	Peter Tang	Meta information modification	3526	2022-09-28 11:30:53	\|

This entry is adapted from the peer-reviewed paper 10.3390/pharmaceutics14091974

With rapid and non-invasive characteristics, the respiratory route of administration has drawn significant attention compared with the limitations of conventional routes. Respiratory delivery can bypass the physiological barrier to achieve local and systemic disease treatment.

nasal drug delivery pulmonary drug delivery nanoparticles COVID-19

1. Introduction

Non-invasive drug delivery generally refers to painless drug delivery methods that provide alternative routes for the delivery of therapeutics via oral, nasal, pulmonary, ocular, or rectal ^[1]. Oral administration has been the most widely used way to treat diseases. However, some barriers affect the delivery of drugs to target sites, such as the blood-brain barrier (BBB) and pulmonary barriers ^[2]. As a complex anatomical and physiological barrier, BBB selectively restricts the entry of substances into the brain; thus, effectively transporting drugs to the brain is a great challenge. Similarly, there are three significant barriers during pulmonary drug delivery. Mucociliary clearance is a mechanical barrier, mainly in the upper respiratory tract. Enzyme chemical barriers, such as peptidases and proteases, are responsible for protein and peptide degradation, and alveolar macrophage immunological barriers restrict the penetration of substances into the alveoli or further absorption into the systemic blood circulation ^[3].

Advances in anatomy and physiology provide advantageous features that make respiratory delivery an excellent route in drug delivery therapies. Novel drug formulations and devices are simultaneously developed to achieve more efficient drug delivery through the respiratory route. Nanoformulation is a particularly promising formulation for overcoming drug delivery barriers. Nanocarriers improve the efficiency of the drug and are promising viable formulations, making them important targets for research in preclinical and clinical practice ^[4]. In recent years, the study of respiratory delivery has increased markedly; however, theoretical reviews in respiratory delivery have rarely been summarized.

2. Non-Invasive Drug Delivery

A significant challenge in achieving therapeutic success is the efficient delivery of drugs. Due to pain, infection risk, high cost, and low patient compliance, parenteral injections are not the preferred method of administration. Furthermore, concerns about needle disposal hinder parenteral administration ^[5]. There are significant advantages to non-invasive drug delivery over injection, including a decreased risk of needle sticks, a low risk of infection, and an increased level of patient compliance with treatment ^[6]^[7].

However, molecular size, hydrophilicity, low permeability, chemical or enzymatic instability, and low permeability of therapeutics pose formidable obstacles to developing non-invasive drug delivery systems ^[8]. Many small molecules and almost all biologics do not possess the ideal physicochemical properties for good absorption from mucosal surfaces or the skin. Various formulation strategies have been proposed to overcome these problems. Innovative nanoformulations with controllable particle sizes and surface modifications have been developed to improve target selectivity, systems half-life, and bioavailability of drugs. Nanotechnology plays a vital role in developing non-invasive drug delivery systems to improve drug clinical outcomes ^[9].

Non-invasive drug delivery mainly includes oral, nasal, pulmonary, rectal, and transdermal routes. Oral administration is the most used drug delivery strategy due to its convenience. Still, it faces the absorption and degradation of drugs in the gastrointestinal tract due to the acidic environment and microorganisms ^[10]. Transdermal administration can eliminate first-pass metabolism and maintain sustained drug release, thereby reducing dosing frequency. The stratum corneum, the outermost part of the skin that contains dead keratinocytes and lipids ^[11], acts as a drug barrier because it limits the absorption of large molecular weight and hydrophilic molecules. Intestinal irritation and poor patient compliance are some of the problems associated with rectal administration.

Respiratory delivery (e.g., nasal and pulmonary drug delivery) has unique advantages compared to other non-invasive drug delivery routes. Nasal drug delivery can bypass hepatic first-pass metabolism, is effective, and patient-friendly regarding self-medication. Moreover, it allows drugs to bypass the BBB and be directly delivered to brain tissue or cerebrospinal fluid via olfactory neurons ^[12]. In the lungs, the size of the surface area (about 80–140 m²), thin alveolar epithelium (0.1–0.5 mm), and ample blood supply contribute to rapid and high drug absorption ^[13]. All these advantages make nasal and pulmonary routes suitable for local and systemic drug delivery.

3. Therapy for Central Nervous System Disorders

Despite an increase in the prevalence of neurological and psychiatric disorders such as Parkinson's disease, Alzheimer's disease, brain tumors, and depression at the global level, drug molecules are still not effectively delivered to the central nervous system (CNS) ^[14]. It is possible to directly administer drugs into parenchyma or cerebrospinal fluid via intraparenchymal or intrathecal infusions, respectively, but these routes of administration are invasive and unsuitable for chronic treatment ^[2]. Furthermore, delivering diagnostic agents or therapeutic drugs with non-targeted may also severely damage neurons and glial cells. Therefore, there is an urgent need for new avenues to deliver therapeutic drugs for neurological diseases ^[15]. More and more researchers have paid attention to treating CNS diseases by nasal drug delivery. However, the precise drug delivery mechanism of the nasal cavity to the CNS is not fully understood. Several reports demonstrate that nose-to-brain drug delivery is mainly mediated by olfactory and trigeminal nerve pathways located at the roof of the nasal cavity ^[16]. The functional pathway through which drugs pass into the CNS from structures deep in the nose innervated by the cranial nerve is called “nose-to-brain” transport ^[17]. In addition, the treatments of Parkinson's disease ^[18], anxiety ^[19], and migraines ^[20] have reported promising results for delivering CNS therapeutics through different inhaler techniques.

3.1. Bypass the Blood-Brain Barrier

The CNS is protected by a highly regulated complex structure called the BBB ^[21]. The BBB is composed of the capillary endothelium, pericytes, and the astrocyte foot processes ^[22]. Specifically designed endothelial cells of the BBB do not have fenestrations, and they possess extensive tight junctions that prevent hydrophilic and polar compounds as well as molecules with high molecular weight from entering the CNS from the bloodstream ^[23]. Astrocytes, which surround cerebral capillaries, also prevent passive diffusion through the cell membrane to minimize the uptake of extracellular substances ^[24]. Although the structure of the BBB is vital to keep harmful substances out, it is also a significant obstacle to the pharmacological treatment of CNS and mental diseases ^[25].

The nose-to-brain route provides a practical, non-invasive way to bypass the BBB and delivers therapeutic agents to the brain. A variety of drug delivery systems, such as nanogels ^[26], nanoparticles ^[27], and solid lipid nanoparticles ^[28], have been studied to deliver drugs to the CNS through intravenous administration, which can cross BBB ^[29]. However, intravenous administration is not suitable for major depressive disorder, Parkinson's disease, and other diseases that need daily administration. Nasal drug delivery has the following advantages: (1) about 98% of small molecules and almost all large proteins and genes cannot pass through the BBB ^[30], but intranasal administration can bypass the BBB and deliver drugs directly to the brain; (2) the nasal cavity has a lot of strengths such as high surface area, high permeability, high vascularization, and the nose-to-brain pathway; and (3) the nose-to-brain route avoids first-pass metabolism in the gastrointestinal tract and liver, thereby avoiding most drug inactivation.

Many pharmaceutical preparations have been used to improve penetration through the physiological barrier of the nasal cavity. As a drug preparation method, nanotechnology combined with the nasal drug delivery route is expected to provide an effective drug delivery system ^[31]^[32]. Currently, by loading a drug that is poorly distributed in the brain into the nanocarrier system, good interactions with the nasal mucosa can be achieved to prolong the residence time and ultimately produce higher drug concentration in the brain parenchyma. Such a nanocarrier can be modified with targeting ligands to preferentially bind to receptors or transporters expressed at the BBB to enhance brain selectivity and permeability ^[33]. In addition, by crossing the barrier through the process of cell transcytosis, this system can be further used for effective drug delivery ^[34]. Among them, nanoparticles are one of the most researched drug delivery systems, ranking as the third most frequent keyword. Since nanoparticles can protect encapsulated drugs from degradation, chemicals, and P-gp efflux, proteins are extracellularly delivered, thus improving the nose-to-brain drug delivery ^[7].

3.2. Treatment of Parkinson's Disease

Parkinson's disease (PD), a neurodegenerative disorder, affects approximately 1–2% of the population over the age of 65 ^[35]. It is characterized by the loss of dopaminergic receptors in the nigrostriatal and mesolimbic systems in the brain ^[36]. As α-synuclein accumulates and dopamine levels are depleted, it develops into the dysfunction of daily tasks. Symptoms of the disease include movement disorders, tremors, and difficulty walking due to a loss of balance and coordination. Treatment for PD involves increasing dopamine levels in the brain or reducing the concentration of dopamine inhibitors. Drugs such as levodopa and carbidopa are converted into dopamine when delivered to the brain.

Combining nanotherapeutics with nasal drug delivery promises to bypass the BBB for targeted therapy to the brain. This approach has been effective in treating a variety of neurodegenerative diseases in previous studies. Monoamine oxidase B (MAO-B) inhibitors are an established therapy for PD and work in part by blocking the MAO-catalyzed metabolism of dopamine in the brain ^[37]. Selegiline and rasagiline are two MAO-B inhibitors commonly used in the clinic. Sridhar et al. synthesized selegiline-loaded chitosan nanoparticles by ionic gelation ^[38]. Compared to oral administration, selegiline concentrations in the brain and plasma were 20- and 12-fold higher, respectively, after intranasal administration, greatly reducing the dose and the side effects of selegiline. Furthermore, C_max in the brain after intranasal nanoparticle administration was significantly higher than that after intranasal thermosensitive gel and plain solution administration. This suggested that chitosan was a biodegradable permeation enhancer that increases the nasal mucosal penetration of selegiline nanoparticles. Rasagiline has advantages over selegiline because its metabolites do not include potentially toxic amphetamines ^[39]. Mittal et al. used the ionic gelation technique to prepare rasagiline-loaded chitosan glutamate nanoparticles (RAS-loaded CG-NPs) ^[40]. After intranasal and intravenous administration, the biodistribution of RAS formulations in mice brains and blood was performed using the HPLC. Intracerebral drug concentrations were significantly always elevated in nasally administered CG-NPs. The results showed that the brain bioavailability was significantly improved following intranasal administration of RAS-loaded CG-NPs, which may represent an achievement of direct nose-to-brain targeting in PD treatment.

3.3. Treatment of Alzheimer's Disease

Alzheimer's disease (AD) is a degenerative brain disease characterized by memory loss and associated cognitive impairments, including poor judgment and decision-making, language impairment, loss of temper control, and emotional disturbances ^[41]. AD initially occurs with the loss or destruction of neurons involved in the brain's cognitive function. Neurons in other brain parts are gradually destroyed, making it difficult to perform essential body functions, such as walking and swallowing. Eventually, the brain will lose its function completely. Although genetics, age, and environmental factors influence this disease, the etiology of AD is not fully understood. Drugs that FDA has approved for AD treatment act as cholinesterase inhibitors and include donepezil, rivastigmine, galantamine, and tacrine ^[42]. Currently, most approved drugs are orally administered in tablet form. Still, they suffer from poor absorption from the digestive tract, difficulty reaching the brain, and a lack of effectiveness at recommended doses. There are several ways to deliver specific drugs to the brain, one of which is the nasal route ^[43].

Tacrine hydrochloride (THA) is an FDA-approved drug for AD treatment with a short half-life. It is a reversible acetylcholinesterase inhibitor that enhances the deficiency of brain cholinergic neurotransmission and prevents the degradation of neurotransmitters by increasing the level of acetylcholine in the brain ^[44]. Jogani et al. investigated a microemulsion delivery system to enhance nasal-brain transport of THA. Additionally, a mucoadhesive agent (Carbopol 934P) was added to prolong the contact time of the formulation in the nasal cavity and enhance THA absorption in the brain, reducing systemic distribution and side effects. The prepared formulation exhibited the mean globule size < 27 nm and zeta potential <−20 mV, and the addition of a mucoadhesive agent further negatively contributed to the system. The biodistribution of the THA solution and its formulation after intravenous and intranasal administration was assessed using 99mTc as a marker. Results showed that nasal drug delivery enhanced brain selectivity and accumulation of THA over intravenous administration ^[45]. In another study, Qian et al. conducted a pharmacokinetic and pharmacodynamic study of HLS-3, a tacrine dimer with high anti-acetylcholinesterase activity, for the treatment of AD. The results showed that intranasal administration of HLS-3 had similar central effects and fewer peripheral adverse effects at a much lower dose than oral tacrine, suggesting that intranasal administration of HLS-3 might be a potential therapy for AD treatment ^[46].

3.4. Treatment of Depression

Depression is a common mental illness that affects a person's thoughts, behaviors, feelings, and circadian rhythms. Pathological causes of depression include chemical imbalances in the brain, decreased energy metabolism, and altered hormone levels ^[47]. According to the serotonin hypothesis, depression results from dysfunctional serotonergic activity leading to reducing serotonin levels in the brain. Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, vilazodone, and fluvoxamine are first-line medications for patients with depression ^[48]. However, the approved oral antidepressants have reduced bioavailability due to first-pass metabolism. The time it takes for a drug to reach its saturation point is often prolonged, resulting in delayed and reduced efficacy. In addition, due to low bioavailability, higher doses need to be ingested, leading to an increased incidence of side effects ^[49]. Furthermore, the therapeutic effect is also limited due to the presence of the BBB.

Nasal drug delivery is an attractive therapeutic strategy and has been used to treat depression. Ketamine, an intranasal antidepressant, has been studied in multiple clinical trials. As an antidepressant, there are several hypotheses for the mechanism of action of ketamine, including synaptic or GluN2B-selective extra-synaptic N-methyl-D-aspartate receptor (NMDAR) inhibition, inhibition of NMDARs localized on GABAergic interneurons, inhibition of NMDAR-dependent burst firing of lateral habenula neurons, and the role of α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor activation. These preclinically proven ketamine mechanisms of action are not mutually exclusive and may act synergistically to exert the drug's antidepressant effects ^[50]^[51]. In March 2019, FDA approved intranasal esketamine (the S (+) enantiomer of ketamine) for the treatment of treatment-resistant depression ^[52]. It was the first antidepressant in the form of a nasal spray, and the therapeutic effects of intranasal esketamine were observed after 4 h from application ^[53]. The rapid onset of action is a considerable advantage of esketamine compared with conventional antidepressants.

Intranasal administration is one of the easier options for delivering molecules to the brain region. Antidepressants like venlafaxine increase synaptic neurotransmitter levels that are diminished due to depression ^[54]. Due to its short elimination half-life and inherent hydrophilicity, it requires frequent administration to maintain its therapeutic concentration and its penetration into the brain needs to be improved. Using venlafaxine-loaded alginate nanogels, Hague et al. showed increased drug permeation through the isolated porcine nasal mucosa. This was attributed to the positively charged amino groups on alginate and the negatively charged sialic acid on the cell membranes. In vivo studies of rats showed that the drug had a higher brain to blood ratio after intranasal administration, revealing that the drug bypassed the BBB and was transported directly to the brain via the nose. Intranasal administration produced a significantly higher brain concentration of the drug (743 ng/mL; t_max = 60 min) than intravenous administration (383 ng/mL; t_max = 30 min). In another study, Haque et al. designed antidepressant nanoparticles containing venlafaxine-loaded alginate chitosan (VLF AG-NPs) for the nose-to-brain treatment of depression. The antidepressant activity of VLF AG-NPs was evaluated by the forced swim test. It showed a significant improvement in behavioral analysis parameters, including swimming, climbing, and immobility, which was observed after intranasal administration of VLF AG-NPs ^[55].

3.5. Treatment of Glioblastoma

In adults, malignant brain tumors are devastating diseases with high morbidity and mortality. Among children, they are the second leading cause of cancer-related death ^[56]. Currently, there are no effective therapies, mainly due to high tumor heterogeneity, chemoresistance, and difficulties imposed by BBB. It is urgently needed to develop new treatment options for glioblastoma, which currently undergoes surgery, radiation therapy, and chemotherapy concurrently ^[57].

Various types of biodegradable and biocompatible polymers have been widely studied, which can prevent toxic and side effects and simultaneously achieve the goal of sustained and controlled release. Chitosan, the 10th highest frequency keyword in the keyword frequency analysis, is the only polycationic polysaccharide extracted from biological sources and is widely used in nano drug delivery systems. Chitosan can increase the residence time of drugs in the olfactory area, reduce mucus clearance, and open the tight junctions between epithelial cells, thereby enhancing the penetration of drugs through mucosal membranes. Galectin-1 (Gal-1), a natural galactose-binding lectin, is overexpressed in glioblastoma multiforme (GBM). To inhibit Gal-1 in GBM, Woensel et al. prepared a highly concentrated suspension of small interfering RNA (siRNA)-loaded chitosan nanoparticles to deliver siRNA to the CNS via nasal drug delivery. The chitosan nanoparticles did not affect the effectiveness of siRNA molecules and rapidly delivered siRNA to murine and human GBM cells, thereby reducing tumor cell migration. Following intranasal administration in healthy mice, it was observed to rapidly spread into the nasal mucosa and further into the olfactory bulbus and the hindbrain ^[58]. Cetuximab (CET) is an anti-epidermal growth factor receptor (EGFR) monoclonal antibody developed for brain tumor targeting because CET specifically binds with high affinity to EGFR. EGFR is simultaneously overexpressed in most brain tumors but not expressed in normal tissues ^[59]. Ferreira et al. ^[60] prepared poly (lactic-co-glycolic acid) (PLGA) and oligomeric chitosan (OCS)-based mucoadhesive nanoparticles to co-deliver α-cyano-4-hydroxycinnamic acid (CHC) and CTX into the brain by nasal drug delivery. Stable nano sized particles (213–875 nm) with high positive surface charge (+33.2 to +58.9 mV) and entrapment efficiency (75.69 to 93.23%) were produced by emulsification/evaporation technique and further combined with the CTX. The CHC-loaded NPs exhibited high cytotoxicity against different glioma cell lines (U251 and SW1088). Analysis of chicken chorioallantoic membranes demonstrated the anti-angiogenic activity of CHC-loaded NPs. In conclusion, this nano drug delivery system can potentially be a new therapeutic alternative for glioblastoma therapy.

3.6. Treatment of Epilepsy

Epilepsy is a neurological disorder characterized by recurrent seizures that affect people of all ages, genders, races, and geographic locations ^[61]. Nearly 50 million people are infected worldwide, with a prevalence rate of 5–10 per 1000 people and more than 0.5% of the global disease burden ^[62].

Antiepileptic drugs, including phenobarbital, phenytoin, felbamate, topiramate, vigabatrin, and gabapentin, are usually taken orally in the form of tablets, capsules, solutions, and suspensions ^[63]. Commercial antiepileptic doses are ineffective for about one-third of epileptic patients ^[64]. Drug resistance may result from a drug not reaching its target area or from a lower concentration of the drug in the brain. Researchers have used nanoformulations to deliver antiepileptic drugs to receptor sites via intravenous, oral, nasal, and transdermal routes ^[65]. Jain et al. formulated amiloride-loaded mucoadhesive nanoemulsions for nose-brain administration. The mucoadhesive nanoemulsions had no toxicity to the sheep nasal mucosa and were determined to be safe after intranasal administration of antiepileptic drugs. The developed formulation also needs to be pharmacokinetically and pharmacodynamically evaluated ^[66]. Gonçalves et al. studied a thermoreversible gel loaded with levetiracetam and administered it to mice in an aerosolized form. Pluronic F-127 and Carbopol^® in the formulation helped form a thermosensitive gel with adequate structural characteristics so that it can act as a liquid aerosol gel in the nasal mucosa. The absolute intranasal bioavailability was 107.44%, indicating a high proportion of the drug systemically absorbed. Histopathological examination of lung tissue after repeated administration by intranasal route showed that the preparation caused no toxicity or structural damage. Although further exploration is required, these nonclinical studies offer new hope for epilepsy treatment ^[67].

4. Therapy for Tracheal/Bronchial and Lung Diseases

Tracheal or bronchial and lung diseases are important causes of death globally, including cough, common cold, and more severe diseases like pulmonary hypertension, lung cancer, and COPD ^[68]. Due to the limitations of conventional administration routes and existing treatment methods, the pulmonary administration route has attracted widespread attention. It has become an important research area for effective therapeutic interventions for respiratory diseases ^[69]. Due to the large surface area of the respiratory endothelium, the elimination of the first-pass metabolism, and small dosages, pulmonary drug delivery has shown enormous potential and has attracted significant attention in pulmonary disease treatment ^[70]. Compared to oral or parenteral routes, even if the dose is reduced, it can take effect quickly and help to minimize adverse reactions. Pulmonary drug delivery can also deliver high concentration biologics to the lungs, and can be effectively used for respiratory infections, lung cancer, and asthma ^[71]. Some of the FDA-approved inhalation products have been summarized in Table 1.

Table 1. Some of the FDA-approved inhalation products ^[72].

Brand Name	Drug	Indication	Manufacturer	Approval Year
Qvar Redihaler^®	Beclomethasone dipropionate	Asthma	Norton Waterford	2017
Bevespi Aerosphere^®	Glycopyrronium, Formoterol fumarate	COPD	Astrazeneca Pharms	2016
Asmanex^® HFA	Mometasone furoate	Asthma	Merck Sharp Dohme	2014
Duaklir Pressair^®	Aclidinium bromide, Formoterol fumarate	COPD	Circassia	2019
Trelegy Ellipta^®	Fluticasone furoate, Umeclidinium, Vilanterol	Asthma, COPD	Glaxosmithkline	2017
Airduo Respiclick^®	Fluticasone propionate, Salmeterol xinafoate	Asthma	Teva Pharm	2017
Utibron^®	Glycopyrrolate, Indacaterol maleate	COPD	Sunovion Pharms Inc	2015
Stiolto Respimat^®	Tiotropium bromide, Olodaterol	COPD	Boehringer Ingelheim	2015
Spiriva Respimat^®	Tiotropium	COPD	Boehringer Ingelheim	2014
Striverdi Respimat^®	Olodaterol hydrochloride	COPD	Boehringer Ingelheim	2014

5. Therapy for Systemic Diseases

The nasal mucosa has rapid blood flow, a highly vascularized epithelial layer, and a significant absorption area. These characteristics offer many advantages for introducing drugs into systemic circulation. The nasal route has been widely studied for the systemic administration of therapeutic agents and has been clinically used, for example with hormones and vaccines. Moreover, research on the lungs as an entrance for systemic drug delivery has been conducted for decades. Due to its large surface area of about 70–100 m², permeable epithelium, and high perfusion properties, the respiratory mucosa is one of the best targets for biopharmaceutical uptake ^[73].

References

Rajiv Bajracharya; Jae Geun Song; Seung Yun Back; Hyo-Kyung Han; Recent Advancements in Non-Invasive Formulations for Protein Drug Delivery. Computational and Structural Biotechnology Journal 2019, 17, 1290-1308, 10.1016/j.csbj.2019.09.004.
Shiv Bahadur; Dinesh M. Pardhi; Jarkko Rautio; Jessica M. Rosenholm; Kamla Pathak; Intranasal Nanoemulsions for Direct Nose-to-Brain Delivery of Actives for CNS Disorders. Pharmaceutics 2020, 12, 1230, 10.3390/pharmaceutics12121230.
Duy Toan Pham; Athittaya Chokamonsirikun; Vipasiri Phattaravorakarn; Waree Tiyaboonchai; Polymeric micelles for pulmonary drug delivery: a comprehensive review. Journal of Materials Science 2020, 56, 2016-2036, 10.1007/s10853-020-05361-4.
Aida Maaz; Ian Blagbrough; Paul De Bank; In Vitro Evaluation of Nasal Aerosol Depositions: An Insight for Direct Nose to Brain Drug Delivery. Pharmaceutics 2021, 13, 1079, 10.3390/pharmaceutics13071079.
Andrew L Lewis; Joël Richard; Challenges in the delivery of peptide drugs: an industry perspective. Therapeutic Delivery 2015, 6, 149-163, 10.4155/tde.14.111.
Driton Vllasaliu; Non-Invasive Drug Delivery Systems. Pharmaceutics 2021, 13, 611, 10.3390/pharmaceutics13050611.
Jitendra; P. K. Sharma; Sumedha Bansal; Arunabha Banik; Noninvasive Routes of Proteins and Peptides Drug Delivery. Indian Journal of Pharmaceutical Sciences 2011, 73, 367-375, 10.4103/0250-474X.95608.
Dipak S. Pisal; Matthew P. Kosloski; Sathy V. Balu-Iyer; Delivery of Therapeutic Proteins. Journal of Pharmaceutical Sciences 2010, 99, 2557-2575, 10.1002/jps.22054.
Prashant Kesharwani; Bapi Gorain; Siew Yeng Low; Siew Ann Tan; Emily Chai Siaw Ling; Yin Khai Lim; Chuan Ming Chin; Pei Yee Lee; Chun Mey Lee; Chun Haw Ooi; et al.Hira ChoudhuryManisha Pandey Nanotechnology based approaches for anti-diabetic drugs delivery. Diabetes Research and Clinical Practice 2018, 136, 52-77, 10.1016/j.diabres.2017.11.018.
Kyeongsoon Park; Ick Chan Kwon; Kinam Park; Oral protein delivery: Current status and future prospect. Reactive and Functional Polymers 2011, 71, 280-287, 10.1016/j.reactfunctpolym.2010.10.002.
N. Kanikkannan; K. Kandimalla; S. S. Lamba; M. Singh; Structure-activity Relationship of Chemical Penetration Enhan-cers in Transdermal Drug Delivery. Current Medicinal Chemistry 2000, 7, 593-608, 10.2174/0929867003374840.
Hussein Akel; Ruba Ismail; Ildikó Csóka; Progress and perspectives of brain-targeting lipid-based nanosystems via the nasal route in Alzheimer’s disease. European Journal of Pharmaceutics and Biopharmaceutics 2020, 148, 38-53, 10.1016/j.ejpb.2019.12.014.
Aaron Anselmo; Yatin Gokarn; Samir Mitragotri; Non-invasive delivery strategies for biologics. Nature Reviews Drug Discovery 2018, 18, 19-40, 10.1038/nrd.2018.183.
Salman Ul Islam; Adeeb Shehzad; Muhammad Bilal Ahmed; Young Sup Lee; Intranasal Delivery of Nanoformulations: A Potential Way of Treatment for Neurological Disorders. Molecules 2020, 25, 1929, 10.3390/molecules25081929.
Jeffrey J. Lochhead; Thomas P. Davis; Perivascular and Perineural Pathways Involved in Brain Delivery and Distribution of Drugs after Intranasal Administration. Pharmaceutics 2019, 11, 598, 10.3390/pharmaceutics11110598.
Giada Botti; Alessandro Dalpiaz; Barbara Pavan; Targeting Systems to the Brain Obtained by Merging Prodrugs, Nanoparticles, and Nasal Administration. Pharmaceutics 2021, 13, 1144, 10.3390/pharmaceutics13081144.
Hafizah Mahmud; Tomonari Kasai; Apriliana Cahya Khayrani; Mami Asakura; Aung Ko Ko Oo; Juan Du; Arun Vaidyanath; Samah El-Ghlban; Akifumi Mizutani; Akimasa Seno; et al.Hiroshi MurakamiJunko MasudaMasaharu Seno Targeting Glioblastoma Cells Expressing CD44 with Liposomes Encapsulating Doxorubicin and Displaying Chlorotoxin-IgG Fc Fusion Protein. International Journal of Molecular Sciences 2018, 19, 659, 10.3390/ijms19030659.
K. A. Grosset; N. Malek; F. Morgan; D. G. Grosset; Inhaled dry powder apomorphine (VR040) for ‘off ’ periods in PD: an in-clinic double-blind dose ranging study. Acta Neurologica Scandinavica 2013, 128, 166-171, 10.1111/ane.12107.
Tingting Liu; Hui Cheng; Li Tian; Yueyue Zhang; Shaotong Wang; Lu Lin; Aromatherapy with inhalation can effectively improve the anxiety and depression of cancer patients: A meta-analysis. General Hospital Psychiatry 2022, 77, 118-127, 10.1016/j.genhosppsych.2022.05.004.
Ebtsam M. Abdou; Soha M. Kandil; Amany Morsi; Maysa W. Sleem; In-vitro and in-vivo respiratory deposition of a developed metered dose inhaler formulation of an anti-migraine drug. Drug Delivery 2019, 26, 689-699, 10.1080/10717544.2019.1618419.
Rosamaria Lombardo; Teresa Musumeci; Claudia Carbone; Rosario Pignatello; Nanotechnologies for intranasal drug delivery: an update of literature. Pharmaceutical Development and Technology 2021, 26, 824-845, 10.1080/10837450.2021.1950186.
Jingying Xu; Jiangang Tao; Jidong Wang; Design and Application in Delivery System of Intranasal Antidepressants. Frontiers in Bioengineering and Biotechnology 2020, 8, 626882, 10.3389/fbioe.2020.626882.
Imola Wilhelm; Ádám Nyúl-Tóth; Maria Suciu; Anca Hermenean; István A Krizbai; Heterogeneity of the blood-brain barrier. Tissue Barriers 2016, 4, e1143544-e1143544, 10.1080/21688370.2016.1143544.
Xiaowei Dong; Current Strategies for Brain Drug Delivery. Theranostics 2018, 8, 1481-1493, 10.7150/thno.21254.
Luigi Battaglia; Pier Paolo Panciani; Elisabetta Muntoni; Maria Teresa Capucchio; Elena Biasibetti; Pasquale De Bonis; Silvia Mioletti; Marco Fontanella; Shankar Swaminathan; Lipid nanoparticles for intranasal administration: application to nose-to-brain delivery. Expert Opinion on Drug Delivery 2018, 15, 369-378, 10.1080/17425247.2018.1429401.
Pasquale Picone; Maria Antonietta Sabatino; Lorena Anna Ditta; Antonella Amato; Pier Luigi San Biagio; Flavia Mulè; Daniela Giacomazza; Clelia Dispenza; Marta Di Carlo; Nose-to-brain delivery of insulin enhanced by a nanogel carrier. Journal of Controlled Release 2018, 270, 23-36, 10.1016/j.jconrel.2017.11.040.
Shadab; Shadabul Haque; Mohammad Fazil; Manish Kumar; Sanjula Baboota; Jasjeet K Sahni; Javed Ali; Optimised nanoformulation of bromocriptine for direct nose-to-brain delivery: biodistribution, pharmacokinetic and dopamine estimation by ultra-HPLC/mass spectrometry method. Expert Opinion on Drug Delivery 2014, 11, 827-842, 10.1517/17425247.2014.894504.
Tyler P. Crowe; Walter H. Hsu; Evaluation of Recent Intranasal Drug Delivery Systems to the Central Nervous System. Pharmaceutics 2022, 14, 629, 10.3390/pharmaceutics14030629.
Xinming Li; John Tsibouklis; Tingting Weng; Buning Zhang; Guoqiang Yin; Guangzhu Feng; Yingde Cui; Irina N. Savina; Lyuba I. Mikhalovska; Susan R. Sandeman; et al.Carol A. HowelSergey V. Mikhalovsky Nano carriers for drug transport across the blood–brain barrier. Journal of Drug Targeting 2016, 25, 17-28, 10.1080/1061186x.2016.1184272.
Shyeilla V. Dhuria; Leah R. Hanson; William H. Frey; Intranasal delivery to the central nervous system: Mechanisms and experimental considerations. Journal of Pharmaceutical Sciences 2010, 99, 1654-1673, 10.1002/jps.21924.
Abhijeet Pandey; Kritarth Singh; Sagar Patel; Rajesh Singh; Kirti Patel; Krutika Sawant; Hyaluronic acid tethered pH-responsive alloy-drug nanoconjugates for multimodal therapy of glioblastoma: An intranasal route approach. Materials Science and Engineering: C 2019, 98, 419-436, 10.1016/j.msec.2018.12.139.
Xue-Jie Qi; Dong Xu; Meng-Li Tian; Jin-Feng Zhou; Qiang-Song Wang; Yuan-Lu Cui; Thermosensitive hydrogel designed for improving the antidepressant activities of genipin via intranasal delivery. Materials & Design 2021, 206, 109816, 10.1016/j.matdes.2021.109816.
Cláudia Pina Costa; J.N. Moreira; Maria Helena Amaral; J. M. Sousa Lobo; A.C. Silva; Nose-to-brain delivery of lipid-based nanosystems for epileptic seizures and anxiety crisis. Journal of Controlled Release 2019, 295, 187-200, 10.1016/j.jconrel.2018.12.049.
Ying Fan; Min Chen; Jinqiang Zhang; Philippe Maincent; Xuefeng Xia; Wen Wu; Updated Progress of Nanocarrier-Based Intranasal Drug Delivery Systems for Treatment of Brain Diseases. Critical Reviews in Therapeutic Drug Carrier Systems 2018, 35, 433-467, 10.1615/critrevtherdrugcarriersyst.2018024697.
Abhijeet D. Kulkarni; Yogesh H. Vanjari; Karan H. Sancheti; Veena S. Belgamwar; Sanjay J. Surana; Chandrakantsing V. Pardeshi; Nanotechnology-mediated nose to brain drug delivery for PD: a mini review. Journal of Drug Targeting 2015, 23, 775-788, 10.3109/1061186x.2015.1020809.
Hsiao-Chun Cheng; Christina M. Ulane Md; Robert Burke; Clinical progression in Parkinson disease and the neurobiology of axons. Annals of Neurology 2010, 67, 715-725, 10.1002/ana.21995.
Letitia Meiring; Jacobus P. Petzer; Lesetja J. Legoabe; Anél Petzer; The evaluation of N-propargylamine-2-aminotetralin as an inhibitor of monoamine oxidase. Bioorganic & Medicinal Chemistry Letters 2022, 67, 128746, 10.1016/j.bmcl.2022.128746.
Vinay Sridhar; Ram Gaud; Amrita Bajaj; Sarika Wairkar; Pharmacokinetics and pharmacodynamics of intranasally administered selegiline nanoparticles with improved brain delivery in PD. Nanomedicine: Nanotechnology, Biology and Medicine 2018, 14, 2609-2618, 10.1016/j.nano.2018.08.004.
Ying Chang; Li-Bo Wang; Dan Li; Ke Lei; Song-Yan Liu; Efficacy of rasagiline for the treatment of Parkinson’s disease: an updated meta-analysis. Annals of Medicine 2017, 49, 421-434, 10.1080/07853890.2017.1293285.
Deepti Mittal; Shadab; Quamrul Hasan; Mohammad Fazil; Asgar Ali; Sanjula Baboota; Javed Ali; Brain targeted nanoparticulate drug delivery system of rasagiline via intranasal route. Drug Delivery 2014, 23, 130-139, 10.3109/10717544.2014.907372.
Navid Rabiee; Sepideh Ahmadi; Ronak Afshari; Samira Khalaji; Mohammad Rabiee; Mojtaba Bagherzadeh; Yousef Fatahi; Rassoul Dinarvand; Mohammadreza Tahriri; Lobat Tayebi; et al.Michael R. HamblinThomas J. Webster Polymeric Nanoparticles for Nasal Drug Delivery to the Brain: Relevance to Alzheimers Disease. Advanced Therapeutics 2020, 4, 2000076, 10.1002/adtp.202000076.
Yosra S.R. Elnaggar; Samar M. Etman; Doaa A. Abdelmonsif; Ossama Y. Abdallah; Intranasal Piperine-Loaded Chitosan Nanoparticles as Brain-Targeted Therapy in Alzheimers Disease: Optimization, Biological Efficacy, and Potential Toxicity. Journal of Pharmaceutical Sciences 2015, 104, 3544-3556, 10.1002/jps.24557.
Yunhai Feng; Haisheng He; FengQian Li; Yi Lu; Jianping Qi; Wei Wu; An update on the role of nanovehicles in nose-to-brain drug delivery. Drug Discovery Today 2018, 23, 1079-1088, 10.1016/j.drudis.2018.01.005.
Sonal Setya; Tushar Madaan; Bal Kishen Razdan; Mamta Farswan; Sushama Talegaonkar; Design and Development of Novel Transdermal Nanoemulgel for Alzheimer’s Disease: Pharmacokinetic, Pharmacodynamic and Biochemical Investigations. Current Drug Delivery 2019, 16, 902-912, 10.2174/1567201816666191022105036.
Viral V. Jogani; Pranav J. Shah; Pushpa Mishra; Anil Kumar Mishra; Ambikanandan Misra; Intranasal Mucoadhesive Microemulsion of Tacrine to Improve Brain Targeting. Alzheimer Disease & Associated Disorders 2008, 22, 116-124, 10.1097/wad.0b013e318157205b.
Shuai Qian; Lisi He; Qianwen Wang; Yin Cheong Wong; Marvin Mak; Chun-Yu Ho; Yifan Han; Zhong Zuo; Intranasal delivery of a novel acetylcholinesterase inhibitor HLS-3 for treatment of Alzheimer disease. Life Sciences 2018, 207, 428-435, 10.1016/j.lfs.2018.06.032.
Gregor Hasler; PATHOPHYSIOLOGY OF DEPRESSION: DO WE HAVE ANY SOLID EVIDENCE OF INTEREST TO CLINICIANS?. World Psychiatry 2010, 9, 155-161, 10.1002/j.2051-5545.2010.tb00298.x.
Jeffrey R. Strawn; Laura Geracioti; Neil Rajdev; Kelly Clemenza; Amir Levine; Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy 2018, 19, 1057-1070, 10.1080/14656566.2018.1491966.
Fadzai Mutingwende; Pierre Kondiah; Philemon Ubanako; Thashree Marimuthu; Yahya Choonara; Advances in Nano-Enabled Platforms for the Treatment of Depression. Polymers 2021, 13, 1431, 10.3390/polym13091431.
P Zanos; T D Gould; Mechanisms of ketamine action as an antidepressant. Molecular Psychiatry 2018, 23, 801-811, 10.1038/mp.2017.255.
Subha Subramanian; Simon Haroutounian; Ben Julian A. Palanca; Eric J. Lenze; Ketamine as a therapeutic agent for depression and pain: mechanisms and evidence. Journal of the Neurological Sciences 2022, 434, 120152, 10.1016/j.jns.2022.120152.
Małgorzata Panek; Paweł Kawalec; Andrzej Pilc; Władysław Lasoń; Developments in the discovery and design of intranasal antidepressants. Expert Opinion on Drug Discovery 2020, 15, 1145-1164, 10.1080/17460441.2020.1776697.
Carla M. Canuso; Jaskaran B. Singh; Maggie Fedgchin; Larry Alphs; Rosanne Lane; Pilar Lim; Christine Pinter; David Hough; Gerard Sanacora; Husseini Manji; et al.Wayne C. Drevets Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. American Journal of Psychiatry 2018, 175, 620-630, 10.1176/appi.ajp.2018.17060720.
Brijesh Shah; Dignesh Khunt; Himanshu Bhatt; Manju Misra; Harish Padh; Intranasal delivery of venlafaxine loaded nanostructured lipid carrier: Risk assessment and QbD based optimization. Journal of Drug Delivery Science and Technology 2016, 33, 37-50, 10.1016/j.jddst.2016.03.008.
Shadabul Haque; Shadab; Jasjeet Kaur Sahni; Javed Ali; Sanjula Baboota; Development and evaluation of brain targeted intranasal alginate nanoparticles for treatment of depression. Journal of Psychiatric Research 2014, 48, 1-12, 10.1016/j.jpsychires.2013.10.011.
Ewa Izycka-Swieszewska; Ewa Bien; Joanna Stefanowicz; Edyta Szurowska; Ewa Szutowicz-Zielinska; Magdalena Koczkowska; Dawid Sigorski; Wojciech Kloc; Wojciech Rogowski; Elzbieta Adamkiewicz-Drozynska; et al. Malignant Gliomas as Second Neoplasms in Pediatric Cancer Survivors: Neuropathological Study. BioMed Research International 2018, 2018, 1-10, 10.1155/2018/4596812.
Franciele Aline Bruinsmann; Gustavo Richter Vaz; Aline De Cristo Soares Alves; Tanira Aguirre; Adriana Raffin Pohlmann; Silvia Stanisçuaski Guterres; Fabio Sonvico; Nasal Drug Delivery of Anticancer Drugs for the Treatment of Glioblastoma: Preclinical and Clinical Trials. Molecules 2019, 24, 4312, 10.3390/molecules24234312.
Matthias Van Woensel; Nathalie Wauthoz; Rémi Rosière; Véronique Mathieu; Robert Kiss; Florence Lefranc; Brecht Steelant; Ellen Dilissen; Stefaan W. Van Gool; Thomas Mathivet; et al.Holger GerhardtKarim AmighiSteven De Vleeschouwer Development of siRNA-loaded chitosan nanoparticles targeting Galectin-1 for the treatment of glioblastoma multiforme via intranasal administration. Journal of Controlled Release 2016, 227, 71-81, 10.1016/j.jconrel.2016.02.032.
Natália N. Ferreira; Sara Granja; Fernanda I. Boni; Fabíola G. Prezotti; Leonardo M. B. Ferreira; Beatriz S. F. Cury; Rui M. Reis; Fátima Baltazar; Maria Palmira D. Gremião; Modulating chitosan-PLGA nanoparticle properties to design a co-delivery platform for glioblastoma therapy intended for nose-to-brain route. Drug Delivery and Translational Research 2020, 10, 1729-1747, 10.1007/s13346-020-00824-2.
Yu-Jen Lu; Er-Yuan Chuang; Yu-Hsin Cheng; T.S. Anilkumar; Huai-An Chen; Jyh-Ping Chen; Thermosensitive magnetic liposomes for alternating magnetic field-inducible drug delivery in dual targeted brain tumor chemotherapy. Chemical Engineering Journal 2019, 373, 720-733, 10.1016/j.cej.2019.05.055.
Sarita Thakran; Debleena Guin; Pooja Singh; Priyanka Singh; Samiksha Kukal; Chitra Rawat; Saroj Yadav; Suman S. Kushwaha; Achal K. Srivastava; Yasha Hasija; et al.Luciano SasoSrinivasan RamachandranRitushree Kukreti Genetic Landscape of Common Epilepsies: Advancing towards Precision in Treatment. International Journal of Molecular Sciences 2020, 21, 7784, 10.3390/ijms21207784.
Ettore Beghi; The Epidemiology of Epilepsy. Neuroepidemiology 2019, 54, 185-191, 10.1159/000503831.
Martin J. Brodie; Patrick Kwan; Current position of phenobarbital in epilepsy and its future. Epilepsia 2012, 53, 40-46, 10.1111/epi.12027.
Francesca Rivers; Terence J. O Brien; Richard Callaghan; Exploring the possible interaction between anti-epilepsy drugs and multidrug efflux pumps; in vitro observations. European Journal of Pharmacology 2008, 598, 1-8, 10.1016/j.ejphar.2008.09.014.
Lorena Bonilla; Gerard Esteruelas; Miren Ettcheto; Marta Espina; María Luisa García; Antoni Camins; Eliana B. Souto; Amanda Cano; Elena Sánchez‐López; Biodegradable nanoparticles for the treatment of epilepsy: From current advances to future challenges. Epilepsia Open 2021, 7, S121-S132, 10.1002/epi4.12567.
Maria Cristina Bonferoni; Silvia Rossi; Giuseppina Sandri; Franca Ferrari; Elisabetta Gavini; Giovanna Rassu; Paolo Giunchedi; Nanoemulsions for “Nose-to-Brain” Drug Delivery. Pharmaceutics 2019, 11, 84, 10.3390/pharmaceutics11020084.
Joana Gonçalves; Joana Bicker; Filipa Gouveia; Joana Liberal; Rui Caetano Oliveira; Gilberto Alves; Amílcar Falcão; Ana Fortuna; Nose-to-brain delivery of levetiracetam after intranasal administration to mice. International Journal of Pharmaceutics 2019, 564, 329-339, 10.1016/j.ijpharm.2019.04.047.
Ajay Kumar Thakur; Dinesh Kumar Chellappan; Kamal Dua; Meenu Mehta; Saurabh Satija; Inderbir Singh; Patented therapeutic drug delivery strategies for targeting pulmonary diseases. Expert Opinion on Therapeutic Patents 2020, 30, 375-387, 10.1080/13543776.2020.1741547.
Xue Jin; Ling Song; Chao-Chao Ma; Yan-Chun Zhang; Shui Yu; RETRACTED: Pulmonary route of administration is instrumental in developing therapeutic interventions against respiratory diseases. Saudi Pharmaceutical Journal 2020, 28, 1655-1665, 10.1016/j.jsps.2020.10.012.
Akshay Chandel; Amit K. Goyal; Goutam Ghosh; Goutam Rath; Recent advances in aerosolised drug delivery. Biomedicine & Pharmacotherapy 2019, 112, 108601, 10.1016/j.biopha.2019.108601.
L. Guilleminault; N. Azzopardi; C. Arnoult; J. Sobilo; Fate of inhaled monoclonal antibodies after the deposition of aerosolized particles in the respiratory system. Journal of Controlled Release 2014, 196, 344-354, 10.1016/j.jconrel.2014.10.003.
Drugs@FDA: FDA-Approved Drugs . Drugs@FDA: FDA-Approved Drugs. Retrieved 2022-9-28
Sally-Ann Cryan; Neeraj Sivadas; Lucila Garcia-Contreras; In vivo animal models for drug delivery across the lung mucosal barrier. Advanced Drug Delivery Reviews 2007, 59, 1133-1151, 10.1016/j.addr.2007.08.023.

© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.

Upload a video for this entry

Information

Subjects: Respiratory System

Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :

Yong-Bo Zhang

Lu Bai

View Times: 689

Update Date: 28 Sep 2022

Table of Contents

Video Upload Options

Confirm