Classifications

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  • A61K47/69—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the conjugate being characterised by physical or galenical forms, e.g. emulsion, particle, inclusion complex, stent or kit
  • A61K47/6905—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the conjugate being characterised by physical or galenical forms, e.g. emulsion, particle, inclusion complex, stent or kit the form being a colloid or an emulsion
  • A61K47/6911—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the conjugate being characterised by physical or galenical forms, e.g. emulsion, particle, inclusion complex, stent or kit the form being a colloid or an emulsion the form being a liposome
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  • A61K9/1272—Non-conventional liposomes, e.g. PEGylated liposomes or liposomes coated or grafted with polymers comprising non-phosphatidyl surfactants as bilayer-forming substances, e.g. cationic lipids or non-phosphatidyl liposomes coated or grafted with polymers
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  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
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  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
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  • A61K47/24—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing atoms other than carbon, hydrogen, oxygen, halogen, nitrogen or sulfur, e.g. cyclomethicone or phospholipids
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  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
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Definitions

• the invention relates to methods for the preparation of a pharmaceutical-vesicle formulation, and associated pharmaceutical-vesicle formulations, pharmaceutical kits and uses as a medicament, in particular for the prevention or treatment of infection by bacteria such as Burkholderia pseudomallei and Francisella tularensis, and viruses such as Venezuelan Equine Encephalitis Virus (VEEV).
• the invention relates in particular to methods of preparing pharmaceutical-vesicle formulations comprising Non-Ionic Surfactant Vesicles (NISVs), or modified vesicles thereof, which entrap pharmaceutical agents including antibiotics such as levofloxacin, doxycycline or ciprofloxacin and antivirals such as humanised anti-VEEV monoclonal IgG Hu1A3B- 7.
• NISVs Non-Ionic Surfactant Vesicles
• antivirals such as humanised anti-VEEV monoclonal IgG Hu1A3B- 7.
• Antimicrobial agents encompassing antibiotics and antivirals effective against bacteria and viruses respectively, continue to be one of the most commonly deployed strategies for resolving infections in an animal host.
• antimicrobial resistance along with the natural ability of microbes to evade treatment, is a continuing concern.
• antimicrobial resistance along with the natural ability of microbes to evade treatment, is a continuing concern.
• antimicrobial therapies there has been a lack of investment in new antimicrobial therapies.
• Burkholderia pseudomallei is an environmental Gram-negative bacterium and the causative agent of the human disease melioidosis.
• B. pseudomallei is endemic to tropical regions such as Thailand and Northern Australia and particularly associated with wet conditions such as paddy fields.
• Human exposure can occur via routes that include through the skin, for example as a result of scratches or other lesions, leading to an acute febrile illness depending on the inoculum size.
• the bacteria can also infect humans via inhalation, resulting in a more acute pneumonic infection.
• F. tularensis is considered an intracellular pathogen and the causative agent of the disease tularemia. Although typical zoonotic hosts of F.
• F. tularensis include rodents and lagomorphs, incidents of tularemia in humans are documented.
• F. tularensis subspecies tularensis is considered the most clinically relevant subspecies, capable of infecting humans with a low infectious dose, in particular via the respiratory route ( ⁇ 50 colony forming units).
• the alpha-virus VEEV is capable of causing disease in animals including horses and humans, and is transmitted via arthropod vectors such as mosquitos and ticks.
• VEEV has been associated with historic use as a biological warfare agent.
• B. pseudomallei has developed mechanisms to evade innate immune defences and persist within a host environment.
• B. pseudomallei has evolved multiple secretory and other immunomodulatory mechanisms to enable survival within intracellular granulomatous lesions for long periods, thus making this pathogen extremely difficult to access and treat effectively.
• viruses, such as VEEV are notoriously difficult to treat due to their need to replicate within host cells. The ability to treat encephalitic viruses is further complicated when the virus accesses and replicate in the brain, an in vivo site protected by the blood brain barrier (BBB).
• BBB blood brain barrier
• B. pseudomallei is known to actively export antibiotics by efflux pumps, thus making this bacterium resistant to multiple antibiotics and very difficult to treat effectively in vivo. Indeed, data suggests that single antibiotic dosing regimens are only partially effective against B. pseudomallei.
• One option for improved efficacy against melioidosis is the application of combination therapy i.e.
• antibiotics such as a b-lactam and a cephalosporin for the acute phase
• a mixture of antibiotics such as co- trimoxazole and the bacteriostatic broad-spectrum antibiotics chloramphenicol and doxycycline for an oral eradication phase to kill residual bacteria.
• Antibiotic treatment of tularemia infection is also dependent on the correct selection of antibiotic.
• b-lactams and macrolides are unsuitable.
• aminoglycosides can be effective, administering such antibiotics can be impractical due to the requirement for the parenteral dosing and for monitoring of serum levels for toxicity.
• ciprofloxacin can be a preferred antibiotic for treatment of tularemia, data from murine models and incidents of human infection have suggested this regimen is not optimal due to relapse of infection once antibiotic dosing has ceased.
• Viruses are notoriously more difficult to treat compared to bacterial pathogens due to their need to replicate within host cells.
• viral targets are also difficult to identify due to the vast variety of viruses (e.g. DNA, RNA, enveloped), antivirals therefore tend to be useful only against a specific viral family or genus.
• a broader approach may be achieved by targeting host-specific responses to viral infection.
• therapies including those for VEEV, are not yet optimized.
• the present invention provides a method for the preparation of a pharmaceutical- vesicle formulation, the method comprising the steps of: a) heating vesicle components comprising a surfactant, a hydrophobic substance and an amphiphile in the present or absence of an organic solvent; b) dissolving a pharmaceutical agent in a pharmaceutically-acceptable carrier and heating the resultant pharmaceutical agent-carrier mixture; c) adding the heated pharmaceutical agent-carrier mixture to the heated vesicle components to provide a formulation mixture; and d) processing the formulation mixture to entrap the pharmaceutical agent and carrier in a vesicle, the vesicle comprising the vesicle components, to form a pharmaceutical-vesicle formulation; wherein the pharmaceutical-vesicle formulation is reconstituted, prior to use, in a pharmaceutically-acceptable carrier.
• the concentration of the pharmaceutical agent entrapped within the vesicle can be measured prior to reconstitution. Furthermore, the pharmaceutical-vesicle formulation can be reconstituted, prior to use, in a known quantity of the pharmaceutical agent dissolved in a pharmaceutically-acceptable carrier to provide a biphasic pharmaceutical-vesicle formulation.
• the invention provides a method for the preparation of a pharmaceutical-vesicle formulation, the method comprising the steps of: a) heating vesicle components comprising monopalmitoyl glycerol, cholesterol and dicetyl phosphate at a temperature in the range of 50 °C to 150 °C; b) dissolving a pharmaceutical agent in a pharmaceutically-acceptable carrier and heating the resultant pharmaceutical agent-carrier mixture at a range of 30-99 °C; c) adding the pharmaceutical agent-carrier mixture to the vesicle components to provide a formulation mixture; and d) processing the formulation mixture to form a pharmaceutical-vesicle formulation, whereby the pharmaceutical agent and carrier is entrapped within a plurality of vesicles; wherein the pharmaceutical-vesicle formulation is reconstituted in a known quantity of the pharmaceutical agent dissolved in a pharmaceutically-acceptable carrier to provide a biphasic pharmaceutical-vesicle formulation.
• vesicle as understood by the skilled person may refer to a nano- or microparticulate structure capable of entrapping or associating with a compound or substance, such as a pharmaceutical agent. While the term‘entrapped’ is used to describe the association between the pharmaceutical agent and the vesicles, it is envisaged that pharmaceutical agent may also be associated with the vesicles as a result of being bound to the vesicle surface.
• pharmaceutical agent refers to one, or at least one (i.e. encompassing more than one), component capable of inducing a biological effect on an animal, in particular a biological effect on tissue or cell(s) within the animal.
• pharmaceutical agent includes therapeutic constituents suitable for use in the prevention or treatment of disease in an animal, for example drugs such as antibiotics, antivirals and/or biological molecules such as an antibody capable of recognising or binding to a pathogen, and/or other biological molecules capable of performing as vaccines, such as an element (e.g. protein, glycoprotein) expressed by a particular biological agent such as bacteria, yeast or virus, and particularly those biological entities considered to be pathogens capable of causing disease.
• Examples of disease include, but are not limited to, infection (for example infection caused by a bacterial or viral pathogen), cancer, inflammatory dysfunction (for example arthritis), diabetes, and/or allergies.
• pharmaceutical agent can include agents that can act to ameliorate the animal’s condition by modifying the animal’s immune response in order to counteract the disease.
• the term‘pharmaceutical agent’ may refer to an immunogenic component with the ability to stimulate an immune response in an animal, such as a human.
• Such an immune response may be a systemic and/or mucosal immune response, for example in the gut and/or lung mucosa, which may stimulate a humoral and/or cell- mediated immune response.
• An immunogenic component may represent an epitope or target (‘antigen’) associated with a specific agent, for example a peptide, polypeptide, protein, glycoprotein, polysaccharide, nucleic acid or any variant or fragment thereof associated with an agent such as a bacterium or virus capable of causing disease in an animal.
• An immunogenic component may be an antigen, including a recombinant antigen, capable of stimulating, or assisting in stimulating, an agent-specific immune response in an animal.
• pharmaceutically-acceptable carrier refers to a substance in which the pharmaceutical agent can be mixed, for example a liquid capable of mixing with the pharmaceutical agent to provide a solution or emulsion, and which is suitable for administrating the pharmaceutical agent, for example in vivo.
• pharmaceutically acceptable carrier encompasses substances known to the skilled person such as phosphate buffered saline (PBS).
• PBS phosphate buffered saline
• the pharmaceutical carriers in the biphasic formulation i.e. entrapped within the vesicles and used to reconstitute the formulation respectively
• the same pharmaceutical carrier are the same pharmaceutical carrier.
• pharmaceutical-vesicle formulation refers to a plurality of vesicles, formed from the vesicle components, within which is entrapped (i.e. entrapped and/or bound) a pharmaceutical agent in a pharmaceutically-acceptable carrier.
• heating temperatures are to be used that are not detrimental to the components being heated.
• the vesicle components may be heated at a temperature of approximately 130 °C.
• methods encompassing the use of off-the-shelf automated laboratory equipment for example microfluidics devices such as Precision Nanosystem’s Nanoassemblr®
• the vesicle components may be heated in the presence of an organic solvent, for example methanol at 100% concentration.
• the heating temperature with respect to method step b) is 50 °C to 60 °C, in particular 60 °C.
• processing includes laboratory processes such as the following-non-limiting examples, to enable the provision of vesicles entrapping the pharmaceutical agent from the vesicle components/pharmaceutical agent-carrier mixture.
• the formulation mixture may be processed by agitation and subsequent pelleting.
• the processes of agitation by vortexing could be applied, for example for 2 minutes at 2500 rpm.
• using a probe homogeniser can be used.
• Subsequent concentration of the formulation mixture could be achieved by centrifugation.
• the formulation mixture is pelleted by ultracentrifugation, for example at 100,000 x g for 1 hour.
• pelleting can be achieved through size exclusion filtration, such as using a spin column.
• the spin column approach is particularly suited for vesicles prepared on automated laboratory equipment. For example, vesicles prepared on the Nanoassemblr® can be separated from unentrapped drug by VivaSpin columns.
• the concentration of the pharmaceutical agent entrapped within the vesicle is measured, for example by High Performance Liquid Chromatography (HPLC), Bradford assay or ninhydrin assay.
• HPLC High Performance Liquid Chromatography
• Bradford assay or ninhydrin assay.
• biphasic pharmaceutical-vesicle formulation refers to a formulation designed in a manner that an amount of the pharmaceutical agent is entrapped (i.e. bound and/or entrapped) within vesicles, while the remaining pharmaceutical agent is free (i.e. not bound and/or entrapped within the vesicles) in an aqueous solution in which the vesicles are suspended.
• Biphasic pharmaceutical-vesicle formulations are typically prepared by re-suspending vesicles with bound/entrapped pharmaceutical agent in a pre-determined concentration of the same pharmaceutical agent in solution. The preferred combination is a 50/50 ratio of bound/entrapped to free antibiotic or that which is necessary to achieve equilibrium or a stable formulation.
• the inventors have successfully generated methods for production of a pharmaceutical-vesicle formulation, requiring optimising an approach of binding and/or entrapping a pharmaceutical agent within a vesicle carrier, and demonstrating by iterative testing that such formulations offer improved pharmaceutical delivery and efficacy in vivo relative to the same pharmaceutical agent delivered in the absence of the vesicle carrier.
• the method of the invention provides for the production of biocompatible and biodegradable vesicles, to which a pharmaceutical agent of choice can be bound and/or entrapped, and provides a platform technology for the delivery of said pharmaceutical agent to an animal.
• the physical properties of the vesicles have been shown by the inventors to confer a series of advantages including: enhancing cellular uptake of a pharmaceutical agent; being amenable to modification to achieve tissue-targeted drug delivery, e.g. a niche(s) where a pathogen may reside thus helping to aid total pathogen clearance; increased bioavailability; being inexpensive to synthesize; and amenable to lyophilisation.
• the method of the invention provides a delivery system, in particular an oral delivery system, which improves the delivery and efficacy of orally-availably pharmaceutical agents, including orally-available antibiotics. Furthermore, the method provides a delivery system with an unexpected and highly significant benefit in protection against pharmaceutical side effects, in particular antibiotic-induced weight loss.
• the vesicle platform has potential for exploitation for the oral delivery not only of antimicrobials, but also for a range of other therapeutics which may cause detrimental side-effects or require enhanced delivery.
• the method of the invention has the capability to entrap (i.e. bind and/or entrap) a variety of different antimicrobial agents in vesicles.
• Biphasic formulations were developed and assessed for stability in liquid and freeze- dried forms at multiple temperatures and time points. For example, optimised formulations of antibiotics using the method have been demonstrated to retain stability when held at -20 °C and full antimicrobial activity in vitro with values for Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) which do not differ from unformulated antibiotics.
• MIC Minimum Inhibitory Concentration
• MBC Minimum Bactericidal Concentration
• the stability of the freeze- dried biphasic formulations, at all temperatures tested and for three months duration stored in a lyophilised state highlights a realistic concept of use. Stability of adapted and/or novel therapeutic formulations is of increasing interest, especially when distributed to low-to-middle income countries (LMIC) where cold storage may not be readably available.
• LMIC low
• the methods devised by the inventors have been shown to enable production of vesicle platform technologies that are very adaptable to modification to aid delivery and can provided clear survival advantages in terms of efficacy of a pharmaceutical agent in vivo, compared to free (i.e. not bound and/or entrapped to a vesicle carrier) pharmaceutical agent. Furthermore, the invention significantly protects against the side effects (principally weight loss) arising from repeated dosing.
• vesicles of the invention are NISVs, for example as described in PCT/GB96/01861 which discloses use of empty NISVs as a therapeutic agent against conditions with elevated cytokines, or modified NISVs.
• a surfactant i.e.
• a compound capable of forming the NISV as a result of water-insoluble (or oil-soluble) and water-soluble components forming aggregates, such as micelles, in solution a hydrophobic substance capable of mixing with the surfactant to form a bi-layer on which the physical properties of the vesicle depends; and a charge-producing amphiphile to cause the vesicle to take on a negative charge, helping to stabilise the vesicles and provide effective dispersion.
• the selected vesicle constituents comprise a monopalmitoyl glycerol surfactant, a hydrophobic substance in the form of cholesterol and a dicetyl phosphate amphiphile.
• a monopalmitoyl glycerol surfactant e.g., a monopalmitoyl glycerol surfactant, a hydrophobic substance in the form of cholesterol and a dicetyl phosphate amphiphile.
• the surfactant, hydrophobic substance and amphiphile are provided in a 5:4:1 molar ratio respectively. This ratio has been shown to work particularly well in the method of the invention.
• the NISVs may incorporate a substance that facilitates the transport of fats, fatty acids and lipids across membranes in vivo (such vesicles termed hereafter ‘bilosomes’), as also described in PCT/GB96/01861.
• a bile salt is provided in the vesicle components and/or when dissolving a pharmaceutical agent in a pharmaceutically-acceptable carrier.
• the inventors have shown that, advantageously, bilosome delivery has no detectable toxicity in gut tissue and, furthermore, oral delivery of antibiotics in bilosomes has provided a significant survival advantage in two murine models of bacterial disease caused by B. pseudomallei and F. tularensis respectively.
• the bile salt is sodium deoxycholate, for example sodium deoxycholate in PBS.
• the vesicle components further comprise a ligand recognised by an in vivo receptor- mediated transport mechanism.
• ligand refers to a substance that can bind to, and/or form a complex with, a biomolecule such as a protein receptor, for example a host cell receptor. Association of the ligand with the vesicles produced by the method of the invention i.e. via incorporation by entrapment within and/or bound to the vesicles during formation of a pharmaceutical-vesicle, can facilitate transportation of the pharmaceutical-vesicle across a specific in vivo barrier or enter a specific in vivo niche (e.g. cell type, tissue type or an intracellular environment), for example as a result of a host receptor-mediated transport mechanism.
• the ligand is glucosamine and/or transferrin or any variant or fragment thereof.
• variants as used through the description with respect to a protein may refer to a sequence of amino acids which differ from the wild-type or base sequence from which they are derived, but wherein the variant retains the desired properties of the wild-type or base sequence.
• a variant derived from transferrin would retain a desired level of ligand structure/function relative to the original transferrin protein, and thus be considered a structural/functional variant.
• amino acid substitutions can be‘conservative’ i.e. replacing an amino acid with another amino acid with similar properties; or ‘non-conservative’ i.e. replacing with another amino acid with different properties.
• suitable variants are preferably at least 70% identical, for example at least 75% identical, at least 80% identical, at least 85% identical, at least 90% identical and preferably at least 95% identical compared to the wild-type or base sequence.
• fragment as used through the description with respect to a protein may refer to any amino acid portion of the wild-type or base sequence, typically wherein the fragment retains the desired properties (e.g. structural, functional) of the wild- type or base sequence.
• a protein fragment may be a sequence of 5-10 amino acids of the wild-type or base sequence of a protein which encodes a particular epitope, and thus be considered to be an epitope fragment.
• NISVs modified with glucosamine to form gNISVs
• tNISVs transferrin
• gNISVs glucosamine
• tNISVs transferrin-modified NISVs
• these glucosamine- and transferrin-modified NISVs have been successfully loaded with the anti-VEEV monoclonal antibody 1A3B-7, in particular the humanised version Hu1A3B-7.
• antibody-loaded gNISVs have been delivered by intravenous injection to Balb/c mice and the antibody cargo has been detected by immunohistochemistry in brain tissue, peaking at 90 minutes post- injection.
• the glucosamine is palmitoylated glucosamine. Palmitic acid is covalently linked to the glucosamine, enhancing the hydrophobicity of the glucosamine and therefore its ability to insert into the vesicle’s bilayer.
• This form (i.e. variant) of glucosamine is particularly suited to forming gNISVs, as palmitoylated glucosamine can be included in the vesicle formulation by dissolution in the organic phase used in automated protocols.
• the transferrin is thiolated using Traut’s reagent, which reacts with the primary amine groups to add a sulfhydryl group.
• a portion of the cholesterol is replaced by cholesterol-PEG-malemide such that a covalent bond forms between the thiolated ligand and the modified cholesterol.
• This arrangement enables cell- and/or tissue-targeting ligands to attach to the vesicles. Any ratio of cholesterol to cholesterol-PEG-malemide is envisaged but in particular 4:1 is preferred.
• Other cell- and/or tissue-targeting ligands can be attached to the vesicle in a similar manner and therefore target the resultant vesicles to other anatomical niches.
• the pharmaceutical agent-carrier mixture and vesicle components are provided in a respective ratio of 3:1.
• the inventors have shown this ratio to be particularly suited to the present invention, in particular for vesicles adapted to cross the BBB.
• the method steps of the invention are performed on a NanoAssemblr® for the preparation of modified vesicles such as gNISVs and tNISVs.
• NISV neoplasminogen activator
• gNISVs and tNISVs have been generated using the NanoAssemblr® which allows for automation and rapid scale-up of formulations.
• the utility of the NanoAssemblr® to rapidly produce, for example, brainsomes loaded with a range of antivirals (e.g. interferons such as IFN-a2p) highlights nanovesicles as a versatile and attractive drug delivery technology.
• the pharmaceutical-vesicle formulation can be frozen and lyophilised prior to storage and/or distribution.
• a cryoprotectant is added prior to freezing and lyophilisation, for example adding sucrose at 100 mM concentration.
• the subsequent storage of freeze-dried batches and demonstration of performance following re-hydration has been achieved.
• the pharmaceutical agent is an antibacterial agent and/or an antiviral agent.
• bilosome-formulated antibiotics exerted as much antimicrobial activity as unformulated antibiotics, indicating that the process of formulation had not adversely affected the antibiotic being tested. Furthermore, the data reported shows that the bilosome delivery of antibiotics not only provides a significant survival advantage, but also reduces the serious side effect of weight loss associated with repeated antibiotic dosing and infection.
• Freeze-dried biphasic NISV and bilosome antibiotic formulations were also assessed for their toxicity in vivo. Encapsulation of antibiotics was seen to be beneficial, in particular by alleviating antibiotic-induced weight loss and protecting from minor organ pathologies. In particular, the results demonstrated that bilosomes had no adverse effects on the murine microbiome. Furthermore, gross pathology data suggested that NISVs and bilosomes can, for example, protect against tissue damage caused by doxycycline. Thus, the NISV and bilosome formulations generated by the method of the invention are well-tolerated and have beneficial properties to counteract the side-effects of repeated, daily dosing with antibiotics.
• the antibacterial agent may be selected from the group of antibiotics including b- lactams (e.g. penicillins such as amoxicillin and flucloxacillin; cephalosporins such as cephalexin), aminoglycosides (e.g. streptomycin, kanamycin), chloramphenicol, glycopeptides (e.g. vancomycin), quinolones (e.g. fluoroquinolones such as ciprofloxacin, levofloxacin), oxazolidinones (e.g. linezolid, tedizolid), sulphonamides (e.g. sulfadiazine), tetracyclines (e.g.
• antibiotics including b- lactams (e.g. penicillins such as amoxicillin and flucloxacillin; cephalosporins such as cephalexin), aminoglycosides (e.g. streptomycin, kanamycin), chloramphen
• tetracycline doxycycline, oxytetracycline
• macrolides e.g. erythromycin, clarithromycin
• ansamycins e.g. geldanamycin, rifamycin
• streptomycins e.g. pristinamycin IA
• lipopeptides e.g. daptomycin
• the antibacterial agent is selected from a group comprising fluoroquinolones and tetracyclines.
• the antibacterial agent is selected from a group comprising levofloxacin, ciprofloxacin and doxycycline.
• the NISV and bilosome formulation technology has been adapted to successfully entrap at least 3 antibiotics (doxycycline, levofloxacin, ciprofloxacin) in NISVs and bilosomes.
• the mixture of components (monopalmitoyl glycerol, dicetyl phosphate and cholesterol) is heated rapidly, the chosen antibiotic(s) added and then processed to form the antibiotic-vesicle formulation.
• Bilosome formulations are prepared by adding bile salts, post-heating stage, at the same time as the antibiotic solution. Formulations with an antibiotic concentration may be 1 -100 mg/ml.
• the formulations generated are stable and retain antimicrobial activity in vitro and in vivo.
• characterisation has identified that encapsulation of levofloxacin into NISVs significantly increased survival of F. tularensis- infected galleria (a suitable invertebrate infection model).
• vesicle formulations can enhance therapy efficacy, with both the bilosome-levofloxacin and bilosome-doxycycline formulations increasing survival rate and time, compared to free antibiotic in a mouse model of melioidosis. Similar preliminary findings have been shown in an F. tularensis model of infection.
• NISVs and bilosomes protect against antibiotic-induced weight loss, for example following administration of ciprofloxacin or levofloxacin. Furthermore, encapsulation of levofloxacin in orally-delivered bilosomes increased accumulation in the liver by two-fold, thus maintaining antibiotic concentrations in this key organ for longer, with positive therapeutic implications.
• the antibacterial agent is at a concentration of 30 mg/ml.
• an antibiotic starting concentration of 30 mg/ml was found to work particularly effectively.
• concentration was achieved by adding antibiotic at a concentration of 30 mg/ml to the pharmaceutically- acceptable carrier, which in turn was added to the vesicle components and the formulation mixture processed.
• the pharmaceutical-vesicle formulation was resuspended in a volume and concentration of antibiotic in a pharmaceutically-acceptable carrier to give approximately equal antibiotic concentrations inside and outside the vesicles.
• the antiviral agent may be selected from the group of antivirals including inhibitors of viral penetration and uncoating, DNA polymerase inhibitors (e.g. acyclovir), mRNA inhibitors (e.g. ribavirin, carbodine), release inhibitors (e.g. neuraminidase inhibitors) and immunomodulators (e.g. interferons).
• DNA polymerase inhibitors e.g. acyclovir
• mRNA inhibitors e.g. ribavirin, carbodine
• release inhibitors e.g. neuraminidase inhibitors
• immunomodulators e.g. interferons
• the antiviral agent is selected from a group comprising IFN-g, IFN-a, carbodine, DZ-13 (Xie et al. Regulatory roles of c-jun in H5N1 influenza virus replication and host inflammation. Biochimica et Biophysica Acta. 1842(2014), 2479- 88) and an antiviral antibody or any variant or fragment thereof.
• the brainsomes developed by the inventors have been shown to be capable of entrapping large antibodies (including VEEV Hu1 A3B-7) and/or a cytokine (e.g. IFNa2p).
• gNISVs have been shown to enhance delivery of pharmaceutical agents (e.g. IgG Ab) in vivo to the brain compared to free antibody.
• the antiviral antibody is Hu1A3B-7 VEEV mAb or any variant or fragment thereof.
• NISV and gNISV delivery of Hu1A3B-7 VEEV mAb is advantageous compared to free mAb. Both platforms reduce viral load in the lung, and increase survival and reduce morbidity. Significantly, the gNISV platform reduces viral load in the brain.
• the invention also provides a pharmaceutical-vesicle formulation prepared according to the first aspect.
• the invention provides a pharmaceutical-vesicle formulation comprising: a) a vesicle comprising monopalmitoyl glycerol, cholesterol and dicetyl phosphate; b) a pharmaceutical agent; and c) a pharmaceutically- acceptable carrier.
• the monopalmitoyl glycerol, cholesterol and dicetyl phosphate are present in a 5:4: 1 molar ratio respectively.
• the pharmaceutical-vesicle formulation further comprises a ligand recognised by an in vivo receptor-mediated transport mechanism.
• the ligand is glucosamine and/or transferrin or any variant or fragment thereof.
• the vesicle component of the pharmaceutical-vesicle formulation is of a size of 50-4000 nm.
• the vesicle component is preferably 2700-3400 nm.
• the size is preferably 100-600 nm.
• the pharmaceutical agent is an antibacterial agent and/or an antiviral agent.
• the antibacterial agent is selected from a group comprising fluoroquinolones and tetracyclines.
• the antibacterial agent is selected from a group comprising levofloxacin, ciprofloxacin and doxycycline.
• the antibacterial agent is present at concentration of 30 mg/ml.
• the antiviral agent is selected from a group comprising IFN-g, IFN-a, carbodine, DZ-13 and an antiviral antibody or any variant or fragment thereof.
• the antiviral antibody is Hu1A3B-7 VEEV mAb or any variant or fragment thereof.
• the invention provides a pharmaceutical kit comprising the pharmaceutical-vesicle formulation according to the second aspect.
• the invention provides a pharmaceutical-vesicle formulation according to the second aspect, or a pharmaceutical kit according to the third aspect, for use as a medicament.
• the invention provides a pharmaceutical-vesicle formulation according to the second aspect, or a pharmaceutical kit according to the third aspect, for use as a medicament for the prevention or treatment of infection in an animal.
• the pharmaceutical-vesicle formulation of the invention could be administered to an animal via any route of administration e.g. parenteral delivery via intramuscular (into muscle), subcutaneous (under the skin), intra-dermal (into skin), intra-peritoneal (into the peritoneum body cavity), intravenous (into a vein), intra- nasal (via the nose) or inhalational administration.
• parenteral delivery via intramuscular (into muscle), subcutaneous (under the skin), intra-dermal (into skin), intra-peritoneal (into the peritoneum body cavity), intravenous (into a vein), intra- nasal (via the nose) or inhalational administration.
• parenteral delivery via intramuscular (into muscle), subcutaneous (under the skin), intra-dermal (into skin), intra-peritoneal (into the peritoneum body cavity), intravenous (into a vein), intra- nasal (via the nose) or inhalational administration.
• bilosomes it is preferable, in
• the pharmaceutical-vesicle formulation of the invention has shown to augment the benefit of an already bioavailable pharmaceutical agent, including: protecting against antibiotic-induced weight loss in animals: providing for improved target tissue deposition and concentration over time; providing immunomodulatory effects; and conferring a lack of toxicity in the gut, in particular against the gut microbiome.
• the animal is a human.
• the invention provides a pharmaceutical-vesicle formulation according to the second aspect, or the pharmaceutical kit according to the third aspect, for use in the prevention or treatment of infection by Burkholderia pseudomallei, Francisella tularensis or VEEV.
• the invention also provides for use of a NanoAssemblr® to prepare a pharmaceutical-vesicle formulation according to the first aspect.
• any feature in one aspect of the invention may be applied to any other aspects of the invention, in any appropriate combination.
• the method aspects may be applied to the pharmaceutical-vesicle formulation aspects, the pharmaceutical kit aspects and/or the use aspects and vice versa.
• the method of the invention extends to a pharmaceutical-vesicle formulation, pharmaceutical kit, and uses substantially as herein described, with reference to the Examples.
• the invention may comprise, consist essentially of, or consist of any feature or combination of features.
• Figure 1 shows graphs demonstrating the stability of biphasic formulations when stored at a range of temperatures in liquid or freeze-dried format
• Figure 2 shows graphs of in vivo assessment of antimicrobial function of levofloxacin formulated in NISVs in the Galleria mellonella model
• Figure 3 shows graphs of repeat dose tolerability studies for biphasic NISV and bilosome formulations of antibiotic:body weight changes
• Figure 4 shows a graph demonstrating weight change in mice control groups for a repeat safety/toxicology study
• Figure 5 shows a graph demonstrating weight change in mice following daily dosing with levofloxacin formulations in a repeat safety/toxicology study
• Figure 6 shows a graph demonstrating weight change in mice following daily dosing with deoxycycline formulations in a repeat safety/toxicology study
• Figure 7 shows a graph demonstrating weigh change in mice following daily dosing with ciprofloxacin formulations in a repeat safety/toxicology study
• Figure 8 shows graphs of broad microbiome analysis following treatment with antibiotic formulations
• Figure 9 shows graphs of the modulation of dendritic cell activation in the presence of NISVs
• Figure 10 shows graphs of the effect of bilosome-levofloxacin compared to free levofloxacin in an aerosol model of B. pseudomailer
• Figure 1 1 shows graphs of the effect of bilosome-doxycycline compared to free doxycycline in an aerosol model of B. pseudomallei
• Figure 12 shows graphs of animal weight data following exposure to an aerosol challenge of B. pseudomallei and treatment with bilosome-levofloxacin or free levofloxacin;
• Figure 13 shows a graph of the effect of bilosome-levofloxacin compared to free levofloxacin in an aerosol model of F. tularensis
• Figure 14 shows graphs of rabbit IgG antibody deposition in mouse tissues
• Figure 15 shows graphs of viral load in mice organs following treatment with different formulations of Hu1A3B-7 VEEV mAb.
• Figure 16 shows a graph of survival in mice in an aerosol model of VEEV following treatment with different Hu1A3B-7 VEEV mAb.
• the method of the invention provides a method for the preparation of a pharmaceutical-vesicle formulation, the method comprising the steps of: a) heating vesicle components comprising monopalmitoyl glycerol, cholesterol and dicetyl phosphate at a temperature in the range of 50 °C to 150 °C; b) dissolving a pharmaceutical agent in a pharmaceutically-acceptable carrier and heating the resultant pharmaceutical agent-carrier mixture at a range of 30-99 °C; c) adding the pharmaceutical agent-carrier mixture to the vesicle components to provide a formulation mixture; and d) processing the formulation mixture to form a pharmaceutical-vesicle formulation, whereby the pharmaceutical agent and carrier is entrapped within a plurality of vesicles; wherein the pharmaceutical-vesicle formulation is reconstituted in a known quantity of the pharmaceutical agent dissolved in a pharmaceutically-acceptable carrier to provide a biphasic pharmaceutical-vesicle formulation.
• the method of the invention provides a delivery system, in particular an oral delivery system, which improves the delivery and efficacy of orally-availably pharmaceutical agents, including orally-available antibiotics. Furthermore, the method provides a delivery system with an unexpected and highly significant benefit in protection against pharmaceutical side effects, for example antibiotic-induced weight loss. In particular, the inventors have shown efficacy of the present invention against B. pseudomallei, F. tularensis and VEEV.
• the antibiotics levofloxacin >98.0% (HPLC), doxycycline hyclate >98.0% (HPLC) and ciprofloxacin (Sigma-Aldrich) were obtained in dry powder form and used in all studies.
• the antibiotics were suspended in PBS at pre-determined concentrations.
• Humanised anti-VEEV monoclonal antibody was produced as previously described (S.A. Goodchild, L.M. O’Brien, J. Steven, M.R. Muller, O.J. Lanning, C.H, Logue, R.V. D’Elia, R.J. Phillpotts, S.D. Perkins.
• a humanised murine monoclonal antibody with broad serogroup specificity protects mice from challenge with Venezuelan equine encephalitis virus. Antiviral Res., 90(2011 ), 1 -8).
• CHO DG44 cells transfected with vector expressing Hu1A3B-7 were cultured in IMDM media supplemented with 10% (v/v) FBS, 1 % antimycotic, 25mg Gentamycin, 1 mM sodium pyruvate, 2mM glutamine, 1 % (v/v) pen/strep, 1 % (v/v) non-essential and 1 % (v/v) essential amino acids (Gibco) and 10mM methotrexate (Sigma).
• Humanised antibody was purified using protein A affinity chromatography using Prosep-A (Millipore) and dialysed into PBS.
• Burkholderia pseudomallei K96423 was used for in vitro and in vivo studies. Bacteria were grown in Luria broth at 37°C on a rotary platform for aerosol challenges and enumerated on L-Agar plates.
• F. tularensis strain LVS was derived from a vaccine ampoule stored at -20°C in DSTL’s culture collection. Bacteria were cultured overnight at 37°C on supplemented blood cysteine glucose agar (BCGA), harvested into PBS and diluted to obtain an OD 6 OO of between 0.15-0.20 (1 x 10 9 CFU/ml). Bacterial numbers for challenge were determined on agar following serial dilution (1 :10) of samples.
• Tissue culture The L929 (murine fibroblast) and Vero (simian kidney) cell lines (European Collection of Animal Cell Cultures, UK) were propagated by standard methods using the recommended culture media. For experimental purposes, cells were maintained in Leibovitz L-15 media supplemented with 2% (v/v) foetal calf serum, 2mM l-glutamine, 50 U/ml penicillin and 50pg/ml streptomycin (L15MM). Media and supplements were all supplied by Sigma-Aldrich (UK).
• virulent virus stocks of VEEV strain TrD To prepare virulent virus stocks of VEEV strain TrD, suckling mice were infected intracerebrally with ⁇ 103pfu virus. Infected brains were harvested at 24 hours, prepared as 10% tissue suspensions in L15MM and clarified by centrifugation at 10,000xg for 15 min. The titre was determined by plaque formation under a carboxymethyl cellulose overlay in Vero cells.
• Titration of virus The titre of virus was determined by plaque formation under a 1.5% (w/v) carboxymethyl cellulose overlay in Vero cells. Briefly, cells were seeded into 24-well plates (1 *10 5 cells well) and incubated overnight. Media was removed and the cells overlaid with 100mI of virus diluted in L15MM. After an incubation of 30 min at room-temperature, 1 ml of double-strength L15MM diluted in 3%(w/v) carboxymethyl cellulose was carefully added to each well. Cells were incubated for 72 hrs, fixed with 10% (v/v) formal saline overnight and then stained with 0.1 % (w/v) crystal violet. The plaques were counted and the amount of virus was calculated.
• 1-monopalmitoyl glycerol, cholesterol and dicetyl phosphate in a 5:4:1 molar ratio were combined and heated to 130°C.
• the relevant antibiotic at 30 mg/ml in PBS was added.
• the relevant antibiotic at 30 mg/ml with sodium deoxycholate in 0.025 M carbonate buffer was added.
• Antibiotics were pre-warmed to 60°C prior to addition to the vesicle constituents. Preparations were subsequently vortexed vigorously for 2 min. Antibiotics were either entrapped as vesicles were formed or after by 5 cycles of freeze-thawing.
• Non-entrapped antibiotic was removed through centrifugation and the pelleted vesicles resuspended in the appropriate buffer for monophasic preparation, or the appropriate buffer containing an amount of the appropriate antibiotic at a concentration equivalent to that entrapped within the vesicle to give biphasic preparations (i.e. 50/50 entrapped Tree preparation).
• NISVs were made by melting 24.8mg monopalmitoyl glycerol, 8.2mg dicetylphosphate, and 23.2mg cholesterol at 130°C, adding 5ml of warmed PBS and vortexing for 2 minutes.
• Sonicated vesicles were made by mixing the same vesicle components in 5ml PBS and heated to 90°C for 60 minutes and after which were sonicated using a probe sonicator for 4 minutes at 20% maximum capacity. To ensure sterility, all vesicles samples were irradiated using an X225 irradiator at 2.2 Gy per minute until a final dosage of 10 Gy.
• glucosamine 86.3mg was dissolved in 93mI of triethanolamine and 15ml of dimethylsulphoxide. This mixture was then added to 283mg of palmitic acid N- hydroxysuccinimide and dissolved in 4m! of chloroform. The solution was stirred for 48 hours at room temperature in the dark. The palmitoylated-glucosamine was precipitated out by chilling the mix and adding ice-cold water. The mix was then applied to a vacuum filter to separate the precipitate. Separate water, chloroform and ethanol washes were applied to the palmitoylated-glucosamine before drying at 40°C for 48 hours.
• Human holo-transferrin was modified with a thiol by mixing transferrin with a 10-fold molar excess of Traut’s reagent at 25°C for 1 hour. Excess Traut’s reagent was removed using a Vivaspin 6 column with a 5 kDa molecular weight cut-off.
• Vesicles were prepared using the NanoAssemblrTM benchtop (Precision Nanosytems) with a 300pm staggered herringbone micromixer chip held at a temperature of 60°C.
• the vesicle components; palmitin, cholesterol and dicetyl- phosphate were solubilised in menthol in 5:4:1 ratio with a total concentration of 5.62mg/ml and heated to 60°C.
• Antibodies either Rabbit IgG, mAb Hu1A3B-7 or Human IgG-FITC
• the aqueous and solvent streams were mixed at a ratio of 3:1 , with a combined flow rate of 12ml/min.
• Drug encapsulation and vesicle formulation occurs simultaneously within the microfluidic chip.
• the methanol and unentrapped drug were removed using a Vivaspin20 (Sartorious) spin column with a 300kDa molecular weight cut off. Concentration of entrapped antibody was determined using standard Bradford’s assay.
• gNISV were prepared in the same manner with the addition of 6.4mg palmitoylated glucosamine to the vesicle components dissolved in methanol.
• tNISV were synthesised by including PEG-Maleimide in the NISV mix.
• vesicles were incubated with the thiolated transferrin for 1 hour at 25°C Excess transferrin was then removed using a Vivaspin 20 column with a 100kDa molecular weight cut off.
• bilosome preparations Large batches of bilosome preparations were formulated and aliquoted for lyophilisation and storage. Aliquots were recovered as required and resuspended in reverse osmosis water, followed by vigorous agitation. Vesicle size and zeta- potentials were determined using a Malvern Zeta-sizer (Zetasizer 30000HS, Malvern Instruments Ltd., UK). Vesicles were pelleted by centrifugation and HPLC used to determine entrapped antibiotic content.
• HPLC analysis was carried out on an Agilent1290 Infinity Series HPLC, using a C18 column (150mm x 4.6mm, 5m) maintained at 50°C.
• the mobile phase for antibiotics consisted of 0.02M Na 2 HP0 4 , pH2 with H 3 P0 4 and either acetonitrile or methanol. Stability Studies
• NISV and bilosome preparations were formulated and aliquots placed at -20°C, 4°C, room temperature and 37°C either as liquid formulation or freeze-dried preparations. Aliquots were recovered at the various time-points and the freeze-dried preparations re-suspended in reverse osmosis water followed vigorous agitation. Vesicle size and zeta-potentials were determined using a Malvern Zeta-sizer (Zetasizer 30000HS, Malvern Instruments Ltd., UK). Vesicles were pelleted by centrifugation and HPLC used to determine entrapped drug content. PK/PD Studies
• Freeze-dried preparations of NISV and bilosome formulated antibiotic (50-100 mg/kg) were resuspended in reverse osmosis water and administered to animals by the intraperitoneal route or by gavage. Other groups of mice received the identical concentration of antibiotic as a solution.
• blood was obtained from superficial venesection at time points up to 24 hours.
• mice were sacrificed by terminal anaesthesia, blood collected from the heart and lung, liver and spleen harvested. Each tissue was weighed and 4x volume of saline added before homogenization. Samples were de-proteinated and passed through a 0.2 pm PFTE filter.
• MICs Minimum inhibitory concentrations
• MICs for antibiotic formulations were determined for B. pseudomallei strain K96243 and F. tularensis SchuS4 using the broth micro dilution method in accordance with the Clinical Laboratory Standards Institute (CLSI) guidelines. Assays were performed in 96 well micro-titre plates in Iso-sensitest broth (BSAC) or Mueller Hinton broth (CLSI), or broth suitable for pathogen requirements, with antibiotic concentrations in the range of 64 mg/L to 0.03 mg/L, and bacteria at a final concentration of approximately 5 x 10 5 CFU/mL. Following incubation at 37°C for 24 h the optical density (OD) of the plates was read in an automated plate reader at a wavelength of 590nm. MICs were determined as the concentration that inhibited >80 % of bacterial growth.
• BSAC Iso-sensitest broth
• CLSI Mueller Hinton broth
• MCCs Minimum bactericidal concentrations
• MBCs for antibiotic formulations were determined by plating 100 pL aliquots of the MIC dilutions showing no visible growth onto L-agar plates or BCGA plates in triplicate and incubating at 37°C for 48 hours. The MBC was recorded as the lowest concentration of antibiotic that killed 99.9 % of the bacteria in the original inoculum.
• G. mellonella caterpillars were stored in the dark. Caterpillars 0.2-0.3 g in weight were employed in all assays.
• a 10 ml Hamilton syringe was used to inject 10 ml aliquots of the inoculum (3 x 10 6 CFU/larvae of F. tularensis LVS) into the hemocoel of each caterpillar via the last left proleg. After infection, caterpillars were incubated in plastic containers.
• a 10 ml Hamilton syringe was also used to inject antimicrobial agents (levofloxacin 15 mg/kg) and controls (PBS) 24 hours post infection. Caterpillars were considered dead when the displayed no movement in response to touch.
• mice were allocated into groups of twelve mice, and treated via the oral route (0.1 ml/day at 10mg/ml concentration) with PBS, empty bilosomes, empty NISVs, antibiotic, NISV-antibiotic or bilosome-antibiotic on days 1-7. Faecal samples were collected three days prior to treatment, 24 hrs after the final dose (day 8), 14 days later (day 22) and 28 days after the cessation of treatment (day 36). Animal weights and condition were recorded daily. On day 8, half the mice in each group were sacrificed and serum, small intestine and large intestine were collected.
• mice Serum samples were stored frozen at -80°C, the large and small intestines were cleaned of contents, rolled into pinwheels and fixed in 10% formalin. The remaining mice were weighed and observed for an additional 28 days before they were sacrificed and serum and tissues harvested as described for the mice sacrificed on day 8.
• Genomic DNA was isolated from faecal samples using the PowerSoil® DNA Isolation Kit (Qiagen) following the manufacturer's instructions. As an alternative to the recommended 250mg of soil, approximately 200mg of faecal sample was added to the PowerBeads tube to undergo cell lysis. Purified DNA was eluted from the spin filter using 50uL of solution C6 and stored at -20°C until PCR amplification.
• the 16S universal Eubacterial primers 515F GTGCCAGCMGCCGCGGTAA and 806R GGACTACHVGGGTWTCTAAT were utilized to evaluate the microbial ecology of each sample on the HiSeq 2500 with methods via the bTEFAP® DNA analysis service.
• Each sample underwent a single-step 30 cycle PCR using HotStarTaq Plus Master Mix Kit (Qiagen, Valencia, CA) were used under the following conditions: 94°C for 3 minutes, followed by 28 cycles of 94°C for 30 seconds; 53°C for 40 seconds and 72°C for 1 minute; after which a final elongation step at 72°C for 5 minutes was performed.
• All amplicon products from different samples were mixed in equal concentrations and purified using Agencourt Ampure beads (Agencourt Bioscience Corporation, MA, USA). Samples were sequenced utilizing the lllumina HiSeq chemistry following manufacturer’s protocols.
• the Q25 sequence data derived from the sequencing was processed using a proprietary analysis pipeline (www.mrdnalab.com, MR DNA, Shallowater, TX). Sequences were depleted of barcodes and primers then short sequences ⁇ 200bp were removed, sequences with ambiguous base calls removed, and sequences with homopolymer runs exceeding 6bp removed. Sequences were then de-noised and chimeras removed. Operational taxonomic units (OTUs) were defined after removal of singleton sequences, clustering at 3% divergence (97% similarity).
• OFT Operational taxonomic units
• OTUs were then taxonomically classified using BLASTn against a curated GreenGenes/RDP/NCBI derived database and compiled into each taxonomic level into both“counts” and“percentage” files. Counts files contain the actual number of sequences while the percent files contain the relative (proportion) percentage of sequences within each sample that map to the designated taxonomic classification.
• Bone marrow cells were obtained from the femurs of 8-wk-old male BALB/c mice and differentiated into dendritic cells using GM-CSF-enriched complete DMEM (DMEM 10% foetal calf serum, 100 U/ml penicillin, 100 pg/ml streptomycin and 2 mM L-glutamine). This routinely results in 80% CD1 1 c+ cells.
• GM-CSF-enriched complete DMEM DMEM 10% foetal calf serum, 100 U/ml penicillin, 100 pg/ml streptomycin and 2 mM L-glutamine. This routinely results in 80% CD1 1 c+ cells.
• BMDCs were then seeded at 1x10 6 cells/well on 24-well tissue culture plates in complete RPMI (RPMI 1640 10% foetal calf serum, 100U/ml penicillin, 100 pg/ml streptomycin and 2 mM L- glutamine) and stimulated with LPS (3 pg/ml) or left unstimulated as controls.
• Cells were simultaneously treated with NISV produced by the melt method, or the sonication method, or left untreated. Cells were harvested 24 hours later and stained with a 1/100 dilution of anti-CD40-APC, anti-CD80-PerCP and anti-CD86-PE-Cy7 before analysis by flow cytometry. Compensation and PMT voltages were set up using single stained controls. Fluorescent minus one (FMO) control was used in order to identify the correct gating strategy and was used in order to produce a negative control. Animal infection studies
• mice Six to eight week old female BALB/c mice (Charles River, UK) were transferred to a high containment Class III rigid isolator, where they were given unlimited access to food and water and allowed to acclimatise for at least 5 days. Mice were allocated to treatment groups (15 per group) and housed in cages of 5. Mice were challenged with 50-100 CFU (10MLD) of B. pseudomallei K96243 or F. tularensis SchuS4 via the aerosol route in a nose-only exposure system using a computerised delivery platform (Biaera Technologies). A sub-optimal therapy study design was used, in which antibiotic administration was started at 6h post-infection and administered once daily for only 7 days, to test therapeutic efficacy.
• CFU CFU
• the antibiotics levofloxacin and doxycycline were delivered daily by the oral route at 50mg/kg and treatment was continued for 7 days.
• the treatment groups comprised bilosome-delivered antibiotics or unformulated antibiotics.
• a subgroup of 5 mice per treatment group was culled at day 3 p.i. to determine bacterial loads in lung, spleen and liver.
• Mice were challenged with VEEV Trinidad Donkey Strain by aerosol using a Biaeara aerosol device. Mice were checked twice daily and scored for clinical symptoms and mice were weighed daily. Mice reaching a humane end-point, based on a pre-deter ined set of objective clinical signs, were promptly culled. Survival times were recorded for some mice and others were culled for analysis of tissues at different time points. All procedures and housing complied with the UK Animal (Scientific Procedures) Act (1986).
• VEEV strain TrD present in mouse tissues (brain, lung, liver and spleen) was determined by titration in Vero cells. Tissues were removed and homogenized in 2 ml L15MM by passing them through a 70 pm nylon cell strainer (BD Falcon). Cell suspension was then diluted serially (1 :10) in L15MM. Diluted homogenate (100 pi) was added to wells of a 24-well plate containing confluent monolayers of Vero cells. The cells were incubated for 72 hrs, after which time the monolayers were fixed by the addition of 10% (v/v) formal saline and stained with 0.1 % (w/v) crystal violet. Cytokine analysis
• cytokine analysis 200 ml aliquots of cell suspension were centrifuged for 5 min at 2000 rpm. Supernatants were removed for cytokine analysis and stored at -80C. The levels of cytokine were measured via 23-plexmurine Luminex array (Bio-Rad), used in accordance with the manufacturer’s instructions. In addition, a magnetic plate washer (Bio-Rad) was used for wash steps and samples were ultimately fixed using 4% paraformaldehyde in PBS for at least 24 h at 4°C.
• FFPE Formalin-fixed Paraffin-embedded
• tissue sections were used for immunohistochemical detection of rabbit IgG with light microscopy, using the same antigen retrieval method (PK).
• the dewaxing/rehydration protocol included a step of endogenous peroxidase quench using a solution of hydrogen peroxide in methanol.
• the reaction was developed using NOVARED (Vector).
• Encapsulation efficiency was determined by removing non-entrapped antibiotic by centrifugation and re-suspending the pellet in an appropriate buffer for immediate analysis via HPLC. The value generated represents the amount of antibiotic that was entrapped into the vesicles. Both monophasic and biphasic formulations were tested for stability, as determined by the retention of the antibiotic in each formulation type over time using HPLC for quantification. The zeta potential and size of the NISV and bilosome samples was also measured.
• biphasic formulations were far superior to the monophasic formulations and so after the first two time points, only the biphasic formulations were continued in the stability assays.
• the biphasic formulations of both NISVs and bilosomes were tested both as liquid and as freeze-dried preparations and at a range of temperatures (37°C, room temperature, 4°C and -20°C). While optimum stability has been demonstrated by biphasic bilosomes stored freeze-dried, all of the biphasic formulations were relatively stable in terms of antibiotic retention, for the time elapsed in the study (3 months).
• Biphasic antibiotic formulations were made as previously described and either left as a liquid solution or subsequently freeze dried (FD) Both formulations were left as a variety of different storage temperatures (37°C, room temperature, 4°C or -20°C) and assayed at multiple time points post manufacture (1 week, 1 month, 3 months) to determine the level of antibiotic that has remained internalised in the vesicle. FD formulations were rehydrated at each time point for the assay. Data are presented as a percentage of the initial entrapped antibiotic).
• Table 1 Total loading, percentage entrapment and zeta potential of bilosome formulations. The values presented in the table are generated from making bilosomes via the melt method with entrapped concentrations determined via HPLC following removal of free antibiotic. Size and zeta potential measurements were determined by a Malvern Zeta-sizer and data are presented as raw values for 3 independent samples. Means and SEM are highlighted.
• the stability (determined via Zeta potential) of the bilosome formulations was tested as freeze-dried preparations at a range of temperatures (room temperature, +4°C and -20°C) and at a range of time post-manufacture (1 week, 1 month and 3 months) (Table 2).
• the bilosome zeta potential remained relatively consistent across all time points and all temperatures.
• Table 2 Stability of bilosomes with time and storage conditions, as measured by zeta potential.
• Bilosome antibiotic formulations were made as previously described and subsequently freeze dried (FD). Formulations were left at a variety of different storage temperature (37°C, Room Temperature, 4°C or -20°C) and assayed at multiple time points post manufacture (1 week, 1 month and 3 months) to determine the zeta potential of the vesicles. FD formulations were rehydrated at each time point for the assay. Measurements were determined by a Malvern Zeta- sizer and data are presented as raw values (zeta potential) for 3 independent samples per time point and per storage conditions. Means and SEM are highlighted in bold.
• NISV- and bilosome-formulated antibiotics exerted as much antimicrobial activity as unformulated antibiotics (Table 3), indicating that the process of formulation had not adversely affected the antibiotic cargo.
• the inventors have also carried out some preliminary in vivo screening in a simple model. Using the wax moth larva ( Galleria mellonella) model, challenged with F.
• Table 3 In vitro assessment of antimicrobial properties of formulated antibiotics by determination of MIC and MBC. Values represented on the table are the median value generated from 3 independent experiments with 3 technical repeats in each experiment. MIC is the lowest concentration that inhibits growth i.e. value is recorded when growth is less than 10% of positive control measured by OD. MBC is the lowest concentration that prevents 99.9% of positive control growth i.e. No bacterial colonies present from 10pl drops on agar plates.
• PK/PD pharmacokinetic/pharmacodvnamics
• NISVs and bilosomes incorporating levofloxacin were selected as the lead formulations for PK/PD analysis in vivo.
• Table 4 PK/PD analysis for biphasic formulations of levofloxacin in NISVs and bilosomes. Summary of key PK/PD metrics following dosing via the intraperitoneal or oral route with free, NISV and bilosome levofloxacin formulations in the blood, liver and spleen. Groups of 5 Balb/c mice were dosed and culled at 0.25, 0.5, 1 , 2, 4, 8, 16 and 24 hours post treatment. Naive mice were used as controls. Cmax, Tmax and AUC data were calculated using standard formulae from raw data.
• mice in each group were sacrificed and necropsies performed. The remaining mice were weighed and observed for an additional 7 days before necropsies were performed. No abnormal findings were noted on day 15 or day 22 in groups treated with any ciprofloxacin or levofloxacin antibiotic formulations. Some minor pathological observations were made in the doxycycline-treated groups. On day 15 no abnormal findings were noted in mice receiving doxycycline orally, but mice receiving doxycycline via IP injection had rounded edges on the liver and peritoneal adhesions, involving the peritoneal wall and the intestines (large and small). These findings were consistent in all animals in both IP groups (NISV and PBS).
• mice receiving doxycycline bilosomes orally On day 22, again no abnormal findings were noted in mice receiving doxycycline bilosomes orally.
• group receiving doxycycline in PBS orally two mice had slightly rounded edges to the lobes of the liver.
• mice treated with doxycycline via the intraperitoneal routes minor peritoneal adhesions were seen in some of the NISV encapsulated groups, but all mice treated with the PBS- doxycycline formulation showed peritoneal adhesions involving spleen, pancreas, intestines and kidney.
• NISV and bilosome formulations of antibiotics significantly improve tolerability, with tissue protecting effects, for repeated dosing of antibiotics.
• mice treated with levofloxacin in PBS lost an average of 3.3% of their starting weight by Day 8, and had a mean weight gain of 3.2% on Day 36.
• mice treated with empty-doxycycline bilosomes lost an average of 0.9% of their starting weight by Day 8, and had a mean weight gain of 1.5% on Day 36.
• AUC Area Under the Curve
• mice were administered antibiotic and the microbiome characterised by next generation sequencing. Genus data was categorised into specific phyla to which they belong and percentage abundance for each treatment group was calculated. Data was graphed on area charts/stacked bar charts.
• a total of fifty-nine (59) genera were defined as high frequency (present in at least 75% of specimens). There was some variation in the presence of these 59 genera in the baseline samples, but at least 57 genera were present in all groups. Slight reductions in representation were seen on days 8 and 22, with some recovery by day 36. The content of the doxycycline-bilosome group was substantially lower than all the other groups at all time points. Upon evaluation of the data, it became clear that this was due to a near-complete absence of Clostridia sequences in this group, which were present at high levels in all other groups.
• a total of eighty-one (81 ) genera were defined as low frequency (present in less than 25% of specimens). No more than 15 of these 81 genera were present in any one group at any time point, with most genera being absent from most specimens. In total, these genera accounted for very little of the total microbial complement, however the data suggest that bilosome levofloxacin treated groups had a more diverse microflora for these low frequency genera.
• bilosome platform is well tolerated in vivo and may encourage the restoration of bacteriodetes and growth of beneficial bacteria (Verucomicrobia) in the gut following antibiotic disturbance.
• Bone marrow cells were obtained from the femurs of 8-wk-old male BALB/c mice and differentiated into bone marrow-derived dendritic cells (BMDCs) using GM-CSF- enriched media. This routinely resulted in 80% CD1 1c + cells.
• BMDCs were then seeded at 5 c 10 5 cells/well on 96-well microtiter tissue culture plates and stimulated with LPS (3ug/ml) or left unstimulated as controls. Cells were simultaneously treated with NISV produced by the melt method, or the sonication method (sn NISV), or left untreated. Cells were harvested 24 hrs later and stained with antibodies to CD40, CD80 or CD86 before analysis by flow cytometry.
• CD40, 80 or 86 levels were not affected in non-LPS stimulated cells treated with either NISV formulation ( Figure 9; *p ⁇ 0.05, **p ⁇ 0.01 ).
• CD40 and CD80 levels were downregulated in LPS- stimulated cells treated with either NISV formulation ( Figure 9).
• CD86 levels were augmented in LPS- stimulated cells treated with either NISV formulation, which is typical of the maturation of myeloid DCs ( Figure 9).
• the efficacy of bilosome formulations of levofloxacin and doxycycline was tested in an aerosol model of melioidosis, using a sub-optimal therapy study design, in which antibiotic administration was started at 6 hours post-infection and administered once daily via the oral route for only 7 days, to test therapeutic efficacy.
• the treatment groups comprised bilosome-delivered antibiotics or unformulated antibiotics, with control groups receiving PBS or empty bilosomes.
• mice were treated with bilosome-delivered levofloxacin p.i. with F. tularensis.
• Antibiotic therapy (20 mg/kg) was commenced at 72 hours after exposure to 100 cfu of aerosolised F. tularensis SchuS4 (approximately 20 MLD) and delivered daily for only 3 days to groups of 15 mice.
• Animals receiving bilosome-delivered levofloxacin by the oral route had a significantly (p ⁇ 0.05) extended time to death, compared with those receiving free levofloxacin (Figure 13). This result provides further evidence of the advantages of bilosome delivery of antibiotics.
• mice administered bilosome-entrapped levofloxacin had significantly reduced levels of some key inflammatory cytokines, compared to those mice receiving unformulated levofloxacin (p ⁇ 0.05: IL-6 lung, IL-13 spleen, Eotaxin Liver, GM-CSF lung and liver, MIP1 b liver).
• IL-6 lung, IL-13 spleen, Eotaxin Liver, GM-CSF lung and liver, MIP1 b liver Analysis of cytokine levels in Burkholderia-mtected mice has shown similar trends.
• NISVs In order to develop an effective therapy for the encephalitic viruses (e.g. VEEV), NISVs have been modified to facilitate their passage across the blood brain barrier (BBB). This approach has been achieved by coating with palmitoylated glucosamine, or covalently linking the cholesterol moiety in the NISV formulation to transferrin, to create gNISV and tNISV respectively (‘brainsomes’). Palmitoylated glucosamine has been incorporated into gNISV with a view to binding Glut-1 receptors (prevalent in the endothelial tissues of the BBB) in vivo. Similarly, tNISV have been prepared by thiolation of human holo-transferrin to allow it to bind a maleimide modified cholesterol component substituted for a portion (29%) of the normal cholesterol included in NISVs.
• BBB blood brain barrier
• Table 5 Physiochemical characterization of NISV variants loaded with antiviral cargo (or surrogate).
• Nanovesicle production (brainsomes and bilosomes) has been successfully scaled- up in the NanoAssemblr®, with the aim of achieving a routinely automated and consistent manufacturing process to prepare nanovesicles with selected coatings and of optimized size ranges.
• NISV, brainsomes and bilosomes have all been successfully made using the NanoAssemblr® (Table 6). Modification of NISVs to provide brainsomes had no significant effect on properties of zeta potential or vesicle size, compared with non-coated NISVs.
• gNISV were stained with Hoechst dye as a model cargo, since the dye is unable to cross the BBB under normal circumstances. Stained gNISV were injected intravenously in the Balb/c mouse and brain tissue removed at 90 minutes. As expected, Hoescht dye alone did not cross the BBB and was not detected in brain. gNISV with encapsulated Hoechst dye crossed the BBB to stain the nuclei of cells, whereas little nuclear staining was detected with unmodified NISV encapsulating Hoechst dye. These data indicate that the gNISV are able to cross the BBB and release their cargo.
• gNISVs have subsequently been used to encapsulate a polyclonal rabbit antibody (MW 150kDa), with the intention ultimately of encapsulating the humanised anti-VEEV monoclonal IgG, Hu1A3B-7.
• MW 150kDa polyclonal rabbit antibody
• VEEV mAb Hu1A3B-7 S.A. Goodchild, L.M. O’Brien, J. Steven, M.R. Muller, O.J. Lanning, C.H, Logue, R.V. D’Elia, R.J. Phillpotts, S.D. Perkins.
• a humanised murine monoclonal antibody with broad serogroup specificity protects mice from challenge with Venezuelan equine encephalitis virus.
• Antiviral Res., 90(201 1 ), 1 -8; further disclosed in WO201 1036435A1 ) was the chosen antiviral used during in vivo infection studies.
• a lethal aerosol model of VEEV infection was used with BALB/c mice exposed to ⁇ 300PFU of VEEV Trinidad Donkey strain. This challenge causes clinical signs of infection at approximately 2 days p.i. with time to death between 5-6 days.
• Table 7 Animal study plan for NISV and gNISV mAb intravenous treatment of aerosol VEEV infection.
• Table 8 Animal study plan for NISV and gNISV mAb intraperitoneal treatment of aerosol VEEV infection. Identical treatment groups (PBS control, Empty vesicle control, VEEV Hu1A3B-7 mAb, NISV Hu1A3B-7 mAb and gNISV Hu1A3B-7 mAb) were assessed using the aerosol VEEV model, with therapy again given once at 24 hours via the intraperitoneal route. In these studies a total of 15 mice per treatment group were used, with 5 mice being culled for virology analysis at day 5 p.i. and the remaining 10 mice monitored for survival.
• NISV-entrapped mAb was also significantly different from free Hu1A3B-7 mAb in terms of viral titre in the lung (p ⁇ 0.001 ).
• NISV entrapped mAb also performed better in the spleen compared to PBS and free Hu1A3B-7 VEEV mAb (p ⁇ 0.001 and ⁇ 0.05 respectively).
• NISV and gNISV delivery of Hu1A3B-7 VEEV mAb is advantageous compared to free mAb.
• Both platforms reduce viral load in the lung, and increase survival and reduce morbidity.
• the gNISV platform reduces viral load in the brain. This would suggest that the vesicles specifically designed to deliver cargo such as pharmaceutical agents to the brain are capable of targeting this tissue and delivering therapeutically-relevant concentrations of cargo.

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