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. 2021 Sep;16(5):633-642.
doi: 10.1016/j.ajps.2021.07.003. Epub 2021 Aug 3.

A practical strategy to subcutaneous administered in-situ gelling co-delivery system of arsenic and retinoic acid for the treatment of acute promyelocytic leukemia

Affiliations

A practical strategy to subcutaneous administered in-situ gelling co-delivery system of arsenic and retinoic acid for the treatment of acute promyelocytic leukemia

Xiao Liu et al. Asian J Pharm Sci. 2021 Sep.

Abstract

Arsenic trioxide (ATO) combined with all trans retinoic acid (ATRA) is the first choice for the treatment of low and medium risk acute promyelocytic leukemia (APL). Clinical studies reported that the combination of ATO and ATRA could achieve a significant curative effect. However, the retinoic acid syndrome, serious drug resistance and the short half-life in vivo which lead to frequent and large dose administration limit the application of ATRA. In addition, the preparations of arsenic are conventional injections and tablets in clinic, which has poor patients' compliance caused by frequent long-term administration and serious side effects. In order to overcome the above limitations, a phospholipid phase separation gel (PPSG) loaded with ATO and ATRA was developed. ATO+ATRA-PPSG (AAP), as a biodegradable sustained-release delivery system, was the first achievement of co-delivery of hydrophilic ATO and lipophilic ATRA with high drug loading which is the main problem in the application of nano preparation. The prepared PPSG displayed high safety and biocompatibility. The drug in PPSG was released slowly and continuously in vivo and in vitro for up to 10 d, which could reduce the side effects caused by the fluctuation of blood drug concentration and solve the problem of the long treatment cycle and frequent administration. In vivo pharmacokinetics depicted that PPSG could improve the bioavailability, decrease the peak concentration, and prolong the t1/2 of ATO and ATRA. Particularly, AAP significantly inhibited the tumor volume, extended the survival period of tumor-bearing mice, and promoted the differentiation of APL cells into normal cells. Therefore, ATO+ATRA-PPSG not only could co-load hydrophilic ATO and lipophilic ATRA according to the clinical dosage, but also possessed the sustained-release and long-acting treatment effect which was expected to reduce administration time and ameliorate compliance of patients. Thus, it had great potential for clinical transformation and application.

Keywords: All trans retinoic acid; Arsenic trioxide; Bioavailability; Compliance; Phospholipid phase separation gel; Sustained-release.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
(A) The phase transformation of PPSG in vitro. (B) The phase transformation of PPSG in vivo. (C) Viscosity profiles of PPSG and AAP in solution and gel states (***P < 0.001). (D) In vitro release of ATO and ATRA in PBS and PBS containing 2% SDS (pH 7.4) at 37 °C. Data were presented as mean ± SD, n = 3.
Fig 2
Fig. 2
In vivo images of mice after subcutaneous injection of DIR and PPSG-DIR (n = 4).
Fig 3
Fig. 3
(A) Mean ATO plasma concentration-time curves of the free ATO and AAP. (B) Mean ATRA plasma concentration-time curves of the free ATRA and AAP. (each point represented the mean ± SD, n = 3).
Fig 4
Fig. 4
In vivo efficacy of saline, free AA, PPSG, ATO-PPSG and AAP on xenotransplantation model. Body weight (A), tumor volume (B) and percent survival (C) of tumor-bearing nude mice after subcutaneous injection. (*P < 0.05, **P < 0.01, ***P < 0.001). Serum biochemical indexes including ALT (D), ALP (E), Creatinine (F) and (G) CD11b+ cells percentage of tumor-bearing nude mice at Day 18 after treated with saline, PPSG, free AA, ATO-PPSG and AAP. (each point represented the mean ± SD, n = 6).
Fig 5
Fig. 5
H&E staining of heart, liver, spleen, lung and kidney from each group at Day 18 after subcutaneous injection of saline, PPSG, free AA, ATO-PPSG and AAP, compared with the healthy mouse (scale bar, 250 μm). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig 6
Fig. 6
(A) The appearance of the skin at the injection site (red circles). (B) H&E staining of skin from each group at the injection site in 30 d (scale bar, 250 μm). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig 7
Fig. 7
H&E staining of heart, liver, spleen, lung and kidney from each group in 30 d after subcutaneous injection of AAP (scale bar, 250 μm).

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