M. Douglas Baumann

An injectable drug delivery platform for sustained combination therapy

We report the development of a series of physical hydrogel blends composed of hyaluronan (HA) and methyl cellulose (MC) designed for independent delivery of one or more drugs, from 1 to 28 days, for ultimate application in spinal cord injury repair strategies. To achieve a diversity of release profiles we exploit the combination of fast diffusion-controlled release of dissolved solutes from the HAMC itself and slow drug release from poly(lactide-co-glycolide) particles dispersed within the gel. Delivery from the composite hydrogels was demonstrated using the neuroprotective molecules NBQX and FGF-2, which were released for 1 and 4 days, respectively; the neuroregenerative molecules dbcAMP and EGF, and proteins alpha-chymotrypsin and IgG, which were released for 28 days. alpha-chymotrypsin and IgG were selected as model proteins for the clinically relevant neurotrophin-3 and anti-NogoA. Particle loaded hydrogels were significantly more stable than HAMC alone and drug release was longer and more linear than from particles alone. The composite hydrogels are minimally swelling and injectable through a 30 gauge/200 microm inner diameter needle at particle loads up to 15 wt.% and particle diameters up to 15 microm.

Intrathecal delivery of a polymeric nanocomposite hydrogel after spinal cord injury

Major traumatic spinal cord injury (SCI) results in permanent paralysis below the site of injury. The effectiveness of systemically delivered pharmacological therapies against SCI can be limited by the blood-spinal cord barrier and side effects. Local drug delivery to the injured spinal cord can be achieved using a minimally invasive biopolymer matrix of hyaluronan and methylcellulose injected into the intrathecal space, bypassing the blood-spinal cord barrier and overcoming limitations of existing strategies. Composite hydrogels of drug-loaded poly(lactide-co-glycolide) (PLGA) nanoparticles dispersed in this biopolymer matrix meet the in vitro design criteria for prolonged local release. Using a blank (without drug) composite designed for 28-day sustained release, we presently explore the mechanism of particle-mediated hydrogel stabilization in vitro and aspects of biocompatibility and safety in vivo. The composite hydrogel is well tolerated in the intrathecal space of spinal cord injured rats, showing no increase in inflammation, scarring, or cavity volume relative to controls, and no significant effect on locomotor function up to 28 days. Furthermore, there was no effect on locomotor function in healthy animals which received the composite hydrogel, although a qualitative increase in ED-1 staining was apparent. These data support the further development of composite hydrogels of hyaluronan and methylcellulose containing PLGA nanoparticles for sustained local delivery to the injured spinal cord, an application for which there are no approved alternatives.

Enhanced neurotrophin-3 bioactivity and release from a nanoparticle-loaded composite hydrogel

Neurotrophin-3 (NT-3) has shown promise in regenerative strategies after spinal cord injury; however, sustained local delivery is difficult to achieve by conventional methods. Controlled release from poly(lactic-co-glycolic acid) (PLGA) nanoparticles has been studied for numerous proteins, yet achieving sustained release of bioactive proteins remains a challenge. To address these issues, we designed a composite drug delivery system comprised of NT-3 encapsulated in PLGA nanoparticles dispersed in an injectable hydrogel of hyaluronan and methyl cellulose (HAMC). A continuum model was used to fit the in vitro release kinetics of an NT-3 analog from a nanoparticle formulation. Interestingly, the model suggested that the linear drug release observed from composite HAMC was due to a diffusion-limiting layer of methyl cellulose on the particle surface. We then studied the effects of processing parameters and excipient selection on NT-3 release, stability, and bioactivity. Trehalose was shown to be the most effective additive for stabilizing NT-3 during sonication and lyophilization and PLGA itself was shown to stabilize NT-3 during these processes. Of four excipients tested, 400g/mol poly(ethylene glycol) was the most effective during nanoparticle fabrication, with 74% of NT-3 detected by ELISA. Conversely, co-encapsulation of magnesium carbonate with NT-3 was the most effective in maintaining NT-3 bioactivity over 28 days according to a cell-based axonal outgrowth assay. Together, the modeling and optimized processing parameters provide insight critical to designing a controlled bioactive release formulation for ultimate testing in vivo.

The effects of intrathecal injection of a hyaluronan-based hydrogel on inflammation, scarring and neurobehavioural outcomes in a rat model of severe spinal cord injury associated with arachnoiditis

Traumatic spinal cord injury (SCI) comprises a heterogeneous condition caused by a complex array of mechanical forces that damage the spinal cord - making each case somewhat unique. In addition to parenchymal injury, a subset of patients experience severe inflammation in the subarachnoid space or arachnoiditis, which can lead to the development of fluid-filled cavities/syringes, a condition called post-traumatic syringomyelia (PTS). Currently, there are no therapeutic means to address this devastating complication in patients and furthermore once PTS is diagnosed, treatment is often prone to failure. We hypothesized that reducing subarachnoid inflammation using a novel bioengineered strategy would improve outcome in a rodent model of PTS. A hydrogel of hyaluronan and methyl cellulose (HAMC) was injected into the subarachnoid space 24 h post PTS injury in rats. Intrathecal injection of HAMC reduced the extent of fibrosis and inflammation in the subarachnoid space. Furthermore, HAMC promoted improved neurobehavioural recovery, enhanced axonal conduction and reduced the extent of the lesion as assessed by MRI and histomorphometric assessment. These findings were additionally associated with a reduction in the post-traumatic parenchymal fibrous scar formation as evidenced by reduced CSPG deposition and reduced IL-1α cytokine levels. Our data suggest that HAMC is capable of modulating inflammation and scarring events, leading to improved functional recovery following severe SCI associated with arachnoiditis.

Localized and Sustained Delivery of Fibroblast Growth Factor-2 from a Nanoparticle-Hydrogel Composite for Treatment of Spinal Cord Injury

After traumatic spinal cord injury, grossly injured blood vessels leak blood and fluid into the parenchyma, leading to a large cystic cavity. Fibroblast growth factor-2 (FGF2) can reduce immediate vasoconstriction of vessels in the tissue surrounding the primary injury and promote angiogenesis. A localized delivery system would both achieve restricted delivery of FGF2 to the spinal cord and limit possible systemic effects such as mitogenesis. To enhance the endogenous angiogenic response after spinal cord injury, FGF2 was encapsulated in poly(lactide-co-glycolide) (PLGA) nanoparticles which were embedded in a biopolymer blend of hyaluronan and methylcellulose (HAMC) and then injected into the intrathecal space. Treatment began immediately after a 26 g clip compression spinal cord injury in rats and consisted of intrathecal delivery of FGF2 from the HAMC/PLGA/FGF2 composite. Control animals received intrathecal HAMC loaded with blank nanoparticles, intrathecal HAMC alone or intrathecal artificial cerebrospinal fluid alone. Sustained and localized delivery of FGF2 from composite HAMC/PLGA/FGF2 achieved higher blood vessel density in the dorsal horns 28 days post-injury, due to either greater angiogenesis near the epicenter of the injury or vasoprotection acutely after spinal cord injury. Importantly, delivery of FGF2 from composite HAMC/PLGA/FGF2 did not produce proliferative lesions that had been previously reported for FGF2 delivered locally using a minipump/catheter. These results suggest that localized and sustained delivery with composite HAMC/PLGA/FGF2 is an excellent system to deliver biomolecules directly to the spinal cord, thereby circumventing the blood spinal cord barrier and avoiding systemic side effects.

Intrathecal drug delivery strategy is safe and efficacious for localized delivery to the spinal cord

Neuroprotective and neuroregenerative strategies for spinal cord injury repair are limited in part by poor delivery techniques. A novel drug delivery system is being developed in our laboratory that can provide localized release of therapeutically relevant molecules from an injectable hydrogel. Design criteria were established for the hydrogel to be--injectable, fast-gelling, biocompatible, biodegradable and able to release biologically active therapeutics when injected into the intrathecal space that surrounds the spinal cord. This novel way of localized drug delivery to the spinal cord was tested first with a collagen gel and then with a new hydrogel blend of hyaluronan and methylcellulose (HAMC). The underlying principle that this novel methodology is both safe and able to provide localized delivery was proven with a fast gelling collagen solution. Using a recombinant human epidermal growth factor, rhEGF, dispersed in collagen, we demonstrated localized release to the injured spinal cord. We extended this technology to other fast-gelling systems and found that HAMC was injectable due to the shear thinning property of hyaluronan (HA), biocompatible and had some therapeutic benefit when injected into the intrathecal space using a compression injury model in rats.

In vitro sustained release of bioactive anti-NogoA, a molecule in clinical development for treatment of spinal cord injury.

Anti-NogoA is a promising anti-inhibitory molecule that has been shown to enhance functional recovery after spinal cord injury when delivered in rat and primate models over the span of weeks. To achieve this sustained release, anti-NogoA is typically delivered by osmotic minipumps; however, external minipumps are susceptible to infection. To address this issue, we developed a drug delivery system that consists of anti-NogoA-loaded poly(lactic-co-glycolic acid) nanoparticles dispersed in a hydrogel of hyaluronan and methylcellulose (composite HAMC). To optimize in vitro release, we screened formulations for improved anti-NogoA bioactivity and sustained release based on combinations of co-encapsulated trehalose, hyaluronan, MgCO(3), and CaCO(3). Co-encapsulated MgCO(3) and CaCO(3) slowed the rate of anti-NogoA release and did not influence anti-NogoA bioactivity. Co-encapsulated trehalose significantly improved anti-NogoA bioactivity at early release time points by stabilizing the protein during lyophilization. Co-encapsulated trehalose with hyaluronan improved bioactivity up to 28d and dramatically increased the rate and duration of sustained delivery. The sustained release of bioactive anti-NogoA from composite HAMC is a compelling formulation for in vivo evaluation in a model of spinal cord injury.

A quantitative ELISA for bioactive anti-Nogo-A, a promising regenerative molecule for spinal cord injury repair.

The detection and quantification of bioactive anti-Nogo-A mAbs, which is of interest for the treatment of spinal cord injury, has previously been accomplished using cellular or indirect immunoassays. In one such assay the presence of Nogo-A inhibits neurite outgrowth from the PC12 neuronal cell line: pre-treatment with anti-Nogo-A overcomes this inhibition and the concentration of anti-Nogo-A is correlated with the reduction in growth inhibition. In the current work we demonstrate the first anti-Nogo-A sandwich ELISA utilizing a Nogo-A fragment in the role of capture agent and the anti-Nogo-A mAb 11c7 as the soluble analyte. Because the Nogo-A fragment contains the amino acid sequence against which 11c7 was raised, we postulate this combination reproduces the native binding mechanism and results in the detection of bioactive anti-Nogo-A. In support of this hypothesis, we have found good agreement between the inhibitory action of the Nogo-A fragment and myelin proteins used in existing PC12 cell assays. Importantly, unlike the several days required for cellular assays the ELISA is a fast and easy to use method for the detection and quantification of bioactive 11c7 in the range of 500-6000 pg/mL.

Chapter 55 – Central Nervous System

Publisher Summary This chapter focuses on tissue engineering strategies, including those based on drug delivery, cell delivery, and physical constructs, all of which are aimed at achieving functional recovery after central nervous system (CNS) injury. The use of drug delivery as a reparative and regenerative strategy after CNS injury is investigated in animal models and clinically. Molecules are delivered systemically and injected locally, the latter to the epidural space, intrathecal space (or into the ventricles), and directly into the cord. The goals of drug delivery in the CNS are to limit degeneration (neuroprotection) and promote regeneration (neuroregeneration). Cell therapy is based on transplanted or host cells either producing the desired therapeutic molecule over a prolonged time to promote endogenous repair or replacing lost tissue that would integrate with the host tissue. There are essentially two methods of cell therapy: cell transplantation, where the cells are derived from autogeneic, allogeneic, or xenogeneic sources, and cell stimulation, where the endogenous cell population is stimulated to promote repair. Physical constructs for tissue therapy in the CNS take the form of scaffolds to support cell growth and, in the spinal cord, tubular scaffolds to assist nerve regeneration. The scaffold might alternatively function solely as a drug delivery system to the surrounding tissue or serve a dual role with cells contained within the scaffold.