Yitzhak Rosen

Carbon nanotubes in drug delivery: focus on infectious diseases

Carbon nanotubes have the potential to address the challenges of combating infectious agents by both minimizing toxicity by dose reduction of standard therapeutics and allowing a multiple payload capacity to achieve both targeted activity and combating infectious strains, resistant strains in particular. One of their unique characteristics is the network of carbon atoms in the nanometer scale, allowing the creation of nano-channels via cellular membranes. This review focuses on the characterization, development, integration and application of carbon nanotubes as nanocarrier-based delivery systems and their appropriate design for achieving the desired drug delivery results in the different areas of infectious diseases. While a more extensive toxicological and pharmacological profile must be obtained, this review will focus on existing research and pre-clinical data concerning the potential use of carbon nanotubes.

Recombinant tissue plasminogen activators (rtPA): A review

INTRODUCTION Acute ischemic stroke (AIS), acute myocardial infarction (AMI), and pulmonary embolism (PE) represent main causes of morbidity and mortality worldwide. These clinical conditions result from an imbalance of the hemostatic system, leading to thrombosis. Recombinant tissue plasminogen activators (rtPAs) are used in patients with AIS, AMI, and PE to treat thrombus. This review focuses on the pharmacology and clinical applications of rtPAs, and therapeutic strategies to improve thrombolytic therapy.

Clinical Applications of Biomedical Microdevices for Controlled Drug Delivery

Miniaturization of devices to micrometer and nanometer scales, combined with the use of biocompatible and functional materials, has created new opportunities for the implementation of drug delivery systems. Advances in biomedical microdevices for controlled drug delivery platforms promise a new generation of capabilities for the treatment of acute conditions and chronic illnesses, which require high adherence to treatment, in which temporal control over the pharmacokinetic profiles is critical. In addition, clinical conditions that require a combination of drugs with specific pharmacodynamic profiles and local delivery will benefit from drug delivery microdevices. This review provides a summary of various clinical applications for state-of-the-art controlled drug delivery microdevices, including cancer, endocrine and ocular disorders, and acute conditions such as hemorrhagic shock. Regulatory considerations for clinical translation of drug delivery microdevices are also discussed. Drug delivery microdevices promise a remarkable gain in clinical outcomes and a substantial social impact. A review of articles covering the field of microdevices for drug delivery was performed between January 1, 1990, and January 1, 2014, using PubMed as a search engine.

The use of micro-electro mechanical systems in vascular monitoring: implications for clinical use

ABSTRACT Introduction: BioMEMS relates to the implementation of Micro-Electro-Mechanical Systems (MEMS), in the biological and medical sphere. BioMEMS sensors are being utilized for many clinical applications, including a wireless urinary pressure system, right heart pressure sensor, and measurements on shearing force on the vascular system An important application of BioMEMS is on Heart failure (HF), a common disease, with a prevalence of 10% or more in persons 70 years of age or older, associated with high morbidity and mortality. HF affects over 5 million people and contributes to over 200,000 deaths a year in the United States alone. Areas covered: The purpose of this paper is to provide a short overview on the successful implementation of BioMEMS sensors in heart failure and vascular medicine. Expert commentary: BioMEMS devices have overcome current limitations in pharmacotherapies for resistant hypertension by electrical modulation of the baroreceeptors. This represents a step towards the development of biomedical micro-devices for those conditions in which pharmacotherapies result poorly effective or elicit unacceptable toxicity.

Prefilled devices for parenteral applications.

Current parenteral administration of drugs suffers from several drawbacks including the requirement of healthcare personnel to administer the drug, the risk of needle stick injuries that may result in the transmission of blood borne pathogens, and patient discomfort. Prefilled devices have emerged as powerful tools to improve parenteral administration of drugs. There are a number of clinical conditions including treatment of endocrine diseases, neurological disorders, autoimmune diseases and emergency medicine where prefilled devices have made major improvements to patient care. Prefilled devices have become an important set of tools for the medical practitioner due to their ease of use and safety, cost effectiveness and patient convenience. This review provides a comprehensive summary of existing prefilled devices, their current clinical uses and corresponding regulatory processes.

Rapidly-deployed small tent hospitals: lessons from the earthquake in Haiti.

The damage to medical facilities resulting form the January 2010 earthquake in haiti necessitated the establishment of field tent hospitals. Much of the local medical infrastructure was destroyed or limited operationally when the Fast Israel Rescue and Search Team (FIRST) arrived in Haiti shortly after the January 2010 earthquake. The FIRST deployed small tent hospitals in Port-au-Prince and in 11 remote areas outside of the city. Each tent was set up in less than a half hour. The tents were staffed with an orthopedic surgeon, gynecologists, primary care and emergency care physicians, a physician with previous experience in tropical medicine, nurses, paramedics, medics, and psychologists. The rapidly deployable and temporary nature of the effort allowed the team to treat and educate, as well as provide supplies for, thousands of refugees throughout Haiti. In addition, a local Haitian physician and his team created a small tent hospital to serve the Petion Refugee Camp and its environs. FIRST personnel also took shifts at this hospital.

Pharmacogenomics-based RNA interference nanodelivery: focus on solid malignant tumors

Introduction: RNA interference represents one of the most promising strategies in fighting disease. However, small RNA interference faces substantial challenges for in vivo application due to the inherent instability of the RNA interference molecule. Among the nonviral gene delivery carriers, nanoparticles have attracted interest due to their success in various model systems. Nanomaterials have unique properties compared to conventional bulk materials that may be applicable in this setting. The nanoparticle complex carrying small interference RNA can undergo surface modification to achieve targeted modification for tissue-specific delivery. However, toxicity issues of the delivery systems need to be addressed and they require a pharmacogenomic profile of their own. Areas covered: The authors review pharmacogenomics, toxicogenomics, nanoparticle-based drug delivery, and small interference RNA, with a focus on how logically engineered nanoparticle delivery systems can be used for personalized medicine in malignant tumors. Expert opinion: Pharmacogenomics may be helpful in addressing possible individualized drug response for both the gene silencing capability of the delivered siRNA and the nanoparticle drug delivery system as both complete and distinct units. This may be done by assessing variations in gene expressions and single nucleotide polymorphisms. Patient profiling may be key as patient noncompliance due to toxicity plays a major role in treatment failure.

Overview of Impella and mechanical devices in cardiogenic shock

ABSTRACT Introduction: Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. The Impella (Abiomed Inc.) is an axial flow pump on a pigtail catheter that is placed across the aortic valve to unload the left ventricle by delivering non-pulsatile blood flow to the ascending aorta. It is used for high-risk percutaneous coronary intervention and CS. Areas covered: Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance. We review Impella and other percutaneous devices such as intra-aortic balloon pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO) and the evidence supporting their use in the setting of CS. Expert commentary: Impella has been proven to be safe and may be superior to other mechanical support devices in CS.