MdNurunnabi,TejalADesai
This article is part of the Biomaterials for Oral Medicine special issue. Oral delivery is considered the most painless, convenient, and widely acceptable route for drug administration due to patient compliance and ease of administration. (1,2) However, almost half of the currently available medications, and most biological molecules including proteins, peptides, antibodies, enzymes, and hormonal drugs, are not effective when administered via the oral route. (3) Large molecular drug molecules are not readily bioavailable in an oral dosage form as they are not stable in a harsh and acidic stomach environment and/or the molecules are too large to diffuse through the intestinal barrier (Figure 1). In addition, acidic gastric fluids, intestinal tight junctions, and a thick mucus layer can prevent absorption of orally administered drug molecules. (4) Figure 1. Large molecules or biological drugs have limited oral bioavailability because of acidic degradation in the stomach, enzymatic degradation in the small intestine, and poor permeability across the intestinal tight junction barrier. The image was prepared in www.biorender.com. This special issue aims to showcase articles focused on advanced technology such as 3D printing of oral formulations, and materials that can overcome gastrointestinal (GI) barriers, for instance, the acidic stomach, mucus, and intestinal tight junctions. In this special issue, we present one review and 10 research articles that discuss the prospects, potential, and feasibility of various materials and their role in the oral delivery of small and large molecular therapeutic modalities. Since the FDA approval of the first 3D printed tablet in 2015, 3D printing technology for pharmaceutical dosage forms including tablets and capsules has received significant attention by the formulation science community and pharmaceutical industries. (5) Here the article by Zhang et al describes 3D printing of oral tablets where the authors utilize magnetic nanoparticles as an alternative sintering agent. Selective laser sintering is a single-step process that has been gaining momentum in the 3D printing and manufacturing of pharmaceutical dosage forms. A carbonyl iron based multifunctional magnetic nanoparticle not only facilitates single-step 3D printed tablet production with lower laser energy but enhances as much as 25% more drug release under a magnetic field. This magnetic particle based oral tablet has shown potential for magnetic field-based controlled drug delivery and can be regulated externally upon magnetic field application. Furthermore, Reiländer et al. have reported on the development of a 3D printed oral dosage form for efficient delivery of carbon monoxide (CO) to treat intestinal bowel disease. This oral CO releasing system allows for a controlled release profile of CO from the device but prevents the release of other components including the molybdenum complex that was used to make the oral device. They have investigated the efficacy and biocompatibility using a porcine in vivo model and found it to be a very effective in oral delivery of CO. Over the last few decades, nanoparticle-based approaches have emerged for the oral delivery of small and large molecules. Here, Mathews et al. shows the development of chitosan- and alginate-based nanoparticles that can penetrate the intestinal barrier. The authors have investigated the efficacy of nanoparticles loaded with praziquantel, an anthelmintic drug, in a Corydoras schwartzi fish model and found these nanoparticles are effective in reducing intestinal parasites by 90% in the fish. The mucosal layer in the gastrointestinal tract plays a vital role in protecting the underlying tissues from the acidic gastric juice as well as maintaining gut homeostasis and health. However, mucus barriers are also one of the most significant barriers for oral drug absorption and transport, especially for large molecule drugs. In their review article, Wright et al. summarize various mucus barrier models that have been used to study in vitro drug transport and permeation of orally administered drugs. Such in vitro mucosal models could be very helpful in screening potential oral delivery carrier candidates and better understanding their permeability and diffusion profiles, and can potentially save time and resources prior to starting in vivo or preclinical studies. Along the same line, Jia et al. have reported on the utilization of an ex vivo model that can be used for understanding intestinal absorption and transcytosis of an orally administered nanoparticle. The authors have developed an optical clearing-based whole tissue imaging strategy to enable high resolution microscopic imaging of intestinal specimens that facilitate distribution of the nanoparticles within the intestinal villi and a quantitative analysis at the cellular level. In this study, the authors develop a polyethylene glycol-modified polystyrene nanoparticle, and show that introduction of Concanavalin A increases intestinal epithelium uptake of the particle by 4 times for nanoparticles with 200 nm in diameter, and ∼3 times for the nanoparticles with 50 nm in diameter. This ex vivo model can be used for understanding the intestinal transport profile of nanoparticles with different sizes in order to optimize nanoparticle-based carriers. Despite growing demand, oral protein delivery is very challenging due to the risk of degradation by the acidic environment in the stomach or enzymatic degradation in the small intestine. To address this issue, Lykins et al. has developed and investigated the effect of particle geometry and size on GT tract retention and distribution of orally administered particles. They observed that a planar and larger microdevice (>300 μm) has longer retention in the stomach than do smaller particles (<200 μm and less) in vivo. They also demonstrated that larger particles distribute across the GI tract but excrete more slowly. Interestingly, as the planar shaped microparticles translocate independently, the microdevices likely come in contact with the target site multiple times and these unique properties likely facilitate better therapeutic outcomes for GI tract specific local diseases. While protein oral delivery is a challenging area within the oral drug delivery field, Banun et al. has used milk-derived proteins for oral delivery of coenzyme-Q10, a hydrophobic small molecule that has antioxidant and anti-inflammatory effects. However, due to poor oral bioavailability, a higher dose of administration is required. The investigators encapsulated coenzyme-Q10 into the milk derived protein ß-lactoglubulin and lactoferrin and investigated their oral delivery using in vitro and in silico models. This protein-based nanoparticle was found to improve oral bioavailability of the payload and thereby improve therapeutic outcomes with a lower dose. In vitro caco-2 assays show a 2.5-fold higher permeability for the protein-based nanoparticle compared to that of free coenzyme-Q10. Moreover, these findings reveal that these milk-derived proteins could potentially be used to facilitate oral delivery of a wide range of hydrophobic small molecules. In the next article, Parvez et al. reported on the oral codelivery of biological and chemotherapeutic agents mediated by a solid lipid nanoparticle. The nanoparticle was grafted with 2-hydroporpyl-ß-cyclodextrin and loaded with melatonin and amphotericin B, and then evaluated for visceral lesihmaniasis treatment upon oral administration. The formulations were administered to L. donovani-infected BALB/c mice and the investigators observed more than a 95% reduction of intracellular parasites in liver tissue. No significant signs of toxicity were observed in macrophage culture and mouse models, showing promise as an effective oral drug delivery vehicle. Over the years, nanoemulsion-based delivery systems have also been attractive for the oral delivery of hydrophobic molecules. In their research article, Thanki et al. incorporated an oleyl acid-based emulsion for the oral delivery of amphotericin B to treat leishmaniasis and fungal infections. The authors have used both in vitro caco-2 cell monolayer and animal models to evaluate their approach and investigate the feasibility of the self-nanoemulsifying agent. Pharmacokinetics studies of this nanoemulsion, loaded with amphotericin B, show an almost 9-fold increase in oral bioavailability than that of free drug in Sprague–Dawley rats. More importantly, oral administration of this antibiotic shows significantly less systemic toxicity compared to intravenously administered free amphotericin B, supporting the biosafety and biocompatibility of this nanoemulsion based vehicle for oral delivery of antibiotics. In the next article of this issue, Vargason et al. report an advanced approach for oral delivery of live biotherapeutic agents. Carriers plat a very important role in live biotherapeutic delivery because carriers not only facilitate efficient delivery but can also maintain the viability and bioactivity of the loaded biotherapeutics. Moreover, unlike chemical-based therapeutics, intestinal retention for a certain duration of the orally administered biotherapeutic is necessary to achieve efficacy. To achieve this goal, the authors modified the surface of a live biotherapeutic payload through covalent and noncovalent chemistry. This surface modification is sought to control the interaction between the GI tract and the biotherapeutics, improve viability, increase attachment to the gut wall, and enhance therapeutic efficacy. The investigators evaluated the impact of surface modification on the growth of the biotherapeutic as well as loss of attachment over the time. This biocompatible surface modification chemistry can be utilized for cell and biotherapeutic delivery sciences. This special issue concludes with a research article on ionic liquid-based mucoadhesive patches for oral drug delivery reported by Mitragotri and colleagues. Ionic liquids have emerged as a promising approach in the noninvasive drug delivery field including oral delivery of biological therapeutics such as peptides and antibodies. (6) In this article the authors have developed a orally administered mucoadhesive patch for local and sustained release of a payload that has the potential to improve treatment of both local and systemic diseases. Previously, Mitragotri and his collaborators have developed choline bicarbonate and geranic acid (CAGE) based ionic liquids for the oral systemic delivery of insulin and found this approach to be effective in reducing blood glucose level in diabetes rats. (7) In this study, they extend these findings, developing a CAGE-patch in association with poly(vinyl alcohol) for sustained and controlled release of insulin upon oral administration. To show concept feasibility, insulin was loaded into the CAGE-patch and release profiles were determined using a Caco-2 and HT-29-MTX-E12 cell monolayer-based in vitro model. The patch showed 30% higher release of the insulin payload compared to the free insulin. Based on the findings in this report, this patch offers a new approach for oral controlled release of large molecules. With the increase in demand for oral medication and the growing number of biological therapeutics, the need for oral drug delivery technologies are more extensive than before. In this special issue we have compiled articles that discuss several biomaterials, techniques, and strategies for improving oral delivery of pharmacotherapeutics. Taken together, we believe that with continued investigation and efforts by the delivery scientists’ community, many of the intravenously administered therapeutics can be translated to oral dosage form for ease and painless administration (Figure 2). Figure 2. Biomaterials-based formulations in the form of nano/microparticles, emulsions, and liposomes can facilitate oral administration by protecting proteins, peptides, antibodies, and RNA from the harsh gastric/intestinal microenvironment and thereby enhance their intestinal retention, permeability, and bioavailability. The image was prepared in www.biorender.com. M.N. prepared the draft of the manuscript. T.A.D. edited, revised, and provided feedback on the manuscript. This article references 7 other publications. This article has not yet been cited by other publications. Figure 1. Large molecules or biological drugs have limited oral bioavailability because of acidic degradation in the stomach, enzymatic degradation in the small intestine, and poor permeability across the intestinal tight junction barrier. The image was prepared in www.biorender.com. Figure 2. Biomaterials-based formulations in the form of nano/microparticles, emulsions, and liposomes can facilitate oral administration by protecting proteins, peptides, antibodies, and RNA from the harsh gastric/intestinal microenvironment and thereby enhance their intestinal retention, permeability, and bioavailability. The image was prepared in www.biorender.com. This article references 7 other publications.