非侵入性基因治疗在中枢神经系统疾病中的应用

非侵入性地将具有治疗作用的基因通过血脑屏障输送至脑内,以治疗中枢神经系统疾病,是生物学领域研究的难点和热点,而应用适宜的转运载体是解决这一难题的有效途径。使用病毒载体或非病毒载体,已成功进行非侵入性基因治疗的中枢神经系统疾病有实验性运动神经疾病、脑部肿瘤和帕金森病等。随着对脑微血管内皮细胞上的受体的研究和新型载体的开发,应用非侵入性基因治疗中枢神经系统疾病将会更为广泛。     

跨血脑屏障药物转运的研究进展

血脑屏障(Blood-brain barrier,BBB)的存在成为人们治疗中枢神经系统疾病(Central nervous system,CNS)所面临的一道难题,因为基本上100%的大分子药物及大于98%的小分子药物均无法穿过血脑屏障.因此,如何使CNS药物跨越血脑屏障从血液进入脑内且发挥药效成为解决难题的关键所在.如今一些借助内源性BBB运载体使药物转运入脑的技术发展起来.并处于实验研究和临床试验阶段,例如借助载体介导的转运系统、受体介导的转运系统的药物治疗策略,以及纳米技术的运用等,都有着良好的应用前景.这些新发现及新技术将为跨血脑屏障药物转运的研究提供新思路.并有望实现对CNS疾病患者的成功治疗.     

血脑屏障与脑药物转运

血脑屏障的存在使大分子药物难以进入脑中发挥疗效。成为中枢神经系统疾病治疗的瓶颈。本就血脑屏障的结构特点、大分子药物转运入脑的途径及药物与载体间的连接策略等问题进行了综述。     

载药纳米粒作为脑靶向给药系统的研究

血脑屏障使大部分的活性药物很难由血液进入脑内发挥作用。载药纳米粒具有脑靶向性,可显著提高药物在脑内浓度,成为药物突破血脑屏障的有效途径。本文综述了近年来载药纳米粒透过血脑屏障的研究进展,并对纳米粒载中药入脑提出展望。     

载药纳米粒作为脑靶向给药系统的研究

血脑屏障使大部分的活性药物很难由血液进入脑内发挥作用。载药纳米粒具有脑靶向性,可显著提高药物在脑内浓度,成为药物突破血脑屏障的有效途径。本文综述了近年来载药纳米粒透过血脑屏障的研究进展,并对纳米粒载中药入脑提出展望。     

哈尔滨医科大学附属第一医院神经外科

血脑屏障的是人体自然屏障之一。其主要作用是阻止有害物质通过颅内血管进入脑实质,并同时辅助排出脑内代谢物质等。对相当多的颅内恶性肿瘤术后患者,血脑屏障在一定程度上阻碍了化疗药物进入脑实质,从而影响化疗效果。因此近年来越来越多的学者将研究重点放在如何开放血脑屏障这个问题上。血脑屏障构成主要为毛细血管的内皮细胞、基膜周细胞和星状胶质细胞的足突,其中血管内皮细胞处于最重要的地位。原因归结于它自身的一个特殊结构--紧密连接。紧密连接是否完整,功能是否可以正常发挥关系到内皮细胞的完整性,因此对血脑屏障的开放有着举足轻重的作用。维持紧密连接结构中功能蛋白功能的能量物质为葡萄糖。脑血管中的葡萄糖进入脑实质需载体或通道,脑组织负责此过程的物质为葡萄糖转运蛋白1(GLUT1)。本文作者通过松胞菌素B抑制葡萄糖转运蛋白1,降低能量供应从而影响紧密连接功能,最终引起血脑屏障开放角度做一综述。     

松胞菌素B开放血脑屏障的研究进展

血脑屏障的是人体自然屏障之一。其主要作用是阻止有害物质通过颅内血管进入脑实质,并同时辅助排出脑内代谢物质等。对相当多的颅内恶性肿瘤术后患者,血脑屏障在一定程度上阻碍了化疗药物进入脑实质,从而影响化疗效果。因此近年来越来越多的学者将研究重点放在如何开放血脑屏障这个问题上。血脑屏障构成主要为毛细血管的内皮细胞、基膜周细胞和星状胶质细胞的足突,其中血管内皮细胞处于最重要的地位。原因归结于它自身的一个特殊结构--紧密连接。紧密连接是否完整,功能是否可以正常发挥关系到内皮细胞的完整性,因此对血脑屏障的开放有着举足轻重的作用。维持紧密连接结构中功能蛋白功能的能量物质为葡萄糖。脑血管中的葡萄糖进入脑实质需载体或通道,脑组织负责此过程的物质为葡萄糖转运蛋白1(GLUT1)。本文作者通过松胞菌素B抑制葡萄糖转运蛋白1,降低能量供应从而影响紧密连接功能,最终引起血脑屏障开放角度做一综述。     

超声联合微泡介导血脑屏障开放及其在中枢神经系统疾病治疗中的作用

血脑屏障(blood-brain barrier,BBB)是一种介于外周循环系统与中枢神经系统之间的动态结构,起着守门员的作用,在维持机体内环境稳定的同时也阻碍了大多数治疗性药物进入大脑.聚焦超声联合微泡以非侵入的方式瞬时、局部可逆开放BBB,有利于药物分子的跨脑转运和中枢神经系统疾病的多功能诊疗.该文详细介绍了血脑屏...     

瘦素转运入脑过程的抑制导致小鼠妊娠期的瘦素抵抗

瘦素是一种由脂肪组织分泌的激素,作用于下丘脑发挥抑制食欲、增加代谢率的作用。在妊娠期间,进食量和外周血瘦素浓度都增加,提示大脑对瘦素变得不敏感,但妊娠期瘦素抵抗的发生机制仍不清楚。血脑屏障的结构可塑性以及载体介导的瘦素向脑内转运过程的改变,是两个可能的瘦素抵抗机制,作者对这两个假说进行了实验验证。在环境发生变化时,血脑屏障会发生结构改变,如紧密连接蛋白ZO-1的表达和有孔毛细血管数增加,而这些结构的改变可以调节外周大分子物质的入脑过程。作者在处女鼠、妊娠期鼠和哺乳期鼠的脑弓状核和正中隆起处,对脑室膜细胞标志分子vimentin、ZO-1和有孔毛细血管标志分子MECA-32进行标记,结果发现三组小鼠的血脑屏障结构没有明显差异。这提示,妊娠期瘦素抵抗不是通过血脑屏障的结构可塑性实现的。     

血脑屏障上的药物转运体P-糖蛋白

血脑屏障(Blood-brain Barrier,简称BBB)是维护脑内环境稳态的重要功能单位,它不仅可以阻止血液中的有害物质进入脑组织,而且能够清除脑内的有毒代谢产物。BBB上表达的转运系统在积极转运营养物质入脑和选择性外排药物的两个方面均发挥了重要作用。其中P-糖蛋白由于自身结构功能的特异性和作用底物的广泛性而备受关注。本文主要论述了BBB上P-糖蛋白的特性、表达、转运底物及其体内外研究的进展情况。P-糖蛋白作为BBB的重要组成部分在中枢神经系统治疗药物的摄取、分布和排泄中发挥了越来越重要的作用。因此,对P-糖蛋白的研究将有助于阐明药物脑部转运机制,为增加药物的BBB通透性、提高脑内靶点药物浓度提供新的研究思路。     

Targeted delivery of antibodies through the blood-brain barrier by MRI-guided focused ultrasound

The blood-brain barrier (BBB) is a persistent obstacle for the local delivery of macromolecular therapeutic agents to the central nervous system (CNS). Many drugs that show potential for treating CNS diseases cannot cross the BBB and there is a need for a non-invasive targeted drug delivery method that allows local therapy of the CNS using larger molecules. We developed a non-invasive technique that allows the image-guided delivery of antibody across the BBB into the murine CNS. Here, we demonstrate that subsequent to MRI-targeted focused ultrasound induced disruption of BBB, intravenously administered dopamine D(4) receptor-targeting antibody crossed the BBB and recognized its antigens. Using MRI, we were able to monitor the extent of BBB disruption. This novel technology should be useful in delivering macromolecular therapeutic or diagnostic agents to the CNS for the treatment of various CNS disorders.     

Drug and gene delivery to the brain: the vascular route

Brain drug development of either small molecule or large molecule (recombinant proteins, gene medicines) neurotherapeutics has been limited, owing to the restrictive transport properties of the brain microvasculature, which forms the blood-brain barrier (BBB) in vivo. Widespread drug delivery to the brain, while not feasible via craniotomy and intracerebral injection, is possible if the drug is delivered to brain via the transvascular route through the BBB. Novel brain drug delivery and drug targeting strategies can be developed from an understanding of the molecular and cellular biology of the brain microvascular and BBB transport processes.     

Monocyte Trafficking,Engraftment, and Delivery of Nanoparticles and an Exogenous Gene into the Acutely Inflamed Brain Tissue – Evaluations on Monocyte-Based Delivery System for the Central Nervous System

The ability of monocytes and monocyte-derived macrophages (MDM) to travel towards chemotactic gradient, traverse tissue barriers, and accumulate precisely at diseased sites makes them attractive candidates as drug carriers and therapeutic gene delivery vehicles targeting the brain, where treatments are often hampered by the blockade of the blood brain barrier (BBB). This study was designed to fully establish an optimized cell-based delivery system using monocytes and MDM, by evaluating their homing efficiency, engraftment potential, as well as carriage and delivery ability to transport nano-scaled particles and exogenous genes into the brain, following the non-invasive intravenous (IV) cell adoptive transfer in an acute neuroinflammation mouse model induced by intracranial injection of Escherichia coli lipopolysaccharides. We demonstrated that freshly isolated monocytes had superior inflamed-brain homing ability over MDM cultured in the presence of macrophage colony stimulating factor. In addition, brain trafficking of IV infused monocytes was positively correlated with the number of adoptive transferred cells, and could be further enhanced by transient disruption of the BBB with IV administration of Mannitol, Bradykinin or Serotonin right before cell infusion. A small portion of transmigrated cells was detected to differentiate into IBA-1 positive cells with microglia morphology in the brain. Finally, with the use of superparamagnetic iron oxide nanoparticles SHP30, the ability of nanoscale agent-carriage monocytes to enter the inflamed brain region was validated. In addition, lentiviral vector DHIV-101 was used to introduce green fluorescent protein (GFP) gene into monocytes, and the exogenous GFP gene was detected in the brain at 48 hours following IV infusion of the transduced monocytes. All together, our study has set up the optimized conditions for the more-in-depth tests and development of monocyte-mediated delivery, and our data supported the notion to use monocytes as a non-invasive cell-based delivery system for the brain.     

Genetically engineered brain drug delivery vectors: cloning, expression and in vivo application of an anti-transferrin receptor single chain antibody-streptavidin fusion gene and protein.

A single chain Fv antibody-streptavidin fusion protein was expressed and purified from bacterial inclusion bodies following cloning of the genes encoding the variable region of the heavy chain and light chain of the murine OX26 monoclonal antibody to the rat transferrin receptor. The latter undergoes receptor mediated transcytosis through the brain capillary endothelial wall in vivo, which makes up the blood-brain barrier (BBB); therefore, the OX26 monoclonal antibody and its single chain Fv analog may act as brain drug delivery vectors in vivo. Attachment of biotinylated drugs to the antibody vector is facilitated by production of the streptavidin fusion protein. The bi-functionality of the OX26 single chain Fv antibody-streptavidin fusion protein was retained, as the product both bound biotin and the rat transferrin receptor in vitro and in vivo, based on pharmacokinetic and brain uptake analyses in anesthetized rats. The attachment of biotin-polyethyleneglycol-fluorescein to the OX26 single chain Fv antibody-streptavidin fusion protein resulted in illumination of isolated rat brain capillaries in confocal fluorescent microscopy. In conclusion, these studies demonstrate that genetically engineered single chain Fv antibody-streptavidin fusion proteins may be used for non-invasive neurotherapeutic delivery to the brain using endogenous BBB transport systems such as the transferrin receptor.     

Strategies to overcome the barrier: use of nanoparticles as carriers and modulators of barrier properties

The blood–brain barrier (BBB) protects the brain from toxic substances within the bloodstream and keeps the brain’s homeostasis stable. On the other hand, it also represents the main obstacle in the treatment of many CNS diseases. Among different techniques, nanoparticles have emerged as promising tools to enhance brain drug delivery of therapeutic molecules. For successful drug delivery, nanoparticles may either modulate BBB integrity or exploit transport systems present on the endothelium. In this review, we present two different nanoparticles to enhance brain drug delivery. Poly(butyl cyanoacrylate) nanoparticles were shown to induce a reversible disruption of the BBB in vitro which may be exploited by simultaneous injection of the drug in question. By coating the poly(butyl cyanoacrylate) nanoparticles with, e.g., ApoE, it is also possible to circumvent the BBB via the LDL-receptor. Another example of the use of receptor-mediated endocytosis to enhance brain uptake of nanoparticles are poly(ethylene glycol)-coated Fe3O4 nanoparticles which are covalently attached to lactoferrin. These nanoparticles have been shown to facilitate the transport via the lactoferrin receptor, and so could then be used for magnetic resonance imaging.     

Biomaterial-based technologies for brain anti-cancer therapeutics and imaging

Treating malignant brain tumors represents one of the most formidable challenges in oncology. Contemporary treatment of brain tumors has been hampered by limited drug delivery across the blood–brain barrier (BBB) to the tumor bed. Biomaterials are playing an increasingly important role in developing more effective brain tumor treatments. In particular, polymer (nano)particles can provide prolonged drug delivery directly to the tumor following direct intracerebral injection, by making them physiochemically able to cross the BBB to the tumor, or by functionalizing the material surface with peptides and ligands allowing the drug-loaded material to be systemically administered but still specifically target the tumor endothelium or tumor cells themselves. Biomaterials can also serve as targeted delivery devices for novel therapies including gene therapy, photodynamic therapy, anti-angiogenic and thermotherapy. Nanoparticles also have the potential to play key roles in the diagnosis and imaging of brain tumors by revolutionizing both preoperative and intraoperative brain tumor detection, allowing early detection of pre-cancerous cells, and providing real-time, longitudinal, non-invasive monitoring/imaging of the effects of treatment. Additional efforts are focused on developing biomaterial systems that are uniquely capable of delivering tumor-associated antigens, immunotherapeutic agents or programming immune cells in situ to identify and facilitate immune-mediated tumor cell killing. The continued translation of current research into clinical practice will rely on solving challenges relating to the pharmacology of nanoparticles but it is envisioned that novel biomaterials will ultimately allow clinicians to target tumors and introduce multiple, pharmaceutically relevant entities for simultaneous targeting, imaging, and therapy in a unique and unprecedented manner.     

Molecular modeling of blood-brain barrier nutrient transporters: in silico basis for evaluation of potential drug delivery to the central nervous system

For drugs that act in the brain, the blood-brain barrier (BBB) is a considerable physical barrier which influences the distribution of drugs to the brain. The BBB is essentially impermeable for hydrophilic and/or charged compounds. Nutrient membrane transporters have an important physiological role in the transport of essential substances across the BBB required for normal brain function. We and others have shown that these transporters may have utility as drug delivery vectors, thereby increasing brain distribution of these compounds via these systems. In this review, we evaluate molecular (in silico) models of BBB transport proteins. Few BBB membrane transporters have been crystallized, but their crystal structures have a possibility for use in homology modeling. Other techniques commonly used are 2D quantitative structure-activity relationships (QSAR), as well as 3D-QSAR techniques including comparative molecular field analysis (CoMFA) and comparative similarity index analysis (CoMSIA). Each of these models provides valuable information for ascertaining their potential basis for BBB transport and brain drug delivery.     

Mechanisms of enhanced antiglioma efficacy of polysorbate 80‐modified paclitaxel‐loaded PLGA nanoparticles by focused ultrasound

The presence of blood‐brain barrier (BBB) greatly limits the availability of drugs and their efficacy against glioma. Focused ultrasound (FUS) can induce transient and local BBB opening for enhanced drug delivery. Here, we developed polysorbate 80‐modified paclitaxel‐loaded PLGA nanoparticles (PS‐80‐PTX‐NPs, PPNP) and examined the enhanced local delivery into the brain for glioma treatment by combining with FUS. Our result showed PPNP had good stability, fast drug release rate and significant toxicity to glioma cells. Combined with FUS, PPNP showed a stronger BBB permeation efficiency both in the in vitro and in vivo BBB models. Mechanism studies revealed the disrupted tight junction, reduced P‐glycoprotein expression and ApoE‐dependent PS‐80 permeation collectively contribute to the enhanced drug delivery, resulting in significantly stronger antitumour efficacy and longer survival time in the tumour‐bearing mice. Our study provided a new strategy to efficiently and locally deliver drugs into the brain to treat glioma.     

Modification of the blood-brain barrier in the chemotherapy of malignant brain tumors

Inadequate drug delivery to the brain, caused by an intact or partially intact blood-brain barrier (BBB), probably accounts for poor therapeutic responsiveness to cytoreductive drugs by malignant metastatic and primary brain tumors. Drug delivery can be enhanced in normal brains and brains with tumors by administering drugs into the carotid or vertebral circulation after osmotic opening of the BBB. The osmotic procedure in humans involves infusion into the carotid or vertebral arteries of a 25% mannitol solution for 30 s. The procedure is reversible, can be accomplished without long-term neurological deficits, and can be monitored in dogs and humans by means of enhanced computerized tomography. Osmotic BBB disruption, when combined with multiple drug administration, has proved effective in treating brain tumors in a small number of clinical cases.     

Signaled drug delivery and transport across the blood–brain barrier

We use a mathematical model to describe the delivery of a drug to a specific region of the brain. The drug is carried by liposomes that can release their cargo by application of focused ultrasound (US). Thereupon, the drug is absorbed through the endothelial cells that line the brain capillaries and form the physiologically important blood–brain barrier (BBB). We present a compartmental model of a capillary that is able to capture the complex binding and transport processes the drug undergoes in the blood plasma and at the BBB. We apply this model to the delivery of levodopa (L-dopa, used to treat Parkinson’s disease) and doxorubicin (an anticancer agent). The goal is to optimize the delivery of drug while at the same time minimizing possible side effects of the US.