A dried preparation of liposomes containing muramyl tripeptide phosphatidylethanolamine as a potent activator of human blood monocytes to the antitumor state

Summary Studies were performed on the activation of human blood monocytes to the antitumor state by a dried preparation of multilamellar vesicle (MLV) liposomes in which synthetic muramyl tripeptide phosphatidylethanolamine (MTP-PE) was inserted directly into the liposome membrane. Dried liposomes composed of synthetic phospholipids [phosphatidylcholine (PC) and phosphatidylserine (PS) in a molar ratio of 7:3] were prepared by lyophilization. Dried liposome-MTP-PE was found to be superior in several ways to free desmethyl muramyl dipeptide (norMDP) or conventional liposome-MTP-PE, prepared immediately before use. First, dried lipsome-MTP-PE was stable and strongly activated monocytes when stored for over 3 months in a freezer at –°C or even in suspension at 4°C. Second, human monocytes in suspension, as well as in the adherent form, were activated to the tumoricidal state by interaction for at least 4 h with the dried preparation of liposome-MTP-PE. Third, monocytes activated with the dried liposome-MTP-PE or conventionally prepared liposome-MTP-PE maintained their tumoricidal activity for a longer period (4 days) than those activated with free norMDP. These results indicate that the dried preparation of liposome-MTP-PE can be stored for a long time, has a reproducible effect that can be standardized and should be valuable for in situ activation of human monocytes to the tumoricidal state, which is associated with eradication of cancer metastases.     

Inhibition of murine hepatic tumor growth by liposomes containing a lipophilic muramyl dipeptide

Summary We have investigated the ability of liposomes containing a lipophilic muramyl dipeptide, N-acetylmuramyl-l-alanyl-d-isoglutamine glycerol dipalmitate (MDP-GDP) to activate Kupffer cell tumoricidal activity in situ and to inhibit the growth of experimental hepatic micrometastases of tumor cell line H-59, a liver-homing variant of the Lewis lung carcinoma. Liposomes prepared from distearoylphosphatidylcholine/dimyristoylphosphatidylglycerol (DSPC/DMPG) and containing MDP-GDP (1 mol and 2 g, respectively) were efficiently taken up by the liver after i.v. administration. A single i.v. injection of DSPC/DMPG liposomes containing MDP-GDP was capable of inducing Kupffer cell tumoricidal activity against H-59 tumor cells as measured in vitro. Control liposomes or 100 g free MDP were ineffective in inducing Kupffer cell tumoricidal activity in situ. Two treatment regimens were evaluated in vivo: firstly, C57BL/6 mice were injected with tumor cell line H-59 and subsequently treated with multiple injections of liposomal MDP-GDP. Secondly, treatment with liposomal MDP-GDP was initiated prior to tumor cell injection and continued after tumor cell injection. The ability of liposomes containing MDP-GDP to reduce the number of hepatic micrometastases using the first protocol was related to the tumor cell inoculum, significant inhibition being observed at lower liver tumor burdens (<25 tumor nodules). Pretreatment of the mice prior to tumor cell challenge followed by treatment afterwards greatly enhanced the efficacy of liposomal MDP-GDP and brought about a highly significant inhibition of the growth of experimental metastases even at high liver tumor burdens (>50 nodules).     

Effect of liposomal muramyl tripeptide phosphatidylethanolamine and indomethacin on hematopoietic recovery in irradiated mice

The effects of liposomal muramyl tripeptide phosphatidylethanolamine (MTP-PE/MLV, radioprotective immunomodulator; 10 mg/kg) and indomethacin (INDO, inhibitor of prostaglandin production; 2 mg/kg) on post-irradiation recovery of hematopoietic functions in mice were investigated. Two agents with distinct radioprotective mechanisms were administered alone or in combination 24 h and 3 h before exposure to 7 Gy (60)Co radiation. In the post-irradiation period (3-14 days) combined pre-treatment of mice accelerated recovery of bone marrow cellularity, weight of spleen and myelopoietic and erythropoietic activity in both hematopoietic organs, compared to treatment with MTP-PE/MLV or indomethacin alone. In the peripheral blood, improved radioprotective effects of combined drug administration were found in the recovery of reticulocytes and platelet count. No further significant differences in the recovery of leukocyte count were observed in the examined groups until post-irradiation day 14. Within the first 3-6 post-irradiation days, the bone marrow and peripheral blood smears of mice pre-treated with indomethacin alone or its combination with MTP-PE/MLV more frequently featured blast cells and large cells with abundant cytoplasm which could be considered the hematopoietic stem cells.     

pH-sensitive liposomes containing polymerized phosphatidylethanolamine and fatty acid.

With the ultimate aim of targeting cancer drugs to malignant tissues, liposomes containing polymeric phosphatidylethanolamine and a fatty acid were prepared. For this purpose diacetylenic phosphatidylethanolamine (DAPE), a phosphatidylethanolamine containing diacetylene, was synthesized. Liposomes containing DAPE, fatty acid, and either phosphatidylethanolamine (PE) or phosphatidylethanolamine-beta-oleoyl-gamma-palmitoyl (POPE) were then prepared. Polymerization of DAPE was effected by UV illumination. The polymeric liposomes so obtained were stable at physiological pH but became leaky below pH 6.5. Of various compositions studied, the greatest pH-sensitivity was found with liposomes composed of 35 mol% DAPE, 35 mol% POPE, and 30 mol% saturated fatty acid. The presence of blood plasma albumin decreased vesicle stability while apolipoprotein A-I (apo A-I) had the opposite effect and plasma as a whole had a slightly stabilizing effect.     

New pH-sensitive liposomes containing phosphatidylethanolamine and a bacterial dirhamnolipid

Phosphatidylethanolamine-based pH-sensitive liposomes of various compositions have been described as efficient systems for cytoplasmic delivery of molecules into cells. Incorporation of an amphiphile of appropriate structure is needed for the stabilization and performance of these vesicles. Among the wide variety of interesting activities displayed by Pseudomonas aeruginosa dirhamnolipids (diRL), is their capacity to stabilize bilayer structures in phosphatidylethanolamine systems. In this work, X-ray scattering, dynamic light scattering, fluorescence spectroscopy and fluorescence microscopy have been used to study the structure and pH-dependent behaviour of phosphatidylethanolamine/diRL liposomes. We show that diRL, in combination with dioleoylphosphatidylethanolamine (DOPE), forms stable multilamellar and unilamellar liposomes. Acidification of DOPE/diRL vesicles leads to membrane destabilization, fusion, and release of entrapped aqueous vesicle contents. Finally, DOPE/diRL pH-sensitive liposomes act as efficient vehicles for the cytoplasmic delivery of fluorescent probes into cultured cells. It is concluded that DOPE/diRL form stable pH-sensitive liposomes, and that these liposomes are incorporated into cultured cells through the endocytic pathway, delivering its contents into the cytoplasm, which means a potential use of these liposomes for the delivery of foreign substances into living cells. Our results establish a new application of diRL as a bilayer stabilizer in phospholipid vesicles, and the use of diRL-containing pH-sensitive liposomes as delivery vehicles.     

The in situ activation of cytotoxic properties in murine Kupffer cells by the systemic administration of whole Mycobacterium bovis organisms or muramyl tripeptide

Summary We determined whether the systemic administration of viable Mycobacterium bovis organisms (BCG) or a lipophilic derivative of muramyl tripeptide (MTP-PE) would lead to the activation of antitumor properties in murine Kupffer cells (KC). KC-mediated tumor cytolysis was determined by the release of radiolabeled nuclear breakdown products of target cells. KC harvested from either C57BL/6 or C3H/HEN mice treated with saline exhibited no cytotoxicity against syngeneic B16 melanoma or UV-2237 fibrosarcoma cells. In contrast, KC harvested from BCG or MTP-PE-injected mice were highly cytotoxic against the tumor targets, as measured by an in vitro radiorelease assay. The demonstration that the administration of macrophage activators can generate in situ tumoricidal activity in KC suggests that these cells can be important in the control of hepatic micrometastases.     

Distribution and fate of free and liposome-encapsulated [3H]nor-muramyl dipeptide and [3H]muramyl tripeptide phosphatidylethanolamine in mice

The pharmacokinetics and metabolism of i.v. administered free (unencapsulated) or liposome-encapsulated hydrophilic [3H]-labeled nor-muramyl dipeptide (nor-MDP) and lipophilic [3H]-labeled muramyl tripeptide phosphatidylethanolamine (MTP-PE) were evaluated. In addition we also examined the distribution and fate of these immunomodulators subsequent to intranasal (i.n.) administration. Unique patterns of circulatory clearance, organ distribution, metabolism, and excretion were observed for each of the four preparations. Nor-MDP in saline was rapidly cleared from the circulation and excreted in the urine as intact molecules. MTP-PE dissolved in saline was cleared from the circulation at a slow rate and found within various organs as intact MTP-PE, lyso-MTP-PE, and MDP. Following the i.v. administration of nor-MDP or MTP-PE in liposomes, patterns of clearance and organ distribution corresponded to that of liposome distribution, i.e., the reticuloendothelial system. Extensive dissociation of hydrophilic nor-MDP from the carrier liposomes occurred, and the immunomodulator was recovered in the urine. In contrast, MTP-PE entrapped in liposomes was retained in target organs for the duration of the study. The i.n. instillation of radiolabeled nor-MDP or MTP-PE was associated with the accumulation of these immunomodulators in the brain. Our results demonstrate the feasibility of targeting hydrophilic and lipophilic immunomodulators to cells of the macrophage-histiocyte series.     

Inhibition of liver metastases in murine colon adenocarcinoma by liposomes containing human C-reactive protein or crude lymphokine

Previous studies from our laboratory have shown that liposomes containing LYNK or CRP inhibit lung metastases in mice bearing the malignant fibrosarcoma, T241. We have now extended these observations to the murine colon adenocarcinoma (MCA-38), which metastasizes to the liver. MCA-38 tumor cells (1 X 10(6)) were implanted in the wall of the cecum by orthotopic transplantation. Three-hundred twenty-six mice bearing such tumors were divided into four treatment groups as follows: (1) no treatment (2) liposomes containing control medium (3) liposomes containing LYNK, and (4) liposomes containing CRP. Treatment was started from day 2, day 18, or 34 after tumor implantation and it was administered on 3 days per week. Each treatment, given parenterally, consisted of 4 mumol liposomes (PS-PC, 1:1) containing the appropriate agents. Mice receiving liposomes containing LYNK or CRP had significantly fewer and smaller liver metastases (25%-28%), than those in the two control groups (53%-54%). Also, a significantly better survival was noted in the two treated groups than in the two control groups. The most likely mechanism of tumor inhibition appears to be through macrophage activation. In the Winn tumor neutralization test, peritoneal macrophages harvested from normal mice 24 h after a single injection of liposomes (2.5 mumol) containing LYNK or CRP markedly inhibited tumor growth when a mixture of effector-target cells (40 : 1) was injected in the footpad. These studies further confirm the suggested role of CRP as an 'immunomodulator' or 'biological response modifier' in yet another tumor system.     

Inhibition of liver metastases in murine colon adenocarcinoma by liposomes containing human C-reactive protein or crude lymphokine

Summary Previous studies from our laboratory have shown that liposomes containing LYNK or CRP inhibit lung metastases in mice bearing the malignant fibrosarcoma, T241. We have now extended these observations to the murine colon adenocarcinoma (MCA-38), which metastasizes to the liver. MCA-38 tumor cells (1×10⁶) were implanted in the wall of the cecum by orthotopic transplantation. Three-hundred twenty-six mice bearing such tumors were divided into four treatment groups as follows: (1) no treatment (2) liposomes containing control medium (3) liposomes containing LYNK, and (4) liposomes containing CRP. Treatment was started from day 2, day 18, or 34 after tumor implantation and it was administered on 3 days per week. Each treatment, given parenterally, consisted of 4 mol liposomes (PS-PC, 1:1) containing the appropriate agents. Mice receiving liposomes containing LYNK or CRP had significantly fewer and smaller liver metastases (25%–28%), than those in the two control groups (53%–54%). Also, a significantly better survival was noted in the two treated groups than in the two control groups. The most likely mechanism of tumor inhibition appears to be through macrophage activation. In the Winn tumor neutralization test, peritoneal macrophages harvested from normal mice 24 h after a single injection of liposomes (2.5 mol) containing LYNK or CRP markedly inhibited tumor growth when a mixture of effector-target cells (40:1) was injected in the footpad. These studies further confirm the suggested role of CRP as an immunomodulator or biological response modifier in yet another tumor system. Abbreviations used: LYNK, crude lymphokines; CRP, C-reactive protein; PC, phosphatidylcholine; PS, phosphatidylserine; PEC, peritoneal exudate cells; HBSS, Hank's Balanced Salt Solution; RPMI, Roswell Park Memorial Institute Con A, Concanavalin A; IgG, human gamma globulin; DMH, dimethylhydrazine     

Unique histological changes in lung metastases of osteosarcoma patients following therapy with liposomal muramyl tripeptide (CGP 19835A lipid)

Summary We have recently begun a phase II trial in patients with osteosarcoma who developed pulmonary metastases during adjuvant chemotherapy or who presented with pulmonary metastases that persisted despite chemotherapy. Eligible patients were rendered free of visible disease by surgery. Liposome-encapsulated muramyl tripeptide phosphatidylethanolamine (MTP-PE, CGP 19835A lipid) (2 mg/m²) was infused twice weekly for 3 months. In five patients, a single tumor nodule recurred within 6 weeks after completion of therapy. These lesions were resected and submitted for pathological examination. Tissue specimens obtained after therapy were compared to those obtained before therapy. All the patients showed a histological change in the characteristics of the pulmonary tumors. In three patients, peripheral fibrosis surrounded the tumor and inflammatory cell infiltration and neovascularization were present. This is in contrast to central necrosis, with viable peripheral tumor cells and no inflammatory response observed in lesions resected following chemotherapy. In a fourth case, evidence of early fibrotic changes was found. This and the fifth case showed a change in malignant characteristics, from high grade before liposomal therapy to low grade after therapy. The present study provides evidence for a biological effect of liposomal MTP-PE.     

Synthesis of N-hydroxysuccinimide esters of phosphatidylethanolamine and some properties of liposomes containing these derivatives

The N-hydroxysuccinimide (NHS) ester of N-suberyl-dimyristoylphosphatidylethanolamine (sub-DMPE) was synthesized by reaction of DMPE with disuccinimidyl suberate, and isolated by preparative plate chromatography. Liposomes, which contain NHS-sub-DMPE, can covalently bind compounds that possess a free amino group such as ε-dinitrophenyl-lysine. The extent of DNP-lysine binding is influenced by the time and temperature of incubation, the amount of NHS-sub-DMPE incorporated into the liposomes, and the initial concentration of DNP-lysine. Binding occurs as a consequence of the formation of a new dinitrophenylated compound which has been characterized. Although NHS-sub-DMPE is stable to storage in organic solvents, preformed liposomes rapidly lose their ability to bind DNP-lysine due to hydrolysis of the N-hydroxysuccinimide ester bond. These findings bear on the future applicability of liposomes, containing N-hydroxysuccinimide esters of PE, as illustrated by the preparation of immunogenic liposomes.     

In situ activation of murine macrophages by liposomes containing lymphokines

Murine alveolar and peritoneal macrophages harvested after injection of lymphokines encapsulated within multilamellar phospholipid vesicles (liposomes) were tumoricidal in vitro. The state and degree of activation depended on the route of liposome administration. Activation of peritoneal macrophages was achieved by intraperitoneal injection of liposomes and alveolar macrophages were activated by injecting liposomes intravenously but not intraperitoneally. The in vivo rendering of macrophages with tumoricidal properties might be useful toward destruction of tumor cells in vivo.     

Treatment of murine SCC VII tumors with localized hyperthermia and temperature-sensitive liposomes containing cisplatin

The release of cisplatin (CDDP) encapsulated in temperature-sensitive unilamellar liposomes to murine SCC VII carcinoma by localized hyperthermia and the effects of the treatment on tumor growth were studied. A transition temperature of the temperature-sensitive liposomes containing cisplatin (LIP-CDDP) was 41 degrees C. Twenty-four hours after injection of LIP-CDDP, the heated tumors (42 degrees C, 60 min) contained 3.3 times more CDDP than the unheated tumors receiving free CDDP. Although the uptake of liposome-associated CDDP by liver was approximately threefold greater at 1.5 h after injection than uptake of free CDDP, it decreased about 50% over a 24-h period. No difference in uptake of the two forms of CDDP by kidney was observed. The combination of LIP-CDDP and localized heating at 42 or 43 degrees C was more effective relative to the amount of CDDP in delaying tumor growth than that of free CDDP and hyperthermia. Treatment with LIP-CDDP plus local heating resulted in a dose-modifying factor of 5.3 when compared with free CDDP and no hyperthermia. The dose-modifying factor was 2.8 when treatment with LIP-CDDP and heat was compared with treatment with free CDDP and heat. Thus CDDP could be released selectively from the temperature-sensitive liposomes by heat and resulted in both a greater uptake of the drug and a delay in tumor growth.     

The effect of high intensity focused ultrasound treatment on metastases in a murine melanoma model

This study aims to assess the risk of high intensity focused ultrasound (HIFU) therapy on the incidence of distant metastases and to investigate its association with HIFU-elicited anti-tumor immunity in a murine melanoma (B16-F10) model. Tumor-bearing legs were amputated immediately after or 2 days following HIFU treatment to differentiate the contribution of the elicited anti-tumor immunity. In mice undergoing amputation immediately after mechanical, thermal, or no HIFU treatment, metastasis rates were comparable (18.8%, 13.3%, and 12.5%). In contrast, with a 2-day delay in amputation, the corresponding metastasis rates were 6.7%, 11.8%, and 40%, respectively. Animal survival rate was higher and CTL activity was enhanced in the HIFU treatment groups. Altogether, our results suggest that HIFU treatment does not increase the risk of distant metastasis. Instead, HIFU treatment can elicit an anti-tumor immune response that may be harnessed to improve the overall effectiveness and quality of cancer therapy.     

pH-dependent stability and fusion of liposomes combining protonatable double-chain amphiphiles with phosphatidylethanolamine

We have prepared a series of novel double-chain amphiphiles with protonatable head groups, including acylated derivatives of various 2-substituted palmitic acids, amino acid conjugates of these species, and 1,2-dioleoyl-3-succinylglycerol. These species can be combined with phosphatidylethanolamine (PE) to prepare reverse-phase evaporation vesicles that are stable and trap hydrophilic solutes at pH 7. At weakly acidic pH values (as high as 6.5, depending on the titratable amphiphilic component), these pH-sensitive vesicles exhibit fusion, with a limited extent of contents mixing and extensive mixing of lipids, accompanied by leakage of aqueous contents. Protons and divalent cations show strong synergistic effects in promoting mixing of both lipids and aqueous contents between pH-sensitive vesicles prepared with any of a variety of double-chain titratable amphiphiles. Calorimetric results indicate that the relative stabilities of different types of pH-sensitive liposomes at low pH cannot be simply correlated with the propensity of the lipids to form a hexagonal II phase under these conditions. Fluorescence measurements demonstrate that single-chain fatty acids, but not double-chain titratable amphiphiles such as N-acyl-2-aminopalmitic acids, are rapidly removed from pH-sensitive vesicles in the presence of other lipid vesicles, serum albumin, or serum. Additionally, pH-sensitive liposomes containing double-chain titratable amphiphiles retain their aqueous contents better than do those containing single-chain amphiphiles in the presence of lipid membranes or albumin. Surprisingly, however, pH-sensitive vesicles of either type show retention of contents in the presence of serum that is comparable to that observed with vesicles composed purely of phospholipids. A model is proposed to explain these latter findings.     

Current treatment of melanoma metastases of the brain

The appearance of brain metastases in patients with malignant melanoma predicts poor prognosis. During the last ten years important progress has been made in the treatment of brain metastases providing longer survival and better quality of life for these patients. In this review article the different treatment modalities, surgery, radiosurgery, radiation therapy and chemotherapy are described and the results published in the literature are briefly presented. Emphasis is made to show the effectiveness of a multimodality approach of this group of patients resulting in a better clinical outcome.     

Systemic activation of macrophages by liposome-entrapped muramyl tripeptide in mice pretreated with the chemotherapeutic agent adriamycin

Summary The purpose of these studies was to determine whether macrophages of mice pretreated with the chemotherapeutic agent adriamycin (ADR) could be systemically activated by IV injection of liposomes containing muramyl tripeptide phosphatidylethanolamine (MTP-PE), a lipophilic derivative of muramyl dipeptide. Lower than normal levels of alveolar macrophages or peritoneal exudate macrophages were found in mice following IV injection of ADR. This decrease was dose-dependent and, in mice given <10 mg ADR/kg, it was transient (14 days). Peritoneal macrophages surviving the administration of 15 mg ADR/kg were tumoricidal.At various times after single or repeated administration of ADR, mice were given IV or IP injections of liposomes containing MTP-PE. One day thereafter, the cytotoxic activity of the in situ-activated macrophages (alveolar or peritoneal exudate) was assessed in culture against syngeneic melanoma cells. Our data demonstrate that under defined conditions the systemic administration of ADR does not interfere with the in situ activation of tumoricidal properties of murine macrophages after IV injection of liposomes containing a macrophage-activating agent.     

Effects on the murine mononuclear phagocyte system of chronic administration of liposomes containing cytotoxic drug or lipid A compared with empty liposomes

In experiments designed to examine the adverse effects of chronic liposome administration in vivo on the mononuclear phagocyte system (reticuloendothelial system), the presence of drug entrapped in the liposomes may increase the level of reticuloendothelial impairment. We have compared the effects on the mononuclear phagocyte system in mice of chronic administration of empty liposomes with the effects of liposomes containing the anti-leishmanial drug meglumine antimoniate. We have also examined the effect on the mononuclear phagocyte system of continued injections of liposomes containing lipid A, a component of bacterial lipopolysaccharide, which is responsible for macrophage activation. Ten intravenous injections of multilamellar liposomes composed of dipalmitoylphosphatidylcholine and cholesterol (1:0.75 M ratio) were given to ICR mice over a 25-day period. Two individual groups of mice received endotoxin-free liposomes in which meglumine antimoniate was either present or absent. One addition group received liposomes containing lipid A derived from Escherichia coli lipopolysaccharide. A control group received sterile saline injections. In each group, a depression of the phagocytic index, as measured by reduction of uptake of particulate carbon, was observed among some of the individual animals 24 h after the first injection. In many mice a marked splenomegaly was observed. A depressed phagocytic index and splenomegaly were most marked for mice receiving lipid A liposomes. However, there was a large individual variability among mice receiving these preparations and some mice in each group had normal spleen size and a nearly normal phagocytic index. Tissue distribution of liposomes containing [14C]dipalmitoylphosphatidylcholine as a phospholipid marker was examined in all groups in mice 24 h after the last injection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dolichol induces membrane leakage of liposomes composed of phosphatidylethanolamine and phosphatidylcholine

Dolichol promotes the leakage of membranes in liposomes composed of phosphatidylethanolamine and phosphatidylcholine but not liposomes composed only of phosphatidylcholine. The membrane leakage was assayed by measuring the entrapment of TEMPOcholine, a cationic spin probe, in liposomes using ESR methods. The percent of membrane leakage induced by dolichol was found to be linearly proportional to the concentrations of dolichol. It is proposed that dolichol enhances the formation of non-bilayer configurations in liposomes containing phosphatidylethanolamine, thereby membrane leakage.     

Survival and prognostic factors for patients with melanoma brain metastases in the era of modern systemic therapy

Historically, the prognosis of patients with melanoma brain metastases is poor, with median overall survival (OS) of 4‐6 months. Little is known of OS in the era of modern systemic therapies and local therapy with stereotactic radiosurgery (SRS) or surgery. Patients diagnosed with melanoma brain metastases at Melanoma Institute Australia from January 2011 to December 2014 were included. OS and prognostic factors were analysed using Cox regression and Kaplan‐Meier survival analyses.355 patients were included. The median OS was 7.1 months (95% confidence interval [CI] 6.0‐8.1). Median OS differed by treatment modality: systemic therapy and SRS and/or surgery 14.9 months (95% CI 10.7‐19.0), SRS and/or surgery with or without whole brain radiotherapy (WBRT) 6.4 months (95% CI 5.4‐7.5), systemic therapy 5.4 months (95% CI 3.1‐7.7), systemic therapy and WBRT 5.2 months (95% CI 4.1‐6.4), WBRT 4.4 months (95% CI 2.4‐6.3), and best supportive care 1.8 months (95% CI 1.2‐2.3). OS for patients with melanoma brain metastases appears improved in the modern era, particularly for patients who are candidates for systemic therapy with SRS and/or surgery.