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      Engineering Quick- and Long-acting Naloxone Delivery Systems for Treating Opioid Overdose

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          Abstract

          Purpose

          Opioids have been the main factor for drug overdose deaths in the United States. Current naloxone delivery systems are effective in mitigating the opioid effects only for hours. Naloxone-loaded poly(lactide-co-glycolide) (PLGA) microparticles were prepared as quick- and long-acting naloxone delivery systems to extend the naloxone effect as an opioid antidote.

          Methods

          The naloxone-PLGA microparticles were made using an emulsification solvent extraction approach with different formulation and processing parameters. Two PLGA polymers with the lactide:glycolide (L:G) ratios of 50:50 and 75:25 were used, and the drug loading was varied from 21% to 51%. Two different microparticles of different sizes with the average diameters of 23 μm and 50 μm were produced using two homogenization-sieving conditions. All the microparticles were critically characterized, and three of them were evaluated with β-arrestin recruitment assays.

          Results

          The naloxone encapsulation efficiency (EE) was in the range of 70–85%. The EE was enhanced when the theoretical naloxone loading was increased from 30% to 60%, the L:G ratio was changed from 50:50 to 75:25, and the average size of the particles was reduced from 50 μm to 23 μm. The in vitro naloxone release duration ranged from 4 to 35 days. Reducing the average size of the microparticles from 50 μm to 23 μm helped eliminate the lag phase and obtain the steady-state drug release profile. The cellular pharmacodynamics of three selected formulations were evaluated by applying DAMGO, a synthetic opioid peptide agonist to a μ-opioid receptor, to recruit β-arrestin 2.

          Conclusions

          Naloxone released from the three selected formulations could inhibit DAMGO-induced β-arrestin 2 recruitment. This indicates that the proposed naloxone delivery system is adequate for opioid reversal during the naloxone release duration.

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          Most cited references40

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          Poly Lactic-co-Glycolic Acid (PLGA) as Biodegradable Controlled Drug Delivery Carrier.

          In past two decades poly lactic-co-glycolic acid (PLGA) has been among the most attractive polymeric candidates used to fabricate devices for drug delivery and tissue engineering applications. PLGA is biocompatible and biodegradable, exhibits a wide range of erosion times, has tunable mechanical properties and most importantly, is a FDA approved polymer. In particular, PLGA has been extensively studied for the development of devices for controlled delivery of small molecule drugs, proteins and other macromolecules in commercial use and in research. This manuscript describes the various fabrication techniques for these devices and the factors affecting their degradation and drug release.
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            Bias Factor and Therapeutic Window Correlate to Predict Safer Opioid Analgesics.

            Biased agonism has been proposed as a means to separate desirable and adverse drug responses downstream of G protein-coupled receptor (GPCR) targets. Herein, we describe structural features of a series of mu-opioid-receptor (MOR)-selective agonists that preferentially activate receptors to couple to G proteins or to recruit βarrestin proteins. By comparing relative bias for MOR-mediated signaling in each pathway, we demonstrate a strong correlation between the respiratory suppression/antinociception therapeutic window in a series of compounds spanning a wide range of signaling bias. We find that βarrestin-biased compounds, such as fentanyl, are more likely to induce respiratory suppression at weak analgesic doses, while G protein signaling bias broadens the therapeutic window, allowing for antinociception in the absence of respiratory suppression.
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              Naloxone dosage for opioid reversal: current evidence and clinical implications

              Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduction in mortality following an opioid overdose. Reversal of opioid toxicity may precipitate an opioid-withdrawal syndrome. At the same time, there is a risk of inadequate response or re-narcotization after the administration of a single dose of naloxone in patients who have taken large doses or long-acting opioid formulations, as the duration of effect of naloxone is shorter than that of many opioid agonists. As out-of-hospital use of this medication is growing, so too is concern about effective but safe dosing.
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                Author and article information

                Contributors
                kpark@purdue.edu
                Journal
                Pharm Res
                Pharm Res
                Pharmaceutical Research
                Springer US (New York )
                0724-8741
                1573-904X
                10 June 2021
                : 1-14
                Affiliations
                [1 ]GRID grid.169077.e, ISNI 0000 0004 1937 2197, Purdue University, , Weldon School of Biomedical Engineering, ; West Lafayette, Indiana 47907 USA
                [2 ]GRID grid.169077.e, ISNI 0000 0004 1937 2197, Purdue University, , Department of Medicinal Chemistry and Molecular Pharmacology, ; West Lafayette, Indiana 47907 USA
                [3 ]GRID grid.169077.e, ISNI 0000 0004 1937 2197, Purdue University, , Purdue Institute for Drug Discovery, ; West Lafayette, Indiana 47907 USA
                [4 ]GRID grid.169077.e, ISNI 0000 0004 1937 2197, Purdue University, , Purdue Institute for Integrative Neuroscience, ; West Lafayette, Indiana 47907 USA
                [5 ]GRID grid.169077.e, ISNI 0000 0004 1937 2197, Purdue University, , Department of Industrial and Physical Pharmacy, ; West Lafayette, Indiana 47907 USA
                Author information
                http://orcid.org/0000-0001-8202-6084
                Article
                3069
                10.1007/s11095-021-03069-x
                8192039
                34114163
                1c573443-a8c1-487f-8ca3-fa867b11cd96
                © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 2 May 2021
                : 27 May 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: UG3 DA048774
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000027, National Institute on Alcohol Abuse and Alcoholism;
                Award ID: AA025368
                Funded by: FundRef http://dx.doi.org/10.13039/100007114, Ralph W. and Grace M. Showalter Research Trust Fund;
                Award ID: 2020-KP
                Award Recipient :
                Categories
                Research Paper

                Pharmacology & Pharmaceutical medicine
                β-arrestin 2 inhibition,damgo,drug loading,encapsulation efficiency,naloxone,opioid overdose,plga microparticles,zero-order release

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