Review on Resealed Erythrocyte
Sarika V. Khandbahale, Saudagar R. B.
Department of Quality Assurance Technique,
R.G. Sapkal College of Pharmacy, Anjaneri,
Nashik
*Corresponding
Author E-mail: sarikavkhandbahale@gmail.com
Erythrocytes, also known as red blood
cells, and have been extensively studied for their potential carrier
capabilities for the delivery of drugs. Such drug-loaded carrier erythrocytes
are prepared simply by collecting blood samples from the organism of interest,
separating erythrocytes from plasma, entrapping drug in the erythrocytes, and
resealing the resultant cellular carriers, these carriers are called resealed
erythrocytes. Among the various carriers
used for targeting drugs to various body tissues, the cellular carriers meet
several criteria desirable in clinical applications, among the most important
being biocompatibility of carrier and its degradation products. Carrier
erythrocytes, resealed erythrocytes loaded by a drug or other therapeutic
agents, have been exploited extensively in recent years for both temporally and
spatially controlled delivery of a wide variety of drugs and other bioactive
agents owing to their remarkable degree of biocompatibility, biodegradability
and a series of other potential advantages. Leucocytes, platelets,
erythrocytes, nano erythrocytes, hepatocytes,
and fibroblast etc. have been proposed
as cellular carrier systems. Among these, the erythrocytes have been the most
investigated and have found to possess greater potential in drug delivery. In
this review article, the potential applications of erythrocytes in drug
delivery have been reviewed with a particular stress on the studies and laboratory
experiences on successful erythrocyte loading and characterization of the
different classes of biopharmaceuticals.
KEYWORDS: Resealed erythrocytes, Drug targeting, isolation, drug loading method, characterization
methods and Applications.
INTRODUCTION:
Blood contains different type of cells like
erythrocytes (RBC), leucocytes (WBC) and platelets, among them erythrocytes are
the most interesting carrier and possess great potential in drug delivery due
to their ability to circulate throughout the body, zero order kinetics,
reproducibility and ease of preparation. Primary aim for the development of
this drug delivery system is to maximize therapeutic performance, reducing
undesirable side effects of drug as well as increase patient compliance.
Erythrocytes, the most abundant cells in
the human body, have potential carrier capabilities for the delivery of drugs.
Erythrocytes are biocompatible, biodegradable, possess very long circulation
half-lives and can be loaded with a variety of chemically and biologically
active compounds using various chemical and physical methods. Most of the
resealed erythrocytes used as drug carriers are rapidly taken up from blood by
macrophages of reticuloendothelial system (RES),
which is present in liver, lung, and spleen of the body . The aim of the
present review is to focus on the various features, drug loading technology and
biomedical application of resealed erythrocytes.
Erythrocyte:(2)
Red blood cells (also referred to as
erythrocytes) are the most common type of blood cells and the vertebrate
organism's principal means of delivering oxygen (O2) to the body tissues via
the blood flow through the circulatory system. The cells develop in the bone
marrow and circulate for about 100–120 days in the body before their components
are recycled by macrophages. Each circulation takes about 20 seconds.
Approximately a quarter of the cells in the human body are red blood cells.
Resealed
Erythrocytes (2)
Such drug-loaded carrier erythrocytes are
prepared simply by collecting blood samples from the organism of interest,
separating erythrocytes from plasma, entrapping drug in the erythrocytes, and
resealing the resultant cellular carriers8. Hence, these carriers are called
resealed erythrocytes. The overall process is based on the response of these
cells under osmotic conditions. Upon reinjection, the drug-loaded erythrocytes
serve as slow circulating depots and target the drugs to a reticuloendothelial
system( RES).
Morphology
and Physiology of Erythrocytes :(5,8)
Erythrocytes (Fig1) are the most abundant
cells in the human body (~5.4million cells/mm3 blood in healthy male and ~4.8
million cells in a healthy female). These cells were described in human blood
samples by Dutch Scientist Lee Van Hock in 1674. In the 19th
century, Hope Seyler identified hemoglobin and its
crucial role in oxygen delivery to various parts of the body. Erythrocytes are biconcave discs with an
average diameter of 7.8μm, a thickness of 2.5μm in periphery,
1μm in the centre, and a volume of 85–91μm3.8 The red blood cell
membrane is dynamic, semi permeable components of the cell associated with
energy metabolism in the maintenance of the permeability characteristic of the
cell of various cations (Na+,K+)
and anions (Cl‐, HCO3‐).
The flexible, biconcave shape enables
erythrocytes to squeeze through narrow capillaries, which may be only 3m wide.
Mature erythrocytes are quite simple in structure. They lack a nucleus and
other organelles. Their plasma membrane encloses hemoglobin, a heme‐containing protein that is responsible for
O2–CO2 binding inside the erythrocytes. The main role of erythrocytes is the
transport of O2 from the lungs to tissues and the CO2 produced in tissues back
to lungs. Thus, erythrocytes are a highly specialized O2 carrier system in the
body. Because a nucleus is absent, all the intracellular space is available for
O2 transport. Also, because mitochondria are absent and because energy is
generated an aerobically in erythrocytes, these cells do not consume any of the
oxygen they are carrying. Erythrocytes live only about 120 days because of wear
and tear on their plasma membranes as they squeeze through the narrow blood
capillaries. The process of erythrocyte formation within the body is known as erythropoiesis. In a mature human being, erythrocytes are
produced in red bone marrow under the regulation of a hemopoietic
hormone called erythropoietin
Isolation
of Erythrocyte: (5)
Source: Erythrocytes may be prepared as
carriers from blood taken from human beings and from different animal species
including erythrocytes of mice, cattle, pigs, dogs, sheep, goats, monkeys,
chicken, rats and rabbits. To isolate erythrocytes, the blood is collected in heparinised tubes by venipuncture.
Freshly collected blood is centrifuged in a refrigerated centrifuge and washed
in order to obtain erythrocyte. The washed cells are suspended in buffer (e.g.
acid‐citrate‐dextrose buffer) at various haematocrit
values as desired.
Fig. 1: Erythrocytes(5)
Advantages(8, 3, 4,5)
1.
Biocompatible,
particularly when autologous cells are used hence no
possibility of triggered immune response.
2.
Biodegradability
with no generation of toxic product.
3.
Considerable
uniform size and shape of carrier.
4.
Relatively
inert intracellular environment can be encapsulated in a small volume of cells.
5.
Isolation
is easy and large amount of drug can be loaded.
6.
Prevention
of degradation of the loaded drug from inactivation by endogenous chemical.
7.
Entrapment
of wide variety of chemicals can be possible.
8.
Entrapment
of drug can be possible without chemical modification of the substance to be
entrapped.
9.
Possible
to maintain steady-state plasma concentration, decrease fluctuation in
concentration.
10.
Protection
of the organism against toxic effect of drug.
11.
Targeting
to the organ of the RES.
12.
Ideal
zero-order drug release kinetic.
13.
Prolong
the systemic activity of drug by residing for a longer time in the body.
14.
Attainment
of steady state plasma concentration with possibility of zero order drug
release kinetics.
15.
Modification
of pharmacokinetics and Pharmacodynamics parameters of drug.
16.
Significant
decrease in side effects.
17.
Large
quantities of drug that can be encapsulated within a small volume of cells
ensure dose sufficiency.
18.
Ability
to target the organs of RES.
DISADVANTAGES:(2)
1.
They
have a limited potential as carrier to non-phagocyte target tissue.
2.
Possibility
of clumping of cells and dose dumping may be there.
3.
Rapid
leakage of certain encapsulated material from the loaded erythrocytes.
4.
Several
molecules may alter the physiology of erythrocytes.
Requirement
for Encapsulation:(2,4)
1.
Variety
of biologically active substance (5000-60,000dalton) can be entrapped in erythrocytes.
2.
Non-polar
molecule may be entrapped in erythrocytes in salts.Example:
tetracycline HCl salt can be appreciably entrapped in
bovine RBC.
3.
Generally,
molecule should be Polar & Non polar molecule also been entrapped.
4.
Hydrophobic
molecules can be entrapped in erythrocyte by absorbing over other molecules.
5.
Once
encapsulated charged molecule are retained longer than uncharged molecule. The
size of molecule entrapped is a significant factor when the molecule is smaller
than sucrose and larger than B-galactosidase.
Factors
which Considering Resealed Erythrocytes as Carrier:(3)
1.
Its
shape and size to permit the passage through the capillaries.
2.
Its
specific physico-chemical properties by which a
prerequisite site can be recognized.
3.
Its
biocompatible and minimum toxicity character.
4.
Its
degradation product, after release of the drug at the target site, should be
biocompatible.
5.
Low
leaching/leakage of drug should take place before target site is reached.
6.
Its
drug released pattern in a controlled manner.
7.
High
drug loading efficiency for broad spectrum of drugs with different properties.
8.
Physico-chemical compatibility with the drug.
9.
The
carrier system should have an appreciable stability during storage.
Erythrocytes
can be used as Carriers in two Ways (4, 6)
1.
Targeting Particular Tissue/Organ:
For targeting, only the erythrocyte
membrane is used. This is obtained by splitting the cell in hypotonic solution
and after introducing the drug into the cells, allowing them to reseal into
spheres. Such erythrocytes are called Red cell ghosts.
2.
For Continuous or Prolonged Release of
Drugs:
Alternatively, erythrocytes can be used as a
continuous or prolonged release system, which provide prolonged drug action.
There are different methods for encapsulation of drugs within erythrocytes.
They remain in the circulation for prolonged periods of time (up to 120 days)
and release the entrapped drug at a slow and steady rate.
Methods
of Drug Loading of in Erythrocytes:(2, 3, 5, 7)
In general, the potential use of
erythrocytes depends on their ability to encapsulate exogenous enzymes or other
substances into erythrocytes. Several methods can be used to load drugs or
other bioactive compounds in erythrocytes, including physical (e.g., electrical
pulse method), osmosis –based systems and chemical methods (e.g., chemical
perturbation of the erythrocytes membrane). Irrespective of the method used,
the optimal characteristics for the successful entrapment of the compound
requires the drug to have a considerable degree of water solubility, resistance
against degradation within erythrocytes, lack of physical or chemical
interaction with erythrocytes membrane, an well-defined pharmacokinetic and Pharmacodynamics
properties. The following methods are used for entrapment of therapeutic agent
into erythrocytes:
Hypo-
osmosis lysis method:
In this process, the intracellular and
extracellular solute of erythrocytes is exchange by osmotic lysis
and resealing .The drug present will be encapsulated within the RBCs by this
process.
A.
Hypotonic dilution:
It was the first method
investigated for the encapsulation of chemicals into erythrocytes and is
simplest and fastest (Fig 2).17 In this method, a volume of packed erythrocytes
is diluted with 2‐20 volumes of aqueous solution of a drug. The solution
tonicity is then restored by adding a hypertonic buffer. The resultant mixture
is then centrifuged, the supernatant is discarded and the pellet is washed with
isotonic buffer solution. These cell are rapidly phagocytosed
by RES macrophages and hence can be used for targeting RES organ.
.
Fig. 2: Hypotonic dilution
B.
Hypotonic Dialysis method:
This method was first
reported by Klibansky in 1959 and was used in 1977 by
Deloach, Ihler and Dale for
loading enzymes and lipids. In the process, an isotonic, buffered suspension of
erythrocytes with a haematocrit value of 70–80 is
prepared and placed in a conventional dialysis tube immersed in 10–20 volumes
of a hypotonic buffer. The medium is agitated slowly for 2 h. The tonicity of
the dialysis tube is restored by directly adding a calculated amount of a
hypertonic buffer to the surrounding medium or by replacing the surrounding
medium by isotonic buffer. The drug to be loaded can be added by either
dissolving the drug in isotonic cell suspending buffer inside a dialysis bag at
the beginning of the experiment or by adding the drug to a dialysis bag after
the stirring is complete.
C.
Hypotonic preswell
technique:
This method was
investigated by Rechsteiner in 1975 and was modified by Jenner et al. for
drug loading. This method based on the principle of first swelling the
erythrocytes without lysis by placing them in
slightly hypotonic solution. The swollen cells are recovered by centrifugation
at low speed. Then, relatively small volumes of aqueous drug solution are added
to the point of lysis. The slow swelling of cells
results in good retention of the cytoplasmic
constituents and hence good survival in vivo. This method is simpler and faster
than other methods, causing minimum damage to cells. Drugs encapsulated in
erythrocytes using this method include propranolol , asparginase, cyclophosphamide,
cortisol-21-phosphate, 1-antitrypsin, methotrexate
insulin, metronidazole, levothyroxine,
enalaprilat and isoniazid.
D.
Isotonic osmotic lysis
method:
This method was
reported by Schrier et al in 1975. This method, also
known as the osmotic pulse method, involves isotonic haemolysis
that is achieved by physical or chemical means. The isotonic solutions may or
may not be isotonic. If erythrocytes are incubated in solutions of a substance
with high membrane permeability, the solute will diffuse into the cells because
of the concentration gradient. This process is followed by an influx of water
to maintain osmotic equilibrium. Chemicals such as urea solution, polyethylene
glycol, and ammonium chloride have been used for isotonic haemolysis.
However, this method also is not immune to changes in membrane structure
composition. In 1987, Franco et al. developed a method that involved suspending
erythrocytes in an isotonic solution of dimethyl sulfoxide (DMSO). The suspension was diluted with an
isotonic-buffered drug solution. After the cells were separated, they were
sealed at 37oC.
E.
Isotonic Osmotic Lysis:
This method is also
known as osmotic pulse method. In which isotonic haemolysis
is achieved by physical or chemical means. If erythrocytes are incubated in
solutions of a substance with high membrane permeability, the solute will
diffuse into the cells because of the concentration gradient. This process is
followed by an influx of water to maintain osmotic equilibrium.
F.
Chemical perturbation of the membrane:
This method is based
on the fact that erythrocyte when exposed to certain chemicals like polyene antibiotic such as amphotericin
B, halothane etc. and the membrane permeability of erythrocyte increases. The
main drawback of this method is that it induces irreversible changes in the
cell membrane and hence are not very popular.
G.
Electro-insertion or Electro encapsulation
method:
In 1973, Zimmermann
tried an electrical pulse method to encapsulate bioactive molecules. Also known
as electroporation, the method is based on the
observation that electrical shock brings about irreversible changes in an
erythrocyte membrane. This method is also called as electroporation.
In this method erythrocyte membrane is open by a dielectric breakdown;
subsequently the pore of erythrocyte can be resealed by incubation at 370C in
an isotonic medium. The various chemical encapsulated into the erythrocytes are
primaquin and related 8- amino quinolone,
vinblastine chlorpromazine and related phenothiazine, propranolol, tetracaine and vitamin A.
Fig. 3: Electro encapsulation
H.
Entrapment by Endocytosis:
Endocytosis involves the addition of one volume of
washed packed erythrocytes to nine volumes of buffer containing 2.5 mM ATP, 2.5 mM MgCl2, and 1mM
CaCl2, followed by incubation for 2 min at room temperature. The pores created
by this method are resealed by using 154 mM of NaCl and incubation at 370C for 2 min. The entrapment of
material occurs by endocytosis. The vesicle membrane
separates endocytosed material from cytoplasm thus
protecting it from the erythrocytes and vice-versa.
Fig. 4: Entrapment by endocytosis
I.
Lipid fusion method:
The lipid vesicles
containing a drug can be directly fuse to human erythrocytes, which lead to an
exchange with a lipid 161 entrapped drug. The methods are useful for entrapping
inositol monophosphate to
improve the oxygen carrying capacity of cells and entrapment efficiency of this
method is very low (~1%).
J.
Loading by electric cell fusion:
This method involves
the initial loading of drug molecules into erythrocyte ghosts followed by
adhesion of these cells to target cells. The fusion is accentuated by the
application of an electric pulse, which causes the release of an entrapped
molecule. An example of this method is loading a cell-specific monoclonal
antibody into an erythrocyte ghost. An antibody against a specific surface
protein of target cells can be chemically cross-linked to drug-loaded cells
that would direct these cells to desired cells.
K.
Use of red cell loader:
Novel method was
developed for entrapment of non-diffusible drugs into erythrocytes. They
developed a piece of equipment called a “red cell loader”. With as little as 50
ml of a blood sample, different biologically active compounds were entrapped
into erythrocytes within a period of 2 h at room temperature under blood
banking conditions. The process is based on two sequential hypotonic dilutions
of washed erythrocytes followed by concentration with a hem filter and an
isotonic resealing of the cells. There was 30% drug loading with 35–50% cell
recovery. The processed erythrocytes had normal survival in vivo. The same
cells could be used for targeting by improving their recognition by tissue
macrophages.
Storage:
(4)
Store encapsulated preparation without loss
of integrity when suspended in hank's balanced salt solution [HBSS] at 40C for
two weeks. Use of group 'O' [universal donor] cells and by using the preswell or dialysis technique, batches of blood for
transfusion. Standard blood bag may be used for both encapsulation and storage.
Evaluation
of Resealed Erythrocyte:
(4-7)
After loading of therapeutic agent on
erythrocytes, the carrier cells are exposed to physical, cellular as well as
biological evaluations.
1.
Shape and Surface Morphology:
The morphology of
erythrocytes decides their life span after administration. The morphological
characterization of erythrocytes is undertaken by comparison with untreated
erythrocytes using either transmission (TEM) or Scanning electron microscopy
(SEM). Other methods like phase contrast microscopy can also be used.
2.
Drug Content:
Drug content of the
cells determines the entrapment efficiency of the method used. The process
involves deproteinization of packed loaded cells (0.5
mL) with 2.0 mL acetonitrile and centrifugation at 2500 rpm for 10 min. The
clear supernatant is analyzed for the drug content.
3.
Cell Counting and Cell Recovery:
This involves
counting the number of red blood cells per unit volume of whole blood, usually
by using automated machine it is determined by counting the no. of intact cells
per cubic mm of packed erythrocytes before and after loading the drug.
4.
Turbulence Fragility:
It is determined by
the passage of cell suspension through needles with smaller internal diameter
(e.g., 30 gauges) or vigorously shaking the cell suspension. In both cases, haemoglobin and drug released after the procedure are
determined. The turbulent fragility of resealed cells is found to be higher.
5.
Drug Release:
The drug loading may
produce sustained release of the drug that influences the pharmacokinetic
behavior in vivo of he loaded erythrocytes. In vitro leakage of the drug from
loaded erythrocytes is tested using autologous plasma
or an isosmotic buffer at 370C with a haematocrit adjusted between 0.5% and 50%. The supernatant
is removed at previously programmed time intervals and replaced by an equal
volume of autologous plasma or buffer. Some authors
recommended performing in vitro release studies from loaded erythrocytes using
a dialysis bag.
6.
Erythrocyte Sedimentation Rate (ESR):
It is an estimate of
the suspension stability of RBC in plasma and is related to the number and size
of the red cells and to relative concentration of plasma protein, especially
fibrinogen and α, β globulins. This test is performed by determining
the rate of sedimentation of blood cells in a standard tube. Normal blood ESR
is 0 to 15 mm/hr. higher rate is indication of active but obscure disease
processes.
7.
Osmotic Fragility:
This test of resealed
erythrocytes is an indicator of the possible changes in cell membrane integrity
and the resistance of these cells to osmotic pressure of the suspension medium.
The test is carried out by suspending cells in media of varying sodium chloride
concentration and determining the haemoglobin
released. In most cases, osmotic fragility of resealed cells is higher than
that of normal cells.
8.
Determination of Entrapped Magnetite:
Atomic absorption
spectroscopic method is reported for determination of the concentration of
particular metal in the sample. The HCl is added to a
fixed amount of magnetite bearing erythrocytes and content are heated at 600C
for 2 hours, then 20 %w/v trichloro acetic acid is
added and supernatant obtained after centrifugation is used to determine
magnetite concentration using atomic absorption spectroscopy.
9.
Haemoglobin Release:
The content of haemoglobin of the erythrocytes may be diminished by the
alterations in the permeability of the membrane of the red blood cells during
the encapsulation procedure. Furthermore, the relationship between the rate of haemoglobin and rate of drug release of the substance
encapsulated from the erythrocytes. The haemoglobin
leakage is tested using a red cell suspension by recording absorbance of
supernatant at 540nm on a spectrophotometer.
10. Cell
Counting and Cell Recovery:
This involves
counting the number of red blood cells per unit volume of whole blood, usually
by using automated machine. Red blood cell recovery may be calculated on the
basis of the differences in the haematocrit and the
volume of the suspension of erythrocytes before and after loading. The goal is
to minimize the loss during the encapsulation procedure to maximize
recovery.
11. In
Vitro Stability:
The stability of the
loaded erythrocytes is assessed by means of the incubation of the cells in the autologous plasma or in an isoosmotic
buffer, setting haematocrit between 0.5% and 5% at
temperatures of 40C and 370C.
12. In-Vitro
Drug Release and Hb Content:
The cell suspensions
(5% haematocrit in PBS) are stored at 40C in ambered colour glass container.
Periodically clear supernatant are drawn using a hypodermic syringe equipped
with 0.45 are filter, deproteined using methanol and
were estimated far drug content. The supernatant of each sample after
centrifugation collected and assayed, % Hb release
may be calculated using formula % Hb release=A540 of
sample-A540 of background A540 of 100% Hb.
13. Osmotic
Shock:
For osmotic shock
study, erythrocytes suspension (1 ml 10% hct) was
diluted with distilled water (5 ml) and centrifuge at 300 rpm for 15 minutes.
The supernant was estimated for % haemoglobin
release analytically.
14. Miscellaneous:
Resealed erythrocyte
can also be characterized by cell sizes, mean cell volume, energy metabolism,
lipid composition, membrane fluidity, rheological properties, and density
gradient separation.
Application
of Resealed Erythrocytes::(5, 7, 8)
Resealed erythrocytes have several possible
applications in various fields of human and veterinary medicine. Such cells
could be used as circulating carriers to disseminate a drug within a prolonged
period of time in circulation or in target-specific organs, including the
liver, spleen, and lymph nodes. A majority of the drug delivery studies using
drug-loaded erythrocytes are in the preclinical phase. In a few clinical
studies, successful results were obtained.
In Vitro Application:
Carrier RBCs have proved to be useful for a
variety of in vitro tests. For in vitro phagocytosis
cells have been used to facilitate the uptake of enzymes by phagolysosomes.
An inside to this study showed that enzymes content within carrier RBC could be
visualized with the help of cytochemical technique.
The most frequent in vitro application of RBC mediated microinjection. A
protein or nucleic acid to be injected into eukaryotic cells by fusion process.
Similarly, when antibody molecules are introduced using erythrocytic
carrier system, they immediately diffuse throughout the cytoplasm. Antibody RBC
auto injected into living cells have been used to confirm the site of action of
fragment of diphtheria toxin. In-vitro tests include utilization of
erythrocytes carrier to introduce ribosomes
inactivating proteins into cells by fusion technique.
In Vivo Applications:
This
includes the following
1.
Slow drug release:
Erythrocytes have
been used as circulating depots for the sustained delivery of antineoplastic, antiparasitics,
veterinary antiamoebics, vitamins, steroids,
antibiotics, and cardiovascular drugs.
2.
Drug Targeting:
Ideally, drug
delivery should be site‐specific and target oriented to exhibit maximal
therapeutic index with minimum adverse effects. Resealed erythrocytes can act
as drug carriers and targeting tools as well. They can be used to target RES
organs as well as non RES organs. Targeting RES organs: Surface modified
erythrocytes are used to target organs of mononuclear phagocytic
systems/ reticuloendothelial system because the
changes in membrane are recognized by macrophages (table3).
The various
approaches used include:
·
Surface
modification with antibodies (coating of loaded erythrocytes by anti‐Rh or other types of antibodies)
·
Surface
modification with glutaraldehyde.
·
Surface
modification with sulfhydryl
·
Surface
chemical crosslinking
·
Surface
modification with carbohydrates such as sialic acid.
3.
Liver Targeting /Enzyme
deficiency/replacement therapy:
Many metabolic
disorders related to deficient or missing enzymes can be treated by injecting
these enzymes. However, the problems of exogenous enzyme therapy include a
shorter circulation half-life of enzymes, allergic reactions, and toxic
manifestations. These problems can be successfully overcome by administering
the enzymes as resealed erythrocytes. The enzymes used include -glycosidase, -glucoronidase, -galactosidase.
The disease caused by an accumulation of glucocerebrosides
in the liver and spleen can be treated by glucocerebrosidase-
loaded erythrocytes.
4.
Treatment of parasitic disease:
The ability of
resealed erythrocytes to selectively accumulate with in RES organs make them
useful tool during the delivery of anti-parasitic agents. Parasitic diseases
that involve harboring parasites in The RES organs can be successfully
controlled by this method. Results were favourable in
studies involving animal models for erythrocytes loaded with anti-malarial,
anti leishmanial and anti-amoebic drugs.
5.
Treatment of hepatic tumours:
Hepatic tumours are one of the most prevalent types of cancer. Antineoplastic drugs such as methotrexate,
bleomycin, asparginase, and
Adriamycin have been successfully delivered by
erythrocytes. Agents such as daunorubicin diffuse
rapidly from the cells upon loading and hence pose a problem. This problem can
be overcome by covalently linking daunorubicin to the
erythrocyte membrane using gluteraldehyde or cisaconitic acid as a spacer. The resealed erythrocytes
loaded with carboplatin show localization in liver.
6.
Removal toxic agents:
Cannon et al.
reported inhibition of cyanide intoxication with murine
carrier erythrocyte containing bovine rhodanase and
sodium thiosulphate. Antagonization
of organophosphorus intoxication by released
erythrocyte containing a recombinate phosphodiestrase also has been reported.
7.
Delivery of antiviral drugs:
Several reports have
been cited in the literature about antiviral agents entrapped in resealed
erythrocytes for effective delivery and targeting. Because most antiviral drugs
are nucleotides or nucleoside analogs, their entrapment and exit through the
membrane needs careful consideration.
8.
Enzyme therapy:
Enzyme therapy offers
considerable promise for the long term treatment of inherited metabolic diseases.
For enzyme therapy the selected carrier must have a long circulatory life,
although specific ultimate uptake would also be advantageous. For all these,
purposes and as a more general carrier of the other therapeutic agents, the
erythrocytes offer the greatest potential, being a natural carrier of endogeneous substrates, non-toxic, non-immunogenic,
biodegradable and easy to obtain.
9.
Removal of RES iron overloads:
Desferrioxamine-loaded erythrocytes have been used to
treat excess iron accumulated because of multiple transfusions to thalassemia patients. Targeting this drug to the RES is
very beneficial because the aged erythrocytes are destroyed in RES organs,
which results in an accumulation of iron in these organs.
10. Targeting
Non RES:
Erythrocytes loaded
with drugs have also been used to target organs outside the RES The various
approaches for targeting non‐RES organs include:
·
Entrapment
of paramagnetic particles along with the drug.
·
Entrapment
of photosensitive material.
·
Use of
ultrasound waves.
·
Antibody
attachment to erythrocytes membrane to get specificity of action.
·
Other
approaches include fusion with liposome, lectin
pre-treatment of resealed cell etc.
Route
of Administration:(5)
Intra peritoneal injection reported that
survival of cells in circulation was equivalent to the cells administered by
i.e. injection .They reported that 25% of resealed cell remained in circulation
for 14 days they also proposed this method of injection as a method for extra
vascular targeting of RBCs to peritoneal macrophages. Subcutaneous route for
slow release of entrapped agents. They reported that the loaded cell released
encapsulated molecules at the injection site.
Novel
Approaches:
Erythrosomes:
These are specially engineered vesicular
systems that are chemically cross-linked to human erythrocytes’ support upon
which a lipid bilayer is coated. This process is
achieved by modifying a reverse-phase evaporation technique. These vesicles
have been proposed as useful encapsulation systems for macromolecular drugs.
Nanoerythrosomes:
These are prepared by extrusion of
erythrocyte ghosts to produce small vesicles with an average diameter of 100
nm. Daunorubicin was covalently conjugated to nanoerythrosomes using gluteraldehyde
spacer. This complex was more active than free daunorubicin
alone, both in vitro and in vivo.
CONCLUSION:
The resealed erythrocytes showed promising
drug carrier characteristics. Due to the several potential advantages over
other, this drug loaded erythrocytes seems to be a promising delivery system
for the controlled and site specific delivery of therapeutic agents. The
preparation of resealed erythrocytes is very easy and can be easily
characterized by different available techniques. However, the concept needs
further research and optimization to become a routine drug delivery system. The
targeted release of therapeutic agents is among the most attractive
applications of erythrocytes carrier which can be extended for the delivery of
biopharmaceuticals. Thus the potential of this delivery system need to be
explored for management of diseases.
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1. T.V. Thulasiramaraju, A. Arunachalam1, G.V. Surendra
babu, N. Syamkumar, V.V. Nagendra babu, M. Nikilesh babu, “ Resealed
Erythrocytes: A novel drug delivery system” International Journal of preclinical
and Pharmaceutical Research , vol 3/ issue 1/ 2011,
page no-3-13
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Received on 15.11.2016 Accepted on 18.12.2016
© Asian Pharma
Press All Right Reserved
Asian J. Res.
Pharm. Sci. 2016; 6(4): 261-268.
DOI: 10.5958/2231-5659.2016.00037.0