Dual Barrier‐Penetrating Inhaled Nanoparticles for Enhanced Idiopathic Pulmonary Fibrosis Therapy

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Abstract

Idiopathic pulmonary fibrosis (IPF) is an age‐related pulmonary interstitial disease with unclear etiology that poses a serious threat to human health. IPF interventions in clinical settings mainly involve oral medications, such as nintedanib (NIN), which exhibit limited accumulation in the lungs and neglect the epithelial micro‐environment. Inhalation is an efficient route for the treatment of pulmonary diseases. However, the mucus barrier in the trachea and the extracellular matrix (ECM) barrier in the interstitium are the two main obstacles to inhaled therapeutic agent delivery. Therefore, in this study, dual barrier‐penetrating inhaled liposomes (AN‐TR) are constructed utilizing tris‐(2‐carboxyethyl)‐phosphine (TCEP) and l‐arginine to penetrate the mucus and ECM barriers, respectively. This approach facilitates the thorough and uniform distribution of NIN and navitoclax (ABT‐263) across all five lung lobes. Furthermore, ABT‐263 can remove the senescent epithelial cells in the trachea and alveoli, thereby improving the efficiency of NIN for IPF treatment. This study suggests dual barrier‐penetrating inhaled liposomes as efficient noninvasive vehicles for first‐line clinical medications to improve the efficacy of IPF treatment.

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Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis.

Luca Richeldi, Roland M du Bois, Ganesh Raghu … (2014)

Nintedanib (formerly known as BIBF 1120) is an intracellular inhibitor that targets multiple tyrosine kinases. A phase 2 trial suggested that treatment with 150 mg of nintedanib twice daily reduced lung-function decline and acute exacerbations in patients with idiopathic pulmonary fibrosis. We conducted two replicate 52-week, randomized, double-blind, phase 3 trials (INPULSIS-1 and INPULSIS-2) to evaluate the efficacy and safety of 150 mg of nintedanib twice daily as compared with placebo in patients with idiopathic pulmonary fibrosis. The primary end point was the annual rate of decline in forced vital capacity (FVC). Key secondary end points were the time to the first acute exacerbation and the change from baseline in the total score on the St. George's Respiratory Questionnaire, both assessed over a 52-week period. A total of 1066 patients were randomly assigned in a 3:2 ratio to receive nintedanib or placebo. The adjusted annual rate of change in FVC was -114.7 ml with nintedanib versus -239.9 ml with placebo (difference, 125.3 ml; 95% confidence interval [CI], 77.7 to 172.8; P<0.001) in INPULSIS-1 and -113.6 ml with nintedanib versus -207.3 ml with placebo (difference, 93.7 ml; 95% CI, 44.8 to 142.7; P<0.001) in INPULSIS-2. In INPULSIS-1, there was no significant difference between the nintedanib and placebo groups in the time to the first acute exacerbation (hazard ratio with nintedanib, 1.15; 95% CI, 0.54 to 2.42; P=0.67); in INPULSIS-2, there was a significant benefit with nintedanib versus placebo (hazard ratio, 0.38; 95% CI, 0.19 to 0.77; P=0.005). The most frequent adverse event in the nintedanib groups was diarrhea, with rates of 61.5% and 18.6% in the nintedanib and placebo groups, respectively, in INPULSIS-1 and 63.2% and 18.3% in the two groups, respectively, in INPULSIS-2. In patients with idiopathic pulmonary fibrosis, nintedanib reduced the decline in FVC, which is consistent with a slowing of disease progression; nintedanib was frequently associated with diarrhea, which led to discontinuation of the study medication in less than 5% of patients. (Funded by Boehringer Ingelheim; INPULSIS-1 and INPULSIS-2 ClinicalTrials.gov numbers, NCT01335464 and NCT01335477.).

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Idiopathic pulmonary fibrosis.

Luca Richeldi, Harold Collard, Mark G. Jones (2017)

Idiopathic pulmonary fibrosis is a prototype of chronic, progressive, and fibrotic lung disease. Healthy tissue is replaced by altered extracellular matrix and alveolar architecture is destroyed, which leads to decreased lung compliance, disrupted gas exchange, and ultimately respiratory failure and death. In less than a decade, understanding of the pathogenesis and management of this disease has been transformed, and two disease-modifying therapies have been approved, worldwide. In this Seminar, we summarise the presentation, pathophysiology, diagnosis, and treatment options available for patients with idiopathic pulmonary fibrosis. This disease has improved understanding of the mechanisms of lung fibrosis, and offers hope that similar approaches will transform the management of patients with other progressive fibrotic lung diseases.