African Journal of Biotechnology Vol. 4 (13), pp. 1591-1597, December 2005
Available online at http://www.academicjournals.org/AJB
ISSN 1684–5315 2005 Academic Journals
Optimising oral systems for the delivery of therapeutic proteins and peptides Ikhuoria M. ARHEWOH, Edith I. AHONKHAI and Augustine O. OKHAMAFE
Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, University of Benin, Benin City
Therapeutic proteins/peptides are mostly administered as parenteral (injectable) preparations as a result of their poor oral bioavailability which is due to degradation by proteolytic enzymes, poor membrane permeability and large molecular size. However, the oral route would be preferred to the parenteral administration because it is more convenient for self-administration, non-invasive and more patient friendly. Consequently, efforts have intensified over the past two decades to maximize the extent of absorption of protein and peptide drugs in order to achieve optimum bioavailability via the oral route. A suitable oral delivery system should retain the drug and maintain its integrity until it gets to the region of maximum absorption where the protein/peptide is released. It would be advantageous for such a delivery system to be capable of attaching itself to the absorptive cells in that region during the course of drug release by means of specific interactions with the tissue components. Furthermore, movement of drug should be independent of prevailing factors in the gut during passage. This review examines the various efforts and strategies that have been used to pursue the goals of effective oral peptide delivery, progress made so far, as well as current trends and future prospects. Relevant issues and phenomena such as membrane permeability control, intestinal absorption, paracellular pathway and targeting have also been discussed. Key words: Protein and peptide delivery, delivery systems, oral administration, targeting, intestinal absorption.
INTRODUCTION
Over the last two decades, the field of biomedical
in the form of haemoglobin, myoglobin and various
research has witnessed dramatic advances in the
lipoproteins, they effect the transport of oxygen and other
understanding, diagnosis, and treatment of human
chemical substances within the body (Schwendeman et
diseases. These developments have been fueled by an
al., 1996; Adessi and Sotto., 2002). The increasing
increased awareness of the essential roles played by
importance of proteins and peptides can be attributed to
endogenous proteins and peptides in the regulation and
three main developments. First, improved analytical
integration of life processes (Samonen, 1985). For
methods have fostered the discovery of numerous
example, in the form of skin, hair, cartilage and muscle,
hormones and peptides that have found applications as
proteins hold together, protect, and provide structure to
biopharmaceuticals. Second, molecular biology and
the body of a multicel ular organism. In the form of
genetic engineering have enabled the large-scale
enzymes, hormones, antibodies and globulins, they
production of polypeptides previously available only in
catalyze, regulate and protect the body chemistry while
smal quantities. Third, there is now a better
understanding of the role of regulatory proteins/peptides
*Corresponding authors E-mail: [email protected],
Consequently, pharmaceutical scientists are now
[email protected]. Tel: +234-8022905981. Fax: +234-
routinely using specific peptide sequences as lead
structures for drug development. (Adessi and Sotto,
Despite the high level of activity in peptide-based drug
Rather than administering the protein itself, the DNA
research, several obstacles hinder the development of
plasmid that codes for it is swal owed. This then attaches
peptides into useful therapeutical y deliverable agents,
to the cel s in the smal intestine where it manufactures
the most important of which is imparting good
the required protein drug using available materials in the
bioavailability while maintaining pharmacological efficacy
cel . The protein is thereafter absorbed into the blood
(Humphrey and Ringrose, 1986). This problem stems
stream. The gene has a short half-life and hence must be
from the unique structural features of peptides which are
administered regularly to be effective. The advantage is
directly linked to their high instability in biological milieu,
that it provides for safe, easily managed treatment unlike
rapid elimination from plasma, poor transportability
most gene-based therapies currently available. It is also
across membranes and ease of metabolism either within
hoped that this system wil be relatively free from ectopic
the gastrointestinal tract or within the cel s lining the tract
expressions usual y experienced with gene therapies
(Davis et al., 1986; Schwendeman et al, 1996).
since the bulk of the administered genes remain within
the intestine and is passed out with feaces along with
sloughed cel s of the intestinal epithelium.
ORAL DELIVERY OF PROTEINS AND PEPTIDES
A primary objective of oral delivery systems is to protect
MEMBRANE PERMEABILITY CONTROL
protein and peptide drugs from acid and luminal
proteases in the GIT. More recent efforts seem to focus
It is important that a successful oral delivery system
on site-specific delivery systems. The site could be an
incorporating a membrane would exhibit a permeability,
organ, a cel subset or even an intracel ular region with
which can be modulated control ed by factors favourable
the objective of restricting the distribution of the peptide
to the targeting of the drug to the specific site of
to the specific target site. This should al ow for an
absorption. To achieve this, suitable polymer additives
increase in efficacy with an attendant decrease in toxicity
may be used. The benefits of this approach have been
highlighted by Okhamafe and Goosen (1993). Membrane
Various systems for achieving site-specific delivery of
permeability control is also a critical factor in living cel
oral y administered protein/peptide drugs have been
encapsulation technology and in the development of
addressed in recent years including coating systems
bioartificial organs. Furthermore, membrane modulation
based on pH changes and enzymatic activity of intestinal
is often employed to improve the strength and stability of
microflora (Macloid et al., 1999; Stubbe et al., 2001),
the microcapsule itself (Okhamafe and Goosen, 1999).
nanoparticles, (Shinji et al., 1997), liposomes (Kimura
Ahonkhai et al. (2005) recently found that by
and Saishin, 1985), matrix devices (Krishnaiah et al.,
incorporating polymers or solid fil ers in the core of
2001) and conjugate (degradable prodrug) formation
chitosan-alginate microcapsule, the release of a model
(Yano et al., 2002; Arhewoh and Okhamafe, 2004). Al of
protein, bovine serum albumin (BSA) can be modulated
these have produced variable release profiles, often
such that 70% of the protein is delivered to the desired
because the transit time through the colon can vary
absorption site in the gut 9 h later (see Figure 1). Related
substantial y from as low as 6 to as high as 30 h. Several
applications include the pre-purification and concentration
of these approaches are somewhat complex and if they
of products of cel encapsulation, release into the
were to be translated into actual manufacture of oral
circulatory system of hormonal and enzymatic products
delivery systems, the products would be expensive and,
generated by bioartificial organs which are protected from
therefore, unaffordable in most developing countries. In
components of the immune system, principal y
our laboratories, preliminary studies on microcapsules of
immunoglobulins. Some relevant parameters to be
chitosan-alginate modified with selected excepients such
considered in membrane permeability control are
as HPMCAS, talc, microcrystal ine cel ulose, polymeta-
crylates and pectins were carried out. Protein release
was determined at different pH media spanning the pH
range of the gut (Figure 1). It was observed that
PROTEIN/PEPTIDE ABSORPTION
microcapsules modified with talc and microcrystal ine
cel ulose had higher protein retention in the core in al the
Intestinal absorption
pH tested (Okhamafe et al., 1996; Ahonkhai et al., 2005;
Arhewoh et al., 2005). This shows that modification of the
The primary function of the intestine is the digestion and
core of chitosan-alginate microcapsules could facilitate
absorption of food substances including proteins. Within
the intestinal lumen, pancreatic endopeptidases chiefly
trypsin, elastase and chymotrypsin together with the
ORAL GENE DELIVERY
exopeptidases, carboxyl peptidase A and B, produce
amino acids and peptides typical y 2 to 6 residues in
In vivo production of proteins through oral gene therapy
length. The efficient absorption of an intact peptide,
has also been investigated (Rothman et al., 2005).
therefore, is the exception rather than the rule. Examples
Table 1. Critical factors affecting microcapsule membrane permeability. Capsule wall Process factor Figure 1. Protein (BSA) release at pH 1.2 from microcapsules modified with different additives – Talc
(T), Eudragit L100 (L), Eudragit RSPM (RS), HPMCAS (H), microcrystal ine cel ulose (M) and Control
oral y absorbed, biological y active peptides are rare.
absorbed in the colon, usual y leaving less than 100 ml of
However, both thyrotrophin-releasing hormone (TRH)
fluid to be excreted in the feces. Most of the absorption in
(Yokohama et al., 1984) and the luteinizing hormone-
the large intestine occurs in the proximal one half of the
releasing hormone (LHRH) analogue, leuprolide
colon, giving this portion the name, absorbing colon. The
(Gonzalez-Barcena et al., 1975) were reported to exert
mucosa of the large intestine, like that of the smal
biological activity when given oral y in rat and man. The
intestine, has a high capability for active absorption of
activity of these two proteins is a reflection of their
sodium (Guyton and Hal , 1996). Numerous bacteria,
extreme potency as only a smal portion of TRH was
especial y colon bacil i, are present normal y in the
actual y absorbed in rat and man. It was further observed
absorbing colon (Wilson and Basit, 2005). They are
that in the rat, absorption is limited to the upper region of
capable of digesting smal amounts of cel ulose, in this
the intestine and is mediated by a Na+ dependent,
way providing a few calories of nutrition to the body each
peptide transport system (Yokohama et al., 1984).
day. Substances formed as a result of bacterial activity
Remarkably, absorption of DN-1417, a close structural
are vitamin K, vitamin B12, thiamin, riboflavin and various
analog of TRH, is not active, but occurs by passive
gases that contribute to flatus in the colon, especial y
diffusion in al parts of the intestine. Furthermore, only
carbon dioxide, hydrogen and methane. It is based on
1% is absorbed in rat and 10% in dog. This example
this bacterial activity that the colon can be used as a site
il ustrates the sensitivity of transport proteins to structural
of drug delivery whereby polymer-coated drugs are
modifications in their substrates (Kimura 1984).
targeted to the colon. The bacteria in the colon degrade
the polymer thus releasing the drug where it can either
exert local action or be absorbed into systemic circulation
Colonic absorption
(Stubbe at al., 2001; Wilson and Basit, 2005).
Most of the water and electrolytes in chyme, which pass
Colonic transit is an important factor in the absorption
through the ileocecal valve into the large intestine, are
of drugs that either act local y in the colon or are
absorbed into systemic circulation from the colon. The
time at which a delivery system arrives at the colon
Targeting the drug to specific cel s along the lining of
depends mainly on the gastric emptying rate (Davies et
the intestine may be useful in facilitating protein/peptide
al., 1991). The arrival time for a tablet or capsule in the
absorption, for instance, M-cel s located on the dome
colon can range from about 5 h in the fasted condition to
epithelium of gut-associated lymphoid tissues are known
13 h or longer in the fed condition. In healthy volunteers,
to be capable of sampling macromolecular antigen from
the colonic transit of tablet or capsules releasing drug
the lumen through an endocytic pathway (Keljo and
over a prolonged period probably delivers most of its
Hamilton, 1983; Kompel a and Lee, 2001). The M-cel s
active ingredients to the colon rather than to the upper GI
are located on Peyer’s patches and the possibility of
administering microparticles oral y to target this site has
been suggested (Eldridge et al., 1990). The researchers
Lymphatic absorption
administered 20 mg of microspheres containing the
fluorescent dye, coumarin-6 to non-anesthesized mice. At
Drugs administered through the gastro-intestinal tract are
48 h, the mice were kil ed and three representative
normal y transported into systemic circulation via the
Peyer’s patches, together with the first mesenteric lymph
portal vein. As a consequence, compounds can
node proximal to the appendix and spleen, were excised
sometimes undergo extensive metabolism during the first
for microscopic observation. The number of absorbed
pass through the liver. Some wel -known drugs, such as
microspheres was counted in frozen sections using a
lignocaine, are almost total y metabolized by this process
florescence microscope. The percentage of ingested
with a consequence that little or none is available to the
dose was not determined; however, of the microspheres
general circulation. Other routes, such as rectal, buccal,
investigated, only those composed of polystyrene, poly
nasal and transdermal, avoid the first pass effect but do
(methylmethacrylate), poly ( hydroxylbutyrate), poly (D, L-
not provide the convenience of oral delivery. If a drug is
lactide), poly (L-lactide) and poly (D, L-lactide-
absorbed through the lymphatic system rather than by
coglycolides) were absorbed into the Peyer’s patches of
the portal circulation, it wil find its way into the blood via
the smal intestine, while those composed of ethyl
the thoracic duct and wil , therefore, avoid the first pass
cel ulose, cel ulose acetate hydrogen phthalate and
effect. A drug absorbed lymphatical y is incorporated into
cel ulose triacetate were not. Microsphere uptake
chylomicrons (and other lipoproteins) produced by the fat
occurred only in Peyer’s patches and was restricted to
digestion process. Various surfactant solubilised systems
those microspheres up to 10 µm in diameter. Absorptive
and other enhancing agents would appear to direct drugs
cel s located on the ideal epithelium are known to be
to the lymphatic route and there are even claims that
capable of sampling luminal peptide growth factors
particulates can be taken up this way (Leferve and Joel.,
(Gonnela et al., 1987) bile acids (Ho, 1987) and
cyanocobalamine (Doscherholmen et al., 1971)
The conjugation of large molecular weight drugs with
From recent advances in protein absorption studies
polymers, such as dextran, appears to be an interesting
have emerged a new system termed ‘Active Peptide
strategy for enhancing the lymphatic uptake of anticancer
Transport’ (APT) (Stevenson and Keon, 1998). APT
agents (Muranishi et al., 1987). In this case the
describes a new formulation that is designed to “actively”
lymphatics could wel be the target site (e.g., for
open alternative absorptive pathways in the body. These
treatment of metastatic spread) rather than the systemic
alternative pathways make transporting proteins to body
cel s and the muscles faster and more efficient. APT is
important because it is designed to al ow the body to
absorb peptides faster and more efficiently. The body has
PATHWAY FOR PROTEIN/PEPTIDE ABSORPTION
three different protein transport systems that it uses for
Identifying a region in the intestine that favours
muscle growth. The first system uses free-form amino
protein/peptide absorption is a crucial step in the design
acids. This is a very inefficient system because the free-
of oral delivery systems for protein drugs. The intestinal
form amino acids must compete with one another for
barrier is of major importance. Furthermore, regional
absorption. The second system involves smal , short
peptide chains of 2 to 3 amino acids linked together.
variations in the penetration barriers to peptides may
result in regional differences in their absorption (Kompel a
These are cal ed di- and tri-peptides. Di- and tri-peptides
and Lee, 2001). There are certain factors that affect the
are absorbed into the blood stream through the
permeability of molecules through the intestinal barrier
transcel ular pathways. The third system involves large
molecular weight peptides and is unique to whey protein.
This is not used when casein, egg white or soy proteins
are digested. It should be noted that not al proteins
Physicochemical properties of the drug molecules
Characteristics of the intestinal barrier
stimulate al three protein transport systems. In fact, only
special y made designer proteins stimulate the pathways.
APT with ful spectrum whey peptides is designed to
facilitate the stimulation of al three transport systems and
molecular delivery vehicle contains a carrier - adapter
can only be found in designer protein. These APT ful
conjugate, which bound non-covalently to a recognition
spectrum whey peptides are a complete spectrum of very
tag fused to the targeting protein (Gaidamakova et al.,
low, low, medium and high molecular weight whey
Another approach towards delivering drugs into cel s is
the concept of loligomers. Loligomers are synthetic
peptides composed of a branched polylysine case
Paracellular pathway
harboring identical arms, each carrying peptide signals
guiding their import and localization into cel s. The most
The paracel ular pathway is found along the intestinal
important advantages of loligomers include:
wal and is used by the second and third transport
The multivalent presentation of targeting signals
systems as an alternative pathway for peptide absorption.
resulting from a tentacular arrangement. Multivalency
This pathway is normal y closed off to entry of peptides
increases the efficiency of import and intracel ular routing
and nutrients by a special cel cal ed “tight junction”
signals as compared to similar linear peptides.
(Stevenson and Koan 1998). In a current model of a tight
Another advantage is that it reduces and delays the
junction, two major integral membrane proteins are found
impact of peptide degradation in terms of cel ular
- occludin and claudin - each with four membrane
processing and compartmentalization (Borkx et al.,
spanning alpha-helices. The junction depends upon extra
cel ular calcium to maintain integrity. The permeability
The vectorial delivery of nucleus – directed loligomers
properties of tight junctions vary considerably in different
into cel s has recently been confirmed by microscopy and
epithelia and epithelial cel s can transiently alter their tight
flow cytometry studies (Borkx et al., 2002). Practical uses
junctions in order to al ow increased flow of solutes and
of loligomers include photosenstizers for use in
water through breaches in the junction barriers
photodynamic therapy and the incorporation of cytotoxin
(doscherholmen et al., 1971; Fanning et al., 1998). The
T-lymphocyte epitopes with a view to creating synthetic
tight junctions usual y prevent the transport of protein
vaccines. Branched peptide such as loligomers
through the paracel ular pathway. However, research has
represents simple and versatile molecular vehicles with
shown that specific amounts of key ingredients, the same
potential applications in a wide variety of drug design
ingredients found in designer protein’s APT, help the tight
junctions to open (Fanning et al., 1998). Natural y, with
both the transcel ular and paracel ular pathways opened,
protein is potential y absorbed faster and in greater
Delivery to cancer cells
amounts. Furthermore, unique protein with molecular
weight larger than the di- or tri-peptides absorbed by the
Cancer treatment has always posed a problem. The
second transport system may be able to pass through
effectiveness of conventional solid tumor treatment is
intact (Stevenson and Koan, 1998; Muranishi and
limited by the systemic toxicity and lack of specificity of
chemotherapeutic agents. Barriers are also frequently
hampering targeting of drugs and toxins to solid tumors
and their microenvironment. Present treatment modalities
TARGETING
are frequently insufficient to eliminate viable cancer cel s
without exceeding the limits of toxicity to normal tissue.
Existing methods for selective targeting are based on
The coming generation of cancer therapeutics depends
chemical conjugation of therapeutic and diagnostic
on the precise targeting and sustained release of anti-
agents or their carriers to cel specific targeting molecules
tumor agents to overcome their limitations.
(Gaidamakova et al., 2001; Pastorino et al., 2001). These
Phage-derived peptides for targeting of doxorubicin
methods are limited by potential damage to targeting
conjugates to solid tumors have been designed
molecules that can be inflicted by the conjugation
(Schatzlein et al., 2001). Nano-conjugates are low
procedure. In addition, conjugation procedures have to
molecular weight conjugates of a smal drug or toxin and
be developed on case - by - case basis (Amidon, 1995). a targeting ligand coupled through a cleavable linker
In order to avoid this problem, a new approach has been
group. They offer potential advantages for tumor specific
developed to constructing molecular vehicles for target-
delivery in diffusion – limited situations. As a model, a
mediated delivery of therapeutics and diagnostic agents.
doxorubicin conjugate targeted to the transferring
In this approach, the targeting molecule is expressed as
receptor (TFR) was chosen. A library of phage
a fusion protein containing a recognition tag. The
expressing a cyclic nanopeptide was panned against
recognition tag is defined as a protein or peptide that can
TFR. The apparent affinity of phages determined by
bind non-covalently with another peptide or protein
surface plasmon resonance (SPR) increased with each
(adapter). In turn, the adapter is chemical y conjugated to
cycle of the panning procedure. After five rounds,
a carrier of therapeutics or diagnostics. The assembled
approximately 80% of phages expressed the same
peptide, which mediated a 30 to 50-fold increased
of peptide drugs because of slow transit, low volume and
receptor specific cel ular uptake of the phages. The
a lack of vigorous stirring, leading to an ability to create
corresponding peptide was synthesized using solid
local conditions favourable to stabilization and absorption
phage peptide chemistry on a sulphonamide based
enhancement. In addition, the colonic region has a high
safety catch resin. Crude mixtures of the peptide, as wel
presence of microbial anaerobic organisms providing
as transferrin itself, were able to inhibit the phage uptake
reducing conditions and sufficient area to partial y
compensate for low peptide mucosal permeability and a
Chitosan nanoparticles encapsulating dextran –
doxorubicin conjugate has been used as carrier for
It is expected that in the foreseeable future more focus
targeting tumors (Mitra, 2001). Doxorubicin (DXR)
wil be on the colon as a region for site-specific delivery of
commonly used in cancer therapy is known to produce
therapeutic substances (proteins, peptides, genes, etc)
undesirable side effects such as cardiotoxicity. To
that are unstable in the other regions of the GIT in order
minimize these, attempts were made to couple the drug
to optimize convenience, therapeutic benefits and safety.
with dextran (DEX) and then to encapsulate this drug
conjugate in hydrogel nanoparticles. By encapsulation of
the drug conjugate in biodegradable, biocompatible long
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Newsletter of the Pennsylvania Health Law Project Statewide Help Line: 1-800-274-3258 On the Internet: www.phlp.org TTY: 1-866-236-6310 Medical Assistance to Change in Rural PA on March 1 Access Plus to Feature Disease Management, Require Referrals in 42 Counties Last year DPW decided for the foreseeable future not to expand HealthChoices (mandatory man-aged care for MA recipients) b