@phdthesis{Reggane2019,
  author    = {Reggane, Maude},
  title     = {Lowering lattice forces of crystalline bases},
  doi       = {10.25972/OPUS-16380},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-163803},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2019},
  abstract  = {The number of active pharmaceutical ingredients (APIs) exhibiting a low solubility in aqueous media or a slow dissolution rate kept rising over the past years urging formulation scientists to explore new ways to tackle poor solubility and to enable oral absorption from such compounds. Bioavailability of poorly water-soluble compounds can be improved by increasing the dissolution rate and/or by increasing the gastro intestinal concentration through transient supersaturation. The dissolution rate of the API can be typically modified by the choice of the physical form, the polymorphic form, the powder surface area, and the local pH, while a transient supersaturation can be extended mainly by nucleation or crystallization inhibiting effects. In the present thesis, three strategies were explored to tailor the dissolution rate, the supersaturation and the hydrotropic solubilization of APIs, weak bases, respectively. The first part of this thesis followed a bioinspired approach to extend the kinetic solubility of salts and co-crystals. API salts and co-crystals are high energy forms that can generate supersaturated solutions with respect to any more stable form, typically the most stable API form in physiological environment. The transient kinetic stabilization of supersaturated states, also termed "parachute effect", is considered to improve bioavailability and is one aspect of the formulation that can be tailored. Inspiration from plants, which store high concentrations of aromatic bases in their vacuoles via complexation with polyphenols, sparked the evaluation to use hydroxybenzoic acid derivatives for salt or co-crystal engineering. Imatinib was chosen as the model compound for this investigation as its aromaticity and flat molecular architecture could favor interactions with hydroxybenzoic acid derivatives. One 1:1 Imatinib syringate co-crystal (I-SYA (1:1)) and one 1:2 Imatinib syringate co-crystal salt (I-SYA (1:2)) were obtained. Their dissolution assays in simulated intestinal fluid (SIF; a 50 mM phosphate buffer of pH 6.8) revealed that they formed stable solutions for several hours and days, respectively, in contrast to the marketed Imatinib mesylate salt (approx. 1h). This kinetic stability in solution was linked to the nucleation inhibition of the less soluble Imatinib hydrate by syringic acid (SYA). In solution 1H-NMR studies evidenced the aggregation of Imatinib and SYA. The amphiphilic nature of both Imatinib and SYA is considered to drive their association in solution, additionally, multiple intermolecular interactions such as hydrogen bonds and π-π stacking are likely to contribute. The association in solution enabled a phase of extended supersaturation, i.e., a parachute against desupersaturation, while no negative impact of aggregation on the permeability of both Imatinib and SYA was observed. A prerequisite to reach supersaturation is a rapid dissolution and release of the API from the formulation. Accordingly, the second and third part of this thesis is focused on the so-called "spring effect" of amorphous solid dispersions (ASDs). The addition of a hydrotropic agent, meaning a molecule that can solubilize poorly water-soluble APIs in aqueous solutions (well-known examples of hydrotropes are benzoic acid and nicotinamide) into an amorphous Ciprofloxacin-polymer matrix led to ternary systems with a significantly faster release and higher concentration of the API in SIF as compared to binary ASDs consisting of Ciprofloxacin (CPX) and polymer only. The stronger spring could be rationalized by an improved wetting of the ASD, or/and by a hydrotropic solubilization effect, although these hypotheses need further investigation. Marked differences in the dissolution profiles of binary ASDs were observed in biorelevant fasted simulated intestinal fluid (FaSSIF; a medium containing Na taurocholate (3 mM) and lecithin (0.75 mM) at pH 6.5) as compared to SIF. In FaSSIF, API release from binary polymeric ASDs was largely improved, and the duration of supersaturation was extended. This suggests that the bile salt Na taurocholate and lecithin present in FaSSIF do improve both dissolution rate and supersaturation of ASDs, the two pillars of ASDs as oral enabling formulations. Indeed, bile salts are endogenous surfactants which, together with phospholipids, play an important role in the wetting, solubilization, and absorption of lipophilic compounds. The aim of the third part of the present thesis was to study ASDs as formulation principles reducing the strong positive food effect of Compound A. By inclusion of Na taurocholate (NaTC) within the matrix of polymeric ASDs a significant improvement of the dissolution rate and the kinetic solubility in SIF were achieved. Transient supersaturated states of up to four orders of magnitude over the equilibrium solubility were obtained. Two ASDs were selected for further in vivo evaluation in dog. The first was a NaTC/Eudragit E based ASD meant to dissolve and release Compound A in the acidic environment of the stomach, where its solubility is the highest. The second relied on the release of Compound A in the neutral environment of the duodenum and jejunum by using an enterically dissolving polymer, HPMC-P. Releasing the API at the site of its putative absorption was an attempt to control supersaturation levels in the duodenum and to prevent portioning and thus dilution effects during transfer from the stomach. In fasted dogs, exposure from the NaTC/HPMC-P ASD was close to that of the reference Compound A formulation under fed conditions, which suggests an improved dissolution rate and kinetic solubility under fasted conditions (historical data). The exposure from the NaTC/Eudragit E ASD was twice as low as from the NaTC/HPMC-P ASD, and also lower compared to Compound A reference formulation, whereas in vitro the parachute effect of the NaTC/Eudragit E ASD was largely superior to that of the NaTC/HPMC-P ASD. A difference in the extend of the parachute could be related to differences in the thermodynamic activity of dissolved molecules from the two ASDs. Indeed, the high instability of the NaTC/HPMC-P ASD could stem from a high thermodynamic activity driving diffusion through membranes, whereas less instable solutions of NaTC/Eudragit E could indicate solubilization effects which often translate into a lower flux through the biological membrane. Additionally, the pH of the environment where dissolution takes place might be an important factor for absorption, and could also account for the difference in exposure from the two ASDs. The aim of this thesis was to explore how the intimate environment of weak, poorly soluble bases could be functionalized to improve dissolution rate and kinetic solubility. The investigations highlighted that the performance of enabling oral delivery formulations of weak bases in aqueous media can be enhanced at different levels. At one end initial dissolution rate of ASDs can be tailored by introducing hydrotropes or/and bile salts within the polymeric matrix of ASDs. Bile salts, when combined with appropriate polymers, had also a precipitation inhibition effect enabling the maintenance of supersaturation for a bio-relevant period of time. These results set the ground for further investigations to comprehend specific interactions between bile salts and APIs, and potentially polymers at the molecular level. It will be interesting to explore how such complex systems can be exploited in the formulation design of poorly water-soluble APIs. In addition, it was observed that the duration of supersaturation generated by salts/co-crystals can be extended by the pertinent selection of counterions or coformers. The in vivo relevance of these tunings remains to be evaluated, as translation from closed, in vitro systems to the highly dynamic gastrointestinal environment is not straightforward. A better understanding of the contribution of each kinetic stage (dissolution, supersaturation, and precipitation) and their interplay with physiological factors impacting absorption is essential to facilitate the design of formulations with improved pharmacokinetics.},
  subject      = {Kokristallisation},
  language  = {en}
}
@article{RinaldettiPfirrmannManzetal.2018,
  author    = {Rinaldetti, S{\´e}bastien and Pfirrmann, Markus and Manz, Kirsi and Guilhot, Joelle and Dietz, Christian and Panagiotidis, Panayiotidis and Spiess, Birgit and Seifarth, Wolfgang and Fabarius, Alice and M{\"u}ller, Martin and Pagoni, Maria and Dimou, Maria and Dengler, Jolanta and Waller, Cornelius F. and Br{\"u}mmendorf, Tim H. and Herbst, Regina and Burchert, Andreas and Janßen, Carsten and Goebeler, Maria Elisabeth and Jost, Philipp J. and Hanzel, Stefan and Schafhausen, Philippe and Prange-Krex, Gabriele and Illmer, Thomas and Janzen, Viktor and Klausmann, Martine and Eckert, Robert and B{\"u}schel, Gerd and Kiani, Alexander and Hofmann, Wolf-Karsten and Mahon, Fran{\c{c}}ois-Xavier and Saussele, Susanne},
  title     = {Effect of ABCG2, OCT1, and ABCB1 (MDR1) Gene Expression on Treatment-Free Remission in a EURO-SKI Subtrial},
  series = {Clinical Lymphoma, Myeloma \& Leukemia},
  volume    = {18},
  journal   = {Clinical Lymphoma, Myeloma \& Leukemia},
  number    = {4},
  doi       = {10.1016/j.clml.2018.02.004},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-226281},
  pages     = {266-271},
  year      = {2018},
  abstract  = {Within the EURO-SKI trial, 132 chronic phase CML patients discontinued imatinib treatment. RNA was isolated from peripheral blood in order to analyze the expression of MDR1, ABCG2 and OCT1. ABCG2 was predictive for treatment-free remission in Cox regression analysis. High transcript levels of the ABCG2 efflux transporter (>4.5 parts per thousand) were associated with a twofold higher risk of relapse. Introduction: Tyrosine kinase inhibitors (TKIs) can safely be discontinued in chronic myeloid leukemia (CML) patients with sustained deep molecular response. ABCG2 (breast cancer resistance protein), OCT1 (organic cation transporter 1), and ABCB1 (multidrug resistance protein 1) gene products are known to play a crucial role in acquired pharmacogenetic TKI resistance. Their influence on treatment-free remission (TFR) has not yet been investigated. Materials and Methods: RNA was isolated on the last day of TKI intake from peripheral blood leukocytes of 132 chronic phase CML patients who discontinued TKI treatment within the European Stop Tyrosine Kinase Inhibitor Study trial. Plasmid standards were designed including subgenic inserts of OCT1, ABCG2, and ABCB1 together with GUSB as reference gene. For expression analyses, quantitative real-time polymerase chain reaction was used. Multiple Cox regression analysis was performed. In addition, gene expression cutoffs for patient risk stratification were investigated. Results: The TFR rate of 132 patients, 12 months after TKI discontinuation, was 54\% (95\% confidence interval [CI], 46\%-62\%). ABCG2 expression (parts per thousand) was retained as the only significant variable (P=.02; hazard ratio, 1.04; 95\% CI, 1.01-1.07) in multiple Cox regression analysis. Only for the ABCG2 efflux transporter, a significant cutoff was found (P=.04). Patients with an ABCG2/GUSB transcript level >4.5 parts per thousand (n=93) showed a 12-month TFR rate of 47\% (95\% CI, 37\%-57\%), whereas patients with low ABCG2 expression (<= 4.5 parts per thousand; n=39) had a 12-month TFR rate of 72\% (95\% CI, 55\%-82\%). Conclusion: In this study, we investigated the effect of pharmacogenetics in the context of a CML treatment discontinuation trial. The transcript levels of the efflux transporter ABCG2 predicted TFR after TKI discontinuation. (C) 2018 The Authors. Published by Elsevier Inc.},
  language  = {en}
}
@phdthesis{Terveer2017,
  author    = {Terveer, Nils},
  title     = {Springs and Parachutes - Development and Characterization of Novel Formulations for Poorly Water-Soluble Drugs},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-154311},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2017},
  abstract  = {Successful formulation development of novel, particularly organic APIs of low molecular weight as candidates for ground-breaking pharmaceutical products is a major challenge for the pharmaceutical industry because of the poor aqueous solubility of most of these compounds. The hit identification strategies of drug development in use today apply high throughput screening techniques for the investigation of thousands of substances. This approach led to a systematical increase in molecular weight and lipophilicity and a decrease of water solubility of lead compounds reaching market access. The high lipophilicity causes an excellent permeability of the compounds which favours the absorption process from the small intestine, but it causes a decrease of water-solubility. It becomes evident that an adequate aqueous solubility is necessary for absorption of the API from the gastrointestinal fluids into the systemic circulation and hence for efficacy of the pharmaceutical product. Only an dissolved API is getting absorbed and becomes efficacious. The precipitated proportion is resigned directly. Therefore, the development of an individual formulation aligning the physicochemical characteristics is necessary for every API to produce supersaturated solutions in the small intestine and to reach an adequate bioavailability after absorption into the systemic circulation. In this thesis a specific formulation development was investigated for two exemplary poorly water-soluble APIs to replace the empirical approach often used today. The basic tyrosine-kinase inhibitor imatinib and six different acetylated amino acids were transferred into ILs. As compared to the free base and the mesylate salt, which is marketed by Novartis AG as Gleevec®, the dissolution rate as well as the supersaturation time was increased significantly. By changing the mesylate anion with its potential genotoxic risks, the total toxicity of the drug product could be decreased. The amorphous ILs proved adequate stability under forcing conditions and there was no recrystallization of the free base observed. The amorphous character of the ILs caused an increased amount of water vapour sorption which can be compensated by special packaging materials. Taken together, the presentation of imatinib as an IL is intended for oral administration as a tablet and can cause a reduction of dose because of the increased solubility. Therefore, the occurrence of side effects can be reduced as compared to Gleevec®. If there is actually an increased bioavailability to observe, has to be proved by the execution of animal trials. The novel NOX inhibitor VAS3947 is intended for the treatment of endothelial dysfunctions causing diseases like heart failure and stroke. The compounds poor aqueous solubility hindered further clinical development so far and make the drug candidate to remain in a very early stage of the drug development process. Therefore, different formulation concepts were evaluated in this study: An amorphous solid dispersion prepared from VAS3947 and Eudragit® L100 by means of spray drying was able to increase the dissolution rate and solubility of the compound significantly, but with the accomplished kinetic solubility being in the low µM range it is not possible to reach therapeutic plasma concentrations. In contrast, the incorporation into cyclodextrins resulted in an 760-fold increased solubility. Different cyclodextrins were evaluated. Especially the lipophilic derivatives of the β-cyclodextrin showed to be the most adequate excipients. The incorporation of the API into the cyclodextrin cavity was proved by means of NMR spectroscopy. Additionally, a formulation of VAS3947 and hydroxypropyl-β-cyclodextrin was prepared. This formulation is intended for the intravenous application during animal trials, which have to be conducted to get to know the pharmacokinetics of VAS3947. This formulation reached a concentration of 1 mg/mL spending striking protection of VAS3947 against degradation. Presentation of VAS3947 as a microemulsion system led also to increase the aqueous solubility of the compound, but not in the same extent as the cyclodextrin formulation. Beside the formulation development a physicochemical characterization was performed to get to know important parameters such as log P and pKa values of VAS3947. An HPLC method was developed and validated to analyse the extent of solubility improvement. A major issue of the compound VAS3947 and all related triazolopyrimidine derivatives, developed by Vasopharm GmbH, is the insufficient chemical stability because of presence of a hemiaminal moiety in the chemical structure. Stability investigations and an extensive biopharmaceutical characterization confirm the hindering of further clinical development by insufficient drug stability and high cytotoxicity. Poor aqueous solubility is an additional disadvantage which can be handled by a concerted formulation development.},
  language  = {en}
}
@article{OPUS4-19073,
  title     = {Long-term outcome of patients with newly diagnosed chronic myeloid leukemia: a randomized comparison of stem cell transplantation with drug treatment},
  series = {Leukemia},
  volume    = {30},
  journal   = {Leukemia},
  number    = {3},
  organization    = {SAKK},
  doi       = {10.1038/leu.2015.281},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-190738},
  pages     = {562 -- 569},
  year      = {2016},
  abstract  = {Tyrosine kinase inhibitors represent today's treatment of choice in chronic myeloid leukemia (CML). Allogeneic hematopoietic stem cell transplantation (HSCT) is regarded as salvage therapy. This prospective randomized CML-study IIIA recruited 669 patients with newly diagnosed CML between July 1997 and January 2004 from 143 centers. Of these, 427 patients were considered eligible for HSCT and were randomized by availability of a matched family donor between primary HSCT (group A; N = 166 patients) and best available drug treatment (group B; N = 261). Primary end point was long-term survival. Survival probabilities were not different between groups A and B (10-year survival: 0.76 (95\% confidence interval (CI): 0.69-0.82) vs 0.69 (95\% CI: 0.61-0.76)), but influenced by disease and transplant risk. Patients with a low transplant risk showed superior survival compared with patients with high( P < 0.001) and non-high-risk disease (P = 0.047) in group B; after entering blast crisis, survival was not different with or without HSCT. Significantly more patients in group A were in molecular remission (56\% vs 39\%; P = 0.005) and free of drug treatment (56\% vs 6\%; P < 0.001). Differences in symptoms and Karnofsky score were not significant. In the era of tyrosine kinase inhibitors, HSCT remains a valid option when both disease and transplant risk are considered.},
  language  = {en}
}
@phdthesis{Hemer2012,
  author    = {Hemer, Sarah},
  title     = {Molecular characterization of evolutionarily conserved signaling systems of Echinococcus multilocularis and their utilization for the development of novel drugs against Echinococosis},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-74007},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2012},
  abstract  = {Alveolar echinococcosis (AE), a severe and life-threatening disease is caused by the small fox tapeworm Echinococcus multilocularis. Currently, the options of chemotherapeutic treatment are very limited and are based on benzimidazole compounds, which act merely parasitostatic in vivo and often display strong side effects. Therefore, new therapeutic drugs and targets are urgently needed. In the present work the role of two evolutionarily conserved signalling pathways in E. multilocularis, namely the insulin signalling cascade and Abl kinases, has been studied in regard to host-parasite interaction and the possible use in anti-AE chemotherapy.},
  subject      = {Fuchsbandwurm},
  language  = {en}
}