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26 CMC PDF
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Department of Nanoengineering; 2Moores Cancer Center; 3Department of Bioengineering and 4Division of Dermatology, University of California San Diego, La Jolla, CA 92093, USA
Abstract: This review focuses on the development of nanoparticle systems for antimicrobial drug delivery. Numerous antimicrobial drugs have been prescribed to kill or inhibit the growth of microbes such as bacteria, fungi and viruses. Even
though the therapeutic efficacy of these drugs has been well established, inefficient delivery could result in inadequate
therapeutic index and local and systemic side effects including cutaneous irritation, peeling, scaling and gut flora reduction. Nanostructured biomaterials, nanoparticles in particular, have unique physicochemical properties such as ultra small
and controllable size, large surface area to mass ratio, high reactivity, and functionalizable structure. These properties can
be applied to facilitate the administration of antimicrobial drugs, thereby overcoming some of the limitations in traditional
antimicrobial therapeutics. In recent years, encapsulation of antimicrobial drugs in nanoparticle systems has emerged as
an innovative and promising alternative that enhances therapeutic effectiveness and minimizes undesirable side effects of
the drugs. Here the current progress and challenges in synthesizing nanoparticle platforms for delivering various antimicrobial drugs are reviewed. We also call attention to the need to unite the shared interest between nanoengineers and microbiologists in developing nanotechnology for the treatment of microbial diseases.
Keywords: Antimicrobial delivery, microbes, liposomes, polymeric nanoparticles, solid lipid nanoparticles, dendrimers.
INTRODUCTION
Upon invasion of the epithelial surfaces, infectious microorganisms spread throughout the body via the circulatory
system. They are then removed from the blood by macrophages which are present in all major organs such as liver,
spleen and bone marrow [1]. After being phagocytosed by
macrophages, the infectious microorganisms are trapped in
phagosomes, which then fuse with lysosomal granules inside
cell cytoplasm forming phagolysosomes. Subsequently, oxygen-dependent or oxygen-independent bacterial killing
mechanisms induced by enzymes inside the phagolysosomes
occur to digest the trapped microorganisms. However, many
microorganisms are able to evade the macrophage digestion
via escaping from the phagosomes, inhibiting the
phagosome-lysosome fusion, withstanding the lysosomal
enzymes, or resisting oxidative and non-oxidative killing
mechanisms. These bacterial defense mechanisms make intracellular infections difficult to eradicate resulting in infectious diseases that range from staph infections to tuberculosis
[1].
An antimicrobial refers to a substance that kills or inhibits the growth of microorganisms. Since the discovery of
antimicrobial drugs in the 1960s [2], many infectious diseases have been overcome. Typically, antimicrobials kill
bacteria by binding to some vital compounds of bacterial
metabolism, thereby inhibiting the synthesis of functional
biomolecules or impeding normal cellular activities. For instance, -lactams such as penicillins and cephalosporins inhibit bacteria cell wall synthesis; tetracyclines, macrolides,
and clindamycin inhibit protein synthesis; metronidazole and
quinolones inhibit nucleic acid synthesis; and sulphonamides
and trimethoprim have an inhibitory effect on enzyme
*Address correspondence to these authors at the Department of Nanoengineering, University of California San Diego, 9500 Gilman Drive, MC-0815,
La Jolla, CA 92093, USA; Tel: 1-858-246-0999; E-mail: zhang@ucsd.edu
Division of Dermatology, University of California San Diego, 9500 Gilman
Drive, La Jolla, CA 92093, USA; Tel: 1-858-822-4627;
E-mail: chunming@ucsd.edu
0929-8673/10 $55.00+.00
Zhang et al.
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DRUG
mental properties including lipid polymorphisms, lipidprotein and lipid-drug interactions, and mechanisms of
liposome disposition in 1980s, the application potential of
liposomes as a drug delivery vehicle was thoroughly recognized and started being transferred to practice. Liposomes
were initially introduced to the cosmetic market by Dior in
1986. In 1995, Doxil (doxorubicin liposomes) became the
first liposomal delivery system approved by the Food and
Drug Administration (FDA) to treat AIDS associated Kaposi
s sarcoma [11, 12]. Liposomal drug delivery system can be
made of either natural or synthetic lipids. One of the most
commonly used lipids in liposome preparation is phosphotidylcholine, which is an electrically neutral phospholipid that
contains fatty acyl chains of varying degrees of saturation
and length. Cholesterol is normally incorporated into the
formulation to adjust membrane rigidity and stability. Structurally, liposomes can be classified into multilamellar vesicles (MLVs), which consist of multiple phospholipid bilayer
membranes, and unilamellar vesicles (ULVs), which have a
single lipid bilayer. ULVs can be further classified into small
unilamellar vesicles (SUVs) and large unilamellar vesicles
(LUVs) depending on their size range [13]. Methods for preparing liposomes can take into consideration parameters such
as the physicochemical characteristics of the liposomal ingredients, materials to be contained within the liposomes,
Fig. (1). Mechanisms of nanoparticle-based antimicrobial drug delivery to microorganisms: (a) nanoparticles fuse with microbial cell wall or
membrane and release the carried drugs within the cell wall or membrane; (b) nanoparticles bind to cell wall and serve as a drug depot to
continuously release drug molecules, which will diffuse into the interior of the microorganisms.
Fig. (2). Schematic illustration of four nanoparticle platforms for antimicrobial drug delivery: (a) liposome, (b) polymeric nanoparticle, (c)
solid lipid nanoparticle, and (d) dendrimer. Black circles represent hydrophobic drugs; black squares represent hydrophilic drugs; and black
triangles represent either hydrophobic or hydrophilic drugs.
Nanotech Antimicrobials
particle size, polydispersity, surface zeta potential, shelftime, batch-to-batch reproducibility, and the possibility for
large-scale production of safe and efficient products.
Liposomes, ULVs in particular, do not form spontaneously.
Rather, liposomes form when a sufficient amount of energy
(e.g., via sonication, homogenization, shaking, or heating) is
supplied to phospholipids placed in water. Typical methods
for generating liposomes include sonication method [14],
(e.g., low shear rates can result in MLVs and high shear rates
can generate ULVs), extrusion method, and heading method
[15].
Currently, liposomes are the most widely used antimicrobial drug delivery system. One of the distinguishing features of liposomes is its lipid bilayer structure, which mimics
cell membranes and can readily fuse with infectious microbes. By directly fusing with bacterial membranes, the
drug payloads of liposomes can be released to the cell membranes or the interior of the bacteria. The unique structure of
liposomes, a lipid membrane surrounding an aqueous cavity,
enables them to carry both hydrophobic and hydrophilic
compounds without chemical modification. In addition, the
liposome surface can be easily functionalized with stealth
material to enhance their in vivo stability or targeting ligands
to enable preferential delivery of liposomes. For example,
polyethylene glycol (PEG) has been frequently conjugated to
liposome surface to create a stealth layer that prolongs the
circulation lifetime of liposomes in the blood stream. Specifically, the PEG coating forms a hydration layer that retards the reticuloendothelial system (RES) recognitions of
liposomes through sterically inhibiting hydrophobic and
electrostatic interactions with plasma proteins. On the other
hand, by attaching targeting ligands such as antibody, antibody segments, aptamer, peptides and small molecule
ligands to the surface of the liposomes, they can selectively
bind to microorganisms or infected cells and then release the
drug payloads to kill or inhibit the growth of the microorganisms.
AmBisome(NeXstar Pharmaceuticals, San Dimas, USA)
is an FDA approved liposomal formulation of amphotericin
B (AMB), which has been widely used in the clinic to treat
Candida spp, Aspergillus spp, Fusarium spp, and other fungi
infections in neutropenic, visceral leishmaniasis, and methylmalonic acidaemia patients [16-18]. In the AmBisome
formulation, AMB are intercalated into the phospholipid
bilayer of liposomes consisting of hydrogenated soy phosphaticylcholine, cholesterol, and distearoyl phosphatidylglycerol (DSPG) [19]. Freeze-fracture electron microscopy
results have shown that AmBisome delivered its drug content through an absorption mechanism. For example, AmBisome attached to the outer cell wall of Candida glabrata [20]
and released AMB to disrupt fungal membranes [21, 22].
Adler-Moore J. et al. have observed great specificity of AmBisome to the site of fungal infections. Following the injection of fluorescently-labeled AmBisome into Candidainfected mice, the localization of fluorescent liposomes has
been observed at the sites of fungal infections [23]. Because
of its liposomal structure, AmBisome has shown greater
pharmacokinetics than free AMB drug, including prolonged
systemic circulation half-life, reduced plasma clearance rate,
decreased renal toxicity, and most importantly, enhanced
therapeutic efficacy [24].
587
Polymyxin B-loaded loposome represents another successful example of liposomal antimicrobial drug delivery.
Polymyxin B has been recognized for treating P. aeruginosa
related infections (e.g., pneumonias and chronic bronchopneumonias of cystic fibrosis). However, its systemic use
has been limited due to toxic side effects such as nephrotoxicity, ototoxicity and neuromuscular blockade. It has been
reported that liposomal encapsulation of polymyxin B dramatically diminished the drugs side effects and improved its
antimicrobial activity against resistant strains of P. aeruginosa [25]. The action mechanism of liposomal polymyxin B
against P. aeruginosais has been recognized as membrane
fusion. Transmission electron microscopy (TEM), flow cytometry and fluorescent resonance energy transfer studies
have revealed lipid reorganizations in P. aeruginosa membranes upon incubation with polymyxin B-loaded liposomes
[26]. Membrane fusion between liposomes and bacteria is a
rapid and spontaneous process driven by non-covalent forces
such as van der Waals force and hydrophobic interactions
that minimize the systems free energy. Antibiotic efflux is a
widely accepted mechanism of microbial drug resistance, in
which proteinaceous transports located in bacterial membranes preferentially pump antimicrobial drugs out of the
cells [27]. When liposomes fuse with cell membranes, a high
dosage of drug contents is immediately delivered to the bacteria, which can potentially suppress the antimicrobial resistance of the bacteria by overwhelming the efflux pumps,
thereby improving drugs antimicrobial activity.
Many other liposome-based antimicrobial drug delivery
systems have also been developed for various applications
[28]. Ampicillin-loaded liposomes have shown elevated drug
stability and higher antimicrobial activity than free drug
against Salmonella typhimurium [29, 30]. Benzyl penicillinloaded liposomes have shown complete growth inhibition of
penicillin-sensitive strain of Staphylococcus aureus at lower
drug concentration and shorter exposure time than free benzyl penicillin [31]. Liposomal ciprofloxacin, a fluoroquinolone antibiotic, has effectively inhibited the number of
Salmonella dublin in mouse spleen [32]. Liposomal gentamicin and streptomycin, which belong to aminogylcoside
antibiotics, have successfully treated mice and guinea pigs
infected with Brucella spp. [33]. It has also been reported
that liposomal vancomycin and teicoplaninhas have significantly enhanced intracellular killing of methicillin-resistant
Staphylococcus aureus (MRSA) [34]. Table 1 summarizes
other antimicrobial liposomes, many of which have been in
clinical use for years.
POLYMERIC NANOPARTICLES FOR ANTIMICROBIAL DRUG DELIVERY
Biocompatible and biodegradable polymers have been
used extensively in the clinic for controlled drug release. The
annual worldwide market of polymer-based controlled release systems is about $60 billion and they are given to over
100 million patients each year [35]. The first polymer-based
drug delivery system was developed by Langer and Folkman
in 1976 for macromolecule delivery[36]. However, the initial
polymeric nanoparticles possessed poor therapeutic efficacy
because of their rapid clearance by the reticuloendothelial
system (RES) after intravenous administration. This limita-
Table 1.
Zhang et al.
Formulation
Drug
Targeted Microorganism
Activity
References
amphotericin B
Aspergillus fumigatus
[73]
polymyxin B
Pseudomonas aeruginosa
[74]
ampillicin
1) increased stability
2) full biological activity of Ampicillin was
observed
[29]
dipalmitoyl-phosphatidylcholine,
dipalmitoyl-phosphatidylglycerol, and
cholesterol
ciprofloxacin
Salmonella dublin
[32]
dipalmitoylphosphatidylcholine (DPPC),
cholesterol, and dimethylammonium
ethane carbamoyl cholesterol (DC-chol)
benzyl penicillin
Staphylococcus aureus
[31]
netilmicin
1) reduction in toxicity
2) increased circulation half-life
3) increased survival rate of animal model
[75]
partially hydrogenated
egg phosphatidylcholine (PHEPC),
cholesterol, and 1,2-distearoylsn-glycero-3-phosphoethanolamine-N(polyethylene glycol-2000) (PEGDSPE)
gentamicin
Klebsiella pneumoniae
[76]
streptomycin
Mycobacterium avium
[77]
amikacin
gram-negative bacteria
[78]
zidovudine
Human immunodeficiency
virus
[79]
egg phosphatidylcholine,
diacetylphosphate, and cholesterol
vancomycin or
teicoplanin
methicillin-resistant
Staphylococcus aureus
(MRSA)
[34]
sisting of hydrophilic and hydrophobic segments. The hydrophobic segment forms a polymeric core containing the
drugs while the hydrophilic segment shields the core from
osponization and degradation. The rate of drug release can
be tuned by varying the length of the hydrophobic chain. A
variety of biodegradable polymers have been used to form
the hydrophobic polymeric core, including poly(lactic acid)
(PLA), poly(glycolic acid) (PGA), poly(lactide-co-glycolide)
(PLGA), poly (-carprolactone) (PCL), and poly(cyanoacrylate) (PCA), whereas polyethylene glycol (PEG) has
been commonly used as a hydrophilic segment. Diblock copolymer nanoparticles are typically prepared through solvent
displacement. In this process, polymers and drugs are first
dissolved in a water-miscible organic solvent such as acetonitrile. The polymer-drug mixture is then added to an aqueous solution. As the organic solvent evaporates, the block
copolymers and drugs undergo nanoprecipitation to form
nanoparticles consisting of a hydrophobic core and a hydrophilic shell. Polymeric nanoparticles are primarily used to
carry and deliver poorly water soluble drugs because of the
hydrophobic nature of the nanoparticle core [39, 40].
The other type of polymeric nanoparticles consists of linear polymers such as polyalkyl acrylates and polymethyl
methacrylate that form nanocapsules through an emulsion
polymerization method. In this process, monomers are first
Nanotech Antimicrobials
dissolved in polymerization media in the presence of surfactants. Polymerization initiators are then added to the solution
to trigger polymerization resulting in the formation of nanocapsules. Antimicrobial drugs can be either absorbed to the
nanocapsules during the polymerization process or covalently conjugated to the surface of the nanoparticles after
they are formed. The absorption process favors hydrophobic
drugs as it requires dissolving the drugs to an oil phase. Hydrophilic drugs are usually attached to the particle through
covalent conjugations. It is worth noting that in the case of
covalent linkage, antimicrobials can be inactivated and need
to be verified of their activity before use. For instance, in a
study on treating staphylococcal infections, Abeylath et al.
have observed that -lactam and ciprofloxacin retained their
potency whereas penicillin was inactivated upon covalent
attachment to nanoparticles [41].
Polymeric nanoparticles have been explored to deliver a
variety of antimicrobial agents to treat various infectious
diseases and have shown great therapeutic efficacy. For example, the antimicrobial activity of amphotericin B-loaded
poly(-caprolactone) nanospheres coated with non ionic surfactant poloxamer 188 have shown greater therapeutic efficacy against Leishmania donovanihas compared to the free
drug counterparts [42]. Rifampicin-loaded polybutylcyanoacrylate nanoparticles have shown enhanced antibacterial
activity both in vitro and in vivo against Staphylococcus
aureus and Mycobacterium avium due to an effective delivery of drugs to macrophages [43]. In another example, ampicillin-encapsulated polyisohexylcyanoacrylate nanoparticles have been studied against Listeria monocytogenesin
Table 2.
589
mouse peritoneal macrophages [44]. Other examples of polymeric nanoparticles for antimicrobial drug delivery are
summarized in Table 2.
SOLID LIPID NANOPARTICLES FOR ANTIMICROBIAL DRUG DELIVERY
Solid lipid nanoparticles (SLNs) are another antimicrobial drug delivery platform that has attracted much attention
since 1990s. SLNs are typically particulate systems with
mean diameters ranging from 50 nm up to 1000 nm for various drug delivery applications [45]. SLNs are mainly comprised of lipids that are in solid phase at the room temperature and surfactants for emulsification. Solid lipids utilized in
SLN formulations include fatty acids (e.g. palmitic acid,
decanoic acid, and behenic acid), triglycerides (e.g. trilaurin,
trimyristin, and tripalmitin), steroids (e.g. cholesterol), partial glycerides (e.g. glyceryl monostearate and gylceryl behenate) and waxes (e.g. cetyl palmitate). Several types of
surfactants are commonly used as emulsifiers to stabilize
lipid dispersion, including soybean lecithin, phosphatidylcholine, poloxamer 188, sodium cholate, and sodium glycocholate. The typical methods of preparing SLNs include
spray drying [46], high shear mixing, ultra-sonication [47],
and high pressure homogenization (HPH) [48].
Several unique properties of SLNs make them a promising antimicrobial drug delivery platform, leading to a few
cosmetic and pharmaceutical products for skin care applications. Firstly, SLNs contain occlusive excipients that, upon
application on skin, readily form a thin film to reduce water
Formulation
Drug
Targeted
Microorganism
Activity
References
arjunglucoside
Leishmania donovani
reduced toxicity
[80]
Phosphorothioate
antisense oligonucleotide
HIV
[81]
saquinavir
HIV
[82]
Alginate nanoparticle
Rifampicin, isoniazid,
pyrazinamide, and
ethambutol.
Mycobacterium
Turberculosis
Poly-lactide-co-glycolide (PLG)
nanoparticle
Rifampicin, isoniazid,
pyrazinamide, and
ethambutol.
Mycobacterium
Turberculosis
1) Enhanced bioavailability
Amphotericin B.
Candida albicans
[85]
halofantrine
Plasmodiumberghe
[86]
Leishmania donovani,
Salmonella typhymurium
and Listeria
monocytogenes
[87, 88]
Beta-lactam/ciprofloxacin
Staphylococcus aureus
and Bacillus anthracis
1) Improved bioavailability
[41, 89]
[83]
2) Improved pharmacokinetic
3) High therapeutic efficacy
[84]
2) Improvied pharmacodynamic
Zhang et al.
Table 3.
Formulation
Drug
Targeted Microorganism
Activity
References
stearic acid
rifampicin, isoniazid,
pyrazinamide
Mycobacterium tuberculosis
[60]
ciprofloxacin
hydrochloride
[90]
tobramycin
Pseudomonas aeruginosa
[91]
clotrimazole
[92]
ketoconazol
fungi
[93]
miconazole nitrate
fungi
[94]
glycerol palmitostearate
econazole nitrate
fungi
[55]
Nanotech Antimicrobials
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591
Formulations
Drug
Targeted Microorganisms
Activity
References
Polyamidoamine
(PAMAM) dendrimers
Nadifloxacin and
prulifloxacin
Various bacteria
[95]
Niclosmide
Tapeworm
[96]
Sulfamethoxazole
Artemether
Gram-positive bacteria(Staphylococcus
aureus, Pseudomonas aeruginosa,
andEscherichia coli)
1)High payload
Plasmodium falciparum
[71]
2) enhanced solubility
3) Prolonged drug circulation half-life
[97]
PAMAM is one of the most studied dendrimers for antimicrobial delivery because of its higher density of functional groups, which make the dendrimer more hydrophilic
and more readily reactive to antimicrobial conjugation. Silver salts loaded PAMAM dendrimers have demonstrated
significant antimicrobial activity against Staphylococcus
aureus, Pseudomonas aeruginosa, and Escherichia coli [71].
Incorporation of antibacterial agents such assulfamethoxazole (SMZ) into the ethylenediamine (EDA) core of
PAMAM dendrimers has significantly improved the drugs
aqueous solubility and antibacterial activity against E. coli
[72]. Many other antimicrobial drugs have been successfully
loaded into dendrimer nanoparticles and have shown improved solubility and therapeutic efficacy. Table 4 summarizes more dendrimer-based antibacterial drug delivery systems.
CONCLUSIONS
In summary, many antimicrobial drugs are difficult to
administer because of their low water-solubility, cytotoxicity
to healthy tissues, and rapid degradation and clearance in the
blood stream. Their antimicrobial activities against intracellular microbes are also severely limited by poor membrane
transport ability. Extensive studies have demonstrated that
nanoparticles such as liposomes, polymeric nanoparticles,
solid lipid nanoparticles and dendrimers are able to overcome these issues and facilitate antimicrobial delivery to
microbial infection sites. While most of these nanoparticlebased antimicrobial drug delivery systems are currently in
preclinical development, several have been approved for
clinical use. With the ongoing efforts in this field, there is no
doubt that nanoparticle-based drug delivery systems will
continue to improve treatment to bacterial infections, especially in life-threatening diseases such as staph infections
and tuberculosis.
Zhang et al.
sues. Potential drug-release triggers include pH value, enzyme and other unique characters of the infection microenvironment. Lastly, few of the current nanoparticle-based antimicrobial drug delivery systems can distinguish microbes
or infectious cells from healthy cells due to the lack of the
specific targeting ability, although targeted drug delivery has
been extensively studied for other disease treatment such as
cancers and cardiovascular diseases. It would be beneficial
for infection treatment if antimicrobial nanoparticles could
be modified with microbe antigen- or infectious cell antigenspecific ligands including antibodies, antibody fragments,
aptamers and peptides.
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In spite of the great progresses on nanoparticle-based antimicrobial drug delivery, here we call attention to the need
to unite the shared interest between nanoengineers and microbiologists in developing novel nanotechnology targeting a
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