Abstract
Delivery of therapeutic agents into the brain has been an ongoing challenge for many years. The poor prognosis for patient with primary malignant brain tumors treated with conventional techniques (surgery, radiotherapy and chemotherapy) has motivated the development of new strategies to deliver drugs into the brain. Local intracranial delivery of antineoplastic agents has appeared to be the most effective drug delivery technique into the central nervous system by circumventing the limitations imposed by the blood brain barrier (BBB). Convection-enhanced delivery (CED) is an alternative strategy to directly infuse drugs into brain tissue. This approach is based on continuous injection of the therapeutic agent under positive pressure via a catheter implanted into the brain. Convective transport driven by pressure gradient allows a widespread distribution of small and large drugs within the brain. In vivo experiments in rodents, cats and primates proved the efficacy of CED to deliver drugs into a targeted zone. However, clinical trials have reported frequent leakage phenomenon leading to mixed results for this delivery technique. A better optimization of operational parameters including infusion rate, catheter design, catheter placement and drug pharmacological formulation should allow achieving accurate and efficient delivery. In conjunction with CED, the use of nanocarriers to enhance drug pharmacokinetic behavior may help to achieve higher therapeutic index against tumor cells over healthy tissues. Additionally, the development of computer simulation to predict drug distribution and the real-time imaging for immediate assessment of convection efficiency may contribute to the CED improvement.
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References
Allard E, Huynh NT, Vessières A, Pigeon P, Jaouen G, Benoit JP, Passirani C (2009) Dose effect activity of ferrocifen-loaded lipid nanocapsules on a 9L-glioma model. Int J Pharm 379(2):317–323
Allard E, Passirani C, Benoit JP (2009) Convection-enhanced delivery of nanocarriers for the treatment of brain tumors. Biomaterials 30:2302–2318
Bauman MA, Gillies GT, Raghavan R, Brady ML, Pedain C (2004) Physical characterization of neurocatheter performance in a brain phantom gelatin with nanoscale porosity: steady-state and oscillatory flows. Nanotechnology 15:92–97
Bidros DS, Vogelbaum MA (2009) Novel drug delivery strategies in neuro-oncology. J Am Soc Exp Neuroth 6:539–546
Bobo RH, Laske DW, Akbasak A, Morrison PF, Dedrick RL, Oldfield EH (1994) Convection-enhanced delivery of macromolecules in the brain. Proc Natl Acad Sci USA 91:2076–2080
Debinski W, Tatter ST (2009) Convection-enhanced delivery for the treatment of brain tumors. Expert Rev Neurother 9:15719–1527
Fiandaca MS, Forsayeth JR, Dickinson PJ, Bankiewicz KS (2008) Image-guided convection-enhanced delivery platform on the treatment of neurological diseases. Neurotherapeutics 5:123–127
Fung LK, Ewend MG, Sills A, Sipos EP, Thompson R, Watts M, Colvin OM, Brem H, Saltzman WM (1998) Pharmacokinetics of interstitial delivery of carmustine, 4-hydroperoxycyclophosphamide, and paclitaxel from a biodegradable polymer implant in the monkey brain. Cancer Res 58:672–684
Hadaczek P, Mirek H, Tamas L, Bohn MC, Noble C, Park JW, Bankiewicz K (2006) The “perivascular pump” driven by arterial pulsation is a powerful mechanism for the distribution of therapeutic molecules within the brain. Mol Therapy 14:69–71
Hamilton JF, Morrision PF, Chen MY, Harvey-White J, Pernaute RS, Phillips H, Oldfield E, Bankiewicz KS (2001) Heparin coinfusion during convection-enhanced delivery (CED) increases the distribution of the glial-derived neurotrophic factor (GDNF) ligand family in rat striatum and enhances the pharmacological activity of neurturin. Exp Neurol 168:155–161
Inoue T, Yamashita Y, Nishihara M, Sugiyama S, Sonoda Y, Kumabe T, Yokoyama M, Tominaga T (2009) Therapeutic efficacy of a polymeric micellar doxorubicin infused by convection-enhanced delivery against intracranial 9L brain tumor models. Neuro-Oncology 11:151–157
Jain RK (1989) Delivery of novel therapeutic agent in tumors: physiological barriers and strategies. J Natl Cancer Inst 81:570–576
Krauze MT, Saito R, Noble C, Bringas J, Forsayeth J, Mcknight TR, Park J, Bankiewicz KS (2005) Effects of the perivascular space on convection-enhanced delivery of liposomes in primate putamen. Exp Neurol 196:104–111
Kunwar S (2003) Convection enhanced delivery of IL13-PE38QQR for treatment of recurrent malignant glioma: presentation of interim findings from ongoing phase 1 studies. Acta Neurochir Suppl 88:105–111.
Kunwar S, Prados MD, Chang SM, Berger MS, Lang FF, Piepmeier JM, Sampson J, Ram Z, Gutin PH, Gibbons RD, Aldape KD, Croteau DJ, Sherman JW, Puri RK (2007) Direct intracerebral delivery of cintredekin besudotox (IL13-PE38QQR) in recurrent malignant glioma: a report by the Cintredekin Besutodox Intraparenchymal Study Group. J Clin Oncol 25:837–844
Lieberman DM, Laske DW, Morrison PF, Bankiewicz KS, Oldfield EH (1995) Convection-enhanced distribution of large molecules in gray matter during interstitial drug infusion. J Neurosurg 82:1021–1029
MacKay JA, Deen DF, Szoka C Jr (2005) Distribution in brain of liposomes after convection enhanced delivery; modulation by particle charge, particle diameter, and presence of steric coating. Brain Res 1035:139–153
Mamot C, Nguyen JB, Pourdehnad M, Hadaczek P, Saito R, Bringas JR, Drummond DC, Hong K, Kirpotin DB, McKnight T, Berger MS, Park JW, Bankiewicz KS (2004) Extensive distribution of liposomes in rodent brains and brain tumors following convection-enhanced delivery. J Neurooncol 68:1–9
Mardor Y, Rahav O, Zauberman Y, Lidar Z, Ocherashvilli A, Daniels D, Roth Y, Maier SR, Orenstein A, Ram Z (2005) Convection-enhanced drug delivery: increased efficacy and Magnetic Resonance Image Monitoring. Cancer Res 65:6858–6863
Misra A, Ganesh s, Shahiwala A, Shah SP (2003) Drug Delivery to the central nervous system: a review. J Pharm Pharm Sci 6:252–273
Morrison PF, Chen MY, Chadwick RS, Lonser RR, Oldfield EH (1999) Focal delivery during direct infusion to brain: role of flow rate, catheter diameter, and tissue mechanics. Am J Physiol 277:1218–1229
Morrison PF, Laske DW, Bobo H, Oldfield EH, Dedrick RL (1994) High-flow microinfusion: tissue penetration and pharmacodynamics. Am J Physiol 266:292–305
Neeves KB, Sawyer AJ, Foley CP, Saltzman WM, Olbricht WL (2007) Dilation and degradation of the brain extracellular matrix enhances penetration of infused polymer nanoparticles. Bain Res 1180:121–132
Olson JJ, Zhang Z, Dillehay D, Stubbs J (2008) Assessment of a balloon-tipped catheter modified for intracerebral convection-enhanced delivery. J Neurooncol 89:159–168
Pardridge WM (2007) Blood-brain barrier delivery. Drug Discov Today 12:54–61
Perlstein B, Ram Z, Daniels D, Ocherashvilli A, Roth Y, Margel S, Mardor Y (2008) Convection-enhanced delivery of maghemite nanoparticles: increased efficacy and MRI monitoring. Neuro-Oncology 10(2):153–161
Raghavan R, Brady ML, Rodríguez-Ponce MI, Hartlep A, Pedain C, Sampson JH (2006) Convection-enhanced delivery of therapeutics for brain disease, and its optimization. Neurosurg Focus 20:E12
Raza SM, Pradilla G, Legnani FG, Thai QA, Olivi A, Weingart JD, Brem H (2005) Local delivery of antineoplastic agents by controlled-release polymers for the treatment of malignant brain tumours. Expert Opin Biol Ther 5:477–494
Rosenberg GA, Kyner WT, Estrada E (1980) Bulk flow of brain interstitial fluid under normal und hyperosmolar conditions. Am J Physiol 238:42–49
Saito R, Krauze MT, Noble CO, Drummond DC, Kirpotin DB, Berger MS, Park JW, Bankiewicz KS (2006) Convection-enhanced delivery of Ls-TPT enables an effective, continuous, low-dose chemotherapy against malignant glioma xenograft model. Neuro-Oncology 8:205–214
Sampson JH, Raghavan R, Brady ML, Provenzale JM, Herndon JE II, Croteau D, Friedman AH, Reardon DA, Coleman RE, Wong T, Bigner DD, Pastan I, Rodríguez-Ponce MI, Tanner P, Puri R, Pedain C (2007) Clinical utility of a patient-specific algorithm for simulating intracerebral drug infusions. Neuro-Oncology 9:343–353
Sawyer AJ, Piepmeier JM, Saltzman WM (2006) New methods for direct delivery of chemotherapy for treating brain tumors. Yale J Biol Med 79:141–152
Seunguk O, Odland R, Wilson SR, Kroeger KM, Liu C, Lowenstein PR, Castro MG, Hall WA, Ohlfest JR (2009) Improved distribution of small molecules and viral vectors in the murine brain using a hollow fiber catheter. Neuro-Oncology 9:343–353
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphroorn MJB, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996
Varenika V, Dickinson P, Bringas J, LeCouteur R, Higgins R, Park J, Fiandaca M, Berger M, Sampson J, Bankiewicz K (2008) Detection of infusate leakage in the brain using real-time imaging of convection-enhanced delivery. J Neurosurg 109:874–880
Yang W, Huo T, Barth RF, Gupta N, Weldon M, Grecula JC, Ross BD, Hoff BA, Chou TC, Rousseau J, Elleaume H (2011) Convection enhanced delivery of carboplatin in combination with radiotherapy for the treatment of brain tumors. J Neurooncol 101:379–390
Yin D, Forsayeth J, Bankiewicz KS (2010) Optimized cannula design and placement for convection-enhanced delivery in rat striatum. J Neurosci Meth 187:46–51
Yokosawa M, Sonoda Y, Sugiyama S, Saito R, Yamashita Y, Nishihara M, Satoh T, Kumabe T, Yokoyama M, Tominaga T (2010) Convection-enhanced delivery of a synthetic retinoid Am80, loaded into polymeric micelles, prolongs the survival of rats bearing intracranial Glioblastoma xenografts. Tohoku J Exp Med 221:257–264
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Laine, AL., Allard, E., Menei, P., Passirani, C. (2011). Brain Tumors: Convection-Enhanced Delivery of Drugs (Method). In: Hayat, M. (eds) Tumors of the Central Nervous system, Volume 3. Tumors of the Central Nervous System, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1399-4_21
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