Nanotechnology for topical cyclosporine: Not a small matter
By Warren R. Heymann, MD
July 19, 2016
Taken at face value, the study by Kumar et al, demonstrating the efficacy of topical cyclosporine for psoriasis, utilizing liposomal nanocarriers (lipogel), might elicit a shrug, because in this randomized study, at 14 weeks, complete clearance of psoriasis was observed in 41% of treated sites with cyclosporine in lipogel compared to 85.7% clearing with clobetasol cream. The authors gave the understated conclusion that future research may lead to better outcomes (1).
I beg to differ. Nanotechnology is huge.
It has been almost 3 decades since Hermann et al attempted to treat psoriasis with topical cyclosporine. Encouraged by the success in controlling psoriasis with oral administration of cyclosporine, these authors could not demonstrate efficacy of the topical cyclosporine utilizing a variety of delivery systems (2). Kumar et al were able to achieve adequate penetrability utilizing liquid-state liposomes composed of high-purity unsaturated phospholipids of submicron range (1). That is a remarkable achievement.
Although more studies on toxicity and comparative studies utilizing topical nanotechnology are warranted, Kumar et al are to be commended for the structure of their study. In a review of nanoparticles and nanofibers for topical drug delivery, Goyal concludes:
From the plethora of research involving nanoparticles in the past two decades, it is clear that nanoparticles have the potential to effectively deliver drugs across the skin barrier. Solid lipid nanoparticles and liposomes offer potential value as topical drug delivery systems in addition to polymeric and metal-based nanoparticles. Electrospun nanofibers have also shown great promise in the area of wound healing and as antimicrobial dressings. However, as demonstrated by the small number of advanced clinical studies, the clinical impact of nanoparticles and fiber mats as topical or transdermal drug delivery systems has been limited. It seems that the translation of a very extensive global research effort into clinically used products has been slow. Although nanotechnology has proven promise in topical applications, a greater emphasis is needed on quantitative studies that can relate the dose and exposure of nanoparticle to nanoparticle penetration and therapeutic efficacy.
1. Kumar RV et al. Efficacy of novel topical liposomal formulation of cyclosporine in mild to moderate stable plaque psoriasis. JAMA Dermatology 2016; 152: 807-14.
2. Hermann RC, et al. Topical ciclosporin for psoriasis: in vitro skin penetration and clinical study. Skin Pharmacol 1988; 1: 246-9.
3. Goyal R, et al. Nanoparticles and nanofibers for topical drug delivery. J Control Release 2015; Oct 28 [Epub ahead of print]
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