期刊
ACTA PHARMACOLOGICA SINICA
卷 43, 期 8, 页码 2094-2108出版社
NATURE PUBL GROUP
DOI: 10.1038/s41401-021-00801-6
关键词
refractory rheumatoid arthritis; P-glycoprotein; total glucosides of paeony; nobiletin; self-nanoemulsifying drug delivery systems
资金
- Science and Technology Development Fund, Macao SAR, China [0067/2019/A2, 0075/2019/AMJ]
This study developed a novel treatment for refractory rheumatoid arthritis by co-delivering total glucosides of paeony and the P-gp inhibitor nobiletin in a nano-SNEDDS formulation, which significantly increased the bioavailability of TGPs and inhibited P-gp function and expression. The co-loaded formulation not only enhanced the therapeutic effects of TGP but also reduced P-gp expression in an adjuvant-induced arthritis rat model, partly through the inhibition of phosphorylated AKT and HIF-1 alpha pathways.
Patients with refractory rheumatoid arthritis (RA) remain a substantial clinical problem, while the overexpression of P-glycoprotein (P-gp) on their lymphocytes may contribute to resistance to anti-rheumatic drugs. This study aims to develop a novel treatment for refractory RA consisting of the combination of total glucosides of paeony (TGPs) and the P-gp inhibitor nobiletin (N), which are codelivered in a self-nanoemulsifying drug delivery system (SNEDDS). Based on the solubility, compatibility, and pseudoternary phase diagram tests, a nano-SNEDDS formulation composed of capryol 90-cremophor EL35-tcranscutol HP (CET) to codeliver TGP and N was developed, and this formulation increased the bioavailability of TGP by 435.04% (indicated with paeoniflorin). A modified adjuvant-induced arthritis (AIA) rat model was verified for the overexpression of P-gp in lymphocytes and resistance to methotrexate (MTX) treatment at the reported anti-inflammatory dosage. CET formulation not only increased the solubility and permeability of TGP but also inhibited the function and expression of P-gp, leading to enhanced bioavailability and intracellular concentration in the lymphocytes of AIA rats and consequently boosting the anti-arthritic effects of TGP. Moreover, TGP and N coloaded CET reduced the expression of P-gp in AIA rats partly by inhibiting the phosphorylated AKT and HIF-1 alpha pathways. In summary, TGP-N coloaded SNEDDS is a novel and effective treatment for refractory RA.
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