Oral Delivery of Kidney Targeting Nanotherapeutics for Polycystic Kidney Disease

Abstract

AbstractAutosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disorder. Although a variety of candidate drugs have been found to modulate cystogenesis in animal studies, results from clinical trials have often been unfavorable due to low renal bioavailability and drug-induced side effects. To mitigate this, nanoparticles can be designed to deliver drugs directly to the target organ to increase effective dose while limiting off-target side effects. Unfortunately, there are no kidney-targeted nanomedicines clinically available, and most of the existing FDA-approved nanoparticles require intravenous administration which is not suitable for ADPKD that require lifelong therapy. To address this, we developed an oral drug delivery system using chitosan nanoparticles (CS-NP) that were loaded with peptide amphiphile micelles carrying metformin (met), an ADPKD drug candidate (CS-KM-met). We previously showed that CS-NP can shield met in the gastrointestinal tract; thus, we hypothesized that CS-NP could also enhance bioavailability of kidney-targeting micelles (KMs) upon oral administration. Specifically, we measured the loading capacity of KM-met in CS-NP, evaluated the stability of CS-KM-met under acidic conditions that mimic the gastric environment, and measuredin vitrotherapeutic effects. Upon oral administration in C57BL/6J mice, CS-KM-met showed significantly greater bioavailability and accumulation in the kidneys as compared to KM-met without CS-NP or free met for up to 24 hours. As such, CS-KM-met treatment in PKD mice (Pkd1fl/fl; Pax8-rtTA; Tet-O-Cre) which develops PKD over the course of 120 days and mimics the chronic and slowly developing nature of the human disease, showed enhanced therapeutic efficacy without affecting safety despite repeated treatment. Herein, we demonstrate the potential of CS-KM as a nanomedicine strategy for oral delivery for the long-term treatment of chronic kidney diseases such as ADPKD for the first time.