The Food and Drug Administration (FDA) regulates pharmaceutical drug products to ensure a continuous supply of high-quality drugs in the USA. Continuous processing has a great deal of potential to address issues of agility, flexibility, cost, and robustness in the development of pharmaceutical manufacturing processes. Over the past decade, there have been significant advancements in science and engineering to support the implementation of continuous pharmaceutical manufacturing. These investments along with the adoption of the quality-by-design (QbD) paradigm for pharmaceutical development and the advancement of process analytical technology (PAT) for designing, analyzing, and controlling manufacturing have progressed the scientific and regulatory readiness for continuous manufacturing. The FDA supports the implementation of continuous manufacturing using science-and risk-based approaches.
We examined in vivo FLT3 inhibition in acute myeloid leukemia patients treated with chemotherapy followed by the FLT3 inhibitor lestaurtinib, comparing newly diagnosed acute myeloid leukemia patients with relapsed patients. Because we noted that in vivo FLT3 inhibition by lestaurtinib was less effective in the relapsed patients compared with the newly diagnosed patients, we investigated whether plasma FLT3 ligand (FL) levels could influence the efficacy of FLT3 inhibition in these patients. After intensive chemotherapy, FL levels rose to a mean of 488 pg/mL on day 15 of induction therapy for newly diagnosed patients, whereas they rose to a mean of 1148 pg/mL in the relapsed patients. FL levels rose even higher with successive courses of chemotherapy, to a mean of 3251 pg/mL after the fourth course. In vitro, exogenous FL at concentrations similar to those observed in patients mitigated IntroductionAcute myeloid leukemia (AML) patients who harbor the FLT3/ITD mutation have an exceptionally poor prognosis. 1,2 During the past decade, efforts have been underway to develop FLT3 inhibitors in the hopes of improving outcomes for these patients. 3 Several agents have now been studied as monotherapy for this disease, and the results have been only modestly successful. Although there have been a few remissions reported, the responses are usually limited to clearance of peripheral blasts, with persistence of disease in the marrow. In light of this, attention has turned to incorporating these agents into existing chemotherapy regimens, on the hypothesis that FLT3 inhibition will synergize with chemotherapy in inducing cytotoxicity. 4 Alternately, others have postulated that mobilizing the leukemia cells from the marrow might enhance the efficacy of FLT3 inhibition and have therefore tested FLT3 inhibitors in combination with CXCR4 inhibition. 5 Several large trials of chemotherapy administered in combination with FLT3 inhibitors are either actively accruing or have recently completed accrual. Because chemotherapy may alter the pharmacokinetics of FLT3 inhibitors and therefore affect target inhibition in vivo, we examined FLT3 inhibition in patients receiving lestaurtinib, an indolocarbazole FLT3 inhibitor, from 2 separate trials in which the agent was combined with chemotherapy. We noted a discrepancy in the degree of FLT3 inhibition, as measured by a plasma inhibitory activity assay, between the 2 groups of patients. We hypothesized that high levels of FLT3 ligand (FL), a cytokine that is known to increase after myelosuppressive therapy, could be interfering with FLT3 inhibition in these trials. We have therefore examined FL levels in response to chemotherapy and FLT3 inhibition, as well as the effect of FL levels on the efficacy of FLT3 inhibitors in vitro and in vivo. Our findings may explain why blasts in the bone marrow are more resistant to FLT3 inhibitors and furthermore have important implications both for FLT3 mutant AML as a disease as well as for efforts to incorporate FLT3 inhibitors into AML therapy. Methods ...
Taking rapid and efficient formation of functional tissues as our long-term goal, we discuss in this study a new and generic approach toward formation of multilayered three-dimensional (3D) tissues using nanofibers. 3:1 poly (epsilon-caprolactone) (PCL) (8% w/v)/collagen (8.0% w/v) solution was electrospun into nanofibers with an average diameter of 454.5 +/- 84.9 nm. The culture of human dermal fibroblasts (NHDF) on PCL/collagen nanofibers showed a high initial cell adhesion (88.1 +/- 1.5%), and rapid cell spreading with spindle morphology. Three-dimensional multilayered cell-nanofiber constructs were built with alternating NHDF seeding (1 x 10(5)cells/layer) and PCL/collagen nanofiber collection on site of electrospinning, where almost all the seeded cells retained in the constructs. The formed construct showed layered structure with uniform cell distribution in between layers of PCL/collagen nanofibers. In the 3D constructs, cells continuously proliferated and deposited new extracellular matrix. By culturing either fibroblast/fiber layered constructs or keratinocyte/fibroblast/fiber layered constructs, dermal-like tissues or bilayer skin tissues (containing both epidermal and dermal layers) were consequently produced within 1 week. Taken together, the present study reports a novel approach to 3D multilayered tissue formation using a bottom-up, on-site layer-by-layer cell assembly while electrospinning. This approach has marked potentials to form functional tissues composed of multiple types of cells, heterogeneous scaffold composition, and customized specific microenvironment for cells.
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