Liposomal formulations
of antibiotics for inhalation offer the
potential for the delivery of high drug doses, controlled drug release
kinetics in the lung, and an excellent safety profile. In this study,
we evaluated the in vivo performance of a liposomal
formulation for the poorly soluble, antituberculosis agent, bedaquiline.
Bedaquiline was encapsulated within monodisperse liposomes of ∼70
nm at a relatively high drug concentration (∼3.6 mg/mL). Formulations
with or without fucose residues, which bind to C-type lectin receptors
and mediate a preferential binding to macrophage mannose receptor,
were prepared, and efficacy was assessed in an in vivo C3HeB/FeJ mouse model of tuberculosis infection (H37Rv strain).
Seven intranasal instillations of 5 mg/kg bedaquiline formulations
administered every second day resulted in a significant reduction
in lung burden (∼0.4–0.6 Δlog10 CFU),
although no differences between fucosylated and nonfucosylated formulations
were observed. A pharmacokinetic study in healthy, noninfected Balb/c
mice demonstrated that intranasal administration of a single dose
of 2.5 mg/kg bedaquiline liposomal formulation (fucosylated) improved
the lung bioavailability 6-fold compared to intravenous administration
of the same formulation at the same dose. Importantly, intranasal
administration reduced systemic concentrations of the primary metabolite, N-desmethyl-bedaquiline (M2), compared with both intravenous
and oral administration. This is a clinically relevant finding as
the M2 metabolite is associated with a higher risk of QT-prolongation
in predisposed patients. The results clearly demonstrate that a bedaquiline
liposomal inhalation suspension may show enhanced antitubercular activity
in the lung while reducing systemic side effects, thus meriting further
nonclinical investigation.