Chronic, intermittent convection-enhanced delivery devices
Chronic, intermittent convection-enhanced delivery devices
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DOI：
10.1016/j.jneumeth.2015.11.008
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发表时间：
2016-02-01
影响因子：
3
通讯作者：
Evans, Sam
中科院分区：
文献类型：
--
作者：
Lewis, Owen;Woolley, Max;Evans, Sam
背景：长期以来，治疗药物直接进入大脑的实质内对流增强递送(CED)一直被认为是一种绕过血脑屏障，给患者提供有意义的药物浓度的媒介。由于在较小的临床前模型中没有观察到的分布不佳，这项技术向临床的转化受到了阻碍。这在一定程度上是由于在人体内发现了更多的靶结构，但主要是由于输液沿导管轨道近端的回流(回流)。在过去的10年里，该领域的技术得到了改进，导致了少量商业上可用的包含反流抑制功能的设备。新方法：虽然这些设备目前适合急性或短期使用，但一些适应症将受益于长期重复、间歇性的治疗药物(帕金森氏症、阿尔茨海默氏症、肌萎缩侧索硬化症、脑肿瘤，如多形性胶质母细胞瘤(GBM)和弥漫性桥脑胶质瘤(DIPG)等)。结果：尽管需要一个长期可访问的平台来处理这些适应症，这方面的经验有限。与现有方法(S)的比较：在撰写本文时，还没有商业可用的临床平台，适用于慢性、间歇或连续的脑内给药。结论：本文回顾了近年来对CED设备的改进以及慢性输液系统的技术现状。(C)2015年提交人。Elsevier B.V.出版。这是一篇基于CC by License(http://creativecommons.org/licenses/by/4.0/).的开放获取文章
Background: Intraparenchymal convection-enhanced delivery (CED) of therapeutics directly into the brain has long been endorsed as a medium through which meaningful concentrations of drug can be administered to patients, bypassing the blood brain barrier. The translation of the technology to clinic has been hindered by poor distribution not previously observed in smaller pre-clinical models. In part this was due to the larger volumes of target structures found in humans but principally the poor outcome was linked to reflux (backflow) of infusate proximally along the catheter track. Over the past 10 years, improvements have been made to the technology in the field which has led to a small number of commercially available devices containing reflux inhibiting features.New method: While these devices are currently suitable for acute or short term use, several indications would benefit from longer term repeated, intermittent administration of therapeutics (Parkinson's, Alzheimer's, Amyotrophic lateral sclerosis, Brain tumours such as Glioblastoma Multiforme (GBM) and Diffuse intrinsic Pontine Glioma (DIPG), etc.).Results: Despite the need for a chronically accessible platform for such indications, limited experience exists in this part of the field.Comparison with existing method(s): At the time of writing no commercially available clinical platform, indicated for chronic, intermittent or continuous delivery to the brain exists.Conclusions: Here we review the improvements that have been made to CED devices over recent years and current state of the art for chronic infusion systems. (C) 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).