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Background: Binge eating disorder) BED) is the most common eating disorder in the United-States. Chronic, orally administered topiramate has shown BED treatment efficacy, but with two major limitations: frequent and severe side effects and slow time to action. SipNose is a novel-non-invasive-intranasal (IN) direct nose-to-brain (DNTB) drug delivery platform that delivers drugs to the central nervous system (CNS) consistently and fast. Herein, we study SipNose-topiramate combination product, as an acute "as needed"(PRN) solution for BED management. Methods: First, we evaluate the innovative SipNose-topiramate's pharmacokinetics (PK) and safety. The second part aimed to demonstrate SipNose-topiramate's PRN-treatment efficacy in reducing the number of binge-eating episodes in 12-BED patients (2-weeks of baseline monitoring [BL], 8-weeks of treatment [TX], 2-weeks of follow up [FU]). In this part 251 treatments were used by the 12 BED patients participated in the study. Results: The PK profile showed peak plasma levels at 90 minutes post-administration, and a t1/2 > 24hr, and demonstrated consistent topiramate delivery with no AE. In the second part, mean weekly binge events (WBE) and binge event days per week (DPW) showed a significant reduction from baseline to treatment period that was maintained in follow up period. Efficacy was corroborated by improved patient illness severity scales. There were no adverse events during all administered treatments. Patients were exposed to less drug when compared with accepted oral dosing. Conclusions: This study introduces the novel SipNose-topiramate drug-device combination as a safe, effective, and controlled method for BED management. Its findings represent a breakthrough approach to BED management both as an intranasal and "as needed" therapy for reducing binge eating episodes with a large-scale reduction in patient drug exposure and thus side effects and with improved patient quality of life. Further studies are needed with larger patient populations to establish SipNose-topiramate as a mainstream treatment for BED. Trial registration: Registration number and date of registration of the clinical studies reported in this article are as follows: 0157-18-HMO, August 15th 2018 and 6814-20-SMC, December 2nd 2020.

Transdermal delivery is an attractive but challenging solution for delivery of drugs. The sea anemone possesses a sophisticated injection system, which utilizes built-in high osmotic pressures. The system is folded within microcapsules and upon activation it injects a long, needle-like tubule of submicron diameter that penetrates the target in a fraction of a second. Here we show that this natural injection system can be adapted for active topical drug delivery once it is isolated from the cells, formulated into a topical gel, and uploaded with the desired drug. The formulated injectors retained their physical characteristics and were capable of penetrating the skin, achieving immediate delivery of a hydrophilic compound. We demonstrate quantitative rapid delivery of lidocaine hydrochloride as a function of microcapsular and drug concentrations. The adaptation of natural injectors for drug delivery combines the benefits of short topical application with rapid delivery of physical devices, thereby presenting a promising alternative for transdermal drug delivery.

Injectable local anesthetics that would last for many days could have a marked impact on periprocedural care and pain management. Formulations have often been limited in duration of action, or by systemic toxicity, local tissue toxicity from local anesthetics, and inflammation. To address those issues, we developed liposomal formulations of saxitoxin (STX), a compound with ultrapotent local anesthetic properties but little or no cytotoxicity. In vitro, the release of bupivacaine and STX from liposomes depended on the lipid composition and on whether dexamethasone was incorporated. In cell culture, bupivacaine, but not STX, was myotoxic (to C2C12 cells) and neurotoxic (to PC12 cells) in a concentration- and time-dependent manner. Liposomal formulations containing combinations of the above compounds produced sciatic nerve blockade lasting up to 7.5 days (with STX + dexamethasone liposomes) in male Sprague–Dawley rats. Systemic toxicity only occurred where high loadings of dexamethasone increased the release of liposomal STX. Mild myotoxicity was only seen in formulations containing bupivacaine. There was no nerve injury on Epon-embedded sections, and these liposomes did not up-regulate the expression of 4 genes associated with nerve injury in the dorsal root ganglia. These results suggest that controlled release of STX and similar compounds can provide very prolonged nerve blocks with minimal systemic and local toxicity.

The delta-conotoxin-TxVIA from Conus textile (delta TxVIA) is a mollusk-specific conotoxin that slows sodium channel inactivation exclusively in mollusk neuronal membranes but reveals high-affinity binding to both mollusk (effective binding) and rat brain (silent binding) neuronal membranes, despite not having any toxic effect in vertebrates in vivo and in vitro. Using binding studies with radioactive delta TxVIA we demonstrate that a different mollusk-specific conotoxin, delta-conotoxin-GmVIA from the venom of Conus gloriamaris, possesses "silent" and effective binding properties in rat brain and mollusk sodium channels, respectively. Binding studies and electrophysiological tests with both vertebrate muscle and insect neuronal preparations have indicated that the silent binding sites of delta TxVIA are highly conserved in a wide range of distinct vertebrate and insect sodium channels. Direct probing of receptor site 2 by a tritiated derivative of batrachotoxin ([3H]BTX-B) revealed that [3H]BTX-B binding in mollusk sodium channels is of high affinity with no addition of enhancing ligands, unlike [3H]BTX-B binding in rat brain. In contrast to the negative allosteric modulation of delta TxVIA binding by veratridine, delta TxVIA is not able to affect the binding of [3H]BTX-B in mollusk neuronal membranes but reduces [3H]BTX-B binding in rat brain in the presence of alpha-scorpion toxins. The latter finding indicates the existence of a pharmacological distinction between the silent and effective binding sites of delta TxVIA and points out possible functionally important structural differences between molluscan and rat brain sodium channels.

The ability of the excitatory anti-insect-selective scorpion toxin AahIT (Androctonus australis hector) to exclusively bind to and modify the insect voltage-gated sodium channel (NaCh) makes it a unique tool to unravel the structural differences between mammalian and insect channels, a prerequisite in the design of selective pesticides. To localize the insect NaCh domain that binds AahIT, we constructed a chimeric channel composed of rat brain NaCh alpha-subunit (rBIIA) in which domain-2 (D2) was replaced by that of Drosophila Para (paralytic temperature-sensitive). The choice of D2 was dictated by the similarity between AahIT and scorpion beta-toxins pertaining to both their binding and action and the essential role of D2 in the beta-toxins binding site on mammalian channels. Expression of the chimera rBIIA-ParaD2 in Xenopus oocytes gave rise to voltage-gated and TTX-sensitive NaChs that, like rBIIA, were sensitive to scorpion alpha-toxins and regulated by the auxiliary subunit beta(1) but not by the insect TipE. Notably, like Drosophila Para/TipE, but unlike rBIIA/beta(1), the chimera gained sensitivity to AahIT, indicating that the phyletic selectivity of AahIT is conferred by the insect NaCh D2. Furthermore, the chimera acquired additional insect channel properties; its activation was shifted to more positive potentials, and the effect of alpha-toxins was potentiated. Our results highlight the key role of D2 in the selective recognition of anti-insect excitatory toxins and in the modulation of NaCh gating. We also provide a methodological approach to the study of ion channels that are difficult to express in model expression systems.

Concerns over neurotoxicity have impeded the development of sustained release formulations providing prolonged duration local anesthesia (PDLA) from a single injection, for which there is an urgent clinical need. Here, we have used toxicogenomics to investigate whether nerve injury occurred during week-long continuous sciatic nerve blockade by microspheres containing bupivacaine, tetrodotoxin, and dexamethasone (TBD). Animals treated with amitriptyline solution (our positive control for local anesthetic-associated nerve injury) developed irreversible nerve blockade, had severely abnormal nerve histology, and the expression of hundreds of genes was altered in the dorsal root ganglia at 4 and 7 days after injection. In marked contrast, TBD-treated nerves reverted to normal function, were normal histologically and there were changes in the expression of a small number of genes. Toxicogenomic studies have great potential in delineating patterns of gene expression associated with specific patterns of tissue injury (e.g. amitriptyline neurotoxicity), and in identifying related changes in gene expression upon exposure to a drug, biomaterial, or drug delivery system. © 2012 Elsevier Ltd.

Several scorpion toxins have been shown to exert their neurotoxic effects by a direct interaction with voltage-dependent sodium channels. Both classical scorpion α-toxins such as Lqh II fromLeiurus quiquestratus hebraeusand α-like toxins as toxin III from the same scorpion (Lqh III) competitively interact for binding on receptor site 3 of insect sodium channels. Conversely, Lqh III, which is highly toxic in mammalian brain, reveals no specific binding to sodium channels of rat brain synaptosomes and displaces the binding of Lqh II only at high concentration. The contrast between the low-affinity interaction and the high toxicity of Lqh III indicates that Lqh III binding sites distinct from those present in synaptosomes must exist in the brain. In agreement, electrophysiological experiments performed on acute rat hippocampal slices revealed that Lqh III strongly affects the inactivation of voltage-gated sodium channels recorded either in current or voltage clamp, whereas Lqh II had weak, or no, effects. In contrast, Lqh III had no effect on cultured embryonic chick central neurons and on sodium channels from rat brain IIA and β1 subunits reconstituted inXenopusoocytes, whereas sea anemone toxin ATXII and Lqh II were very active. These data indicate that the α-like toxin Lqh III displays a surprising subtype specificity, reveals the presence of a new, distinct sodium channel insensitive to Lqh II, and highlights the differences in distribution of channel expression in the CNS. This toxin may constitute a valuable tool for the investigation of mammalian brain function.