Dendrimer compositions and their use in treatment of diseases of the eye
The treatment of many ocular disorders is hampered because of poor penetration of systemically administered drugs into the eye. The tight junctional complexes (zonulae occludens) of the retinal pigment epithelium and retinal capillaries are the site of the blood-ocular barrier. This barrier inhibits penetration of substances, including antibiotics, into the vitreous. Over the last 18 years we have evaluated the nontoxic doses of various drugs. These include antibiotics and antifungals for treatment of bacterial and fungal endophthalmitis, antivirals for treatment of viral retinitis (specifically, when medication with these drugs poses the threat of toxicity to other organs). Intravitreal antineoplastic drugs have been studied to prevent cell proliferation in the vitreous cavity after retinal attachment surgery, which can lead to proliferative vitreoretinopathy (PVR). Furthermore, we evaluated the anti-inflammatory action of dexamethasone and cyclosporine A to reduce intraocular inflammation after intraocular surgery or in uveitis. Because these studies had been performed in the presence of the vitreous, which can slow down the diffusion of the drugs toward the retina, it was necessary to reevaluate the concentration of drugs which could be administered intravitreally in the vitrectomized eye. The nontoxic dose of numerous drugs when added to vitrectomy infusion fluid has also been evaluated. Furthermore, the role of vitrectomy in the treatment of bacterial fungal endophthalmitis has been studied and the role of vitrectomy in this ocular disorder is defined.
1. A method for treating an inflammatory and/or angiogenic disease in the eye of the subject in need thereof, comprising injecting for systemic delivery a dendrimer composition in an effective amount to treat the inflammatory and/or angiogenic disease in the eye of the subject,
wherein the dendrimer composition comprises hydroxyl-terminated poly(amidoamine) (PAMAM) dendrimers covalently linked to one or more therapeutic agents, which can be the same or different.
2. The method of claim 1 , wherein the dendrimers are included in a formulation comprising liposomes, microcapsules, nanoparticles, or nanocapsules.
3. The method of claim 1 , wherein the PAMAM dendrimer is a G3, G4, G5, G6, G7, G8, G9 or G10 PAMAM dendrimer.
4. The method of claim 1 , wherein the inflammatory disease of the eye is selected from the group consisting of age-related macular degeneration (AMD), retinitis pigmentosa, optic neuritis, infection, uveitis, sarcoid, sickle cell disease, retinal detachment, temporal arteritis, retinal ischemia, arteriosclerotic retinopathy, hypertensive retinopathy, retinal artery blockage, retinal vein blockage, hypotension, diabetic retinopathy, macular edema, and choroidal neovascularization.
5. The method of claim 1 , wherein the dendrimer composition is repeatedly administered to the subject daily, weekly, biweekly, monthly, or bimonthly.
6. The method of claim 1 , wherein the one or more therapeutic agents are selected from the group consisting of proteins, oligonucleotides, and small molecules.
7. The method of claim 6 , wherein the one or more therapeutic agents are selected from the group consisting of vitamin A, vitamin C, vitamin E, and beta-carotene.
8. The method of claim 6 , wherein the one or more therapeutic agents are anti-inflammatory agents selected from the group consisting of triamcinolone acetonide, methyl prednisone, dexamethasone, COX-2 inhibitors, gold compound anti-inflammatory agents, salicylate anti-inflammatory agents, N-acetyl cysteine, minocycline, aflibercept, rapamycin, and anti-VEGF agents.
9. The method of claim 6 , wherein the one or more therapeutic agents are antibodies selected from the group consisting of daclizumab, basiliximab, ranibizumab, and pegaptanib sodium.
10. The method of claim 6 , wherein the one or more therapeutic agents are selected from the group consisting of enzymes, receptor antagonists or agonists, hormones, growth factors, and antibodies.
11. The method of claim 6 , wherein the oligonucleotides are selected from the group consisting of siRNAs, and microRNAs.
12. The method of claim 1 , wherein the composition is administered in combination with one or more additional therapeutically active agents.
13. The method of claim 1 , wherein the composition is administered intravenously.