Lung-Targeted Itraconazole Delivery Using PVA-Based Nano-in-Microparticles for Improved Treatment of Pulmonary Aspergillosis

Jin-Hyuk Jeong,1,* Hee-Sung Lee,1,* Jae-Cheol Choi,1 Ji-Hyun Kang,2 Dong-Wook Kim,3 Chan-Su Park,1 Chun-Woong Park1 1College of Pharmacy, Chungbuk National University, Cheongju, 28160, Republic of Korea; 2School of Pharmacy, Institute of New Drug Development, and Respiratory Drug Development Research Institute, Jeonbuk National University, Jeonju, Republic of Korea; 3College of Pharmacy, Wonkwang University, Iksan, 54538, Republic of Korea*These authors contributed equally to this workCorrespondence: Chun-Woong Park, College of Pharmacy, Chungbuk National University, Cheongju, 28160, Republic of Korea, Tel +82 43 261 3330, Fax +82 43 268 2732, Email [email protected] Chan-Su Park, College of Pharmacy, Chungbuk National University, Cheongju, 28160, Republic of Korea, Tel +82 10 5841 9359, Email [email protected]: Pulmonary aspergillosis (PA) presents a substantial therapeutic challenge, especially in immunocompromised patients, where conventional systemic treatments like oral and intravenous routes often result in limited efficacy and increased adverse effects. This study focuses on the development and evaluation of an inhalable itraconazole (ITZ) formulation within a nanoparticles-in-microparticles (NIM) system.Methods: Polyvinyl alcohol 500 (PVA), used in varying concentrations, played a crucial role as a stabilizer in both the wet bead milling and spray drying processes, enhancing drug release and aerodynamic performance. The influence of PVA ratios on drug penetration into pulmonary mucus and interactions with pulmonary defense mechanisms were thoroughly investigated through in-vitro simulations.Results: Pharmacokinetic analysis in Sprague-Dawley (SD) rats revealed enhanced distribution of ITZ-NIMs in pulmonary tissues and bronchoalveolar lavage fluid (BALF), representing a significant improvement in localized drug concentration. Efficacy against Aspergillus fumigatus was confirmed by a reduction in galactomannan levels, inhibition of fungal growth in lung tissues, and increased survival rates. Importantly, pulmonary delivery of ITZ significantly reduced hepatotoxicity markers, including alanine aminotransferase (ALT) and alkaline phosphatase (ALP), when compared to oral administration.Conclusion: The incorporation of PVA in NIM technology demonstrated not only improved pulmonary targeting and drug release but also minimized systemic toxicity, highlighting the potential of nanoparticle-based inhalation systems in treating respiratory fungal infections like aspergillosis. These findings emphasize the pivotal role of PVA in the formulation, stability, and therapeutic efficacy of NIM-based drug delivery systems for pulmonary applications, advancing the use of nanoparticle technology in respiratory drug delivery. Keywords: Polyvinyl alcohol 500, PVA, dry powder inhaler, DPI, nanoparticles-in-microparticles, NIM, itraconazole, ITZ, aspergillosis