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The Conjunctival Barrier in Ocular Drug Delivery

Hovhannes J. Gukasyan, Kwang-Jin Kim, and Vincent H.L. Lee

Abstract Within the context of topical and local drug delivery to the eye, the mammalian conjunctiva functions as a unique biological barrier. Various model systems as in vitro tools have been rened and validated over the years to assess drug absorption across the conjunctiva. Passive and active drug transport as well as endocytic routes of transconjunctival drug permeation have been extensively characterized. The subconjunctival space offers the possibility of delivering multiple types of sustained release formulations to the eye. Additionally, the concept of transscleral/conjunctival iontophoresis has been proven as a viable option for topical, relatively noninvasive delivery of select categories of molecules. Furthermore, a number of ocular surface disorders have been associated with conjunctival phenotypes, making this tissue a potential drug target. The aim of this chapter is to facilitate the understanding of conjunctival (transport) physiology and establishment of in vitro models of conjunctiva validated for predicting drug delivery to the eye in health and disease. The models are evaluated in terms of assessing their electrical, morphological, and permeability properties as well as expression proles of endogenous active transporter(s) and marker enzyme(s). Finally, we provide protocols and methods, as an appendix to this chapter, to be used for in vitro studies of the conjunctiva for testing preclinical biopharmaceutics. Keywords: Ocular drug delivery; Noncorneal route; Transporters; Iontophoresis; Endocytosis; Dry eye; Inammation; Subconjunctival injections

Abbreviations
Ad5 AIC ATB ATP cAMP CFTR GSH Isc Adenovirus type 5 Air-interfaced culture Na+ /Cl -coupled broad specicity amino acid transporter B0,+ Adenosine triphosphate Cyclic adenosine monophosphate Cystic brosis transmembrane conductance regulator Glutathione Short-circuit current

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L -NA

NO NOS PD P-gp RCEC TEER

NG -nitro-L-arginine Nitric oxide Nitric oxide synthase Potential difference P-glycoprotein Rabbit conjunctival epithelial cells Transepithelial electrical resistance

13.1. Introduction to the Ocular Surface and the Relative Contribution of the Conjunctiva
The conjunctiva is a thin, mucus-secreting, relatively well vascularized (compared to avascular cornea) tissue that covers 80% of the ocular surface. It comprises the inner surface of the eyelids and is part of the anterior sclera ending where the cornea begins. While the conjunctiva has been long thought to play a simple protective role in the eye by functioning as a passive physical barrier, it is an intricate and heterogeneous tissue which participates in the maintenance of tear lm stability due to the mucus secreted by its resident goblet cells [1, 2]. Studies performed in recent years have characterized additional functional and practical features of the conjunctiva, that is, contributing to the regulation of electrolyte and uid balance in the microenvironment of its mucosal surface as well as providing a unique conduit for drug delivery to the anterior and posterior segments of the eye when drugs are applied topically to ocular surfaces [3, 4]. The dynamic nature of conjunctiva was demonstrated from the identication of several transport mechanisms for Na+ absorption from the conjunctival mucosa: Na+ -glucose, Na+ -amino acid, and Na+ -nucleoside cotransporters, in addition to the predominant and active Cl secretion. Permeability of the conjunctiva to a wide variety of hydrophilic and lipophilic molecules and drugs was also characterized in the recent past, which is detailed in a recent review [5]. Furthermore, multiple reports substantiate mechanisms of conjunctival ion transport, a key dening property of this tissue. Pharmacological ngerprints of conjunctival ion transport include signicant reduction by the serosal application of bumetanide, an inhibitor of Na+ /K+ /2Cl cotransporter, the only known serosal entry pathway for Cl into conjunctival cells to date [68]. Net conjunctival Cl secretion is modulated by cyclic adenosine monophosphate (cAMP), protein kinase C, and Ca2+ , suggesting the presence of at least three mucosal Cl exit pathways [8]. Moreover, the existence and apical localization of CFTR (cystic brosis transmembrane conductance regulator) was conrmed by electrophysiological, molecular, biological, and immunocytochemical methods in the pigmented rabbit conjunctival epithelium [9, 10]. By contrast, metabolic enzymes or biochemical elimination mechanisms in the conjunctiva remain largely unknown. In addition to acting as a highly specialized secretory epithelium within the context of biochemical and metabolic capabilities, the conjunctiva also displays esterase activity [11], and is likely to express isoforms of drug efux pumps (e.g., P-glycoprotein, P-gp) [12]. Lastly, the vectorial secretion of glutathione (GSH, an abundant and ubiquitous antioxidant tripeptide) from conjunctival epithelial cells has been functionally characterized in both the primary

Chapter 13 The Conjunctival Barrier in Ocular Drug Delivery Figure 13.1 A cross-sectional representation of the ocular surface, highlighting the conjunctival tissue as a thick black contour. Three distinct areas of the conjunctiva are labeled along with adjacent ocular tissues.

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Fornicial conjunctiva

Lacrimal gland

Bulbar conjunctiva
Upper eyelid

Sclera

Cornea Anterior segment

Palpebral conjunctiva

Posterior segment

culture model and excised tissues of conjunctivas obtained from the pigmented rabbit [13]. The ocular epithelium, obtained from other mammalian epithelial tissues that serve as primary barriers from the outside environment, is atypical in structure and function. Comprising relatively and proportionally a small area of the total body surface, the ocular surface includes two continuous but very different tissues of the conjunctiva and cornea. While the conjunctiva covers most of the ocular surface area, only a small fraction (called the bulbar region) covers the anterior sclera, which has an air interface exposed to the environment during open-eye intervals (Figure 13.1). It continues through the fornicial and palpebral regions as highly vascularized, thin/semitransparent, elastic, and heterogeneous tissue (Figure 13.1). The cornea is a hydrophobic barrier continuous with the bulbar conjunctiva (Figure 13.1), has a smaller relative surface area, shows a clear transparency to light, exhibits a characteristic high resistance to passive diffusion of ions and molecules, and withstands against the intraocular pressure. Both the corneal and conjunctival epithelial tissues are constantly subjected to light irradiation, atmospheric oxygen, environmental chemicals, and physical abrasion. Each of these factors poses stress of primarily oxidative nature that can ultimately contribute to ocular surface damage and disease, if left unchecked. Natural protective components like water-soluble antioxidants (e.g., vitamin C, L-cyst(e)ine, GSH, uric acid, pyruvate, and tyrosine), lipid-soluble antioxidants (e.g., tocopherols and retinols), and highly specialized enzymes (e.g., superoxide dismutase, catalase, and GSH peroxidase) have all been identied in human tear uid collected at normal and stimulated secretion rates and are thought to serve as a frontline defense for the ocular surface tear lm and underlying tissues. While mechanisms or glandular sources of these antioxidants have not been identied denitively, the conjunctiva may be a possible source due to its dynamic properties of biochemical, electrophysiological, and secretory functions.

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13.2. Trans- and Sub-Conjunctival Ocular Drug Delivery

Although the cornea is the primary route of drug entry into the eye following topical administration, applied drugs also reach intraocular tissues by conjunctivascleral pathway. About 15% of a topically applied drug dose often reaches the anterior segment of the eye. Therefore, subsequent diffusion of absorbed drugs to the posterior segment of the eye will often be relatively insignicant. Eye drops are eliminated from the precorneal area within 90 s and absorbed systemically by way of the highly vascular conjunctival stroma and nasolachrymal ducts. Despite several anatomical hurdles for intraocular drug delivery by the conjunctival pathway, a number of critical discoveries have been reported which highlight the importance of this route. Nipradilol, a -blocker, and iganidipine, a Ca2+ antagonist, are good examples that have been reported to reach the posterior segment of the eye in preclinical species, respectively [5]. Improving the conjunctival drug permeability is one of the major challenges in ocular drug delivery. Enhancing transcellular drug penetration by increasing drug lipophilicity through the use of prodrugs or analogs or improving paracellular penetration by using enhancers to open tight junctions was reported with some success. The transcellular route signicantly contributes toward the absorption of lipophilic drugs, but is less signicant for hydrophilic species. Propranolol, with a log partition coefcient between octanol and water (log PC) of 3.21, is absorbed through cornea and conjunctiva up to tenfold greater than a hydrophilic drug of similar size, for example, sotalol with a log PC of 0.62. A sigmoidal relationship, reported in various other tissues and in vitro epithelial cell culture systems, describes penetration of compounds through the conjunctiva and cornea, in a manner that an increase in lipophilicity is seen with a rise in permeation, followed by apparent saturation at high lipophilicity. Since hydrophilic drugs penetrate primarily via the paracellular pathway between epithelial cells through the tight junctions, their penetration area is extremely small compared to the surface area offered by transcellular route for absorption of lipophilic species. However, most lipophilic drugs are prone to efux mechanisms afforded by pumps (e.g., P-gp) localized on the apical side of conjunctiva [5]. Delivery of biologic pharmaceuticals via the conjunctival route has been studied as an alternative to injections. Because of their hydrophilic nature, peptide and protein drugs permeate across ocular epithelia predominantly via the paracellular route. In conjunctival tissues, penetration through tight junctions comprising the paracellular pathway is the rate-limiting step for diffusion of macromolecule drugs. When this pathway is modeled to be populated with equivalent pores having a cylindrical shape, analysis suggests that conjunctiva may allow the passive restricted diffusion via such pores of hydrophilic substances <20,000 Da. The theoretical radius of such equivalent pores is predicted to be 5.5 nm [14]. In addition, an external enzymatic barrier also restricts the penetration of peptide drugs across the conjunctiva, where enkephalins, substance P, and insulin have been shown to signicantly degrade during penetration across the tissue when instilled to the mucosal uid of conjunctivas mounted in modied Ussing chambers [1517]. Within this context, the coapplication of protease inhibitors (e.g., camostat mesylate and leupeptin) in the mucosal uid afforded the absorption of an increased

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fraction of intact vasopressin across the excised pigmented rabbit conjunctiva [18]. Recent reports indicate that the conjunctival tissue may also be endowed with endocytic vesicular routes for absorption of macromolecules [19, 20]. It is important to note that the roles and their respective contributions of caveolae, clathrin-coated pits, and other subcellular vesicle-associated elements in absorption/secretion of protein drugs remain ambiguous at best [5]. Most of the prominent carrier-mediated transport systems, which have been extensively characterized in the gastrointestinal tract, have been reported for ocular absorption of amino acids, small peptides, sugars, monocarboxylates, organic cations, phosphates, bile acids, and several water-soluble vitamins [5]. These carrier-mediated transport systems can contribute toward the ocular absorption of mimetic drugs. Since paracellular transport of drugs in ocular epithelia, especially the cornea and conjunctiva, is relatively limited in its capacity, carrier-mediated drug transport systems endowed in the conjunctival epithelium (which has a larger surface area than the cornea) offer great advantages. Na+ -coupled cotransport of D-glucose, L-arginine, nucleosides, and monocarboxylates as well as proton-dependent dipeptide cotransport have all been reported in the conjunctival mucosa [5]. Utilizing these transporters for absorption of (pro)-drugs has been proven conceptually feasible in local, ocular drug delivery. Nitric oxide synthase (NOS) inhibitors (e.g., NG -nitroL -arginine methyl ester, NG -monomethyl- L -arginine, and NG -nitro- L -arginine, L -NA) are absorbed by the same active mechanism of the B0,+ (ATB0,+ ) which utilizes the essential amino acid L-arginine in the excised pigmented rabbit conjunctiva [21, 22]. As nitric oxide (NO) plays a cytostatic or cytotoxic role in the conjunctiva and anterior uveal tract, transconjunctival delivery of NOS inhibitors is a practical strategy to alleviate symptoms associated with NO overproduction. Since ATB0,+ is abundantly expressed in the mucosal aspect of conjunctiva and recognizes almost all of naturally occurring neutral and cationic amino acids as substrates, it may be a major drug delivery facilitator to target by rational design approaches. Therefore, there are a wide range of options for chemical modication of drugs through the application of prodrug approaches. For example, herpes simplex virus inhibitor, valacyclovir, is transported as a substrate through mouse and human ATB0,+ , in various tissues including the eye. By virtue of analogous or similar amino acid structures, ATB0,+ also affords the transport of acyclovir glutamic acid -ester [23]. Dipeptide transporters known to play a key role in the oral absorption of certain -lactam antibiotics and angiotensin-converting enzyme inhibitors are also present in the mucosal aspect of the conjunctiva (albeit with relatively lower expression levels) [2426]. Nucleoside transporters are reported to be expressed in the conjunctival mucosa [27], offering the potential for the targeting of nucleoside mimetic antiviral drugs. However, this class of transporter proteins exhibit narrow specicity for substrates, which may entail a comparatively narrow option for chemical design in targeted drug delivery [5]. The use of polymeric nanoparticles in the eye has gained considerable interests in recent years. Ocular disposition, safety, efcacy, and pharmacokinetic proles of various nanoparticles offer a wide range of application for the delivery of many drugs used to treat common ocular disorders. Polymeric nanoparticles have been utilized to enhance the performance of ibuprofen and cyclosporine, while reducing systemic side effect of carteolol compared with

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commercial aqueous eye drops [28]. Poly-D,L-lactide-co-glycolide nanoparticles have been shown to be internalized (albeit direct proof of endocytosis is lacking) in primary cultures of pigmented rabbit conjunctival epithelial cells (RCEC) [19]. As alluded above, although endocytic mechanisms of nanoparticles in the conjunctiva have not been fully characterized, this drug delivery strategy may be a useful tool to apply in ocular delivery of novel therapeutics through this tissue. The use of polymeric nano- and microparticles in subconjunctival route of ocular drug delivery offers a unique method for enhancing local exposure level of drugs by maximizing and maintaining intraocular concentrations with minimal frequency of dosing. Compared to direct intravitreal injection, this approach is less invasive, although it requires the rational formulation design/small-scale engineering of both dimension and surface properties of the drug. Subconjunctival injection of polylactide microparticles (3.6 m) led to a much higher budesonide concentration in retina and vitreous humor over 14 days, compared to solutions of dosing nanoparticles of smaller (345 nm) size [29]. Collagen matrix and brin-based sealants provided a better controlled release of cisplatin and carboplatin, compared to a simple drug solutions, attaining higher drug concentrations after subconjunctival administration of rabbits in several intraocular tissues [30]. Since the sclera, an immediate underlying tissue, is signicantly more permeable than the conjunctiva, physical and biological barriers of both cornea and conjunctiva are circumvented in subconjunctival injections [5]. Iontophoresis is a relatively noninvasive technique that uses electric currents to drive introduction of ionized drug substances into tissues or across the tissue barriers. Transcorneal or transscleral/conjunctival iontophoresis has been utilized in ocular drug delivery. Transcorneal iontophoresis effectively enhances aqueous humor concentrations of drugs including gentamicin, tobramycin, and vidarabine monophosphate, but falls short of delivering these therapeutics in high enough concentrations to the posterior segment of the eye due to the presence of the iris-lens barrier [3135]. In contrast, transscleral/conjunctival iontophoresis affords higher concentrations of ticarcillin, cefazolin, and gentamicin in the vitreous humor as a function of applied current density and duration [36]. Iontophoretic drug penetration heavily depends on the intensity and duration of applied currents, perhaps two of the major limitations of this technique from practical and commercial points of view. Recently, this technique was successfully applied for intraocular gene delivery of uoresceinlabeled anti-NOS oligonucleotides to the retina with an efcacy in the rat model of endotoxin-induced uveitis, suggesting that transscleral/conjunctival iontophoresis facilitates the topical penetration of intact oligonucleotides into intraocular tissues [5].

13.3. An Overview of Conjunctival Disorders

Conjunctivitis, or pink eye, is an inammation of the conjunctiva and probably the most widespread form of ailment in this tissue. If left untreated, it can have serious consequences on vision and overall health. There are many forms of conjunctivitis, and symptoms can range from itchy, burning, or teary eyes (allergic conjunctivitis) to more severe cases of bacterial and viral conjunctivitis (commonly known as pink eye). Each type requires

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different treatment regimen and is highly contagious except for allergic conjunctivitis. Because of the similarity of the symptoms, only medical doctors trained well in ophthalmology can denitively distinguish between various types of conjunctivitis and could determine the appropriate course of therapy [37]. A number of ocular surface disorders collectively termed as Dry Eye Syndromes have also been associated with the conjunctiva. For example, a deciency and/or imbalance in compositions of the tear lm is often found on the ocular surface during keratoconjunctivitis sicca. Since the conjunctiva plays a direct role in the maintenance of the tear uid stability via secretion of mucin [1] by its resident goblet cells [4] and basal uid secretion driven by electro-osmotic gradients across the tissue [3], the conjunctiva is a well deserved, but not intensively studied, target of interest in research efforts aimed against combating Dry Eye Syndromes. Anatomical characteristics of disease in conjunctival inammatory conditions have been reported. In contrast to the bacterial form of conjunctivitis, viral conjunctivitis shows a clear, watery discharge. The affected eye is irritated and red with a swollen eyelid. This condition is also highly contagious and while onset is in one eye it can quickly infect the other eye. There are a number of viruses that can trigger this form of conjunctivitis. Some viral infection is a relatively mild form that clears up on its own, while other viruses produce a more severe form of the infection, such as herpes simplex conjunctivitis frequently seen in children or herpes zoster conjunctivitis which can lead to serious eye damage. Adenovirus (Ad) is the most frequent viral cause of epidemic ocular infections. Ocular Ad infection may lead to disseminated disease, which can be fatal in children or in individuals with acquired immunodeciencies. A wealth of knowledge about the relationship (that can be applied to improve treatment) between Ad and human ocular tissues is made possible with the development of cotton rat and rabbit models, Ad-induced pulmonary and ocular infections, together with the availability of human Ad mutants [3840]. The adenovirus type 5 (Ad5) rabbit ocular infection model has been established for evaluation of various antiviral and anti-inammatory agents in Ad5-induced ocular disease treatment [38].

13.4. Models for Studying Conjunctival Transport Properties

13.4.1. Excised Conjunctival Tissues The Ussing chamber technique, originally engineered to study transepithelial ion transport, has been optimized to study drug transport and electrophysiology of excised mammalian conjunctivas. This technique utilizes small tissue sheets that are mounted between two compartments of mucosal and serosal aspects of the isolated conjunctival tissue, which are bathed with a physiological buffer that is continuously bubbled with a stream of gas (compressed air or air balanced with 5% CO2 ). In addition to providing sufcient oxygen tension for maintaining tissue viability, this conguration creates essential uid circulation in each reservoir. A schematic diagram of Ussing chamber approaches is shown in Figure 13.2. Compounds of interest are added to either the mucosal or serosal

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V A Automatic Voltage Clamp Apparatus Agar Bridges

Calomel Electrode Ag/AgCl Electrode

3M KCl

Isolated Conjunctival Tiussue

Bathing Buffer BR/BRS, bubbling with 5%CO2 in air

Figure 13.2 A schematic diagram of excised conjunctival tissues (shown) or Transwell-grown, primary cultured rabbit conjunctival epithelial cell layers mounted in a modied Ussing-type chamber. Two calomel electrodes for measurements of transtissue voltages and two Ag/AgCl electrodes for passing electrical currents across the conjunctival epithelial barrier are shown. This represents a four-electrode setup where one set of voltage and current electrodes connect via agar (containing 13 M KCl) bridges to mucosal (or apical) uid and the other to serosal (or basolateral) uid (See also color insert).

side of the excised conjunctiva (mounted in the chamber) to estimate uxes in the absorptive or secretory directions, respectively. Viability of isolated conjunctival tissues mounted in the Ussing chambers can be monitored continuously throughout transport studies, enabling the measurement of subtle changes due to experimental agents (e.g., certain drugs under test) over those afforded by the vehicle alone in control tissues. Validation studies have demonstrated measurements of active transport properties of excised conjunctivas for at least 4 h. Concurrent studies of paracellular transport markers (e.g., D-mannitol) are usually carried out to ascertain the integrity of the excised conjunctiva under investigation. A separate study using morphological investigation of tissue ultrastructure for duration of experiments may provide some useful information. Monitoring tissue viability and integrity during the transport experiments is achieved by measuring transepithelial potential difference (PD) and resistance using the automatic voltage clamp unit. Other advantages of using Ussing chamber techniques for conjunctival tissue transport studies include the added feasibility of looking at largely unknown mechanisms underlying ocular drug metabolism, regional absorption differences (i.e., bulbar, fornicial, or palpebral conjunctiva segments), and relatively small amounts of drug needed to perform ux estimates, with analytically cleaner samples being collectible. While dissection of the tissue requires some practices that may be technically taxing at rst, the conjunctival Ussing chamber model of excised tissues and primary cultured conjunctival models (vide infra) are critical and rewarding tools for studies classifying compounds used in ophthalmic drug delivery. In this subsection, we provide a brief synopsis of Ussing chamber techniques.

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Conjunctival short-circuit current, termed Isc , describes the cumulative sum of all active, energy-driven, and electrogenic transport processes occurring across the conjunctiva. The Ussing chamber apparatus can impose an experimental condition called zero voltage clamp, where the electrical PD developed across the conjunctival tissue is forced to zero (i.e., offset to zero) by imposing an electrical PD of the same magnitude but opposite sign. The resultant current owing across the tissue is termed short-circuit current (Isc ), bringing down the spontaneously developed PD to zero (thus the name short-circuiting is used to describe the procedure). Under short-circuited conditions, there are no electrical gradient across the tissue and by using the same Ringers solution or culture medium on both sides of the barrier, the chemical gradients are also zero. Thus, asymmetric uxes of ions or solutes measured under such zero gradient conditions across the barrier have to be energized by the barrier itself (e.g., via utilization of cell energy in the form of ATP consumption; e.g., sodium pumps and/or vesicular transport dependent on cytoskeletal networkbased movements of cell organelles and so forth). Surgically excised pigmented rabbit conjunctival tissues display a tear side negative PD of 15.5 1.5 mV (mean S.E.M. of 7080 determinations) when mounted in a modied Ussing-type chamber [68, 41]. The voltage detection apparatus is composed of two matched calomel electrodes positioned very closely to the tissue surfaces. A pair of Ag/AgCl electrodes is used to send and receive electrical currents (that are generated by imposing an electrical PD of the same magnitude with opposite sign of the observed PD), which are positioned away from the tissue surfaces in order to ensure uniform current density across the tissue and short the bath-tissue-bath circuit (Figure 13.2). Overall tissue resistance (transepithelial electrical resistance, TEER) can then be estimated by taking the ratio between the observed PD and Isc , or TEER = PD/Isc (which describes the Ohms law). Conjunctival TEER ranges from 0.75 to 1.5 k cm2 [6, 7]. A variety of automatic voltage clamp devices with special modications have been extensively utilized in electrophysiological studies of Isc in several ocular tissues including the amphibian corneal epithelium [42] and human fetal retinal pigment epithelium [43, 44], as well as non-ocular tissues like the rat tracheal epithelium [45]. A strong temperature dependency and inhibitory effect of serosally instilled ouabain on the rabbit conjunctival Isc are characteristic of active ion transport driven by Na+ /K+ -ATPases in the conjunctiva [6, 7]. Utilizing healthy conjunctival tissues under various ex vivo congurations has allowed for mechanistic studies of potential drug transport routes. Moreover, it is just as feasible to surgically isolate conjunctivas from ocular disease models for transport studies under pathological conditions with some limitations. Ocular infection models have been established using competent human Ad and thoroughly characterized in pigmented and albino rabbits [38, 39]. As compared to excised conjunctival tissues in health or disease, in vitro cultivations of respective epithelial cells on permeable matrices under primary culture conditions allow further investigative control on many additional dimensions. Studies of the conjunctival epithelial barrier alone, i.e., excluding the participation of systemic and lymphatic routes, provide a unique opportunity for a greater throughput in simultaneous transport investigations that consume minimal animal resources with lowest data variability [26].

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H IT N W IO T UT EN OL TM S EA ase TR DN A

PIGMENTED MALE

CR SA

IFI

CE

HARVEST CELLS EXCISE EYEBALL FROM SOCKET & SEPARATE THE CONJUNCTIVA TREATMENT WITH A PROTEASE SOLUTION

LIQUID COVERED CONDITION

RESUSPEND CELLS IN GROWTH MEDIUM SEED ON TRANSWELLS

40 m CELL STRAINER WASH CELLS FILTRATION

AIR INTERFACE CONDITION

CULTURED CELLS ARE PLACED UNDER AIR-INTERFACE CONDITION FROM DAY 4

COATED FILTERS CULTURE MEDIUM

Figure 13.3 A owchart illustrating various steps for the preparation and maintenance of primary rabbit conjunctival epithelial cell layers, cultured under liquid-covered and air-interfaced conditions (See also color insert).

13.4.2. Primary Culture Models of Conjunctival Epithelial Cell Layers Cell cultures are a useful, high throughput means for evaluating drug transport mechanisms, impact of formulations, and physiological factors inuencing absorption across biological barriers (e.g., epithelia). Functional primary cultures of RCEC under conventional liquid-covered or advanced air-interfaced culture (AIC) conditions are available (Figure 13.3) [26, 46]. Conjunctival epithelial cell cultures exhibit morphological as well as functional similarities to the tissue in vitro or in vivo. Cultured cells form functional tight junctions and express various enzymes (e.g., esterases, phosphodiesterases, and GSH metabolizing enzymes) and transporters (for amino acids, dipeptides, and nucleosides), similarly to those found in tissues in vitro or in vivo. Primary isolates of conjunctival epithelial cells achieve differentiated phenotypes and form multilayer of cells, displaying epithelial characteristics with isles of mucinsecreting goblet cell populations. Culture time-dependent organization of tight junctions, development of cell polarity, and expression of various transport mechanisms have been reported [26, 46]. Test compounds are typically added to the apical side of the multilayer of cultured cells, while the cumulative appearance in the basolateral compartment is measured using appropriate measurement schemes (e.g., radioactivity assays or uorescence determinations depending on the tags on the drugs of interest). Evaluation of in vitro system integrity is performed through measuring electrical resistance across the multilayered cells cultured on permeable supports (e.g., TranswellTM systems) using specially engineered voltage-sensing and current-passing electrodes, attached to a portable voltohmeter (e.g., MilliCell device, Millipore Corp., Billerica, MA, or EVOM device, World Precision Instruments, Sarasota, FL).

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An alternative method for assessing cell layer integrity is through the use of hydrophilic paracellular transport markers (e.g., radiolabeled D-mannitol or uorescein-Na+ ), which passively traverse cells by the paracellular route. Small amounts of compound required for in vitro conjunctival cell culture transport experiments make this approach well suited for screening purposes. Relative absorption index of a series of pharmacologically active molecules can be ranked against known markers for the identication of candidates with potential absorption problems, which is a reliable tool to select drug candidates with optimal characteristics. 13.4.3. Conjunctival Disease Models Understanding differences in drug transport and metabolism in diseased conjunctival tissue is also important. A number of critical and physiological characteristics of conjunctival epithelial cells are altered in inammatory states. An Ad5 infection model of the conjunctiva has been developed for utility in studying modulations of transport mechanisms in health and disease [38]. This virus-inoculated model has been adapted for tissue studies in the Ussing chamber conguration, as well as for primary cultures of conjunctival epithelial cells. The Ad5 infection model is a pertinent and critical tool for understanding the ophthalmic drug delivery paradigm across the conjunctival tissue in (health and) disease. Detailed protocols for this and other related subjects described above are included as appendix to this chapter.

13.5. Summary and Conclusions

The conjunctival tissue covers 80% of the ocular surface in higher mammalian species and offers a unique route of delivering drugs locally to the eye. Paracellular, transcellular, active, and endocytic routes of drug absorption play a key role in topical ocular delivery via the conjunctiva. Transscleral/conjunctival iontophoresis offers an alternative noninvasive topical delivery strategy for charged drugs including macromolecular biologics. Lastly, the subconjunctival route of drug delivery provides critical space and capacity for minimally invasive, safe, and sustained exposure of therapeutics to intraocular compartments. The conjunctiva plays an important role in the etiology of a number of ocular surface disorders as potential drug targets and an absorption conduit. Multiple methods (see details in appendix) are available to study the preclinical biopharmaceutics of the conjunctiva, facilitating physiological traits of the conjunctiva, and improving the design of ocular drug delivery strategies to the eye in health and disease. Acknowledgments: Supported by grants HL38658 (KJK), HL64365 (KJK and VHLL), EY12356 (VHLL), and the Hastings Foundation. HJG thanks the AFPE, PhRMA, and USC Town and Gown. The authors appreciate contributions by scientists who have worked on conjunctival transport in collaboration or directly in our laboratories (in the alphabetical order of last names): Drs P. Ashton, S. K. Basu, E. Hayakawa, Y. Horibe, K. I. Hosoya, S. D. Kashi, U. B. Kompella, A.A. Kulkarni, M. A. Narawane, M. G. Qaddoumi, J. R. Robinson, P. Saha, M. H. Shiue, R. E. Stratford Jr., L. Sun, H. Ueda, W. Wang, and J. J. Yang.

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