Inhaled fosamprenavir for laryngopharyngeal reflux: Toxicology and fluid dynamics modeling

  • Laryngoscope Investig Otolaryngol. 2024 Jan 24;9(1):e1219. doi: 10.1002/lio2.1219.
Alexandra Lesnick  1 ,  Tina L Samuels  1 ,  Donna Seabloom  2 ,  Beverly Wuertz  2 ,  Abhilash Ojha  3 ,  Davis Seelig  4 ,  Frank Ondrey  2 ,  Timothy S Wiedmann  5 ,  Chris Hogan  3 ,  Emma Torii  4 ,  Hui Ouyang  6 ,  Ke Yan  7 ,  Guilherme J M Garcia  1  8 ,  Jonathan M Bock  1 ,  Nikki Johnston  1  9
Affiliations
  • 1. Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USA.
  • 2. Otolaryngology Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA.
  • 3. Mechanical Engineering University of Minnesota Minneapolis Minnesota USA.
  • 4. Comparative Pathology Shared Resource Masonic Cancer Center, University of Minnesota Minneapolis Minnesota USA.
  • 5. Pharmaceutics University of Minnesota Minneapolis Minnesota USA.
  • 6. Mechanical Engineering University of Texas-Dallas Dallas Texas USA.
  • 7. Pediatrics Quantitative Health Sciences Medical College of Wisconsin Milwaukee Wisconsin USA.
  • 8. Biomedical Engineering Medical College of Wisconsin Milwaukee Wisconsin USA.
  • 9. Microbiology and Immunology Medical College of Wisconsin Milwaukee Wisconsin USA.
PMID: 38362183 DOI: 10.1002/lio2.1219
Abstract

Objectives: Approximately 25% of Americans suffer from laryngopharyngeal reflux (LPR), a disease for which no effective medical therapy exists. Pepsin is a predominant source of damage during LPR and a key therapeutic target. Fosamprenavir (FOS) inhibits pepsin and prevents damage in an LPR mouse model. Inhaled FOS protects at a lower dose than oral; however, the safety of inhaled FOS is unknown and there are no inhalers for laryngopharyngeal delivery. A pre-Good Lab Practice (GLP) study of inhaled FOS was performed to assess safety and computational fluid dynamics (CFD) modeling used to predict the optimal particle size for a laryngopharyngeal dry powder inhaler (DPI).

Methods: Aerosolized FOS, amprenavir (APR), or air (control) were provided 5 days/week for 4 weeks (n = 6) in an LPR mouse model. Organs (nasal cavity, larynx, esophagus, trachea, lung, liver, heart, and kidney) were assessed by a pathologist and bronchoalveolar lavage cytokines and plasma cardiotoxicity markers were assessed by Luminex assay. CFD simulations were conducted in a model of a healthy 49-year-old female.

Results: No significant increase was observed in histologic lesions, cytokines, or cardiotoxicity markers in FOS or APR groups relative to the control. CFD predicted that laryngopharyngeal deposition was maximized with aerodynamic diameters of 8.1-11.5 μm for inhalation rates of 30-60 L/min.

Conclusions: A 4-week pre-GLP study supports the safety of inhaled FOS. A formal GLP assessment is underway to support a phase I clinical trial of an FOS DPI for LPR.

Level of evidence: NA.

Keywords
computational fluid dynamics; dry powder inhaler; laryngopharyngeal delivery; laryngopharyngeal reflux; pepsin.
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