Recent advances in targeted drug delivery for treatment of osteoarthritis

Curr Opin Rheumatol. 2021 Jan;33(1):94-109. doi: 10.1097/BOR.0000000000000761.

Abstract

Purpose of review: Osteoarthritis is associated with severe joint pain, inflammation, and cartilage degeneration. Drugs injected directly into intra-articular joint space clear out rapidly providing only short-term benefit. Their transport into cartilage to reach cellular targets is hindered by the tissue's dense, negatively charged extracellular matrix. This has limited, despite strong preclinical data, the clinical translation of osteoarthritis drugs. Recent work has focused on developing intra-joint and intra-cartilage targeting drug delivery systems (DDS) to enable long-term therapeutic response, which is presented here.

Recent findings: Synovial joint targeting hybrid systems utilizing combinations of hydrogels, liposomes, and particle-based carriers are in consideration for pain-inflammation relief. Cartilage penetrating DDS target intra-cartilage constituents like aggrecans, collagen II, and chondrocytes such that drugs can reach their cellular and intra-cellular targets, which can enable clinical translation of disease-modifying osteoarthritis drugs including gene therapy.

Summary: Recent years have witnessed significant increase in both fundamental and clinical studies evaluating DDS for osteoarthritis. Steroid encapsulating polymeric microparticles for longer lasting pain relief were recently approved for clinical use. Electrically charged biomaterials for intra-cartilage targeting have shown promising disease-modifying response in preclinical models. Clinical trials evaluating safety of viral vectors are ongoing whose success can pave the way for gene therapy as osteoarthritis treatment.

Trial registration: ClinicalTrials.gov NCT02790723 NCT04119687 NCT03203330.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Aggrecans / administration & dosage
  • Animals
  • Cartilage, Articular / metabolism
  • Chondrocytes / metabolism
  • Drug Delivery Systems / methods*
  • Extracellular Matrix / metabolism
  • Genetic Therapy / methods
  • Humans
  • Inflammation / drug therapy
  • Injections, Intra-Articular / methods
  • Nanoparticles / administration & dosage
  • Osteoarthritis / drug therapy*
  • Pain / drug therapy
  • Steroids / administration & dosage
  • Synovial Membrane / metabolism

Substances

  • Aggrecans
  • Steroids

Associated data

  • ClinicalTrials.gov/NCT02790723
  • ClinicalTrials.gov/NCT04119687
  • ClinicalTrials.gov/NCT03203330