Amikacin liposome inhalation suspension (ALIS)

An Investigational Treatment for Serious Chronic Lung Infections

Amikacin liposome inhalation suspension (ALIS) is an investigational drug comprising the antibiotic amikacin in Insmed’s proprietary liposomal technology formulation.

An Investigational Treatment for Serious Chronic Lung Infections
The active ingredient, amikacin, is an antibiotic used to treat a broad range of gram-negative infections. Amikacin is in the aminoglycoside class of antibiotics and is currently delivered intravenously or intramuscularly.11

What Are Liposomes?

Liposomes are microscopic membrane shells that contain water. In a liposome drug delivery system, water-soluble drugs, like amikacin, are located in the liposome’s water core. The goal of a liposome delivery system, which is currently investigational, is to deliver medicine directly to the site of the lung infection.

Proprietary Liposomal Technology
Insmed’s proprietary liposomal technology is designed specifically for delivery of pharmaceuticals to the lung.
Proprietary Liposomal Technology
In preclinical studies, ALIS liposomes are readily taken up by alveolar macrophages whose normal function is to “swallow” inhaled particles, delivering amikacin within the infected cells.2,3

The Role of the Liposome
In NTM lung infections, the infecting bacteria invade and multiply chiefly within macrophages.4 Based on in vitro studies, materials found in a patient’s mucus and biofilms that are produced by bacteria to protect themselves have negative charges.5-7 Because opposite charges attract each other, positively charged antibiotics like amikacin, bind to the negatively charged compounds.8-10 This prevents effective penetration of positively charged antibiotic drugs into the spaces in which the bacteria are located.9-11
References

1Amikacin 250 mg/ml Injection [summary of product characteristics], Hospira UK Ltd, Maidenhead, UK; 2015.

2 Malinin V, Neville ME, Eagle G, Perkins W, Gupta R. Lung distribution and clearance of low- or high-dose dual-labeled liposomal amikacin for inhalation in rats dosed once daily for 28 days. Poster presented at: North American Cystic Fibrosis Conference; October 9- 11, 2014; Atlanta, Georgia.

3Rose SJ, Neville ME, Gupta R, Bermudez LE (2014) Delivery of aerosolized liposomal amikacin as a novel approach for the treatment of nontuberculous mycobacteria in an experimental model of pulmonary infection. PLoS ONE. 2014;9(9): e108703. doi:10.1371/journal.pone.0108703.

4Crowle AJ, Tsang AY, Vatter AE, May MH. Comparison of 15 laboratory and patient- derived strains of Mycobacterium avium for ability to infect and multiply in cultured human macrophages. J Clin Microbiol. 1986;24(5):812-821.

5Groneberg DA, Eynott PR, Oates T, et al. Expression of MUC5AC and MUC5B mucins in normal and cystic fibrosis lung. Respir Med. 2002;96(2):81-86.

6Bansil R, Turner BS. Mucin structure, aggregation, physiological functions and biomedical applications. Curr Opin Colloid Interface Sci. 2006;11(2-3):164-170.

7Boyd A, Chakrabarty AM. Pseudomonas aeruginosa biofilms: role of the alginate exopolysaccharide. J Indust Microbiol. 1995;15:162-8

8Bennett JE, Dolin R, Blaser MJ. Aminoglycosides. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Saunders; 2015: 310-321.

9Nichols WW, Dorrington SM, Slack MPE, Walmsley HL. Inhibition of tobramycin diffusion by binding to alginate. Antimicrob Agents Chemother. 1988;32(4):518-523.

10Hunt BE, Weber A, Berger A, Ramsey B, Smith AL. Macromolecular mechanisms of sputum inhibition of tobramycin activity. Antimicrob Agents Chemother. 1995;39(1):34- 39.

11Gordon CA, Hodges NA, Marriott C. Antibiotic interaction and diffusion through alginate and exopolysaccharide of cystic fibrosis-derived Pseudomonas aeruginosa. J Antimicrob Chemother. 1988;22:667-674.