title: Features of complement activation-related pseudoallergy to liposomes with different surface charge and PEGylation: comparison of the porcine and rat responses.
abstract: Pigs are known to provide a sensitive model for studying complement (C) activation-related pseudoallergy (CARPA), a hypersensitivity reaction to liposomal and many other nanomedicines that limits their clinical use. The utility of rats as a CARPA model has, however, not been analyzed to date in detail. The present study compared the two models by inducing CARPA with i.v. bolus injections of two reactogenic liposomes that differed from each other in surface properties: one was AmBisome, a strong anionic, free-surface small unilamellar liposome (SUV), while the other was neutral, polyethylene glycol (PEG)-grafted SUV wherein the 2 kDa-PEG was anchored to the membrane via cholesterol (Chol-PEG). Both in pigs and rats AmBisome caused significant consumption of C3, indicating C activation, along with paralleling massive changes in blood pressure, white blood cell, platelet counts and in plasma thromboxane B2 levels, indicating CARPA. These processes were similar in the two species in terms of kinetics, but significantly differed in the doses that caused major hemodynamic changes (~0.01 and ~22 mg phospholipid (PL)/kg in pigs and rats, respectively). Pigs responded to AmBisome with pulmonary hypertension and systemic hypotension, and the reaction was not tachyphylactic. The major response of rats was systemic hypotension, leukopenia followed by leukocytosis, and thrombocytopenia. Chol-PEG liposomes caused severe reaction in pigs at 0.1 mg/kg, while the reaction they caused in rats was mild even at 300 mg PL/kg. Importantly, the reaction to Chol-PEG in pigs was partly tachyphylactic. These observations highlight fundamental differences in the immune mechanisms of porcine and rat CARPA, and also show a major impact of liposome surface characteristics, determining the presence or absence of tachyphylaxis. The data suggest that rats are 2-3 orders of magnitude less sensitive to liposomal CARPA than pigs; however, the causes of these differences, the PEG-dependent tachyphylaxis and the massive reactivity of Chol-PEG liposomes remain unclear.
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Dézsi
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Fülöp
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Mészáros
authors.affiliation: Department of Pathophysiology, Semmelweis University Budapest, Hungary; MTA-SE Pediatrics and Nephrology Research Group, Budapest, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Szénási
authors.affiliation: SeroScience Ltd., Budapest, Hungary.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Urbanics
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.
authors.forename: Csenge
authors.initials: C
authors.lastname: Vázsonyi
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary.
authors.forename: Erik
authors.initials: E
authors.lastname: Őrfi
authors.affiliation: Department of Pathophysiology, Semmelweis University Budapest, Hungary; MTA-SE Pediatrics and Nephrology Research Group, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Rosivall
authors.affiliation: Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Réka
authors.initials: R
authors.lastname: Nemes
authors.affiliation: Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Robbert Jan
authors.initials: RJ
authors.lastname: Kok
authors.affiliation: Department of Targeted Therapeutics, MIRA Institute, University of Twente, Enschede, The Netherlands.
authors.forename: Josbert M
authors.initials: JM
authors.lastname: Metselaar
authors.affiliation: Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Department of Targeted Therapeutics, MIRA Institute, University of Twente, Enschede, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Storm
authors.affiliation: Nanomedicine Research and Education Center, Semmelweis University, Budapest, Hungary; Department of Pathophysiology, Semmelweis University Budapest, Hungary; SeroScience Ltd., Budapest, Hungary; Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Budapest, Hungary. Electronic address: Jszebeni2@gmail.com.
authors.forename: János
authors.initials: J
authors.lastname: Szebeni
mesh_terms: D000818:Animals; D003167:Complement Activation / Q000187:drug effects*; D004342:Drug Hypersensitivity / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000139:chemically induced / Q000276:immunology / Q000503:physiopathology; D007958:Leukocyte Count; D008055:Lipids / Q000737:chemistry; D008081:Liposomes / Q000009:adverse effects* / Q000737:chemistry / Q000494:pharmacology; D008297:Male; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000737:chemistry; D017208:Rats, Wistar; D013045:Species Specificity; D013499:Surface Properties; D013552:Swine; D013929:Thromboxane B2 / Q000097:blood
chemical_list: D008055:Lipids; D008081:Liposomes; D011092:Polyethylene Glycols; D013929:Thromboxane B2
keywords: Adverse drug effects; Anaphylatoxins; Anaphylaxis; CARPA; Nanomedicines; Pseudoallergy