Oral delivery of systemic monoclonal antibodies, peptides and small molecules using gastric auto-injectors

• Published in: Nature biotechnology 2022-01, Vol.40 (1), p.103-109
• Main Authors: Abramson, Alex, Frederiksen, Morten Revsgaard, Vegge, Andreas, Jensen, Brian, Poulsen, Mette, Mouridsen, Brian, Jespersen, Mikkel Oliver, Kirk, Rikke Kaae, Windum, Jesper, Hubálek, František, Water, Jorrit J., Fels, Johannes, Gunnarsson, Stefán B., Bohr, Adam, Straarup, Ellen Marie, Ley, Mikkel Wennemoes Hvitfeld, Lu, Xiaoya, Wainer, Jacob, Collins, Joy, Tamang, Siddartha, Ishida, Keiko, Hayward, Alison, Herskind, Peter, Buckley, Stephen T., Roxhed, Niclas, Langer, Robert, Rahbek, Ulrik, Traverso, Giovanni
• Format: Article
• Language: English
• Subjects: 631/61; 631/61/2297; 631/61/2298; 631/61/51; 639/166; Administration, Oral; Agriculture; Animal models; Animals; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Bioavailability; Bioinformatics; Biological Availability; Biomedical and Life Sciences; Biomedical Engineering/Biotechnology; Biomedicine; Biotechnology; Capsules; Dosage; Drug delivery; Drug dosages; Epinephrine; Gastrointestinal system; Gastrointestinal tract; Immunotherapy; Injectors; Insulin; Life Sciences; Monoclonal antibodies; Oral administration; Peptides; Pharmacokinetics; Pharmacology; Swine
• ISSN: 1087-0156; 1546-1696; 1546-1696
• DOI: 10.1038/s41587-021-01024-0

Oral administration provides a simple and non-invasive approach for drug delivery. However, due to poor absorption and swift enzymatic degradation in the gastrointestinal tract, a wide range of molecules must be parenterally injected to attain required doses and pharmacokinetics. Here we present an orally dosed liquid auto-injector capable of delivering up to 4-mg doses of a bioavailable drug with the rapid pharmacokinetics of an injection, reaching an absolute bioavailability of up to 80% and a maximum plasma drug concentration within 30 min after dosing. This approach improves dosing efficiencies and pharmacokinetics an order of magnitude over our previously designed injector capsules and up to two orders of magnitude over clinically available and preclinical chemical permeation enhancement technologies. We administered the capsules to swine for delivery of clinically relevant doses of four commonly injected medications, including adalimumab, a GLP-1 analog, recombinant human insulin and epinephrine. These multi-day dosing experiments and oral administration in awake animal models support the translational potential of the system. Biologics are delivered by a pill that pricks the stomach wall.