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Sammar Fathy Elhabal,1 Nashwa Abdelaal,2 Saeed AS Al-Zuhairy,3 Mohamed Fathi Mohamed Elrefai,4,5 Mohamed Mansour Khalifa,6 Mohammad Ahmad Khasawneh,7 Ahmed Mohsen Elsaid Hamdan,8 Passant M Mohie,9 Rania A Gad,10 Soad L Kabil,11 Mohamed Kandeel El-Ashery,12,13 Bhaskara R Jasti,14 Nahla A Elzohairy,15,16 Nehal Elfar,17 Tayseer Elnawawy,18 Fatma E Hassan,19,20 Mohamed Ahmed El-Nabarawi21 1Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, Egypt; 2Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA; 3Department of Pharmacy, Kut University College, Kut, Wasit, Iraq; 4Department of Anatomy, Histology, Physiology, and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, Jordan; 5Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 6Department of Human Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt; 7Department of Chemistry, College of Science, U.A.E. University, Al-Ain, United Arab Emirates; 8Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 9Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 10Department of Pharmacology and Toxicology, Faculty of Pharmacy, Nahda University, Beni-Suef, Egypt; 11Department of Clinical Pharmacology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 12Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 13Medicinal Chemistry Department, Faculty of Pharmacy, King Salman International University, Ras-Sedr, South Sinai, Egypt; 14Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy & Health Sciences, University of the Pacific, Stockton, CA, USA; 15Air Force Specialized Hospital, Cairo, Egypt; 16Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, Egypt; 17Department of Pharmaceutical Technology, Faculty of Pharmacy, Horus University, New Demiette, Egypt; 18Department of Pharmaceutics, Egyptian Drug Authority, Cairo, Egypt; 19Medical Physiology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Giza, Egypt; 20General Medicine Practice Program, Department of Physiology, Batterjee Medical College, Jeddah, Saudi Arabia; 21Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, EgyptCorrespondence: Mohammad Ahmad Khasawneh, Email mohammad.khasawneh@uaeu.ac.aePurpose: Improving the treatment of psoriasis is a serious challenge today. Psoriasis is an immune-mediated skin condition affecting 125 million people worldwide. It is commonly treated with cyclosporine-A (CsA) and dithranol (DTH). CsA suppresses the activation of T-cells, immune cells involved in forming psoriatic lesions. Meanwhile, DTH is a potent anti-inflammatory and anti-proliferative drug that effectively reduces the severity of psoriasis symptoms such as redness, scaling, and skin thickness. CsA and DTH belong to BCS class II with limited oral bioavailability. We aim to develop a drug delivery system for topical co-delivery of CsA and DTH, exploring its therapeutic potential.Methods: Firstly, we developed a niosomal drug delivery system based on ceramide IIIB to form Cerosomes. Cerosomes were prepared from a mixture of Ceramide, hyaluronic acid, and edge activator using a thin-film hydration technique. To co-deliver CsA and DTH topically for the treatment of psoriasis. These two hydrophobic drugs encapsulated into our synthesized positively charged particle cerosomes.Results: Cerosomes had an average particle size of (222.36 nm± 0.36), polydispersity index of (0.415± 0.04), Entrapment Efficiency of (96.91%± 0.56), and zeta potential of (29.36± 0.38mV) for selected formula. In vitro, In silico, in vivo, permeation, and histopathology experiments have shown that cerosomes enhanced the skin penetration of both hydrophobic drugs by 66.7% compared to the CsA/DTH solution. Imiquimod (IMQ) induced psoriatic mice model was topically treated with our CsA/DTH cerosomes. We found that our formulation enhances the skin penetration of both drugs and reduces psoriasis area and severity index (PASI score) by 2.73 times and 42.85%, respectively, compared to the CsA/DTH solution. Moreover, it reduces the levels of proinflammatory cytokines, TNF-α, IL-10, and IL-6 compared to CsA/DTH solution administration.Conclusion: The Cerosomes nano-vesicle-containing CsA/DTH represents a more promising topical treatment for psoriasis, giving new hope to individuals with psoriasis, compared to commercial and other conventional alternatives. Keywords: biopharmaceutics classification system class II, BCS II, niosomes based on ceramide IIIB, cerosomes, psoriasis, psoriasis area and severity index, PASI score, imiquimod, IMQ, proinflammatory cytokines, niosomes |
