One way to increase the effectiveness of a hydrogel is to incorporate condition-specific drugs or molecules which can function to sustain encapsulated cells or provide support for the tissue surrounding an implanted hydrogel. These can include growth factors and differentiating factors to specify the fate of encapsulated stem cells, or anti-inflammatory agents to suppress the immune system of the host. One well known example of drug delivery via polymers to the CNS is the release of the chemotherapeutic agent, carmustine (BCNU), from implantable polymer wafers to combat brain tumors (Gliadel
™ system) (
Brem and Gabikian, 2001;
Panigrahi et al., 2011). Major advantages of encapsulating carmustine include stabilizing the drug, which normally has a short half-life, and providing precise control over the localization of drug release, limiting collateral damage to healthy brain tissue and reducing side-effects (
Brem, 1990;
Brem and Gabikian, 2001;
Panigrahi et al., 2011). A number of studies have demonstrated the growth and differentiation of neural cells by incorporating neurotrophic factors into polymers and hydrogels. For example, ciliary neurotrophic factor (CNTF) has been incorporated to promote neural cell proliferation, differentiation, and neurite outgrowth (
Burdick et al., 2006;
Tzeng and Lavik, 2010). Similar results have been seen with neurotrophin-3 (NT3), platelet-derived growth factor (PDGF), glial-derived neurotrophic factor (GDNF), and nerve growth factor (NGF) (
Johnson et al., 2010;
Wood et al., 2010).
Lee, et al. (2010) used a 3D lithographic printing technique to incorporate layers of hydrogel containing neural stem cells on top of hydrogel layers containing vascular endothelial growth factor (VEGF) to demonstrate neural stem cell migration towards the growth factor. Additionally, monomers and peptides, such as a reactive oxygen species-binding polymerizable superoxide dismutase (SOD) mimetic metalloporphyrin macromer (MnTPPyP-Acryl; ref. (
Cheung et al., 2008)) or a peptide antagonist to tumor necrosis factor-α (TNFα), can be added to the surface of the hydrogel to impede the host inflammatory system from targeting encapsulated cells (
Cheung et al., 2008;
Lin et al., 2009).
Though there are still many variables to consider, drug delivery mediated by hydrogel is perhaps the most common hydrogel application. Additionally, some of the first clinical uses of hydrogels were as drug delivery-tools. As suggested, the incorporation of growth factors and trophic molecules into a hydrogel system allows researchers targeted site application along with temporal control over release. Gelatin-based hydrogels were used to deliver dopamine to the striatal region of Parkinsonian rats (
Senthilkuma et al., 2007), while the immense variation afforded with synthetic PEG hydrogels have allowed the tailored release of neurotrophic factors over a matter of weeks to months (
Burdick et al., 2006). Many proteins and molecules that are difficult to deliver due to stability or kinetics, or compounds that are toxic systemically, have been the focus of research into hydrogel-based drug delivery.
Release of therapeutics from a hydrogel is dependent not only on hydrogel-defined factors, such as degradation and mesh size, but it is also dependent on the therapeutic molecule itself. How the therapeutic molecule is incorporated, for example tethering or encapsulation in the hydrogel or within microparticles, and the actual size of the molecule can define the release profile of the molecule from a hydrogel.
The size and chemical identity of incorporated molecules can affect the release kinetics from the hydrogel. Specifically, a small mesh size hydrogel may prevent larger molecules from readily diffusing from the hydrogel and thus, may require the hydrogel to degrade before they are released. For instance, small molecules, such as the drug diltiazem (used to block calcium channels) at ~5Å in diameter, could readily diffuse out of most hydrogels (
Peppas et al., 1999). In contrast, glial-derived neurotrophic factor (GDNF), a rectangular molecule of about 30 × 36 × 80Å (~23kDa), must be incorporated into a hydrogel with a mesh size of 80Å or larger in order for it to easily escape the hydrogel by diffusion (
Eigenbrot and Gerber, 1997). Larger molecules and cells often require degradation of the hydrogel before they can progress into the environment (the average neuron soma ranges from 4–100μm, or 40,000–1,000,000Å, in diameter (
Chudler, 2011)). Because diffusion can occur more quickly than degradation, molecules incorporated into the hydrogel that are smaller can reach their target more quickly than larger molecules that must wait for the hydrogel to dissolve, resulting in two or more different release rates. These differing release kinetics can be ideal for a hydrogel designed with both encapsulated trophic factors or immunosuppressors and cells, where the diffusible factors can go to work immediately to provide a host environment that is well-suited for, or more closely matched to, the encapsulated cells, which are released later as the hydrogel degrades. Lastly, the polarity of molecules can also affect how they disperse from a hydrogel.
Jeong, et al. (2000a), demonstrated that hydrophilic drugs, such as ketoprofen, are released more readily from a hydrogel, where the release rate is determined by diffusion; compared to hydrophobic drugs, such as spironolactone, where release requires hydrogel degradation.
Tethering of molecules to the polymer itself can also greatly impact the release and distribution of molecules from a hydrogel (
DuBose et al., 2005). In the case of tethered molecules, release kinetics are dependent on the degradation (hydrolysis or enzymatic cleavage) of the bonds between the therapeutic molecule and hydrogel backbone. Tethering can be accomplished much in the same way that the hydrogel is formed – by introducing the molecule during the polymerization process, the same bonds that connect hydrogel monomers can connect drugs and other proteins (i.e. ester bonds between thiol and ether groups) (
DuBose et al., 2005). Certain molecules can also be used to tether drugs to the hydrogel, such as heparin, which binds PEG backbones and has been shown to have a reversible affinity with a number of growth factors (
Lin and Anseth, 2009). Tethering can also be achieved through enzyme-sensitive oligopeptide tethers, such as matrix metalloproteinase-sensitive tethers bound to vascular endothelial growth factor (VEGF), which when released induces angiogenesis (
Zisch et al., 2003). However, it is important to consider that tethered molecules must withstand the polymerization procedures and the tethers themselves should be biocompatible, as the activity of the molecule could be decreased if the bonding or tethering molecules block active sites or remain attached to the drug post-release (
Lin and Anseth, 2009).
Incorporating drugs first into a smaller polymer structures, or microparticles, which are then incorporated into a larger hydrogel structure, is another way to control drug release (
Anderson and Shive, 1997;
Elisseeff et al., 2001;
Burdick et al., 2006;
Hou et al., 2008;
Guo et al., 2010;
Spiller et al., 2010;
Lampe et al., 2011). Microparticles can be used to carry trophic factors and a variety of small molecule drugs, proteins, and peptides, such as siRNAs. Interesting examples of the use of microparticles include encapsulating antigens for the development of systemic immunity (
Eldridge et al., 1991;
Ermak et al., 1995;
Thomasin et al., 1996). In the central nervous system, microparticles have been used to deliver dopamine and norepinephrine into the striatum of rats to suppress the symptoms of Parkinson’s disease (
McRae et al., 1992). Microparticles (or microspheres) are often made of polymer materials and are subject to variation in polymerization and degradation chemistry and kinetics, particle size, and loading density. Like hydrogels and other degradable polymers, polymer microparticles can be designed with varying rates of degradation. This can be advantageous for applications in which molecule release from a microparticle is designed to occur at a different time point than hydrogel degradation. Such design might be warranted if a hydrogel were being used to implant cells but there was need for extended release of supporting factors – the hydrogel would be degraded, allowing the cells to incorporate into the surrounding tissue while still receiving trophic support from factors incorporated into microparticles.
Microparticles can also be used when more than one therapeutic agent is needed and each needs to be released in its own time and location. In a recent study, hydrogel strands carrying two formulations of poly(lactic-
co-glycolic acid) (PLGA)-based microparticles were implanted into the rat brain (
Lampe et al., 2011). One group of PLGA-based microparticles were loaded with brain-derived neurotrophic factor (BDNF) and designed to degrade slowly. The other formulation of PLGA-microparticles was loaded with glial cell-derived neurotrophic factor (GDNF) and designed to degrade more quickly. The fast releasing microparticles released all the GDNF within a 28 day window, whereas the slow releasing microparticles released BDNF consistently for at least 2 months. The study demonstrated that the rate of protein release can be controlled by altering the rate of degradation of the microparticles, without changing the properties of the overall hydrogel strand (
Lampe et al., 2011). This could be beneficial in treating Parkinson’s disease where BDNF release from slower degrading microparticles into the striatum could encourage neurite outgrowth (
Østergaard et al., 1996;
Yurek et al., 1996), while GDNF release from faster degrading microparticles into the substantia nigra from the same hydrogel strand could provide immediate cell support for grafted neurons (
Lin et al., 1993;
Ai et al., 2003).