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Updated: Jun 25, 2026
Delivery of Antibodies into the Murine Brain via Convection-enhanced Delivery
Published on: July 18, 2019
Convection-enhanced delivery: neurosurgical issues
1Department of Neurosurgery, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA. hallw@upstate.edu
Abstract:
Because primary brain tumors treated with surgery, radiation therapy, and chemotherapy have a poor prognosis, this has led investigators to develop new innovative therapies such as targeted toxins. These large molecules do not cross the blood brain barrier and must be delivered into the brain by a technique known as convection-enhanced delivery (CED). When administering these agents, there are a number of pharmacokinetic considerations that must be considered that will directly affect the volume of distribution of the drug being administered and ultimately the therapeutic effect of the agent. A number of different catheter types have been used to perform CED with a hollow fiber design offering several advantages over other variations. Specific parameters have been developed to optimize the placement of the drug delivery catheters in order to enhance drug distribution in the brain. Considerable effort has been expended to identify a reliable way to image the distribution of targeted toxins administered by CED using a combination of magnetic resonance imaging and single photon emission computed tomography. Unfortunately many infusions performed in tumor patients are unsuccessful due to ventricular/subarachnoid leak or pooling of the drug in necrotic tumor tissue. To date, no targeted toxin clinical trial has demonstrated statistically significant clinical results leading to the universal acceptance of this treatment. Other agents such as standard chemotherapy or liposomal preparations have been delivered by CED. Non-neoplastic neurological diseases are being considered for treatment by CED and treating different locations of the brain other that the cerebral hemispheres are under investigation.
Insights
Targeted toxins delivered via convection-enhanced delivery (CED) show promise for brain tumors but face challenges. Optimizing drug distribution and imaging are key to improving therapeutic outcomes for brain tumor patients.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pharmacology
Background:
- Primary brain tumors have a poor prognosis despite standard treatments like surgery, radiation, and chemotherapy.
- Targeted toxins are an innovative therapy, but their large molecular size necessitates specialized delivery methods like convection-enhanced delivery (CED) due to the blood-brain barrier.
- Convection-enhanced delivery (CED) requires careful pharmacokinetic consideration to optimize drug distribution and therapeutic efficacy.
Purpose of the Study:
- To review the advancements and challenges in using convection-enhanced delivery (CED) for targeted toxin administration in brain tumors.
- To discuss pharmacokinetic considerations, catheter designs, and imaging techniques relevant to CED.
- To highlight the limitations and future directions for CED in treating brain tumors and other neurological diseases.
Main Methods:
- Review of literature on convection-enhanced delivery (CED) techniques for targeted toxin administration.
- Discussion of catheter design, including hollow fiber advantages.
- Exploration of imaging modalities like MRI and SPECT for tracking drug distribution.
Main Results:
- Hollow fiber catheters offer advantages for CED.
- Optimization of catheter placement parameters enhances drug distribution.
- Imaging techniques are being developed to visualize drug distribution, but challenges remain.
- Infusion failures due to leaks or pooling in necrotic tissue are common.
- No targeted toxin clinical trial has yet shown statistically significant results for universal acceptance.
Conclusions:
- Convection-enhanced delivery (CED) is a promising method for delivering targeted toxins across the blood-brain barrier for brain tumors.
- Further optimization of delivery parameters, catheter technology, and imaging is needed to overcome current limitations.
- CED is also being explored for non-neoplastic neurological diseases and other brain regions beyond the cerebral hemispheres.
