Overcoming the challenges of topical antibody administration for improving healing outcomes: a review of recent laboratory and clinical approaches.

Therapeutic antibodies present numerous opportunities for the treatment of wounds and cutaneous conditions; however, they have not been widely adopted due to the difficulty of administering antibodies through the skin. Local antibody administration to the skin may result in fewer side effects, reduce cost of therapy and be less invasive than systemic methods and recent advances in antibody engineering have addressed many stability and formulation challenges. Penetration of the epidermal barrier is crucial to effective delivery of antibodies and other protein drugs and can be achieved through chemical or physical methods. Chemical penetration enhancement is poorly suited for delivery of large hydrophilic molecules such as antibodies; however, enhancers based on surfactants or terpenes may improve antibody delivery to the dermis and novel cell-penetrating peptides provide opportunities for well-tolerated local antibody delivery. Physical penetration enhancement methods (including electroporation, iontophoresis, microneedles and ultrasound) address many formulation challenges common to chemical penetration enhancers; however, more studies are required to demonstrate effective antibody delivery for clinical translation. While topical antibody administration to the skin remains challenging, advances in antibody engineering and skin penetration enhancement may render antibodies more viable treatment options for improving wound outcomes.