Systems approach to vaginal delivery of drugs II: In situ vaginal absorption of unbranched aliphatic alcohols

3D printing in vaginal drug delivery: a revolution in pharmaceutical manufacturing

INTRODUCTION

The Food and Drug Administration's approval of the first three-dimensional (3D) printed tablet, Spritam®, led to a burgeoning interest in using 3D printing to fabricate numerous drug delivery systems for different routes of administration. The high degree of manufacturing flexibility achieved through 3D printing facilitates the preparation of dosage forms with many actives with complex and tailored release profiles that can address individual patient needs.

AREAS COVERED

This comprehensive review provides an in-depth look into the several 3D printing technologies currently utilized in pharmaceutical research. Additionally, the review delves into vaginal anatomy and physiology, 3D-printed drug delivery systems for vaginal applications, the latest research studies, and the challenges of 3D printing technology and future possibilities.

EXPERT OPINION

3D printing technology can produce drug-delivery devices or implants optimized for vaginal applications, including vaginal rings, intra-vaginal inserts, or biodegradable microdevices loaded with drugs, all custom-tailored to deliver specific medications with controlled release profiles. However, though the potential of 3D printing in vaginal drug delivery is promising, there are still challenges and regulatory hurdles to overcome before these technologies can be widely adopted and approved for clinical use. Extensive research and testing are necessary to ensure safety, effectiveness, and biocompatibility.

Advances and future perspectives in epithelial drug delivery

Epithelial surfaces protect exposed tissues in the body against intrusion of foreign materials, including xenobiotics, pollen and microbiota. The relative permeability of the various epithelia reflects their extent of exposure to the external environment and is in the ranking: intestinal≈ nasal ≥ bronchial ≥ tracheal > vaginal ≥ rectal > blood-perilymph barrier (otic), corneal > buccal > skin. Each epithelium also varies in their morphology, biochemistry, physiology, immunology and external fluid in line with their function. Each epithelium is also used as drug delivery sites to treat local conditions and, in some cases, for systemic delivery. The associated delivery systems have had to evolve to enable the delivery of larger drugs and biologicals, such as peptides, proteins, antibodies and biologicals and now include a range of physical, chemical, electrical, light, sound and other enhancement technologies. In addition, the quality-by-design approach to product regulation and the growth of generic products have also fostered advancement in epithelial drug delivery systems.

Studies and methodologies on vaginal drug permeation

The vagina stands as an important alternative to the oral route for those systemic drugs that are poorly absorbed orally or are rapidly metabolized by the liver. Drug permeation through the vaginal tissue can be estimated by using in vitro, ex vivo and in vivo models. The latter ones, although more realistic, assume ethical and biological limitations due to animal handling. Therefore, in vitro and ex vivo models have been developed to predict drug absorption through the vagina while allowing for simultaneous toxicity and pathogenesis studies. This review focuses on available methodologies to study vaginal drug permeation discussing their advantages and drawbacks. The technical complexity, costs and the ethical issues of an available model, along with its accuracy and reproducibility will determine if it is valid and applicable. Therefore every model shall be evaluated, validated and standardized in order to allow for extrapolations and results presumption, and so improving vaginal drug research and stressing its benefits.

The vagina as a route for drug delivery: a review

Overactive bladder (OAB) syndrome has a significant deleterious impact on quality of life. After conservative therapy and bladder retaining, antimuscarinic drugs remain the mainstay of OAB management. Oral therapy is associated with frequent side effects, leading to the development of alternative agents and formulations or the use of novel routes of drug administration, such as the vaginal route. The vagina is often ideal for drug delivery because it allows the use of lower doses, maintains steady drug administration levels, and requires less frequent administration than the oral route. With vaginal drug administration, absorption is unaffected by gastrointestinal disturbances, there is no first-pass effect, and use is discreet. The aim of this review is to provide a background overview of vaginal development, anatomy, and physiology and the effect this has on the use of this route for both local and systemic drug delivery, with special reference to OAB management. Vaginal therapy continues to be an underused route of drug delivery. Vaginal administration allows nondaily, low, continuous dosing, which results in stable drug levels and may, in turn, achieve a lower incidence of side effects and improve patient compliance. These benefits must be balanced against inherent patient or physician bias against using this route and the need to overcome cultural, personal, and hygiene-related barriers to this form of therapy. More sophisticated and programmable vaginal rings are being developed for systemic delivery of therapeutically important macromolecules, such as antimuscarinic therapy in OAB management.

Vaginal drug delivery systems for HIV prevention

Microbicides have become a principal focus for HIV prevention strategies. The successful design of drug delivery systems for vaginal microbicide drug candidates brings with it a multitude of challenges. It is imperative that the chemical and physical characteristics of the drug candidate and its mechanism of action be clearly understood and considered to successfully deliver and target drug candidates efficiently. In addition, an understanding of the dynamic nature of the vaginal environment, the tissue and innate barriers present, as well as patient preferences are critical considerations in the design of effective microbicide products. Although the majority of drug candidates clinically evaluated to date have been delivered using conventional semisolid aqueous-based gel dosage forms, drug delivery system design has recently been extended to include advanced delivery systems such as vaginal rings, quick-dissolve films, and tablets. Ultimately, it may be necessary to develop multiple dosage platforms for a single active agent to provide users with options that can be used within the constraints of their social environment, personal choice, and environmental conditions.

A review of current intravaginal drug delivery approaches employed for the prophylaxis of HIV/AIDS and prevention of sexually transmitted infections

The objective of this review is to describe the current status of several intravaginal anti-HIV microbicidal delivery systems these delivery systems and microbicidal compounds in the context of their stage within clinical trials and their potential cervicovaginal defence successes. The global Human Immuno-Deficiency Virus (HIV) pandemic continues to spread at a rate of more than 15,000 new infections daily and sexually transmitted infections (STIs) can predispose people to acquiring HIV infection. Male-to-female transmission is eight times more likely to occur than female-to-male transmission due to the anatomical structure of the vagina as well as socio-economic factors and the disempowerment of women that renders them unable to refuse unsafe sexual practices in some communities. The increased incidence of HIV in women has identified the urgent need for efficacious and safe intravaginal delivery of anti-HIV agents that can be used and controlled by women. To meet this challenge, several intravaginal anti-HIV microbicidal delivery systems are in the process of been developed. The outcomes of three main categories are discussed in this review: namely, dual-function polymeric systems, non-polymeric systems and nanotechnology-based systems. These delivery systems include formulations that modify the genital environment (e.g. polyacrylic acid gels and lactobacillus gels), surfactants (e.g. sodium lauryl sulfate), polyanionic therapeutic polymers (e.g. carageenan and carbomer/lactic acid gels), proteins (e.g. cyanovirin-N, monoclonal antibodies and thromspondin-1 peptides), protease inhibitors and other molecules (e.g. dendrimer based-gels and the molecular condom). Intravaginal microbicide delivery systems are providing a new option for preventing the transmission of STIs and HIV.

Permeability of tritiated water through human cervical and vaginal tissue

The increased incidence of human immunodeficiency virus infection in women has identified an urgent need to develop a female-controlled method to prevent acquisition of human immunodeficiency virus and other sexually transmitted diseases. Women would apply the product intravaginally before intercourse. Development of such a product requires a better understanding of the permeability characteristics of the tissues with which such products would come into contact. However, limited studies have been performed in this area. In the present study, water permeability of fresh human cervical and vaginal tissue was evaluated. The average apparent permeability coefficient was found to be 8 x 10(-5) cm/s for fresh human cervical tissue and 7 x 10(-5) cm/s for fresh human vaginal tissue. Considering the lack of regularity in obtaining cervical and vaginal tissue from surgical specimens, additional tests were performed to evaluate the effect of freezing on tritiated water permeability. No statistically significant differences were observed in the permeability values obtained when comparing fresh versus frozen tissues.

The vagina as a route for systemic drug delivery

Exhaustive efforts have been made toward the administration of drugs, via alternative routes, that are poorly absorbed after the oral administration. The vagina as a route of drug delivery has been known since ancient times. In recent years, the vaginal route has been rediscovered as a potential route for systemic delivery of peptides and other therapeutically important macromolecules. However, successful delivery of drugs through the vagina remains a challenge, primarily due to the poor absorption across the vaginal epithelium. The rate and extent of drug absorption after intravaginal administration may vary depending on formulation factors, vaginal physiology, age of the patient and menstrual cycle. Suppositories, creams, gels, tablets and vaginal rings are commonly used vaginal drug delivery systems. The purpose of this communication is to provide the reader with a summary of advances made in the field of vaginal drug delivery. This report, therefore, summarizes various vaginal drug delivery systems with an introduction to vaginal physiology and factors affecting drug absorption from the vaginal route.

Intravaginal gels as drug delivery systems

Recently, there has been a great deal of interest in the design and application of different dosage forms via the vaginal route. Several studies have proven that the vagina is an effective route for drug administration intended mainly for local action, but systemic effects of some drugs also can be attained. The major advantages of this route include accessibility, good blood supply, the ability to bypass first-pass liver metabolism, and permeability to large molecular weight drugs, such as peptides and proteins. Among the delivery systems proposed for this route is the use of intravaginal gels, which have been found to be potential vaginal drug delivery systems. The bioadhesives used in the formulation of gels play a key role in the release of the drug through the attachment to the vaginal mucosa, where the drug diffuses from the gel to the mucus.

The scope and potential of vaginal drug delivery

The vagina, in addition to being a genital organ with functions related to conception, serves as a potential route for drug administration. Mainly used for local action in the cervico-vaginal region, it has the potential of delivering drugs for systemic effects and uterine targeting. Currently available vaginal dosage forms have several limitations, necessitating the need to develop novel drug delivery systems. In addition, consideration of the regulatory aspects and consumer preferences for vaginal formulations is also required in the early stages of development.

Comparative permeability of human vaginal and buccal mucosa to water

There is currently a resurgence of interest in the oral mucosa as a route for drug delivery. The relative scarcity of human oral mucosa for in vitro permeability studies, and the fact that vaginal mucosa is histologically similar and more abundant than the former, caused us to compare these 2 tissues with respect to their barrier properties to water. Specimens of fresh, clinically-healthy human vaginal and buccal mucosa from non-smokers were taken from excised tissue obtained during vaginal hysterectomies and various oral surgical procedures. Biopsies from each specimen were mounted in flow-through diffusion cells and their permeability to tritiated water determined using a continuous flow-through perfusion system. Specimens were examined histologically before and after permeability experiments and similarities between vaginal and buccal tissues verified. No statistically significant differences between mean steady state flux values (10-16 h) for vaginal and buccal mucosa, respectively, were found. Human vaginal mucosa is therefore as permeable as buccal mucosa to water, and these results warrant further investigation with other compounds to establish whether vaginal mucosa may be a useful model for buccal mucosa for drug permeability studies.

Characterization of the barrier properties of mucosal membranes

The barrier properties of the nasal, rectal, and vaginal membranes were investigated in the rabbit by comparing physical characteristics and permeability to model hydrophilic and lipophilic compounds. It was found that the nasal, rectal, and vaginal mucosae differ in their physical characteristics and interactions. The nasal mucosa had the highest in vitro transport of both the model hydrophilic compound, mannitol, and the model lipophilic compound, progesterone. Although the nasal mucosa was found to have some hydrophilic character, it appears that these mucosae are primarily lipophilic in nature. The role of the lipid domain in the barrier properties of these mucosal membranes was investigated using progesterone and a series of its hydroxyprogesterone analogues. Membrane permeability was found to decrease as the order of hydrophilicity of the progestins increased, indicating that the lipid domain plays an important role in the barrier function of these membranes. The changes observed in the physical properties and permeability of the mucosal membranes after extraction of the lipids also demonstrated the importance of the lipid domain in the maintenance of the mucosal barrier.

Application of diffusion theory to the relationship between partition coefficient and biological response

A diffusion model for transport through multilaminates is studied as a possible way to predict the optimal biological response of a set of congeners with respect to the oil-water partition coefficient, P. The model predicts the bilinear form typical of biological response data and, unlike the earlier kinetic model, also relates the results to physical processes, predicts the structure with the optimal response in terms of diffusion constants, and shows such an optimum prior to steady state for an infinite dose. Diffusion through an oil-water multilaminate causes extraordinary separation of permeating species based on partition coefficient and diffusion constant for times shorter than the lag time.

Physicochemical characterization of the human nail: permeation pattern for water and the homologous alcohols and differences with respect to the stratum corneum

In order to develop a basic concept of the permeability of the human nail plate and thus create a better understanding of the toxic potentials and therapeutic possibilities of substances applied to the nail, avulsed cadaver nails have been placed in specially constructed diffusion chambers and their permeation by water and the n-alkanols through dodecanol, all in high aqueous dilution, has been investigated. The permeability coefficient of water is 16.5 X 10(-3) cm h-1 and that for methanol is 5.6 X 10(-3) cm h-1. Ethanol's permeability coefficient measured 5.8 X 10(-3) cm h-1. Permeability coefficients decreased systematically thereafter to a low value of 0.27 X 10(-3) cm h-1 at n-octanol. The middle chain length alkanols, n-pentanol through n-octanol, have similar permeability coefficients but n-decanol and n-dodecanol show higher rates of permeation. The data suggest that, as a membrane, the hydrated human nail plate behaves like a hydrogel of high ionic strength to the polar and semipolar alcohols. Declining permeability rates appear linked to decreased partitioning into the complex matrix of the plate as the compounds become hydrophobic. The results for n-decanol and n-dodecanol introduce the possibility that a parallel lipid pathway exists which favours the permeation of these exceedingly hydrophobic species.

Vaginal absorption of a potent luteinizing hormone-releasing hormone analog (leuprolide) in rats I: absorption by various routes and absorption enhancement

The absorption of a potent luteinizing hormone-releasing hormone analog (leuprolide) through different routes was evaluated by determining the ovulation-inducing activity in diestrous rats. Vaginal administration showed the greatest potency among nonparenteral routes and was followed successively by rectal, nasal, and oral administration. Mixed micellar solution with monoolein-bile acids improved the intestinal absorption of leuprolide, and nasal absorption was enhanced by adding sodium glycocholate, surfactin, or polyoxyethylene 9 lauryl ether, but these bioavailabilities were still insufficient. The vaginal absorption was enhanced by organic acids: citric, succinic, tartaric, and glycocholic; the absolute bioavailability increased to approximately 20%. The vaginal absorption from jellies, as practical dosage forms, yielded sufficient activity of leuprolide, but absorption was slightly reduced with highly polar polymers or with higher concentrations of polymers. It was concluded that vaginal administration of leuprolide can be a rational dosage method for a long-term antitumor therapy.

Intestinal absorption-partition relationships: a tentative functional nonlinear model

Models and equations designed to elucidate passive intestinal absorption mechanisms by analysis of the relationship between the absorption rate constant (ka) and either the partition coefficients (P) or a related partition constant for homologous series of substances, are reviewed. Classical nonlinear physical models, such as those which assume the existence of a nonstirred layer or equilibrium extraction, predict sigmoidal or hyperbolic relationships between ka and P, whereas other models, which regard the membrane as a heterogeneous multicompartment system, predict parabolic or bilinear relationships between log ka and log P. In the present paper, an alternative model is proposed, which incorporates the Wagner-Sedman equilibrium extraction model together with the existence of pores, which play a fundamental role for compounds below 250 in molecular weight. Several apparently contradictory absorption-partition literature data are shown to be highly consistent with the tentative model proposed.

Systems approach to vaginal delivery of drugs IV: methodology for determination of membrane surface pH

A physical model including a diffusional layer in series with the membrane was developed for studying the possible differences between the pH at the membrane surface and that in the bulk solution. Both the membrane-secreted substances (acids and bases) and buffer constituents in the bulk solutions are assumed to contribute to the surface pH. Equations derived for this situation, together with experimental determinations of the acidic dissociation constant of the secreted material, the total secretion flux, the flux of total secreted acidic species, and the diffusion layer thickness, allow estimates to be made of the pH at the membrane surface. With the rabbit vagina, the membrane surface pH was close to that of the bulk solution in most cases. These results were supported by the fact that the absorption of 1-alkanoic acids in pH 2.2 phosphate buffers was relatively constant over the buffer concentration range of 0.003-0.1 M phosphate.

Systems approach to vaginal delivery of drugs V: in situ vaginal absorption of 1-alkanoic acids

The vaginal absorption of a homologous series of ionizable compounds, the 1-alkanoic acids, was studied using a perfusion method with a rib-cage cell surgically implanted in the rabbit vagina. The absorption rates of these compounds followed first-order kinetics. The physical model previously used for the 1-alkanols, but accounting for the pKa and pH effects in the present case was employed in the analysis of the carboxylic acid data. The aqueous diffusion layer thickness was 0.031 cm. The permeability coefficient for the lipoidal pathway increased 3.5-fold per methylene group. Both values agree reasonably well with those obtained in the alcohol study.

Vaginal drug absorption in rhesus monkeys I: development of methodology

Earlier reports from these laboratories described a procedure for determining vaginal drug absorption in the rabbit based upon a perfusion system, and data on the vaginal absorption of the straight-chain aliphatic alcohols and carboxylic acids were given. These studies have been extended to the rhesus monkey. Rib-cage-type cells were designed for intravaginal insertion through the vulval orifice and to fit the specific dimensions of the monkey vagina. The general design of the cell was similar to that used in the rabbit vaginal absorption studies. The persusion system was checked by using 3H-polyethylene glycol 4000, and no significant leaks from the cell were found. The absorption of the alcohols followed first-order kinetics. The computed apparent permeability coefficients for the alcohols were of comparable magnitude to those previously reported for the rabbit vaginal membrane.