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Abdelgader A, Govender M, Kumar P, Choonara YE. A Novel Intrauterine Device for the Spatio-Temporal Release of Norethindrone Acetate as a Counter-Estrogenic Intervention in the Genitourinary Syndrome of Menopause. Pharmaceutics 2024; 16:587. [PMID: 38794250 PMCID: PMC11124343 DOI: 10.3390/pharmaceutics16050587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The genitourinary syndrome of menopause (GSM) is a widely occurring condition affecting millions of women worldwide. The current treatment of GSM involves the use of orally or vaginally administered estrogens, often with the risk of endometrial hyperplasia. The utilization of progestogens offers a means to counteract the effects of estrogen on the endometrial tissue, decreasing unwanted side effects and improving therapeutic outcomes. In this study, a norethindrone acetate (NETA)-loaded, hollow, cylindrical, and sustained release platform has been designed, fabricated, and optimized for implantation in the uterine cavity as a counter-estrogenic intervention in the treatment of GSM. The developed system, which comprises ethyl cellulose (EC) and polycaprolactone (PCL), has been statistically optimized using a two-factor, two-level factorial design, with the mechanical properties, degradation, swelling, and in vitro drug release of NETA from the device evaluated. The morphological characteristics of the platform were further investigated through scanning electron microscopy in addition to cytocompatibility studies using NIH/3T3 cells. Results from the statistical design highlighted the platform with the highest NETA load and the EC-to-PCL ratio that exhibited favorable release and weight loss profiles. The drug release data for the optimal formulation were best fitted with the Peppas-Sahlin model, implicating both diffusion and polymer relaxation in the release mechanism, with cell viability results noting that the prepared platform demonstrated favorable cytocompatibility. The significant findings of this study firmly establish the developed platform as a promising candidate for the sustained release of NETA within the uterine cavity. This functionality serves as a counter-estrogenic intervention in the treatment of GSM, with the platform holding potential for further advanced biomedical applications.
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Affiliation(s)
| | | | | | - Yahya E. Choonara
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa
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Mugada V, Kolakota RK, Jadda SB, Kotapadu U, Veesam M. Does hormone replacement therapy benefit post-menopausal women? – a scoping review. MEDICAL SCIENCE PULSE 2019. [DOI: 10.5604/01.3001.0013.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-menopausal women experience symptoms such as irregular periods, lower fertility, vaginal dryness, hot flashes and night sweats. Hormone replacement therapy (HRT) relieves menopausal symptoms. The aim of this review was to assess the benefits and risks of HRT in post-menopausal women. A scoping review was conducted for original peer-reviewed English language papers using the electronic databases of PUBMED, JAMA, BMC and TRIP. The papers were subjected to a three-stage screening process. The type of study, year of study, age, participants, type of therapy and the aim of the study defined the inclusion and exclusion criteria. HRT was associated with reduced risk and prevalence of end-stage kidney disease, gastric esophageal reflex disease (GORD) symptoms, periodontal disease and associated with the increased risk of overall cancers. The benefits of HRT depend on the duration of therapy, formulation, route of administration, time of initiating therapy (age <60 years) and type of therapy. Post-menopausal symptomatic women mostly benefited with hormone replacement therapy. To reduce risks of adverse events, HRT should be initiated with appropriate monitoring.
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Affiliation(s)
- Vinodkumar Mugada
- Department of Pharmacy Practice, Vignan Institute of Pharmaceutical Technology, Duvvada, AP, India
| | - Raj Kiran Kolakota
- Department of Pharmacy Practice, Vignan Institute of Pharmaceutical Technology, Duvvada, AP, India
| | - Sujana Bhargavi Jadda
- Department of Pharmacy Practice, Vignan Institute of Pharmaceutical Technology, Duvvada, AP, India
| | - Urmila Kotapadu
- Department of Pharmacy Practice, Vignan Institute of Pharmaceutical Technology, Duvvada, AP, India
| | - Mounika Veesam
- Department of Pharmacy Practice, Vignan Institute of Pharmaceutical Technology, Duvvada, AP, India
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Liu M, Degner J, Davis JW, Idler KB, Nader A, Mostafa NM, Waring JF. Identification of HLA-DRB1 association to adalimumab immunogenicity. PLoS One 2018; 13:e0195325. [PMID: 29614084 PMCID: PMC5882140 DOI: 10.1371/journal.pone.0195325] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/20/2018] [Indexed: 02/07/2023] Open
Abstract
Anti-drug antibody formation occurs with most biological agents across disease states, but the mechanism by which they are formed is unknown. The formation of anti-drug antibodies to adalimumab (AAA) may decrease its therapeutic effects in some patients. HLA alleles have been reported to be associated with autoantibody formation against interferons and other TNF inhibitors, but not adalimumab. We analyzed samples from 634 subjects with either rheumatoid arthritis (RA) or hidradenitis suppurativa (HS): 37 subjects (17 RA and 20 HS) developed AAA (AAA+) during adalimumab treatment and 597 subjects (348 RA, 249 HS) did not develop AAA (AAA-) during the clinical trials. Using next-generation sequencing-based HLA typing, we identified three protective HLA alleles (HLA-DQB1*05, HLA-DRB1*01,and HLA-DRB1*07) that were less prevalent in AAA+ than AAA-subjects (ORs: 0.4, 0.25 and 0.28, respectively; and P values: 0.012, 0.012 and 0.018, respectively) and two risk HLA alleles (HLA-DRB1*03 and HLA-DRB1*011) that were more abundant in AAA+ than AAA-subjects (ORs: 2.52, and 2.64, respectively; and P values: 0.006 and 0.019). Similar to the finding of Billiet et al. who found that carriage of the HLA-DRB1*03 allele was more prevalent in those with anti-infliximab antibodies (OR = 3.6, p = 0.002, 95% CI: [1.5,8.6]).), we found HLA-DRB1*03 allele was also more prevalent in anti-adalimumab positive (OR = 2.52, p = 0.006, 95% CI: [1.37,4.63]). The results suggest that specific HLA alleles may play a key role in developing AAAs in RA and HS patients treated with adalimumab.
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Affiliation(s)
- Mohan Liu
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Jacob Degner
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Justin Wade Davis
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Kenneth B Idler
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Ahmed Nader
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, United States of America
| | - Nael M Mostafa
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, United States of America
| | - Jeffrey F Waring
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
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Warner M, Huang B, Gustafsson JA. Estrogen Receptor β as a Pharmaceutical Target. Trends Pharmacol Sci 2016; 38:92-99. [PMID: 27979317 DOI: 10.1016/j.tips.2016.10.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 01/11/2023]
Abstract
A major issue in clinical endocrinology today is how to use hormones to achieve the health benefits that they clearly can provide but avoid the negative side effects, that is, how to develop more precise medicines. This problem of how to use hormones is pervasive in clinical endocrinology. It is true for estrogen, progesterone, androgen, vitamin D, and thyroid hormone, and the problem is amplified in the case of new ligands for the more recently discovered nuclear receptors. Selective targeting of hormone receptor subtypes is one attractive way to harness the beneficial effects of hormones while reducing unwanted side effects. Here, we focus on estrogen receptor (ER)β, which has promise as a selective target in hormone replacement therapy, and in breast and prostate cancers.
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Affiliation(s)
- Margaret Warner
- Center for Nuclear Receptors and Cell Signaling, Department of Cell Biology and Biochemistry, University of Houston, Texas, USA
| | - Bo Huang
- Center for Nuclear Receptors and Cell Signaling, Department of Cell Biology and Biochemistry, University of Houston, Texas, USA
| | - Jan-Ake Gustafsson
- Center for Nuclear Receptors and Cell Signaling, Department of Cell Biology and Biochemistry, University of Houston, Texas, USA; Center for Innovative Medicine, Department of Biosciences and Nutrition, Novum, Karolinska Institutet, Huddinge, Sweden.
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Cekici A, Baser U, Isik G, Akhan SE, Issever H, Onan U. Periodontal treatment outcomes in post menopausal women receiving hormone replacement therapy. J Istanb Univ Fac Dent 2015; 49:39-44. [PMID: 28955544 PMCID: PMC5573503 DOI: 10.17096/jiufd.61637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/20/2015] [Indexed: 12/26/2022] Open
Abstract
Purpose: To evaluate the effect of hormone replacement
therapy(HRT) on periodontal treatment outcomes in
a group of postmenopausal women with periodontitis. Materials and Methods: 23 post-menopausal
chronic periodontitis patients were included in this
study. The test group(n=11) consisted of women
who started HRT with this study and received
conjugated estrogen and medroxyprogesteron. The
control group(n=12) was women not taking any HRT
or supplement therapy. Study groups received the
same periodontal treatment. All subjects examiend
by recording the following: plaque index (PI), sulcus
bleeding index (SBI), periodontal pocket depth (PD)
and relative attachment level (RAL) from 6 sites in
each tooth. Measurements were recorded at the
baseline, 1 month, 3 months, and 6 months following
periodontal treatment. Serum estrogene level and
bone mineral density was recorded at baseline
and 6 months following periodontal treatment. Results: The GI change was greater in the
control group. There wasn’t significant difference
by means of PD, the attachment gain was
significantly greater in the HRT receiving group. Conclusion: HRT seems to have a positive
effect on periodontal treatment outcomes.
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Affiliation(s)
- Ali Cekici
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Ulku Baser
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Gulden Isik
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
| | - Suleyman E Akhan
- Department of Gyneocology and Obstetrics, Faculty of Medicine, Istanbul University, Turkey
| | - Halim Issever
- Department of Public Health, Faculty of Medicine, Istanbul University, Turkey
| | - Utku Onan
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Turkey
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Salem H, El-Mazny A. A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer. Int J Gynaecol Obstet 2011; 115:188-90. [DOI: 10.1016/j.ijgo.2011.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/19/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
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Pizzo G, Guiglia R, Licata ME, Pizzo I, Davis JM, Giuliana G. Effect of hormone replacement therapy (HRT) on periodontal status of postmenopausal women. Med Sci Monit 2011; 17:PH23-7. [PMID: 21455116 PMCID: PMC3539527 DOI: 10.12659/msm.881700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease. MATERIAL/METHODS Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT-), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed. RESULTS Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT- patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P<0.0001). The percentage of gingival sites with positive BOP was significantly lower in the HRT+ group compared to the HRT- group (34.85% vs. 65.15%; P=0.0007). Plaque accumulation was also tested in ANCOVA as a possible explanatory variable for the differences observed in gingival bleeding. The ANCOVA showed no significant differences in gingival bleeding between HRT+ and HRT- women (P=0.4677). No significant differences in past smoking status and oral contraceptive use were detected between HRT+ and HRT- women (P=0.9999 and P=0.0845, respectively). CONCLUSIONS These findings indicated that long-term HRT was not associated with relevant effects on periodontal status and clinical measures of periodontal disease, thus suggesting that HRT may not confer protection against periodontitis in postmenopausal women.
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Affiliation(s)
- Giuseppe Pizzo
- Section of Oral Sciences, University of Palermo, Palermo, Italy.
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Tarkkila L, Kari K, Furuholm J, Tiitinen A, Meurman JH. Periodontal disease-associated micro-organisms in peri-menopausal and post-menopausal women using or not using hormone replacement therapy. A two-year follow-up study. BMC Oral Health 2010; 10:10. [PMID: 20429938 PMCID: PMC2867770 DOI: 10.1186/1472-6831-10-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 04/29/2010] [Indexed: 11/25/2022] Open
Abstract
Background Despite conflicting results on the use of hormone replacement therapy (HRT) there is no doubt that many women benefit from it. Women using HRT are known to be more health conscious in general with putative positive implications in the mouth. However, we observed recently in our cohort hardly any difference in oral health status between HRT-users and non-users. There are only a few studies about HRT and oral microbiota. We hypothesized that counts of periodontal micro-organisms are lower in health-conscious HRT-users than non-users. Methods Two-year open follow-up study was conducted on originally 200 HRT-users and 200 non-users from age cohorts of 50-58 years. After clinical examination pooled subgingival plaque samples were taken for polymerase chain reaction analyses. The results of finally 135 women meeting the inclusion criteria were analyzed with cross-tabulation and chi-square test. Explanatory factors were studied by step-wise logistic regression analysis. Results In HRT group, the numbers of positive samples for Porphyromonas gingivalis (P. gingivalis, p < 0.07), Prevotella intermedia (P. intermedia, p < 0.05)and Tannerella forsythia (T. forsythia, p < 0.01) decreased in women with ≥ 4-mm-deep pockets. Respectively in HRT users with ≥ 6-mm-deep pockets the numbers of positive samples for P. gingivalis (p < 0.05) and T. forsythia (p < 0.01) were decreased. No corresponding differences were observed in the non-HRT group. In logistic regression, the existence of deep periodontal pockets explained the majority of cases harboring specific micro-organisms in both groups. Conclusion Although use of HRT did not correlate with periodontal health status, HRT led to decreasing numbers of positive samples of the periodontal pathogens P. gingivalis and T. forsythia. Further studies with longer observation time are needed to observe the clinical relevance of the results.
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Affiliation(s)
- Laura Tarkkila
- Institute of Dentistry, University of Helsinki, Helsinki, Finland.
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Svart K, Lehtinen R, Nieminen T, Nikus K, Lehtimäki T, Kööbi T, Niemelä K, Niemi M, Turjanmaa V, Kähönen M, Viik J. Exercise electrocardiography detection of coronary artery disease by ST-segment depression/heart rate hysteresis in women: The Finnish Cardiovascular Study. Int J Cardiol 2010; 140:182-8. [DOI: 10.1016/j.ijcard.2008.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 08/08/2008] [Accepted: 11/08/2008] [Indexed: 11/15/2022]
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Pauklin S, Petersen-Mahrt SK. Progesterone inhibits activation-induced deaminase by binding to the promoter. THE JOURNAL OF IMMUNOLOGY 2009; 183:1238-44. [PMID: 19553525 DOI: 10.4049/jimmunol.0803915] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Regulation of activation-induced deaminase (AID), an essential factor in Ig diversification, can alter not only somatic hypermutation and class switch recombination (CSR), but may also influence oncogenesis. AID deaminates cytosine to uracil in the Ig locus, thereby initiating Ig diversification. Unregulated AID can induce oncogenic DNA alterations in Ig and non-Ig loci, leading to mutations, recombination, and translocations. In this study, we demonstrate that AID mRNA production in activated mouse splenic B cells can be reduced by treatment with the sex hormone progesterone. This down-regulation is independent of translation or splicing and is predominantly achieved by inhibiting transcription. During cell treatment we could detect progesterone receptor bound to the AID promoter in proximity to NF-kappaB binding. Importantly, the progesterone-induced repression was also extended to the protein level of AID and its activity on somatic hypermutation and class switch recombination.
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Affiliation(s)
- Siim Pauklin
- DNA Editing Lab, Clare Hall Laboratories, Cancer Research U.K., South Mimms, United Kingdom
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Abstract
One of the major social issues nowadays is the aging society. Korea is already an aging society, and 63 cities and districts are ultra-aged societies where the rate of people older than 65 yr exceeds 20%. Among them, more than 67% are women. These statistics reveal the importance of healthcare for older women. Disease and disability of older women are very closely related to the loss of female sex hormones after menopause. Major hormone-dependent aging problems in women such as osteoporosis, Alzheimer's disease (AD), urinary incontinence, and coronary atherosclerosis were surveyed in this review, and the key role of hormones in those diseases and hormone replacement therapy (HRT) were summarized. We expect that this review would provide some understanding of factors that must be considered to give optimal care to older women for healthy lives.
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Affiliation(s)
- Byung Hwa Jung
- Bioanalysis and Biotransformation Research Center, Korea Institute of Science and Technology, Seoul, Korea
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wook Bai
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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