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Howard SA, Benhabbour SR. Non-Hormonal Contraception. J Clin Med 2023; 12:4791. [PMID: 37510905 PMCID: PMC10381146 DOI: 10.3390/jcm12144791] [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: 06/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.
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Affiliation(s)
- Sarah Anne Howard
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Soumya Rahima Benhabbour
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Schimpf U, Caldas-Silveira E, Katchan L, Vigier-Carriere C, Lantier I, Nachmann G, Gidlöf S, Jonasson AF, Björndahl L, Trombotto S, Druart X, Crouzier T. Topical reinforcement of the cervical mucus barrier to sperm. Sci Transl Med 2022; 14:eabm2417. [PMID: 36449601 DOI: 10.1126/scitranslmed.abm2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Close to half of the world's pregnancies are still unplanned, reflecting a clear unmet need in contraception. Ideally, a contraceptive would provide the high efficacy of hormonal treatments, without systemic side effects. Here, we studied topical reinforcement of the cervical mucus by chitosan mucoadhesive polymers as a form of female contraceptive. Chitosans larger than 7 kDa effectively cross-linked human ovulatory cervical mucus to prevent sperm penetration in vitro. We then demonstrated in vivo using the ewe as a model that vaginal gels containing chitosan could stop ram sperm at the entrance of the cervical canal and prevent them from reaching the uterus, whereas the same gels without chitosan did not substantially limit sperm migration. Chitosan did not affect sperm motility in vitro or in vivo, suggesting reinforcement of the mucus physical barrier as the primary mechanism of action. The chitosan formulations did not damage or irritate the ewe vaginal epithelium, in contrast to nonoxynol-9 spermicide. The demonstration that cervical mucus can be reinforced topically to create an effective barrier to sperm may therefore form the technological basis for muco-cervical barrier contraceptives with the potential to become an alternative to hormonal contraceptives.
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Affiliation(s)
- Ulrike Schimpf
- Division of Glycoscience, Department of Chemistry, School of Engineering Science in Chemistry, Biotechnology and Health (CBH), AlbaNova University Center, KTH Royal Institute of Technology, 106 91 Stockholm, Sweden.,Department of Material and Environmental Chemistry (MMK), Stockholm University, 106 91 Stockholm, Sweden
| | - Erika Caldas-Silveira
- PIXANIM, Physiologie de la Reproduction et des Comportements, UMR INRAE, CNRS, Université de Tours, IFCE, 37380 Nouzilly, France
| | - Ljudmila Katchan
- Cirqle Biomedical Contraception ApS, Ole Maaløes Vej 3, 2200 Copenhagen, Denmark
| | | | - Isabelle Lantier
- French National Institute for Agriculture, Food, and Environment (INRAE), UMR ISP, Université de Tours, 37380 Nouzilly, France
| | - Gilai Nachmann
- Division of Glycoscience, Department of Chemistry, School of Engineering Science in Chemistry, Biotechnology and Health (CBH), AlbaNova University Center, KTH Royal Institute of Technology, 106 91 Stockholm, Sweden
| | - Sebastian Gidlöf
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, Sweden
| | - Aino Fianu Jonasson
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, Sweden
| | - Lars Björndahl
- ANOVA-Andrology, Sexual Medicine, Transmedicine, Karolinska University Hospital and Karolinska Institutet, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
| | - Stéphane Trombotto
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, IMP, UMR 5223, F-69622 Villeurbanne, France
| | - Xavier Druart
- PIXANIM, Physiologie de la Reproduction et des Comportements, UMR INRAE, CNRS, Université de Tours, IFCE, 37380 Nouzilly, France
| | - Thomas Crouzier
- Division of Glycoscience, Department of Chemistry, School of Engineering Science in Chemistry, Biotechnology and Health (CBH), AlbaNova University Center, KTH Royal Institute of Technology, 106 91 Stockholm, Sweden.,Cirqle Biomedical Contraception ApS, Ole Maaløes Vej 3, 2200 Copenhagen, Denmark.,AIMES-Center for the Advancement of Integrated Medical and Engineering Sciences, Karolinska Institutet and KTH Royal Institute of Technology, 171 77 Stockholm, Sweden.,Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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Hexavalent sperm-binding IgG antibody released from vaginal film for development of potent on-demand nonhormonal female contraception. Proc Natl Acad Sci U S A 2021; 118:2107832118. [PMID: 34815336 PMCID: PMC8640842 DOI: 10.1073/pnas.2107832118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Nearly half of all pregnancies in the United States are unintended due to millions of women avoiding available hormonal contraceptive methods as a result of real and/or perceived side effects associated with the use of exogenous hormones. Topical vaginal delivery of antisperm monoclonal antibodies that could agglutinate sperm into clusters too large to penetrate mucus and prevent sperm from reaching the egg represents a potentially safe and potent mechanism for nonhormonal contraception. We report here the engineering of a vaginal film loaded with hexavalent (i.e., 6 Fab) antisperm IgG, made using GMP manufacturing processes, that possesses significantly superior agglutination potency than the parent IgG, enabling potent on-demand nonhormonal contraception via effectively agglutinating all human sperm within minutes. Nonhormonal products for on-demand contraception are a global health technology gap; this unmet need motivated us to pursue the use of sperm-binding monoclonal antibodies to enable effective on-demand contraception. Here, using the cGMP-compliant Nicotiana-expression system, we produced an ultrapotent sperm-binding IgG antibody possessing 6 Fab arms per molecule that bind a well-established contraceptive antigen target, CD52g. We term this hexavalent antibody “Fab-IgG-Fab” (FIF). The Nicotiana-produced FIF had at least 10-fold greater sperm-agglutination potency and kinetics than the parent IgG, while preserving Fc-mediated trapping of individual spermatozoa in mucus. We formulated the Nicotiana-produced FIF into a polyvinyl alcohol–based water-soluble contraceptive film and evaluated its potency in reducing progressively motile sperm in the sheep vagina. Two minutes after vaginal instillation of human semen, no progressively motile sperm were recovered from the vaginas of sheep receiving FIF Film. Our work supports the potential of multivalent contraceptive antibodies to provide safe, effective, on-demand nonhormonal contraception.
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