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Oladipo SD, Omondi B, Mocktar C. Co(III)
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′‐diarylformamidine dithiocarbamate complexes: Synthesis, characterization, crystal structures and biological studies. Appl Organomet Chem 2020. [DOI: 10.1002/aoc.5610] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Segun D. Oladipo
- School of Chemistry and Physics, Westville CampusUniversity of Kwazulu‐Natal Private Bag X54001 Durban 4000 South Africa
| | - Bernard Omondi
- School of Chemistry and Physics, Pietermaritzburg CampusUniversity of Kwazulu‐Natal Private Bag X01 Scottsville 3209 South Africa
| | - Chunderika Mocktar
- Discipline of Pharmaceutical Sciences, School of Health SciencesUniversity of Kwazulu‐Natal Private Bag X54001 Durban 4000 South Africa
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Fernandes T, Baxi K, Sawarkar S, Sarmento B, das Neves J. Vaginal multipurpose prevention technologies: promising approaches for enhancing women's sexual and reproductive health. Expert Opin Drug Deliv 2020; 17:379-393. [PMID: 32036727 DOI: 10.1080/17425247.2020.1728251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Multipurpose prevention technologies (MPTs) have the potential to avert multiple concomitant sexual and reproductive health issues in women such as sexually transmitted infections and unintended pregnancy. MPTs incorporate one or more active pharmaceutical ingredients in a single product, which adds more convenience for users and may promote increased adherence. Various vaginal dosage forms/delivery systems have been studied for designing MPTs. However, several challenges remain that are mainly related to requirements of individual drugs or intended multiple applications.Areas covered: This review focuses on the emerging need and development of vaginal MPTs. It illustrates numerous examples that are currently in the preclinical and clinical development pipeline, highlighting the concept behind vaginal MPTs. The article also highlights the challenges associated with formulation design and development, including regulatory issues that need to be addressed.Expert opinion: Vaginal MPTs present great potential to empower women with novel, efficient, and safe products for protection against sexually transmitted infections and unintended pregnancy. However, several technological issues and regulatory gaps still need to be addressed in order to meet real-world needs.
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Affiliation(s)
- Trinette Fernandes
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai,India
| | - Krishna Baxi
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai,India
| | - Sujata Sawarkar
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai,India
| | - Bruno Sarmento
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
| | - José das Neves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
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Tietz K, Klein S. In Vitro Methods for Evaluating Drug Release of Vaginal Ring Formulations-A Critical Review. Pharmaceutics 2019; 11:pharmaceutics11100538. [PMID: 31623277 PMCID: PMC6836189 DOI: 10.3390/pharmaceutics11100538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022] Open
Abstract
The vagina is a promising site for both local and systemic drug delivery and represents an interesting administration route for compounds with poor oral bioavailability. Whereas most of the currently marketed dosage forms were designed as immediate release formulations, intravaginal rings (IVRs) offer the possibility of a controlled vaginal drug delivery over several weeks or months. For a long time, the development of IVRs was limited to steroid-releasing formulations. Recently, IVRs have witnessed a surge of new interest as promising delivery systems for microbicides. Therefore, various novel IVR designs have been introduced. To ensure that only safe and effective IVRs will be administered to patients, it is important to properly distinguish between IVRs with desired and undesired release performance. In vitro methods for evaluating drug release of IVRs that present with sufficient predictive capacity for in vivo drug release, and discriminatory power with regard to IVRs quality, are an essential tool for this purpose. The objective of the present review article is to present the current status of in vitro drug release testing of IVRs and to critically discuss current compendial and non-official in vitro drug release methods with regard to their discriminatory power and in vivo predictivity.
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Affiliation(s)
- Katharina Tietz
- Center of Drug Absorption and Transport, Institute of Biopharmaceutics and Pharmaceutical Technology, Department of Pharmacy, Felix-Hausdorff-Str. 3, University of Greifswald, Greifswald 17489, Germany
| | - Sandra Klein
- Center of Drug Absorption and Transport, Institute of Biopharmaceutics and Pharmaceutical Technology, Department of Pharmacy, Felix-Hausdorff-Str. 3, University of Greifswald, Greifswald 17489, Germany.
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Tintori C, Iovenitti G, Ceresola ER, Ferrarese R, Zamperini C, Brai A, Poli G, Dreassi E, Cagno V, Lembo D, Canducci F, Botta M. Rhodanine derivatives as potent anti-HIV and anti-HSV microbicides. PLoS One 2018; 13:e0198478. [PMID: 29870553 PMCID: PMC5988308 DOI: 10.1371/journal.pone.0198478] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022] Open
Abstract
Although highly active antiretroviral therapies (HAART) remarkably increased life expectancy of HIV positive people, the rate of novel HIV-1 infections worldwide still represent a major concern. In this context, pre-exposure prophylaxis (PrEP) approaches such as vaginal microbicide gels topically releasing antiretroviral drugs, showed to have a striking impact in limiting HIV-1 spread. Nevertheless, the co-presence of other genital infections, particularly those due to HSV-1 or 2, constitute a serious drawback that strongly limits the efficacy of PrEP approaches. For this reason, combinations of different compounds with mixed antiviral and antiretroviral activity are thoroughly investigated Here we report the synthesis and the biological evaluation of a novel series of rhodanine derivatives, which showed to inhibit both HIV-1 and HSV-1/2 replication at nanomolar concentration, and were found to be active also on acyclovir resistant HSV-2 strains. The compounds showed a considerable reduction of activity in presence of serum due to a high binding to serum albumin, as determined through in vitro ADME evaluations. However, the most promising compound of the series maintained a considerable activity in gel formulation, with an EC50 comparable to that obtained for the reference drug tenofovir. Moreover, the series of compounds showed pharmacokinetic properties suitable for topical formulation, thus suggesting that the novel rhodanine derivatives could represent effective agents to be used as dual anti HIV/HSV microbicides in PrEP approaches.
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Affiliation(s)
- Cristina Tintori
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Giulia Iovenitti
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Elisa Rita Ceresola
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
| | - Roberto Ferrarese
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
| | - Claudio Zamperini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
- Lead Discovery Siena S.r.l., Castelnuovo Berardenga, Siena, Italy
| | - Annalaura Brai
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
- Lead Discovery Siena S.r.l., Castelnuovo Berardenga, Siena, Italy
| | - Giulio Poli
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Elena Dreassi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Valeria Cagno
- Laboratory of Molecular Virology and Antiviral Research. Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino, Italy
- Department of Molecular Microbiology, University of Geneva, Geneva, Switzerland
| | - David Lembo
- Laboratory of Molecular Virology and Antiviral Research. Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino, Italy
| | - Filippo Canducci
- Laboratory of Microbiology and Virology, Ospedale San Raffaele, Milan, Italy
| | - Maurizio Botta
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
- Lead Discovery Siena S.r.l., Castelnuovo Berardenga, Siena, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States of America
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Smith JM, Moss JA, Srinivasan P, Butkyavichene I, Gunawardana M, Fanter R, Miller CS, Sanchez D, Yang F, Ellis S, Zhang J, Marzinke MA, Hendrix CW, Kapoor A, Baum MM. Novel multipurpose pod-intravaginal ring for the prevention of HIV, HSV, and unintended pregnancy: Pharmacokinetic evaluation in a macaque model. PLoS One 2017; 12:e0185946. [PMID: 28982161 PMCID: PMC5628903 DOI: 10.1371/journal.pone.0185946] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/21/2017] [Indexed: 12/19/2022] Open
Abstract
Globally, women bear an uneven burden for sexual HIV acquisition. Results from two clinical trials evaluating intravaginal rings (IVRs) delivering the antiretroviral agent dapivirine have shown that protection from HIV infection can be achieved with this modality, but high adherence is essential. Multipurpose prevention technologies (MPTs) can potentially increase product adherence by offering protection against multiple vaginally transmitted infections and unintended pregnancy. Here we describe a coitally independent, long-acting pod-IVR MPT that could potentially prevent HIV and HSV infection as well as unintended pregnancy. The pharmacokinetics of MPT pod-IVRs delivering tenofovir alafenamide hemifumarate (TAF2) to prevent HIV, acyclovir (ACV) to prevent HSV, and etonogestrel (ENG) in combination with ethinyl estradiol (EE), FDA-approved hormonal contraceptives, were evaluated in pigtailed macaques (N = 6) over 35 days. Pod IVRs were exchanged at 14 days with the only modification being lower ENG release rates in the second IVR. Plasma progesterone was monitored weekly to determine the effect of ENG/EE on menstrual cycle. The mean in vivo release rates (mg d-1) for the two formulations over 30 days ranged as follows: TAF2 0.35-0.40; ACV 0.56-0.70; EE 0.03-0.08; ENG (high releasing) 0.63; and ENG (low releasing) 0.05. Mean peak progesterone levels were 4.4 ± 1.8 ng mL-1 prior to IVR insertion and 0.075 ± 0.064 ng mL-1 for 5 weeks after insertion, suggesting that systemic EE/ENG levels were sufficient to suppress menstruation. The TAF2 and ACV release rates and resulting vaginal tissue drug concentrations (medians: TFV, 2.4 ng mg-1; ACV, 0.2 ng mg-1) may be sufficient to protect against HIV and HSV infection, respectively. This proof of principle study demonstrates that MPT-pod IVRs could serve as a potent biomedical prevention tool to protect women's sexual and reproductive health and may increase adherence to HIV PrEP even among younger high-risk populations.
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Affiliation(s)
- James M. Smith
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John A. Moss
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Priya Srinivasan
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Irina Butkyavichene
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Manjula Gunawardana
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Rob Fanter
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Christine S. Miller
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Debbie Sanchez
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Flora Yang
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Shanon Ellis
- Libra Management Group, Decatur, Georgia, United States of America
| | - Jining Zhang
- Libra Management Group, Decatur, Georgia, United States of America
| | - Mark A. Marzinke
- Department of Medicine, Johns Hopkins University, Osler, Baltimore, Maryland, United States of America
- Department of Pathology, Johns Hopkins University, Sheikh Zayed Tower, Baltimore, Maryland, United States of America
| | - Craig W. Hendrix
- Department of Medicine, Johns Hopkins University, Osler, Baltimore, Maryland, United States of America
| | - Amita Kapoor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Capitol Court, Madison, Wisconsin, United States of America
| | - Marc M. Baum
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
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Dunn J, Zhang Q, Weeks MR, Li J, Liao S, Li F. Indigenous HIV Prevention Beliefs and Practices Among Low-Earning Chinese Sex Workers as Context for Introducing Female Condoms and Other Novel Prevention Options. QUALITATIVE HEALTH RESEARCH 2017; 27:1302-1315. [PMID: 27811288 PMCID: PMC5440208 DOI: 10.1177/1049732316673980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
New interventions to reduce HIV and sexually transmitted infections (STI) among female sex workers are introduced into the context of women's existing prevention beliefs and practices. These indigenous practices affected implementation of our program to introduce female condoms to women in sex-work establishments in southern China. We used ethnographic field observations and in-depth interviews to document common prevention methods women reported using to protect themselves before and during intervention implementation. Individual, sex-work establishment, and other contextual factors, including sources of information and social and economic pressures to use or reject prevention options, shaped their perceptions and selection of these methods and affected adoption of female condoms as an additional tool. Efforts to improve uptake of effective prevention methods among low-income sex workers require attention to the context and spectrum of women's HIV/STI prevention practices when introducing innovations such as female condoms, microbicides, pre-exposure prophylaxis pills, and others, as they become available.
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Affiliation(s)
- Jennifer Dunn
- 1 Institute for Community Research, Hartford, Connecticut, USA
| | | | | | - Jianghong Li
- 1 Institute for Community Research, Hartford, Connecticut, USA
| | - Susu Liao
- 3 Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Li
- 3 Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Aniagyei SE, Sims LB, Malik DA, Tyo KM, Curry KC, Kim W, Hodge DA, Duan J, Steinbach-Rankins JM. Evaluation of poly(lactic-co-glycolic acid) and poly(dl-lactide-co-ε-caprolactone) electrospun fibers for the treatment of HSV-2 infection. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 72:238-251. [PMID: 28024582 PMCID: PMC5810955 DOI: 10.1016/j.msec.2016.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
More diverse multipurpose prevention technologies are urgently needed to provide localized, topical pre-exposure prophylaxis against sexually transmitted infections (STIs). In this work, we established the foundation for a multipurpose platform, in the form of polymeric electrospun fibers (EFs), to physicochemically treat herpes simplex virus 2 (HSV-2) infection. To initiate this study, we fabricated different formulations of poly(lactic-co-glycolic acid) (PLGA) and poly(dl-lactide-co-ε-caprolactone) (PLCL) EFs that encapsulate Acyclovir (ACV), to treat HSV-2 infection in vitro. Our goals were to assess the release and efficacy differences provided by these two different biodegradable polymers, and to determine how differing concentrations of ACV affected fiber efficacy against HSV-2 infection and the safety of each platform in vitro. Each formulation of PLGA and PLCL EFs exhibited high encapsulation efficiency of ACV, sustained-delivery of ACV through one month, and in vitro biocompatibility at the highest doses of EFs tested. Additionally, all EF formulations provided complete and efficacious protection against HSV-2 infection in vitro, regardless of the timeframe of collected fiber eluates tested. This work demonstrates the potential for PLGA and PLCL EFs as delivery platforms against HSV-2, and indicates that these delivery vehicles may be expanded upon to provide protection against other sexually transmitted infections.
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Affiliation(s)
- Stella E Aniagyei
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, United States
| | - Lee B Sims
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, United States
| | - Danial A Malik
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, United States
| | - Kevin M Tyo
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, United States; Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, United States
| | - Keegan C Curry
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, United States
| | - Woihwan Kim
- Department of Medicine, University of Louisville, Louisville, KY 40202, United States
| | - Daniel A Hodge
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, United States
| | - Jinghua Duan
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, United States; Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, United States
| | - Jill M Steinbach-Rankins
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, United States; Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, United States; Department of Microbiology and Immunology, University of Louisville, Louisville, KY 40202, United States; Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, United States.
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Friend DR. An update on multipurpose prevention technologies for the prevention of HIV transmission and pregnancy. Expert Opin Drug Deliv 2016; 13:533-45. [PMID: 26742698 DOI: 10.1517/17425247.2016.1134485] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Multipurpose Prevention Technologies (MPTs) are designed to address two or more indications from a single product. The overall goal is to prevent unintended pregnancy and transmission of one or more STIs including HIV-1. AREAS COVERED The topics covered herein are advances in over the past three years. Advances include development of novel intravaginal rings capable of releasing microbicides to prevent transmission of HIV-1 and unintended pregnancy. These rings include the potential to prevent transmission of more than one STI and unintended pregnancy. There are also gels that can potentially accomplish the same thing. Finally, combination of a drug and barrier device are also covered. EXPERT OPINION There has been considerable advance in this field over the past three years. There is one ring currently in a Phase I clinical trial and others are soon to follow. Some of these drug delivery systems are by necessity rather complicated and hence could be prohibitively expensive in the developing world. Conducting multiple clinical trials to support regulatory approval of two or more indications represents a significant barrier. It remains unclear that women will be more motivated to use MPT products than has been observed in recent microbicide-only clinical trials. Despite these challenges, the need for MPTs remain acute hopefully ensuring they will continue to be developed over the coming years.
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Ugaonkar SR, Wesenberg A, Wilk J, Seidor S, Mizenina O, Kizima L, Rodriguez A, Zhang S, Levendosky K, Kenney J, Aravantinou M, Derby N, Grasperge B, Gettie A, Blanchard J, Kumar N, Roberts K, Robbiani M, Fernández-Romero JA, Zydowsky TM. A novel intravaginal ring to prevent HIV-1, HSV-2, HPV, and unintended pregnancy. J Control Release 2015; 213:57-68. [PMID: 26091920 DOI: 10.1016/j.jconrel.2015.06.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/02/2015] [Accepted: 06/14/2015] [Indexed: 12/12/2022]
Abstract
Women urgently need a self-initiated, multipurpose prevention technology (MPT) that simultaneously reduces their risk of acquiring HIV-1, HSV-2, and HPV (latter two associated with increased risk of HIV-1 acquisition) and prevents unintended pregnancy. Here, we describe a novel core-matrix intravaginal ring (IVR), the MZCL IVR, which effectively delivered the MZC combination microbicide and a contraceptive. The MZCL IVR contains four active pharmaceutical ingredients (APIs): MIV-150 (targets HIV-1), zinc acetate (ZA; targets HIV-1 and HSV-2), carrageenan (CG; targets HPV and HSV-2), and levonorgestrel (LNG; targets unintended pregnancy). The elastomeric IVR body (matrix) was produced by hot melt extrusion of the non-water swellable elastomer, ethylene vinyl acetate (EVA-28), containing the hydrophobic small molecules, MIV-150 and LNG. The solid hydrophilic core, embedded within the IVR by compression, contained the small molecule ZA and the macromolecule CG. Hydrated ZA/CG from the core was released by diffusion via a pore on the IVR while the MIV-150/LNG diffused from the matrix continuously for 94 days (d) in vitro and up to 28 d (study period) in macaques. The APIs released in vitro and in vivo were active against HIV-1ADA-M, HSV-2, and HPV16 PsV in cell-based assays. Serum LNG was at levels associated with local contraceptive effects. The results demonstrate proof-of-concept of a novel core-matrix IVR for sustained and simultaneous delivery of diverse molecules for the prevention of HIV, HSV-2 and HPV acquisition, as well as unintended pregnancy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Brooke Grasperge
- Tulane National Primate Research Center, Tulane University, Covington, LA 70433, USA
| | - Agegnehu Gettie
- Aaron Diamond AIDS Research Center, Rockefeller University, NY 10065, USA
| | - James Blanchard
- Tulane National Primate Research Center, Tulane University, Covington, LA 70433, USA
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Steinbach JM. Protein and oligonucleotide delivery systems for vaginal microbicides against viral STIs. Cell Mol Life Sci 2015; 72:469-503. [PMID: 25323132 PMCID: PMC11113570 DOI: 10.1007/s00018-014-1756-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/10/2014] [Accepted: 10/06/2014] [Indexed: 01/17/2023]
Abstract
Intravaginal delivery offers an effective option for localized, targeted, and potent microbicide delivery. However, an understanding of the physiological factors that impact intravaginal delivery must be considered to develop the next generation of microbicides. In this review, a comprehensive discussion of the opportunities and challenges of intravaginal delivery are highlighted, in the context of the intravaginal environment and currently utilized dosage forms. After a subsequent discussion of the stages of microbicide development, the intravaginal delivery of proteins and oligonucleotides is addressed, with specific application to HSV and HIV. Future directions may include the integration of more targeted delivery modalities to virus and host cells, in addition to the use of biological agents to affect specific genes and proteins involved in infection. More versatile and multipurpose solutions are envisioned that integrate new biologicals and materials into potentially synergistic combinations to achieve these goals.
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Affiliation(s)
- Jill M Steinbach
- Department of Bioengineering, Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., CTRB, Room 623, Louisville, KY, 40202, USA.
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Das U, Sharma M, Kilbourne-Brook M, Coffey PS. Exploring vaginal ring acceptability for contraception and sexually transmissible infection protection in India: a qualitative research study. Sex Health 2015; 12:532-40. [PMID: 26259736 DOI: 10.1071/sh15045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/17/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background New vaginal rings are being developed as single and multipurpose prevention technologies to protect women from pregnancy and/or sexually transmissible infections, such as HIV. Data on ring acceptability in low-resource settings is critical for new technologies to meet user needs. METHODS Women from slum and lower-income areas around Delhi, India, participated in focus group discussions on vaginal ring product perceptions and preferences. Participants were recruited based on following eligibility categories: age, marital status, contraceptive use, and number of children. The translated transcriptions of the qualitative data were analysed using a coding scheme generated from the areas of inquiry and relevant literature. RESULTS A total of 103 women from lower-middle-class or slum areas in Delhi participated in 13 focus group discussions between December 2012 and January 2013. Participants shared perceptions of vaginal ring product attributes, including size, colour, intended use (single indication or dual purpose), duration of use, side effects, biodegradability, and various preferences regarding product use, including access, use during sex, wear patterns, cleaning, and disposal. Participants also reflected on willingness to pay and male partner acceptability. CONCLUSIONS The results of this hypothetical acceptability study indicate that these low-income women in Delhi are: willing to try vaginal rings; unconcerned about wearing them during sex; very interested in protection from infections and unintended pregnancy; indifferent about colour of new rings; emphatic about being told that rings may change colour from menstrual blood staining; comfortable with thinner rings; willing to try thicker rings once familiar with thinner rings; in favour of starting with 1-month rings and then transitioning to longer-term rings; and in favour of first accessing rings at a facility and then managing resupply independently.
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Malcolm RK, Boyd P, McCoy CF, Murphy DJ. Beyond HIV microbicides: multipurpose prevention technology products. BJOG 2014; 121 Suppl 5:62-9. [PMID: 25335842 DOI: 10.1111/1471-0528.12852] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
Abstract
Multipurpose prevention technologies (MPTs) that aim to simultaneously prevent unintended pregnancy, HIV-1 infection and other sexually transmitted infections are among the most innovative and complex products currently in development within women's sexual and reproductive health care. In this review article, MPTs are placed within the wider context of combination products, combination drug products and multi-indication products. The current MPT product landscape is mapped and assessed with reference to existing products for the corresponding single indications, before identifying the gaps in the current MPT product pipeline and highlighting priority products and challenges moving forward.
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Affiliation(s)
- R K Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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Clark JT, Clark MR, Shelke NB, Johnson TJ, Smith EM, Andreasen AK, Nebeker JS, Fabian J, Friend DR, Kiser PF. Engineering a segmented dual-reservoir polyurethane intravaginal ring for simultaneous prevention of HIV transmission and unwanted pregnancy. PLoS One 2014; 9:e88509. [PMID: 24599325 PMCID: PMC3943718 DOI: 10.1371/journal.pone.0088509] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/07/2014] [Indexed: 11/06/2022] Open
Abstract
The HIV/AIDS pandemic and its impact on women prompt the investigation of prevention strategies to interrupt sexual transmission of HIV. Long-acting drug delivery systems that simultaneously protect womenfrom sexual transmission of HIV and unwanted pregnancy could be important tools in combating the pandemic. We describe the design, in silico, in vitro and in vivo evaluation of a dual-reservoir intravaginal ring that delivers the HIV-1 reverse transcriptase inhibitor tenofovir and the contraceptive levonorgestrel for 90 days. Two polyether urethanes with two different hard segment volume fractions were used to make coaxial extruded reservoir segments with a 100 µm thick rate controlling membrane and a diameter of 5.5 mm that contain 1.3 wt% levonorgestrel. A new mechanistic diffusion model accurately described the levonorgestrel burst release in early time points and pseudo-steady state behavior at later time points. As previously described, tenofovir was formulated as a glycerol paste and filled into a hydrophilic polyurethane, hollow tube reservoir that was melt-sealed by induction welding. These tenofovir-eluting segments and 2 cm long coaxially extruded levonorgestrel eluting segments were joined by induction welding to form rings that released an average of 7.5 mg tenofovir and 21 µg levonorgestrel per day in vitro for 90 days. Levonorgestrel segments placed intravaginally in rabbits resulted in sustained, dose-dependent levels of levonorgestrel in plasma and cervical tissue for 90 days. Polyurethane caps placed between segments successfully prevented diffusion of levonorgestrel into the tenofovir-releasing segment during storage.Hydrated rings endured between 152 N and 354 N tensile load before failure during uniaxial extension testing. In summary, this system represents a significant advance in vaginal drug delivery technology, and is the first in a new class of long-acting multipurpose prevention drug delivery systems.
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Affiliation(s)
- Justin T. Clark
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Meredith R. Clark
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Arlington, Virginia, United States of America
| | - Namdev B. Shelke
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Todd J. Johnson
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Eric M. Smith
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Andrew K. Andreasen
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Joel S. Nebeker
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Judit Fabian
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - David R. Friend
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Arlington, Virginia, United States of America
| | - Patrick F. Kiser
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston IL, United States of America
- * E-mail:
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Friend DR, Clark JT, Kiser PF, Clark MR. Multipurpose prevention technologies: products in development. Antiviral Res 2013; 100 Suppl:S39-47. [PMID: 24188708 DOI: 10.1016/j.antiviral.2013.09.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 09/28/2013] [Accepted: 09/29/2013] [Indexed: 11/16/2022]
Abstract
Multipurpose prevention technologies (MPTs) are broadly defined as products capable of simultaneously addressing multiple sexual and reproductive health needs including unintended pregnancy, STIs including HIV-1, and other reproductive tract infections. MPTs have been discussed for a few decades but little product development has occurred. With the recent proof-of-concept that a topically applied antiretroviral (ARV) can effectively reduce sexual transmission of HIV-1 (tenofovir 1% gel) the impetus to develop MPTs is gaining momentum. Products currently in development are broadly categorized as either long-acting or on-demand. Long-acting MPTs include intravaginal rings (IVRs) and long-acting injectable products. Several IVR MPTs are under development including one designed to release tenofovir to prevent transmission of HIV-1 and levonorgestrel (LNG) to prevent unintended pregnancy over a 90-day period. Another MPT IVR under development is designed to release the ARV dapivirine and LNG for 2 months. Long-acting injectable pre-exposure prophylaxis (PrEP) formulations of rilpivirine (TMC278) and GSK1265744 have entered clinical evaluation and could form the basis of long-acting injectable products for HIV-1 prevention and prevention of unintended pregnancy. On-demand products include TFV 1% gel (HIV-1/HSV-2 prevention), a zinc/carrageenan zinc gel (HIV-1/HSV-2 prevention), and the SILCS diaphragm administered with TFV 1% gel. Significant technical, funding, and regulatory hurdles must be overcome to develop most MPTs; however, the significant reproductive health benefits to many women around the world should provide motivation to overcome these hurdles. This article is based on a presentation at the "Product Development Workshop 2013: HIV and Multipurpose Prevention Technologies", held in Arlington, Virginia on February 21-22, 2013. It forms part of a special supplement to Antiviral Research.
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Affiliation(s)
- David R Friend
- CONRAD Program, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 1911 N. Fort Myer Drive, Suite 900, Arlington, VA 22209, United States.
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Polis CB, Westreich D, Balkus JE, Heffron R. Assessing the effect of hormonal contraception on HIV acquisition in observational data: challenges and recommended analytic approaches. AIDS 2013; 27 Suppl 1:S35-43. [PMID: 24088682 PMCID: PMC4153830 DOI: 10.1097/qad.0000000000000036] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Determining whether hormonal contraception, particularly the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), increases a woman's risk of HIV acquisition is a priority question for public health. However, assessing the relationship between various hormonal contraceptive methods and HIV acquisition with observational data involves substantial analytic design issues and challenges. Studies to date have used inconsistent approaches and generated a body of evidence that is complex and challenging to interpret. METHODS In January 2013, the United States Agency for International Development and FHI 360 supported a meeting of epidemiologists, statisticians, and content experts to develop recommendations for future observational analyses of hormonal contraception and HIV acquisition. RESULTS Meeting participants generated recommendations regarding careful definition of exposure groups; handling potential confounders, mediators, and effect modifiers; estimating and addressing the magnitude of measurement error; using multiple methods to account for pregnancy; and exploring the potential for differential exposure to HIV-infected partners. Advantages and disadvantages of various statistical approaches to account for time-varying confounding and estimating total and direct effects were also discussed. CONCLUSION Implementing these recommendations in future observational hormonal contraception-HIV acquisition analyses will enhance interpretation of existing studies and strengthen the overall evidence base for this complex and important area.
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Affiliation(s)
- Chelsea B Polis
- aOffice of Population and Reproductive Health, United States Agency for International Development (USAID), Washington, DC bDepartment of Epidemiology, University of North Carolina, Chapel Hill cDepartment of Obstetrics & Gynecology and Global Health Institute, Duke University, Durham, North Carolina dVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center eDepartment of Global Health, University of Washington, Seattle, Washington, USA. *Chelsea B. Polis, Daniel Westreich, Jennifer E. Balkus and Renee Heffron contributed equally to the writing of the article
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Friend DR, Kiser PF. Assessment of topical microbicides to prevent HIV-1 transmission: Concepts, testing, lessons learned. Antiviral Res 2013; 99:391-400. [DOI: 10.1016/j.antiviral.2013.06.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/26/2013] [Accepted: 06/28/2013] [Indexed: 11/30/2022]
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Moss JA, Malone AM, Smith TJ, Kennedy S, Nguyen C, Vincent KL, Motamedi M, Baum MM. Pharmacokinetics of a multipurpose pod-intravaginal ring simultaneously delivering five drugs in an ovine model. Antimicrob Agents Chemother 2013; 57:3994-7. [PMID: 23752507 PMCID: PMC3719699 DOI: 10.1128/aac.00547-13] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 06/01/2013] [Indexed: 02/03/2023] Open
Abstract
Multipurpose technologies that simultaneously protect from sexually transmitted infections and unintended pregnancy are urgently needed. Pod-intravaginal rings (IVRs) formulated with the antiretroviral agents (ARVs) tenofovir, nevirapine, and saquinavir and the contraceptives etonogestrel and estradiol were evaluated in sheep. Steady-state concentrations were maintained for 28 days with controlled, sustained delivery. This proof-of-principle study demonstrates that pod IVRs can deliver three ARVs from different mechanistic classes and a progestin-estrogen combination over the wide range needed for putative preventative efficacy.
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Affiliation(s)
- John A. Moss
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, USA
| | | | - Thomas J. Smith
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, USA
- Auritec Pharmaceuticals, Inc., Santa Monica, California, USA
| | - Sean Kennedy
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, USA
| | - Cali Nguyen
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, USA
- Auritec Pharmaceuticals, Inc., Santa Monica, California, USA
| | - Kathleen L. Vincent
- Center for Biomedical Engineering, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Massoud Motamedi
- Center for Biomedical Engineering, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Marc M. Baum
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, USA
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Harrison PF, Hemmerling A, Romano J, Whaley KJ, Young Holt B. Developing multipurpose reproductive health technologies: an integrated strategy. AIDS Res Treat 2013; 2013:790154. [PMID: 23533733 PMCID: PMC3600264 DOI: 10.1155/2013/790154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 11/17/2022] Open
Abstract
WOMEN WORLDWIDE CONFRONT TWO FREQUENTLY CONCURRENT REPRODUCTIVE HEALTH CHALLENGES: the need for contraception and for protection from sexually transmitted infections, importantly HIV/AIDS. While conception and infection share the same anatomical site and mode of transmission, there are no reproductive health technologies to date that simultaneously address that reality. Relevant available technologies are either contraceptive or anti-infective, are limited in number, and require different modes of administration and management. These "single-indication" technologies do not therefore fully respond to what is a substantial reproductive health need intimately linked to pivotal events in many women's lives. This paper reviews an integrated attempt to develop multipurpose prevention technologies-"MPTs"-products explicitly designed to simultaneously address the need for both contraception and protection from sexually transmitted infections. It describes an innovative and iterative MPT product development strategy with the following components: identifying different needs for such technologies and global variations in reproductive health priorities, defining "Target Product Profiles" as the framework for a research and development "roadmap," collating an integrated MPT pipeline and characterizing significant pipeline gaps, exploring anticipated regulatory requirements, prioritizing candidates for problem-solving and resource investments, and implementing an ancillary advocacy agenda to support this breadth of effort.
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Affiliation(s)
- P. F. Harrison
- Coalition for Advancing Multipurpose Innovations (CAMI)/Public Health Institute, USA
- AVAC, Global Advocacy for HIV Prevention, New York, USA
| | - A. Hemmerling
- Coalition for Advancing Multipurpose Innovations (CAMI)/Public Health Institute, USA
- University of California, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
| | | | | | - B. Young Holt
- Coalition for Advancing Multipurpose Innovations (CAMI)/Public Health Institute, USA
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A 90-day tenofovir reservoir intravaginal ring for mucosal HIV prophylaxis. Antimicrob Agents Chemother 2012; 56:6272-83. [PMID: 23006751 DOI: 10.1128/aac.01431-12] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A vaginal gel containing the antiretroviral tenofovir (TFV) recently demonstrated 39% protection against HIV infection in women. We designed and evaluated a novel reservoir TFV intravaginal ring (IVR) to potentially improve product effectiveness by providing a more controlled and sustained vaginal dose to maintain cervicovaginal concentrations. Polyurethane tubing of various hydrophilicities was filled with a high-density TFV/glycerol/water semisolid paste and then end-sealed to create IVRs. In vitro, TFV release increased with polyurethane hydrophilicity, with 35 weight percent water-swelling polyurethane IVRs achieving an approximately 10-mg/day release for 90 days with mechanical stiffness similar to that of the commercially available NuvaRing. This design was evaluated in two 90-day in vivo sheep studies for TFV pharmacokinetics and safety. Overall, TFV vaginal tissue, vaginal fluid, and plasma levels were relatively time independent over the 90-day duration at approximately 10(4) ng/g, 10(6) ng/g, and 10(1) ng/ml, respectively, near or exceeding the highest observed concentrations in a TFV 1% gel control group. TFV vaginal fluid concentrations were approximately 1,000-fold greater than levels shown to provide significant protection in women using the TFV 1% gel. There were no toxicological findings following placebo and TFV IVR treatment for 28 or 90 days, although slight to moderate increases in inflammatory infiltrates in the vaginal epithelia were observed in these animals compared to naïve animals. In summary, the controlled release of TFV from this reservoir IVR provided elevated sheep vaginal concentrations for 90 days to merit its further evaluation as an HIV prophylactic.
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Tan D. Potential role of tenofovir vaginal gel for reduction of risk of herpes simplex virus in females. Int J Womens Health 2012; 4:341-50. [PMID: 22927765 PMCID: PMC3422111 DOI: 10.2147/ijwh.s27601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A surprising result of the groundbreaking CAPRISA-004 trial, which demonstrated the efficacy of vaginal tenofovir 1% gel in reducing the risk of human immunodeficiency virus (HIV)-1 infection by 39% in heterosexual women, was the added benefit of this microbicide in reducing acquisition of herpes simplex virus type 2 (HSV-2) by 51%. HSV-2 is the most common cause of genital ulcer disease worldwide, and is responsible for considerable morbidity among women and neonates. The virus is further implicated in increasing the risk of both HIV acquisition and transmission, and may have additional adverse consequences in HIV-coinfected persons, making HSV-2 prevention an important clinical and public health objective. While tenofovir had not previously been widely considered to be an anti-herpes drug, in vitro activity against HSV is well documented, raising interest in potential future applications of tenofovir and its prodrugs in HSV-2 control. This article reviews the currently available data for tenofovir as an anti-herpes agent, as well as unanswered questions about delivery systems, drug formulation, rectal administration, drug resistance, and clinical applications.
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Affiliation(s)
- Dhs Tan
- Divisions of Infectious Diseases, St Michael's Hospital, University, Health Network, and University of Toronto, Toronto, Canada
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