Vaginal suppositories containingLactobacillus acidophilus: development and characterization

Fabrication and characterization of bioprints with Lactobacillus crispatus for vaginal application

Bacterial vaginosis (BV) is characterized by low levels of lactobacilli and overgrowth of potential pathogens in the female genital tract. Current antibiotic treatments often fail to treat BV in a sustained manner, and > 50% of women experience recurrence within 6 months post-treatment. Recently, lactobacilli have shown promise for acting as probiotics by offering health benefits in BV. However, as with other active agents, probiotics often require intensive administration schedules incurring difficult user adherence. Three-dimensional (3D)-bioprinting enables fabrication of well-defined architectures with tunable release of active agents, including live mammalian cells, offering the potential for long-acting probiotic delivery. One promising bioink, gelatin alginate has been previously shown to provide structural stability, host compatibility, viable probiotic incorporation, and cellular nutrient diffusion. This study formulates and characterizes 3D-bioprinted Lactobacillus crispatus-containing gelatin alginate scaffolds for gynecologic applications. Different weight to volume (w/v) ratios of gelatin alginate were bioprinted to determine formulations with highest printing resolution, and different crosslinking reagents were evaluated for effect on scaffold integrity via mass loss and swelling measurements. Post-print viability, sustained-release, and vaginal keratinocyte cytotoxicity assays were conducted. A 10:2 (w/v) gelatin alginate formulation was selected based on line continuity and resolution, while degradation and swelling experiments demonstrated greatest structural stability with dual genipin and calcium crosslinking, showing minimal mass loss and swelling over 28 days. 3D-bioprinted L. crispatus-containing scaffolds demonstrated sustained release and proliferation of live bacteria over 28 days, without impacting viability of vaginal epithelial cells. This study provides in vitro evidence for 3D-bioprinted scaffolds as a novel strategy to sustain probiotic delivery with the ultimate goal of restoring vaginal lactobacilli following microbiological disturbances.

Drugging the microbiome and bacterial live biotherapeutic consortium production

Research leading to characterization, quantification, and functional attribution of the microbes throughout the human body has led to many drug-development programs. These programs aim to manipulate a patient's microbiome through the addition of new strains or functions, the subtraction of deleterious microbes, or the rebalancing of the existing population through various drug modalities. Here, we present a general overview of those modalities with a specific focus on bacterial live biotherapeutic products (LBPs). The bacterial LBP modality has unique concerns to ensure product quality, thus, topics related to manufacturing, quality control, and regulation are addressed.

Formulation and Optimization of Metronidazole and Lactobacillus spp. Layered Suppositories via a Three-Variable, Five-Level Central Composite Design for the Management of Bacterial Vaginosis

Bacterial vaginosis, a polymicrobial clinical syndrome characterized by a shift in healthy vaginal microbiota due to bacterial colonization, is characterized by high recurrence rates after conventional treatment with an antimicrobial agent. This has necessitated the need to develop a formulation that has the potential to ensure Lactobacilli viability and bacterial clearance. This study seeks to develop and optimize a layered suppository using a five-level central composite design to ensure optimized metronidazole release and lactic acid viability. Layered suppositories were formulated using the fusion method using polyethylene glycol blend 1500/4000 and Ovucire^® as suppository bases. Lactobacillus fermentum was incorporated in the molten mass before molding the solid body suppositories into the cavity of hollow-type suppositories and sealing the molten excipients. Artificial neural network model predictions for product optimization showed high predictive capacity, closely resembling experimental observations. The highest disintegration time recorded was 12.76 ± 0.37 min, with the optimized formulations showing lower times of 5.93 ± 0.98 min and an average weight of 1.17 ± 0.07 g. Histopathological observations determined high compatibility of suppositories with vaginal cells with no distortion or wearing of the vagina epithelium. This optimized formulation provides a safe and promising alternative to conventional suppositories in the treatment and prevention of the recurrence of bacterial vaginosis.

Characteristics of Probiotic Preparations and Their Applications

The probiotics market is one of the fastest growing segments of the food industry as there is growing scientific evidence of the positive health effects of probiotics on consumers. Currently, there are various forms of probiotic products and they can be categorized according to dosage form and the site of action. To increase the effectiveness of probiotic preparations, they need to be specifically designed so they can target different sites, such as the oral, upper respiratory or gastrointestinal tracts. Here we review the characteristics of different dosage forms of probiotics and discuss methods to improve their bioavailability in detail, in the hope that this article will provide a reference for the development of probiotic products.

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.

Development of bifunctional vaginal suppositories by joint use terconazole and probiotic for treatment and prophylaxis of vulvovaginal candidiasis

OBJECTIVE

The objective of this article is the creation and investigation of bifunctional suppositories that are endowed with antifungal and probiotic properties intended for the treatment of vulvovaginal candidiasis (VVC) and colonization of the vaginal cavity by powerful lactobacilli.

MATERIALS AND METHODS

Freeze-dried Lactobacillus delbrueckii MH10 was used as a probiotic, which is an active producer of H₂O₂ isolated from a healthy woman's vagina. Hydrophilic PEG 4000/400, amphiphilic Suppocire AP, and lipophilic Novata ABPH bases were used for the preparation of vaginal suppositories and each included 80 mg terconazole and 25 mg (∼10⁹ CFU) lactobacilli. The release kinetic of active agents from suppositories was studied using the British Pharmacopeia's basket dissolution method, and the physicochemical properties were studied using known methods. Bioadhesion of suppositories was evaluated by flow rate from polyacrylamide substrate inclined at 60°. Antagonism of lactobacillus against fungi was studied using the disk diffusion method and joint cultivation in simulated vaginal fluid.

RESULTS

The release rate of active ingredients from the suppositories was PEG 4000/400 > Suppocire AP > Novata ABPH in decreasing order. Suppositories made of Suppocire AP possessed higher adhesion ability to artificial mucosa and longer shelf life. It was revealed that during joint cultivation L. delbrueckii MH10 kills more than 90% of C. albicans population.

CONCLUSIONS

Due to its physicochemical, biopharmaceutical, and bioadhesive properties, the base Suppocire AP is preferable for manufacturing vaginal bifunctional suppositories. Lactobacilli kill C. albicans by coaggregating and direct releasing hydrogen peroxide onto target cells.

Advancements in the Pharmaceutical Applications of Probiotics: Dosage Forms and Formulation Technology

Probiotics have demonstrated their high potential to treat and/or prevent various diseases including neurodegenerative disorders, cancers, cardiovascular diseases, and inflammatory diseases. Probiotics are also effective against multidrug-resistant pathogens and help maintain a balanced gut microbiota ecosystem. Accordingly, the global market of probiotics is growing rapidly, and research efforts to develop probiotics into therapeutic adjuvants are gaining momentum. However, because probiotics are living microorganisms, many biological and biopharmaceutical barriers limit their clinical application. Probiotics may lose their activity in the harsh gastric conditions of the stomach or in the presence of bile salts. Moreover, they easily lose their viability under thermal or oxidative stress during their preparation and storage. Therefore, stable formulations of probiotics are required to overcome the various physicochemical, biopharmaceutical, and biological barriers and to maximize their therapeutic effectiveness and clinical applicability. This review provides an overview of the pharmaceutical applications of probiotics and covers recent formulation approaches to optimize the delivery of probiotics with particular emphasis on various dosage forms and formulation technologies.

Cisplatin and Probiotic Biomass Loaded Pessaries for the Management of Cervical Cancer

INTRODUCTION

Cancer is a type of disease, in which the growth of cells is abnormal and uncontrolled. One of the most common cancers among women is cervical cancer. In India, cervical cancer is one of leading causes of cancer mortality among women 30 to 69 years of age, accounting for 17% of all cancer deaths. The work present here shows the combined effects of anticancer drug along with probiotics to circumvent the side effects associated with chemotherapy and to enhance the therapeutic effect.

MATERIALS AND METHODS

Cisplatin and drug loaded pessaries were prepared by melt mold method using the blend of PEG's (Polyethylene Glycol) and further characterized for various in vitro and in vivo parameters.

RESULTS AND DISCUSSION

The free radical scavenging activity of probiotic Lactobacillus rhamnosus by DPPH (2,2-diphenyl-1-picrylhydrazyl) assay was observed to be 60.77μg/mL The mean weight variation, melting time, content uniformity, friability and hardness of the prepared pessary were 1.25±0.025mg, 10.86±0.64min, 99.89±0.74, 0.25%, 2.2kg/cm2. Histopathology studies presented that the developed formulation are safe for local delivery of cisplatin.

CONCLUSION

This study provides the basis for a combination of local delivery approach along with the beneficial effects of probiotic strain which could be better a approach for the treatment of cervical cancer.

Influence of Plasticizers on the pH-Dependent Drug Release and Cellular Interactions of Hydroxypropyl Methylcellulose/Zein Vaginal Anti-HIV Films Containing Tenofovir

Vaginal films featuring the pH-dependent release of tenofovir (TFV) were developed for the prevention of sexual transmission of human immunodeficiency syndrome (HIV). Films based on hydroxypropyl methylcellulose and zein were prepared incorporating different plasticizers [oleic acid, lactic acid, glycerol, and polyethylene glycol 400 (PEG)] and evaluated for in vitro drug release in an acidic simulated vaginal fluid (pH 4.2) and a slightly alkaline mixture of simulated seminal and vaginal fluids (pH 7.5). Results revealed that optimal biphasic TFV release was possible with proper combination of plasticizers (PEG and oleic acid, 1:7 w/w) and by adjusting the plasticizer/matrix-forming material ratio. The films had similar or higher levels of TFV associated with genital epithelial cells (Ca Ski or HEC-1-A cells) but lower drug permeability compared to the free drug. These data confirm that films have the potential to achieve suitable mucosal levels of TFV with low systemic exposure. The films developed could protect women from HIV sexual transmission.

Immobilization of vaginal Lactobacillus in polymeric nanofibers for its incorporation in vaginal probiotic products

Probiotic products require high number of viable and active microorganisms during storage. In this work, the survival of human vaginal Lactobacillus gasseri CRL1320 and Lactobacillus rhamnosus CRL1332 after nanofiber-immobilization by electrospinning with polyvinyl-alcohol, and during storage was evaluated. The optimization of bacterial immobilization and storage conditions using bioprotectors (skim milk-lactose and glycerol) and oxygen-excluding packaging was carried out, compared with lyophilization. After electrospinning, a higher survival rate of L. rhamnosus (93%) compared to L. gasseri (84%) was obtained in nanofibers, with high viable cells (>10⁷ colony-forming unit/g) of the two probiotics in nanofibers stored at -20°C up to 14 days. The storage in oxygen-excluding packaging was an excellent strategy to extend the shelf-life of L. rhamnosus (up to 1.7 × 10⁸ CFU/g) in nanofibers stored at 4°C during 360 days, with no addition of bioprotectives, resulting similar to freeze-dried-cells. L. rhamnosus was successfully incorporated into polymeric hydrophilic nanofibers with a mean diameter of 95 nm. The composite materials were characterized in terms of morphology, and their physicochemical and thermal properties assessed. Nanofiber-immobilized L. rhamnosus cells maintained the inhibition to urogenital pathogens. Thus, polymeric nanofiber-immobilized L. rhamnosus CRL1332 can be included in vaginal probiotic products to prevent or treat urogenital infections.

Self-Emulsified Nanoemulsion for Vaginal Administration: In Vitro Study of Effect on Lactobacillus acidophilus

Self-emulsified nanoemulsions (SENs), one of the promising lipid-based drug delivery systems may be used to deliver drugs through vaginal route. Vaginal cavity remains healthy because of the defensive action by its microflora against the pathogenic infections, and any disturbance to this microflora by the delivery systems gives invitation to the infections. In the present study, the growth inhibition and cytotoxic effects of two SENs and their components on L. acidophilus were evaluated. The two SENs showed inhibitory effects on the growth of L. acidophilus in a concentration-dependent manner when tested at the concentration range of 0.1-5.0%. The SEN composed of medium chain mono/di-glyceride had greater inhibitory effect than the one composed of long chain monoglyceride. The study on the effect by the individual lipids with the surfactant Kolliphor® RH40 further confirmed that the growth inhibitory and cytotoxic effects were in the order of Capmul® MCM > Maisine® CC > Miglyol® 810 > Kolliphor® RH40. Both OD₆₀₀ and CFU counting were used to measure the viability of the culture. The results from the two methods were in good correlation except when there was no growth, suggesting OD₆₀₀ can be used when there is no complete growth inhibition.

International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats

Urinary tract disease is a common clinical presentation in dogs and cats, and a common reason for antimicrobial prescription. This document is a revision and expansion on the 2011 Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats, providing recommendations for diagnosis and management of sporadic bacterial cystitis, recurrent bacterial cystitis, pyelonephritis, bacterial prostatitis, and subclinical bacteriuria. Issues pertaining to urinary catheters, medical dissolution of uroliths and prophylaxis for urological procedures are also addressed.

First Steps towards the Pharmaceutical Development of Ovules Containing Lactobacillus Strains: Viability and Antimicrobial Activity as Basic First Parameters in Vaginal Formulations

In the majority of Latin-American countries, including Argentina, there is a limited availability of vaginal bioproducts containing probiotics in the market. In addition, the conventional treatments of genital tract infections in women represent a high cost to the public health systems. The future development of this type of bioproducts that employ specific lactobacilli strains would not only have a meaningful impact on women's health but would also represent a significant challenge to the pharmaceutical industry. The aims of the work described in this paper were (i) to study different pharmaceutical formulations of vaginal ovules containing Lactobacillus fermentum L23 and L. rhamnosus L60, to determine in which formulation lactobacilli viability was sustained for longer time and (ii) to evaluate if probiotic strains maintained both the antimicrobial activity and biofilm-producing ability after being recovered from the ovules. In this study, we developed and characterized three pharmaceutical formulations containing different glycerol amounts and specific lactobacilli strains. Three relevant parameters, cell viability, antimicrobial activity, and biofilm production, by lactobacilli recovered from the ovules were tested. Although the viability of L23 and L60 strains was mainly influenced by high ovule's glycerol proportion, they survived at 4 °C during the 180 days. Both lactobacilli's antimicrobial activity and biofilm-producing ability were maintained for all treatments. In conclusion, employing a much reduced number of components, we were able to select the most suitable pharmaceutical formulation which maintained not only lactobacilli viability for a long period of time but also their antimicrobial activity and biofilm-producing ability.

Evaluation of the Live Biotherapeutic Product, Asymptomatic Bacteriuria Escherichia coli 2-12, in Healthy Dogs and Dogs with Clinical Recurrent UTI

Background

Antimicrobial resistance is an emerging problem.

Hypothesis/Objective

To investigate the safety and efficacy of a live biotherapeutic product, ASB E. coli 2‐12 for UTI treatment.

Animals

Six healthy research dogs; nine client‐owned dogs with recurrent UTI.

Methods

Prospective noncontrolled clinical trial. For safety data, research dogs were sedated, a urinary catheter was inserted into the bladder; 10¹⁰CFU/mL of ASB E. coli 2‐12 was instilled. Urine was cultured on days 1, 3, and 8 post‐instillation and dogs were observed for lower urinary tract signs (LUTS). For client‐owned dogs, ASB E. coli 2‐12 was instilled similarly and urine cultures analyzed on days 1, 7, and 14 days postinstillation.

Results

No LUTS were noted in any of the 6 research dogs after ASB E. coli 2‐12 infusion. Pulse field gel electrophoresis (PFGE) studies confirmed the bacterial strains isolated matched that ASB E. coli 2‐12 strain. Four of the nine client‐owned dogs had complete or nearly complete clinical cures by day 14. Of these four dogs, 3 also had microbiologic cures at day 14; one of these dogs had subclinical bacteriuria (in addition to ASB E. coli 2‐12). Three of these four dogs had ASB E. coli 2‐12 isolated from their urine at day 14. With the exception of mild, temporary, self‐limiting, hyporexia in two dogs on the day of biotherapeutic administration, there were no major adverse effects.

Conclusions and Clinical Importance

These results suggest ASB E. coli 2‐12 is safe and should be investigated in a larger controlled study evaluating clinical UTI in dogs.