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Conte J, Saatkamp RH, Sanches MP, Argenta DF, da Rosa Monte Machado G, Kretzer IF, Parize AL, Caon T. Development of biopolymer films loaded with fluconazole and thymol for resistant vaginal candidiasis. Int J Biol Macromol 2024:133356. [PMID: 38945715 DOI: 10.1016/j.ijbiomac.2024.133356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
Vulvovaginal candidiasis (VVC) is an opportunistic infection caused by a fungus of the Candida genus, affecting approximately 75 % of women during their lifetime. Fungal resistance cases and adverse effects have been the main challenges of oral therapies. In this study, the topical application of thin films containing fluconazole (FLU) and thymol (THY) was proposed to overcome these problems. Vaginal films based only on chitosan (CH) or combining this biopolymer with pectin (PEC) or hydroxypropylmethylcellulose acetate succinate (HPMCAS) were developed by the solvent casting method. In addition to a higher swelling index, CH/HPMCAS films showed to be more plastic and flexible than systems prepared with CH/PEC or only chitosan. Biopolymers and FLU were found in an amorphous state, contributing to explaining the rapid gel formation after contact with vaginal fluid. High permeability rates of FLU were also found after its immobilization into thin films. The presence of THY in polymer films increased the distribution of FLU in vaginal tissues and resulted in improved anti-Candida activity. A significant activity against the resistant C. glabrata was achieved, reducing the required FLU dose by 50 %. These results suggest that the developed polymer films represent a promising alternative for the treatment of resistant vulvovaginal candidiasis, encouraging further studies in this context.
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Affiliation(s)
- Júlia Conte
- Postgraduate Program in Pharmacy (PGFAR), Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Rodrigo Henrique Saatkamp
- Postgraduate Program in Chemistry, Chemistry Department, Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Mariele Paludetto Sanches
- Postgraduate Program in Chemistry, Chemistry Department, Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Débora Fretes Argenta
- Postgraduate Program in Pharmacy (PGFAR), Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Gabriella da Rosa Monte Machado
- Postgraduate Program in Pharmacy (PGFAR), Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Iara Fabrícia Kretzer
- Postgraduate Program in Pharmacy (PGFAR), Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Alexandre Luis Parize
- Postgraduate Program in Chemistry, Chemistry Department, Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil
| | - Thiago Caon
- Postgraduate Program in Pharmacy (PGFAR), Federal University of Santa Catarina, Trindade, 88040-900 Florianopolis, SC, Brazil.
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Subi MTM, Selvasudha N, Vasanthi HR. Vaginal drug delivery system: A promising route of drug administration for local and systemic diseases. Drug Discov Today 2024; 29:104012. [PMID: 38705512 DOI: 10.1016/j.drudis.2024.104012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
Scientists around the globe have done cutting-edge research to facilitate the delivery of poorly absorbed drugs via various routes of administration and different delivery systems. The vaginal route of administration has emerged as a promising mode of drug delivery, attributed to its anatomy and physiology. Novel drug delivery systems overcome the demerits of conventional systems via nanobiotechnology. This review will focus on the disorders associated with women that are currently targeted by vaginal drug delivery systems. In addition, it will provide insights into innovations in drug formulations for the general benefit of women.
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Affiliation(s)
- M Tamil Mani Subi
- Department of Biotechnology, Pondicherry University, Kalapet, Puducherry, India
| | | | - Hannah R Vasanthi
- Department of Biotechnology, Pondicherry University, Kalapet, Puducherry, India.
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Saha I, Halder J, Rajwar TK, Mahanty R, Pradhan D, Dash P, Das C, Rai VK, Kar B, Ghosh G, Rath G. Novel Drug Delivery Approaches for the Localized Treatment of Cervical Cancer. AAPS PharmSciTech 2024; 25:85. [PMID: 38605158 DOI: 10.1208/s12249-024-02801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
Cervical cancer (CC) is the fourth leading cancer type in females globally. Being an ailment of the birth canal, primitive treatment strategies, including surgery, radiation, or laser therapy, bring along the risk of infertility, neonate mortality, premature parturition, etc. Systemic chemotherapy led to systemic toxicity. Therefore, delivering a smaller cargo of therapeutics to the local site is more beneficial in terms of efficacy as well as safety. Due to the regeneration of cervicovaginal mucus, conventional dosage forms come with the limitations of leaking, the requirement of repeated administration, and compromised vaginal retention. Therefore, these days novel strategies are being investigated with the ability to combat the limitations of conventional formulations. Novel carriers can be engineered to manipulate bioadhesive properties and sustained release patterns can be obtained thus leading to the maintenance of actives at therapeutic level locally for a longer period. Other than the purpose of CC treatment, these delivery systems also have been designed as postoperative care where a certain dose of antitumor agent will be maintained in the cervix postsurgical removal of the tumor. Herein, the most explored localized delivery systems for the treatment of CC, namely, nanofibers, nanoparticles, in situ gel, liposome, and hydrogel, have been discussed in detail. These carriers have exceptional properties that have been further modified with the aid of a wide range of polymers in order to serve the required purpose of therapeutic effect, safety, and stability. Further, the safety of these delivery systems toward vital organs has also been discussed.
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Affiliation(s)
- Ivy Saha
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Jitu Halder
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Tushar Kanti Rajwar
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Ritu Mahanty
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Deepak Pradhan
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Priyanka Dash
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Chandan Das
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Vineet Kumar Rai
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Biswakanth Kar
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Goutam Ghosh
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India
| | - Goutam Rath
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, India.
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Liang X, Pacuła-Miszewska AJ, Vartak R, Prajapati M, Zheng H, Zhao C, Mao G, Patel K, Fedosova NU, Ścianowski J, Billack B. N-3-Methylbutyl-benzisoselenazol-3(2H)-one Exerts Antifungal Activity In Vitro and in a Mouse Model of Vulvovaginal Candidiasis. Curr Issues Mol Biol 2024; 46:2480-2496. [PMID: 38534773 DOI: 10.3390/cimb46030157] [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: 01/08/2024] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
In the present work, we evaluated the antifungal activities of two novel ebselen analogs, N-allyl-benzisoselenazol-3(2H)-one (N-allyl-bs) and N-3-methylbutylbenzisoselenazol-3(2H)-one (N-3mb-bs). Colorimetric and turbidity assays were performed to determine the minimum inhibitory concentration (MIC) of these compounds in S1 (fluconazole-sensitive) and S2 (fluconazole-resistant) strains of C. albicans. N-3mb-bs was more active than the N-allyl-bs compound. It is noteworthy that the concentration of N-3mb-bs observed to inhibit fungal growth by 50% (18.2 µM) was similar to the concentration observed to inhibit the activity of the yeast plasma membrane H+-ATPase (Pma1p) by 50% (19.6 µM). We next implemented a mouse model of vulvovaginal candidiasis (VVC) using the S1 strain and examined the mouse and yeast proteins present in the vaginal lavage fluid using proteomics. The yeast proteins detected were predominately glycolytic enzymes or virulence factors associated with C. albicans while the mouse proteins present in the lavage fluid included eosinophil peroxidase, desmocollin-1, and gasdermin-A. We then utilized the N-3mb-bs compound (12.5 mg/kg) in the mouse VVC model and observed that it significantly reduced the vaginal fungal burden, histopathological changes in vagina tissue, and expression of myeloperoxidase (MPO). All in all, the present work has identified a potentially promising drug candidate for VVC treatment.
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Affiliation(s)
- Xiuyi Liang
- Department of Pharmaceutical Sciences, St. John's University, Queens, NY 11439, USA
| | | | - Richa Vartak
- Department of Pharmaceutical Sciences, St. John's University, Queens, NY 11439, USA
| | - Milankumar Prajapati
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI 02912, USA
| | - Haiyan Zheng
- Center for Advanced Biotechnology and Medicine, Piscataway, NJ 08854, USA
| | - Caifeng Zhao
- Center for Advanced Biotechnology and Medicine, Piscataway, NJ 08854, USA
| | - Ganming Mao
- Department of Pharmaceutical Sciences, St. John's University, Queens, NY 11439, USA
| | - Ketankumar Patel
- Department of Pharmaceutical Sciences, St. John's University, Queens, NY 11439, USA
| | | | - Jacek Ścianowski
- Faculty of Chemistry, Nicolaus Copernicus University, 87-100 Toruń, Poland
| | - Blase Billack
- Department of Pharmaceutical Sciences, St. John's University, Queens, NY 11439, USA
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El-Salamouni NS, Yakout MA, Labib GS, Farid RM. Preparation and evaluation of vaginal suppo-sponges loaded with benzydamine, in-vitro/in-vivo study. Pharm Dev Technol 2024; 29:86-97. [PMID: 38243554 DOI: 10.1080/10837450.2024.2306803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
This study aimed to design a new Benzydamine HCl (BNZ) suppo-sponge for controlled, mucoadhesive dosage form for vaginal candidiasis treatment, offering advantages over traditional creams, ointments, or gels. BNZ-loaded suppo-sponges were fabricated by simple casting / freeze-drying technique utilizing the cross-linking of chitosan (Cs) with vanillin (V). Vaginal suppo-sponges were prepared based on different vanillin cross-linking ratios (V).n), from 0 to 2%w/w. To best of our knowledge, this is the first study that uses Schiff's base between chitosan and vanillin as a drug delivery system to treat fungal vaginal infections. Schiff's base formation was confirmed by FT-IR. In-vitro appraisal showed acceptable physical and mechanical characteristics. Formulations based on cross-linking of Cs with V showed a more pronounced in-vitro antifungal activity. In-vitro drug release revealed a prolonged release pattern, becoming more noticeable with the higher cross-linked suppo-sponges (22.34% after 8 h). In-vivo testing of CsV2 suppo-sponge indicated a more pronounced reduction in fungal count than both CsV0 and Tantum® Rosa in the first week, with a peak reduction on day 7 and the 10th and 11th days of the second week. Conclusively, Chitosan/vanillin suppo-sponges represent a promising delivery system for drugs intended for local treatment of vaginal candidiasis. than both CsV0 and Tantum® Rosa in the first week, with a peak reduction on day 7 and the 10th and 11th days of the second week. Conclusively, Chitosan/vanillin suppo-sponges represent a promising delivery system for drugs intended for local treatment of vaginal candidiasis.
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Affiliation(s)
- Noha S El-Salamouni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Marwa A Yakout
- Department of Microbiology & Immunology, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Gihan S Labib
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Ragwa M Farid
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
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Zhao X, Boyd P, Bashi YD, Murphy DJ, McCoy CF, Coulter S, Laverty G, Malcolm RK. Two into one does go: Formulation development of a multipurpose combination vaginal ring releasing dapivirine and metronidazole for prevention of HIV infection and treatment of bacterial vaginosis. Int J Pharm 2023; 648:123572. [PMID: 37926178 DOI: 10.1016/j.ijpharm.2023.123572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Bacterial vaginosis (BV) is a common but often asymptomatic dysbiosis of the human vagina characterized by an imbalance in the normal vaginal microbiota due to loss of lactobacilli and an overgrowth of certain anaerobic bacteria. While BV itself is not a sexually transmitted infection, it is associated with an increased risk in women of various sexually acquired infections, including human immunodeficiency virus (HIV) infection. There is, therefore, a strong rationale for pursuing new multipurpose products that seek to treat or prevent BV alongside preventing HIV infection. With the dapivirine-releasing vaginal ring for HIV prevention now approved in several African countries, here we report formulation development of a next-generation ring product that releases both dapivirine (DPV) and the antibiotic drug metronidazole (MET). Following thermal analysis studies to characterize the phase behaviour of DPV-MET mixtures and rheological analysis to assess the cure characteristics of the active silicone elastomer mixes, matrix-type rings were manufactured containing 25 or 200 mg DPV in combination with 100, 250, 500, 1000 or 2000 mg MET. The results for drug content, in vitro release, mechanical testing, and Gardnerella vaginalis time-kill experiments demonstrate the feasibility of incorporating both DPV and MET in a matrix-type ring formulation and indicate that clinically effective release rates may be possible.
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Affiliation(s)
- Xinyu Zhao
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Peter Boyd
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Yahya Dallal Bashi
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Diarmaid J Murphy
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Clare F McCoy
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Sophie Coulter
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Garry Laverty
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK
| | - R Karl Malcolm
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast BT9 7BL, UK.
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Kola-Mustapha AT, Aliu MH, Bello RH, Adedeji OJ, Ghazali YO. The Formulation and Evaluation of Melaleuca alternifolia Cheel and Cymbopogon flexuosus Linn Essential Oils Emulgel for the Treatment of Vulvovaginal Candidiasis. Gels 2023; 9:949. [PMID: 38131935 PMCID: PMC10743309 DOI: 10.3390/gels9120949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
The global concern regarding the occurrence of antifungal resistance to synthetic conventional azoles used for treating vulvovaginal candidiasis, along with the associated side effects, is significant. Consequently, the pursuit for substitutes such as natural therapies has ensued. Essential oils, derived from plants, have been extensively researched and found to possess antibacterial and antifungal properties. This study aimed to assess the antifungal efficacy of two essential oils, both alone and in combination, against Candida albicans. Essential oils were formulated into an emulgel separately and as combinations. The essential oils of Melaleuca alternifolia and Cymbopogon flexuosus were used in this study. The resulting emulgel formulations were characterized for their antifungal activity against Candida albicans. Physiochemical properties such as pH, viscosity, and appearance were also determined. The prepared emulgels were thereafter observed for stability over a period of 1 month. The MIC of Melaleuca alternifolia was seen to be 50 µL/mL while Cymbopogon flexuous was seen to be more potent at 25 µL/mL against C. albicans exhibiting strong synergistic effect at 0.4. The emulgel formed was white in color, smooth on skin, and had the odor of the essential oils, which is sweet to the nose. The pH of the formulations with the essential oils were acidic in the range of 3.70-3.83, making them suitable for vagina application. The emulgels had viscosities ranging from 4417.6 to 8968.7 mPas, owing to the thickness of the essential oils contained. The emulgel formulation with the combination of essential oils was more potent that the two with individual essential oils; furthermore, the one with Cymbopogon flexuous was more potent than the one with Melaleuca alternifolia. Based on the properties of the formulated emulgels and their activity against the test organism, the preparations have significant potential in the management of vulvovaginal candidiasis.
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Affiliation(s)
- Adeola Tawakalitu Kola-Mustapha
- College of Pharmacy, Alfaisal University, Riyadh 11461, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B 1515, Ilorin 240101, Nigeria
| | - Miracle Halima Aliu
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B 1515, Ilorin 240101, Nigeria
| | - Ronke Hadiyat Bello
- Department of Pharmaceutical Microbiology and Biotechnology, University of Ilorin, P.M.B 1515, Ilorin 240003, Nigeria
| | - Oluwakorede Joshua Adedeji
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B 1515, Ilorin 240101, Nigeria
| | - Yusuf Oluwagbenga Ghazali
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B 1515, Ilorin 240101, Nigeria
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Rahmanian-Devin P, Fadaei MR, Mashreghi M, Askari VR. Preparation and characterization of vaginal suppository of semisynthetic derivatives of ergot alkaloids cabergoline. Saudi Pharm J 2023; 31:101849. [PMID: 38028218 PMCID: PMC10663909 DOI: 10.1016/j.jsps.2023.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background There is evidence that vaginal cabergoline can help to prevent ovarian hyperstimulation syndrome. Therefore, the vaginal suppository may be a good choice because it can be administered directly into the vagina and has no adverse effects on the stomach. In this regard we developed a cabergoline suppository as an alternative to cabergoline tablets. Design-Expert was used to determine the most suitable concentrations of PEG 6000/400, and Tween 80 to obtain a stable suppository. Specific ratios of PEG6000/400 and Tween 80 were entered as factors, and release, melting time, and hardness were evaluated as responses. In addition, the final formulation was evaluated for weight changes, pH, drug content, degradation time, deformation time, in vitro drug release, DSC analysis, infrared spectroscopy, and stability properties. Results The suppositories were all smooth and white. They all had a weight that averaged less than 5 %. The formulations showed a pH between 6 and 6.5. The active ingredient content ranged between 79.666 ± 8.54 % and 99.67 ± 6.55 %. Suppository stiffness was between 2.74 ± 0.04 and 4.20 ± 0.03. The decomposition time of the suppositories varied between 11.25 ± 0.15 to 20.19 ± 0.08 min. The deformation time was between 26.11 ± 0.06 to 38.59 ± 0.47 min. Cabergoline content was released over 45 min from formulations of F10 (∼46 %), F2 (∼64 %), F6 (∼69 %), F4 (∼79 %), F1 (∼88 %), and F7 (∼93 %). However, other formulations released more than 95 % within 45 min. Conclusions All variables except melting time significantly affected our responses. In vitro studies have indicated that the optimized cabergoline formula could be an excellent alternative to cabergoline oral formulations.
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Affiliation(s)
- Pouria Rahmanian-Devin
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Fadaei
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mashreghi
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Reza Askari
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
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Silverstein RG, Cromeens MG, Rowland C, Ogbansiegbe JA, Mihas P, Benhabbour SR, Carey ET. Preferred physical characteristics of lidocaine thin film for women with vestibulodynia. FRONTIERS IN PAIN RESEARCH 2023; 4:1217035. [PMID: 37790121 PMCID: PMC10544975 DOI: 10.3389/fpain.2023.1217035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Vestibulodynia (VBD) is the most common cause of sexual pain in the United States, affecting up to 15% of reproductive-aged women during their lifetime with limited treatment options. The purpose of this study was to describe ideal physical characteristics of a vulvar film designed for insertional sexual pain in sexually active women with VBD. Methods Twenty women were recruited to participant in one of six, semi-structured 60-minute focus group discussions regarding treatment options for VBD. Heterosexual women, aged 18-51 years old with a diagnosis of vulvodynia, vestibulodynia or insertional dyspareunia fit the inclusion criteria. Those who reported no episodes of vaginal intercourse in the prior 18 months were excluded. A new vulvar film technology loaded with 50 mg of 5% lidocaine was introduced to the group. Participants took part in focus groups on a rolling basis depending on availability. Focus group discussions were audio-recorded and transcribed verbatim. Two study investigators coded the transcripts using inductive coding and merged their respective projects to resolve disagreements. We analyzed data related to each code to develop code clusters and higher-level primary topics regarding device preferences. Data related to each of these primary topics was analyzed to assess the range of participant attitudes and preferences and to identify patterns within each primary topic. Results One hundred and sixteen women were recruited, and twenty women were enrolled. The mean age for the participants was 33.3 years. Most women were educated with at least some college (93%), White (78.6%), married (75%), and had income greater than $100,000 (50%). Analysis of the focus group discussions identified five common topics addressed by participants: desired loaded medication, film size, film shape, film flexibility, and ease and accuracy of use. Concerns across topics included comfort, sexual spontaneity, and efficacy. Interest in loading the device with other acceptable medications or combination with lidocaine was independently noted in 2/6 (33%) of the focus groups. Discussion Mucoadhesive vulvar thin films may be an acceptable drug delivery system for insertional sexual pain for women with VBD.
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Affiliation(s)
- R. Gina Silverstein
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States
| | | | - Caroline Rowland
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Joseph A. Ogbansiegbe
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Paul Mihas
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, NC, United States
| | - S. Rahima Benhabbour
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, United States and North Carolina State University, Raleigh, NC, United States
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erin T. Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States
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10
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Dikbas L. In vitro assessment of the immobilized mannanase enzyme against infection-causing Candida. Future Microbiol 2023; 18:885-896. [PMID: 37584513 DOI: 10.2217/fmb-2022-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Developing an effective treatment for fungal infections is among contemporary medicine's challenges. In this study we aimed to eradicate mannan in pathogenic Candidae's cell walls using a nontoxic method, mannanase. Materials & Methods: We investigated the in vitro antifungal activities of mannanase immobilized on zinc oxide nanoparticles (ZnONps) and reduced graphene oxide nanoparticles (RGONps), as well as therapeutics against Candidae. Mannanase was purified from Bacillus invictae (activity: 5.15 EU/ml; range: 60-80%) and then immobilized it to ZnO and RGO to enhance its effectiveness. Results: Mannanase immobilized on ZnONps had the highest activity, with a value of 4.97 EU/ml, more effective than amphotericin-B. However, it could not reach the inhibition rates of other antifungals. Conclusion: Mannanase immobilized on ZnONps could be an effective fungicide for Candida biocontrol.
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Affiliation(s)
- Levent Dikbas
- Specialist in Obstetrics & Gynecology, Reyap Hospital, IVF Center, Tekirdag, Turkey
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Lajarin-Reinares M, Naveira-Souto I, Mallandrich M, Suñer-Carbó J, Llagostera Casas M, Calvo MA, Fernandez-Campos F. Repurposing Disulfiram as an Antifungal Agent: Development of a New Disulfiram Vaginal Mucoadhesive Gel. Pharmaceutics 2023; 15:pharmaceutics15051436. [PMID: 37242678 DOI: 10.3390/pharmaceutics15051436] [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: 03/21/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Alternative formulations need to be developed to improve the efficacy of treatments administered via the vaginal route. Mucoadhesive gels with disulfiram, a molecule that was originally approved as an antialcoholism drug, offer an attractive alternative to treat vaginal candidiasis. The aim of the current study was to develop and optimize a mucoadhesive drug delivery system for the local administration of disulfiram. Such formulations were composed of polyethylene glycol and carrageenan to improve the mucoadhesive and mechanical properties and to prolong the residence time in the vaginal cavity. Microdilution susceptibility testing showed that these gels had antifungal activity against Candida albicans, Candida parapsilosis, and Nakaseomyces glabratus. The physicochemical properties of the gels were characterized, and the in vitro release and permeation profiles were investigated with vertical diffusion Franz cells. After quantification, it was determined that the amount of the drug retained in the pig vaginal epithelium was sufficient to treat candidiasis infection. Together, our findings suggest that mucoadhesive disulfiram gels have the potential to be an effective alternative treatment for vaginal candidiasis.
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Affiliation(s)
- Maria Lajarin-Reinares
- Department of Genetics and Microbiology, Campus Microbiology Unit, Autonomous University of Barcelona, 08193 Bellaterra, Spain
- R & D Development, Reig Jofre Laboratories, 08970 Sant Joan Despí, Spain
| | - Iria Naveira-Souto
- R & D Development, Reig Jofre Laboratories, 08970 Sant Joan Despí, Spain
| | - Mireia Mallandrich
- Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - Joaquim Suñer-Carbó
- Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - Montserrat Llagostera Casas
- Department of Genetics and Microbiology, Campus Microbiology Unit, Autonomous University of Barcelona, 08193 Bellaterra, Spain
| | - Maria Angels Calvo
- Department of Animal Health and Anatomy, Faculty of Veterinary, Autonomous University of Barcelona, 08193 Bellaterra, Spain
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Dinte E, Iovanov RI, Bodoki AE, Colosi IA, Colosi HA, Tosa N, Vostinaru O, Tomuta I. Optimization of a Mucoadhesive Vaginal Gel Containing Clotrimazole Using a D-Optimal Experimental Design and Multivariate Analysis. Polymers (Basel) 2023; 15:polym15092023. [PMID: 37177171 PMCID: PMC10181139 DOI: 10.3390/polym15092023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
The aim of this study was to develop a suitable clotrimazole (CLT)-loaded mucoadhesive vaginal gel (CLT-MVG) for topical applications in vaginal candidiasis. Ten CLT-MVG formulations were prepared, consisting of mixtures of acid polyacrylic (Carbopol 940) and polyethene oxides, Sentry Polyox WSRN 1105 or 750, according to an experimental D-optimal design, and CLT was suspended at a ratio of 1%. The prepared CLT-MVG formulations were studied in vitro, and the formulation containing Carbopol 940 0.89% combined with PEO 1105 1.39% was identified with the optimal rheological and in vitro bioadhesion properties, ensuring the prolonged release of CLT, with a similarity factor greater than 50, indicating dissolution profile similarity for three batches of the optimized formulation. This optimized formulation showed a pH in the tolerance range, and an adequate ex vivo mucoadhesion time, while the FT-IR studies revealed no interactions between the excipients and CLT. The microscopic analysis identified a mean particle size of suspended CLT of 5.24 ± 0.57 μm. The in vitro antifungal activity of the optimized formulation was tested on twenty strains of Candida albicans and proved to be better compared to a marketed clotrimazole preparation, showing a greater inhibition effect (p < 0.05). The optimized formulation could be a good candidate for the local treatment of vaginal mycosis.
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Affiliation(s)
- Elena Dinte
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Rares Iuliu Iovanov
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andreea Elena Bodoki
- Department of General and Inorganic Chemistry, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, 400010 Cluj-Napoca, Romania
| | - Ioana Alina Colosi
- Department of Microbiology, Iuliu Hatieganu, Faculty of Medicine, University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Horatiu Alexandru Colosi
- Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Nicoleta Tosa
- Molecular and Biomolecular Department, National Institute for Research & Development of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania
| | - Oliviu Vostinaru
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Ioan Tomuta
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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13
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Fernandes L, Costa R, Henriques M, Rodrigues ME. Simulated vaginal fluid: Candida resistant strains' biofilm characterization and vapor phase of essential oil effect. J Mycol Med 2023; 33:101329. [PMID: 36270212 DOI: 10.1016/j.mycmed.2022.101329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/28/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Vulvovaginal candidiasis is a disease that affects millions of women worldwide. Oral formulations, topical creams or ointments are the conventional dosage forms, with an increase in drug administration through vaginal via. The use of simulated biological fluids (e.g. vaginal fluid) in the evaluation of antifungal therapies may better mimic the real biological environments and therefore provide a better understanding of the behavior of the antifungal. METHODS The main objective of this work was to compare planktonic growth and biofilm formation of Candida species, on common growth medium, Sabouraud Dextrose Broth (SDB) and on vaginal simulation conditions, Simulated Vaginal Fluid (SVF), through the optical density determination, colony-forming units and scanning electron microscopy. In addition, under the same conditions this study also evaluated the ability of vapor phase of oregano and white thyme essential oils (VP-EOs), potential alternative treatment, to inhibit biofilm formation and to destroy mature biofilms of vaginal isolates, through the colony-forming units determination. RESULTS Candida isolates maintained the same biofilm formation capacity and morphology in both media (SVF and SDB). Furthermore, the results obtained in this work related with VP-EOs effect agree with results acquired, previously, with SDB. This means that the effect of VP-EOs is not affected by the SVF medium, and that this fluid allows the dissolution of the volatile and bioactive compounds. CONCLUSIONS These results can predict the in vivo behavior, suggesting a potential effective application of VP-EOs as prophylactic or therapeutic treatment for biofilm-related vulvovaginal candidiasis.
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Affiliation(s)
- Liliana Fernandes
- Centre of Biological Engineering, LMaS - Laboratório de Microbiologia Aplicada à Saúde, LABBELS -Associate Laboratory, University of Minho, Campus de Gualtar, Braga, Guimarães 4710-057, Portugal
| | - Raquel Costa
- Costa Raquel, Aromas Aqua Spa - Clínica saúde, Praça 5 outubro n° 32, Vila Verde, Braga 4730-731, Portugal
| | - Mariana Henriques
- Centre of Biological Engineering, LMaS - Laboratório de Microbiologia Aplicada à Saúde, LABBELS -Associate Laboratory, University of Minho, Campus de Gualtar, Braga, Guimarães 4710-057, Portugal
| | - Maria Elisa Rodrigues
- Centre of Biological Engineering, LMaS - Laboratório de Microbiologia Aplicada à Saúde, LABBELS -Associate Laboratory, University of Minho, Campus de Gualtar, Braga, Guimarães 4710-057, Portugal.
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14
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Advanced Solid Formulations For Vulvovaginal Candidiasis. Pharm Res 2023; 40:593-610. [PMID: 36451068 DOI: 10.1007/s11095-022-03441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
Vulvovaginal candidiasis (VVC) is an opportunistic and endogenous infection caused by a fungus of the Candida genus, which can cause pruritus, dysuria, vulvar edema, fissures and maceration of the vulva. The treatment of vaginal candidiasis is carried out mainly by antifungal agents of azole and polyene classes; however, fungal resistance cases have been often observed. For this reason, new therapeutic agents such as essential oils, probiotics and antimicrobial peptides are being investigated, which can be combined with conventional drugs. Local administration of antimicrobials has also been considered to allow greater control of drug delivery and reduce or avoid undesirable systemic adverse effects. Conventional dosage forms such as creams and ointments result in reduced residence time in the mucosa and non-sustained and variable drug delivery. Therefore, advanced solid formulations such as intravaginal rings, vaginal films, sponges and nanofibers have been purposed. In these systems, polymers in different ratios are combined aiming to achieve a specific drug release profile and high mucoadhesion. Overall, a more porous matrix structure leads to a higher rate of drug release and mucoadhesion. The advantages, limitations and technological aspects of each dosage form are discussed in detail in this review.
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15
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Patel R, Yadav BK, Patel G. Progresses in Nano-Enabled Platforms for the Treatment of Vaginal Disorders. RECENT PATENTS ON NANOTECHNOLOGY 2023; 17:208-227. [PMID: 35762539 DOI: 10.2174/1872210516666220628150447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The most common vaginal disorders are within the uterus. According to the latest statistics, vaginal disorders occur in 50% to 60% of females. Although curative treatments rely on surgical therapy, still first-line treatment is a non invasive drug. Conventional therapies are available in the oral and parenteral route, leading to nonspecific targeting, which can cause dose-related side effects. Vaginal disorders are localized uterine disorders in which intrauterine delivery via the vaginal site is deemed the preferable route to mitigate clinical drug delivery limitations. OBJECTIVE This study emphasizes the progress of site-specific and controlled delivery of therapeutics in the treatment of vaginal disorders and systemic adverse effects as well as the therapeutic efficacy. METHODS Related research reports and patents associated with topics are collected, utilized, and summarized the key findings. RESULTS The comprehensive literature study and patents like (US 9393216 B2), (JP6672370B2), and (WO2018041268A1) indicated that nanocarriers are effective above traditional treatments and have some significant efficacy with novelty. CONCLUSION Nowadays, site-specific and controlled delivery of therapeutics for the treatment of vaginal disorders is essential to prevent systemic adverse effects and therapeutic efficacy would be more effective. Nanocarriers have therefore been used to bypass the problems associated with traditional delivery systems for the vaginal disorder.
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Affiliation(s)
- Riya Patel
- Department of Pharmaceutics, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat 388421, India
| | - Bindu Kumari Yadav
- Department of Pharmaceutics, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat 388421, India
| | - Gayatri Patel
- Department of Pharmaceutics, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat 388421, India
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16
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Pandey M, Ting JSS, Gorain B, Jain N, Mayuren J. Miniaturized Polymeric Systems for the Intravaginal Gene Therapies: Recent Update on Unconventional Delivery. Curr Pharm Des 2023; 29:3254-3262. [PMID: 37438899 DOI: 10.2174/1381612829666230712162540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 07/14/2023]
Abstract
The prevalence of vaginal infection is increasing among women, especially at reproductive age. For proper eradication of infection, the effective concentration of a drug is required at the infection site. Therefore, local delivery is recommended to exert a direct therapeutic effect at the site action that causes a reduction in dose and side effects. The main focus of vaginal drug delivery is to enhance retention time and patient compliance. The high recurrence rate of vaginal infection due to the lack of effective treatment strategies opens the door for new therapeutic approaches. To combat these setbacks, intravaginal gene therapies have been investigated. High attention has been gained by vaginal gene therapy, especially for sexually transmitted infection treatment. Despite much research, no product is available in the market, although in vitro and preclinical data support the vaginal route as an effective route for gene administration. The main focus of this review is to discuss the recent advancement in miniaturized polymeric systems for intravaginal gene therapies to treat local infections. An overview of different barriers to vaginal delivery and challenges of vaginal infection treatment are also summarised.
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Affiliation(s)
- Manisha Pandey
- Department of Pharmaceutical Sciences, Central University of Haryana, Haryana 123031, India
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | | | - Bapi Gorain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi 835215, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, India
| | - Jayashree Mayuren
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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17
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Chauhan A, Alam MA, Kaur A, Malviya R. Advancements and Utilizations of Scaffolds in Tissue Engineering and Drug Delivery. Curr Drug Targets 2023; 24:13-40. [PMID: 36221880 DOI: 10.2174/1389450123666221011100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
The drug development process requires a thorough understanding of the scaffold and its three-dimensional structure. Scaffolding is a technique for tissue engineering and the formation of contemporary functioning tissues. Tissue engineering is sometimes referred to as regenerative medicine. They also ensure that drugs are delivered with precision. Information regarding scaffolding techniques, scaffolding kinds, and other relevant facts, such as 3D nanostructuring, are discussed in depth in this literature. They are specific and demonstrate localized action for a specific reason. Scaffold's acquisition nature and flexibility make it a new drug delivery technology with good availability and structural parameter management.
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Affiliation(s)
- Akash Chauhan
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Md Aftab Alam
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Awaneet Kaur
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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18
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Chhitij T, Seo JE, Keum T, Noh G, Bashyal S, Lamichhane S, Kim JH, Lee JH, Park JH, Choi J, Song SH, Lee S. Optimized self-microemulsifying drug delivery system improves the oral bioavailability and brain delivery of coenzyme Q 10. Drug Deliv 2022; 29:2330-2342. [PMID: 35850616 PMCID: PMC9848412 DOI: 10.1080/10717544.2022.2100515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Our study aimed to develop a self-microemulsifying drug delivery system for the poorly aqueous-soluble drug Coenzyme Q10, to improve the dissolution and the oral bioavailability. Excipients were selected based on their Coenzyme Q10 solubility, and their concentrations were set for the optimization of the microemulsion by using a D-optimal mixture design to achieve a minimum droplet size and a maximum solubility of Coenzyme Q10 within 15 min. The optimized formulation was composed of an oil (omega-3; 38.55%), a co-surfactant (Lauroglycol® 90; 31.42%), and a surfactant (Gelucire® 44/14; 30%) and exhibited a mean droplet size of 237.6 ± 5.8 nm and a drug solubilization (at 15 min) of 16 ± 2.48%. The drug dissolution of the optimized formulation conducted over 8 h in phosphate buffer medium (pH 6.8) was significantly higher when compared to that of the Coenzyme Q10 suspension. A pharmacokinetic study in rats revealed a 4.5-fold and a 4.1-fold increase in the area under curve and the peak plasma concentration values generated by the optimized formulation respectively, as compared to the Coenzyme Q10 suspension. A Coenzyme Q10 brain distribution study revealed a higher Coenzyme Q10 distribution in the brains of rats treated with the optimized formulation than the Coenzyme Q10 suspension. Coenzyme Q10-loaded self microemulsifying drug delivery system was successfully formulated and optimized by a response surface methodology based on a D-optimal mixture design and could be used as a delivery vehicle for the enhancement of the oral bioavailability and brain distribution of poorly soluble drugs such as Coenzyme Q10.
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Affiliation(s)
- Thapa Chhitij
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Jo-Eun Seo
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Taekwang Keum
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Gyubin Noh
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Santosh Bashyal
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea,Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Shrawani Lamichhane
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Jung Hwan Kim
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Jae Heon Lee
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Jee Hun Park
- R&D Center, Korean Drug Co., Ltd, Seoul, Republic of Korea
| | - Jaewoong Choi
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea,R&D Center, Korean Drug Co., Ltd, Seoul, Republic of Korea
| | - Se Hyun Song
- College of Pharmacy, Kyungsung University, Busan, 48434, Republic of Korea
| | - Sangkil Lee
- Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, Daegu, Republic of Korea,Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA,CONTACT Sangkil Lee Center for Forensic Pharmaceutical Sciences, College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-Gu, Daegu42601, Republic of Korea, Tel: +82-53-580-6655, FAX: +82-53-580-5164
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19
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Development and characterization of amphotericin B nanoemulsion-loaded mucoadhesive gel for treatment of vulvovaginal candidiasis. Heliyon 2022; 8:e11489. [DOI: 10.1016/j.heliyon.2022.e11489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/22/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
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Vaginal Nanoformulations for the Management of Preterm Birth. Pharmaceutics 2022; 14:pharmaceutics14102019. [PMID: 36297454 PMCID: PMC9611874 DOI: 10.3390/pharmaceutics14102019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2022] Open
Abstract
Preterm birth (PTB) is a leading cause of infant morbidity and mortality in the world. In 2020, 1 in 10 infants were born prematurely in the United States. The World Health Organization estimates that a total of 15 million infants are born prematurely every year. Current therapeutic interventions for PTB have had limited replicable success. Recent advancements in the field of nanomedicine have made it possible to utilize the vaginal administration route to effectively and locally deliver drugs to the female reproductive tract. Additionally, studies using murine models have provided important insights about the cervix as a gatekeeper for pregnancy and parturition. With these recent developments, the field of reproductive biology is on the cusp of a paradigm shift in the context of treating PTB. The present review focuses on the complexities associated with treating the condition and novel therapeutics that have produced promising results in preclinical studies.
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21
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Dubashynskaya NV, Petrova VA, Romanov DP, Skorik YA. pH-Sensitive Drug Delivery System Based on Chitin Nanowhiskers-Sodium Alginate Polyelectrolyte Complex. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15175860. [PMID: 36079241 PMCID: PMC9456586 DOI: 10.3390/ma15175860] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 05/31/2023]
Abstract
Polyelectrolyte complexes (PECs), based on partially deacetylated chitin nanowhiskers (CNWs) and anionic polysaccharides, are characterized by their variability of properties (particle size, ζ-potential, and pH-sensitivity) depending on the preparation conditions, thereby allowing the development of polymeric nanoplatforms with a sustained release profile for active pharmaceutical substances. This study is focused on the development of hydrogels based on PECs of CNWs and sodium alginate (ALG) for potential vaginal administration that provide controlled pH-dependent antibiotic release in an acidic vaginal environment, as well as prolonged pharmacological action due to both the sustained drug release profile and the mucoadhesive properties of the polysaccharides. The desired hydrogels were formed as a result of both electrostatic interactions between CNWs and ALG (PEC formation), and the subsequent molecular entanglement of ALG chains, and the formation of additional hydrogen bonds. Metronidazole (MET) delivery systems with the desired properties were obtained at pH 5.5 and an CNW:ALG ratio of 1:2. The MET-CNW-ALG microparticles in the hydrogel composition had an apparent hydrodynamic diameter of approximately 1.7 µm and a ζ-potential of -43 mV. In vitro release studies showed a prolonged pH-sensitive drug release from the designed hydrogels; 37 and 67% of MET were released within 24 h at pH 7.4 and pH 4.5, respectively. The introduction of CNWs into the MET-ALG system not only prolonged the drug release, but also increased the mucoadhesive properties by about 1.3 times. Thus, novel CNW-ALG hydrogels are promising carriers for pH sensitive drug delivery carriers.
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Affiliation(s)
- Natallia V. Dubashynskaya
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia
| | - Valentina A. Petrova
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia
| | - Dmitry P. Romanov
- Institute of Silicate Chemistry of the Russian Academy of Sciences, Adm. Makarova emb. 2, 199034 St. Petersburg, Russia
| | - Yury A. Skorik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia
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22
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Jaquilin P J R, Oluwafemi OS, Thomas S, Oyedeji AO. Recent advances in drug delivery nanocarriers incorporated in temperature-sensitive Pluronic F-127–A critical review. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Multiple Roles of Chitosan in Mucosal Drug Delivery: An Updated Review. Mar Drugs 2022; 20:md20050335. [PMID: 35621986 PMCID: PMC9146108 DOI: 10.3390/md20050335] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Chitosan (CS) is a linear polysaccharide obtained by the deacetylation of chitin, which, after cellulose, is the second biopolymer most abundant in nature, being the primary component of the exoskeleton of crustaceans and insects. Since joining the pharmaceutical field, in the early 1990s, CS attracted great interest, which has constantly increased over the years, due to its several beneficial and favorable features, including large availability, biocompatibility, biodegradability, non-toxicity, simplicity of chemical modifications, mucoadhesion and permeation enhancer power, joined to its capability of forming films, hydrogels and micro- and nanoparticles. Moreover, its cationic character, which renders it unique among biodegradable polymers, is responsible for the ability of CS to strongly interact with different types of molecules and for its intrinsic antimicrobial, anti-inflammatory and hemostatic activities. However, its pH-dependent solubility and susceptibility to ions presence may represent serious drawbacks and require suitable strategies to be overcome. Presently, CS and its derivatives are widely investigated for a great variety of pharmaceutical applications, particularly in drug delivery. Among the alternative routes to overcome the problems related to the classic oral drug administration, the mucosal route is becoming the favorite non-invasive delivery pathway. This review aims to provide an updated overview of the applications of CS and its derivatives in novel formulations intended for different methods of mucosal drug delivery.
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Engineering drug delivery systems to overcome the vaginal mucosal barrier: Current understanding and research agenda of mucoadhesive formulations of vaginal delivery. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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25
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Thapa R, Gurung S, Parat MO, Parekh HS, Pandey P. Application of Sol–Gels for Treatment of Gynaecological Conditions—Physiological Perspectives and Emerging Concepts in Intravaginal Drug Delivery. Gels 2022; 8:gels8020099. [PMID: 35200479 PMCID: PMC8871440 DOI: 10.3390/gels8020099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 02/05/2023] Open
Abstract
Approaches for effective and sustained drug delivery to the female reproductive tract (FRT) for treating a range of gynaecological conditions remain limited. The development of versatile delivery platforms, such as soluble gels (sol–gels) coupled with applicators/devices, holds considerable therapeutic potential for gynaecological conditions. Sol–gel systems, which undergo solution-to-gel transition, triggered by physiological conditions such as changes in temperature, pH, or ion composition, offer advantages of both solution- and gel-based drug formulations. Furthermore, they have potential to be used as a suitable drug delivery vehicle for other novel drug formulations, including micro- and nano-particulate systems, enabling the delivery of drug molecules of diverse physicochemical character. We provide an anatomical and physiological perspective of the significant challenges and opportunities in attaining optimal drug delivery to the upper and lower FRT. Discussion then focuses on attributes of sol–gels that can vastly improve the treatment of gynaecological conditions. The review concludes by showcasing recent advances in vaginal formulation design, and proposes novel formulation strategies enabling the infusion of a wide range of therapeutics into sol–gels, paving the way for patient-friendly treatment regimens for acute and chronic FRT-related conditions such as bacterial/viral infection control (e.g., STDs), contraception, hormone replacement therapy (HRT), infertility, and cancer.
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Affiliation(s)
- Ritu Thapa
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia; (R.T.); (M.-O.P.)
| | - Shila Gurung
- School of Health and Allied Sciences, Pokhara University, Pokhara-30, Kaski 33700, Nepal;
| | - Marie-Odile Parat
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia; (R.T.); (M.-O.P.)
| | - Harendra S. Parekh
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia; (R.T.); (M.-O.P.)
- Correspondence: (H.S.P.); (P.P.)
| | - Preeti Pandey
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia; (R.T.); (M.-O.P.)
- Correspondence: (H.S.P.); (P.P.)
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Dahl DK, Whitesell AN, Sharma-Huynh P, Maturavongsadit P, Janusziewicz R, Fox RJ, Loznev HT, Button BM, Schorzman AN, Zamboni W, Ban J, Montgomery SA, Carey ET, Benhabbour SR. A mucoadhesive biodissolvable thin film for localized and rapid delivery of lidocaine for the treatment of vestibulodynia. Int J Pharm 2022; 612:121288. [PMID: 34800616 PMCID: PMC8753993 DOI: 10.1016/j.ijpharm.2021.121288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 01/27/2023]
Abstract
Vestibulodynia (VBD), an idiopathic pain disorder characterized by erythema and pain of the vulvar vestibule (the inner aspect of the labia minora and vaginal opening), is the most common cause of sexual pain for women of reproductive age. Women also feel discomfort with contact with clothing and tampon use. As most women with this disorder only have pain with provocation of the tissue, topical anesthetics applied to the vestibule are the current first line treatment for temporary pain relief. Treatment options are limited due to anatomical constraints of the vestibular region, poor drug retention time, imprecise dosing, leakage, and overall product messiness. In this study we report a novel approach to treatment of VBD using thin film designed to fit the vulvar vestibule and deliver lidocaine locally. Two use cases for VBD treatment were identified 1) rapid drug release (<5 min), for use prior to intercourse and 2) long-acting release (≥120 min) for prolonged use and relief throughout the day. Cellulose-based mucoadhesive thin films were fabricated using a solvent casting method. Three polymers including hydroxyethylcellulose (HEC), hydroxypropylcellulose (HPC), and hydroxypropylmethycellulose (HMPC), were selected owing to their biocompatibility and ideal properties for film casting. Films casted with HEC, HPC, and HPMC exhibited mucoadhesive properties relative to a control, with the highest mucoadhesive force recorded for films casted with HPC. Effect of media volume, pH, presence of mucin and presence of drug on film dissolution rates were investigated. Dissolution rates were independent of media volume, media pH or drug presence, whereas faster dissolution rates were obtained for all films in presence of mucin. In vitro lidocaine release kinetics were influenced by polymer type, percent drug loading and film casting thickness. Lidocaine release was based on a diffusion mechanism rather than through film dissolution and faster release (∼5 min) was observed for HEC films compared HPC films (∼120 min). Higher drug loading and film thickness resulted in slower and more prolonged release kinetics of lidocaine. All films were biocompatible and exhibited good mechanical properties. Two film formulations (9% w/w HPC with 12% w/w LHC, 5% w/w HEC with 6% w/w LHC) were optimized to meet the two use case scenarios for VBD treatment and moved into in vivo testing. In vivo testing demonstrated the safety of the films in BALB/c mice, and the pharmacokinetic analysis demonstrated the delivery of lidocaine primarily to the vaginal tissue. We demonstrate the ability to develop a mucoadhesive, biodissolvable thin film and fine-tune drug release kinetics to optimize local delivery of lidocaine to the vulva.
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Affiliation(s)
- Denali K. Dahl
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashlyn N. Whitesell
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Preetika Sharma-Huynh
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Panita Maturavongsadit
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rima Janusziewicz
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan J. Fox
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Henry T. Loznev
- Department of Biochemistry & Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian M. Button
- Department of Biochemistry & Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison N. Schorzman
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Carolina Institute for Nanomedicine, UNC Advanced Translational Pharmacology and Analytical Chemistry Lab
| | - William Zamboni
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Carolina Institute for Nanomedicine, UNC Advanced Translational Pharmacology and Analytical Chemistry Lab
| | - Jisun Ban
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Carolina Institute for Nanomedicine, UNC Advanced Translational Pharmacology and Analytical Chemistry Lab
| | | | - Erin T. Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S. Rahima Benhabbour
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Li B, Pan L, Zhang H, Xie L, Wang X, Shou J, Qi Y, Yan X. Recent Developments on Using Nanomaterials to Combat Candida albicans. Front Chem 2022; 9:813973. [PMID: 35004630 PMCID: PMC8733329 DOI: 10.3389/fchem.2021.813973] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 12/25/2022] Open
Abstract
Vaginal candidiasis (VC) is a common disease of women and the main pathogen is Candida albicans (C. albicans). C. albicans infection incidence especially its drug resistance have become a global health threat due to the existence of C. albicans biofilms and the low bioavailability of traditional antifungal drugs. In recent years, nanomaterials have made great progresses in the field of antifungal applications. Some researchers have treated fungal infections with inorganic nanoparticles, represented by silver nanoparticles (AgNPs) with antifungal properties. Liposomes, polymeric nanoparticles, metal-organic frameworks (MOFs), and covalent organic frameworks (COFs) were also used to improve the bioavailability of antifungal drugs. Herein, we briefly introduced the recent developments on using above nanomaterials to combat C. albicans in antifungal applications.
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Affiliation(s)
- Bingxin Li
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Luyao Pan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haofeng Zhang
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingping Xie
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xi Wang
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiahui Shou
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Qi
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
| | - Xiaojian Yan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Current trends in chitosan based nanopharmaceuticals for topical vaginal therapies. Int J Biol Macromol 2021; 193:2140-2152. [PMID: 34780894 DOI: 10.1016/j.ijbiomac.2021.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/03/2021] [Accepted: 11/06/2021] [Indexed: 01/21/2023]
Abstract
Large surface area, rich vascularisation, well defined mucous membrane, balanced pH and relatively low enzymatic activity makes vagina a suitable site for drugs associated with women's health issues like Urinary tract infection (UTI) and vaginal infections. Therapeutic performance of intravaginal dosage forms largely depends on the properties of polymers and drugs. Chitosan (CS) because of its unique physical, chemical, pharmaceutical and biopharmaceutical properties have received a great deal of attention as an essential component in vaginal drug delivery systems. Further the presence of free amino and hydroxyl groups on the chitosan skeleton allows easy derivatization under mild conditions to meet specific application requirements. Moreover, CS-based nanopharmaceuticals like nanoparticles, nanofiber, nanogel, nanofilm, liposomes and micelles are widely studied to improve therapeutic performance of vaginal formulations. However, susceptibility of CS to the acidic pH of vagina, poor loading of hydrophobic drugs, rapid mucosal turn over are the key issues need to be addressed for successful outcomes. In this review, we have discussed the application of CS and CS derivatives in vaginal drug delivery and also highlight the recent progress in chitosan based nanocarrier platforms in terms of their limitations and potentials.
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An easy 3D printing approach to manufacture vertical diffusion cells for in vitro release and permeation studies. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cazorla-Luna R, Ruiz-Caro R, Veiga MD, Malcolm RK, Lamprou DA. Recent advances in electrospun nanofiber vaginal formulations for women's sexual and reproductive health. Int J Pharm 2021; 607:121040. [PMID: 34450222 DOI: 10.1016/j.ijpharm.2021.121040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/21/2021] [Indexed: 12/22/2022]
Abstract
Electrospinning is an innovative technique that allows production of nanofibers and microfibers by applying a high voltage to polymer solutions of melts. The properties of these fibers - which include high surface area, high drug loading capacity, and ability to be manufactured from mucoadhesive polymers - may be particularly useful in a myriad of drug delivery and tissue engineering applications. The last decade has witnessed a surge of interest in the application of electrospinning technology for the fabrication of vaginal drug delivery systems for the treatment and prevention of diseases associated with women's sexual and reproductive health, including sexually transmitted infections (e.g. infection with human immunodeficiency virus and herpes simplex virus) vaginitis, preterm birth, contraception, multipurpose prevention technology strategies, cervicovaginal cancer, and general maintenance of vaginal health. Due to their excellent mechanical properties, electrospun scaffolds are also being investigated as next-generation materials in the surgical treatment of pelvic organ prolapse. In this article, we review the latest advances in the field.
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Affiliation(s)
- Raúl Cazorla-Luna
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Departamento de Farmacia Galénica y Tecnología Alimentaria, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Roberto Ruiz-Caro
- Departamento de Farmacia Galénica y Tecnología Alimentaria, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María-Dolores Veiga
- Departamento de Farmacia Galénica y Tecnología Alimentaria, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Okur NÜ, Yağcılar AP, Siafaka PI. Promising Polymeric Drug Carriers for Local Delivery: The Case of in situ Gels. Curr Drug Deliv 2021; 17:675-693. [PMID: 32510291 DOI: 10.2174/1567201817666200608145748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/28/2020] [Accepted: 04/18/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND At present, the controlled local drug delivery is a very promising approach compared to systemic administration, since it mostly targets the affected tissue. In fact, various drug carriers for local delivery have been prepared with improved therapeutic efficacy. OBJECTIVE in situ polymer gels are drug delivery systems that not only present liquid characteristics before their administration in body, but once they are administered, form gels due to gelation. Their gelation mechanism is due to factors such as pH alteration, temperature change, ion activation or ultraviolet irradiation. in situ gels offer various advantages compared to conventional formulations due to their ability to release drugs in a sustainable and controllable manner. Most importantly, in situ gels can be used in local drug delivery applications for various diseases. METHODS This review includes the basic knowledge and theory of in situ gels as well as their various applications according to their administration route. RESULTS Various natural, semisynthetic, and synthetic polymers can produce in situ polymeric gels. For example, natural polysaccharides such as alginic acid, chitosan, gellan gum, carrageenan etc. have been utilized as in situ gels for topical delivery. Besides the polysaccharides, poloxamers, poly(Nisopropylacrylamide), poly(ethyleneoxide)/ (lactic-co-glycolic acid), and thermosensitive liposome systems can be applied as in situ gels. In most cases, in situ polymeric gels could be applied via various administration routes such as oral, vaginal, ocular, intranasal and injectable. CONCLUSION To conclude, it can be revealed that in situ gels could be a promising alternative carrier for both chronic and immediate diseases.
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Affiliation(s)
- Neslihan Üstündağ Okur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Ayşe Pınar Yağcılar
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Panoraia I Siafaka
- Faculty of Sciences, School of Chemistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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32
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Vaginal drug delivery approaches for localized management of cervical cancer. Adv Drug Deliv Rev 2021; 174:114-126. [PMID: 33857555 DOI: 10.1016/j.addr.2021.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/10/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022]
Abstract
Cervical cancer or cervical intraepithelial neoplasia (CIN) remain a major public health problem among women globally. Traditional methods such as surgery are often associated with possible complications which may impact future pregnancies and childbirth especially for young female patients. Vagina with a high contact surface is a suitable route for the local and systemic delivery of drugs but its abundant mucus in continuous exchange presents a barrier for the popularization of conventional vaginal formulations including suppositories, gel, patch, creams and so on. So the development of new pharmaceutical forms based on nanotechnology became appealing owing to its several advantages such as mucosa penetration, bioadhesion, controlled drug release, and decreased adverse effects. This review provided an overview of the development of topical treatment of cervical cancer or CIN through vaginal drug delivery ranging from conventional vaginal formulations to new nanocarriers to the newly developed phototherapy and gene therapy, analyzing the problems faced by current methods used, and advising the developing trend in future. The methods of establishing preclinical animal model are also discussed.
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Osmałek T, Froelich A, Jadach B, Tatarek A, Gadziński P, Falana A, Gralińska K, Ekert M, Puri V, Wrotyńska-Barczyńska J, Michniak-Kohn B. Recent Advances in Polymer-Based Vaginal Drug Delivery Systems. Pharmaceutics 2021; 13:884. [PMID: 34203714 PMCID: PMC8232205 DOI: 10.3390/pharmaceutics13060884] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
The vagina has been considered a potential drug administration route for centuries. Most of the currently marketed and investigated vaginal formulations are composed with the use of natural or synthetic polymers having different functions in the product. The vaginal route is usually investigated as an administration site for topically acting active ingredients; however, the anatomical and physiological features of the vagina make it suitable also for drug systemic absorption. In this review, the most important natural and synthetic polymers used in vaginal products are summarized and described, with special attention paid to the properties important in terms of vaginal application. Moreover, the current knowledge on the commonly applied and innovative dosage forms designed for vaginal administration was presented. The aim of this work was to highlight the most recent research directions and indicate challenges related to vaginal drug administrations. As revealed in the literature overview, intravaginal products still gain enormous scientific attention, and novel polymers and formulations are still explored. However, there are research areas that require more extensive studies in order to provide the safety of novel vaginal products.
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Affiliation(s)
- Tomasz Osmałek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Anna Froelich
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Barbara Jadach
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Adam Tatarek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Piotr Gadziński
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Aleksandra Falana
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Kinga Gralińska
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Michał Ekert
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Vinam Puri
- Department of Pharmaceutics, William Levine Hall, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Life Sciences Building, New Jersey Center for Biomaterials, Piscataway, NJ 08854, USA; (V.P.); (B.M.-K.)
| | - Joanna Wrotyńska-Barczyńska
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St., 60-535 Poznań, Poland;
| | - Bozena Michniak-Kohn
- Department of Pharmaceutics, William Levine Hall, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Life Sciences Building, New Jersey Center for Biomaterials, Piscataway, NJ 08854, USA; (V.P.); (B.M.-K.)
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Dual-Responsive Micellar Microgels Matrixed with Surface-Engineered Lipids: a New Approach for Controlled Vaginal Drug Delivery. J Pharm Innov 2021. [DOI: 10.1007/s12247-021-09546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tuğcu-Demiröz F, Saar S, Kara AA, Yıldız A, Tunçel E, Acartürk F. Development and characterization of chitosan nanoparticles loaded nanofiber hybrid system for vaginal controlled release of benzydamine. Eur J Pharm Sci 2021; 161:105801. [PMID: 33691155 DOI: 10.1016/j.ejps.2021.105801] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
Vaginal infections caused by various pathogens such as fungi, viruses and protozoa are frequently seen. Systemic and local treatments can be applied to eliminate these infections. Novel vaginal drug delivery systems can be used to provide local treatment. Vaginal drug delivery systems prevent systemic side effects and can provide long-term drug release in the vaginal area. Nanofibers and nanoparticles have a wide range of applications and can also be preferred as vaginal drug delivery systems. Benzydamine is a non-steroidal anti-inflammatory and antiseptic drug which is used for treatment of vaginal infections. The aim of this study was to compare the nanofiber and gel formulations containing lyophilized benzydamine nanoparticles with nanofiber and gel formulations containing free benzydamine, and to provide prolonged release for protection from the vaginal infections. Ionic gelation method was used for the preparation of benzydamine loaded nanoparticles. To produce benzydamine nanoparticles loaded nanofiber formulations, polyvinylpyrrolidone (PVP) solutions were prepared at 10% concentrations and mixed with nanoparticles. Hydroxypropyl methylcellulose (HPMC) was used as a gelling agent at the concentration of 1% for the vaginal gel formulation. Nanoparticles were characterized in terms of zeta potential, polydispersity index and particle size. Viscosity, surface tension and conductivity values of the polymer solutions were measured for the electrospinning. Mechanical properties, contact angle and drug loading capacity of the fibers were determined. Scanning electron microscopy (SEM), differential scanning calorimetry (DSC), transmission electron microscopy (TEM), fourier-transform infrared (FT-IR) spectroscopy, mucoadhesion, ex vivo permeability studies and in vitro release studies were performed for the selected formulations. Ex vivo permeability studies were performed using Franz diffusion cell method. SEM and TEM images showed that fiber diameters increased with loading of nanoparticles. DSC studies showed no interaction between excipients used in the formulation. Tensile strength and elongation at break values of the fibers increased with the loading of nanoparticles, and the contact angle values of the fibers were found to be 0°. Addition of benzydamine nanoparticles to gel and nanofiber formulations increased mucoadhesion compared to free benzydamine loading formulations. Benzydamine nanoparticle loaded gel and nanofiber formulations penetrated slower than that of free benzydamine gel and fiber formulations. The results demonstrated that benzydamine and benzydamine nanoparticle loaded fibers and gels could be a potential drug delivery system for the treatment of vaginal infections. Chitosan nanoparticle loaded nanofiber formulations are offered as an alternative controlled release vaginal formulations for vaginal infections.
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Affiliation(s)
- Fatmanur Tuğcu-Demiröz
- Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06330- Etiler, Ankara, Turkey.
| | - Sinem Saar
- Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06330- Etiler, Ankara, Turkey
| | - Adnan Altuğ Kara
- Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06330- Etiler, Ankara, Turkey
| | - Ayşegül Yıldız
- Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06330- Etiler, Ankara, Turkey
| | - Emre Tunçel
- Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06330- Etiler, Ankara, Turkey
| | - Füsun Acartürk
- Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06330- Etiler, Ankara, Turkey
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Araujo VHS, de Souza MPC, Carvalho GC, Duarte JL, Chorilli M. Chitosan-based systems aimed at local application for vaginal infections. Carbohydr Polym 2021; 261:117919. [PMID: 33766328 DOI: 10.1016/j.carbpol.2021.117919] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Vaginal administration is a promising route for the local treatment of infectious vaginal diseases since it can bypass the first-pass metabolism, drug interactions, and adverse effects. However, the commercial products currently available for topical vulvovaginal treatment have low acceptability and do not adequately explore this route. Mucoadhesive systems can optimize the efficacy of drugs administered by this route to increase the retention time of the drug in the vaginal environment. Several polymers are used to develop mucoadhesive systems, among them chitosan, a natural polymer that is highly biocompatible and technologically versatile. Thus, the present review aimed to analyze the studies that used chitosan to develop mucoadhesive systems for the treatment of local vaginal infections. These studies demonstrated that chitosan as a component of mucoadhesive drug delivery systems (DDS) is a promising device for the treatment of vaginal infectious diseases, due to the intrinsic antimicrobial activity of this biopolymer and because it does not interfere with the effectiveness of the drugs used for the treatment.
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Affiliation(s)
| | | | | | - Jonatas Lobato Duarte
- School of Pharmaceutical Sciences, São Paulo State University, Araraquara, SP, Brazil
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, São Paulo State University, Araraquara, SP, Brazil.
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3D printed clotrimazole intravaginal ring for the treatment of recurrent vaginal candidiasis. Int J Pharm 2021; 596:120290. [DOI: 10.1016/j.ijpharm.2021.120290] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 12/22/2022]
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Anothra P, Pradhan D, Naik PK, Ghosh G, Rath G. Development and characterization of 5-fluorouracil nanofibrous film for the treatment of stomach cancer. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ré ACS, Martins JF, Cunha-Filho M, Gelfuso GM, Aires CP, Gratieri T. New perspectives on the topical management of recurrent candidiasis. Drug Deliv Transl Res 2021; 11:1568-1585. [PMID: 33469892 DOI: 10.1007/s13346-021-00901-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Candidiasis is a common opportunistic infection caused by fungi of the Candida genus that affects mainly mucocutaneous tissues (e.g., vaginal, oral, and mammary). This condition has been known for a long time; thus, innumerous topical and systemic treatments are already available on the market worldwide. Yet, recurrent superficial candidiasis (RSC) is an expected outcome, still lacking effective and convenient treatments. Although several individual conditions may contribute to disease recurrence, biofilms' presence seems to be the main etiological factor contributing to antifungal resistance. More than proposing novel antifungal agents, current research seems to be focusing on improving the pharmaceutical technology aspects of formulations to address such a challenge. These include extending and improving intimate contact of drug delivery systems with the mucocutaneous tissues, increasing drug loading dose, and enhancing topical drug permeation. This review discusses the current understanding of the RSC and the use of pharmaceutical technology tools in obtaining better results. Even though several drawbacks of conventional formulations have been circumvented with the help of nano- or microencapsulation techniques and with the use of mucoadhesive formulation excipients, many challenges remain. In particular, the need to mask the unpalatable taste of formulations for the treatment of oral candidiasis, and the necessity of formulations with a "dryer" sensorial feeling and improved performances in providing higher bioavailability for the treatment of mammary and vaginal candidiasis.
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Affiliation(s)
- Ana Carolina S Ré
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Jayanaraian F Martins
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Marcílio Cunha-Filho
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Guilherme M Gelfuso
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Carolina P Aires
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Taís Gratieri
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil. .,Campus Universitário Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil.
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Abstract
While contraceptive drugs have enabled many people to decide when they want to have a baby, more than 100 million unintended pregnancies each year in the world may indicate the contraceptive requirement of many people has not been well addressed yet. The vagina is a well-established and practical route for the delivery of various pharmacological molecules, including contraceptives. This review aims to present an overview of different contraceptive methods focusing on the vaginal route of delivery for contraceptives, including current developments, discussing the potentials and limitations of the modern methods, designs, and how well each method performs for delivering the contraceptives and preventing pregnancy.
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Pandey M, Choudhury H, Abdul-Aziz A, Bhattamisra SK, Gorain B, Carine T, Wee Toong T, Yi NJ, Win Yi L. Promising Drug Delivery Approaches to Treat Microbial Infections in the Vagina: A Recent Update. Polymers (Basel) 2020; 13:E26. [PMID: 33374756 PMCID: PMC7795176 DOI: 10.3390/polym13010026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
An optimal host-microbiota interaction in the human vagina governs the reproductive health status of a woman. The marked depletion in the beneficial Lactobacillus sp. increases the risk of infection with sexually transmitted pathogens, resulting in gynaecological issues. Vaginal infections that are becoming increasingly prevalent, especially among women of reproductive age, require an effective concentration of antimicrobial drugs at the infectious sites for complete disease eradication. Thus, topical treatment is recommended as it allows direct therapeutic action, reduced drug doses and side effects, and self-insertion. However, the alterations in the physiological conditions of the vagina affect the effectiveness of vaginal drug delivery considerably. Conventional vaginal dosage forms are often linked to low retention time in the vagina and discomfort which significantly reduces patient compliance. The lack of optimal prevention and treatment approaches have contributed to the unacceptably high rate of recurrence for vaginal diseases. To combat these limitations, several novel approaches including nano-systems, mucoadhesive polymeric systems, and stimuli-responsive systems have been developed in recent years. This review discusses and summarises the recent research progress of these novel approaches for vaginal drug delivery against various vaginal diseases. An overview of the concept and challenges of vaginal infections, anatomy and physiology of the vagina, and barriers to vaginal drug delivery are also addressed.
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Affiliation(s)
- Manisha Pandey
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
- Centre for Bioactive Molecules and Drug Delivery, Institute for Research, Development and Innovation, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Hira Choudhury
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
- Centre for Bioactive Molecules and Drug Delivery, Institute for Research, Development and Innovation, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Azila Abdul-Aziz
- Department of Chemical and Environmental Engineering, Malaysia-Japan International Institute of Technology, Universiti Teknologi Malaysia, Jalan Sultan Yahya Petra, Kuala Lumpur 54100, Malaysia; or
| | - Subrat Kumar Bhattamisra
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia;
| | - Bapi Gorain
- Faculty of Health and Medical Sciences, School of Pharmacy, Taylor’s University, Subang Jaya, Selangor 47500, Malaysia;
- Center for Drug Delivery and Molecular Pharmacology, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor 47500, Malaysia
| | - Teng Carine
- Undergraduate School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (T.C.); (T.W.T.); (N.J.Y.); (L.W.Y.)
| | - Tan Wee Toong
- Undergraduate School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (T.C.); (T.W.T.); (N.J.Y.); (L.W.Y.)
| | - Ngiam Jing Yi
- Undergraduate School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (T.C.); (T.W.T.); (N.J.Y.); (L.W.Y.)
| | - Lim Win Yi
- Undergraduate School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (T.C.); (T.W.T.); (N.J.Y.); (L.W.Y.)
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Pandit A, Kedar A, Koyate K. Hollow pessary loaded with lawsone via self-microemulsifying drug delivery system for vaginal candidiasis. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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de Oliveira Neto AS, Souza ILA, Amorim MES, de Freitas Souza T, Rocha VN, do Couto RO, Fabri RL, de Freitas Araújo MG. Antifungal efficacy of atorvastatin-containing emulgel in the treatment of oral and vulvovaginal candidiasis. Med Mycol 2020; 59:476-485. [PMID: 32823281 DOI: 10.1093/mmy/myaa071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/29/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022] Open
Abstract
Drug repositioning has been an important ally in the search for new antifungal drugs. Statins are drugs that act to prevent sterol synthesis in both humans and fungi and for this reason they are promissory candidates to be repositioned to treat mycoses. In this study we evaluated the antifungal activity of atorvastatin by in vitro tests to determine the minimum inhibitory concentration against azole resistant Candida albicans and its mechanisms of action. Moreover, the efficacy of both atorvastatin-loaded oral and vaginal emulgels (0.75%, 1.5% and 3% w/w) was evaluated by means of in vivo experimental models of oral and vulvovaginal candidiasis, respectively. The results showed that atorvastatin minimal inhibitory concentration against C. albicans was 31.25 μg/ml. In oral candidiasis experiments, the group treated with oral emulgel containing 3.0% atorvastatin showcased total reduction in fungal load after nine days of treatment. Intravaginal delivery atorvastatin emulgel showed considerable effectiveness at the concentration of 3% (65% of fungal burden reduction) after nine days of treatment. From these findings, it is possible to assert that atorvastatin may be promising for drug repositioning towards the treatment of these opportunistic mycoses.
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Affiliation(s)
- Ari Soares de Oliveira Neto
- Laboratory of Pharmacology, Federal University of São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | - Israel Lucas Antunes Souza
- Laboratory of Pharmacology, Federal University of São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | - Maria Eliza Samuel Amorim
- Laboratory of Pharmaceutical Development, Federal University of São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | - Thalita de Freitas Souza
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Vinicius Novaes Rocha
- Department of Veterinary Medicine, Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Rene Oliveira do Couto
- Laboratory of Pharmaceutical Development, Federal University of São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | - Rodrigo Luiz Fabri
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
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Campos LM, de Oliveira Lemos AS, da Cruz LF, de Freitas Araújo MG, de Mello Botti GCR, Júnior JLR, Rocha VN, Denadai ÂML, da Silva TP, Tavares GD, Scio E, Fabri RL, Pinto PF. Development and in vivo evaluation of chitosan-gel containing Mitracarpus frigidus methanolic extract for vulvovaginal candidiasis treatment. Biomed Pharmacother 2020; 130:110609. [PMID: 34321177 DOI: 10.1016/j.biopha.2020.110609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 02/08/2023] Open
Abstract
Vulvovaginal candidiasis (VVC) is characterized by inflammatory changes in the vaginal mucosa caused by abnormal colonization of Candida species. Traditional topical therapies using reference antifungal drugs usually present several issues and limitations for VVC treatment. Thus, the interest in new vaginal formulations, mainly those based on compounds from natural origin, has been growing over the last years. Methanolic extract from the plant species Mitracarpus frigidus (Willd. Ex Reem Schult.) K. Schum (MFM) has presented potential antifungal activity against C. albicans vaginal infection. Here, we aimed to develop and characterize a gynecological gel formulation based on chitosan containing MFM and to evaluate its anti-C. albicans effectiveness in the treatment of VVC. First, MFM was incorporated into a gel formulation based on chitosan in three final concentrations: 2.5 %, 5.0 %, and 10.0 %. Next, these gel formulations were subjected to stationary and oscillatory rheological tests. Finally, the gel was tested in an experimental VVC model. The rheological tests indicated pseudoplastic fluids, becoming more viscous and elastic with the increase of the extract concentration, indicating intermolecular interactions. Our in vivo analyses demonstrated a great reduction of vulvovaginal fungal burden and infection accompanied with the reduction of mucosal inflammation after MFM chitosan-gel treatment. The present findings open perspectives for the further use of the MFM-chitosan-gel formulation as a therapeutic alternative for VVC treatment.
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Affiliation(s)
- Lara Melo Campos
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Ari Sérgio de Oliveira Lemos
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Luisa Ferreira da Cruz
- Laboratory of Pharmacology, Federal University of São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | | | | | - Janildo Ludolf Reis Júnior
- Department of Veterinary Medicine, Faculty of Medicine, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Vinícius Novaes Rocha
- Department of Veterinary Medicine, Faculty of Medicine, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Ângelo Márcio Leite Denadai
- Department of Pharmacy, Institute of Life Sciences, Federal University of Juiz de Fora, Campus Governador Valadares, Governor Valadares, MG, Brazil
| | - Thiago Pereira da Silva
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Guilherme Diniz Tavares
- Laboratory of Nanostructured Systems Development, Department of Pharmaceutical Science, Faculty of Pharmacy, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Elita Scio
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Rodrigo Luiz Fabri
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil.
| | - Priscila Faria Pinto
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
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Araujo VHS, Duarte JL, Carvalho GC, Silvestre ALP, Fonseca-Santos B, Marena GD, Ribeiro TDC, Dos Santos Ramos MA, Bauab TM, Chorilli M. Nanosystems against candidiasis: a review of studies performed over the last two decades. Crit Rev Microbiol 2020; 46:508-547. [PMID: 32795108 DOI: 10.1080/1040841x.2020.1803208] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The crescent number of cases of candidiasis and the increase in the number of infections developed by non-albicans species and by multi-resistant strains has taken the attention of the scientific community, which has been searching for new therapeutic alternatives. Among the alternatives found the use of nanosystems for delivery of drugs already commercialized and new biomolecules have grown, in order to increase stability, solubility, optimize efficiency and reduce adverse effects. In view of the growing number of studies involving technological alternatives for the treatment of candidiasis, the present review came with the intention of gathering studies from the last two decades that used nanotechnology for the treatment of candidiasis, as well as analysing them critically and pointing out the future perspectives for their application with this purpose. Different studies were considered for the development of this review, addressing nanosystems such as metallic nanoparticles, mesoporous silica nanoparticles, polymeric nanoparticles, liposomes, nanoemulsion, microemulsion, solid lipid nanoparticle, nanostructured lipid carrier, lipidic nanocapsules and liquid crystals; and different clinical presentations of candidiasis. As a general overview, nanotechnology has proven to be an important ally for the treatment against the diversity of candidiasis found in the clinic, whether in increasing the effectiveness of commercialized drugs and reducing their adverse effects, as well as allowing exploring more effectively properties therapeutics of new biomolecules.
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Affiliation(s)
- Victor Hugo Sousa Araujo
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Jonatas Lobato Duarte
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Gabriela Corrêa Carvalho
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | | | - Bruno Fonseca-Santos
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Gabriel Davi Marena
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil.,Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Tais de Cassia Ribeiro
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Matheus Aparecido Dos Santos Ramos
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil.,Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Taís Maria Bauab
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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Fonseca-Santos B, Silva PB, Rigon RB, Sato MR, Chorilli M. Formulating SLN and NLC as Innovative Drug Delivery Systems for Non-Invasive Routes of Drug Administration. Curr Med Chem 2020; 27:3623-3656. [PMID: 31232233 DOI: 10.2174/0929867326666190624155938] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 01/18/2023]
Abstract
Colloidal carriers diverge depending on their composition, ability to incorporate drugs and applicability, but the common feature is the small average particle size. Among the carriers with the potential nanostructured drug delivery application there are SLN and NLC. These nanostructured systems consist of complex lipids and highly purified mixtures of glycerides having varying particle size. Also, these systems have shown physical stability, protection capacity of unstable drugs, release control ability, excellent tolerability, possibility of vectorization, and no reported production problems related to large-scale. Several production procedures can be applied to achieve high association efficiency between the bioactive and the carrier, depending on the physicochemical properties of both, as well as on the production procedure applied. The whole set of unique advantages such as enhanced drug loading capacity, prevention of drug expulsion, leads to more flexibility for modulation of drug release and makes Lipid-based nanocarriers (LNCs) versatile delivery system for various routes of administration. The route of administration has a significant impact on the therapeutic outcome of a drug. Thus, the non-invasive routes, which were of minor importance as parts of drug delivery in the past, have assumed added importance drugs, proteins, peptides and biopharmaceuticals drug delivery and these include nasal, buccal, vaginal and transdermal routes. The objective of this paper is to present the state of the art concerning the application of the lipid nanocarriers designated for non-invasive routes of administration. In this manner, this review presents an innovative technological platform to develop nanostructured delivery systems with great versatility of application in non-invasive routes of administration and targeting drug release.
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Affiliation(s)
- Bruno Fonseca-Santos
- Sao Paulo State University - UNESP, School of Pharmaceutical Sciences, Department of Drugs and Medicines, Araraquara, Sao Paulo 14801-903, Brazil
| | - Patrícia Bento Silva
- University of Brasilia (UnB), Department of Genetics and Morphology, Brasilia, Federal District 70910-970, Brazil
| | - Roberta Balansin Rigon
- University of Campinas (UNICAMP), Faculty of Pharmaceutical Sciences, Campinas, Sao Paulo 13083-871, Brazil
| | - Mariana Rillo Sato
- Sao Paulo State University - UNESP, School of Pharmaceutical Sciences, Department of Drugs and Medicines, Araraquara, Sao Paulo 14801-903, Brazil
| | - Marlus Chorilli
- Sao Paulo State University - UNESP, School of Pharmaceutical Sciences, Department of Drugs and Medicines, Araraquara, Sao Paulo 14801-903, Brazil
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Xu C, Chen Y, Zheng Z, Liu Y, Cao S, Xu Y. Mussel-Inspired Biocompatible PAADOPA/PAAm Hydrogel Adhesive for Amoxicillin Delivery. Ind Eng Chem Res 2020. [DOI: 10.1021/acs.iecr.0c01720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Chengyuan Xu
- State Key Laboratory of Chemical Engineering, East China University of Science and Technology, 200237 Shanghai, P. R. China
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, 200237 Shanghai, P. R. China
| | - Yang Chen
- State Key Laboratory of Chemical Engineering, East China University of Science and Technology, 200237 Shanghai, P. R. China
| | - Zhiyuan Zheng
- State Key Laboratory of Chemical Engineering, East China University of Science and Technology, 200237 Shanghai, P. R. China
| | - Yongchun Liu
- State Key Laboratory of Chemical Engineering, East China University of Science and Technology, 200237 Shanghai, P. R. China
| | - Song Cao
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, 200237 Shanghai, P. R. China
| | - Yisheng Xu
- State Key Laboratory of Chemical Engineering, East China University of Science and Technology, 200237 Shanghai, P. R. China
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Kaur S, Kaur S. Recent Advances in Vaginal Delivery for the Treatment of Vulvovaginal Candidiasis. Curr Mol Pharmacol 2020; 14:281-291. [PMID: 32564767 DOI: 10.2174/1573405616666200621200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/25/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is a common vaginal infection caused by candida species, affecting 70% of the women. It may occur due to the imbalance in the vaginal micro- biodata, pregnancy, diabetes, use of antibiotics, frequent sexual activities or AIDS. AIM The main aim of this review is to provide overview about different vaginal delivery systems for the administration of antifungal agents like conventional, mucoadhesive and muco-penetrating delivery systems. METHOD The conventional delivery systems available have limited efficacy due to the less residence time and adverse effects. In order to overcome these issues, a delivery system with mucoadhesive and muco-penetrating properties is required. Mucoadhesive polymers have excellent binding properties with mucin and thus increasing residence time. On the other hand, muco-penetrating polymers transport the antifungal agents across the mucus layer. RESULTS This review summarizes the pathophysiology of VVC along with novel delivery systems for the treatment of infection through mucoadhesive and muco-penetrating approaches. Surface modifications of nano/ microparticles with mucoadhesive or muco-penetrating particles may provide delivery systems with improved therapeutic efficacy. CONCLUSION Based on the available data, conventional and mucoadhesive drug delivery systems have some limitations, they still require improvement/ development for safe and effective delivery of antifungal agents.
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Affiliation(s)
- Sandeep Kaur
- Department of Pharmaceutics, ISF College of Pharmacy, Moga (Punjab), India
| | - Sukhbir Kaur
- Department of Pharmaceutics, ISF College of Pharmacy, Moga (Punjab), India
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Song R, Yan F, Cheng M, Dong F, Lin Y, Wang Y, Song B. Ultrasound-Assisted Preparation of Exopolysaccharide/Nystatin Nanoemulsion for Treatment of Vulvovaginal Candidiasis. Int J Nanomedicine 2020; 15:2027-2044. [PMID: 32273700 PMCID: PMC7104221 DOI: 10.2147/ijn.s241134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/06/2020] [Indexed: 01/04/2023] Open
Abstract
PURPOSE As one of the classic anti-Canidia albicans (CA) and vulvovaginal candidiasis (VVC) drugs, nystatin (NYS) is limited by poor water solubility and easy aggregation. Traditional NYS vaginal delivery formulations do not fully adapt to the specific environment of the vaginal cavity. The use of exopolysaccharides (EPS) has great application potential in emulsifiers, but its use has not been reported in nanoemulsions. In this work, an EPS/NYS nanoemulsion (ENNE) was developed to improve the activities of NYS against CA and VVC. METHODS The ENNE was prepared by ultrasonic method using EPS as an emulsifier, liquid paraffin oil as an oil phase, PEG400 as a co-emulsifier, and NYS as the loaded drug. ENNE preparation was optimized by response surface method. After optimization, in vitro and in vivo analysis of the anti-CA activity; animal experiments; staining with propidium iodide (PI), periodic acid-schiff (PAS), and hematoxylin-eosin (H&E); and cytokine experiments were performed to investigate the therapeutic ability against VVC. RESULTS The optimal formulation and preparation parameters of ENNE were determined as follows: EPS content of 1.5%, PEG400 content of 3.2%, NYS content of 700 μg/mL, paraffin oil content of 5.0%, ultrasonic time of 15 min, and ultrasonic amplitude of 35%. The ENNE showed an encapsulated structure with an average particle size of 131.1 ± 4.32 nm. ENNE exhibited high storage and pH stability, as well as slow release. The minimum inhibitory concentration (MIC) of ENNE against CA was only 0.125 μg/mL and the inhibition zone was 19.0 ± 0.5 mm, for greatly improved anti-CA effect. The prepared ENNE destroyed the membrane of CA cells, and exhibited good anti-CA effect in vivo and therapeutic ability against VVC. CONCLUSION The results of this study will promote the application of EPS in nanotechnology, which should lead to new and effective local drug formulations for treating VVC.
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Affiliation(s)
- Ruiteng Song
- School of Pharmacy, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
| | - Fang Yan
- School of Pharmacy, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
| | - Min Cheng
- Clinical Medical College, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
| | - Fakun Dong
- School of Pharmacy, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
| | - Yongqi Lin
- School of Pharmacy, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
| | - Yuzhen Wang
- Medical Imaging Specialty, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
| | - Bo Song
- School of Pharmacy, Weifang Medical University, Weifang, Shandong261053, People’s Republic of China
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Bolla PK, Clark BA, Juluri A, Cheruvu HS, Renukuntla J. Evaluation of Formulation Parameters on Permeation of Ibuprofen from Topical Formulations Using Strat-M ® Membrane. Pharmaceutics 2020; 12:E151. [PMID: 32069850 PMCID: PMC7076669 DOI: 10.3390/pharmaceutics12020151] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
Topical drug delivery is an attractive alternative to conventional methods because of advantages such as non-invasive delivery, by-pass of first pass metabolism, and improved patient compliance. However, several factors such as skin, physicochemical properties of the drug, and vehicle characteristics influence the permeation. Within a formulation, critical factors such as concentration of drug, physical state of drug in the formulation, and organoleptic properties affect the flux across the skin. The aim of the study was to develop and investigate topical semisolid preparations (creams and gels) with ibuprofen as the model drug and investigate the effect of various formulation parameters on the in-vitro performance across the Strat-M® membrane using flow-through cells. In addition, the physical stability of the developed formulations was investigated by studying viscosity, pH, and appearance. All the formulations developed in the study had appealing appearance with smooth texture and no signs of separation. Viscosity and pH of the formulations were acceptable. Cumulative amount of drug permeated at the end of 24 h was highest for clear gel (3% w/w ibuprofen; F6: 739.6 ± 36.1 µg/cm2) followed by cream with high concentration of ibuprofen in suspended form (5% w/w; F3: 320.8 ± 17.53 µg/cm2), emulgel (3% w/w ibuprofen; F5: 178.5 ± 34.5 µg/cm2), and cream with solubilized ibuprofen (3% w/w; F2A: 163.2 ± 9.36 µg/cm2). Results from this study showed that permeation of ibuprofen was significantly influenced by formulation parameters such as concentration of ibuprofen (3% vs. 5% w/w), physical state of ibuprofen (solubilized vs. suspended), formulation type (cream vs. gel), mucoadhesive agents, and viscosity (high vs. low). Thus, findings from this study indicate that pharmaceutical formulation scientists should explore these critical factors during the early development of any new topical drug product in order to meet pre-determined quality target product profile.
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Affiliation(s)
- Pradeep Kumar Bolla
- Department of Biomedical Engineering, College of Engineering, The University of Texas at El Paso, 500 W. University Ave, El Paso, TX 79968, USA;
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC 27268, USA;
| | - Bradley A. Clark
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC 27268, USA;
| | - Abhishek Juluri
- Department of Pharmaceutics, The University of Mississippi, Oxford, MS 38677, USA;
| | - Hanumanth Srikanth Cheruvu
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad 500037, India;
| | - Jwala Renukuntla
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC 27268, USA;
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