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Kalams SA, Rogers LM, Smith RM, Barnett L, Crumbo K, Sumner S, Prashad N, Rybczyk K, Milne G, Dowd SE, Chong E, Winikoff B, Aronoff DM. Neither vaginal nor buccal administration of 800 μg misoprostol alters mucosal and systemic immune activation or the cervicovaginal microbiome: a pilot study. EUR J CONTRACEP REPR 2016; 21:436-442. [PMID: 27636701 DOI: 10.1080/13625187.2016.1229765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to assess the extent to which misoprostol alters mucosal or systemic immune responses following either buccal or vaginal administration. METHODS This was a prospective, crossover pilot study of 15 healthy, reproductive-age women. Women first received 800 μg misoprostol either via buccal or vaginal administration and were crossed over 1 month later to receive the drug via the other route. Cervicovaginal lavage samples, cervical Cytobrush samples, cervicovaginal swabs, urine and blood were obtained immediately prior to drug administration and the following day. Parameters assessed included urine and cervicovaginal misoprostol levels, whole blood cytokine responses (by ELISA) to immune stimulation with lipopolysaccharide, peripheral blood and cervical lymphocyte phenotyping by flow cytometry, cervicovaginal antimicrobial peptide measurement by ELISA and vaginal microbial ecology assessment by 16S rRNA sequencing. RESULTS Neither buccal nor vaginal misoprostol significantly altered local or systemic immune and microbiological parameters. CONCLUSION In this pilot study, we did not observe significant alteration of mucosal or systemic immunology or vaginal microbial ecology 1 day after drug administration following either the buccal or vaginal route.
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Affiliation(s)
- Spyros A Kalams
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Lisa M Rogers
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Rita M Smith
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Louise Barnett
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Katie Crumbo
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Shonda Sumner
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Naomi Prashad
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Kyle Rybczyk
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Ginger Milne
- b Division of Clinical Pharmacology, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Scot E Dowd
- c MR DNA (Molecular Research) , Shallowater , TX , USA
| | - Erica Chong
- d Gynuity Health Projects LLC , New York , NY , USA
| | | | - David M Aronoff
- a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
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Gobejishvili L, Ghare S, Khan R, Cambon A, Barker DF, Barve S, McClain C, Hill D. Misoprostol modulates cytokine expression through a cAMP pathway: Potential therapeutic implication for liver disease. Clin Immunol 2015; 161:291-9. [PMID: 26408955 DOI: 10.1016/j.clim.2015.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/09/2015] [Accepted: 09/15/2015] [Indexed: 12/20/2022]
Abstract
Dysregulated cytokine metabolism plays a critical role in the pathogenesis of many forms of liver disease, including alcoholic and non-alcoholic liver disease. In this study we examined the efficacy of Misoprostol in modulating LPS-inducible TNFα and IL-10 expression in healthy human subjects and evaluated molecular mechanisms for Misoprostol modulation of cytokines in vitro. Healthy subjects were given 14day courses of Misoprostol at doses of 100, 200, and 300μg four times a day, in random order. Baseline and LPS-inducible cytokine levels were examined ex vivo in whole blood at the beginning and the end of the study. Additionally, in vitro studies were performed using primary human PBMCs and the murine macrophage cell line, RAW 264.7, to investigate underlying mechanisms of misoprostol on cytokine production. Administration of Misoprostol reduced LPS inducible TNF production by 29%, while increasing IL-10 production by 79% in human subjects with no significant dose effect on ex vivo cytokine activity; In vitro, the effect of Misoprostol was largely mediated by increased cAMP levels and consequent changes in CRE and NFκB activity, which are critical for regulating IL-10 and TNF expression. Additionally, chromatin immunoprecipitation (ChIP) studies demonstrated that Misoprostol treatment led to changes in transcription factor and RNA Polymerase II binding, resulting in changes in mRNA levels. In summary, Misoprostol was effective at beneficially modulating TNF and IL-10 levels both in vivo and in vitro; these studies suggest a potential rationale for Misoprostol use in ALD, NASH and other liver diseases where inflammation plays an etiologic role.
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Affiliation(s)
- Leila Gobejishvili
- Department of Internal Medicine, University of Louisville, United States; Department of Pharmacology & Toxicology, University of Louisville, United States.
| | - Smita Ghare
- Department of Internal Medicine, University of Louisville, United States
| | - Rehan Khan
- RK Gastroenterology & Hepatology, Coppell, TX, United States
| | - Alexander Cambon
- Department of Bioinformatics & Biostatistics, University of Louisville, United States
| | - David F Barker
- Department of Internal Medicine, University of Louisville, United States
| | - Shirish Barve
- Department of Internal Medicine, University of Louisville, United States; Department of Pharmacology & Toxicology, University of Louisville, United States
| | - Craig McClain
- Department of Internal Medicine, University of Louisville, United States; Department of Pharmacology & Toxicology, University of Louisville, United States; VA Medical Center, Louisville, KY, United States
| | - Daniell Hill
- Department of Internal Medicine, University of Louisville, United States; VA Medical Center, Louisville, KY, United States
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Mjösberg J, Berg G, Jenmalm MC, Ernerudh J. FOXP3+ Regulatory T Cells and T Helper 1, T Helper 2, and T Helper 17 Cells in Human Early Pregnancy Decidua1. Biol Reprod 2010; 82:698-705. [DOI: 10.1095/biolreprod.109.081208] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Aronoff DM, Hao Y, Chung J, Coleman N, Lewis C, Peres CM, Serezani CH, Chen GH, Flamand N, Brock TG, Peters-Golden M. Misoprostol impairs female reproductive tract innate immunity against Clostridium sordellii. THE JOURNAL OF IMMUNOLOGY 2008; 180:8222-30. [PMID: 18523288 DOI: 10.4049/jimmunol.180.12.8222] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Fatal cases of acute shock complicating Clostridium sordellii endometritis following medical abortion with mifepristone (also known as RU-486) used with misoprostol were reported. The pathogenesis of this unexpected complication remains enigmatic. Misoprostol is a pharmacomimetic of PGE(2), an endogenous suppressor of innate immunity. Clinical C. sordellii infections were associated with intravaginal misoprostol administration, suggesting that high misoprostol concentrations within the uterus impair immune responses against C. sordellii. We modeled C. sordellii endometritis in rats to test this hypothesis. The intrauterine but not the intragastric delivery of misoprostol significantly worsened mortality from C. sordellii uterine infection, and impaired bacterial clearance in vivo. Misoprostol also reduced TNF-alpha production within the uterus during infection. The intrauterine injection of misoprostol did not enhance mortality from infection by the vaginal commensal bacterium Lactobacillus crispatus. In vitro, misoprostol suppressed macrophage TNF-alpha and chemokine generation following C. sordellii or peptidoglycan challenge, impaired leukocyte phagocytosis of C. sordellii, and inhibited uterine epithelial cell human beta-defensin expression. These immunosuppressive effects of misoprostol, which were not shared by mifepristone, correlated with the activation of the G(s) protein-coupled E prostanoid (EP) receptors EP2 and EP4 (macrophages) or EP4 alone (uterine epithelial cells). Our data provide a novel explanation for postabortion sepsis leading to death and also suggest that PGE(2), in which production is exaggerated within the reproductive tract during pregnancy, might be an important causal determinant in the pathogenesis of more common infections of the gravid uterus.
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Affiliation(s)
- David M Aronoff
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA.
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