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Davis S, Parthun K, Friend DR. A nine-month repeat-dose intravaginal ring (Ovaprene) irritation study in sheep. Contraception 2024; 133:110387. [PMID: 38342425 DOI: 10.1016/j.contraception.2024.110387] [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: 08/31/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Ovaprene is a novel, investigational, intravaginal hormone-free monthly ring contraceptive designed for use in women of reproductive age to be worn over multiple weeks (one menstrual cycle). The objective of this work was to evaluate the safety of Ovaprene during a nine-month repeat-dose sheep study. STUDY DESIGN In addition to traditional safety endpoints such as histopathological evaluation of the sheep female reproductive tract, vaginal fluids were collected and tested for released iron over time. Also, the amount of iron in the rings was assessed following removal, and serum iron levels were measured. There were four sheep in each group (Ovaprene group and sham group). RESULTS There were no macroscopic clinical findings. There was minimal to mild, mixed or mononuclear cell infiltration present in all levels of vagina (cranial, mid, and caudal) from all animals including sham controls based on post-study necropsy. The female reproductive tract from animals treated with the Ovaprene ring was comparable to the sham controls. The concentrations of serum iron in sheep treated with Ovaprene ring were similar compared to a sham treated animal. The average amount of ferrous gluconate released from Ovaprene over the 29-day period of use was 175 mg of the approximately 512 mg nominally loaded into the rings. CONCLUSIONS Overall, the Ovaprene devices were well-tolerated in female sheep. IMPLICATIONS This study should support a chronic (e.g., one year) contraceptive efficacy study in women.
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Affiliation(s)
- Sarah Davis
- Surgery and Efficacy, Charles River Laboratories, Mattawan, MI, USA
| | - Kelsey Parthun
- Surgery and Efficacy, Charles River Laboratories, Mattawan, MI, USA
| | - David R Friend
- Research and Development, Daré Bioscience, Inc., San Diego, CA, USA.
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Magill E, Demartis S, Gavini E, Permana AD, Thakur RRS, Adrianto MF, Waite D, Glover K, Picco CJ, Korelidou A, Detamornrat U, Vora LK, Li L, Anjani QK, Donnelly RF, Domínguez-Robles J, Larrañeta E. Solid implantable devices for sustained drug delivery. Adv Drug Deliv Rev 2023; 199:114950. [PMID: 37295560 DOI: 10.1016/j.addr.2023.114950] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Implantable drug delivery systems (IDDS) are an attractive alternative to conventional drug administration routes. Oral and injectable drug administration are the most common routes for drug delivery providing peaks of drug concentrations in blood after administration followed by concentration decay after a few hours. Therefore, constant drug administration is required to keep drug levels within the therapeutic window of the drug. Moreover, oral drug delivery presents alternative challenges due to drug degradation within the gastrointestinal tract or first pass metabolism. IDDS can be used to provide sustained drug delivery for prolonged periods of time. The use of this type of systems is especially interesting for the treatment of chronic conditions where patient adherence to conventional treatments can be challenging. These systems are normally used for systemic drug delivery. However, IDDS can be used for localised administration to maximise the amount of drug delivered within the active site while reducing systemic exposure. This review will cover current applications of IDDS focusing on the materials used to prepare this type of systems and the main therapeutic areas of application.
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Affiliation(s)
- Elizabeth Magill
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Sara Demartis
- Department of Chemical, Physical, Mathematical and Natural Sciences, University of Sassari, Sassari, 07100, Italy
| | - Elisabetta Gavini
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, 07100, Italy
| | - Andi Dian Permana
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Raghu Raj Singh Thakur
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Re-Vana Therapeutics, McClay Research Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Muhammad Faris Adrianto
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Re-Vana Therapeutics, McClay Research Centre, 97 Lisburn Road, Belfast BT9 7BL, UK; Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Airlangga University, Surabaya, East Java 60115, Indonesia
| | - David Waite
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Re-Vana Therapeutics, McClay Research Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Katie Glover
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Camila J Picco
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Anna Korelidou
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Usanee Detamornrat
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Linlin Li
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Fakultas Farmasi, Universitas Megarezky, Jl. Antang Raya No. 43, Makassar 90234, Indonesia
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Universidad de Sevilla, 41012 Seville, Spain.
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK.
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Gupta D, Prabhakar B, Wairkar S. Non-oral routes, novel formulations and devices of contraceptives: An update. J Control Release 2022; 345:798-810. [PMID: 35378212 DOI: 10.1016/j.jconrel.2022.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Family planning enables society to prevent unintended pregnancies and helps in attaining desired spacing between the pregnancies. It is done with the use of contraceptive methods and infertility treatments. The use of contraceptives serves to ease maternal ill-health and reduce pregnancy-related deaths and helps to decrease the number of unsafe abortions and HIV transmission from mothers to newborns. The most popular contraception method is a daily dose of combined oral contraceptives pills. However, poor compliance and various adverse effects are common problems of oral contraceptives that considerably reduce their long-term use. Thus, several non-oral contraceptive options have been developed for better compliance, reduced side effects and improved therapeutic efficacy. This review presented the non-oral contraceptive formulations given by different routes such as transdermal, nasal, subcutaneous, intramuscular, intrauterine and vaginal routes. These formulations delivering contraceptives, mainly through devices, include transdermal patches and microneedles, nasal sprays, intrauterine devices and intrauterine systems, vaginal rings, contraceptive implants and contraceptive injections, which are unique in their specific advantages and drawbacks.
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Affiliation(s)
- Deepak Gupta
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India.
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Recent progress in advanced biomaterials for long-acting reversible contraception. J Nanobiotechnology 2022; 20:138. [PMID: 35300702 PMCID: PMC8932341 DOI: 10.1186/s12951-022-01329-5] [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: 11/23/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
Unintended pregnancy is a global issue with serious ramifications for women, their families, and society, including abortion, infertility, and maternal death. Although existing contraceptive strategies have been widely used in people's lives, there have not been satisfactory feedbacks due to low contraceptive efficacy and related side effects (e.g., decreased sexuality, menstrual cycle disorder, and even lifelong infertility). In recent years, biomaterials-based long-acting reversible contraception has received increasing attention from the viewpoint of fundamental research and practical applications mainly owing to improved delivery routes and controlled drug delivery. This review summarizes recent progress in advanced biomaterials for long-acting reversible contraception via various delivery routes, including subcutaneous implant, transdermal patch, oral administration, vaginal ring, intrauterine device, fallopian tube occlusion, vas deferens contraception, and Intravenous administration. In addition, biomaterials, especially nanomaterials, still need to be improved and prospects for the future in contraception are mentioned.
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Rafiei F, Tabesh H, Farzad S, Farzaneh F, Rezaei M, Hosseinzade F, Mottaghy K. Development of Hormonal Intravaginal Rings: Technology and Challenges. Geburtshilfe Frauenheilkd 2021; 81:789-806. [PMID: 34276064 PMCID: PMC8277443 DOI: 10.1055/a-1369-9395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
Intravaginal rings (IVRs) are minimally invasive polymeric devices specifically designed to be used for the sustained and prolonged release of various type of drugs such as hormones. One of the benefits of using topical drug delivery systems (e.g., IVRs) is the fact that systemic drug delivery may cause drug resistance due to elevated drug levels. Topical drug delivery also provides higher concentrations of the drug to the target site and has fewer side effects. In addition, when a drug is administered vaginally, the hepatic first-pass effect is avoided, resulting in higher absorption. Contraception and treatments for specific diseases such as endometriosis and hormone deficiencies can be improved by the administration of hormones via an IVR. This article aims to classify and compare various designs of commercially available and non-commercial hormonal IVRs and to analyze their performance. Current challenges affecting the development of IVRs are investigated, and
proposed solutions are discussed. A comprehensive search of publications in MEDLINE/PubMed and of commercial product data of IVRs was performed, and the materials, designs, performance, and applications (e.g., contraception, endometriosis, estrogen deficiency and urogenital atrophy) of hormonal IVRs were thoroughly evaluated. Most hormonal IVRs administer female sex hormones, i.e., estrogen and progestogens. In terms of material, IVRs are divided into 3 main groups: silicone, polyurethane, and polyethylene-co-vinyl acetate IVRs. As regards their design, there are 4 major designs for IVRs which strongly affect their performance and the timing and rate of hormone release. Important challenges include reducing the burst release and maintaining the bioavailability of hormones at their site of action over a prolonged period of administration as well as lowering production costs. Hormonal IVRs are a promising method which could be used to facilitate combination therapies by
administering multiple drugs in a single IVR while eliminating the side effects of conventional drug administration methods. IVRs could considerably improve womenʼs quality of life all over the world within a short period of time.
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Affiliation(s)
- Fojan Rafiei
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Hadi Tabesh
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Shayan Farzad
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States
| | - Farah Farzaneh
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rezaei
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Fateme Hosseinzade
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Khosrow Mottaghy
- Institute of Physiology, RWTH Aachen University, Aachen, Germany
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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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7
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Sharifzadeh G, Hezaveh H, Muhamad II, Hashim S, Khairuddin N. Montmorillonite-based polyacrylamide hydrogel rings for controlled vaginal drug delivery. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 110:110609. [PMID: 32204060 DOI: 10.1016/j.msec.2019.110609] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 12/18/2019] [Accepted: 12/26/2019] [Indexed: 01/21/2023]
Abstract
Vaginal drug delivery is regarded as a promising route against women-related health issues such as unwanted pregnancies and sexually transmitted infections. However, only a very few studies have been reported on the use of hydrogel rings with low cytotoxicity for vaginal drug delivery applications. Moreover, the effect of nanoparticles on hydrogel vaginal rings has not been clearly evaluated. To overcome these challenges, we hereby developed nanocomposite hydrogel rings based on polyacrylamide-sodium carboxymethyl cellulose-montmorillonite nanoparticles in the ring-shaped aluminum mold for controlled drug delivery. The hydrogel rings were synthesized by using N,N'-methylene bisacrylamide, N,N,N',N'-tetramethyl ethylene diamine, and ammonium persulfate, as a crosslinker, accelerator, and initiator, respectively. The obtained rings were 5.5 cm in diameters and 0.5 cm in rims. Chemical structures of the nanocomposite rings were confirmed by Fourier transform infrared, and Nuclear Magnetic Resonance spectroscopies. Additionally, the swelling ratio of hydrogels was appeared to be adjusted by the introduction of nanoparticles. In vitro release experiment of methylene blue, as a hydrophilic model drug, revealed that the nanocomposite rings could not only reduce burst effect (almost more than twice), but also achieve prolonged release for 15 days in the vaginal fluid simulant which mimic the vaginal conditions at pH of almost 4.2, and a temperature of 37 °C. Importantly, the resultant hydrogel rings with or without various concentrations of montmorillonite showed low cytotoxicity toward human skin fibroblasts. Furthermore, different antibacterial activities against Escherichia coli were observed for various concentrations of montmorillonite in hydrogels. These results suggest the great potential of montmorillonite-based hydrogel rings for vaginal drug delivery.
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Affiliation(s)
- Ghorbanali Sharifzadeh
- Department of Polymer Engineering, School of Chemical Engineering, 81310, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Hadi Hezaveh
- Manufacturing Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria 3169, Australia
| | - Ida Idayu Muhamad
- Food and Biomaterial Engineering Research Group (FoBERG), Bioprocess and Polymer Engineering Department, School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia; Biomaterials Cluster, IJN-UTM Cardiovascular Engineering Centre, Block B, V01, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
| | - Shahrir Hashim
- Department of Bioprocess and Polymer Engineering, School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia.
| | - Nozieana Khairuddin
- Department of Basic Science and Engineering, Faculty of Agriculture and Food Science, Universiti Putra Malaysia, Bintulu Sarawak Campus, P.O. Box 396, Nyabau Road, 97008 Bintulu, Sarawak, Malaysia
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8
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Injectable Vaginal Hydrogels as a Multi-Drug Carrier for Contraception. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9081638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Injectable intravaginal hydrogels could deliver drugs systemically without hepatic first pass effect. This paper focuses on the contraceptive function of an injectable temperature-sensitive four-arm star-shaped poly(D,L-lactic-co-glycolic acid)-b-methoxy poly(ethylene glycol) (4sPLGA-mPEG) block copolymer hydrogels as a carrier of three drugs. In vitro controlled release profiles were investigated via HPLC, and it showed that the cumulative release amounts of indomethacin (IMC), gestodene (GSD), and ethinyl estradiol (EE) from copolymer hydrogels could be regulated by adjusting the lactide/glycolide (LA/GA) mol ratio. In addition, in vitro release profiles of IMC, GSD, and EE well corresponded to Higuchi model. The acute toxicity of copolymer hydrogels loaded with different dosage contents multi-drug was evaluated in vivo. As to the high dosage group, the uterus was hydropic at day 1 and ulcerated at day 5, followed with intestinal adhesion. Regarding the middle dosage group, no festering of tissues was observed and, blood coagulum existed in the uterus at different days. For low dosage group, no significant tissue necrosis was found. Finally, the antifertility experiments confirmed that hydrogels loaded with the multi-drug had an excellent contraceptive effect. The above results indicated that injectable copolymer hydrogel as a multi-drug carrier was promising as a novel contraception method.
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Tyo KM, Minooei F, Curry KC, NeCamp SM, Graves DL, Fried JR, Steinbach-Rankins JM. Relating Advanced Electrospun Fiber Architectures to the Temporal Release of Active Agents to Meet the Needs of Next-Generation Intravaginal Delivery Applications. Pharmaceutics 2019; 11:E160. [PMID: 30987206 PMCID: PMC6523330 DOI: 10.3390/pharmaceutics11040160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 02/07/2023] Open
Abstract
Electrospun fibers have emerged as a relatively new delivery platform to improve active agent retention and delivery for intravaginal applications. While uniaxial fibers have been explored in a variety of applications including intravaginal delivery, the consideration of more advanced fiber architectures may offer new options to improve delivery to the female reproductive tract. In this review, we summarize the advancements of electrospun coaxial, multilayered, and nanoparticle-fiber architectures utilized in other applications and discuss how different material combinations within these architectures provide varied durations of release, here categorized as either transient (within 24 h), short-term (24 h to one week), or sustained (beyond one week). We seek to systematically relate material type and fiber architecture to active agent release kinetics. Last, we explore how lessons derived from these architectures may be applied to address the needs of future intravaginal delivery platforms for a given prophylactic or therapeutic application. The overall goal of this review is to provide a summary of different fiber architectures that have been useful for active agent delivery and to provide guidelines for the development of new formulations that exhibit release kinetics relevant to the time frames and the diversity of active agents needed in next-generation multipurpose applications.
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Affiliation(s)
- Kevin M Tyo
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
- Center for Predictive Medicine, Louisville, KY 40202, USA.
| | - Farnaz Minooei
- Department of Chemical Engineering, University of Louisville, Louisville, KY 40292, USA.
| | - Keegan C Curry
- Department of Biology, University of Louisville, Louisville, KY 40292, USA.
| | - Sarah M NeCamp
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY 40292, USA.
| | - Danielle L Graves
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY 40292, USA.
| | - Joel R Fried
- Department of Chemical Engineering, University of Louisville, Louisville, KY 40292, USA.
| | - Jill M Steinbach-Rankins
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
- Center for Predictive Medicine, Louisville, KY 40202, USA.
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY 40292, USA.
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, Louisville, KY 40292, USA.
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Jalalvandi E, Shavandi A. In situ-forming and pH-responsive hydrogel based on chitosan for vaginal delivery of therapeutic agents. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:158. [PMID: 30349982 DOI: 10.1007/s10856-018-6166-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Abstract
One of the important routes of drug administration for localized delivery of contraceptives and cervical cancer treatment agents is vaginal canal. Due to the low pH of vagina, a pH-responsive drug delivery system was developed. This hydrogel was synthesized based on a mucoadhesive biopolymer, chitosan (CS), that promotes the interaction between the hydrogel and mucosal surface of the vagina, potentially increasing the residence time of the system. This injectable hydrogel was formed via acid-labile Schiff-base linkages between free amine groups and aldehyde functionalities on modified chitosan. A novel approach was taken to add aldehyde functionalities to chitosan using a two-step reaction. Two types of slow and fast degrading hydrogels were prepared and loaded with iron (II) gluconate dihydrate, a non-hormonal spermicide, and doxorubicin hydrochloride, an anti-cancer drug. The release profiles of these drugs at different pH environments were assessed to determine the pH-dependent release mechanism. Mechanical properties, swell-ability and degradation rate of these matrices were studied. The cross-linking density of the hydrogel as well as pH changes played an important role in the characteristic of these hydrogels. The hydrogels degraded faster in lower pH, while the hydrogel with lower cross-linking density showed longer gelation time and faster degradation rate compared to the gel with higher cross-linking density. In vitro cytotoxicity assessment of these hydrogels in 48 h indicated the non-toxic effect of these hydrogels toward mesenchymal stem cells (MSCs) in the test period.
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Affiliation(s)
- Esmat Jalalvandi
- Department of Mechanical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405, USA.
| | - Amin Shavandi
- Department of Food Science, Centre for Bioengineering and Nanomedicine, University of Otago, Dunedin, 9054, New Zealand
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Sabbagh F, Muhamad II. Physical and Chemical Characterisation of Acrylamide-Based Hydrogels, Aam, Aam/NaCMC and Aam/NaCMC/MgO. J Inorg Organomet Polym Mater 2017. [DOI: 10.1007/s10904-017-0599-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Malcolm RK, Boyd PJ, McCoy CF, Murphy DJ. Microbicide vaginal rings: Technological challenges and clinical development. Adv Drug Deliv Rev 2016; 103:33-56. [PMID: 26829289 DOI: 10.1016/j.addr.2016.01.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Vaginal rings (VRs) are flexible, torus-shaped, polymeric devices designed to sustain delivery of pharmaceutical drugs to the vagina for clinical benefit. Following first report in a 1970 patent application, several steroid-releasing VR products have since been marketed for use in hormone replacement therapy and contraception. Since 2002, there has been growing interest in the use of VR technology for delivery of drugs that can reduce the risk of sexual acquisition of human immunodeficiency virus type 1 (HIV-1), the causative agent of acquired immunodeficiency syndrome (AIDS). Although no vaginally-administered product has yet been approved for HIV reduction/prevention, extensive research efforts are continuing and a number of VR devices offering sustained release of so-called 'HIV microbicide' compounds are currently being evaluated in late-stage clinical studies. This review article provides an overview of the published scientific literature within this important field of research, focusing primarily on articles published within peer-reviewed journal publications. Many important aspects of microbicide-releasing VR technology are discussed, with a particular emphasis on the technological, manufacturing and clinical challenges that have emerged in recent years.
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Genina N, Holländer J, Jukarainen H, Mäkilä E, Salonen J, Sandler N. Ethylene vinyl acetate (EVA) as a new drug carrier for 3D printed medical drug delivery devices. Eur J Pharm Sci 2016; 90:53-63. [DOI: 10.1016/j.ejps.2015.11.005] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
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Optimization of curcumin loaded vaginal in-situ hydrogel by box-behnken statistical design for contraception. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2015.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Helbling IM, Ibarra JC, Luna JA. Evaluation and optimization of progesterone release from intravaginal rings using response surface methodology. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2015.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Das U, Sharma M, Kilbourne-Brook M, Coffey PS. Exploring vaginal ring acceptability for contraception and sexually transmissible infection protection in India: a qualitative research study. Sex Health 2015; 12:532-40. [PMID: 26259736 DOI: 10.1071/sh15045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/17/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background New vaginal rings are being developed as single and multipurpose prevention technologies to protect women from pregnancy and/or sexually transmissible infections, such as HIV. Data on ring acceptability in low-resource settings is critical for new technologies to meet user needs. METHODS Women from slum and lower-income areas around Delhi, India, participated in focus group discussions on vaginal ring product perceptions and preferences. Participants were recruited based on following eligibility categories: age, marital status, contraceptive use, and number of children. The translated transcriptions of the qualitative data were analysed using a coding scheme generated from the areas of inquiry and relevant literature. RESULTS A total of 103 women from lower-middle-class or slum areas in Delhi participated in 13 focus group discussions between December 2012 and January 2013. Participants shared perceptions of vaginal ring product attributes, including size, colour, intended use (single indication or dual purpose), duration of use, side effects, biodegradability, and various preferences regarding product use, including access, use during sex, wear patterns, cleaning, and disposal. Participants also reflected on willingness to pay and male partner acceptability. CONCLUSIONS The results of this hypothetical acceptability study indicate that these low-income women in Delhi are: willing to try vaginal rings; unconcerned about wearing them during sex; very interested in protection from infections and unintended pregnancy; indifferent about colour of new rings; emphatic about being told that rings may change colour from menstrual blood staining; comfortable with thinner rings; willing to try thicker rings once familiar with thinner rings; in favour of starting with 1-month rings and then transitioning to longer-term rings; and in favour of first accessing rings at a facility and then managing resupply independently.
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Grammen C, Baes M, Haenen S, Verguts J, Augustyns K, Zydowsky T, La Colla P, Augustijns P, Brouwers J. Vaginal Expression of Efflux Transporters and the Potential Impact on the Disposition of Microbicides in Vitro and in Rabbits. Mol Pharm 2014; 11:4405-14. [DOI: 10.1021/mp5005004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Carolien Grammen
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
| | - Myriam Baes
- Department
of Pharmaceutical and Pharmacological Sciences, Laboratory for Cell
Metabolism, KU Leuven—University of Leuven, Leuven, Belgium
| | - Steven Haenen
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
| | - Jasper Verguts
- Department
of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Augustyns
- Laboratory
of Medicinal Chemistry, University of Antwerp, Antwerp, Belgium
| | - Thomas Zydowsky
- The Population Council, New York, New York 10017, United States
| | - Paolo La Colla
- Department
of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Patrick Augustijns
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
| | - Joachim Brouwers
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
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Aderibigbe B, Sadiku E, Jayaramudu J, Sinha Ray S. Controlled dual release study of curcumin and a 4-aminoquinoline analog from gum acacia containing hydrogels. J Appl Polym Sci 2014. [DOI: 10.1002/app.41613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Emmanuel Sadiku
- Department of Chemical; Metallurgical and Material Engineering, Tshwane University of Technology; Pretoria South Africa
| | - Jarugala Jayaramudu
- Department of Chemical; Metallurgical and Material Engineering, Tshwane University of Technology; Pretoria South Africa
- DST/CSIR National Centre for Nanostructured Materials; Council for Scientific and Industrial Research; Pretoria 0001 South Africa
| | - Suprakas Sinha Ray
- DST/CSIR National Centre for Nanostructured Materials; Council for Scientific and Industrial Research; Pretoria 0001 South Africa
- Department of Applied Chemistry; University of Johannesburg; Doornfontein 2028 Johannesburg South Africa
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21
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The Optimization of an Intravaginal Ring Releasing Progesterone Using a Mathematical Model. Pharm Res 2013; 31:795-808. [DOI: 10.1007/s11095-013-1201-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/31/2013] [Indexed: 10/26/2022]
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Preparation and evaluation of intravaginal ring containing drospirenone. Adv Pharmacol Sci 2013; 2013:192408. [PMID: 23401679 PMCID: PMC3562644 DOI: 10.1155/2013/192408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 11/18/2022] Open
Abstract
In the present study, we investigated the feasibility of the vaginal administration of drospirenone silicone IVR. The in vitro release characteristics of matrix-type and reservoir-type IVR were compared under sink conditions in 21 days. At the same time, API excipients compatibility and preformulation study was performed by HPLC, IR, and DSC methods. Biocompatibility of reservoir system was evaluated by tolerability on tissue level in rats. It was found that, under strong light exposure, high temperature, and high humidity conditions, drospirenone and excipients had no significant interactions. The daily release of reservoir-type IVR was about 0.5 mg/d sustaining 21 days, which significantly decreased the burst effect compared with the matrix system. When drospirenone was modified by the PVPk30 in the reservoir system formulation, the daily release rate increased to 1.0 mg/d sustaining 21 days. The cumulative release of reservoir-type IVR was fitted to zero release equation. In addition, biocompatibility of drospirenone IVR system in this dosage is safe. It is feasibility feasibile to further developed for safe, convenient, and effective contraceptive drug delivery with reduced dosing interval.
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Abstract
Microbicides are topically applied, user controlled dosage forms that are being developed to prevent the transmission of HIV during coitus. Early candidates focused on coitally dependent dosage forms such as gels and creams. More recent development has focused on broadening the coitally dependent options through the introduction of films and fast dissolving tablets. Additionally, it has become important to have longer acting products to minimize the burden of user compliance and thus vaginal rings have been developed providing sustained delivery of antiretroviral drugs. This chapter discusses the history of microbicides along with a detailed description of coitally dependent products, gels, films, tablets diaphragms, as well as coitally independent dosage forms such as vaginal rings and the introduction of a new technology, electrospun fibers.
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Affiliation(s)
- L C Rohan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh Magee Women's Research Institute, Pittsburgh, PA, USA,
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Derby N, Zydowsky T, Robbiani M. In search of the optimal delivery method for anti-HIV microbicides: are intravaginal rings the way forward? Expert Rev Anti Infect Ther 2013; 11:5-8. [PMID: 23428097 PMCID: PMC4771061 DOI: 10.1586/eri.12.155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fetherston SM, Boyd P, McCoy CF, McBride MC, Edwards KL, Ampofo S, Malcolm RK. A silicone elastomer vaginal ring for HIV prevention containing two microbicides with different mechanisms of action. Eur J Pharm Sci 2012; 48:406-15. [PMID: 23266465 DOI: 10.1016/j.ejps.2012.12.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/22/2012] [Accepted: 12/03/2012] [Indexed: 12/11/2022]
Abstract
Vaginal rings are currently being developed for the long-term (at least 30 days) continuous delivery of microbicides against human immunodeficiency virus (HIV). Research to date has mostly focused on devices containing a single antiretroviral compound, exemplified by the 25mg dapivirine ring currently being evaluated in a Phase III clinical study. However, there is a strong clinical rationale for combining antiretrovirals with different mechanisms of action in a bid to increase breadth of protection and limit the emergence of resistant strains. Here we report the development of a combination antiretroviral silicone elastomer matrix-type vaginal ring for simultaneous controlled release of dapivirine, a non-nucleoside reverse transcriptase inhibitor, and maraviroc, a CCR5-targeted HIV-1 entry inhibitor. Vaginal rings loaded with 25mg dapivirine and various quantities of maraviroc (50-400mg) were manufactured and in vitro release assessed. The 25mg dapivirine and 100mg maraviroc formulation was selected for further study. A 24-month pharmaceutical stability evaluation was conducted, indicating good product stability in terms of in vitro release, content assay, mechanical properties and related substances. This combination ring product has now progressed to Phase I clinical testing.
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Affiliation(s)
- Susan M Fetherston
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Peter Boyd
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Clare F McCoy
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | - Marcella C McBride
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK
| | | | - Stephen Ampofo
- International Partnership for Microbicides, Silver Spring, MD 20910, USA
| | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland, UK.
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Ball C, Krogstad E, Chaowanachan T, Woodrow KA. Drug-eluting fibers for HIV-1 inhibition and contraception. PLoS One 2012; 7:e49792. [PMID: 23209601 PMCID: PMC3509119 DOI: 10.1371/journal.pone.0049792] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/12/2012] [Indexed: 01/06/2023] Open
Abstract
Multipurpose prevention technologies (MPTs) that simultaneously prevent sexually transmitted infections (STIs) and unintended pregnancy are a global health priority. Combining chemical and physical barriers offers the greatest potential to design effective MPTs, but integrating both functional modalities into a single device has been challenging. Here we show that drug-eluting fiber meshes designed for topical drug delivery can function as a combination chemical and physical barrier MPT. Using FDA-approved polymers, we fabricated nanofiber meshes with tunable fiber size and controlled degradation kinetics that facilitate simultaneous release of multiple agents against HIV-1, HSV-2, and sperm. We observed that drug-loaded meshes inhibited HIV-1 infection in vitro and physically obstructed sperm penetration. Furthermore, we report on a previously unknown activity of glycerol monolaurate (GML) to potently inhibit sperm motility and viability. The application of drug-eluting nanofibers for HIV-1 prevention and sperm inhibition may serve as an innovative platform technology for drug delivery to the lower female reproductive tract.
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Affiliation(s)
- Cameron Ball
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Emily Krogstad
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Thanyanan Chaowanachan
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Kim A. Woodrow
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Malcolm RK, Fetherston SM, McCoy CF, Boyd P, Major I. Vaginal rings for delivery of HIV microbicides. Int J Womens Health 2012. [PMID: 23204872 PMCID: PMC3508658 DOI: 10.2147/ijwh.s36282] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Following the successful development of long-acting steroid-releasing vaginal ring devices for the treatment of menopausal symptoms and contraception, there is now considerable interest in applying similar devices to the controlled release of microbicides against HIV. In this review article, the vaginal ring concept is first considered within the wider context of the early advances in controlled-release technology, before describing the various types of ring device available today. The remainder of the article highlights the key developments in HIV microbicide-releasing vaginal rings, with a particular focus on the dapivirine ring that is presently in late-stage clinical testing.
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Affiliation(s)
- R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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Controlled-release vaginal ring drug-delivery systems: a key strategy for the development of effective HIV microbicides. Ther Deliv 2012; 1:785-802. [PMID: 22834014 DOI: 10.4155/tde.10.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Over half of all HIV-infected adults are women and heterosexual intercourse is a significant mode of viral transmission. This review examines the potential for using polymeric vaginal ring systems to provide controlled delivery of HIV microbicides in order to prevent heterosexual transmission of the virus. DISCUSSION Continuous delivery of microbicides has the potential to be more effective than one-off dosing. Thus, controlled-release vaginal delivery devices are now a key area of HIV prevention research. Initial clinical trials on vaginal rings loaded with dapivirine (a candidate microbicide) have indicated that these products are safe and well tolerated by women. These devices are female-initiated, robust and capable of long-term delivery of the active agent. CONCLUSIONS Vaginal rings may offer an effective system for the controlled delivery of microbicides to prevent heterosexual transmission of HIV. Candidate vaginal ring microbicide products are now in clinical trials.
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Baum MM, Butkyavichene I, Gilman J, Kennedy S, Kopin E, Malone AM, Nguyen C, Smith TJ, Friend DR, Clark MR, Moss JA. An intravaginal ring for the simultaneous delivery of multiple drugs. J Pharm Sci 2012; 101:2833-43. [PMID: 22619076 PMCID: PMC3857731 DOI: 10.1002/jps.23208] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/04/2012] [Accepted: 05/02/2012] [Indexed: 01/04/2023]
Abstract
Intravaginal delivery of microbicide combinations is a promising approach for the prevention of sexually transmitted infections, but requires a method of providing simultaneous, independent release of multiple agents into the vaginal compartment. A novel intravaginal ring (IVR) platform has been developed for simultaneous delivery of the reverse-transcriptase inhibitor tenofovir (TFV) and the guanosine analogue antiviral acyclovir (ACV) with independent control of release rate for each drug. The IVR is based on a pod design, with up to 10 individual polymer-coated drug cores embedded in the ring releasing through preformed delivery channels. The release rate from each pod is controlled independently of the others by the drug properties, polymer coating, and size and number of delivery channels. Pseudo-zero-order in vitro release of TFV (144 ± 10 µg day) and ACV (120 ± 19 µg day⁻¹) from an IVR containing both drugs was sustained for 28 days. The mechanical properties of the pod IVR were evaluated and compared with the commercially available Estring® (Pfizer, NY, NY). The pod-IVR design enables the vaginal delivery of multiple microbicides with differing physicochemical properties, and is an attractive approach for the sustained intravaginal delivery of relatively hydrophilic drugs that are difficult to deliver using conventional matrix IVR technology.
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Affiliation(s)
- Marc M. Baum
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, 91107
| | | | - Joshua Gilman
- Auritec Pharmaceuticals, Inc., Santa Monica, California, 90401
| | - Sean Kennedy
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, 91107
| | - Etana Kopin
- Auritec Pharmaceuticals, Inc., Santa Monica, California, 90401
| | | | - Cali Nguyen
- Auritec Pharmaceuticals, Inc., Santa Monica, California, 90401
| | - Thomas J. Smith
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, 91107
- Auritec Pharmaceuticals, Inc., Santa Monica, California, 90401
- Department of Opthamology, University of Kentucky, Lexington, Kentucky, 40506
| | - David R. Friend
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Arlington, Virginia, 22209
| | - Meredith R. Clark
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Arlington, Virginia, 22209
| | - John A. Moss
- Department of Chemistry, Oak Crest Institute of Science, Pasadena, California, 91107
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Intravaginal rings: controlled release systems for contraception and prevention of transmission of sexually transmitted infections. Drug Deliv Transl Res 2011; 1:185-93. [DOI: 10.1007/s13346-011-0024-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
HIV infection rates in the developing world remain a serious problem. One potential approach to reduce infection rates is to use products known as microbicides, referred to herein as microbicide drug products (MDPs). These are drugs capable of, when administered topically to the vagina (or rectum), interfering with infection by one or more mechanisms. This review article covers the latest pharmaceutical developments in the area of microbicides dosage forms and delivery systems. These products are principally designed for use in the developing world and must therefore address cultural and societal issues generally unknown in the developed world. The first-generation microbicides evaluated clinically were principally polyanions. These drugs, administered intravaginally as gels, were found to be ineffective in preventing transmission of HIV from men to women. Second-generation drugs such as tenofovir, dapivirine, and UC781 are reverse transcriptase inhibitors developed as gels formulations and intravaginal rings (IVRs). Gels are considered coitally-related products while IVRs are coitally-independent systems designed to release the drug over a four-week period or possibly longer (up to 3 or 4 months). Other dosage forms under development include fast dissolving films, tablets/capsules, and possibly vaginal sponges. Dual protection systems are also under development. These systems include formulations capable of preventing HIV infection along with a second drug capable of preventing conception or other viral infections such as HSV.
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Abstract
OBJECTIVE An effective vaginal microbicide against sexual HIV transmission remains elusive, with requirements for adherence to appropriate application of effective, nontoxic products being a major deterrent. We explored methods to enable sustained release of combinations of antiretroviral microbicides, utilizing intravaginal rings composed of biosoluble Acacia gum or nonbiodegradable hydrogel of 2-hydroxyethyl methacrylate and sodium methacrylate, materials approved for use by the US Food and Drug Administration. DESIGN AND METHODS The reverse transcriptase inhibitors TMC120, PMPA, 3'-azido-3'-deoxythymidine, and a newly characterized anti-HIV agent, Boc-lysinated betulonic acid, were incorporated into vaginal rings with different combinations. Daily and cumulative release rates of these inhibitors in ring eluates were determined by high-performance liquid chromatography, gas chromatography, or immunoassay. Anti-HIV effects were measured by assessment of p24 Gag antigen in T-cell cultures exposed to HIV-1 isolates. RESULTS Drug release rates were sustained at concentrations higher than the minimum effective dose for HIV inhibition. The release was maintained for no less than 15 and 28 days from the Acacia gum and 2-hydroxyethyl methacrylate and sodium methacrylate rings, respectively. Boc-lysinated betulonic acid showed more than 90% inhibition of HIV-1 infection in H9 cells, with little toxicity to normal cells. CONCLUSION The intravaginal rings described here are capable of efficacious drug delivery. Incorporation of several antiretroviral agents, including betulinol derivatives, which act at multiple levels of the HIV life cycle, may provide a synergistic effect to achieve higher efficacy on the inhibition of HIV infection.
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Heikinheimo O, Lähteenmäki P. Contraception and HIV infection in women. Hum Reprod Update 2009; 15:165-76. [PMID: 18978360 PMCID: PMC2639085 DOI: 10.1093/humupd/dmn049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 09/11/2008] [Accepted: 09/22/2008] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV. METHODS Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception. RESULTS Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness. CONCLUSIONS All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.
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Affiliation(s)
- Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki, Finland.
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Gupta KM, Pearce SM, Poursaid AE, Aliyar HA, Tresco PA, Mitchnik MA, Kiser PF. Polyurethane intravaginal ring for controlled delivery of dapivirine, a nonnucleoside reverse transcriptase inhibitor of HIV-1. J Pharm Sci 2009; 97:4228-39. [PMID: 18338805 DOI: 10.1002/jps.21331] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Women-controlled methods for prevention of male-to-female sexual transmission of HIV-1 are urgently needed. Providing inhibitory concentrations of HIV-1 reverse transcriptase inhibitors to impede the replication of the virus in the female genital tissue offers a mechanism for prophylaxis of HIV-1. To this end, an intravaginal ring device that can provide long duration delivery of dapivirine, a nonnucleoside reverse transcriptase inhibitor of HIV-1, was developed utilizing a medical-grade polyether urethane. Monolithic intravaginal rings were fabricated and sustained release with cumulative flux linear with time was demonstrated under sink conditions for a period of 30 days. The release rate was directly proportional to the amount of drug loaded. Another release study conducted for a week utilizing liposome dispersions as sink conditions, to mimic the partitioning of dapivirine into vaginal tissue, also demonstrated release rates constant with time. These results qualify polyether urethanes for development of intravaginal rings for sustained delivery of microbicidal agents.
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Affiliation(s)
- Kavita M Gupta
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
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