1. Introduction
In the last International Women’s Day, the Executive Director of UNAIDS highlighted the need to empower women to end the AIDS pandemic. The infection by HIV represents the third leading cause of death in women between the ages of 15 and 49, and only 55% of women report that they have control over decisions about their sexual and reproductive health and rights [
1].
Among the different available tools for HIV prevention that could be under women’s control, vaginal microbicides can be highlighted. They are agents for topical application intended to pre-exposure prophylaxis by blocking the initial stages of the infection in the vagina. Gels, capsules, tablets, films, and intravaginal rings are some of the developed systems for this purpose [
2]. Among them, vaginal tablets offer several advantages, such as easy and economical manufacture at the industrial scale, versatility in the formulation in terms of drug release control, easy handling and stability in different environmental conditions [
3]. Several vaginal tablets intended for the prevention of HIV have already reached the clinical phase. For example, vaginal tablets containing the reverse transcriptase inhibitors Tenofovir (TFV) and/or Emtricitabine [
4] and an entry inhibitor named DS003 [
5] have been tested in clinical trials.
As stated by Cobb et al. [
6], most microbicides are designed for on-demand use and offer short-acting protection against the virus. For this reason, the development of controlled-release antiretroviral formulations could solve the problem of acceptability and adherence of these prevention systems. Against immediate drug release, drug controlled release offers advantages such as lower side effects and improved compliance by patients due to reduced administration frequency [
7]. This type of drug release can be achieved by including one or more excipients capable of controlling the release process in the formulation. Among them, it is worth mentioning swellable polymers, whose structure is modified in the presence of water or biological fluids, thus altering the release of the drug to the medium. One of the most frequent polymers in the development of swellable matrices is hydroxypropyl methylcellulose (HPMC) [
8], a semi-synthetic non-ionic cellulose derivative with excellent mucoadhesive characteristics [
9]. Another polymer is chitosan, a chitin-derivative polysaccharide which exhibits mucoadhesive properties due to its cationic nature. It also has swelling ability and a huge potential for controlled drug release [
10]. The combination of HPMC and chitosan as mucoadhesive polymers in the formulation of vaginal tablets for the controlled release of TFV has already allowed to enhance the properties offered by the systems composed by each polymer separately [
11].
Another type of excipients that has been widely studied for controlled drug release is porous materials. Properties such as their well-organized structure, high surface area, and pore sizes which can be tuned make them excellent candidates as drug carriers [
12]. According to the pore size, porous materials can be classified as microporous (<2 nm), mesoporous (2–50 nm), or macroporous (>50 nm). In addition, they can be organic, inorganic, or hybrid in nature [
13]. Mesoporous silica- and carbon- based materials could be cited among the inorganic mesoporous materials that have been most used as drug carriers [
12,
14]. In this line, we previously synthesized mesoporous silicon oxycarbide particles as an excipient for the controlled release of Acyclovir [
15] and micro-mesoporous hybrid particles for the sustained release of TFV [
16]. The developed particles were evaluated in terms of cellular toxicity using two human cell lines: HEC-1-A (a uterus/endometrium epithelial cell line) and MT-2 (a lymphoblastic cell line). The MTT method was used to evaluate cell toxicity, which was recorded after 48 h of incubation of the cells in the presence of the inorganic particles. The results ensure the safety of the inorganic material, that did not present cytotoxic effect in the concentrations tested (up to 1 mg/mL) [
15].
Finally, the coating of solid dosage forms represents a broadly used strategy to obtain a controlled drug release. Film coating is the most common and versatile technique and entails the application of a polymeric formulation on the surface of solid dosage forms such as tablets. This resource allows not only to improve characteristics such as the appearance and organoleptic properties of the dosage forms, but also to modify the release of the drug [
17]. Polymethacrylates, including those commercialized under the Eudragit
® brand, are synthetic copolymers which exhibit great film-forming properties. They are frequently used as pharmaceutical coating excipients to obtain drug controlled release profiles, among others [
18]. Namely, Eudragit
® RS (ammonium methacrylate copolymer type B), which presents quaternary ammonium groups in its structure, is characterized by being insoluble in water but permeable, which allows the controlled release of drugs when used in film coating [
19]. In addition to providing sustained drug release, it also has adhesive properties; a study showed that nanocapsules based on Eudragit
® RS were more mucoadhesive than those manufactured with Eudragit
® S and Poly(ε-caprolactone) [
20].
With this background, the objective of the present research work was to develop TFV-controlled release mucoadhesive vaginal tablets by combining the three aforementioned strategies (mucoadhesive swellable polymers, inorganic particles and film coating) for the prevention of the sexual transmission of HIV in women.
2. Materials and Methods
2.1. Materials
Triethoxysilane (TREOS, 99%), isopropanol (iPrOH, 99%), HCl (35%), and NH4OH (28%) were acquired from Merck (Darmstadt, Germany). Hydroxyl terminated polydimethyl siloxane (PDMS, M = 1700 g·mol−1) and γ-aminopropyl trimethoxy silane (APS, 98%) were supplied by ABCR (Karlsruhe, Germany) and Gelest (Morrisville, PA, USA), respectively.
Chitosan (MW = 10
5 g/mol, deacetylation degree = 97% and viscosity = 92 mPa·s [
21]) was supplied by Nessler (Madrid, Spain) and hydroxypropyl methylcellulose Methocel
® K 100 M (HPMC, MW = 72 × 10
4 g/mol) was a kind gift from Colorcon Ltd. (Kent, UK). Kollidon
® 30 (polyvinyl pyrrolidone K30, PVP) and magnesium stearate PRS-CODEX (MgSt) were supplied by BASF (Ludwingshafen, Germany) and Panreac (Barcelona, Spain), respectively. Tenofovir (TFV) was acquired from Carbosynth Limited (Compton, UK). Eudragit
® RS (ERS, MW = 407.932 g/mol) was kindly supplied by Evonik (Essen, Germany). Triethyl citrate (TEC) and acetone were acquired from Sigma-Aldrich
® (St. Louis, MO, USA) and Panreac (Barcelona, Spain), respectively.
All other reagents in this study were of analytical grade and used without further purification. Demineralized water was used in all cases.
2.2. Obtaining, Functionalization and TFV-Loading of Silicon Oxycarbide (SiOC) Particles
The synthesis of the SiOC material based on the sol-gel method was previously described (
Figure 1) [
15]. Briefly, two solutions were separately prepared and stirred for 2 h until homogenization; the first containing TREOS and PDMS in 70/30 weight ratio and ½ iPrOH and the second with H
2O, HCl and ½ iPrOH. The H
2O/iPrOH/HCl/TREOS molar ratio was 3/4.5/0.05/1. The second solution was added dropwise over the first one and thermostatized at 80 °C for 2 h. Within the first minutes after the beginning of the reaction, 1 M NH
4OH solution was added (in a 1:2 volume proportion with respect to the wet gel) for the resulting sol to be gelled. The obtained gel was dried at 50 °C for a week and then at 120 °C until constant weight. After that, it was pyrolyzed at 1100 °C for 2 h in N
2 atmosphere giving rise finally to a porous SiOC material.
Once obtained, the SiOC material was functionalized with APS in aqueous medium. The coupling agent (APS) was previously hydrolyzed for 30 min in water at 25 °C at a 0.25% APS/H2O w/w ratio. After that, 0.5 g of SiOC particles were added and the stirring was maintained for an additional 30 min. The resulting surface modified material was filtered, dried at 50 °C overnight and then at 110 °C for 6 h.
The APS-functionalized oxycarbide particles were then loaded with TFV. First, 300 mg of the drug was dissolved in 220 mL of water under stirring for 2 h. After that, 0.45 g of functionalized SiOC particles were added and the mixture was stirred for 30 min and finally placed in a glycerin bath at 50 °C until the complete evaporation of the solvent (2 days).
2.3. Tablets Manufacture
Three batches of tablets containing the previously obtained TFV-loaded SiOC particles were prepared. Their composition is shown in
Table 1. The difference between these batches is the chitosan/HPMC ratio, which is 1 for T1, 0.53 for T2, and 1.9 for T3. In all cases, the required amounts of TFV-loaded particles for a dose of 30 mg of drug were used. The manufacturing of the tablets was based on previously described methodologies [
11,
22]. Briefly, chitosan, HPMC, and TFV-loaded SiOC were physically mixed. After that, a wet granulation using a 0.5 mm mesh metal sieve and an ethanolic solution of PVP as a binder was performed. The obtained granulate was dried at room temperature for 24 h and then the corresponding amount of MgSt was added. The flowability of the granules was determined according to the methodology described in the European Pharmacopoeia (2.9.16) and compared to the flowability of the powders before granulation. Finally, the granules were compressed using a press like that used in the preparation of IR spectroscopy pills. The force applied was 5 t for 4 min for each tablet. Thickness, diameter, and hardness of all the batches were measured in triplicate using a hardness tester PTB 311 (Pharma Test, Hainburg, Germany).
2.4. Coating of the SiOC-Based Tablets
The previously manufactured tablets were subsequently coated to increase the control over drug release and improve some other properties, such as comfortability in terms of swelling. The composition of the coated tablets is collected in
Table 2. A solution of Eudragit
® RS (10%
w/
v) in acetone was used as coating solution. About 0.5%
w/
v TEC was included as plasticizer in the coating solution. Each tablet was immersed twice in this solution and left to dry for 24 h at room temperature. The process was repeated until the total coating supposed an increase of around 10% (7–11%) in the initial weight of the tablet.
2.5. Characterization Techniques
2.5.1. Swelling Test
This test was performed to evaluate the influence of the vaginal fluid in the structure of the tablets due to the presence of the swellable polymers (chitosan and HPMC) and how this process could condition the drug release. Based on a method described by Mamani et al. [
23], three tablets of each batch (both coated and uncoated) were fixed to stainless steel discs of 3 cm diameter using ethyl cyanoacrylate (Loctite
®) as adhesive material. Each disc was then immersed in a beaker containing 100 mL of simulated vaginal fluid (SVF, pH = 4.2 [
24]), then placed into an oscillating water bath (P SELECTA
® UNITRONIC OR, JP SELECTA S.A., Barcelona, Spain) at 15 opm and 37 °C, thus simulating the in vivo conditions. At preset times, the discs with the formulations were extracted from the beakers and weighted on a precision balance (METTLER
® AT 200, Mettler-Toledo S.A.E., Barcelona, Spain) after removing the excess of SVF using a paper towel. The swelling ratio was calculated according to the following Equation (1):
where
Ts refers to the weight of the swollen tablet at each weighing time and
Td to the weight of the tablet before the immersion in SVF (dry).
As the weight of the tablets is not the same in all the batches but the amount of swellable polymer is, for a correct comparison between coated and uncoated tablets, the adjusted swelling ratio was calculated using the Equation (2):
Being SR the previously calculated swelling ratio, Td the weight of the tablet and SP the amount of swellable polymer in the tablet.
At the same predetermined weighing times, the diameter of the swollen tablets was measured to observe how the volume of the formulation is modified as a function of the swelling.
The consistency of the swollen tablets was measured by means of a TA.TXTplus Texture Analyzer at 2, 6, 48, and 120 h. A protocol was designed with the equipment on compression mode, loaded with a 5 kg load cell, using a cylindrical probe (5 mm) moving at 0.5 mm/s. Penetration force and work were recorded. The height of the gel and the dried tablet were extrapolated from the results.
2.5.2. Scanning Electron Microscopy (SEM) and Hg Porosimetry
To determine how the inclusion of the SiOC particles and the arrangement of the polymer chains define the structure of the tablets in the presence of vaginal fluid, the uncoated swollen tablets were studied by SEM and mercury porosimetry. The dry tablets were previously attached to the stainless-steel discs and then immersed in beakers containing 100 mL of SVF, which were placed in the oscillating water bath at 37 °C and 15 opm, as described in the swelling test. Once the formulations reached their maximum swelling ratio, they were extracted from the medium and freeze-dried in a Lio-Labor® freeze dryer (Telstar, Barcelona, Spain) with a freezing temperature of −45 °C, a sublimation temperature from −45 to 25 °C and a sublimation pressure of 4.54 × 10−4 atm attained inside the chamber. The obtained freeze-dried samples are suitable only for comparative structure analysis.
The microstructure of the resulting freeze-dried tablets was observed using a field emission scanning electron microscope (Hitachi S-4700, Tokyo, Japan) at 20.0 kV and mercury porosimetry was carried out with an Autopore II 9215 (Micromeritics Corp., Norcross, GA, USA) to determine pore size distributions (PSD). The corresponding pore volumes (Vp), pore areas (Sp), mean pore sizes (Dp), bulk and apparent densities (ρB, ρA), and porosities (P) of the swelling witnesses were calculated from these PSD, assuming cylindrical pore shapes.
2.5.3. Mucoadhesion Test
The adhesion time of the tablets to the mucosa was evaluated by an ex vivo study based on a previously described methodology [
21]. A sample of bovine vaginal mucosa—kindly provided by a local slaughterhouse—was fixed to a stainless-steel plate with a width of 5 cm and a height of 8.5 cm using ethyl cyanoacrylate (Loctite
®) as adhesive material. Subsequently, a tablet was placed on that mucosa, ensuring its adhesion by placing a weight of 500 g for 30 s to standardize the process. Each plate was fully immersed—at an angle of 60°—in a beaker containing SVF, and then into the oscillating water bath at 37 °C and 15 opm. The times required for the tablets to dissolve, erode, and/or detach from the mucosa were recorded. These assays were performed in duplicate for each formulated batch.
2.5.4. Drug Release Test
One of the main objectives of this work was to obtain vaginal dosage forms offering a controlled release of TFV. Drug release test was carried out in the oscillating water bath at 37 °C and 15 opm, wherein the formulations were placed into borosilicate glass flasks containing 80 mL of SVF (thus ensuring sink conditions). Aliquots of 5 mL were extracted from each flask at preset times, replacing the volume removed with clean SVF. After filtration and dilution of the taken samples, the amount of TFV in the medium was quantified by UV-Visible spectroscopy at a wavelength of 261 nm using a Shimadzu
® UV-1700 spectrophotometer (Kyoto, Japan). These assays were performed in triplicate for each batch of tablets, both uncoated and coated. Similarity factor f
2 was used to compare the drug release profiles obtained [
25].
In order to understand the mechanisms responsible for the release of the drug from the SiOC particles and the tablets, the results obtained in this test were processed to determine whether they fitted the Higuchi, Hopfenberg and Korsmeyer–Peppas kinetics [
26].
Higuchi Kinetics
It can be summarized by the following Equation (3), which is known as the “simplified Higuchi model”:
where
Qt is the amount of drug released at time
t and
KH is the Higuchi dissolution constant. Based on this model, the drug is released by a diffusion process according to Fick’s first law and proportionally to the square root of time.
Hopfenberg Kinetics
This release kinetics responds to the following Equation (4):
where
Mt/M∞ is the fraction of drug dissolved in the medium (
Mt is the amount of drug dissolved at time
t and
M∞ is the dose),
k0 is the erosion constant,
C0 is the initial concentration of the drug in the dosage form,
a0 is the radius of the sphere or cylinder or the average thickness of the slab (depending on the formulation), and
n is the exponent which varies according to the geometry (with a value of 1 for slabs, 2 for cylinders and 3 for spheres). Considering that
, the above equation converts into Equation (5):
According to this model, the drug release is caused by an erosive process of the dosage form, which can take different geometric forms as mentioned.
Korsmeyer–Peppas Kinetics
In general, this kinetic responds to the following Equation (6):
where
Mt/M∞ is the fraction of drug released in relation to the dose,
a is a constant that depends on the structural and geometric characteristics of the dosage form,
t is the time, and
n is the exponent indicating the mechanism responsible for the drug release. In this case, diffusion predominates when the value of
n is less than or equal to 0.45; values between 0.45 and 0.89 indicate an “anomalous transport” based on diffusion and the structural modification of the dosage form;
n values equal to 0.89 (“case II transport”) and over 0.89 (“super-case II transport”) indicate drug releases that are due only to structural changes in the formulation.
4. Conclusions
HPMC and chitosan-based vaginal tablets are able to form a gel in the presence of vaginal fluid, which allows the release of the antiretroviral drug TFV to be controlled. The drug can be loaded into APS-functionalized SiOC particles, which act as a reservoir of the active principle when included in the tablets. When both mechanisms for controlling drug release are combined in the same formulation, TFV release is sustained for 5 days. The inclusion of the SiOC particles in the tablets also modifies the microstructure obtained after the gelation of the system; it decreases the medium pore size and the total pore volume, and as a consequence the amount of vaginal fluid that is incorporated to the structure is notably reduced. The formation of this denser gel results in an improved mucoadhesion of the system to the vaginal mucosa, up to 6–7 days in ex vivo studies.
Film coating of the previously manufactured tablets with the methacrylic derivative Eudragit® RS, plasticized with triethyl citrate, allows modifying the mechanism for TFV release. Thus, the coated tablets required water diffusion through the film coating to achieve HPMC and chitosan gelation, and the swelling of the coated system is lower and extended for longer times, which results in TFV controlled release for up to 7 days. This formulation could be an interesting strategy for the prevention of HIV-1 sexual transmission, since a single administration could provide effective drug levels in the vagina during a week. However, the film coating reduces the ex vivo mucoadhesion of the tablets, and this could hamper the retention of the system in the vagina. Therefore, further studies are required to evaluate the real in vivo retention time. The sustained drug release provided by film coating and the mucoadhesion obtained with the swellable polymers must be balanced to ensure the suitability of the developed system for this purpose. The administration of the developed vaginal tablets would be useful to prevent HIV infection although more assays should be carried out to confirm this point.