Vaginal deployment and tenofovir delivery by microbicide gels.

Gels are one of the soft material platforms being evaluated to deliver topically acting anti-HIV drugs (microbicides) to the vaginal environment. For each drug, its loaded concentration, gel properties and applied volume, and frequency of dosing can be designed to optimize PK and, thence, PD. These factors also impact user sensory perceptions and acceptability. Deterministic compartmental modeling of vaginal deployment and drug delivery achieved by test gels can help delineate how multiple parameters characterizing drug, vehicle, vaginal environment, and dosing govern details of PK and PD and also gel leakage from the canal. Such microbicide delivery is a transport process combining convection, e.g., from gel spreading along the vaginal canal, with drug diffusion in multiple compartments, including gel, mucosal epithelium, and stroma. The present work builds upon prior models of gel coating flows and drug diffusion (without convection) in the vaginal environment. It combines and extends these initial approaches in several key ways, including: (1) linking convective drug transport due to gel spreading with drug diffusion and (2) accounting for natural variations in dimensions of the canal and the site of gel placement therein. Results are obtained for a leading microbicide drug, tenofovir, delivered by three prototype microbicide gels, with a range of rheological properties. The model includes phosphorylation of tenofovir to tenofovir diphosphate (which manifests reverse transcriptase activity in host cells), the stromal concentration distributions of which are related to reference prophylactic values against HIV. This yields a computed summary measure related to gel protection ("percent protected"). Analyses illustrate tradeoffs amongst gel properties, drug loading, volume and site of placement, and vaginal dimensions, in the time and space history of gel distribution and tenofovir transport to sites of its anti-HIV action and concentrations and potential prophylactic actions of tenofovir diphosphate therein.

Comparison of the rheological properties of Advantage-S and Replens.

The rheological properties of Advantage-S and Replens were measured at body (37 degrees C) and room temperature (25 degrees C) over a range of physiologically relevant shear rates. The viscosity of Replens was found to differ from that of Advantage-S, particularly at room temperature. In addition, the two materials differed in their miscibility with a vaginal fluid simulant.

Rheological properties of contraceptive gels.

The rheological properties of 4 commercially available contraceptive drug delivery gels and their dilutions with a vaginal fluid simulant were measured. These properties govern the critical functions of spreading and retention of these gels over the vaginal surfaces. Measurements made on Conceptrol, KY Plus, Gynol II, and Advantage-S included stress growth, stress relaxation and residual stress, and the shear rate dependence of viscosity. All gels exhibited non-Newtonian behavior including shear thinning and viscoelasticity. Conceptrol and Gynol II had no residual stress, while both KY Plus and Advantage-S did. The gels differed in their response to dilution with vaginal fluid simulant.

Factors influencing nonoxynol-9 permeation and bioactivity in cervical mucus.

The effects of delivery gel pH and osmolarity on both the mass transport and 'biodiffusion' of the spermicide nonoxynol-9 (N9) in bovine cervical mucus were evaluated. Delivery gels were calcium chloride crosslinked alginate containing 3% N9, and were manufactured over a pH range of 3.4 to 5.9 and an osmolarity range of 300 to 900 mosmol. Mass transfer parameters (diffusion coefficients and total drug loading) were determined using a new UV spectrophotometric technique while biodiffusion (the diffusion distance into mucus at which sperm are killed) was assessed using the Double Ended Test. It was found that delivery gel pH had a significant effect on spermicidal efficacy of the alginate-N9 system; biodiffusion increased with decreasing pH. Actual N9 diffusion into mucus was found to be influenced by both the delivery gel pH and osmolarity. At high N9 concentration (near the gel/mucus interface), mass transport tended to decrease with decreasing pH at the highest osmolarity. At low concentration, mass transport tended to decrease with increasing osmolarity and decrease with increasing pH at the highest osmolarity. The difference between low and high concentration behavior can be attributed to N9 micelle formation. These findings are interpreted in the context of the design of intravaginal drug delivery vehicles for spermicides.

A vaginal fluid simulant.

A fluid medium was developed to simulate the fluid produced in the human vagina. The composition of the medium was based on an extensive review of the literature on constituents of human vaginal secretions. In choosing the ingredients for this medium, the goal was to emphasize properties that influence interactions of vaginal fluid with topical contraceptive, prophylactic, or therapeutic products. Among these properties, pH and osmolarity play a dominant role in physicochemical processes that govern drug release and distribution.

PIP: This article investigates a vaginal fluid simulant intended to model the fluid properties originating in the vagina--specifically the vaginal transudite found in healthy, nonpregnant premenopausal women. Methods of volume measurement of vaginal fluid fell into two categories: those that measured the quantity of vaginal fluid present at any one time and those that measured production over an extended interval. A volume of 0.75 ml vaginal fluid simulant was used. The proposed simulant was designed to incorporate information about chemical composition determined by previous researchers; this information emphasized pH modeling and the osmolarity of the material. Consequently, the specific "recipe" for 1 liter of this simulant given as compound and weight (g) was as follows: NaCl, 3.51; KOH, 1.40; Ca(OH)2, 0.222; borine serum albumin, 0.018; lactic acid, 2.00; acetic acid, 1.00; glycerol, 0.16; urea, 0.4; glucose, 5.0. The simulant was designed to have the same physical and chemical properties as those known to influence intravaginal gel efficacy. Further efforts by other researchers are needed if improved simulants are to be developed.

Spectrophotometric analysis of molecular transport in gels.

An automated spectrophotometric method has been developed for analyzing molecular transport out from and into gels. A Beckman DU7500 diode-array UV-visible spectrophotometer with gel scanner was modified to accept and longitudinally scan a quartz diffusion cell, 0.3x10x40 mm. Molecules of interest are identified and concentrations quantitated via analysis of spectrophotometric absorbance peaks relative to background absorbance of the gel. Thus, concentration profiles are obtained as functions of both position and time. Test data are fitted to a diffusion model via nonlinear least-squares regression. Precision and accuracy of the method were assessed via analysis of several test molecules and gels: (1) 30 mg/ml nonoxynol-9 (N9), contained in 1% sodium alginate gel cross-linked with 2.5 mM calcium chloride, permeating standardized, reconstituted bovine cervical mucus (BCM); (2) 2.5 mg/ml sodium fluorescein, contained in and permeating 10 mg/ml and 100 mg/ml gelatin gels; and (3) 1.0 mg/ml sodium ganciclovir, contained in and permeating 10 mg/ml sodium hyaluronate gel. Diffusion coefficients for (1) and (3) were 3.8x10-7 and 54.1x10-7 cm2/s, respectively. All measurements of diffusion coefficients, partition coefficients, and solute loads obtained in this study were highly repeatable (most C.V.'s<8%). The mean diffusion coefficient for (2) was within 3% of values predicted from theory for the 100 mg/ml gel; the mean partition coefficient for (3) was within 2% of the expected value. This new technique is simpler than many traditional ones in that it does not require labeling of test molecules nor changes in refractive index of target materials. It is particularly well-suited to situations in which the target material is a gel, because no stirring of the target is necessary.

Treatment of human spermatozoa with seminal plasma inhibits protein tyrosine phosphorylation.

It has long been known that seminal plasma contains factors that influence the fertilizing capacity of spermatozoa in many different ways. However, little is understood of the biochemical cascades triggered when spermatozoa and seminal plasma interact. In this study, we examined how incubation with seminal plasma affected protein tyrosine phosphorylation in human spermatozoa. Increased protein tyrosine phosphorylation is a hallmark of sperm capacitation in several mammalian species, including human. Seminal plasma blocks protein tyrosine phosphorylation when added to washed, non-capacitated spermatozoa. Removal of seminal plasma and incubation in capacitating medium led to partial recovery of the tyrosine phosphorylation cascade. Addition of seminal plasma to a suspension of spermatozoa previously incubated for 5 h under capacitating conditions decreased the level of tyrosine phosphorylation on all proteins in a dose-dependent manner. In this case, the phosphotyrosine signal did not increase upon removal of seminal plasma followed by overnight incubation in fresh capacitating media, indicating that removal of seminal plasma was necessary but not sufficient for protein tyrosine phosphorylation to occur. These results indicate that human seminal plasma contains factors that influence the tyrosine phosphorylation status of human spermatozoa.

Swimming of spermatozoa in a linear viscoelastic fluid.

A modified resistive force theory is developed for a spermatozoon swimming in a general linear viscoelastic fluid. The theory is based on a Fourier decomposition of the flagellar velocity, which leads to solving the Stokes flow equations with a complex viscosity. We use a model spermatozoon with a spherical head which propagates small amplitude sinusoidal waves along its flagellum. Results are obtained for the velocity of propulsion and the rate of working for a free swimming spermatozoon and the thrust on a fixed spermatozoon. There is no change in propulsive velocity for a viscoelastic fluid compared to a Newtonian fluid. The rate of working does change however, decreasing with increasing elasticity of the fluid, for a Maxwell fluid. Thus the theory predicts that a spermatozoon can swim faster in a Maxwell fluid with the same expenditure of energy for a Newtonian fluid.

Incidence and implications of altered semen quality on family planning.

Alterations in the expression of the human genome, or interference with its products, can be induced in the male reproductive system by chemicals mimicking or antagonizing naturally occurring hormones. Opportunities exist for disruption at the hypothalamus, pituitary and testis levels. Recent concerns generated by the increased incidence of testicular cancer, congenital anomalies of the male genitalia and possible alterations in human semen quality have been linked to the environment. The report by Carlsen in 1992 [1] suggested that semen quality has deteriorated over the past six decades. More recent reports suggest that the decline may be globally non-uniform and regional in nature. The effects of any such declines upon overall pregnancy rates are generally unknown, although some studies have attempted to address them. A preliminary review of the impact of a small decrease in sperm concentrations suggests that a directly measurable reduction in fecundity does not occur, but that future problems could be anticipated. Decrements in semen quality will alter the epidemiological probabilities of pregnancy due to coitus on different cycle days and may thereby change the duration of the fertile time. Current understanding of the implications of altered semen quality on relative fertility is not sufficient to change our current teaching and practice of NFP.

Analysis of pre-ovulatory changes in cervical mucus hydration and sperm penetrability.

Changes in cervical mucus occur during the proliferative phase of the menstrual cycle and are known to correlate with receptivity to sperm and to the endocrine milieu. Prior studies, however, have often lacked biological incisiveness and technical objectivity and precision. This study analyzed daily changes in mucus water content (hydration) prior to the LH surge (LH+0) in normal women, in relation to daily levels of serum LH, FSH, estradiol and progesterone, and to daily tests of sperm penetration of the mucus. Cervical mucus was studied for 12 cycles in 10 ovulating women. Three to ten mucus specimens were collected per cycle, over the days LH-8 to LH+0. Each specimen was subjected to measurement of both water content (hydration) and penetration by spermatozoa from fresh specimens of normal human semen. For the latter, a new microscale assay was developed and applied, which was amenable to very small volumes of mucus. The new technique determines objective measures of both the numbers of penetrating sperm (motile and non-motile) and the distance penetrated by the forward most vanguard sperm. In these experiments, variations in semen quality were controlled by performing a companion penetration assay in an artificial 1.5% polyacrylamide gel. The patterns of change in mucus hydration varied quantitatively among women, with preovulatory baseline levels ranging from 93.8-96.5%. All normal cycles (as defined by endocrine profiles) displayed a significant increase in hydration over a one-day period occurring 3-4 days before the LH peak. The magnitude of this shift varied among women between 2 and 3% (absolute hydration), a distinction well within the precision of the hydration assay. This quantum increase in hydration was more pronounced than the corresponding increase in serum estradiol on the same day. The change in mucus hydration, and the associated increase in sperm penetrability, were more consistent among cycles than the changes in reproductive hormones. There was a strong but non-linear correlation between mucus hydration and sperm penetrability. Once the value of hydration rose above approximately 97.5%, there was a substantial increase in penetrability. This 'cut-off point' in sperm penetrability was in the middle of the range of hydration values (across women) which preceded the quantum jump in hydration-which, itself, preceded the surge of LH. Hydration began to increase approximately 2 days before measurable increases in sperm penetration of the mucus in vitro. These results demonstrate that mucus hydration may be a valuable marker of the approach to ovulation and delineation of the fertile period. They also provide new methods for assessing sperm penetration into both large peri-ovulatory and very small samples of collected mucus.

Alteration of human sperm kinematics in cervical mucus due to nonoxynol-9.

Traditional endpoints of the double-ended test (DET), a contraceptive screening assay used to evaluate the ability of a compound to permeate cervical mucus and inhibit sperm progression, ignore important information about sublethal effects upon sperm cells. Improved contraceptive agents may capitalize on such sublethal aspects. This study utilized a DET testing protocol that included measurement of human sperm motion characteristics as an indicator of cell function within spermicide-exposed human mucus. The currently available spermicide nonoxynol-9 (N9) was used as the test compound and was dissolved in two different delivery solutions, deionized (DI) water and saline, to evaluate the effects of the osmolarity and pH of the delivery vehicle on test results. The N9-water treatment demonstrated significantly greater activity than the N9-saline treatment in terms of all measured variables, exhibiting an apparent "biopermeation" distance approximately 3 mm further into the mucus. The DI water control treatment displayed less activity than N9-saline in terms of the vanguard penetration distance, but comparable or greater activity in terms of inhibiting kinematic variables. The saline control treatment had no effect in terms of any measured variable. Dose responses to N9 of sperm in mucus were inferred from DET results combined with direct measures of N9 diffusion. These were compared to dose responses to N9 of seminal sperm, indicating that N9 inhibits sperm motion at lower concentrations in mucus than in semen.

PIP: The double-ended test (DET) generally used to assess the ability of new spermicidal compounds to permeate cervical mucus and inhibit sperm progression overlooks the importance of sublethal effects on sperm cells. This study utilized a DET protocol that incorporated measurement of human sperm motion characteristics as an indicator of cell function within nonoxynol-9-exposed human mucus. Nonoxynol-9 was dissolved in both deionized water and saline to assess the effects of the osmolarity and pH of the delivery vehicle. All variables exhibited significant effects due to the nonoxynol-9-water treatment at distances as far as 13 mm into the mucus. The water treatment exhibited a biopermeation distance approximately 3 mm further into the mucus than the saline treatment and greater activity in terms of inhibiting kinematic variables. On the other hand, penetration of vanguard sperm was inhibited more by nonoxynol-9-saline. The reduction in straightline velocity of sperm was due more to a disruption in the pattern of motion than a reduction in overall sperm vigor. The measurements of sperm motility obtained in this study can be combined with information about local nonoxynol-9 concentrations in mucus to infer the dose-response of nonoxynol-9 against sperm in mucus. Overall, these findings indicate that the use of hypotonic solutions to deliver contraceptive agents can significantly increase the efficacy of the compounds through both increased transport rates and added bioactivity due to the carrier itself.

Assessment of reproductive disorders and birth defects in communities near hazardous chemical sites. III. Guidelines for field studies of male reproductive disorders.

Exposures to environmental toxicants can have detrimental effects on several aspects of human male reproduction: fertility, sexual function, hormone status, and pregnancy/birth outcomes. However, no simple prescreening methods are available for reliably identifying potential hazards; questionnaires alone are relatively imprecise and inefficient in the absence of field data. Multidisciplinary field studies are required that include detailed exposure information, health and reproductive histories, physical examinations, semen analyses, and possibly, hormone analyses. Semen analysis is a critical component of field studies for evaluating two aspects of male reproduction: 1) changes in sperm or seminal content, which may be indicative of adverse effects on the male reproductive system with possible implications for fertility potential; and 2) defects in sperm DNA or chromosomes, which may be associated with subsequent changes in viability during embryonic development and health risks to the offspring. Semen analyses may be tiered: 1) initially, each semen study may include conventional semen assays (concentration, motility, and morphology) as well as specific biomarkers indicated by the health effect of concern in the study cohort: and 2) archived samples (i.e., frozen, videotaped, or smeared) may be utilized in later second-tier analyses to further characterize specific findings. Before initiating any field study, it is cost effective to critically evaluate the suitability of the cohort by confirming exposure and determining that there are adequate numbers of male participants in each exposure category. Such evaluations must be based on the statistical sensitivities of the specific tissue biomarkers and health endpoints for detecting changes. This article summarizes the components of the ideal field study and identifies research needs for improving field studies of male effects and for understanding the mechanisms of male reproductive toxicity. Several promising semen methods currently under development are also discussed.

Effects of psychological stress on human semen quality.

We investigated the relationship between psychological stress and sperm concentration, motility, and morphometry in a prospective study of 157 volunteers who were enrolled in a prepaid health plan. We measured psychological job stress and life-event stress by telephone interview. Sperm-kinematic and nuclear-morphometric variables were measured using computer-assisted image analyses. Sperm concentration, percent motility, and semen volume were determined by objective visual methods. We performed multiple linear regression for each semen variable to examine its relationship to stress, controlling for potential confounders. Stress at work and total number of life events were not related to differences in semen quality. However, the recent death of a close family member was associated with a reduction in straight-line velocity (P = 0.002) and percent of progressively motile sperm (P = 0.02); it was also marginally associated with an increase in the fraction of sperm with larger and more tapered nuclei. These findings suggest that the fecundity of men experiencing the stress of a family member's death might be temporarily diminished.

Measurement and modulation of nonoxynol-9 diffusion and bioactivity against spermatozoa in human cervical mucus.

Assays of sperm penetration into cervical mucus, in the configuration of double-ended tests (DETs), are an accepted format for evaluating the efficacy of sperm-directed contraceptives in mucus. In order to distinguish relative contributions of compound permeation into, and compound bioactivity within, cervical mucus with respect to vanguard sperm penetration measured in DETs, direct measurements were made of concentration profiles of the spermicide nonoxynol-9 (N9) after diffusion into mucus-filled capillary tubes. N9 was dissolved in two different delivery solutions, deionized water and saline, in an attempt to exploit a Donnan-mediated swelling of mucus for enhanced delivery of the spermicide. Average diffusion coefficients, 7 and 5 x 10(-7) cm2/sec for N9-water and N9-saline, respectively, indicate that the diffusion of N9, a surfactant material, is governed by the size of the N9 micelle rather than the molecular size, in the concentration range typically found in commercial preparations Permeation of N9 into mucus was significantly greater for water versus saline as delivery solution, although the difference was slight. A more pronounced difference between the two treatments was found in DET results, due to an osmotic and/or pH activity of the delivery solution itself against sperm in mucus.

Location of the PH-20 protein on acrosome-intact and acrosome-reacted spermatozoa of cynomolgus macaques.

Fluorescence microscopy and transmission electron microscopy (TEM) were used to determine the location of the membrane protein PH-20 on spermatozoa of cynomolgus macaques. Rabbit antiserum raised against recombinant cynomolgus macaque sperm PH-20 was used as the primary antibody, and the second antibody was goat anti-rabbit IgG conjugated with either fluorescein isothiocyanate or 15 nm gold particles. Spermatozoa were evaluated before capacitation and after capacitation and induction of acrosome reactions with calcium ionophore A23187. In sperm suspensions with a high percentage of intact acrosomes, fluorescence labeling was observed uniformly over most of the sperm head. The sperm midpiece and tail were not labeled. In sperm suspensions with a high percentage of acrosome reactions, most spermatozoa labeled intensely over the anterior sperm head, but labeling of the posterior sperm head was greatly reduced. TEM of acrosome-intact spermatozoa revealed gold particles distributed uniformly on the plasma membrane overlying the acrosome, the equatorial segment, and most of the post-acrosomal region. After the acrosome reaction, gold label was present on the inner acrosomal membrane and on the plasma membrane overlying the equatorial segment. Very little label was present on the plasma membrane in the post-acrosomal region of acrosome-reacted spermatozoa. The location of PH-20 on the surface of macaque spermatozoa suggests a function for this protein in primary and/or secondary binding to the zona pellucida. The apparent decrease in amount of PH-20 on the posterior head of macaque spermatozoa following the acrosome reaction is consistent with the migration of this protein to the inner acrosomal membrane, as demonstrated previously for the homologous PH-20 protein of guinea pig spermatozoa.

Kinematic response of human spermatozoa to nonoxynol-9.

This study was an examination of the dose response of the kinematics of human sperm motion to 1-min and 30-min incubations with the spermicide Nonoxynol-9 (N9). At concentrations resulting in only slight reductions in percentages of motile sperm (MOT), increasing N9 decreased the progressiveness of sperm motion (reflected in decreasing straight line velocity). This decline in progressiveness resulted from both decline in the vigor (reflected in decreasing curvilinear velocity; VCL) and disruption of the pattern (reflected in decreasing linearity; LIN) of such motion. Since, after the 1-min incubation, VCL declined only slightly for seminal sperm over this range of N9 concentrations, declines in sperm progressiveness were primarily due to decreases in LIN. For sperm collected from the pellet fraction from a Percoll gradient technique, however, VCL declined substantially even at low concentrations of spermicide. These Percoll-separated sperm were, on the other hand, less sensitive to N9 than seminal sperm in terms of the dose response of MOT. This added resistance may be attributed to selection or to environmental or physiological changes caused by Percoll separation. Responses in mean amplitude of lateral head displacement (ALH) to increasing N9 also differed for the two treatments, increasing on average for seminal sperm while decreasing on average for Percoll-separated sperm.

Operational standards for CASA instruments.

Computer-aided sperm analysis (CASA) technology is 7 years old. Over 120 papers have been written that verify the technology or apply it in basic and clinical studies. Most of the technical problems with CASA, such as the dependence of velocity on video frame rate, inaccuracy of count and percent motility for low- and high-concentration specimens, parameter dependence on the number of frames analyzed, sensitivity of the subjective threshold setting, confusion over the presence of debris, and different implementations of algorithms across instruments, still persist. A critical review of the literature reveals that no standard practices are followed within or across instruments. Moreover, no standards have been embraced or recommended by professional societies. Despite its potential to provide objective measurements of specimen and individual sperm parameters, and to automate the laboratory semen analysis, the promise of CASA has not been fulfilled. Unless laboratory medicine defines instrument performance and laboratory standards and co-operates with industry to achieve these goals, CASA technology may remain a research curiosity. This outcome is especially worrisome in the context of increasing requirements for laboratory accuracy, precision, standardization, and accreditation under the Clinical Laboratory Improvement Act of 1988.

Sampling factors influencing accuracy of sperm kinematic analysis.

Sampling conditions that influence the accuracy of experimental measurement of sperm head kinematics were studied by computer simulation methods. Several archetypal sperm trajectories were studied. First, mathematical models of typical flagellar beats were input to hydrodynamic equations of sperm motion. The instantaneous swimming velocities of such sperm were computed over sequences of flagellar beat cycles, from which the resulting trajectories were determined. In a second, idealized approach, direct mathematical models of trajectories were utilized, based upon similarities to the previous hydrodynamic constructs. In general, it was found that analyses of sampling factors produced similar results for the hydrodynamic and idealized trajectories. A number of experimental sampling factors were studied, including the number of sperm head positions measured per flagellar beat, and the time interval over which these measurements are taken. It was found that when one flagellar beat is sampled, values of amplitude of lateral head displacement (ALH) and linearity (LIN) approached their actual values when five or more sample points per beat were taken. Mean angular displacement (MAD) values, however, remained sensitive to sampling rate even when large sampling rates were used. Values of MAD were also much more sensitive to the initial starting point of the sampling procedure than were ALH or LIN. On the basis of these analyses of measurement accuracy for individual sperm, simulations were then performed of cumulative effects when studying entire populations of motile cells. It was found that substantial (double digit) errors occurred in the mean values of curvilinear velocity (VCL), LIN, and MAD under the conditions of 30 video frames per second and 0.5 seconds of analysis time. Increasing the analysis interval to 1 second did not appreciably improve the results. However, increasing the analysis rate to 60 frames per second significantly reduced the errors. These findings thus suggest that computer-aided sperm analysis (CASA) application at 60 frames per second will significantly improve the accuracy of kinematic analysis in most applications to human and other mammalian sperm.

The relation of computer-based measures of sperm morphology and motility to male infertility.

We investigated the relation between various sperm characteristics, including morphometric parameters, and impaired fertility among 596 men who participated in a national study. Semen was collected and processed by using a standardized protocol, and sperm measurements were made using a computer-aided sperm analysis instrument. We defined infertility in two ways: (1) the inability to father a child after trying for a year or longer, and (2) the number of children fathered. We found that all measures of sperm motion were decreased among men with impaired fertility. After adjustment for the other motion parameters and various potential confounders, however, only the percentage of progressive cells was associated with infertility. One morphometric parameter, the mean length/width ratio, was consistently associated with both measures of infertility, even after adjustment for potential covariates. This measure was also strongly associated with infertility among various subgroups defined by poor sperm concentration, motility, and morphology. The sperm length/width ratio appears to be an important correlate of infertility in males.