Contraception Research and Development

Physiological changes during pregnancy result in altered maternal drug metabolism that impacts efficacy and safety of therapeutics in pregnant women. Pregnancy induced hormonal, immunologic, or metabolic changes may also influence and alter drug disposition. Despite research efforts focused on pharmacokinetics of medications used in pregnant women in the past decade, knowledge gaps exist in understanding how pregnancy influences drug disposition and placental drug transporters. Moreover, there is a scarcity of research in understanding the safety and effectiveness of therapeutics in lactating women. This study aimed to determine the effect of pregnancy on levels of miRNAs regulating drug metabolizing enzymes and transporters (DMET). We utilized longitudinal serum specimens collected in 3-month intervals from 88 women who became pregnant during follow-up in a large prospective study of hormonal contraception and HIV acquisition in Uganda and Zimbabwe. We used the HTG EdgeSeq platform coupled with Illumina sequencing to obtain the global miRNA transcriptome in paired specimens collected before, during and after pregnancy. To identify differentially expressed (DE) miRNAs that distinguish pregnancy from pre-conception or breastfeeding we used mixed effect model accounting for multiple samples from the pregnancy event and controlling for fixed effects of batch, country, Nugent score category and sexually transmitted infections. To identify hormonally regulated miRNAs independently associated with Box-Cox-transformed levels of progesterone (P4), β-estradiol (E2), and sex-hormone binding protein (SHBG) we controlled in addition for age, pregnancy and breastfeeding P-values were corrected using the Benjamini-Hochberg false discovery rate (FDR). DMET-targeting miRNAs were identified using miRTarBase focusing on interactions verified by 3'-UTR luciferase reporter assay and overlapped with DE miRNAs with FDR < 0.05. Of 140 DMET-targeting miRNAs among the 2079 miRNAs in the global peripheral blood transcriptome, 41 unique DMET-targeting miRNAs were found to be DE during pregnancy - 38 differentiating pregnancy from preconception and 9 differentiating pregnancy from breastfeeding. The 56 DMETs confirmed as targets of the DE miRNAs included 8 members of the ABC (ATP-binding cassette) transporter family, all abundantly expressed in the placenta, and 4 members of the cytochrome P450 Phase 1 enzyme family with major role in xenobiotics detoxification. The study also revealed a strong (FDR<0.05), predominantly positive association between specific DMET-targeting miRNAs and sex hormone-binding globulin (SHBG) levels, suggesting a miRNA-mediated downregulation of DMETs as SHBG levels rise during pregnancy. This research provides crucial insights into the molecular mechanisms underlying altered drug disposition in pregnant and lactating women, paving the way for improved therapeutic management and personalized medicine in these populations.

This study introduces a convenient and ultra-sensitive method of detection and quantification of the antiviral drug, tenofovir (TFV), by surface-enhanced Raman spectroscopy (SERS). Novel spatially resolved instrumentation for spectral acquisition and subsequent statistical analysis for hot spot selection was developed for convenient quantification of TFV in an aqueous matrix. Methods of statistical analysis include the use of partial least squares (PLS) regression vector analysis and spectral ranking by quality indices computed using CHAOS theory. Hydroxylamine-reduced Ag colloidal nanoparticles evaporated to dryness on an aluminum well-plate were used as the SERS substrate. To our knowledge, quantification of TFV down to 25 ng/mL by SERS, comprising clinically relevant concentrations, has not been previously reported. Furthermore, in this work we propose a novel method of quantification of aqueous TFV standards by SERS using statistical treatment of data by PLS and CHAOS theory. Based on these data, we propose future studies to develop a method of TFV detection and quantification in biological samples, beneficial to clinicians for rapid assessment of drug adherence during the treatment and prevention of viral diseases.

The aim of this study was to explore the perceived impact of practice scholarship among DNP-prepared nurses and the relationship of impact to primary work role and years since graduation. Healthcare organizations continuously seek ways to improve health outcomes and reduce cost. Doctor of Nursing Practice-prepared nurses are educated with essential competencies to lead healthcare reform initiatives based on their practice scholarship contribution. A cross-sectional design was used to administer a self-report online survey to a convenience sample of 306 DNP graduates currently in practice. The highest impact of practice scholarship was perceived on patients, populations, quality of care, and the profession. The impact on policy, cost, and cost savings was significantly lower. No significant difference was found on practice scholarship impact based on role or between years of experience since graduation. Doctor of Nursing Practice competencies support practice scholarship outcomes. Organizational resources are needed to support the impact of practice scholarship.

Herpes simplex virus type 1 (HSV-1) causes a lifelong latent infection with an estimated global prevalence of 66%. Primary and recurrent HSV infections are characterized by a tingling sensation, followed by an eruption of vesicles, which can cause painful erosions. Commonly used antiviral drugs against HSV infection are nucleoside analogues including acyclovir (ACV), famciclovir, and valacyclovir. Although these nucleoside analogues reduce morbidity and mortality in immunocompetent individuals, ACV-resistant HSV strains (ACVR-HSV) have been isolated from immunocompromised patients. Thus, ACVR-HSV infection poses a critical emerging public health concern. Recently, we reported that ginkgolic acid (GA) inhibits HSV-1 by disrupting viral structure, blocking fusion, and inhibiting viral protein synthesis. Additionally, we showed GA affords a broad spectrum of fusion inhibition of all three classes of fusion proteins, including those of HIV, Ebola, influenza A and Epstein Barr viruses. Here we report GA’s antiviral activity against HSV-1 skin infection in BALB/cJ mice. GA-treated mice demonstrated a significantly reduced mortality rate and decreased infection scores compared to controls treated with dimethylsulfoxide (DMSO)-vehicle. Furthermore, GA efficiently inhibited ACVR-HSV-1 strain 17+ in vitro and in vivo. Since GA’s mechanism of action includes virucidal activity and fusion inhibition, it is expected to work alone or synergistically with other anti-viral drugs, and we anticipate it to be effective against additional cutaneous and potentially systemic viral infections.

While vitamin D insufficiency is known to impact a multitude of health outcomes, including HIV-1, little is known about the role of vitamin D-mediated immune regulation in the female reproductive tract (FRT). We performed a pilot clinical study of 20 women with circulating 25(OH)D levels <62.5 nmol/L. Participants were randomized into either weekly or daily high-dose oral vitamin D supplementation groups. In addition to serum vitamin D levels, genital mucosal endpoints, including soluble mediators, immune cell populations, gene expression, and ex vivo HIV-1 infection, were assessed. While systemic vitamin D levels showed a significant increase following supplementation, these changes translated into modest effects on the cervicovaginal factors studied. Paradoxically, post-supplementation vitamin D levels were decreased in cervicovaginal fluids. Given the strong correlation between vitamin D status and HIV-1 infection and the widespread nature of vitamin D deficiency, further understanding of the role of vitamin D immunoregulation in the female reproductive tract is important.