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Vaginal microbiome modulates topical antiretroviral drug pharmacokinetics
Ekaterina Taneva, Shada Sinclair, Pedro M.M. Mesquita, Brian Weinrick, Scott A. Cameron, Natalia Cheshenko, Kerry Reagle, Bruce Frank, Sujatha Srinivasan, David Fredricks, Marla J. Keller, Betsy C. Herold
Ekaterina Taneva, Shada Sinclair, Pedro M.M. Mesquita, Brian Weinrick, Scott A. Cameron, Natalia Cheshenko, Kerry Reagle, Bruce Frank, Sujatha Srinivasan, David Fredricks, Marla J. Keller, Betsy C. Herold
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Research Article AIDS/HIV

Vaginal microbiome modulates topical antiretroviral drug pharmacokinetics

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Abstract

Tenofovir gel and dapivirine ring provided variable HIV protection in clinical trials, reflecting poor adherence and possibly biological factors. We hypothesized that vaginal microbiota modulates pharmacokinetics and tested the effects of pH, individual bacteria, and vaginal swabs from women on pharmacokinetics and antiviral activity. Tenofovir, but not dapivirine, uptake by human cells was reduced as pH increased. Lactobacillus crispatus actively transported tenofovir leading to a loss in drug bioavailability and culture supernatants from Gardnerella vaginalis, but not Atopobium vaginae, blocked tenofovir endocytosis. The inhibition of endocytosis mapped to adenine. Adenine increased from 65.5 μM in broth to 246 μM in Gardnerella, but decreased to 9.5 μM in Atopobium supernatants. This translated into a decrease in anti-HIV activity when Gardnerella supernatants or adenine were added to cultures. Dapivirine was also impacted by microbiota, as drug bound irreversibly to bacteria, resulting in decreased antiviral activity. When drugs were incubated with vaginal swabs, 30.7% ± 5.7% of dapivirine and 63.9% ± 8.8% of tenofovir were recovered in supernatants after centrifugation of the bacterial cell pellet. In contrast, no impact of microbiota on the pharmacokinetics of the prodrugs, tenofovir disoproxil fumarate or tenofovir alafenamide, was observed. Together, these results demonstrate that microbiota may impact pharmacokinetics and contribute to inconsistent efficacy.

Authors

Ekaterina Taneva, Shada Sinclair, Pedro M.M. Mesquita, Brian Weinrick, Scott A. Cameron, Natalia Cheshenko, Kerry Reagle, Bruce Frank, Sujatha Srinivasan, David Fredricks, Marla J. Keller, Betsy C. Herold

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Figure 4

Effects of bacterial supernatants on drug uptake.

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Effects of bacterial supernatants on drug uptake.
(A) Bacterial culture ...
(A) Bacterial culture supernatants (1:4 dilution) were applied to Jurkat cells for 1 hour prior to the addition of 0.5 μM [3H]TFV or [3H]TDF and Jurkat cell–associated drug quantified by liquid scintillation counting. (B) Supernatants from indicated strains of G. vaginalis, A. vaginae, L. crispatus, L. iners, or P. bivia were diluted 1:8 to 1:64 in PBS and applied to cells for 1 hour prior to addition of 50 μM [14C]TFV. Data are presented as mean ± SEM from at least 2 independent experiments with duplicate measurements per condition. (C) Different human cell lines or primary CD4+ T cells were exposed to 1:8 dilution of A. vaginae (DNF00720) or 1:32 dilution of G. vaginalis (DNF00162) supernatants for 1 hour prior to exposure to 0.5 μM radiolabeled drugs. Results are mean ± SEM of duplicate measurements from at least 2 independent experiments. (D) Bacterial culture supernatants (1:4 dilution) were applied to Jurkat cells for 1 hour prior to the addition of radiolabeled adefovir (ADF), adefovir dipivoxil (ADP), or dapivirine DPV and cell-associated drug quantified by scintillation counting. Results are mean ± SEM of duplicate measurements from 2 independent experiments. (E) Jurkat cells were incubated with the indicated culture supernatants, abiotic control broth, 80 μM dynasore, or PBS prior to exposure to 50 μg/ml of Alexa Fluor 555–conjugated transferrin (Tf-555) in the presence of the supernatants. The plasma membranes were stained green with DiO, nuclei blue with DAPI, and the transferrin is red. Representative images from 2 independent experiments are shown. (F) Approximately 100 cells from 6–9 randomly selected fields were counted and the percentage of cells that internalized Tf-555 is shown. The asterisks indicate significant differences relative to abiotic controls by unpaired Student’s t test (A and F) or by ANOVA with Tukey’s multiple-comparison correction (C and D). *P < 0.05; ***P < 0.001; ****P < 0.0001.

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