To test this theory, Pedro Mesquita, a postdoctoral fellow in Dr. Herold's lab, developed a model that mimicked the genital tract environment. It was composed of two chambers separated by a barrier of cultured human cells that form tight junctions. After treating the epithelial cells with different microbicides, the researchers tested the barrier's permeability to HIV by placing HIV in the upper chamber, T cells in the lower chamber, and then monitoring the infection of the T cells over time.
When the epithelial barrier was treated with placebo, HIV was unable to pass through to the lower chamber, leaving the T cells uninfected. "But when we applied nonoxynol-9, the virus went right through the barrier and infected the T cells," says Dr. Herold. This result was no surprise, since nonoxynol-9 is a detergent, a class of chemicals known to be disruptive to cells. What was surprising, she says, was to observe the same result with cellulose sulfate ─ a sulfated polymer that is not a detergent and was shown to be safe in all of the other bioassays and in early clinical trials. These findings may explain the unanticipated clinical trial results in which use of cellulose sulfate was associated with an increase in HIV transmission.
The researchers later tested their model on two other microbicide candidates now being evaluated in large-scale clinical efficacy trials. Both drugs tenofovir and PRO 2000 performed well by not disrupting the epithelial barrier.
"Our findings strongly suggest that microbicides can increase the risk of HIV infection through a mechanism other that inflammation namely, by disrupting the protective epithelial cell barrier,"
|Contact: Dierdre Branley|
Albert Einstein College of Medicine