Comprehensive study of antiretroviral drug permeability at the cervicovaginal mucosa via an in vitro model

Constandinos Carserides, Kieron Smith, Marta Zinicola, Abhinav Kumar, Magda Swedrowska, Carlo Scala, Gary Cameron, Zoe Riches, Francesco Iannelli, Gianni Pozzi, Georgina Hold, Ben Forbes, Charles G Kelly, Karolin Hijazi* (Corresponding Author)

*Corresponding author for this work

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Modulation of drug transporter activity at mucosal sites of HIV-1 transmission may be exploited to optimize retention of therapeutic antiretroviral drug concentrations at target submucosal CD4+ T cells. Previously, we showed that darunavir was a substrate for the P-glycoprotein efflux drug transporter in colorectal mucosa. Equivalent studies in the cervicovaginal epithelium have not been reported. Here, we describe the development of a physiologically relevant model to investigate the permeability of antiretroviral drugs across the vaginal epithelium. Barrier properties of the HEC-1A human endometrial epithelial cell line were determined, in a dual chamber model, by measurement of transepithelial electrical resistance, immunofluorescent staining of tight junctions and bi-directional paracellular permeability of mannitol. We then applied this model to investigate the permeability of tenofovir, darunavir and dapivirine. Efflux ratios indicated that the permeability of each drug was transporter-independent in this model. Reduction of pH to physiological levels in the apical compartment increased absorptive transfer of darunavir, an effect that was reversed by inhibition of MRP efflux transport via MK571. Thus, low pH may increase the transfer of darunavir across the epithelial barrier via increased MRP transporter activity. In a previous in vivo study in the macaque model, we demonstrated increased MRP2 expression following intravaginal stimulation with darunavir which may further increase drug uptake. Stimulation with inflammatory modulators had no effect on drug permeability across HEC-1A barrier epithelium but, in the VK2/E6E7 vaginal cell line, increased expression of both efflux and uptake drug transporters which may influence darunavir disposition.
Original languageEnglish
Article number1938
Number of pages22
Issue number9
Early online date13 Sept 2022
Publication statusPublished - 13 Sept 2022

Bibliographical note

Funding: This work was supported by the European Union’s Seventh Programme for research, technological development and demonstration under grant agreement No 305316 as part of the MOTIF (Microbicides Formulation Through Innovative Formulation for Vaginal and Rectal Delivery) project.
Acknowledgments: We thank all members of the MOTIF consortium for helpful discussions and exchange of ideas during the course of this study.


  • HIV‐1
  • female genital tract
  • darunavir
  • tenofovir
  • dapivirine
  • drug permeability
  • drug transporters
  • dual chamber model
  • HEC-1A


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