TY - JOUR
T1 - Hyperosmolar sexual lubricant causes epithelial damage in the distal colon
T2 - Potential implication for HIV transmission
AU - Fuchs, Edward J.
AU - Lee, Linda A.
AU - Torbenson, Michael S.
AU - Parsons, Teresa L.
AU - Bakshi, Rahul P.
AU - Guidos, Anita M.
AU - Wahl, Richard L.
AU - Hendrix, Craig W.
PY - 2007/3/1
Y1 - 2007/3/1
N2 - Background. Many sexual lubricants are hyperosmolar. Hyperosmolar enemas induce epithelial damage, and enema use has been associated with an increased risk of HIV infection. To inform the development of rectal microbicide formulation, we evaluated the effects of hyperosmolar gels on the rectal mucosa. Methods. Two commercial lubricants were compounded into iso-osmolar and hyperosmolar mixtures (283 and 3429 mOsm/kg, respectively). Each gel was radiolabeled with 500 μCi of 99mTechnetium-diethylene triaminepentaacetic acid, and 10 mL was given rectally to 10 subjects in random sequence. Sigmoidoscopy by an endoscopist blinded to treatment assignment was performed 90 min later to obtain luminal and mucosal samples. Urine radiolabel detection was used to assess mucosal permeability. Results. Epithelial denudation 10 cm from the anus occurred to a greater degree with the hyperosmolar gel than with the iso-osmolar formulation (median toxicity grade, 2.50 vs. 1.17 out of 3, respectively; P = .009). The hyperosmolar gel was also associated with lower isotope luminal concentration at 10 cm, compared with the iso-osmolar gel (median, 8.9% vs. 54.6% of administered concentration, respectively). Mucosal permeability measured through 12 h was reduced with the hyperosmolar gel (P = .037). Conclusion. Rectally applied hyperosmolar gels induce greater epithelial denudation and luminal secretion than iso-osmolar gels. Because denudation plausibly increases the risk of HIV transmission, hyperosmolar gels make poor rectal microbicide formulations, and hyperosmolar sexual lubricants may increase susceptibility to HIV infection.
AB - Background. Many sexual lubricants are hyperosmolar. Hyperosmolar enemas induce epithelial damage, and enema use has been associated with an increased risk of HIV infection. To inform the development of rectal microbicide formulation, we evaluated the effects of hyperosmolar gels on the rectal mucosa. Methods. Two commercial lubricants were compounded into iso-osmolar and hyperosmolar mixtures (283 and 3429 mOsm/kg, respectively). Each gel was radiolabeled with 500 μCi of 99mTechnetium-diethylene triaminepentaacetic acid, and 10 mL was given rectally to 10 subjects in random sequence. Sigmoidoscopy by an endoscopist blinded to treatment assignment was performed 90 min later to obtain luminal and mucosal samples. Urine radiolabel detection was used to assess mucosal permeability. Results. Epithelial denudation 10 cm from the anus occurred to a greater degree with the hyperosmolar gel than with the iso-osmolar formulation (median toxicity grade, 2.50 vs. 1.17 out of 3, respectively; P = .009). The hyperosmolar gel was also associated with lower isotope luminal concentration at 10 cm, compared with the iso-osmolar gel (median, 8.9% vs. 54.6% of administered concentration, respectively). Mucosal permeability measured through 12 h was reduced with the hyperosmolar gel (P = .037). Conclusion. Rectally applied hyperosmolar gels induce greater epithelial denudation and luminal secretion than iso-osmolar gels. Because denudation plausibly increases the risk of HIV transmission, hyperosmolar gels make poor rectal microbicide formulations, and hyperosmolar sexual lubricants may increase susceptibility to HIV infection.
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U2 - 10.1086/511279
DO - 10.1086/511279
M3 - Article
C2 - 17262713
AN - SCOPUS:33847035951
VL - 195
SP - 703
EP - 710
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 5
ER -