1. Introduction
Acquired Immunodeficiency Syndrome (AIDS) has been one of the most distressing diseases caused by the Human Immunodeficiency Virus (HIV) in the last few decades [
1]. Unfortunately, in more than half of HIV-positive people, neurological problems have been discovered. These neurological problems impact the central nervous system and the peripheral nervous system, or both [
2]. Neuropsychiatric problems have been documented in HIV-positive and also in AIDS patients in recent years. NeuroAIDS refers to the neuropsychiatric problems that affect 30–50 percent of AIDS patients. The entry of HIV into the central nervous system via direct penetration across the blood–brain barrier or via peripherally contaminated macrophages is the primary cause of neuroAIDS [
3]. Antiretroviral medication is an important part of the treatment of HIV/AIDS patients. On the other hand, even with combination antiretroviral therapy, neuroAIDS or HIV-linked neuronal abnormalities remain an important public health problem amongst AIDS patients. This is primarily because of the low perfusion of antiretroviral drugs to the brain, causing an insufficient drug level at the target, which is primarily limited by the formidable physiological blood–brain barrier [
4]. Tight junctions in the endothelial cells of blood capillaries that lead to the brain operate as a barrier to most medications, preventing drugs and solutes from passing through [
5]. As a result, even when using antiretroviral drugs for a long time, modest and persistent viral replication occurs in the central nervous system (CNS). Hence, new techniques to improve anti-HIV medication delivery to the CNS are needed.
Darunavir is a nonpeptidic protease inhibitor (
Figure 1), which has been demonstrated to be effective against wild-type HIV. It has become an integral part of antiretroviral therapy, which is widely regarded as the key advancement in the area of HIV treatment [
6]. The molecular weight of darunavir is 593.73 g/mole, and it is highly lipophilic (log
p 3.94), with limited aqueous solubility (0.15 mg/mL at 20 °C) [
7]. The therapeutic efficacy and safety of darunavir, when used in combination with other antiretroviral medications, have been proven through several clinical investigations [
8,
9].
Intranasal drug delivery has become an emerging alternative for the local and systemic therapy of different pharmaceutical actives [
10]. The intranasal route of administering drugs is a noninvasive method for delivering antiretroviral medicines into the brain and CNS, bypassing the blood–brain barrier. The olfactory and trigeminal nerves offer unique connections between the brain and the external environment, which, in turn, can transport medications directly from the nasal cavity to the brain via the intranasal pathway, thus bypassing the blood–brain barrier [
11]. The intranasal route is divided into two sections, one intracellular, and the other extracellular. In the intracellular pathway, endocytosis occurs in olfactory sensory cells, which is accompanied by axonal transport to synaptic clefts in the olfactory bulb, where the drug is exocytosed. In the extracellular method, drugs are carried directly into the cerebral spinal fluid by first entering through the paracellular space over the nasal epithelium, and then through the perineural space to the brain’s subarachnoid space [
12]. The intranasal delivery approach works well for medications that are unable to enter the blood–brain barrier and exhibit action in the CNS, eliminating the need for systemic distribution and reducing systemic side effects. Intranasal therapy can be easily administered by patients, which provides higher patient compliance, the quick onset of action, avoids first-pass metabolism, and can provide direct delivery to the brain [
13]. Moreover, the mucus membrane is highly vascularized and possesses high permeability. Given the nasal cavity’s anatomical features, the nasal route could be an effective choice for delivering antiretroviral drugs straight from the nose to the brain. Indeed, it has been demonstrated that the nasal-mucosa-tight junctions can be reversibly unblocked, even for large molecular actives, including peptides and proteins [
14]. This, in turn, leads to the delivery of various biologics, which is evidenced by the large number of commercial products available and many more clinical trials [
15]. In addition, various categories of drugs, including those for AIDS, Parkinson’s, Alzheimer’s, and cancer, have been used for the brain-targeted delivery by using the nasal route [
16]. A large number of antiretroviral therapeutic molecules from various categories have been approved by the United States Food and Drug Administration (US FDA) for the treatment of neuroAIDS [
2]. Many formulation strategies have been assessed to deliver these therapeutics to provide direct nose-to-brain delivery [
16,
17]. Drops, sprays, gels, powders, inserts, ointments, and other nasal preparations are utilized to transport the medicine to the target site, the brain [
13]. In situ gelling techniques are commonly used for brain targets among such preparations.
The development of controlled-release delivery systems for local and systemic medication has sparked a lot of interest in various in situ polymeric formulations. In situ gel-forming systems are an intriguing polymeric system that begins as a flowing water solution before being supplied, and then goes through a phase transition to make a viscoelastic gel in a physiological setting [
13]. In situ gel-forming systems have a higher viscosity that transforms into a gel when triggered by different conditions [
18]. Due to their ease of control and practical benefits, temperature-responsive hydrogels are perhaps the most frequently researched class of environment-responsive polymer systems in dosage-forms research [
13,
19]. Temperature change causes gelation in thermosensitive hydrogels, which are liquid at room temperature, but gel when in contact with bodily fluids. In reality, in situ sol–gel transition happens when thermosensitive polymers in the formulation come into contact with the nasal membrane’s physiological temperature. Poloxamers are synthetic triblock copolymers, which possess thermosensitive gelling capabilities, great aqueous solubility, less toxicity/irritation, and superior drug-release qualities, making them ideal for in situ gel preparations [
20]. The thermoreversible property of Poloxamer is primarily because of its negative coefficient of solubility in block copolymer micelles. Typically, Poloxamer forms monomolecular micelles or multimolecular aggregates, depending on the concentrations, which results in gel formation [
21]. The gelation temperature and gelation time are the critical factors to be estimated to optimize thermosensitive gel. The gelation temperature is described as the lowest temperature upon which the prepared formulation undergoes a phase change to improve viscosity or become a semisolid gel. In general, an excellent thermoresponsive in situ gel has a glass transition temperature over the room temperature (25 °C) and achieves gel–sol transition at the physiological temperature of the nasal cavity. Hence, it is preferred that nasal in situ formulations have a gelation temperature above 25 and below 34 °C. The use of Poloxamer alone generally does not provide enough mechanical strength and mucoadhesion [
22]. Hence, mucoadhesive polymers are generally included in nasal in situ gel formulations to provide mucoadhesion and thereby offer greater residence in the application site. Carbopol is most widely used as a mucoadhesive agent in the in situ gel formulations due to its excellent mucoadhesive property, as well as the fact that it ensures good viscosity [
23]. In light of this, the current study attempted to formulate a mucoadhesive darunavir-loaded thermosensitive gel for intranasal delivery that might provide appropriate adhesion, a longer residence time in the nasal mucosa, and prolonged drug release. Indeed, this is a first-of-its-kind study in terms of the use of a darunavir-loaded in situ gel for intranasal delivery. Preliminary formulations (F1–F9) were prepared and evaluated for various pharmaceutical properties. A 3
2 factorial design was used to optimize and evaluate the in situ mucoadhesive nasal gel containing darunavir (0.2% w/v). The concentrations of Carbopol 934P and Poloxamer 407 were selected as influencing variables, and the gelation temperature and percentage of drug release were selected as a response. The optimized formulation was evaluated for drug interaction, thermal behavior, permeation, ciliotoxicity, and in vivo brain bioavailability in a rat model.
4. Materials and Methods
4.1. Materials
Darunavir and Poloxamer 407 were a gift sample from Emcure, Gandhinagar, India. Polyethylene glycol (PEG) 400, PEG 6000, glycerol, and sodium citrate were donated by Suvidhinath Laboratories, Baroda, India. Carbopol 934 P, methylparaben, and propylparaben were purchased from Chemdyes Corporation, Rajkot, India. Acetonitrile was purchased from Merck, Mumbai, India.
4.2. Analysis of Darunavir
The analysis of darunavir was performed by a high-performance liquid chromatography (HPLC) system (Shimadzu, Tokyo, Japan). A solvent system consisting of a combination of potassium phosphate buffer (10 mmol/L, pH ~ 3) and acetonitrile in 51:49 was used for the separation of darunavir using a monolithic C18 column (Zorbax, 150 mm × 4.6 mm, i.d, 5 µm) [
50]. The solvents were adjusted to run at 0.6 mL/min across the column, and drug elution was monitored with a UV detector set to 202 nm. Nevirapine was used as an internal standard. The injection volume was 50 µL, and the retention time was seen at 3.6 min. Validation of the analytical method was conducted by performing various parameters, such as sensitivity, selectivity, linearity, accuracy, precision, ruggedness, and limit of quantification. The developed method showed linearity in the range of a 4–600 ng/mL concentration, with the value of r
2 = 0.9978.
4.3. Solubility Determination
The saturation solubility of darunavir in water and different solubilizers was determined by an established method, according to the literature [
51], at room temperature (25 ± 1 °C). Solubilizers (glycerin, sodium citrate, PEG 400, and PEG 6000), at a concentration of 30% w/v, were used to check darunavir solubility. In addition, a combination of PEG 400 and PEG 6000, at a concentration of 15% w/v, was also assessed. In brief, an excess amount of darunavir was added to prepare a saturated solution of darunavir in water and different solubilizers, and the vials were tightly closed. Vortex mixture was used to mix all the solutions for 10–15 min, and was then sonicated for 10 min. The solution mixtures were agitated mechanically for 12 h, kept aside for an hour to achieve equilibrium, and later filtered through a 0.22 µm membrane filter unit (Millipore Corporation, Bedford, MA, USA). Each sample was filtered and diluted using the mobile phase and analyzed using HPLC.
4.4. Preparation of Darunavir Gel
The gel was prepared using a process that has been previously reported [
31]. The composition of prepared in situ gels (F1–F9) is summarized in
Table 1. In brief, the required amount of Poloxamer 407 (18–22% w/v) was dissolved in a glass beaker containing cold distilled water and was stored at 4 °C to dissolve it completely. Carbopol 934P (0.1–0.5% w/v) was solubilized separately in water by keeping it for 24 h, and was slowly added to the above Poloxamer solution with constant stirring. The prepared gelling solution was added with darunavir (0.2% w/v), solubilizer (30% w/v), and methylparaben (0.05%). The preparation was mixed under constant stirring by a magnetic stirrer to make a homogeneous solution.
4.5. Evaluation of Prepared Gels
4.5.1. Appearance
The formulation was evaluated for appearance by visual inspection on the basis of its clarity under sufficient lighting, and it was visualized against a black/whiteboard by inverting the sample to provide swirling action to check the motion of particulate matter and fibers. Moreover, it was observed for the presence of any particulate matter and the development of turbidity in the formulations [
40].
4.5.2. pH and Drug Content
The pH of prepared in situ gel formulations was determined by a pH meter (Mettler Toledo MP-220, Greifensee, Switzerland), which was previously calibrated. Determination of drug content was carried out by taking 1 g of in situ gel and mixing (5 min) with mobile phase using a laboratory mixer (EIE 405, EIE Instruments, Ahmedabad, India). The solution was further filtered (0.22 µm pore size) and the drug content was analyzed.
4.5.3. Determination of Gelation Temperature
The gelation temperature of prepared gels was measured by the visual examination method mentioned in the literature [
20]. Briefly, 5 mL of the formulation was taken in a 10 mL glass vial containing a magnetic bead and sealed. The vials were immersed in a water bath controlled with a thermostat, and the bath temperature was gradually increased from 20 °C to 40 °C by precisely measuring the temperature using a thermometer with a 0.1 °C scale range. The magnetic bead was stirred at a speed of 80 rpm. The temperature wherein the bead ceased rotating was used to determine the gelation temperature.
4.5.4. Mucoadhesive Strength Determination
The force required to separate the in situ gel from sheep nasal mucosa was measured using a texture analyzer (Stable Microsystems, Surrey, UK). The testing was conducted on the freshly cut piece (2 cm × 2 cm) of isolated sheep nasal mucosa, previously equilibrated with simulated nasal fluid (comprised of sodium chloride: 8.77 g/L; potassium chloride: 2.98 g/L; calcium chloride: 0.59 g/L, adjusted to pH 6.5 using 0.1 M sodium hydroxide) for 15 min at 37 ± 0.5 °C. A portion of the nasal mucosa was glued to the top platen assembly, such that the mucosal side was facing outwards [
37]. On the lower platen, a set amount of gel (500 mg) was applied. The upper probe was then let down at a pace of 0.5 mm/s onto the bottom platen until it made contact with a specified compressive force of 1 N and a contact time of 60 s. The probe was then detached at a distance of 15 mm at a speed of 0.5 mm/s [
52]. The required force to separate the formulation from the sheep mucosa was determined.
4.5.5. Viscosity
The measurement of viscosity of prepared gels was carried out using a Brookfield Viscometer (LVDVI prime, Middleborough, MA, USA) at a temperature of 30 ± 1 °C and an angular velocity of 20 rpm.
4.5.6. Spreadability
Spreadability is calculated by the area covered by gel formulation per unit time (cm
2/min). It was measured by using a 1 mL graduated pipette attached to the rubber bulb, and the pipette was fixed on the clamp vertically in such a way that there was a distance of 2 cm between the tip of the pipette and the horizontal surface of the Whatman filter paper (0.45 µm). Place 0.1 mL of formulation from the graduated pipette at the center of the filter paper. Spreadability was measured by calculating the surface area covered by formulation on filter paper at a fixed time interval of 20 s [
38].
4.6. In Vitro Drug Release
Franz diffusion cell (Orchid Scientific and Innovative India Ltd., Nashik, India) was used for in vitro release study, with an effective surface area of 1.3 cm
2. Drug release was carried out using simulated nasal fluid (pH 6.4) with the help of a cellophane membrane (MWCO 12–14 kDa) [
53]. Briefly, gel equivalent to 4 mg of darunavir was applied on the surface of the previously soaked dialyzing membrane, which was kept between the receptor and donor compartment. The receptor compartment contains simulated nasal fluid (pH 6.4, 20 mL). The whole assembly of the diffusion cell was placed on a water bath, which was thermostatically controlled at 37 ± 0.5 °C, and the receiver solution was stirred at 50 rpm [
54]. Withdrawal of samples was carried out at a periodic time up to 8 h and replaced with an equal volume of simulated nasal fluid (pH 6.4). The samples were diluted subsequently, and analytical estimation was performed for darunavir by HPLC. To pick the best-fit release model, various mathematical models, such as zero-order, Higuchi, Korsmeyer, Peppas, and others, were utilized. From the kinetic release data, the correlation coefficient (
r2), as well as release kinetics, were determined [
55].
4.7. Optimization of Variables Using 32 Factorial Designs
Generally, factorial designs were conducted to study the influence of several factors on experimental outcomes. On the basis of influencing factors, a full factorial design with 2 factors at 3 levels was selected for optimization. The concentrations of Carbopol 934P (X
1) and Poloxamer 407 (X
2) were selected as influencing variables, and gelation temperature (Y
1) and % drug release (Y
2) at 8 h were selected as the responses. As the factors are quantitative, it was required that the experiment be performed at three levels when it was expected to have curvature of the response [
56]. The factors were studied at three levels (−1, 0, +1), demonstrating low, medium, and high, respectively, as shown in
Table 6. Statistical models having polynomial equations and interaction terms were used to evaluate response. A total of nine experimental runs were carried out, and formulations were coded from D1 to D9. Prepared design batches were analyzed for clarity, pH, drug content, gelation temperature, mucoadhesive strength, viscosity, spreadability, and drug release after 8 h. Responses were analyzed by the statistical model.
4.8. Fourier Transform Infrared (FTIR) Spectroscopy
Spectra of pure darunavir, optimized formulation, and placebo gel were recorded to assess the possible interaction between drug and excipients. Samples (3–5 mg) were dissolved in 1 mL chloroform and 100 µL solution injected in the liquid cell of the IR compartment, and scanned between wavenumbers 4000 and 400 cm−1 using FTIR (6100, Jasco, Tokyo, Japan), and the spectra were compared for changes in drug peaks.
4.9. Differential Scanning Colorimetric (DSC) Analysis
DSC method was used to study the thermal behavior of drugs, Poloxamer, physical mixture, placebo, and in situ gel formulation using the Hitachi DSC instrument (DSC 7020, Japan). Weighed samples (5 mg) were placed in a separate aluminum crucible (25 μL), crimped, and nonhermetically sealed, while an empty pan was used as a standard. Thermograms were taken in an inert atmosphere by purging nitrogen gas at a flow rate of 50 mL/min, with a temperature range of 30–110 °C, at a uniform heating rate of 10 °C/min. Drug, polymer, and physical mixture were directly analyzed in solid form, whereas in situ gels of darunavir were first freeze-dried, and then analyzed for thermal analysis. The final formulation was kept for the primary freezing at −40 °C in the deep freezer (RQVD-300 PLUS; Remi, Mumbai, India) for 36 h. After that, final drying was carried out at −80 °C in the deep freezer (TFD 8503; ilShin Biobase, Dongducheon, Korea) for 12 h and used for DSC analysis.
4.10. Ex Vivo Permeation
Drug diffusion of prepared in situ gels was determined using the Franz diffusion cell setup described under in vitro release study [
57]. The nasal cavity of sheep was collected from the nearby slaughterhouse, and fresh nasal mucosa was removed and stored in saline water at −20 °C in a deep freezer. Stored tissue was placed in a diffusion cell between two compartments. The mucosal surface was in touch with the formulation, while the receiver compartment contained simulated nasal fluid [
58]. In situ gel containing darunavir (D7) equivalent to 4 mg or aqueous suspension (control) was applied to donor compartment. The diffusion cell was kept under agitation by a magnetic stirrer at 50 rpm, while the temperature of the system was set at 34 ± 0.5 °C by a circulating water bath. Samples were withdrawn every hour until 8 h, and an equal volume of samples of simulated nasal fluid (pH 6.4) was replaced.
4.11. Nasal Ciliotoxicity Studies
Nasal ciliotoxicity of optimized formulation (D7) was performed ex vivo on the nasal mucosa of sheep, according to the institutional ethical guidelines (Protocol No. IP/PCEU/FAC/27/2020/029). Histopathological studies were performed to evaluate nasal toxicity on tissue. Three identically sized sheep nasal mucosa pieces (A, B, and C) were chosen and put on Franz diffusion cells [
35]. As a negative control, A was applied with 0.5 mL of phosphate buffer, B was applied with 0.5 mL of isopropyl alcohol as a positive control, and C was applied with 0.5 mL of optimized nasal in situ gel formulation of darunavir (D7) as a test. The mucosa was washed with nasal saline fluid after 6 h and subjected to histological tests utilizing hematoxylin–eosin staining [
59]. A light microscope (ZEISS, Axioscope 5, Jena, Germany) with a magnification of 400 was used to examine the stained slides, and images were taken with a camera mounted to the microscope.
4.12. In Vivo Pharmacokinetic Studies
A preclinical study employing animals was conducted, according to the protocols of the Institutional Animal Ethical Review Board (Protocol No. IP/PCEU/FAC/27/2020/029). Each male Sprague Dawley rat, with an average weight of 250–300 g, was utilized for the estimation of various pharmacokinetic parameters. All animals were housed in separate cages in a well-controlled room (20 ± 2 °C and alternating 12 h light/12 h dark cycle) and were given free access to standard diet and water. Animals were fasted for at least 12 h before the administration of the assigned formulation. Rats were separated into Group I and Group II, with six animals at every time point. Animals in Group I received optimized in situ gel formulation with 0.2% w/v of darunavir (30 µL, 2.4 mg/kg) intranasally, while Group II rats were administered with drug solution (prepared using 5% dimethyl sulfoxide, 45% ethanol, and 40% normal saline to achieve 1.5 mg/mL darunavir solution) [
60] intravenously (2.4 mg/kg) through the tail vein. Blood samples were withdrawn in heparin precoated tubes from the tail vein at specific time intervals (0.25, 0.5, 1, 2, 4, 6, and 12 h). Protein precipitation in plasma was carried out by adding an equal volume of acetonitrile [
61] containing nevirapine (internal standard), and samples were subjected to centrifugation (1789×
g for 15 min) and then filtered. Similarly, isolated brain tissues (collected by sacrificing rats after inducing anesthesia using intraperitoneal urethane (1.0 g/kg)) were homogenized in methanol and mixed with acetonitrile containing internal standard, and the solvent was filtered. Samples of plasma and brain extract were analyzed using HPLC. The mean recovery of drugs from plasma and brain were 97.68 and 94.22%, respectively. Various pharmacokinetic parameters, such as C
max, T
max, and AUC
0-t, were estimated by noncompartmental analysis [
62].
4.13. Stability Studies
The stability of the selected in situ gel was examined at temperatures of 25 °C ± 2 °C (60 ± 5% RH) and at 4 °C ± 2 °C (55 ± 5% RH) for 3 months, according to the ICH guidelines [
56,
63]. Samples were kept in glass vials covered with a screw cap. Every month, samples were taken and evaluated for appearance, pH, drug content, gelation temperature, mucoadhesive strength, and drug release.
4.14. Data Analysis
The outcomes of the experimental data were examined quantitatively using one-way ANOVA or the T-test in GraphPad Prism 6 (Graph-Pad Software, Inc., La Jolla, CA, USA). Statistical significance was defined as a difference in data with a p-value of less than 0.05.