title: Neither vaginal nor buccal administration of 800 μg misoprostol alters mucosal and systemic immune activation or the cervicovaginal microbiome: a pilot study.
abstract: OBJECTIVE
  The aim of the study was to assess the extent to which misoprostol alters mucosal or systemic immune responses following either buccal or vaginal administration.
  
  
  METHODS
  This was a prospective, crossover pilot study of 15 healthy, reproductive-age women. Women first received 800 μg misoprostol either via buccal or vaginal administration and were crossed over 1 month later to receive the drug via the other route. Cervicovaginal lavage samples, cervical Cytobrush samples, cervicovaginal swabs, urine and blood were obtained immediately prior to drug administration and the following day. Parameters assessed included urine and cervicovaginal misoprostol levels, whole blood cytokine responses (by ELISA) to immune stimulation with lipopolysaccharide, peripheral blood and cervical lymphocyte phenotyping by flow cytometry, cervicovaginal antimicrobial peptide measurement by ELISA and vaginal microbial ecology assessment by 16S rRNA sequencing.
  
  
  RESULTS
  Neither buccal nor vaginal misoprostol significantly altered local or systemic immune and microbiological parameters.
  
  
  CONCLUSIONS
  In this pilot study, we did not observe significant alteration of mucosal or systemic immunology or vaginal microbial ecology 1 day after drug administration following either the buccal or vaginal route.
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Spyros A
authors.initials: SA
authors.lastname: Kalams
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Rogers
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Rita M
authors.initials: RM
authors.lastname: Smith
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Barnett
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Crumbo
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Shonda
authors.initials: S
authors.lastname: Sumner
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Prashad
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Rybczyk
authors.affiliation: b Division of Clinical Pharmacology, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Ginger
authors.initials: G
authors.lastname: Milne
authors.affiliation: c MR DNA (Molecular Research) , Shallowater , TX , USA.
authors.forename: Scot E
authors.initials: SE
authors.lastname: Dowd
authors.affiliation: d Gynuity Health Projects LLC , New York , NY , USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Chong
authors.affiliation: d Gynuity Health Projects LLC , New York , NY , USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Aronoff
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000494:pharmacology*; D000278:Administration, Buccal; D000282:Administration, Intravaginal; D002584:Cervix Uteri / Q000187:drug effects / Q000276:immunology / Q000382:microbiology; D018592:Cross-Over Studies; D053492:Elafin / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007107:Immune System / Q000187:drug effects; D008214:Lymphocytes / Q000187:drug effects; D064307:Microbiota; D016595:Misoprostol / Q000008:administration & dosage / Q000494:pharmacology*; D010865:Pilot Projects; D014481:United States; D014621:Vagina / Q000187:drug effects / Q000276:immunology / Q000382:microbiology
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D053492:Elafin; C506806:PI3 protein, human; D016595:Misoprostol
keywords: Abortion; microbial ecology; mucosal immunology; prostaglandins