Stavudine (d4T), a nucleoside reverse transcriptase inhibitor (NRTI) used to treat infection by the human immunodeficiency virus (HIV), is associated with the development of peripheral neuropathy and pain in HIV-positive patients. The mechanisms of this toxic neuropathy are poorly understood, primarily due to a lack of relevant animal models of the neuropathological process initiated by d4T. I investigated whether daily oral or subcutaneous administration of d4T produces neuropathological changes. Compared to previous descriptions of mechanical hypersensitivity induced by daily oral administration of d4T to rats at a dose of 50 mg.kg-1over a four week period, I found that this dosing regimen did not result in hyperalgesia to blunt and punctuate mechanical stimuli applied to the gastrocnemeus muscle. In agreement with the lack of hyperalgesia, oral administration of d4T at 50 mg.kg-1 over a four week period did not induce significant myelinated nerve fibre loss or morphological changes in the sciatic nerve. I then investigated whether administering 100 mg.kg-1 d4T subcutaneously, and therefore avoiding first-pass metabolism, to rats for four weeks causes hyperalgesia and neuropathological changes in nerve morphology. Daily subcutaneous injections of d4T at 100 mg.kg-1 over a four week period did not induce the development of hyperalgesia to a punctate mechanical stimulus applied to the tail or significant neuropathology. My studies demonstrate that multiple administrations of d4T at 50 mg.kg-1 orally or 100 mg.kg-1 subcutaneously over a four week period do not induce hyperalgesia or nerve fibre pathology in rats. Thus, developing a robust animal model of d4T-induced neuropathy may be challenging in the absence of HIV-infection, such that occurs in infected patients. Key words: HIV, ART, d4T, hypernociception

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HIV/AIDS is the most threatening and challenging infectious diseases of our time, with the highest increase of newly infected cases reported. This infectious disease was discovered in the early eighties under homosexual men and was later to be discovered in heterosexuals. HIV is a systemic immunosuppressive disorder which causes a depletion of CD4+ T cells and develops into the acquired immunodeficiency syndrome - AIDS. Africa is the continent most affected by HIV/AIDS with the southern parts of Africa having the highest prevalence rates compared to the rest of Africa. Statistics indicate that AIDS is responsible for 3% of deaths in children worldwide - one in seven people dying of an HIV-related illness is a child under the age of 15 years. It was stated by the WHO that countries should develop improved antiretrovirals regimes for the prevention of mother-to-child transmission. Difficulties in administering antiretrovirals (ARVs) to patients (especially children) are the strict dosage regimes and the severe adverse reactions. These factors complicate patient adherence. The list of problems in treating patients is endless and includes the distribution, stability as well as the low efficacy of these drugs. Most of the above mentioned problems and obstacles related to ARVs and ARV treatment could be minimized or eliminated by the use of a stable and effective drug delivery system. Enhancing ARV treatment may be accomplished by the use of the Pheroid™ drug delivery system. Pheroids™ consists mainly of fatty acids and sterile nitrous oxide gassed water. Pharmacological active substances are entrapped into submicron and micron sized structures called Pheroids™. Research showed promising results and advantages in delivering drugs through oral and transdermal routes using Pheroid™ technology. The focus of this study was to test the possible enhancement of the efficacy of antiretrovirals using Pheroid™ technology. The assays used to study this possible enhancement were a modified neutral red and a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay. These assays confirmed and illustrated the toxic and protective properties of the tested ARVs (stavudine, lamivudine and nevirapine). An MT-2 cell line was used and infected with an HIV-1 strain, SW7-TCL. Applying Pheroid™ technology in these assays resulted in massive cell death, due to increased ARV toxic levels within the cells. Viability tests proved that Pheroids™ had no effect on the viability of cells at the concentration typically used. This confirmed the enhancing properties of Pheroids™ in the delivery of drugs into the cells. The MTT assay was further adapted from a seven day incubation period to a three day incubation period. By using a low concentration series and a three day incubation period the loss of cells through toxicity was partially overcome. One of the problems that arose form this study was the non-reproducibility of the results. Absorbance levels fluctuated at specific concentrations of the same ARV, which cause difficulties in comparing results. This result was repeatedly confirmed in this syncytium forming infection model. In conclusion, Pheroid™ technology enhanced the delivery of ARVs into the cells although it resulted in cell death. Both the neutral red and MTT assays were found to be inaccurate but further development, research and assay optimization could result in improved in vitro studies. The article format was used for this thesis, as described in the general academic rules in section A.13.7.3 of the North West University. Chapter 1 deals with HIV/AIDS related problems, statistics and treatment obstacles. Chapter 2 is a summary of the cell viability assays used in this study. Pheroid™ technology and its application to ARV treatment are dealt with in chapter 3. The proposed article for submission in the journal Cell Death and Differentiation has been included in chapter 4. Some of the results from the study are reported in the article and annexures, whilst other results are shown and discussed in Chapter 5. Chapter 6 gives a conclusion and final summary of this study. All other experimental methods and results are enclosed in the annexures, as is the "Guide for authors" for the article. / Thesis (M.Sc. (Pharmaceutics))--North-West University, Potchefstroom Campus, 2008.

HIV/AIDS is the most threatening and challenging infectious diseases of our time, with the highest increase of newly infected cases reported. This infectious disease was discovered in the early eighties under homosexual men and was later to be discovered in heterosexuals. HIV is a systemic immunosuppressive disorder which causes a depletion of CD4+ T cells and develops into the acquired immunodeficiency syndrome - AIDS. Africa is the continent most affected by HIV/AIDS with the southern parts of Africa having the highest prevalence rates compared to the rest of Africa. Statistics indicate that AIDS is responsible for 3% of deaths in children worldwide - one in seven people dying of an HIV-related illness is a child under the age of 15 years. It was stated by the WHO that countries should develop improved antiretrovirals regimes for the prevention of mother-to-child transmission. Difficulties in administering antiretrovirals (ARVs) to patients (especially children) are the strict dosage regimes and the severe adverse reactions. These factors complicate patient adherence. The list of problems in treating patients is endless and includes the distribution, stability as well as the low efficacy of these drugs. Most of the above mentioned problems and obstacles related to ARVs and ARV treatment could be minimized or eliminated by the use of a stable and effective drug delivery system. Enhancing ARV treatment may be accomplished by the use of the Pheroid™ drug delivery system. Pheroids™ consists mainly of fatty acids and sterile nitrous oxide gassed water. Pharmacological active substances are entrapped into submicron and micron sized structures called Pheroids™. Research showed promising results and advantages in delivering drugs through oral and transdermal routes using Pheroid™ technology. The focus of this study was to test the possible enhancement of the efficacy of antiretrovirals using Pheroid™ technology. The assays used to study this possible enhancement were a modified neutral red and a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay. These assays confirmed and illustrated the toxic and protective properties of the tested ARVs (stavudine, lamivudine and nevirapine). An MT-2 cell line was used and infected with an HIV-1 strain, SW7-TCL. Applying Pheroid™ technology in these assays resulted in massive cell death, due to increased ARV toxic levels within the cells. Viability tests proved that Pheroids™ had no effect on the viability of cells at the concentration typically used. This confirmed the enhancing properties of Pheroids™ in the delivery of drugs into the cells. The MTT assay was further adapted from a seven day incubation period to a three day incubation period. By using a low concentration series and a three day incubation period the loss of cells through toxicity was partially overcome. One of the problems that arose form this study was the non-reproducibility of the results. Absorbance levels fluctuated at specific concentrations of the same ARV, which cause difficulties in comparing results. This result was repeatedly confirmed in this syncytium forming infection model. In conclusion, Pheroid™ technology enhanced the delivery of ARVs into the cells although it resulted in cell death. Both the neutral red and MTT assays were found to be inaccurate but further development, research and assay optimization could result in improved in vitro studies. The article format was used for this thesis, as described in the general academic rules in section A.13.7.3 of the North West University. Chapter 1 deals with HIV/AIDS related problems, statistics and treatment obstacles. Chapter 2 is a summary of the cell viability assays used in this study. Pheroid™ technology and its application to ARV treatment are dealt with in chapter 3. The proposed article for submission in the journal Cell Death and Differentiation has been included in chapter 4. Some of the results from the study are reported in the article and annexures, whilst other results are shown and discussed in Chapter 5. Chapter 6 gives a conclusion and final summary of this study. All other experimental methods and results are enclosed in the annexures, as is the "Guide for authors" for the article. / Thesis (M.Sc. (Pharmaceutics))--North-West University, Potchefstroom Campus, 2008.

Als Prüfung auf das genotoxische Potenzial einer Substanz ist die Entstehung von Micronuclei in proliferierendem Gewebe als genetischer Endpunkt wissenschaftlich und behördlich anerkannt. Zugrunde liegendes Experimentalmodell für diesen Test sind zumeist Mäuse und Ratten, deren Knochenmark das Zielgewebe dieses Tests darstellt. Dieses Testmodell geht mit dem Tod der verwendeten Tiere einher. Die vorliegende Arbeit greift den von Wolf & Lüpke (1997) sowie Wolf (1999) vorgestellten HET-MN (Hen’s Egg Test for MicroNucleus induction) auf, der angebrütete Hühnereier als Experimentalmodell verwendet (Bebrütungsdauer 11 Tage, d11). Zielorgan ist das periphere Blut der extraembryonalen Membranen. Das entnommene Blut wurde nach modifizierten hämatologischen Standard-verfahren angefärbt und die Zellen im Hellfeld-Durchlicht-Mikroskop bei 1000-facher Vergrößerung ausgezählt. Anhand der nucleosidanalogen Reverse Transkriptase Hemmer Zidovudin, Stavudin, Zalcitabin, Lamivudin und Didanosin fand ein Abgleich mit den durch Tierversuche gewonnenen Daten statt. In den versuchsreihen zu Zidovudin, Stavudin Zalcitabin, Didanosin und in den Kombinationsversuchen mit Zidovudin und Didanosin konnten die Daten aus der Literatur reproduzierbar bestätigt werden; wobei der HET-MN sensitiver reagierte als das Testmodell am Tier. Für Lamivudin konnte reproduzierbar eine biologisch und statistisch relevante, dosisabhängige Erhöhung der Micronucleusfrequenz erzielt werden. Damit steht der HET-MN in Kontrast zu den in der Literatur verfügbaren Informationen. Die im HET-MN gewonnenen Daten ließen in allen Versuchsreihen auf vergleichbare oder höhere Sensitivität als im Micronucleustest an Nagern schließen. Damit stellt der HET-MN eine kostengünstige und methodisch leicht durchführbare Alternative zum Tierversuch dar und wird trotz seiner hohen Komplexität und den damit verbundenen in-vivo-ähnlichen Bedingungen allen Belangen des Tierschutzes gerecht.