Release of zinc from the NSDS for Tablets of Similar Hardness.

<p>Values are based on a weight fraction proportion; n = 3; error bars represent standard error.</p

Physical Characteristics of Tablets using United States Pharmacopoeia Methods.

<p>Physical Characteristics of Tablets using United States Pharmacopoeia Methods.</p

Representative pressure profile in the breastfeeding simulation apparatus.

<p>Values are representative of that of a suckling infant, and were measured from the breastfeeding simulation apparatus over 10 seconds occurring several minutes into a trial run testing tablet T2.</p

Characterisation of zinc delivery from a nipple shield delivery system using a breastfeeding simulation apparatus

<div><p>Zinc delivery from a nipple shield delivery system (NSDS), a novel platform for administering medicines to infants during breastfeeding, was characterised using a breastfeeding simulation apparatus. In this study, human milk at flow rates and pressures physiologically representative of breastfeeding passed through the NSDS loaded with zinc-containing rapidly disintegrating tablets, resulting in release of zinc into the milk. Inductively coupled plasma optical emission spectrometry was used to detect the zinc released, using a method that does not require prior digestion of the samples and that could be applied in other zinc analysis studies in breast milk. Four different types of zinc-containing tablets with equal zinc load but varying excipient compositions were tested in the NSDS <i>in vitro</i>. Zinc release measured over 20 minutes ranged from 32–51% of the loaded dose. Total zinc release for sets tablets of the same composition but differing hardness were not significantly different from one another with P = 0.3598 and P = 0.1270 for two tested pairs using unpaired t tests with Welch’s correction. By the same test total zinc release from two sets of tablets having similar hardness but differing composition were also not significantly significant with P = 0.2634. Future zinc tablet composition and formulation optimisation could lead to zinc supplements and therapeutics with faster drug release, which could be administered with the NSDS during breastfeeding. The use of the NSDS to deliver zinc could then lead to treatment and prevention of some of the leading causes of child mortality, including diarrheal disease and pneumonia.</p></div

Breastfeeding Simulation Apparatus.

<p>(adapted from Gerrard et al., [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0171624#pone.0171624.ref009" target="_blank">9</a>]).</p

Release of zinc from the NSDS for Tablet Composition 1.

<p>Values are based on a weight fraction proportion; n = 3; error bars represent standard error.</p

Laboratory-Manufactured Elemental Zinc Content of the Tablets as Measured by ICP-OES.

<p>Laboratory-Manufactured Elemental Zinc Content of the Tablets as Measured by ICP-OES.</p

Tablet Disintegration and Zinc Release Characterisation.

<p>Tablet Disintegration and Zinc Release Characterisation.</p

Lysososmal dissolution of LM Fe(III) poly oxo-hydroxide.

<p><b>A</b>, Solubility in simulated lysosomal conditions at pH 5.0 with 10 mM citric acid and 0.15 M NaCl. Soluble Fe was measured by ICP-OES following 5 min ultrafiltration (3000 Da MWCO) for the LM Fe(III) poly oxo-hydroxide (black) and for un-modified Fe(III) poly oxo-hydroxide (solid blue). Nanoparticulate Fe was obtained from the Fe in the supernatant following centrifugation excluding the soluble (ultrafilterable) Fe, and is shown for LM Fe(III) poly oxo-hydroxide (red) and for un-modified Fe(III) poly oxo-hydroxide (dotted blue). Values are plotted as mean ± s.d. of 3 independent experiments (each experiment with 3 replicates). <b>B</b>, Effect of inhibition of lysosomal acidification using monensin on Fe utilization by differentiated Caco-2 cells. Data are shown as a percentage of the control (without monensin) at 24 h: i.e. 1 h exposure to 200 µM nanoparticulate LM Fe(III) poly oxo-hydroxide (open circles) or Fe(III) maltol (closed squares) ± 5-30 µM monensin followed by 23 h in non-supplemented MEM. Results are means ± s.d. of 3 independent experiments (each experiment with 3 replicate wells). **, <i>p</i><0.005; ***, <i>p</i><0.001 in relation to the soluble Fe control (Fe(III)maltol). <b>C</b>, Change in TEER in the Caco-2 cell monolayer following 1 h exposure to 10 μM monensin (closed squares), 30 μM monensin (open diamonds) or non-supplemented BSS control (closed inverted triangles) and with 23 h further incubation in fresh MEM (24 h in total). Values are expressed as a percentage of the initial measurement at the start of the exposure time (corresponding to 0 h) and are shown as mean ± s.d. of 2 independent experiments (each experiment with 3 replicate wells). Experimental points are connected with a solid line to aid visualization and not because a linear relationship is assumed between time and TEER measurement. ***, <i>p</i>=0.0003; ****, <i>p</i><0.0001 in relation to the non-supplemented BSS control.</p

Ferritin-protein levels in Caco-2 cells following exposure to LM Fe(III) poly oxo-hydroxide (nano Fe), Fe(III) maltol (FeM) or Fe(II) sulphate-ascorbate (FeSO₄ + AA).

<p><b>A</b>, Ferritin-protein regulation in differentiated and undifferentiated cells. ***, <i>p</i>=0.0003. Cells were incubated for 1 h with 200 μM Fe plus a further 23 h in fresh, non-supplemented MEM to allow for ferritin formation. <b>B</b>, Phase distribution of Fe in the BSS uptake medium: i.e. fractional percentage of microparticulate (black bars), nanoparticulate (red bars) and soluble Fe (open bars) for each Fe material. Values are mean ± s.d. of 3 independent experiments. <b>C</b>, Effect of LM Fe(III) poly oxo-hydroxide particle dispersion (in BSS medium, closed bars) or agglomeration (in MEM medium, open bars) on ferritin-protein levels in differentiated cells: the LM Fe(III) poly oxo-hydroxide was dispersed in its nano-form (99 ± 2% nano) using BSS or agglomerated (97 ± 2% microparticulate) using MEM. Data are mean of 3 independent experiments (each experiment with 3 replicate wells). FeM: soluble iron control, Fe(III) maltol. ***, <i>p</i>=0.0002 for the comparison between BSS and MEM. <b>D</b>, TEER changes in differentiated Caco-2 cell monolayer at different time points during incubation with BSS supplemented with LM Fe(III) poly oxo-hydroxide (open circles) or non-supplemented BSS control (closed inverted triangles). Incubations were for 3 h with 200 μM Fe (measurements at 1, 2 & 3 h) plus a further 21 h in fresh, non-supplemented MEM (24-h). Values are expressed as a percentage of the initial measurement and are shown as mean ± s.d. of 3 independent experiments (each experiment with 3 replicate wells). Experimental points are connected with a solid line to aid visualization and not because a linear relationship is assumed between time and TEER measurement. Detailed methodology is available in the Methods Section and in Methods S1.</p