The use of 4-VCD intraperitoneally in rodents promotes selective ovotoxicity, follicular depletion, premature ovarian failure, and changes in the estrous cycle [20, 28, 29]. The beginning of ovotoxicity was evidenced after ten days of treatment with 4-VCD intraperitoneally [27], detected by the increase in the population of atretic primordial follicles and, from the 12th day of treatment, a significant decrease is detected. in the counting of healthy primordial and primary follicles [20, 27]. In the present study, when evaluating the ovotoxicity of 4-VCD through a less invasive route than the intraperitoneal route, it was noted that the use of intravaginal 4-VCD, using chitosan gel as a vehicle, promoted toxicity only to the primordial follicles and affected the estrous cycle of treated rats. However, there was no evidence of sterility during the study period, suggesting that the ovotoxic action of 4-VCD via the intravaginal route is less intense than intraperitoneal route. The findings are, however, promising, considering chemosterilization and support future studies.
Firstly, chitosan is a natural polymer and was chosen for the development of the gel, as it presents good biocompatibility, biodegradability, and easy absorption [30]. For inoculation, the intravaginal gel containing 4-VCD based on chitosan was easily expelled and applied, with an administration volume of 0.2mL, showing good muco-adhesive characteristics and local retention. These characteristics enhance its use since the chitosan-based gel (positive charge) performs electrostatic interactions with the vaginal mucus (negative charge), thus allowing good mucus adhesion and local permanence, guaranteeing drug release [31, 32]. Besides, the gel has antibacterial properties [33]. Furthermore, 24 hours after applying the compound, it was possible to perform vaginal washes without gel residue or interference in the vaginal cytological analysis. In view of this, the chitosan-based gel appeared to be a suitable means of delivering 4-VCD intravaginally.
Regarding observations related to the estrous cycle, it is known that rats treated with compounds that are harmful to the reproductive system, may present periods of estrus or diestrus lengthened in each cycle (≥ 4 days of diestrus and ≥ 3 days of estrus), causing long-lasting estrous cycles [23]. In the present study, the evaluation of the estrous cycle showed that the rats in the 4-VCD group at both moments (M1 and M2) presented a cycle classified as abnormal, with a greater number of days in diestrus. As a result, a prolongation of the estrous cycle and a lower number of cycles were noted in relation to the GC. These findings corroborate the findings of studies that used 4-VCD in doses of 40 and 80 mg/kg intraperitoneally in rats that presented irregularities in the estrous cycle at the beginning of treatment, characterized by the prolongation of days in the diestrus phase and thus, also a lower number of estrous cycles in the given period [28, 34, 35]. These changes begin to be observed in the first 30 days of treatment, starting from the third estrous cycle [28, 34]. In the long term, Mayer et al. [29] observed that the cyclicity is interrupted 360 days after the start of treatment with 4-VCD, after the exhaustion of antral follicles. In the present study, due to the short evaluation period, it was not possible to determine whether the same evolution would occur with the use of 4-VCD in intravaginal gel, even so, interference with cyclicity was noted, justifying future studies that include long-term evaluation.
Furthermore, it was noted that one of the rats in the 4-VCD group (1/10) showed signs of inflammation in the uterus and vagina in M1, noted macroscopically during data collection. It is known that insults to the vaginal mucosa can trigger a local inflammatory response, and leukocytes can be found in vaginal washes up to 48 hours after the event, thus mimicking the diestrus phase and confusing the assessment of vaginal cytology for up to 14 days [23, 36]. Clear signs of vaginal inflammation were not evident in the other animals in the treated group (9/10), and the possible interference of the gel containing 4-VCD in the local inflammatory response was not completely ruled out and could have been inferred in the analyzes of the estrous cycle in M1. The 4-VCD has corrosive characteristics that cause insults to inoculating tissues; cases of inflammation of mucous membranes, skin, muscles, and other organs have already been observed [22, 39, 41–44]. However, to confirm this hypothesis, studies that include histopathological evaluation of the involved tissues are necessary for further conclusions. However, it is important to highlight that 80% of the rats in the 4-VCD group maintained irregular cycles in M2 after the gel inoculations were suspended, characterized by periods of prolonged estrus and a smaller number of estrous cycles.
Interestingly, the irregularities in the estrous cycle detected at the beginning of 4-VCD treatment appear to be related to the onset of 4-VCD ovotoxicity to small preantral follicles. This is because the prolongation of estrous cycle phases occurs in parallel with the decrease in the population of healthy follicles and the increase in the number of atretic follicles [20–28, 34, 35].
It is known that follicular damage caused by 4-VCD in rats begins after 10 days of intraperitoneal administration at a dose of 80 mg/kg, confirmed by the degradation of oocyte DNA, without there being yet a significant loss in the number of primordial and primary follicles [27]; and with 12 to 15 days of intraperitoneal treatment with 4-VCD at the aforementioned dose, a significant decrease in the global count of primordial and primary follicles is detected [20, 27]. However, in the present study it was observed that one day after the end of intravaginal treatment with 4-VCD (M1) it was not possible to detect a significant difference in the number of healthy or atretic follicles between the groups. But, at this moment, the proportion of healthy primordial follicles was higher in the CG, as well as the proportion of atretic primordial follicles was higher in the 4-VCD group. Thus, these findings corroborate those of other articles [20, 29], in which 4-VCD was able to promote a decrease in the population of healthy follicles, increasing follicular atresia. Although the results indicate an ovotoxic action of 4-VCD in M1, the data suggest that through the intravaginal route the ovotoxicity of the compound does not occur with the same intensity or speed as observed through the intraperitoneal route [20, 27, 28].
Differently from what was observed in M1, in M2 a significant increase in the number of atretic primordial follicles was noted in the 4-VCD group. However, no difference was observed in the number of healthy primordial and primary follicles, nor in the number of atretic primary follicles. These findings are in accordance with literature data on the onset of ovotoxicity induced by 4-VCD. According to Kao et al. [20], the initial phase of follicular damage induced by the compound is noted by an increase in the population of atretic follicles, followed by a decrease in the number of healthy follicles. Therefore, it is believed that, for there to be a significant decrease in the number of healthy follicles, a greater dosage and/or time of exposure to the compound would be necessary. Nevertheless, Hinds et al. [45] when using 4-VCD orally at different doses (150–450 mg/kg) for five days in mice, they did not notice ovotoxicity, attributing the inefficiency of the compound to the short exposure time and doses considered low for this route. In parallel, a study conducted by Abolaji et al. [46], when using 4-VCD in rats orally, at doses of 100, 250 and 500 mg/kg, ovotoxicity of 4-VCD was demonstrated, but exposure to the compound lasted 28 days. Reiterating the findings in M1, in M2 it was found that in the 4-VCD group, a significantly higher proportion of atretic primordial follicles and a lower proportion of healthy primordial follicles was observed in relation to the CG, demonstrating the ovotoxic action of the compound via the intravaginal route with just 15 days of exposure.
It is known that 4-VCD has an ovotoxic nature through different routes and doses [20, 22, 27, 28, 47] and when associated with other chemical compounds [48, 49]. However, the route of inoculation can influence its mechanism of action [45, 50]. According to the findings of the present study, the intravaginal route for administration of 4-VCD showed signs of ovotoxicity, but there was no complete damage to the primordial follicles in the groups evaluated. It is known that for chemosterilization to occur and fertility to be compromised, the entire population of primordial follicles must be affected [20, 29, 51]. As growing and antral follicles are recruited from primordial and primary follicles, their population will only be affected when the small preantral follicles begin to decrease significantly [20, 29].
According to Hinds et al. [52], up to 30 repeated doses of 4-VCD orally are necessary for it to affect the fertility of rats. In the study conducted by Reis et al. [19], the administration of 4-VCD at a dose of 160 mg/kg for 15 consecutive days subcutaneously in rats significantly decreased the population of healthy antral follicles. However, ovotoxicity induced by 4-VCD to primordial follicles, at a dose of 80 mg/kg intraperitoneally, occurs at a constant rate, in response to daily/repeated dosing, between 10 and 30 days, and is not a single event [20, 27, 28]. Because of this, it is believed that longer exposure (more than 15 days) to 4-VCD intravaginally is necessary for ovarian atresia and, thus, sterility to occur. Future studies should be carried out to determine whether a longer exposure time and/or a higher dose of 4-VCD via the intravaginal route will be able to promote infertility in rats. However, the present study shows important evidence that this pathway has the potential to be better studied.