RESUMEN
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive fibro-stenotic strictures and destruction of the biliary tree. Currently, there is no effective treatment which can delay its progression or ameliorate the transplant-free survival. Moreover, a major chontroversy in PSC is whether to use UDCA. More recently, novel pharmacological agents emerged aiming at: i) modulation of bile composition; ii) immunomodulation; iii) targeting the gut microbiome; iv) targeting fibrosis. Successful PSC therapy, however, will be most likely a personalized combination of different drugs plus endoscopic treatment. This review aims at offering an overview on the experimental pharmacological strategies currently exploited for PSC treatment.
Asunto(s)
Colagogos y Coleréticos/administración & dosificación , Colangitis Esclerosante/tratamiento farmacológico , Ácido Ursodesoxicólico/administración & dosificación , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Bilis/efectos de los fármacos , Sistema Biliar , Colagogos y Coleréticos/farmacocinética , Colangitis Esclerosante/microbiología , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Ácidos Fíbricos/administración & dosificación , Ácidos Fíbricos/farmacología , Microbioma Gastrointestinal/efectos de los fármacos , Humanos , Inmunomodulación/efectos de los fármacos , Ácido Ursodesoxicólico/farmacologíaRESUMEN
Ursodeoxycholic acid (UDCA) is used in the oral therapy of hepatobiliary cholestatic diseases. Due to UDCA low aqueous solubility, two pediatric oral suspensions (25 mg/mL) were formulated with a few excipients, suspension A (SA) and suspension B (SB) with a vehicle, including two suspending agents. Physical, chemical and microbiological stability and a rheological study were performed at three different conditions (5 °C ± 3 °C, 25 °C ± 2 °C/60% RH ± 5% RH and 40 °C ± 2 °C/75% RH ± 5% RH) for 120 days. Moreover, dissolution study, content uniformity, related substances, and a study of relative oral bioavailability were also carried out. Both suspensions were physically, chemically and microbiologically stable throughout the study. SA and SB can be stored at 25 °C and 5 °C for at least 120 days whereas SA can be kept at 40 °C for at least 90 days and SB for 120 days. They both met USP specifications for dissolution, content uniformity, and related substances. SA and SB showed an improved relative oral bioavailability compared to the solid dosage form and they both displayed similar relative oral bioavailability with no significant differences between them. The developed suspensions proved to be safe and adequate and they are ideal for pediatric use for their acceptability, accurate dose administration and treatment adherence.
Asunto(s)
Colagogos y Coleréticos/administración & dosificación , Excipientes/química , Ácido Ursodesoxicólico/administración & dosificación , Administración Oral , Animales , Disponibilidad Biológica , Química Farmacéutica , Colagogos y Coleréticos/química , Colagogos y Coleréticos/farmacocinética , Estabilidad de Medicamentos , Almacenaje de Medicamentos , Humedad , Masculino , Ratas , Ratas Sprague-Dawley , Reología , Solubilidad , Suspensiones , Temperatura , Ácido Ursodesoxicólico/química , Ácido Ursodesoxicólico/farmacocinéticaRESUMEN
Sodium deoxycholate (NaDOC) inhibits the intestinal Ca2+ absorption and ursodeoxycholic acid (UDCA) stimulates it. The aim of this study was to determine whether NaDOC and UDCA produce differential effects on the redox state of duodenal mitochondria altering the Krebs cycle and the electron transport chain (ETC) functioning, which could lead to perturbations in the mitochondrial dynamics and biogenesis. Rat intestinal mitochondria were isolated from untreated and treated animals with either NaDOC, UDCA, or both. Krebs cycle enzymes, ETC components, ATP synthase, and mitochondrial dynamics and biogenesis markers were determined. NaDOC decreased isocitrate dehydrogenase (ICDH) and malate dehydrogenase activities affecting the ETC and ATP synthesis. NaDOC also induced oxidative stress and increased the superoxide dismutase activity and impaired the mitochondrial biogenesis and functionality. UDCA increased the activities of ICDH and complex II of ETC. The combination of both bile acids conserved the functional activities of Krebs cycle enzymes, ETC components, oxidative phosphorylation, and mitochondrial biogenesis. In conclusion, the inhibitory effect of NaDOC on intestinal Ca2+ absorption is mediated by mitochondrial dysfunction, which is avoided by UDCA. The stimulatory effect of UDCA alone is associated with amelioration of mitochondrial functioning. This knowledge could improve treatment of diseases that affect the intestinal Ca2+ absorption.
Asunto(s)
Colagogos y Coleréticos/farmacología , Ácido Desoxicólico/farmacología , Duodeno/efectos de los fármacos , Mitocondrias/metabolismo , Ácido Ursodesoxicólico/farmacología , Animales , Calcio/farmacocinética , Colagogos y Coleréticos/farmacocinética , Ciclo del Ácido Cítrico/efectos de los fármacos , Ácido Desoxicólico/farmacocinética , Transporte de Electrón , Absorción Intestinal/efectos de los fármacos , Masculino , ATPasas de Translocación de Protón Mitocondriales/metabolismo , Biogénesis de Organelos , Fosforilación Oxidativa/efectos de los fármacos , Estrés Oxidativo , Ratas , Ratas Wistar , Superóxido Dismutasa/metabolismo , Ácido Ursodesoxicólico/farmacocinéticaRESUMEN
The case of a 34-year-old woman with primary biliary cholangitis (PBC) before, during and after pregnancy is described. The use of ursodeoxycholic acid (UDCA) during and after pregnancy is discussed. UDCA has not been approved by the drug regulatory authorities as a pregnancy-safe drug; therefore, the reluctance of clinicians to prescribe UDCA during pregnancy is understandable. This Grand Round aims to provide a detailed analysis of the current evidence, safety data and clinical experience with UDCA (and alternative drugs) during pregnancy and lactation. Based on this analysis, advice for clinicians regarding the use of UDCA during pregnancy and lactation is given.
Asunto(s)
Cirrosis Hepática Biliar/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Ácido Ursodesoxicólico , Adulto , Lactancia Materna/métodos , Colagogos y Coleréticos/administración & dosificación , Colagogos y Coleréticos/efectos adversos , Colagogos y Coleréticos/farmacocinética , Toma de Decisiones Clínicas , Femenino , Humanos , Cirrosis Hepática Biliar/sangre , Cirrosis Hepática Biliar/diagnóstico , Embarazo , Resultado del Tratamiento , Ácido Ursodesoxicólico/administración & dosificación , Ácido Ursodesoxicólico/efectos adversos , Ácido Ursodesoxicólico/farmacocinéticaRESUMEN
Ursodeoxycholic acid (UDCA) is a secondary bile acid component used for treating primary biliary cirrhosis. This study evaluated and compared the pharmacokinetic (PK) profiles of UDCA and its conjugates glyco-UDCA (G-UDCA) and tauro-UDCA (T-UDCA) in healthy elderly subjects and younger adults. In this randomized, open-label, 2-treatment, 1-sequence, and parallel study, subjects received 400 or 800 mg UDCA on day 1, followed by 200 mg UDCA twice daily for 2 weeks. Blood samples were obtained up to 24 hours after the first UDCA dose. Changes in miRNA-122, γ-glutamyl transferase, aspartate aminotransferase, and alanine aminotransferase levels from baseline were assessed to determine the safety and pharmacological effects of UDCA. This study examined the outcomes of 16 elderly subjects and 16 younger adults. Dose-normalized peak concentration of and systemic exposure to UDCA were 2 to 4 times higher, and the corresponding values of G-UDCA and T-UDCA were 1.7 times higher in the elderly subjects than in the younger adults. The subjects in both groups showed multiple peak profiles of UDCA and its conjugates. The miRNA-122 levels and hepatic enzyme test results were within the normal range in the elderly subjects after multiple administration of UDCA. This study is the first to confirm that the PK measurements of UDCA were higher in elderly subjects than in younger adults, which may improve the clinical outcomes of elderly subjects.
Asunto(s)
Colagogos y Coleréticos/farmacocinética , Ácido Ursodesoxicólico/farmacocinética , Adulto , Anciano , Envejecimiento/sangre , Envejecimiento/metabolismo , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Colagogos y Coleréticos/sangre , Humanos , MicroARNs/sangre , Ácido Ursodesoxicólico/sangre , Adulto Joven , gamma-Glutamiltransferasa/sangreRESUMEN
Baicalin is one of the main active ingredients of choleretic traditional Chinese medicine drug Radix Scutellariae. The aim of this study was to explore the pharmacokinetic characteristics of baicalin in rats with 17α-ethynylestradiol (EE)-induced intrahepatic cholestasis (IC) based on its choleretic effects. Firstly, rats were subcutaneously injected with EE solution (5 mg/kg, 0.25 mL/100 g) for 5 consecutive days to construct an IC model. Then the bile excretion rate, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bile acid (TBA) and pathological changes of the liver were detected. Secondly, after successfully modeling, the rats were intragastrically given baicalin solution (200 mg/kg) (n=6). Blood samples were collected from the tail vein at different time points after intragastric administration. The protective effects of low- (50 mg/kg), medium- (100 mg/kg) and high-dose (200 mg/kg) baicalin on the liver in IC rats were evaluated. The content of baicalin in plasma was detected by liquid chromatography-mass spectrometry/mass spectrometry and pharmacokinetics parameters were calculated. Pharmacodynamic results showed that low-, medium- and high-dose baicalin all significantly increased the average excretion rate of bile (P<0.05), and significantly decreased serum levels of ALT, AST and ALP and TBA (P<0.05). Meanwhile, HE staining showed that baicalin significantly relieved EE-induced hepatocyte edema and necrosis. Pharmacokinetic results exhibited that the absorption of baicalin in both IC and normal control rats showed bimodal phenomenon. Cmax, AU(0-t) and AUC(0-∞) of baicalin in IC rats were significantly higher than those of the normal control group (P<0.01). T1/2 of plasma baicalin in the model group was significantly extended to (11.09±1.84) h, with clearance dropping to 61.78% of that of the normal control group (P<0.01). The above results suggested that baicalin had protective effects on the liver of IC rats, accompanied by significantly increased in vivo exposure, delayed in vivo clearance and markedly alterative pharmacokinetic characteristics. This study provides a theoretical basis for further development of baicalin as a feasible drug for treating IC.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacocinética , Colagogos y Coleréticos/farmacocinética , Colestasis Intrahepática/tratamiento farmacológico , Flavonoides/farmacocinética , Animales , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Colagogos y Coleréticos/administración & dosificación , Colagogos y Coleréticos/uso terapéutico , Colestasis Intrahepática/etiología , Etinilestradiol/toxicidad , Flavonoides/administración & dosificación , Flavonoides/uso terapéutico , Masculino , Ratas , Ratas WistarRESUMEN
BACKGROUND: Pruritus (itch) is a symptom commonly experienced by patients with cholestatic liver diseases such as primary biliary cholangitis (PBC, previously referred to as primary biliary cirrhosis). Bile acids (BAs) have been proposed as potential pruritogens in PBC. The ileal bile acid transporter (IBAT) protein expressed in the distal ileum plays a key role in the enterohepatic circulation of BAs. Pharmacological inhibition of IBAT with GSK2330672 may reduce BA levels in the systemic circulation and improve pruritus. METHODS: This clinical study (BAT117213 study) is sponsored by GlaxoSmithKline (GSK) with associated exploratory studies supported by the National Institute for Health Research (NIHR). It is a phase 2a, multi-centre, randomised, double bind, placebo controlled, cross-over trial for PBC patients with pruritus. The primary objective is to investigate the safety and tolerability of repeat doses of GSK2330672, and explore whether GSK2330672 administration for 14 days improves pruritus compared with placebo. The key outcomes include improvement in pruritus scores evaluated on a numerical rating scale and other PBC symptoms in an electronic diary completed twice daily by the patients. The secondary outcomes include the evaluation of the effect of GSK2330672 on total serum bile acid (BA) concentrations, serum markers of BA synthesis and steady-state pharmacokinetics of ursodeoxycholic acid (UDCA). DISCUSSION: BAT117213 study is the first randomised controlled crossover trial of ileal bile acid transporter inhibitor, a novel class of drug to treat pruritus in PBC. The main strengths of the trial are utility of a novel, study specific, electronic symptom diary as patient reported outcome to measure the treatment response objectively and the crossover design that allows estimating the treatment effect in a smaller number of patients. The outcome of this trial will inform the trial design of future development phase of the IBAT inhibitor drug. The trial will also provide opportunity to conduct metabonomic and gut microbiome studies as explorative and mechanistic research in patients with cholestatic pruritus. TRIAL REGISTRATION: EudraCT number: 2012-005531-84, ClinicalTrials.gov Identifier: NCT01899703 , registered on 3(rd) July 2013.
Asunto(s)
Cirrosis Hepática Biliar/complicaciones , Metilaminas/uso terapéutico , Transportadores de Anión Orgánico Sodio-Dependiente/antagonistas & inhibidores , Prurito/tratamiento farmacológico , Simportadores/antagonistas & inhibidores , Tiazepinas/uso terapéutico , Adolescente , Adulto , Anciano , Ácidos y Sales Biliares/sangre , Biomarcadores/sangre , Colagogos y Coleréticos/farmacocinética , Colagogos y Coleréticos/uso terapéutico , Estudios Cruzados , Quimioterapia Combinada , Femenino , Humanos , Masculino , Metilaminas/administración & dosificación , Metilaminas/efectos adversos , Metilaminas/farmacocinética , Persona de Mediana Edad , Transportadores de Anión Orgánico Sodio-Dependiente/uso terapéutico , Prurito/etiología , Simportadores/uso terapéutico , Tiazepinas/administración & dosificación , Tiazepinas/efectos adversos , Tiazepinas/farmacocinética , Ácido Ursodesoxicólico/farmacocinética , Ácido Ursodesoxicólico/uso terapéutico , Adulto JovenRESUMEN
The bile salt export pump (BSEP) is expressed on the canalicular membrane of hepatocytes regulating liver bile salt excretion, and impairment of BSEP function may lead to cholestasis in humans. This study explored drug biliary excretion, as well as serum chemistry, individual bile acid concentrations and liver transporter expressions, in the SAGE Bsep knockout (KO) rat model. It was observed that the Bsep protein in KO rats was decreased to 15% of that in the wild type (WT), as quantified using LC-MS/MS. While the levels of Ntcp and Mrp2 were not significantly altered, Mrp3 expression increased and Oatp1a1 decreased in KO animals. Compared with the WT rats, the KO rats had similar serum chemistry and showed normal liver transaminases. Although the total plasma bile salts and bile flow were not significantly changed in Bsep KO rats, individual bile acids in plasma and liver demonstrated variable changes, indicating the impact of Bsep KO. Following an intravenous dose of deuterium labeled taurocholic acid (D4-TCA, 2 mg/kg), the D4-TCA plasma exposure was higher and bile excretion was delayed by approximately 0.5 h in the KO rats. No differences were observed for the pravastatin plasma concentration-time profile or the biliary excretion after intravenous administration (1 mg/kg). Collectively, the results revealed that these rats have significantly lower Bsep expression, therefore affecting the biliary excretion of endogenous bile acids and Bsep substrates. However, these rats are able to maintain a relatively normal liver function through the remaining Bsep protein and via the regulation of other transporters. Copyright © 2016 John Wiley & Sons, Ltd.
Asunto(s)
Transportadoras de Casetes de Unión a ATP/metabolismo , Bilis/metabolismo , Pravastatina/farmacocinética , Ácido Taurocólico/farmacocinética , Miembro 11 de la Subfamilia B de Transportador de Casetes de Unión al ATP , Transportadoras de Casetes de Unión a ATP/genética , Animales , Anticolesterolemiantes/sangre , Anticolesterolemiantes/farmacocinética , Ácidos y Sales Biliares/metabolismo , Colagogos y Coleréticos/sangre , Colagogos y Coleréticos/farmacocinética , Hígado/metabolismo , Masculino , Pravastatina/sangre , Ratas Sprague-Dawley , Ratas Transgénicas , Ácido Taurocólico/sangreRESUMEN
Hepatic accumulation of bile acids is central to the pathogenesis of cholestatic liver diseases. Endocrine hormone fibroblast growth factor 19 (FGF19) may reduce hepatic bile acid levels through modulation of bile acid synthesis and prevent subsequent liver damage. However, FGF19 has also been implicated in hepatocellular carcinogenesis, and consequently, the potential risk from prolonged exposure to supraphysiological levels of the hormone represents a major hurdle for developing an FGF19-based therapy. We describe a nontumorigenic FGF19 variant, M70, which regulates bile acid metabolism and, through inhibition of bile acid synthesis and reduction of excess hepatic bile acid accumulation, protects mice from liver injury induced by either extrahepatic or intrahepatic cholestasis. Administration of M70 in healthy human volunteers potently reduces serum levels of 7α-hydroxy-4-cholesten-3-one, a surrogate marker for the hepatic activity of cholesterol 7α-hydroxylase (CYP7A1), the enzyme responsible for catalyzing the first and rate-limiting step in the classical bile acid synthetic pathway. This study provides direct evidence for the regulation of bile acid metabolism by FGF19 pathway in humans. On the basis of these results, the development of nontumorigenic FGF19 variants capable of modulating CYP7A1 expression represents an effective approach for the prevention and treatment of cholestatic liver diseases as well as potentially for other disorders associated with bile acid dysregulation.
Asunto(s)
Ácidos y Sales Biliares/metabolismo , Colagogos y Coleréticos/uso terapéutico , Colestasis Extrahepática/tratamiento farmacológico , Colestasis Intrahepática/tratamiento farmacológico , Factores de Crecimiento de Fibroblastos/uso terapéutico , Hígado/efectos de los fármacos , Adulto , Animales , Australia , Biomarcadores/sangre , Colagogos y Coleréticos/efectos adversos , Colagogos y Coleréticos/farmacocinética , Colestasis Extrahepática/genética , Colestasis Extrahepática/metabolismo , Colestasis Extrahepática/patología , Colestasis Intrahepática/genética , Colestasis Intrahepática/metabolismo , Colestasis Intrahepática/patología , Colestenonas/sangre , Colesterol 7-alfa-Hidroxilasa/genética , Colesterol 7-alfa-Hidroxilasa/metabolismo , Modelos Animales de Enfermedad , Método Doble Ciego , Regulación hacia Abajo , Factores de Crecimiento de Fibroblastos/efectos adversos , Factores de Crecimiento de Fibroblastos/biosíntesis , Factores de Crecimiento de Fibroblastos/genética , Factores de Crecimiento de Fibroblastos/farmacocinética , Regulación Enzimológica de la Expresión Génica , Técnicas de Transferencia de Gen , Variación Genética , Voluntarios Sanos , Humanos , Hígado/metabolismo , Hígado/patología , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Masculino , Ratones , Persona de Mediana Edad , ARN Mensajero/metabolismo , Proteínas Recombinantes/uso terapéutico , Medición de Riesgo , Adulto JovenRESUMEN
The objective of this study was to prepare and characterize ursodeoxycholic acid submicron emulsion (UA-SME) loaded with ursodeoxycholic acid phytosomes (UA-PS) and optimize the process variables. A screening experiment with response surface methodology with Box-Behnken design (BBD) was used to optimize the process parameters of UA-SME. The blood concentrations of UA after oral administration of UA-SME and UA coarse drug were assayed. The optimum process conditions were finally obtained by using a desirability function. It was found that stirring velocity, homogenization pressure and homogenization cycles were the most important variables that affected the particles size, polydispersity index and entrapment efficiency of UA-SME. Results showed that the optimum stirring velocity, homogenization pressure and cycles were 16 000 rpm, 60 MPa and 10 cycles, respectively. The mean diameter, polydispersity index and entrapment efficiency of UA-SME were 251.9 nm, 0.241 and 74.36%, respectively. Pharmacokinetic parameters of UA and UA-SME in rats were Tmax 2.215 and 1.489 h, Cmax 0.0364 and 0.1562 µg/mL, AUC0-∞ 3.682 and 13.756 µg h/mL, respectively. The bioavailability of UA in rats was significantly different (p < 0.05) after oral administration of UA-SME compared to those of UA coarse drug. This was due to improvement of the hydrophilicity and lipophilic property of UA-SME.
Asunto(s)
Colagogos y Coleréticos/administración & dosificación , Emulsiones/química , Fosfolípidos/química , Ácido Ursodesoxicólico/administración & dosificación , Administración Oral , Animales , Disponibilidad Biológica , Colagogos y Coleréticos/química , Colagogos y Coleréticos/farmacocinética , Masculino , Tamaño de la Partícula , Ratas , Ratas Wistar , Ácido Ursodesoxicólico/química , Ácido Ursodesoxicólico/farmacocinéticaRESUMEN
BACKGROUND: Rifampicin (RIFA) and ursodeoxycholic acid (UDCA) were found to stimulate different but complementary hepatobiliary detoxification pathways in gallstone patients. AIM: To study whether single drug effects are sustained or even enhanced by combination of both drugs and whether possible effects are mediated by circulating fibroblast growth factor 19 (FGF19), which has recently been identified as a master regulator of bile acid biosynthesis. METHODS: 20 patients scheduled for laparoscopic cholecystectomy were randomized to a combination of UDCA (1 g/day during 3 weeks before surgery) and RIFA (600 mg/day during 1 week before surgery), or no treatment. Routine biochemistry, lipids, bile acid synthesis (7α-hydroxy-4-cholesten-3-one, C-4) and FGF19 were measured in serum. Bile acids were analyzed in serum and bile. A wedge liver biopsy was taken for determination of expression of hepatobiliary ABC transporters on mRNA and protein levels and of enzymes and regulatory transcription factors involved in the metabolism of biliary compounds on mRNA levels. RESULTS: Combination treatment with both RIFA and UDCA significantly stimulated bile acid and bilirubin detoxification (CYP3A4, p < 0.001), conjugation (UGT1A1, p < 0.001) and elimination (MRP2, p < 0.05), as well as bile acid synthesis (p < 0.05), as compared to untreated controls. Notably, serum FGF19 levels in RIFA- and UDCA-treated patients did not differ from controls. CONCLUSION: Combined treatment with RIFA and UDCA preserves the previously observed beneficial effects of single treatment with RIFA, including stimulation of bile acid synthesis. Most notably, the latter effect in humans is not mediated by FGF19.
Asunto(s)
Colelitiasis/tratamiento farmacológico , Rifampin/farmacocinética , Ácido Ursodesoxicólico/farmacocinética , Adulto , Anciano , Bilis/química , Ácidos y Sales Biliares/análisis , Ácidos y Sales Biliares/biosíntesis , Transporte Biológico/efectos de los fármacos , Biopsia , Colagogos y Coleréticos/administración & dosificación , Colagogos y Coleréticos/farmacocinética , Colelitiasis/metabolismo , Colelitiasis/patología , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Inhibidores Enzimáticos/administración & dosificación , Inhibidores Enzimáticos/farmacocinética , Femenino , Humanos , Inactivación Metabólica , Hígado/efectos de los fármacos , Hígado/metabolismo , Hígado/patología , Masculino , Persona de Mediana Edad , Rifampin/administración & dosificación , Ácido Ursodesoxicólico/administración & dosificación , Adulto JovenRESUMEN
INTRODUCTION: Type 2 diabetes often involves derangements in lipid levels in addition to insulin resistance and diminishing insulin secretion. Colesevelam hydrochloride, a bile acid sequestrant (BAS), is approved for adjunctive therapy to diet and exercise for glycemic control in type 2 diabetes. In clinical studies in patients with type 2 diabetes, colesevelam, added to existing metformin, sulfonylurea or insulin therapy, reduced hemoglobin A(1c) (HbA(1c)) by a mean of 0.5% and low-density lipoprotein-cholesterol (LDL-C) by 13-17%. AREAS COVERED: Information pertaining to colesevelam and other BAS was collected using a PubMed literature search of journal articles dating from 1960 to present. Additional articles were identified from bibliographies and from abstracts from American Diabetes Association conferences. The authors review the pharmacology of colesevelam as well as clinical efficacy, safety and tolerability data generated from clinical trials. EXPERT OPINION: Colesevelam induces moderate but significant improvements in HbA(1c) and LDL-C. Outcomes data are needed to determine whether or not colesevelam confers long-term protection against micro- and macrovascular complications. Although colesevelam does not induce weight gain, triglyceride levels tend to increase ~ 15%, the implications of which are unknown at this time. The mechanism(s) by which colesevelam improves glycemia are not yet understood but might involve enhanced meal-induced incretin secretion and altered farnesoid X receptor signaling.
Asunto(s)
Alilamina/análogos & derivados , Anticolesterolemiantes/uso terapéutico , Colagogos y Coleréticos/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Alilamina/efectos adversos , Alilamina/farmacocinética , Alilamina/farmacología , Alilamina/uso terapéutico , Anticolesterolemiantes/efectos adversos , Anticolesterolemiantes/farmacología , Glucemia/metabolismo , Colagogos y Coleréticos/efectos adversos , Colagogos y Coleréticos/farmacocinética , Colagogos y Coleréticos/farmacología , LDL-Colesterol/sangre , Clorhidrato de Colesevelam , Terapia Combinada , Diabetes Mellitus Tipo 2/terapia , Angiopatías Diabéticas/prevención & control , Interacciones Farmacológicas , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Triglicéridos/sangreRESUMEN
BACKGROUND & AIMS: Ursodeoxycholic acid (UDCA) exerts anticholestatic, antifibrotic and antiproliferative effects in primary biliary cirrhosis (PBC) via mechanisms not yet fully understood. Its adequate biliary enrichment is considered mandatory for therapeutic efficacy. However, precise determination of biliary enrichment of UDCA is not possible in clinical practice. Therefore, we investigated (i) the relationship between biliary enrichment and plasma pharmacokinetics of UDCA, (ii) the effect of UDCA on plasma and biliary bile acid composition and conjugation patterns, and (iii) on the intestinal detoxification machinery in patients with PBC and healthy controls. METHODS: In 11 PBC patients and 11 matched healthy subjects, cystic bile and duodenal tissue were collected before and after 3 weeks of administration of UDCA (15 mg/kg/day). Extensive pharmacokinetic profiling of bile acids was performed. The effect of UDCA on the intestinal detoxification machinery was studied by quantitative PCR and Western blotting. RESULTS: The relative fraction of UDCA and its conjugates in plasma at trough level[x] correlated with their biliary enrichment[y] (r=0.73, p=0.0001, y=3.65+0.49x). Taurine conjugates of the major hydrophobic bile acid, chenodeoxycholic acid, were more prominent in bile of PBC patients than in that of healthy controls. Biliary bile acid conjugation patterns normalized after treatment with UDCA. UDCA induced duodenal expression of key export pumps, BCRP and P-glycoprotein. CONCLUSIONS: Biliary and trough plasma enrichment of UDCA are closely correlated in PBC and health. Taurine conjugation may represent an adaptive mechanism in PBC against chenodeoxycholic acid-mediated bile duct damage. UDCA may stabilize small intestinal detoxification by upregulation of efflux pumps.
Asunto(s)
Ácidos y Sales Biliares/sangre , Colagogos y Coleréticos/farmacocinética , Cirrosis Hepática Biliar/tratamiento farmacológico , Cirrosis Hepática Biliar/metabolismo , Ácido Ursodesoxicólico/farmacocinética , Adulto , Sistema Biliar/efectos de los fármacos , Sistema Biliar/metabolismo , Proteínas Portadoras/genética , Proteínas Portadoras/metabolismo , Colagogos y Coleréticos/administración & dosificación , Colagogos y Coleréticos/sangre , Colestasis/tratamiento farmacológico , Colestasis/metabolismo , Citocromo P-450 CYP3A/genética , Citocromo P-450 CYP3A/metabolismo , Duodeno/efectos de los fármacos , Duodeno/metabolismo , Femenino , Perfilación de la Expresión Génica , Glicina/sangre , Humanos , Inactivación Metabólica/fisiología , Mucosa Intestinal/metabolismo , Persona de Mediana Edad , Taurina/sangre , Ácido Ursodesoxicólico/administración & dosificación , Ácido Ursodesoxicólico/sangreRESUMEN
The purpose of this work is to investigate the effect of the genipin/hydroxypropyl-ß-cyclodextrin (HP-ß-CD) inclusion complex on the intestinal absorption of genipin and identify its mechanism of action. The phase solubility profile was classified as A(L) type, indicating the formulation of a 1:1 stoichiometry inclusion complex. Fourier transform infrared spectroscopy, Differential scanning calorimetry, X-ray powder diffractometry, and (1)H nuclear magnetic resonance (NMR) and two-dimensional (2D) (1)H rotating-frame Overhauser enhancement (ROESY) NMR spectroscopies further confirmed the formulation of the inclusion complex with superior dissolution properties than the drug alone. The results of single-pass intestinal perfusion showed that the intestinal absorption of genipin was affected by P-glycoprotein (Pgp). The absorption rate and permeability value of the inclusion complex were significantly higher than the free drug, suggesting that its enhancing effect was involved in its solubilizing effect and Pgp inhibitory effect. The mechanisms of HP-ß-CD on Pgp inhibition were demonstrated by restraining the Pgp ATPase activity rather than changing the fluidity of the cell membrane.
Asunto(s)
Absorción Intestinal/efectos de los fármacos , Glicósidos Iridoides/farmacocinética , beta-Ciclodextrinas/farmacología , 2-Hidroxipropil-beta-Ciclodextrina , Miembro 1 de la Subfamilia B de Casetes de Unión a ATP/antagonistas & inhibidores , Animales , Química Farmacéutica , Colagogos y Coleréticos/farmacocinética , Glicósidos Iridoides/química , Iridoides , Espectroscopía de Resonancia Magnética , Masculino , Ratas , Ratas Sprague-Dawley , Solubilidad , Espectroscopía Infrarroja por Transformada de Fourier , beta-Ciclodextrinas/química , beta-Ciclodextrinas/farmacocinéticaRESUMEN
PURPOSE: To investigate possible effects of the SLCO1B1 polymorphism on the pharmacokinetics of ursodeoxycholic acid (UDCA) and its metabolites in healthy volunteers. METHODS: In a crossover study with two phases, 15 healthy volunteers with the SLCO1B1*1A/*1A genotype, seven with the *1B/*1B genotype, and five with the *15/*15 or *5/*15 genotype ingested placebo or a single 150-mg dose of UDCA. Plasma concentrations of bile acids and their biosynthesis marker were determined up to 24 h post-ingestion by liquid chromatography-tandem mass spectrometry. RESULTS: The SLCO1B1 genotype had no significant effect on the pharmacokinetics of UDCA. The geometric mean ratios (95% confidence interval) of UDCA area under the plasma concentration-time curve from 0 to 12 h (AUC(0-12)) in subjects with the SLCO1B1*1B/*1B genotype and in subjects with the SLCO1B1*15/*15 or *5/*15 genotype to the AUC(0-12) in subjects with the SLCO1B1*1A/*1A genotype were 1.07 (0.85, 1.35; P = 0.459) and 0.93 (0.75, 1.15; P = 0.563), respectively. In addition, following either placebo or UDCA administration, the SLCO1B1 polymorphism showed no association with the AUC(0-24) of the glycine and taurine conjugates of UDCA, with endogenous bile acids, or with the incremental AUC(0-24) of a bile acid synthesis marker. Compared with placebo, UDCA ingestion increased the AUC(0-24) of cholic acid, glycochenodeoxycholic acid, glycocholic acid, and glycodeoxycholic acid by 1.5-, 1.1-, 1.2-, and 1.2- fold (P < 0.05), respectively. CONCLUSIONS: Genetic polymorphism in SLCO1B1 does not affect pharmacokinetics of UDCA, suggesting that OATP1B1 is not rate-limiting to the hepatic uptake of therapeutic UDCA. Further studies are required to clarify the mechanisms by which UDCA increases the plasma concentrations of endogenous bile acids.
Asunto(s)
Colagogos y Coleréticos/farmacocinética , Transportadores de Anión Orgánico/genética , Polimorfismo de Nucleótido Simple , Ácido Ursodesoxicólico/farmacocinética , Ácidos y Sales Biliares/biosíntesis , Ácidos y Sales Biliares/sangre , Biomarcadores/sangre , Colagogos y Coleréticos/administración & dosificación , Colagogos y Coleréticos/sangre , Cromatografía Liquida , Estudios Cruzados , Interpretación Estadística de Datos , Femenino , Genotipo , Humanos , Transportador 1 de Anión Orgánico Específico del Hígado , Masculino , Estudios Prospectivos , Espectrometría de Masas en Tándem , Ácido Ursodesoxicólico/administración & dosificación , Ácido Ursodesoxicólico/sangre , Adulto JovenRESUMEN
Liquiritigenin (LQ), an active component of licorice, has an inhibitory effect on LPS-induced inhibitory nitric oxide synthase expression. This study investigated the effects of LQ on choleresis, the expression of hepatic transporters and phase-II enzymes, and fulminant hepatitis. The choleretic effect and the pharmacokinetics of LQ and its glucuronides were monitored in rats. After intravenous administration of LQ, the total area under the plasma concentration-time curve of glucuronyl metabolites was greater than that of LQ in plasma, which accompanied elevations in bile flow rate and biliary excretion of bile acid, glutathione, and bilirubin. The expressions of hepatocellular transporters and phase-II enzymes were assessed by immunoblots, real-time PCR, and immunohistochemistry. In the livers of rats treated with LQ, the protein and mRNA levels of multidrug resistance protein 2 and bile salt export pump were increased in the liver, which was verified by their increased localizations in canalicular membrane. In addition, LQ treatment enhanced the expression levels of major hepatic phase-II enzymes. Consistent with these results, LQ treatments attenuated galactosamine/LPS-induced hepatitis in rats, as supported by decreases in the plasma alanine aminotransferase, liver necrosis, and plasma TNF-alpha. These results demonstrate that LQ has a choleretic effect and the ability to induce transporters and phase-II enzymes in the liver, which may be associated with a hepatoprotective effect against galactosamine/LPS. Our findings may provide insight into understanding the action of LQ and its therapeutic use for liver disease.
Asunto(s)
Bilis/metabolismo , Proteínas Portadoras/efectos de los fármacos , Colagogos y Coleréticos/farmacología , Enzimas/metabolismo , Flavanonas/farmacología , Hígado/efectos de los fármacos , Subfamilia B de Transportador de Casetes de Unión a ATP/efectos de los fármacos , Subfamilia B de Transportador de Casetes de Unión a ATP/metabolismo , Miembro 11 de la Subfamilia B de Transportador de Casetes de Unión al ATP , Transportadoras de Casetes de Unión a ATP/efectos de los fármacos , Transportadoras de Casetes de Unión a ATP/metabolismo , Animales , Biotransformación , Proteínas Portadoras/genética , Proteínas Portadoras/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Colagogos y Coleréticos/administración & dosificación , Colagogos y Coleréticos/farmacocinética , Modelos Animales de Enfermedad , Enzimas/genética , Epóxido Hidrolasas/metabolismo , Flavanonas/administración & dosificación , Flavanonas/farmacocinética , Galactosamina , Glucurónidos/metabolismo , Glucuronosiltransferasa/metabolismo , Glutatión Transferasa/metabolismo , Hemo Oxigenasa (Desciclizante)/metabolismo , Infusiones Intravenosas , Isoenzimas/metabolismo , Lipopolisacáridos , Hígado/enzimología , Masculino , Fase II de la Desintoxicación Metabólica , ARN Mensajero/metabolismo , Ratas , Ratas Sprague-Dawley , Factores de Tiempo , Regulación hacia Arriba , Miembro 4 de la Subfamilia B de Casete de Unión a ATPRESUMEN
The aim of this study was to prepare ursodeoxycholic acid-phospholipid complex (UDCA-PLC) to enhance oral bioavailability of UDCA, and the physicochemical properties of the complex were studied. Compared with those of UDCA tablet after oral administration in rats, the main pharmacokinetic characteristics and bioavailability of UDCA-PLC orally administered were evaluated. Tetrahydrofuran was used as a reaction medium, UDCA and phospholipids were resolved into the medium, and UDCA-PLC was formed after the organic solvent was evaporated off under vacuum condition. The physicochemical properties of the complex were evaluated using scanning electron microscopy (SEM), transmission electron microscopy (TEM), differential scanning calorimetry (DSC), X-ray diffraction, particle size distribution analysis, and n-octanol/water partition coefficient (P) study. The blood concentrations of UDCA-PLC and UDCA tablet at different time points after oral administration in rats were assayed by high-performance liquid chromatography (HPLC) after derivatization. The pharmacokinetic parameters were computed by software program 3p87. The X-ray diffraction and DSC studies showed that UDCA and phospholipids in the UDCA-PLC were combined by noncovalent bond, not forming a new compound, and n-octanol/water partition coefficient (P) of UDCA-PLC was effectively enhanced. The mean serum concentration-time curves of UDCA after oral administration of UDCA-PLC and UDCA tablet in rats were both in accordance with open two-compartment model. Pharmacokinetic parameters of UDCA tablet and the PLC in rats were T(max) 1.9144 and 1.5610 h, C(max) 0.0576 and 0.1346 microg/mL, and AUC(0-infinity) 4.736 and 11.437 microg h/mL, respectively. The bioavailability of UDCA in rats was significantly different (p < .05) compared with those of UDCA tablet after administration. The UDCA-PLC would be more prospective formulation in future.
Asunto(s)
Colagogos y Coleréticos/farmacocinética , Portadores de Fármacos/química , Fosfolípidos/química , Ácido Ursodesoxicólico/farmacocinética , Administración Oral , Animales , Área Bajo la Curva , Disponibilidad Biológica , Rastreo Diferencial de Calorimetría , Química Farmacéutica , Cromatografía Líquida de Alta Presión , Masculino , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Tamaño de la Partícula , Ratas , Ratas Wistar , Comprimidos , Difracción de Rayos XRESUMEN
Geniposide, an iridoid glucoside, is a major constituent in the fruits of Gardenia jasminoides (Gardenia fruits), a popular Chinese herb. Genipin, the aglycone of geniposide, is used to prepare blue colorants in food industry and also a crosslinking reagent for biological tissue fixation. In this study, we investigated the metabolism and pharmacokinetics of genipin and geniposide in rats. Blood samples were withdrawn via cardiopuncture and the plasma samples were assayed by HPLC method before and after hydrolysis with sulfatase and beta-glucuronidase. The results indicated that after oral administration of genipin or Gardenia fruit decoction, genipin sulfate was a major metabolite in the bloodstream, whereas the parent forms of genipin and geniposide were not detected. Importantly, oral administration of 200mg/kg of genipin resulted in a mortality of 78% (7/9) in rats.
Asunto(s)
Colagogos y Coleréticos/metabolismo , Colagogos y Coleréticos/farmacocinética , Iridoides/metabolismo , Iridoides/farmacocinética , Animales , Calibración , Fenómenos Químicos , Química Física , Colagogos y Coleréticos/toxicidad , Cromatografía Líquida de Alta Presión , Interpretación Estadística de Datos , Gardenia/química , Hidrólisis , Inyecciones Intravenosas , Glicósidos Iridoides , Iridoides/toxicidad , Masculino , Extractos Vegetales/química , Extractos Vegetales/farmacocinética , Ratas , Ratas Sprague-Dawley , Reproducibilidad de los ResultadosRESUMEN
Ursodeoxycholic acid (UDCA), previously used for cholesterol gallstone dissolution, is currently considered the first choice therapy for many forms of cholestatic syndromes. Many mechanisms and sites of action have been proposed for UDCA, but definitive data are still missing regarding the key points of its efficacy and optimal dosage in order to achieve a sustained clinical effect. Among the suggested mechanisms of action of UDCA, changes in bile acid pool composition, hepatocyte membrane protection, immunomodulatory effects and bicarbonate-rich hypercholeresis have been extensively studied. However, recent evidence indicate that UDCA is a potent intracellular signalling agent that counterbalances impaired biliary secretion, inhibits hepatocyte apoptosis and protects injured cholangiocytes against toxic effects of bile acids. It is clear that the relative contribution of these mechanisms to the anticholestatic action of UDCA depends on the type and stage of the liver injury. Available clinical evidence suggest that UDCA treatment has to be initiated as early as possible and that higher doses could be more efficacious in inducing and maintaining clinical remission of cholestatic diseases. The future availability of UDCA derivatives will possibly enhance the chances to effectively treat chronic cholestatic diseases.
Asunto(s)
Colagogos y Coleréticos/uso terapéutico , Colestasis/tratamiento farmacológico , Hepatopatías/tratamiento farmacológico , Ácido Ursodesoxicólico/uso terapéutico , Animales , Ácidos y Sales Biliares/metabolismo , Transporte Biológico Activo/efectos de los fármacos , Niño , Colagogos y Coleréticos/farmacocinética , Colagogos y Coleréticos/farmacología , Colestasis/genética , Colestasis/fisiopatología , Femenino , Humanos , Embarazo , Ácido Ursodesoxicólico/farmacocinética , Ácido Ursodesoxicólico/farmacologíaRESUMEN
Polyethylene glycol (PEG) hydrogels show promise as scaffolds for growth factor delivery to enhance cartilage repair. However, methods to control growth factor release in vivo are needed. We have recently shown that in vitro polymer degradation and in vitro growth factor release kinetics can be altered using PEG crosslinked with different concentrations of genipin. However, the degradation and behavior of PEG-genipin in vivo within the cartilage repair site are unknown. This study was conducted to test the hypotheses that the degradation of PEG-genipin can be altered in vivo within osteochondral defects by changing the concentration of genipin, and that PEG-genipin is biocompatible within the mammalian diarthrodial environment. PEG-genipin cylindrical polymers crosslinked using 8mM, 17.6 mM, or 35.2 mM of genipin were implanted into osteochondral defects made in the trochlea of 24 male Sprague- Dawley rats (48 knees). Rats were sacrificed at 5 weeks and gross, cross-sectional, and histologic assessments were performed. Altering the genipin concentration changed the in vivo degradation properties of the hydrogel ( p < 0.01). Consistent with in vitro findings, polymer degradation was inversely related to the concentration of genipin. Near-complete degradation was seen at 8 mM, intermediate degradation at 17.6 mM, and minimal degradation at 35.2 mM. The results of this study show the degradation of PEGgenipin can be altered in vivo within osteochondral defects by changing the concentration of genipin and that PEG-genipin is biocompatible within osteochondral defects. This new in vivo data support potential use of PEG-genipin polymer as an innovative delivery system to control in vivo release of growth factors for improving articular cartilage repair.