Effect of benfluorex on insulin secretion and insulin action in streptozotocin-diabetic rats

Angiogenin-loaded fibrin/bone powder composite scaffold for vascularized bone regeneration

Background

Angiogenin (ANG) is a potent stimulator of angiogenesis. The aim of this study was to fabricate an ANG-loaded scaffold and to evaluate its angiogenic and osteogenic effects. In this study, we fabricated an ANG-loaded scaffold using bovine bone powder and fibrin glue. We then evaluated the structural, morphological, and mechanical properties of the scaffold and the in vitro release profile of ANG. Cell proliferation, viability, and adhesion were evaluated using endothelial cells in vitro, and angiogenesis and new bone formation were evaluated using a rabbit calvarial defect model in vivo.

Results

Micro-computed tomography imaging showed that the bone powder was uniformly distributed in the scaffold, and scanning electron microscopy showed that the bone powder was bridged by polymerized fibrin. The porosity and compressive strength of the scaffolds were ~60 % and ~0.9 MPa, respectively, and were not significantly altered by ANG loading. In vitro, at 7 days, approximately 0.4 μg and 1.3 μg of the ANG were released from the FB/ANG 0.5 and FB/ANG 2.0, respectively and sustained slow release was observed until 25 days. The released ANG stimulated cell proliferation and adherence and was not cytotoxic. Furthermore, in vivo implantation resulted in enhanced angiogenesis, and new bone formation depended on the amount of loaded ANG.

Conclusions

These studies demonstrate that a fibrin and bone powder scaffold loaded with ANG might be useful to promote bone regeneration by enhanced angiogenesis.

Therapeutic effect of benfluorex in type II diabetic patients on diet regimen alone

A randomized double-blind study of benfluorex (150 mg x 3 daily) versus placebo was conducted over 3 months in 32 type II diabetic patients (24 men and 8 women, aged 52 +/- 8.4 years) with mild stable obesity [body-mass index (BMI) 27 +/- 1.6 kg/ m2], moderate fasting hyperglycemia (fasting blood glucose 9 +/- 0.5 mmol/L, HbA1c 6.7 +/- 0.9%) and moderate hyperinsulinemia (18.6 +/- 3.0 microU/mL) when on treatment with diet alone. After a 1-month placebo run-in period, subjects were randomized to benfluorex or placebo three tablets daily. Inclusion parameters and end-of-study measures were body weight, BMI, fasting blood glucose, glycemic profile, HbA1c, fasting insulinemia, basal and stimulated C-peptide, and an insulin tolerance test (0.1 U/kg). The groups were homogeneous at baseline, except for glycemic profile (higher postprandial glycemia in the group randomized to benfluorex). At the end of the study, the groups did not differ in body weight or BMI; however, HbA1c decreased more with benfluorex (6.0 +/- 1.0% versus 6.8 +/- 0.9%, p = 0.024), as did the mean glycemic profile (7.8 +/- 1.4 versus 8.5 +/- 1.7 mmol/L, p < 0.001), including a particular decrease in postprandial glycemia. The decreases in fasting blood glucose and insulinemia appeared larger with benfluorex (7.7 +/- 1.3 versus 8.4 +/- 1.6 mmol/L and 13.5 +/- 4.5 versus 16.1 +/- 5.1 microU/mL, respectively), but were not statistically significant. The increase in the insulin sensitivity index (Kitt) was greater with benfluorex (+0.54 +/- 1.4 versus +0.25 +/- 1.3%/mn), but the difference was not statistically significant. The same was observed for the stimulated C-peptide. In type II diabetics with mild obesity and hyperglycemia previously managed with diet alone, benfluorex has significant long-term effect on HbA1c and mean daily blood glucose, and tends to lower insulinemia.

Therapeutic benefit of benfluorex in type II diabetic patients treated with sulfonylureas

The objective of this study was to evaluate the effect of benfluorex in type II diabetic patients already treated with sulfonylureas (SU) in a randomized placebo-controlled trial. After a 4-week placebo run-in, 68 patients (49 men and 19 women; age range 40-70 years; known duration of diabetes 0.5-19 years) were randomized to double-blind 12-week treatment with benfluorex (B) or placebo (P). Primary end points were HbA1c and fasting blood glucose (FBG). Secondary end points were glucose tolerance (meal test over 120 min), plasma insulin, C-peptide, and lipid profile. Results were analyzed using both intention-to-treat analysis (ITT) in patients completing at least one treatment visit and per protocol analysis in those completing the whole study. There were no baseline differences between the two groups in any study parameter. Fifty-eight patients completed the study (28 B, 30 P), and 66 patients (33 B, 33 P) were eligible for ITT analysis. Over the 12-week treatment period, FBG decreased by 14.9% in the B group (-1.39 mmol/L, p < 0.001), and 3.2% in the P group (-0.28 mmol/L, NS) according to the ITT analysis and by 17.4% (p < 0.001) and 3.8% (NS), respectively, in the per protocol analysis. The difference in FBG outcome between the two groups was significant (p = 0.009 and p = 0.004, respectively). In patients completing the study, mean HbA1c decreased in the B group (-0.66%, p = 0.005) and remained stable in the P group (+0.14%, NS). HbA1c outcome differed between the two groups (p = 0.007). The decrease in AUCglucose was greater in the B group than in the P group (-210 +/- 220 versus -60 +/- 270 mmol/L x 120 min, p = 0.026). Plasma insulin and C-peptide changes did not differ between the two groups. Low-density lipoprotein (LDL) cholesterol decreased in B patients and was stable in P patients (-0.43 versus -0.05 mmol/L, p = 0.026). Of the 68 randomized patients, six on B and four on P reported at least one adverse event, causing dropout in five and two patients, respectively. In conclusion, benfluorex is an effective agent for combination therapy in type II diabetic patients poorly controlled on SUs alone.