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Bui TV, Prot-Bertoye C, Ayari H, Baron S, Bertocchio JP, Bureau C, Davis P, Blanchard A, Houillier P, Prie D, Lillo-Le Louet A, Courbebaisse M. Safety of Inulin and Sinistrin: Combining Several Sources for Pharmacovigilance Purposes. Front Pharmacol 2021; 12:725417. [PMID: 34867328 PMCID: PMC8637630 DOI: 10.3389/fphar.2021.725417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Inulin and its analog sinistrin are fructose polymers used in the food and pharmaceutical industries. In 2018, The French National Agency for the Safety of Medicines and Health Products (ANSM) decided to withdraw products containing sinistrin and inulin due to several reports of serious hypersensitivity reactions, including a fatal outcome. Objective: To assess the safety of inulin and sinistrin use in France. Methods: We searched multiple sources to identify adverse reactions (ARs) to inulin or sinistrin: first, classical pharmacovigilance databases including the French Pharmacovigilance (FPVD) and the WHO Database (VigiBase); second, data from a clinical trial, MultiGFR; third, data regarding current use in an hospital. All potential ARs to inulin or sinistrin were analyzed with a focus on hypersensitivity reactions and relationships to batches of sinistrin. Results: From 1991 to 2018, 134 ARs to inulin or sinistrin were registered in the FPVD or VigiBase. Sixty-three cases (47%) were classified as serious, and 129 cases (96%) were hypersensitivity reactions. We found an association between a batch of sinistrin and the occurrence of hypersensitivity reactions. During the MultiGFR clinical trial, 7 patients (7/163 participants) had an Adverse reaction; of these, 4 were hypersensitivity reactions including one case of grade 4 anaphylactic shock. In the hospital, no ARs were observed. In the literature, ARs to inulin and sinistrin are very rarely reported and mostly benign. Conclusion: Most ARs to inulin and sinistrin are hypersensitivity reactions that appear to be associated with sinistrin batches.
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Affiliation(s)
- T-V Bui
- Assistance Publique-Hôpitaux de Paris, Centre Régional de Pharmacovigilance, Hôpital Européen Georges Pompidou, Paris, France
| | - C Prot-Bertoye
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CNRS ERL 8228-Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - H Ayari
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - S Baron
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CNRS ERL 8228-Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - J-P Bertocchio
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - C Bureau
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France
| | - P Davis
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France
| | - A Blanchard
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CNRS ERL 8228-Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France.,Assistance Publique Hôpitaux des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Centre d'investigation Clinique, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - P Houillier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CNRS ERL 8228-Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France
| | - D Prie
- Faculté de Médecine, Université de Paris, Paris, France.,Service des Explorations Fonctionnelles, Hôpital Necker, APHP Centre-Université de Paris, Paris, France.,INEM Unité Inserm U1151, Paris, France
| | - A Lillo-Le Louet
- Assistance Publique-Hôpitaux de Paris, Centre Régional de Pharmacovigilance, Hôpital Européen Georges Pompidou, Paris, France
| | - M Courbebaisse
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France.,Faculté de Médecine, Université de Paris, Paris, France.,INEM Unité Inserm U1151, Paris, France
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Sangla F, Marti PE, Verissimo T, Pugin J, de Seigneux S, Legouis D. Measured and Estimated Glomerular Filtration Rate in the ICU: A Prospective Study. Crit Care Med 2021; 48:e1232-e1241. [PMID: 33044285 DOI: 10.1097/ccm.0000000000004650] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare estimated glomerular filtration rate using classical static and kinetic equations with measured glomerular filtration rate assessed by plasma iohexol clearance in a mixed population of critical care patients. PATIENTS Unselected patients older than 18 and admitted to a general ICU. DESIGN Interventional prospective single center study. INTERVENTION Measurement of glomerular filtration rate by the plasma clearance of an IV single dose of iohexol and estimation of glomerular filtration rate with creatinine or cystatin C-based standard and kinetic equations as well as urinary creatinine clearance. MEASUREMENTS AND MAIN RESULTS Sixty-three patients were included with a median age of 66 years old. The median measured glomerular filtration rate was 51 mL/min/1.73 m (interquartile range, 19-85 mL/min/1.73 m). All used equations displayed significant biases, high errors, and poor accuracy when compared with measured glomerular filtration rate, overestimating renal function. The highest accuracy and lowest error were observed with cystatin C-based chronic kidney disease epidemiology collaboration equations. Both modification of diet in renal disease and Cockcroft-Gault equations displayed the lowest performance. Kinetic models did not improve performances, except in patients with unstable creatinine levels. Creatinine- but not cystatin C-based estimations largely derived over ICU stay, which appeared more related to sarcopenia than fluid balance. Finally, estimated glomerular filtration rate misclassified patients according to classical glomerular filtration rate categories in approximately half of the studied cases. CONCLUSIONS All known estimated glomerular filtration rate equations displayed high biases and unacceptable errors when compared with measured glomerular filtration rate in a mixed ICU population, with the lowest performance related to creatinine-based equations compared with cystatin C. In the ICU, we advocate for caution when using creatinine based estimated glomerular filtration rate equations. Drifting of serum creatinine levels over time should also be taken into consideration when assessing renal function in the ICU.
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Affiliation(s)
- Fréderic Sangla
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Pierre Emmanuel Marti
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Thomas Verissimo
- Laboratory of Nephrology, Department of Medicine and Cell Physiology, University hospital and University of Geneva, Geneva, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Sophie de Seigneux
- Laboratory of Nephrology, Department of Medicine and Cell Physiology, University hospital and University of Geneva, Geneva, Switzerland.,Service of Nephrology, Department of Internal Medicine Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - David Legouis
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland.,Laboratory of Nephrology, Department of Medicine and Cell Physiology, University hospital and University of Geneva, Geneva, Switzerland
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Yan MR, Welch R, Rush EC, Xiang X, Wang X. A Sustainable Wholesome Foodstuff; Health Effects and Potential Dietotherapy Applications of Yacon. Nutrients 2019; 11:nu11112632. [PMID: 31684122 PMCID: PMC6893727 DOI: 10.3390/nu11112632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/16/2022] Open
Abstract
A sustainable food supply is an ever-growing public and planetary health concern influenced by food culture, food practices, and dietary patterns. Globally, the consumption of plant foods that offer physiological and biochemical benefits is increasing. In recent years, products made from yacon (Smallanthus sonchifolius) tubers and leaves, e.g., in the form of syrup, powder, and herbal tea, have steadily emerged with scientific evidence to validate their possible health claims. Yacon was introduced to New Zealand in 1966, and its products can now be produced on a commercial scale. This paper reviews literature published mainly in the last 10 years concerning the health-related properties of yacon as a wholesome foodstuff and its bioactive components, e.g., fructooligosaccharides. Literature was sourced from Web of Science, PubMed, EBSCO Health, and Google Scholar up to June 2019. The potential markets for yacon in the field of food technology and new dietotherapy applications are discussed. Furthermore, the unique features of New Zealand-produced yacon syrup are introduced as a case study. The paper explores the scientific foundation in response to the growing public interest in why and how to use yacon.
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Affiliation(s)
- Mary R Yan
- AUT Food Network, Auckland University of Technology, Auckland 1010, New Zealand.
- Community and Social Sciences, Unitec Institute of Technology, Auckland 1025, New Zealand.
| | - Robert Welch
- Yacon New Zealand Ltd., Auckland 1051, New Zealand.
| | - Elaine C Rush
- AUT Food Network, Auckland University of Technology, Auckland 1010, New Zealand.
| | - Xuesong Xiang
- National Institute of Nutrition and Health, China CDC, Beijing 100050, China.
| | - Xin Wang
- Plant Protection and Microbiology, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China.
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