Mechanisms responsible for the inhibitory effects of benfluorex on hepatic intermediary metabolism

Assessing Drug-Induced Mitochondrial Toxicity in Cardiomyocytes: Implications for Preclinical Cardiac Safety Evaluation

Drug-induced cardiotoxicity not only leads to the attrition of drugs during development, but also contributes to the high morbidity and mortality rates of cardiovascular diseases. Comprehensive testing for proarrhythmic risks of drugs has been applied in preclinical cardiac safety assessment for over 15 years. However, other mechanisms of cardiac toxicity have not received such attention. Of them, mitochondrial impairment is a common form of cardiotoxicity and is known to account for over half of cardiovascular adverse-event-related black box warnings imposed by the U.S. Food and Drug Administration. Although it has been studied in great depth, mitochondrial toxicity assessment has not yet been incorporated into routine safety tests for cardiotoxicity at the preclinical stage. This review discusses the main characteristics of mitochondria in cardiomyocytes, drug-induced mitochondrial toxicities, and high-throughput screening strategies for cardiomyocytes, as well as their proposed integration into preclinical safety pharmacology. We emphasize the advantages of using adult human primary cardiomyocytes for the evaluation of mitochondrial morphology and function, and the need for a novel cardiac safety testing platform integrating mitochondrial toxicity and proarrhythmic risk assessments in cardiac safety evaluation.

Effects of benfluorex on fatty acid and glucose metabolism in isolated rat hepatocytes: from metabolic fluxes to gene expression

The effects of benfluorex and two of its metabolites (S 422-1 and S 1475-1) on fatty acid and glucose metabolic fluxes and specific gene expression were studied in hepatocytes isolated from 24-h fasted rats. Both benfluorex and S 422-1 (0.1 or 1 mmol/l) reduced beta-oxidation rates and ketogenesis, whereas S 1475-1 had no effect. At the same concentration, benfluorex and S 422-1 were more efficient in reducing gluconeogenesis from lactate/pyruvate than S 1475-1. Benfluorex inhibited gluconeogenesis at the level of pyruvate carboxylase (45% fall in acetyl-CoA concentration) and of glyceraldehyde-3-phosphate dehydrogenase (decrease in ATP/ADP and NAD(+)/NADH ratios). Accordingly, neither benfluorex nor S 422-1 inhibited gluconeogenesis from dihydroxyacetone, but both stimulated gluconeogenesis from glycerol. In hepatocytes cultured in the presence of benfluorex or S 422-1 (10 or 100 micromol/l), the expression of genes encoding enzymes of fatty acid oxidation (carnitine palmitoyltransferase [CPT] I), ketogenesis (hydroxymethylglutaryl-CoA synthase), and gluconeogenesis (glucose-6-phosphatase, PEPCK) was decreased, whereas mRNAs encoding glucokinase and pyruvate kinase were increased. By contrast, Glut-2, acyl-CoA synthetase, and CPT II gene expression was not affected by benfluorex or S 422-1. In conclusion, this work suggests that benfluorex mainly via S 422-1 reduces gluconeogenesis by affecting gene expression and metabolic status of hepatocytes.

Addition of benfluorex to biguanide improves glycemic control in obese non-insulin-dependent diabetes: a double-blind study versus placebo

The oral antidiabetic benfluorex lowers insulin resistance in liver and muscle without stimulating insulin secretion; it is more effective than a biguanide in lowering insulin and triglyceride levels and does not elevate lactate. This double-blind multicenter community study compared the addition of benfluorex versus placebo to diet plus metformin in 127 uncontrolled obese type II diabetics. After a 2-month run-in on diet plus metformin, overall mean glucose was 7.7 mmol/L or greater (fasting) and/or 11 mmol/L or greater (2 h after 75-g oral glucose), with 20% or greater excess body weight [body-mass index (women/men): > or = 26.9/> or = 27.2 kg/m2). Patients were then randomized to adjuvant benflouorex (n = 63; 150 mg t.i.d.) or placebo (n = 64) for 90 days, with centralized biochemical monitoring. On benfluorex, glucose decreased from day 0 to day 90 (fasting: 8.99+/-2.76 to 7.81+/-2.32 mmol/L, p = 0.002; 2 h post-load: 16.56+/-4.49 to 15.09+/-5.09 mmol/L, p = 0.029) versus increases on placebo (intergroup p = 0.003 and p = 0.001, respectively). HbA decreased on benfluorex (7.47+/-1.44 to 7.12+/-1.13%; p = 0.013) versus no change on placebo. Basal and stimulated insulin and C peptide did not change in either group. Body weight remained similar in both groups. Tolerability was good in both groups, with no increase in hypoglycemia on benfluorex. Adjuvant behfluorex improves glycemic control in obese type II diabetics uncontrolled by diet plus metformin. The combination is safe, well-tolerated and suitable for introduction into routine practice.

Benfluorex improves muscle insulin responsiveness in middle-aged rats previously subjected to long-term high-fat feeding

It has been reported that benfluorex ameliorates the insulin resistance induced by high-fat feeding when its administration is initiated at the same time as the change in diet. Here we have examined whether benfluorex reverses insulin resistance when this is established in middle-aged rats chronically maintained on a high-fat diet. Untreated 12-month-old rats that had been subjected to a high-fat diet for the last 6 months showed markedly lower insulin-induced stimulation of 2-deoxyglucose uptake by strips of soleus muscle and a reduced expression of GLUT4 glucose carriers in skeletal muscle. However, animals subjected to the same protocol but treated with benfluorex during the last month of high-fat feeding showed marked improvement in insulin-stimulated glucose transport by soleus muscle. Benfluorex treatment caused a substantial increase in the content of GLUT4 protein in white muscle; however, GLUT4 levels in red muscle remained low. Our results indicate: (i) that benfluorex treatment in middle-aged rats reverses the insulin resistance induced by high-fat feeding in soleus muscle; (ii) benfluorex is active even when it is administered once the insulin-resistant state is already established; (iii) reversion of muscle insulin resistance by benfluorex can occur independently of modifications in GLUT4 protein expression.

Benfluorex, a hypotriglyceridemic drug, reduces lipid peroxidation and alleviates adverse metabolic complications of copper deficiency

The pathologies associated with copper deficiency in rats fed fructose may be induced, in part, by hypertriglyceridemia and lipid peroxidation. Reducing triacylglycerol levels in plasma may result in lowering lipid peroxidation, which in turn could ameliorate metabolic effects resulting from the combination of fructose feeding and copper deficiency. Benfluorex, a hypolipidemic factor able to reduce hypertriglyceridemia, was administered to weanling male rats fed either copper-deficient (0.6 microgram Cu/g) or adequate (6.0 micrograms Cu/g) diets containing fructose as the sole dietary carbohydrate. In copper-deficient rats, benfluorex (50 micrograms.kg-1.d-1) reduced plasma triacylglycerols from 45 to 31 mg/dL, reduced lipid peroxidation by approximately 50%, and prevented the enlargements of heart and liver size and the atrophy of the pancreas, and ameliorated anemia. It is suggested that lipid peroxidation associated with hypertriglyceridemia may be responsible for the pathologies induced by the combination of fructose consumption and copper deficiency.

Evidence for posttranscriptional regulation of GLUT4 expression in muscle and adipose tissue from streptozotocin-induced diabetic and benfluorex-treated rats

In this study we explored the expression of GLUT4 glucose carriers in muscle and adipose tissues from streptozotocin-induced diabetic and benfluorex-treated rats. In nondiabetic rats, benfluorex treatment decreased GLUT4 protein content in muscle and brown adipose tissue, with no change in GLUT4 mRNA. This effect occurred in the presence of normal circulating levels of insulin and glucose. Seventeen days after streptozotocin injection, diabetic rats showed a decreased GLUT4 protein content in adipose tissues and in both red and white skeletal muscle. Diabetic rats showed decreased GLUT4 mRNA levels in white and brown adipose tissue, whereas messenger concentrations remained unaltered in red and white fibers of skeletal muscle. The interaction of benfluorex and diabetes on GLUT4 protein expression showed a tissue-specific pattern. Benfluorex treatment to some extent prevented the decrease in GLUT4 protein in white and brown adipose tissue and in white muscle associated with diabetes. In contrast, diabetes and benfluorex caused an additive decrease in GLUT4 expression in red skeletal muscle. The effects of benfluorex on GLUT4 content in tissues from diabetic rats occurred in the absence of alterations in GLUT4 mRNA levels, suggesting a modification of translational or posttranslational steps. Benfluorex did not ameliorate the hyperglycemia of diabetic rats. Our results indicate that red and white skeletal muscle respond to diabetes and benfluorex in a heterogeneous manner, which suggests the existence of differences in the mechanisms that regulate GLUT4 expression. Furthermore, our data indicate that GLUT4 expression in muscle and adipose tissue can be regulated by modification of translational or posttranslational steps.

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.

Research prospects with benfluorex

The recent recognition that insulin resistance is associated with a number of risk factors for atherosclerotic cardiovascular disease has increased the interest in agents that are able to improve insulin sensitivity. The capacity of benfluorex (Médiator) to enhance insulin action has led to much speculation regarding its mechanism of action. Chronic benfluorex treatment, in a variety of genetic and dietary animal models of diabetes and insulin resistance, has been shown to diminish, circulating insulin levels and to decrease blood glucose, triglycerides, and cholesterol concentrations. From these studies, it is possible to postulate a multifactorial mode of action of this drug that involves three independent but interactive processes: (1) a direct effect on insulin target tissues, mediated by mechanisms distal to the binding of insulin to its receptor, (2) modulation of the glucoregulatory hormone balance, including a diminution in both adrenal and sympathetic tone, leading to improved hepatic sensitivity to insulin, and (3) reduced hepatic and muscle lipid availability, leading to improved glucose utilization in skeletal muscle. The multiplicity of the neuroendocrine and biochemical effects of benfluorex cannot be explained by a single cellular or molecular action. It has been suggested that insulin sensitizers may act on key molecules involved in the sequence of biochemical events involving the insulin signal transduction process. The identification of these molecular targets and the determination of their relative importance in the treatment of type II diabetes remains to be established and constitutes the main subject of ongoing research with benfluorex.

Effects of benfluorex metabolites on membrane fluidity and insulin-related processes

As little work has dealt with the antihyperglycemic property of benfluorex at the hepatocyte level, we studied the effects of its main metabolites, S422 and S1475, on membrane fluidity and on insulin binding, internalization and action in healthy rat hepatocytes. Both metabolites were effective fluidizing agents. Neither one affected insulin binding. Only S422 favored the bound insulin-receptor internalization process. The metabolites produced no change in basal alpha-aminoisobutyric acid uptake. Only S422 promoted the insulin-stimulated alpha-aminoisobutyric acid uptake in a dose-dependent way. Therefore, our study demonstrated that: (i) the effects of S422 on insulin-related processes in isolated hepatocytes were direct, specific and not due to any membrane fluidizing mechanism; (ii) S422 improved hepatocyte response to insulin at a post-binding level. These results in vitro give an additional explanation, at the cellular level, of the benefit of benfluorex treatment for non insulin-dependent diabetes patients.

In vitro influence of benfluorex and its main metabolites on rat liver microsomal membrane properties

Benfluorex and its three main metabolites at 30 microM have been shown to inhibit Acyl CoA cholesterol acyl transferase activity in rat liver microsome preparations and to fluidize these membranes, as reflected by a decrease in the lipid order parameter. When drug concentrations were higher (60-200 microM), the compounds differed in their enzymatic inhibition properties but retained the same fluidizing effects. Only the parent compound had a dose-dependent inhibiting effect. These results are discussed with regard to the chemical properties of compounds, in particular their electric charges and their lipophilic characters.

Modulation of glucagon-induced glucose production by dexfenfluramine in rat hepatocytes

The mechanism of the antihyperglycaemic action of dexfenfluramine (DEXF) was investigated in isolated rat hepatocytes exposed to glucagon. Preincubation of hepatocytes with DEXF caused a dose-dependent inhibition of cyclic AMP formation by 100 nM glucagon (Ki = 0.29 mM) that was almost complete at 1 mM DEXF. Surprisingly, glucagon-induced phosphorylase activation was not affected by DEXF despite the significant drop in cyclic AMP levels. Glucose production stimulated by glucagon was inhibited by up to 48% by 1 mM DEXF, and the rate of glucose production correlated positively with the steady-state concentration of glucose 6-phosphate. DEXF also partially restored lactate + pyruvate production which was abolished by an optimal concentration of glucagon. Although DEXF was not able to prevent the inactivation of pyruvate kinase by glucagon, the lack of further accumulation of phosphoenolpyruvate in DEXF-treated cells supports the conclusion that the flux through pyruvate kinase is stimulated, probably via the increase in fructose 2,6-bisphosphate, thereby increasing glycolysis. Our results thus indicate that DEXF counteracts the inhibition of glycolysis by glucagon and that this property might contribute to the antihyperglycaemic effect of this drug. Furthermore, this study shows that, in the presence of the drug, glucagon caused phosphorylase activation and pyruvate kinase inactivation without a significant increase in cyclic AMP levels.

Effects of chronic benfluorex treatment on the activities of key enzymes of hepatic carbohydrate metabolism in old Sprague-Dawley rats

Chronic effects of benfluorex on some parameters of carbohydrate metabolism have been studied in 24-month-old Sprague-Dawley rats. Treatment once a day for 14 days with 25 mg benfluorex per kg body weight lowered body weight, decreased circulating insulin and resulted in an increase in hepatic glycogen. Measurement of the activities of several important regulatory enzymes of hepatic carbohydrate metabolism showed a significant decrease in the activities of phosphoenolpyruvate carboxykinase and glycogen phosphorylase. The activity of glucose-6-phosphatase, on the other hand, was slightly increased. Taken collectively, our data offer an explanation for the observed inhibition of hepatic glucose production by chronic benfluorex treatment in cases of hyperinsulinemia.

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

We have examined the effect of chronic (20 days) oral administration of benfluorex (35 mg/kg) in a rat model of non-insulin-dependent diabetes mellitus (NIDDM), as induced by injection of streptozotocin 5 days after birth and characterized by frank hyperglycaemia, hypoinsulinaemia, and hepatic and peripheral insulin resistance. In the benfluorex-treated diabetic rats, basal plasma glucose levels were decreased (7.9 +/- 0.2 mM as compared with 17.2 +/- 1.1 mM in the pair-fed untreated diabetic and 6.7 +/- 0.2 mM in the benfluorex-treated non-diabetic rats) while the basal and the glucose-stimulated (IVGTT) plasma insulin levels were not improved. The lack of improvement of glucose-induced insulin release after benfluorex treatment was confirmed under in vitro conditions (perfused pancreas). In the benfluorex-treated diabetic rats, basal glucose production and overall glucose utilization were normalized. Following hyperinsulinaemia (euglycaemic clamp), glucose production was normally suppressed while overall glucose utilization was not significantly improved. Since benfluorex exerts a predominant action on the liver in the present rat model of diabetes, and since increased basal hepatic glucose output is a major metabolic abnormality and is responsible for much of the elevated fasting blood glucose levels in NIDDM, the use of such a compound in NIDDM may be potentially relevant.

Mechanism(s) of the blood glucose lowering action of benfluorex

Benfluorex is a hypolipidaemic agent with biguanide-like properties. To evaluate its blood glucose lowering action, a single-blind study protocol was designed. Two groups of seven type II (non-insulin-dependent) diabetic patients matched for age (50 +/- 4 vs. 53 +/- 1 years), sex, body mass index (27.8 +/- 0.6 vs. 26.5 +/- 0.7 kg/m2), and duration of diabetes were studied before and after 1 month of treatment with benfluorex 150 mg tid (= tres in die = three times a day), PO (= per os = by mouth) or a placebo, respectively. All patients had previously been treated by diet alone. In all patients, parameters of glucose and lipid metabolism were obtained. Insulin sensitivity was assessed by means of a euglycaemic (5.1 +/- 0.1 mM) hyperinsulinaemic (516 +/- 28 pM) clamp performed in combination with [3(-3)H]glucose infusion and indirect calorimetry. In no case was there a significant change in body mass index (27.6 +/- 0.5 vs. 26.4 +/- 0.7 kg/m2). After 1 month of treatment, fasting plasma glucose (6.8 +/- 0.2 vs. 8.1 +/- 0.6 mM) and HbA1C (glycated haemoglobin; 6.5 +/- 0.2 vs. 8.0 +/- 0.7%) were lower in the benfluorex group than in the placebo-treated patients (both p < 0.05). No change was observed in hepatic glucose production (HGP) (13.5 +/- 1.4 vs. 13.9 +/- 1.1 mumol/min per kg), the basal rate of glucose, and lipid oxidation and non-oxidative glucose metabolism, or in plasma triglyceride and total cholesterol concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Benfluorex decreases insulin resistance and improves lipid profiles in obese type 2 diabetic patients

Benfluorex hydrochloride has known lipid- and glucose-lowering effects. We evaluated the change in lipids, fasting glucose, and insulin sensitivity in ten obese type 2 diabetic patients after treatment with benfluorex or a placebo for 2 weeks using a double-blind, cross-over design. Insulin sensitivity was measured using the euglycaemic-hyperinsulinaemic glucose clamp technique at two insulin infusion rates for 2 h each: 0.05 U/kg per h (clamp 1) and 0.10 U/kg per h (clamp 2). Mean fasting glucose decreased from 13.1 +/- 1.1 to 10.2 +/- 0.9 mmol/l after benfluorex (p < 0.001) and rose from 11.9 +/- 0.9 to 13.3 +/- 1.0 mmol/l after the placebo (p = 0.028). Insulin did not change significantly. Glucose uptake (GU) as a parameter for insulin sensitivity was compared for treatment with benfluorex versus the placebo. Total GU during clamp 1 was 643.4 +/- 323.8 mmol after benfluorex and 250.1 +/- 193.3 mmol after the placebo (p = 0.035), and during clamp 2, 2490.7 +/- 490.5 mmol after benfluorex and 1544.3 +/- 693.9 mmol after the placebo (p = 0.018). The dynamic analysis on the last 30 min of clamp 2 showed a significant difference in glucose infusion rate (GIR) profile, with mean levels yielding 5.36 mmol/kg per min after benfluorex and 3.87 mmol/kg per min after the placebo (p = 0.018); there were no differences in plasma insulin concentrations or plasma glucose levels. It is concluded that in this short-term study benfluorex increases insulin sensitivity in obese type 2 diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute effect of benfluorex on glucose metabolism

The antihyperlipidaemic agent benfluorex [1-(3-trifluoromethylphenyl)-2-(2-benzoyl-oxyethyl)-aminopropane] and its metabolite S422 [1-(3-trifluoromethylphenyl)-2-(2-hydroxyethyl)-aminopropane] were examined for an acute (after 1-2 hr) effect on glucose metabolism in normal rats. Enteral administration of benfluorex (25 mg/kg) did not affect basal plasma glucose and insulin concentrations. However, enteral and intravenous glucose tolerance were modestly improved without enhancing the insulin response to glucose. Hepatic gluconeogenesis from lactate was not acutely altered by benfluorex (25 mg/kg) in vivo or by S422 (1 mM) in vitro, but S422 (1 mM) slightly reduced (by 11%) hepatic glycogen mobilization in vitro after 2 hr. S422 (1 mM) increased (by 47%) glucose oxidation by diaphragm muscle in vitro. The effect was additive to that of insulin. Anaerobic glucose metabolism and glycogenesis of diaphragm muscle were not affected by S422. The results suggest that benfluorex can acutely improve glucose tolerance associated with increased glucose oxidation by muscle.

The liver metabolite S-422 of the hypolipidaemic drug benfluorex decreases cholesterol esterification in fibroblasts and monocyte-like cells

The effects of S-422 (1-(3-trifluoromethylphenyl)-2-[N-(2-hydroxyethyl) amino] propane), an hepatic metabolite of the hypolipidaemic drug Benfluorex, on lipid metabolism have been investigated in two experimental models: in human fetal lung fibroblasts, for study of the apo B/E receptor-mediated regulation of cholesterol metabolism, and in murine J 774 monocyte-like cells, for study of the scavenger receptor-mediated induction of cholesteryl ester accumulation. In human fibroblasts S-422 increased low density lipoprotein (LDL) catabolism by about 20%, whereas it decreased oleic acid incorporation into triacylglycerols and cholesteryl esters by 25 and 35%, respectively. In J 774 cells, S-422 decreased acetylated LDL degradation and cholesteryl ester formation by about 35%. In both cell types, ACAT activity was significantly reduced by the drug, either after a 24 h pretreatment of the cultured cells, or after an in vitro 30 min preincubation of cell homogenates. The results suggest that S-422, and thus Benfluorex, might prevent the development of atherosclerotic plaques.

Benfluorex and blood glucose control in non insulin-dependent diabetic patients

Benfluorex has been reported to decrease blood glucose in different dismetabolic conditions, particularly in noninsulin-dependent diabetic (NIDD) patients, but the mechanism of this effect is poorly known. We evaluate fasting glucose production (3H-glucose infusion) and B-cell secretion (phi 1, phi 2 and glucose utilization SI) (minimal model technique) in 7 mild, diet treated, NIDDM patients after 6-week administration of benfluorex (450 mg/day) and placebo, in random sequence and double blind design. Body weight, HbA1c, plasma glucose profile, fasting plasma insulin, lactate, pyruvate, beta-OH-butyrate, total cholesterol, HDL-cholesterol and triglycerides were also measured at the end of each treatment. Mean values of body weight (71 +/- 4 vs 69 +/- 4 kg, p less than 0.01), HbA1c (8.3 +/- 0.2 vs 7.7 +/- 0.2%, p less than 0.01), fasting plasma glucose (137.0 +/- 6.5 vs 121.4 +/- 5.6 mg/dl, p less than 0.01), lactate (1.82 +/- 0.13 vs 1.22 +/- 0.11 mmol/l, p less than 0.0025) pyruvate (0.164 +/- 0.011 vs 0.095 +/- 0.010 mmol/l, p less than 0.0005), and beta-OH-butyrate (0.91 +/- 0.06 vs 0.66 +/- 0.04 mmol/l, p less than 0.005) were significantly lower after benfluorex than after placebo. phi 1, phi 2 and SI values were not significantly different in the two treatments. Fasting glucose production was significantly lower after benfluorex than after placebo: 2.46 +/- 1.57 vs 1.84 +/- 0.85 mg/kg.min, p less than 0.02. These results demonstrate that 6-week treatment with benfluorex produces a significant blood glucose lowering effect in mild NIDDM patients, mainly by decreasing glucose production.

Failure of fenfluramine to affect basal and insulin-stimulated hexose transport in rat skeletal muscle

Fenfluramine is an effective appetite suppressant that mediates its action via serotoninergic neurons. We studied the effect of pure d- and l-fenfluramine on in vitro hexose transport in isolated rat soleus muscles and skeletal muscle cells in culture. We found no evidence to suggest that the fenfluramine enantiomers affect the basal transport activity. Furthermore, the drugs did not interfere with the ability of glucose to regulate its own transport. Muscle responsiveness to insulin was not altered by the enantiomers, nor did insulin unmask any effect of fenfluramine on muscle hexose transport. These conclusions are based on experiments performed with a wide concentration range of drug and insulin, from the therapeutic to suprapharmacological levels. We discuss our results in view of published data on the effects of fenfluramine on peripheral glucose metabolism.

Effects of chronic administration of benfluorex to rats on the metabolism of corticosterone, glucose, triacylglycerols, glycerol and fatty acid

(1) Rats were fed on diets enriched with sucrose, beef tallow or corn oil and treated for 11-16 days with 50 mg of benfluorex per kg of body weight. By these times the growth rate and food intake were not significantly different from those of control rats. (2) Benfluorex approximately halved the concentration of circulating triacylglycerol in rats fed the beef tallow or sucrose diets. (3) It did not significantly alter the total lipoprotein lipase activity in diaphragm, heart and adipose tissue. (4) The clearance of triacylglycerols from chylomicrons exhibited two t 1/2 values of about 0.6 and 6.9 min in rats fed the beef tallow diet. Benfluorex did not significantly alter these values. (5) Benfluorex did not significantly alter the rate of appearance of triacylglycerol in the blood of rats injected with Triton WR 1339 to block triacylglycerol uptake. It did, however, decrease the rise in circulating glucose which presumably resulted from the stress of the procedure. (6) Benfluorex decreased the extent and duration of the rise in serum corticosterone when rats maintained on the corn oil diet were fed acutely with fructose. It also decreased the circulating concentrations of glycerol, triacylglycerol and glucose after fructose feeding. (7) Rats fed on the corn oil diet and then treated with benfluorex had lower concentrations of circulating glucose, triacylglycerol, glycerol and fatty acids after being injected with 2-deoxyglucose. (8) It is proposed that some of the long-term hypoglycaemic and hypotriglyceridaemic effects of benfluorex could be mediated indirectly through changes in endocrine balance, perhaps via the serotonergic system and in particular, by decreasing the effects of stress hormones relative to insulin. The implications of these findings are discussed in relation to controlling metabolism in stress conditions and for the management of obesity, diabetes and atherosclerosis.

Effects of fenfluramine on hepatic intermediary metabolism

Effects of fenfluramine on hepatic intermediary metabolism have been studied using the isolated hepatocyte system. Fenfluramine inhibits the formation of glucose from lactate plus pyruvate and from alanine as well as the production of ketone bodies from added oleate. The latter observation suggests that inhibition of gluconeogenesis may result from a decrease in the level of mitochondrial acetyl-CoA. Fatty acid synthesis by hepatocytes is slightly stimulated by fenfluramine, perhaps as a consequence of the increase in cytosolic reducing equivalents, observed as an increase in the ratio of lactate/pyruvate.