Beneficial effect of carbohydrate maldigestion induced by a disaccharidase inhibitor (AO-128) in the treatment of chronic portal-systemic encephalopathy. A double-blind, randomized, controlled trial

Bovine Serum Albumin–Loaded Pectinate Beads as Colonic Peptide Delivery System: Preparation and In Vitro Characterization

Objective of this study was to prepare a drug delivery system for therapeutic peptides that are degraded in the upper part of the gastrointestinal tract due to degradation activity of the enzymes. Delivering peptide to the colon in which enzymatic activity is low is next hope for absorption of these agents. Pectin, a naturally occurring water soluble polysaccharide, as a matrix for peptide delivery was studied. Degradation of pectin by the colonic enzymes makes it suitable for colon-specific delivery of drugs. Bovine serum albumin (BSA) was used as a model peptide. Calcium pectinate beads were prepared by extruding BSA-loaded pectin solution to an agitating calcium chloride solution, and gelled spheres were formed instantaneously by an ionotropic gelation reaction. The effect of several factors such as concentration of pectin, concentration of calcium chloride, and total drug loading on the pattern of drug release in the dissolution medium was studied. Prepared beads showed good resistance in the release medium. The entrapment efficiency of the beads was high (between 63% and 99%). Entrapment efficiency of BSA was reversely dependent to the amount of the drug loaded in the beads. The amount of BSA loaded on the beads affects pattern of drug release. The concentration of the pectin showed the highest impact on the rate of drug release. Presence of the pectiolytic enzymes facilitated the drug release from the beads.

Inhibitory effect of voglibose and gymnemic acid on maltose absorption in vivo

AIM: To determine whether diabetic care can be improved by combination of voglibose and gymnemic acid (GA), we compared the combinative and individual effects of voglibose and GA on maltose absorption in small intestine.

METHODS: The small intestine 30 cm long from 2 cm caudal ward Treitz’s ligament of Wistar rat was used as an in situ loop, which was randomly perfused in recircular mode with maltose (10 mmol/L) with or without different dosages of voglibose and/or GA for 1 h. To compare the time course, perfusion of 10 mmol/L maltose was repeated four times. Each time continued for 1 h and separated by 30 min rinse. In the first time, lower dosages of GA (0.5 g/L) and/or voglibose (2 μmol/L) were contained except control.

RESULTS: Absorptive rate of maltose was the lowest in combinative group (P < 0.05, ANOVA), for example, the inhibition rate was about 37% during the first hour when0.5 g/L-GA and 2 μmol/L voglibose with 10 mmol/L maltose were perfused in the loop. The onset time was shortened to 30 min and the effective duration was prolonged to 4 h with the combination; therefore the total amount of maltose absorption during the effective duration was inhibited more significantly than that in the individual administration (P < 0.05, U test of Mann Whitney). The effect of GA on absorptive barriers of the intestine played an important role in the combinative effects.

CONCLUSION: There are augmented effects of voglibose and GA. The management of diabetes mellitus can be improved by employing the combination.

Hepatic encephalopathy in liver cirrhosis: pathogenesis, diagnosis and management

The pathogenesis of hepatic encephalopathy (HE) is unknown. Many theories have been proposed. Most established therapies are based on such theories but since no theory has have ever been proved, therapies have to be considered empiric. The spectrum of HE ranges from minimal cerebral functional deficits, which can only be found by sensitive psychometric tests, to coma with signs of decerebration. HE has arbitrarily been divided into stages. A number of precipitating factors are known and the first line of therapy should always be the elimination of these factors. The differential diagnosis includes all states of impaired consciousness and deficits in cerebral function in patients with chronic liver disease, and clinical and biochemical tests to differentiate are indicated. The therapeutic options for HE include: protein restriction only for a limited time in comatous patients; nonabsorbable antibiotics (aminoglycosides), which because of adverse effects are also limited to higher grades of HE: intestinal cleansing which is applicable in all degrees of HE; lactulose, branched chain aminoacids and ornithin aspartate which have been proven to be effective and can be applied long term in patients with lower grades of HE.