A correlation between gastrointestinal dysfunction and cirrhosis severity

Efficacy of Jianpiyangxue granule on gastrointestinal autonomic nerve dysfunction and its impact on adverse reactions

OBJECTIVE

To explore the efficacy of Jianpiyangxue granules on gastrointestinal autonomic nerve dysfunction and their impact on adverse reactions.

METHODS

From September 2016 to September 2020, 120 patients with gastrointestinal autonomic nerve dysfunction treated in our hospital were retrospectively selected and randomly assigned to a treatment group (TG) which was administered Jianpiyangxue granules prepared by our hospital and a control group (CG) which was administered routine Western medicine treatment (B vitamins + oryzanol). There were 60 patients in each group. The clinical efficacy and incidences of adverse effects were compared between the groups. The gastrointestinal hormone indexes, the inflammatory cytokines, and the immune indexes were analyzed before and after the therapy. The gastrin (GAS) and motilin (MTL) levels were measured using the motilin stimulating method, and the somatostatin (SS) levels were measured using ELISA for comparison. The autonomic nerve dysfunction symptoms were used for the evaluation. The degree of neurological functional defects scale (NIHSS) was used to assess the neurological functional defect levels. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were used to assess the patients' psychological statuses.

RESULTS

After the therapy, the GAS, MTL, and SS expressions in the TG were remarkably higher than they were in the CG. The CRP and IL-6 expressions in the TG were significantly lower than they were in the CG. The TG had higher IgG, IgM, and IgA levels as compared with the CG, higher grade 0 and grade 1 scores on the gastrointestinal autonomic nerve dysfunction, but lower grade 2 and 3 scores were observed compared to the CG. Significantly lower NIHSS, SAS, and SDS scores were recorded in the TG compared with the CG. The TG yielded more promising outcomes in terms of the total effective rate and the incidences of adverse reactions than the CG.

CONCLUSION

Jianpiyangxue granules contribute to enhancing the clinical efficacy, reducing the incidence of adverse reactions, and improving the gastrin, somatostatin, and other indicators in treating gastrointestinal autonomic nerve dysfunction.

Physiologically Based Pharmacokinetic/Pharmacodynamic Modeling to Support Waivers of In Vivo Clinical Studies: Current Status, Challenges, and Opportunities

Physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD) modeling has been extensively applied to quantitatively translate in vitro data, predict the in vivo performance, and ultimately support waivers of in vivo clinical studies. In the area of biopharmaceutics and within the context of model-informed drug discovery and development (MID3), there is a rapidly growing interest in applying verified and validated mechanistic PBPK models to waive in vivo clinical studies. However, the regulatory acceptance of PBPK analyses for biopharmaceutics and oral drug absorption applications, which is also referred to variously as "PBPK absorption modeling" [Zhang et al. CPT: Pharmacometrics Syst. Pharmacol. 2017, 6, 492], "physiologically based absorption modeling", or "physiologically based biopharmaceutics modeling" (PBBM), remains rather low [Kesisoglou et al. J. Pharm. Sci. 2016, 105, 2723] [Heimbach et al. AAPS J. 2019, 21, 29]. Despite considerable progress in the understanding of gastrointestinal (GI) physiology, in vitro biopharmaceutic and in silico tools, PBPK models for oral absorption often suffer from an incomplete understanding of the physiology, overparameterization, and insufficient model validation and/or platform verification, all of which can represent limitations to their translatability and predictive performance. The complex interactions of drug substances and (bioenabling) formulations with the highly dynamic and heterogeneous environment of the GI tract in different age, ethnic, and genetic groups as well as disease states have not been yet fully elucidated, and they deserve further research. Along with advancements in the understanding of GI physiology and refinement of current or development of fully mechanistic in silico tools, we strongly believe that harmonization, interdisciplinary interaction, and enhancement of the translational link between in vitro, in silico, and in vivo will determine the future of PBBM. This Perspective provides an overview of the current status of PBBM, reflects on challenges and knowledge gaps, and discusses future opportunities around PBPK/PD models for oral absorption of small and large molecules to waive in vivo clinical studies.