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Roelofs JJM, Camps G, Leenders LM, Marciani L, Spiller RC, Van Eijnatten EJM, Alyami J, Deng R, Freitas D, Grimm M, Karhunen LJ, Krishnasamy S, Le Feunteun S, Lobo DN, Mackie AR, Mayar M, Weitschies W, Smeets PAM. Intra- and interindividual variability in fasted gastric content volume. Neurogastroenterol Motil 2024:e14904. [PMID: 39189312 DOI: 10.1111/nmo.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/15/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Gastric fluid plays a key role in food digestion and drug dissolution, therefore, the amount of gastric fluid present in a fasted state may influence subsequent digestion and drug delivery. We aimed to describe intra- and interindividual variation in fasted gastric content volume (FGCV) and to determine the association with age, sex, and body size characteristics. METHODS Data from 24 MRI studies measuring FGCV in healthy, mostly young individuals after an overnight fast were pooled. The analysis included 366 participants who had up to 6 repeated measurements, with a total of 870 measurements. Linear mixed model analysis was performed to calculate intra- and interindividual variability and to assess the effects of age, sex, weight, height, weight*height as a proxy for body size, and body mass index (BMI). RESULTS FGCV ranged from 0 to 156 mL, with a mean (± SD) value of 33 ± 25 mL. The overall coefficient of variation within the study population was 75.6%, interindividual SD was 15 mL, and the intraindividual SD was 19 mL. Age, weight, height, weight*height, and BMI had no effect on FGCV. Women had lower volumes compared to men (MD: -6 mL), when corrected for the aforementioned factors. CONCLUSION FGCV is highly variable, with higher intraindividual compared to interindividual variability, indicating that FGCV is subject to day-to-day and within-day variation and is not a stable personal characteristic. This highlights the importance of considering FGCV when studying digestion and drug dissolution. Exact implications remain to be studied.
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Affiliation(s)
- Julia J M Roelofs
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Guido Camps
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Louise M Leenders
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Luca Marciani
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Robin C Spiller
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | - Jaber Alyami
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Radiological Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ruoxuan Deng
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Daniela Freitas
- Université Paris-Saclay, INRAE, AgroParisTech, UMR SayFood, Thiverval-Grignon, France
| | - Michael Grimm
- Institute of Pharmacy, Center of Drug Absorption and Transport, University of Greifswald, Greifswald, Germany
| | - Leila J Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Shanthi Krishnasamy
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan R Mackie
- Food Colloids and Processing Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Morwarid Mayar
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Werner Weitschies
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Paul A M Smeets
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Shawahna R, Saba'aneh H, Daraghmeh A, Qassarwi Y, Franco V, Declèves X. Solubility of lamotrigine in age-specific biorelevant media that simulated the fasted- and fed-conditions of the gastric and intestinal environments in pediatrics and adults: implications for traditional, re-formulated, modified, and new oral formulations. BMC Biotechnol 2023; 23:36. [PMID: 37684623 PMCID: PMC10492362 DOI: 10.1186/s12896-023-00809-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Lamotrigine is an effective antiseizure medication that can be used in the management of focal and generalized epilepsies in pediatric patients. This study was conducted to quantify and compare the solubility of lamotrigine in age-specific biorelevant media that simulated the fasted and fed conditions of the gastric and intestinal environments in pediatrics and adults. Another aim was to predict how traditional, re-formulated, modified, and new oral formulations would behave in the gastric and intestinal environments across different age groups. METHODS Solubility studies of lamotrigine were conducted in 16 different age-specific biorelevant media over the pH range and temperature specified by the current biopharmaceutical classification system-based criteria. The age-specific biorelevant media simulated the environments in the stomach and proximal gastrointestinal tract in both fasted and fed conditions of adults and pediatric sub-populations. The solubility of lamotrigine was determined using a pre-validated HPLC-UV method. RESULTS Lamotrigine showed low solubility in the 16 age-specific biorelevant media as indicated by a dose number of > 1. There were significant age-specific variabilities in the solubility of lamotrigine in the different age-specific biorelevant media. Pediatric/adult solubility ratios of lamotrigine fell outside the 80-125% range in 6 (50.0%) and were borderline in 3 (25.0%) out of the 12 compared media. These ratios indicated that the solubility of lamotrigine showed considerable differences in 9 out of the 12 (75.0%) of the compared media. CONCLUSION Future studies are still needed to generate more pediatric biopharmaceutical data to help understand the performances of oral dosage forms in pediatric sub-populations.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Hala Saba'aneh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Amal Daraghmeh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yara Qassarwi
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Valentina Franco
- Section of Translational Neurovascular Research, IRCCS Mondino Foundation, Via Mondino 2, Pavia, 27100, Italy
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
| | - Xavier Declèves
- Biologie du Médicament-Toxicologie, AP-HP, Hôpital Cochin, 27 rue du Faubourg St. Jacques, Paris, 75679, France
- Faculty of Health, Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, 75006, France
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Fox M, Gyawali CP. Dietary factors involved in GERD management. Best Pract Res Clin Gastroenterol 2023; 62-63:101826. [PMID: 37094911 DOI: 10.1016/j.bpg.2023.101826] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 04/26/2023]
Abstract
Gastroesophageal reflux disease (GERD) is extremely common, and even modest weight gain has been associated with higher symptom burden as well as objective evidence of reflux on endoscopy and physiological measurement. Certain trigger foods, especially citrus, coffee, chocolate, fried food, spicy food and red sauces are frequently reported to worsen reflux symptoms, although hard evidence linking these items to objective GERD is lacking. There is better evidence that large meal volume and high calorie content can increase esophageal reflux burden. Conversely, sleeping with the head end of the bed raised, avoiding lying down close to meals, sleeping on the left side and weight loss can improve reflux symptoms and objective reflux evidence, especially when the esophagogastric junction 'reflux barrier' is compromised (e.g., in the presence of a hiatus hernia). Consequently, attention to diet and weight loss are both important elements of management of GERD, and need to be incorporated into management plans.
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Affiliation(s)
- Mark Fox
- Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland; Department of Gastroenterology and Hepatology, University Hospital, Zürich, Switzerland
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, USA.
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Spatial-temporal mapping of the intra-gastric pepsin concentration and proteolysis in pigs fed egg white gels. Food Chem 2022; 389:133132. [PMID: 35526282 DOI: 10.1016/j.foodchem.2022.133132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/07/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022]
Abstract
While there is a consensus that food structure affects food digestion, the underlying mechanisms remain poorly understood. A previous experiment in pigs fed egg white gels of same composition but different structures evidenced such effect on food gastric disintegration. In this study, we detailed the consequences on intra-gastric pH, pepsin concentration and proteolysis by sampling throughout the stomach over 6 h digestion. Subsequent amino acid absorption was investigated as well by blood sampling. While acidification was almost homogeneous after 6 h digestion regardless of the gel, pepsin distribution never became uniform. Pepsin started to accumulate in the pylorus/antrum region before concentrating in the body stomach beyond 4 h, time from which proteolysis really started. Interestingly, the more acidic and soft gel resulted in a soon (60 min) increase in proteolysis, an earlier and more intense peak of plasmatic amino acids, and a final pepsin concentration three times higher than with the other gels.
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Esmaeili M, Ajami M, Barati M, Javanmardi F, Houshiarrad A, Mousavi Khaneghah A. The significance and potential of functional food ingredients for control appetite and food intake. Food Sci Nutr 2022; 10:1602-1612. [PMID: 35592279 PMCID: PMC9094468 DOI: 10.1002/fsn3.2783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
Dramatically rising global levels of obesity have raised consumers’ commercial and public health interest in foods that may help control appetite and weight. The satiety cascade consists of sensory, cognitive, physical, and hormonal events following food intake, preventing overeating, and the desire to eat for a long time. Functional foods can be one of the most influential factors in reducing appetite as long as effective ingredients, such as fiber and protein, are used to design these products. Also, functional foods should be designed to reduce appetite at different levels of oral processing, stomach, small intestine, and large intestine by various mechanisms. Therefore, the satiety power of functional foods depends on the type of ingredients and their amount. Because each compound has a different mechanism of action, it is recommended to use different compounds to influence satiety in functional foods.
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Affiliation(s)
- Mina Esmaeili
- Department of Nutrition Research National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Marjan Ajami
- Department of Food and Nutrition Policy and Planning National Nutrition and Food Technology Research Institute School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Meisam Barati
- Department of Cellular and Molecular Nutrition Faculty of Nutrition and Food Technology National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fardin Javanmardi
- Department of Food Science and Technology National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Anahita Houshiarrad
- Department of Nutrition Research National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science and Nutrition Faculty of Food Engineering University of Campinas (UNICAMP) Campinas Brazil
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Rivera del Rio A, van der Wielen N, Gerrits WJ, Boom RM, Janssen AE. In silico modelling of protein digestion: A case study on solid/liquid and blended meals. Food Res Int 2022; 157:111271. [DOI: 10.1016/j.foodres.2022.111271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
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Wollmer E, Ungell AL, Nicolas JM, Klein S. Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines. Adv Drug Deliv Rev 2022; 181:114084. [PMID: 34929252 DOI: 10.1016/j.addr.2021.114084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/13/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.
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Glycemic response, satiety, gastric secretions and emptying after bread consumption with water, tea or lemon juice: a randomized crossover intervention using MRI. Eur J Nutr 2022; 61:1621-1636. [PMID: 35013789 DOI: 10.1007/s00394-021-02762-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/25/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Numerous studies, including our previous work with lemon juice, have reported that low-pH meals reduce the glycemic response to starchy foods. However, the underlying mechanism is not yet understood. Tea, for its polyphenol content, has also been investigated. The main objective of this research was to concurrently study gastric emptying, appetite perceptions and glycemic responses to bread consumed with water, tea, or lemon juice. METHODS In this randomized, crossover intervention, ten participants consumed equal portions of bread (100 g) with 250 mL of water, water-diluted lemon juice, or black tea at breakfast. Gastric volumes, blood glucose concentrations and appetite perceptions were alternately assessed over 180 min using magnetic resonance imaging, the finger-prick method and visual analogue scales, respectively. RESULTS Compared to water, lemon juice led to a 1.5 fold increase of the volume of gastric contents, 30 min after the meal (454.0 ± 18.6 vs. 298.4 ± 19.5 mL, [Formula: see text] ± SEM P < 0.00001). Gastric emptying was also 1.5 times faster (P < 0.01). Conversely, lemon juice elicited a lower glycemic response than water (blood glucose concentrations at t = 55 min were 35% lower, P = 0.039). Tea had no effect. Changes in appetite perceptions and gastric volumes correlated well, but with no significant differences between the meals. CONCLUSIONS Lemon juice lowered the glycemic response and increased both gastric secretions and emptying rate. The results are compatible with the hypothesis that the reduction of the glycemic response is mainly due to the interruption of starch hydrolysis via the acid-inhibition of salivary α-amylase. TRIAL REGISTRATION NUMBER NCT03265392, August 29, 2017.
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9
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Sclocco R, Nguyen C, Staley R, Fisher H, Mendez A, Velez C, Kettner NW, Kuo B, Napadow V. Non-uniform gastric wall kinematics revealed by 4D Cine magnetic resonance imaging in humans. Neurogastroenterol Motil 2021; 33:e14146. [PMID: 33797166 PMCID: PMC10315015 DOI: 10.1111/nmo.14146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Assessment of gastric function in humans has relied on modalities with varying degrees of invasiveness, which are usually limited to the evaluation of single aspects of gastric function, thus requiring patients to undergo a number of often invasive tests for a full clinical understanding. Therefore, the development of a non-invasive tool able to concurrently assess multiple aspects of gastric function is highly desirable for both research and clinical assessments of gastrointestinal (GI) function. Recently, technological advances in magnetic resonance imaging (MRI) have provided new tools for dynamic (or "cine") body imaging. Such approaches can be extended to GI applications. METHODS In the present work, we propose a non-invasive assessment of gastric function using a four-dimensional (4D, volumetric cine imaging), free-breathing MRI sequence with gadolinium-free contrast enhancement achieved through a food-based meal. In healthy subjects, we successfully estimated multiple parameters describing gastric emptying, motility, and peristalsis propagation patterns. KEY RESULTS Our data demonstrated non-uniform kinematics of the gastric wall during peristaltic contraction, highlighting the importance of using volumetric data to derive motility measures. CONCLUSIONS & INFERENCES MRI has the potential of becoming an important clinical and gastric physiology research tool, providing objective parameters for the evaluation of impaired gastric function.
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Affiliation(s)
- Roberta Sclocco
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Logan University, Chesterfield, MO, USA
| | - Christopher Nguyen
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rowan Staley
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - Harrison Fisher
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - April Mendez
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Velez
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | | | - Braden Kuo
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - Vitaly Napadow
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Logan University, Chesterfield, MO, USA
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Nadia J, Olenskyj AG, Stroebinger N, Hodgkinson SM, Estevez TG, Subramanian P, Singh H, Singh RP, Bornhorst GM. Tracking physical breakdown of rice- and wheat-based foods with varying structures during gastric digestion and its influence on gastric emptying in a growing pig model. Food Funct 2021; 12:4349-4372. [PMID: 33884384 DOI: 10.1039/d0fo02917c] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is currently a limited understanding of the effect of food structure on physical breakdown and gastric emptying of solid starch-based foods during gastric digestion. Moisture uptake, pH, particle size, rheological, and textural properties of six solid starch-based diets from different sources (Durum wheat and high amylose white rice) and of different macrostructures (porridge, native grain, agglomerate/couscous, and noodle) were monitored during 240 min of gastric digestion in a growing pig model. Changes in the physical properties of the gastric digesta were attributed to the influence of gastric secretions and gastric emptying, which were both dependent on the buffering capacity and initial macrostructure of the diets. Differences between the proximal and distal stomach regions were found in the intragastric pH and texture of the gastric digesta. For example, rice couscous, which had the smallest particle size and highest buffering capacity among the rice-based diets, had the shortest gastric emptying half-time and no significant differences between proximal and distal stomach digesta physical properties. Additionally, a relationship between gastric breakdown rate, expressed as gastric softening half-time from texture analysis, and gastric emptying half-time of dry matter was also observed. These findings provide new insights into the breakdown processes of starch-based solid foods in the stomach, which can be beneficial for the development of food structures with controlled rates of breakdown and gastric emptying during digestion.
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Affiliation(s)
- Joanna Nadia
- School of Food and Advanced Technology, Massey University, Private Bag 11222, Palmerston North, New Zealand
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Shawahna R, Zyoud A, Haj-Yahia A, Taya R. Evaluating Solubility of Celecoxib in Age-Appropriate Fasted- and Fed-State Gastric and Intestinal Biorelevant Media Representative of Adult and Pediatric Patients: Implications on Future Pediatric Biopharmaceutical Classification System. AAPS PharmSciTech 2021; 22:84. [PMID: 33649887 DOI: 10.1208/s12249-021-01958-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022] Open
Abstract
Prediction of performance of traditional, reformulated, and novel oral formulations in adults and pediatrics is of great importance. This study was conducted to assess solubility of celecoxib in age-appropriate fasted- and fed-state gastric and intestinal biorelevant media, classify celecoxib into biopharmaceutical classification system (BCS), and assess the effects of age-related developmental changes in the composition and volume of gastrointestinal fluids on the solubility and performance of oral formulations containing celecoxib. Solubility of celecoxib was assessed at 37°C in the pH range specified by the BCS-based criteria in 13 age-appropriate biorelevant media reflective of the gastric and proximal small intestinal environment in both fasted and fed states in adults and different pediatric subpopulations. A validated HPLC-UV method was used to quantify celecoxib. Experimental and computational molecular descriptors and in vivo pharmacokinetic data were used to assign the permeability class of celecoxib. Celecoxib belonged to BCS class 2. The pediatric to adult solubility ratios were outside the 80-125% boundaries in 3 and borderline in 1 biorelevant media. Significant age-related variability could be predicted for oral formulations containing celecoxib intended for pediatric use. Findings of this study indicated that the criteria used in the adult BCS might not be directly applied to pediatric subpopulations.
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Loisios-Konstantinidis I, Dressman J. Physiologically Based Pharmacokinetic/Pharmacodynamic Modeling to Support Waivers of In Vivo Clinical Studies: Current Status, Challenges, and Opportunities. Mol Pharm 2020; 18:1-17. [PMID: 33320002 DOI: 10.1021/acs.molpharmaceut.0c00903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
| | - Jennifer Dressman
- Institute of Pharmaceutical Technology, Goethe University, Frankfurt am Main 60438, Germany.,Fraunhofer Institute of Translational Pharmacology and Medicine (ITMP), Carl-von-Noorden Platz 9, Frankfurt am Main 60438, Germany
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Martir J, Flanagan T, Mann J, Fotaki N. BCS-based biowaivers: Extension to paediatrics. Eur J Pharm Sci 2020; 155:105549. [PMID: 32941998 DOI: 10.1016/j.ejps.2020.105549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 12/25/2022]
Abstract
A BCS-based biowaiver allows extrapolation of drug product bioequivalence (when applicable) based on the BCS class of the drug and in vitro dissolution testing. Drug permeability and solubility considerations for adult BCS might not apply directly to paediatric subpopulations and bridging of adult and paediatric formulations should be undertaken with caution. The aims of this study were to: (i.) identify compounds which would change drug solubility classification in the paediatric population, and (ii.) to assess the risk of extending BCS-based biowaiver criteria into paediatric products of these compounds. Amoxicillin, prednisolone, and amlodipine were selected as the model compounds. Dissolution studies of IR formulations of these compounds were conducted with USP II (paddle) and mini-paddle apparatus, in media of three pHs (pH 1.2, 4.5 and 6.8). Three dissolution setups were tested: (1) 'typical' BCS-based biowaiver conditions, (2) "BE" setup derived from BE study protocols (volume: 250 mL), and (3) "paediatric" setup based on representative volume for the paediatric population (50 mL). Results revealed that extension of regulated BCS-based biowaiver criteria for paediatric application is not as simple as scaling down volumes. It was further shown that BCS-based biowaiver criteria should not be applied when there is the risk of change of the drug solubility class, from the adult to paediatric populations. A deeper knowledge of the paediatric gastrointestinal environment is still lacking and would assist in refining the biopharmaceutical tools needed to appropriately evaluate formulation performance across age groups. This would potentially reduce the number of clinical studies required and speed up formulation development.
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Affiliation(s)
- J Martir
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, UK; Currently at UCB Pharma, Chemin du Foriest, B - 1420 Braine-l'Alleud, Belgium
| | - J Mann
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, UK
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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14
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Sager M, Grimm M, Aude P, Schick P, Merdivan S, Hasan M, Kromrey ML, Sivert A, Benameur H, Koziolek M, Tzvetkov MV, Weitschies W. In vivo characterization of enTRinsic™ drug delivery technology capsule after intake in fed state: A cross-validation approach using salivary tracer technique in comparison to MRI. J Control Release 2019; 313:24-32. [DOI: 10.1016/j.jconrel.2019.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/19/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
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15
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Intraluminal Impact of Food: New Insights from MRI. Nutrients 2019; 11:nu11051147. [PMID: 31126027 PMCID: PMC6567872 DOI: 10.3390/nu11051147] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023] Open
Abstract
Understanding how the gut responds to food has always been limited by the available investigatory techniques. Previous methods involving intubation and aspiration are largely limited to liquid-only meals. The aim of this review is to describe how MRI has allowed analysis of the processing of complex multiphase meals. This has demonstrated the role of physical factors such as viscosity, fat and fibre content in controlling gastric secretion and motility. It has also allowed the description of changes induced in small bowel water content and the role of osmotic effects of poorly absorbed carbohydrates such as fructose, sorbitol and mannitol. Intestinal secretions can be shown to be stimulated by a range of fruit and vegetables and the effect of this on colonic water content can also be measured. This has been used to demonstrate the mode of action of commonly used laxatives including bran and psyllium. The wealth of data which can be obtained together with its non-invasive nature and safety makes the technique ideal for the serial evaluation of the impact of different nutrients and drugs in both health and disease.
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16
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Sager M, Grimm M, Jedamzik P, Merdivan S, Kromrey ML, Hasan M, Koziolek M, Tzvetkov MV, Weitschies W. Combined Application of MRI and the Salivary Tracer Technique to Determine the in Vivo Disintegration Time of Immediate Release Formulation Administered to Healthy, Fasted Subjects. Mol Pharm 2019; 16:1782-1786. [DOI: 10.1021/acs.molpharmaceut.8b01320] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maximilian Sager
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Michael Grimm
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Philipp Jedamzik
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Simon Merdivan
- Department of Pharmaceutical Biology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Marie-Luise Kromrey
- Department of Diagnostic Radiology and Neuroradiology, University Hospital Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Mahmoud Hasan
- Department of Clinical Pharmacology, University Hospital Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
| | - Mirko Koziolek
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Mladen V. Tzvetkov
- Department of Clinical Pharmacology, University Hospital Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
| | - Werner Weitschies
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
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17
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Jede C, Wagner C, Kubas H, Weber C, Weigandt M, Koziolek M, Weitschies W. Automated small-scale in vitro transfer model as screening tool for the prediction of in vivo-dissolution and precipitation of poorly solubles. Int J Pharm 2019; 556:150-158. [PMID: 30553006 DOI: 10.1016/j.ijpharm.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 12/22/2022]
Abstract
Precipitation testing, especially for weakly basic APIs, represents a key parameter in drug substance characterization during early development stages, where the amount of API available is limited. Therefore, it was the aim of this study to develop an automated small-scale in vitro transfer model to characterize the supersaturation and precipitation behavior of two poorly water-soluble drugs. Following automation and scale-down of the standard transfer model, the developed small-scale model was used to assess the impact of gastrointestinal variability, i.e. gastric pH, gastric emptying, and gastrointestinal fluid volumes, on supersaturation and precipitation of two weakly basic model compounds, ketoconazole and a new chemical entity from the research laboratories of Merck KGaA, MSC-A. The experiments revealed that variations in gastrointestinal parameters affected the in vitro behavior of ketoconazole, but not of MSC-A. Elevated gastric pH, as it can result from co-medication with acid-reducing drugs, resulted in lower degrees of supersaturation for both substances. This result is in agreement with the observation that the oral bioavailability of ketoconazole is lowered when proton pump inhibitors are co-administered. The small-scale transfer model presented herein represents a valuable in vitro tool to assess the risk of drug precipitation, additionally covering a broad range of gastrointestinal parameters.
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Affiliation(s)
- Christian Jede
- Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Felix-Hausdorff-Strasse 3, 17489 Greifswald, Germany; Pharmaceutical Technologies, Chemical and Pharmaceutical Development, Merck KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
| | - Christian Wagner
- Pharmaceutical Technologies, Chemical and Pharmaceutical Development, Merck KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
| | - Holger Kubas
- Pharmaceutical Technologies, Chemical and Pharmaceutical Development, Merck KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
| | - Christian Weber
- Project and Dossier Leadership, Chemical and Pharmaceutical Development, Merck KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
| | - Markus Weigandt
- Pharmaceutical Technologies, Chemical and Pharmaceutical Development, Merck KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
| | - Mirko Koziolek
- Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Felix-Hausdorff-Strasse 3, 17489 Greifswald, Germany
| | - Werner Weitschies
- Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Felix-Hausdorff-Strasse 3, 17489 Greifswald, Germany.
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18
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Abstract
PURPOSE OF REVIEW This review examines the hormonal regulation of gastric emptying, a topic of increasing relevance, given the fact that medications that are analogs of some of these hormones or act as agonists at the hormonal receptors, are used in clinical practice for optimizing metabolic control in the treatment of type 2 diabetes and in obesity. RECENT FINDINGS The major effects on gastric emptying result from actions of incretins, particularly gastric inhibitory polypeptide, glucagon-like peptide-1, and peptide tyrosine-tyrosine, the duodenal and pancreatic hormones, motilin, glucagon, and amylin, and the gastric orexigenic hormones, ghrelin and motilin. All of these hormones delay gastric emptying, except for ghrelin and motilin which accelerate gastric emptying. These effects on gastric emptying parallel the effects of the hormones on satiation (by those retarding emptying) and increase appetite by those that accelerate emptying. Indeed, in addition to the effects of these hormones on hypothalamic appetite centers and glycemic control, there is evidence that some of their biological effects are mediated through actions on the stomach, particularly with the glucagon-like peptide-1 analogs or agonists used in treating obesity. SUMMARY Effects of gastrointestinal hormones on gastric emptying are increasingly recognized as important mediators of satiation and postprandial glycemic control.
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Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, Minnesota, USA
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19
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Parker H, Hoad CL, Tucker E, Costigan C, Marciani L, Gowland P, Fox M. Gastric motor and sensory function in health assessed by magnetic resonance imaging: Establishment of reference intervals for the Nottingham test meal in healthy subjects. Neurogastroenterol Motil 2018; 30:e13463. [PMID: 30216596 DOI: 10.1111/nmo.13463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current investigations of gastric emptying rarely identify the cause of symptoms or provide a definitive diagnosis in patients with dyspepsia. This study assessed gastric function by magnetic resonance imaging (MRI) using the modular "Nottingham test meal" (NTM) in healthy volunteers (HVs). METHODS The NTM comprises (a) 400 mL liquid nutrient (0.75 kcal/mL) labeled with Gadolinium-DOTA and (b) an optional solid component (12 agar-beads [0 kcal]). Filling sensations were documented. MRI measurements of gastric volume, emptying, contraction wave frequency, and secretion were obtained using validated methods. KEY RESULTS Gastric function was measured in a population of 73 HVs stratified for age and sex. NTM induced moderate satiety and fullness. Labeled fluid was observed in the small bowel in all subjects after meal ingestion ("early-phase" GE). Secretion was rapid such that postprandial gastric content volume was often greater than meal volume (GCV0 > 400 mL), and there was increasing dilution of the meal during the study (P < 0.001). Gastric half-time was median 66-minutes (95% reference interval 35 to 161-minutes ["late-phase" GE]). The number of intact agar beads in the stomach was 7/12 (58%) at 60-minutes and 1/12 (8%) at 120-minutes. Age, bodyweight and sex had measurable effects on gastric function; however, these were small compared to inter-individual variation for most metrics. CONCLUSIONS AND INFERENCES Reference intervals are presented for MRI measurements of gastric function assessed for the mixed liquid/solid NTM. Studies in patients will determine which metrics are of clinical value and also whether the reference intervals presented here offer optimal diagnostic sensitivity and specificity.
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Affiliation(s)
- Helen Parker
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline L Hoad
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Emily Tucker
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carolyn Costigan
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Luca Marciani
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Mark Fox
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
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20
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Schneider F, Hoppe M, Koziolek M, Weitschies W. Influence of Postprandial Intragastric Pressures on Drug Release from Gastroretentive Dosage Forms. AAPS PharmSciTech 2018; 19:2843-2850. [PMID: 29845498 DOI: 10.1208/s12249-018-1022-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022] Open
Abstract
Despite extensive research in the field of gastroretentive dosage forms, this "holy grail" of oral drug delivery yet remained an unmet goal. Especially under fasting conditions, the reproducible retention of dosage forms in the stomach seems to be an impossible task. This is why such systems are often advised to be taken together with food. But also the postprandial motility can contribute significantly to the failure of gastroretentive dosage forms. To investigate the influence of postprandial pressure conditions on drug release from such systems, we used a novel in vitro dissolution tool, the dissolution stress test device. With the aid of this device, we simulated three different intragastric pressure profiles that may occur after postprandial intake. These transit scenarios were based on recently obtained, postprandial SmartPill® data. The tested systems, Glumetza® 1000 and Madopar® HBS 125, are marketed dosage forms that are based on different approaches to achieve proper gastric retention. All three transit scenarios revealed a highly pressure-sensitive drug release behavior, for both drugs. For Madopar® HBS 125, nearly complete drug release was observed even after early occurring pressures. Glumetza® 1000 seemed to be more resistant to these, most likely due to incomplete wetting of the system. On the contrary to these findings, data from standard dissolution tests using the paddle apparatus displayed controlled drug release for both systems for about 6 h. Based on these results, it can be doubted that established gastroretentive systems stay intact over a longer period of time, even under postprandial conditions.
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21
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Sohal IS, Cho YK, O'Fallon KS, Gaines P, Demokritou P, Bello D. Dissolution Behavior and Biodurability of Ingested Engineered Nanomaterials in the Gastrointestinal Environment. ACS NANO 2018; 12:8115-8128. [PMID: 30021067 DOI: 10.1021/acsnano.8b02978] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Engineered nanomaterials (ENM) are extensively used as food additives in numerous food products, and at present, little is known about the fate of ingested ENM (iENM) in the gastrointestinal (GI) environment. Here, we investigated the dissolution behavior, biodurability, and persistence of four major iENM (TiO2, SiO2, ZnO, and two Fe2O3) in individual simulated GI fluids (saliva, gastric, and intestinal) and a physiologically relevant digestion cascade (saliva → gastric → intestinal) in the fasted state over physiologically relevant time frames. TiO2 was found to be the most biodurable and persistent iENM in simulated GI fluids with a maximum of only 0.42% (4 μM Ti4+ ion release) dissolution in cascade digestion, followed by iron oxides, of which the rod-like morphology was more biodurable and persistent (0.7% maximum dissolution, 8.7 μM Fe3+) than the acicular one (2.27% maximum dissolution, 16.7 μM Fe3+) in the cascade digestion, respectively. SiO2 and ZnO were less biodurable than Fe2O3, with 65.5% (416 μM Si4+) and 100% (1718.1 μM Zn2+) dissolution in the gastric phase, respectively. In the intestinal phase, however, Si4+ ions reprecipitated, possibly due to sudden pH changes, while ZnO remained completely dissolved. These observations were also confirmed using high-resolution particle size and concentration, and electron microscopy, time-dependent analysis. In terms of decreasing biodurability and persistence in the simulated GI environment, the tested nanomaterials can be ranked as follows: TiO2 ≫ rod-like Fe2O3 > acicular Fe2O3 ≫ SiO2 > ZnO, which is in agreement with limited animal biokinetics data. Chronic uptake of these iENM as particles or ions by the GI tract, especially in the presence of a food matrix and authentic digestive media, and associated implications for human health warrants further investigation.
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Affiliation(s)
| | | | - Kevin S O'Fallon
- Development and Engineering Center , Natick Soldier Research , Natick , Massachusetts 01760 , United States
| | | | - Philip Demokritou
- Department of Environmental Health and the Harvard Center for Nanotechnology and Nanotoxicology, Harvard T. H. Chan School of Public Health , Harvard University , Boston , Massachusetts 02115 , United States
| | - Dhimiter Bello
- Department of Environmental Health and the Harvard Center for Nanotechnology and Nanotoxicology, Harvard T. H. Chan School of Public Health , Harvard University , Boston , Massachusetts 02115 , United States
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22
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Sager M, Jedamzik P, Merdivan S, Grimm M, Schneider F, Kromrey ML, Hasan M, Oswald S, Kühn J, Koziolek M, Weitschies W. Low dose caffeine as a salivary tracer for the determination of gastric water emptying in fed and fasted state: A MRI validation study. Eur J Pharm Biopharm 2018; 127:443-452. [DOI: 10.1016/j.ejpb.2018.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022]
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23
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Keller J, Bassotti G, Clarke J, Dinning P, Fox M, Grover M, Hellström PM, Ke M, Layer P, Malagelada C, Parkman HP, Scott SM, Tack J, Simren M, Törnblom H, Camilleri M. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15:291-308. [PMID: 29622808 PMCID: PMC6646879 DOI: 10.1038/nrgastro.2018.7] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Disturbances of gastric, intestinal and colonic motor and sensory functions affect a large proportion of the population worldwide, impair quality of life and cause considerable health-care costs. Assessment of gastrointestinal motility in these patients can serve to establish diagnosis and to guide therapy. Major advances in diagnostic techniques during the past 5-10 years have led to this update about indications for and selection and performance of currently available tests. As symptoms have poor concordance with gastrointestinal motor dysfunction, clinical motility testing is indicated in patients in whom there is no evidence of causative mucosal or structural diseases such as inflammatory or malignant disease. Transit tests using radiopaque markers, scintigraphy, breath tests and wireless motility capsules are noninvasive. Other tests of gastrointestinal contractility or sensation usually require intubation, typically represent second-line investigations limited to patients with severe symptoms and are performed at only specialized centres. This Consensus Statement details recommended tests as well as useful clinical alternatives for investigation of gastric, small bowel and colonic motility. The article provides recommendations on how to classify gastrointestinal motor disorders on the basis of test results and describes how test results guide treatment decisions.
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Affiliation(s)
- Jutta Keller
- Israelitic Hospital, Academic Hospital University of Hamburg, Orchideenstieg 14, 22297 Hamburg, Germany.,
| | - Gabrio Bassotti
- University of Perugia, Piazza dell’Università, 1, 06121 Perugia, Italy
| | - John Clarke
- Stanford University, 900 Blake Wilbur Dr, Palo Alto, CA 94304, USA
| | - Phil Dinning
- Flinders Medical Centre, GPO Box 2100, Adelaide 5001, Australia
| | - Mark Fox
- University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland, and St. Claraspital, Kleinriehenstrasse 30, 4058 Basel, Switzerland
| | | | - Per M. Hellström
- Uppsala University Hospital, Building 40, SE‑75185, Uppsala, Sweden
| | - Meiyun Ke
- Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Peter Layer
- Israelitic Hospital, Academic Hospital University of Hamburg, Orchideenstieg 14, 22297 Hamburg, Germany
| | - Carolina Malagelada
- University of Barcelona, Passeig de la Vall d’Hebron, 119–129, 08035 Barcelona, Spain
| | - Henry P. Parkman
- Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA
| | - S. Mark Scott
- Queen Mary University of London, The Wingate Institute, 26 Ashfield Street, Whitechapel, London E1 2AJ, UK
| | - Jan Tack
- University Hospital Gasthuisberg, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Magnus Simren
- Sahlgrenska Academy, University of Gothenburg, Blå stråket 5, 41345 Gothenburg, Sweden
| | - Hans Törnblom
- Sahlgrenska Academy, University of Gothenburg, Blå stråket 5, 41345 Gothenburg, Sweden
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24
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Grimm M, Koziolek M, Kühn JP, Weitschies W. Interindividual and intraindividual variability of fasted state gastric fluid volume and gastric emptying of water. Eur J Pharm Biopharm 2018. [PMID: 29522898 DOI: 10.1016/j.ejpb.2018.03.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The amount and composition of gastrointestinal media are crucial parameters in oral drug delivery. In fasted state, variable residual gastric volumes and gastric emptying behavior often cause variable drug release and absorption from oral drug products. Unfortunately, interindividual and intraindividual variability of the gastric conditions in fasted state are currently insufficiently mapped. In this work, datasets from 5 MRI studies with 16 treatments in total were pooled. The interindividual and intraindividual variability of residual gastric volumes after 10 h overnight fasting and the subsequent emptying of 240 mL of water were compared in healthy human subjects under conditions mimicking clinical studies. This work shows that even under standardized clinical conditions, residual gastric volumes and water emptying are highly variable. Interestingly, interindividual and intraindividual variabilities of both parameters were comparable, suggesting that the variability within the studies was mainly resulting from intraindividual day-to-day variations. The mean resting volumes in all conducted investigations amounted to 25 ± 18 mL (n = 120). Furthermore, 85 ± 13% (n = 22) of initially available gastric volume (resting volume plus 240 mL) was emptied after 30 min. The findings of this work will hopefully contribute to a better comprehension of the variability of oral drug release and absorption.
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Affiliation(s)
- Michael Grimm
- Department of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany
| | - Mirko Koziolek
- Department of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Werner Weitschies
- Department of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
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25
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Abstract
In 2001, it was observed that the cardia region of the lumen of the stomach remained highly acidic after a meal and escaped the buffering effect of the food. This phenomenon was termed the acid pocket and is thought to explain why reflux symptoms occur after meals despite the buffering effect of food. This review describes the discovery of the acid pocket and our progress in understanding the intragastric physiology producing it, its exaggeration in hiatus hernia and role in reflux disease. The recent discovery that the acid pocket is attenuated in the Helicobacter pylori-infected population and the significance of this to the negative association between H. pylori and reflux disease and its complications is also addressed. Finally, the role of the acid pocket in providing protection from potentially pathogenic ingested microorganisms is discussed.
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26
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Sager M, Schneider F, Jedamzik P, Wiedmann M, Schremmer E, Koziolek M, Weitschies W. Effect of Coadministered Water on the In Vivo Performance of Oral Formulations Containing N-Acetylcysteine: An In Vitro Approach Using the Dynamic Open Flow-Through Test Apparatus. Mol Pharm 2017; 14:4272-4280. [DOI: 10.1021/acs.molpharmaceut.7b00763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Maximilian Sager
- Department
of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
| | - Felix Schneider
- Department
of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
| | - Philipp Jedamzik
- Department
of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
| | | | | | - Mirko Koziolek
- Department
of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
| | - Werner Weitschies
- Department
of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17487 Greifswald, Germany
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27
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Parker HL, Tucker E, Blackshaw E, Hoad CL, Marciani L, Perkins A, Menne D, Fox M. Clinical assessment of gastric emptying and sensory function utilizing gamma scintigraphy: Establishment of reference intervals for the liquid and solid components of the Nottingham test meal in healthy subjects. Neurogastroenterol Motil 2017; 29. [PMID: 28589661 DOI: 10.1111/nmo.13122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current investigations of stomach function are based on small test meals that do not reliably induce symptoms and analysis techniques that rarely detect clinically relevant dysfunction. This study presents the reference intervals of the modular "Nottingham test meal" (NTM) for assessment of gastric function by gamma scintigraphy (GSc) in a representative population of healthy volunteers (HVs) stratified for age and sex. METHODS The NTM comprises 400 mL liquid nutrient (0.75 kcal/mL) and an optional solid component (12 solid agar-beads (0 kcal). Filling and dyspeptic sensations were documented by 100 mm visual analogue scale (VAS). Gamma scintigraphy parameters that describe early and late phase Gastric emptying (GE) were calculated from validated models. KEY RESULTS Gastric emptying (GE) of the liquid component was measured in 73 HVs (male 34; aged 45±20). The NTM produced normal postprandial fullness (VAS ≥30 in 41/74 subjects). Dyspeptic symptoms were rare (VAS ≥30 in 2/74 subjects). Gastric emptying half-time with the Liquid- and Solid-component -NTM was median 44 (95% reference interval 28-78) minutes and 162 (144-193) minutes, respectively. Gastric accommodation was assessed by the ratio of the liquid-NTM retained in the proximal:total stomach and by Early phase emptying assessed by gastric volume after completing the meal (GCV0). No consistent effect of anthropometric measures on GE parameters was present. CONCLUSIONS AND INFERENCES Reference intervals are presented for GSc measurements of gastric motor and sensory function assessed by the NTM. Studies involving patients are required to determine whether the reference interval range offers optimal diagnostic sensitivity and specificity.
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Affiliation(s)
- H L Parker
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton-On-Tees, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - E Tucker
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - E Blackshaw
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - C L Hoad
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - L Marciani
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Perkins
- Radiological Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D Menne
- Menne Biomed Consulting, Tübingen, Germany
| | - M Fox
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Abdominal Center: Gastroenterology, St. Claraspital, Basel, Switzerland
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28
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Vardar R, Keskin M, Valitova E, Bayrakci B, Yildirim E, Bor S. Effect of alginate in patients with GERD hiatal hernia matters. Dis Esophagus 2017; 30:1-7. [PMID: 28859383 DOI: 10.1093/dote/dox039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
Alginate-based formulations are frequently used as add-on proton pump inhibitor (PPI) therapy to help control of heartburn and regurgitation. There are limited data regarding the mechanisms and effects of alginate-based formulations. We aimed to evaluate the effects of the sodium alginate intake and its likely temporal relations on intraesophageal reflux events by MII-pH in patients with and without hiatal hernia (HH). Fifty GERD patients (18 with HH, 32 without HH) with heartburn or regurgitation once a week or more common were included. After combined multichannel intraluminal impedance and pH-metry (MII-pH) had been performed, all patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g regular yoghurt, and 200 mL water with total energy value of 744 kcal: 37.6% of carbohydrates, 21.2% of proteins, and 41.2% of lipids) during two consecutive days. On separate random two consecutive days, all patients took 10 mL of sodium alginate (GA; Gaviscon Advance; Reckitt Benckiser Healthcare, Hull, UK) or 10 mL of water, 30 minutes after the refluxogenic meal. After eating refluxogenic meal, patients were examined ½ hour for basal conditions, 1 hour in upright, and 1 hour in supine positions. Alginate significantly decreased acid reflux after intake at the first hour in comparison to water in patients with HH (6.1 vs. 13.7, P = 0.004) and without HH (3.5 vs. 5.5, P = 0.001). Weakly acid reflux were increased at the first hour in patients with HH (3.4 vs. 1.3, P = 0.019) and without HH (1.7 vs. 5, P = 0.02) compared to water. There was no distinctive effect of alginate on the height of proximal migration of reflux events in patients with HH and without HH. Alginate decreases acid reflux events within a limited time period, especially at the first hour both in patients with and without HH. Alginate has no effect on the height of reflux events along the esophagus both in patients with and without HH.
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Affiliation(s)
- R Vardar
- Ege University School of Medicine, Division of Gastroenterology.,Ege Reflux Study Group
| | - M Keskin
- Ege Reflux Study Group.,Department of Gastroenterology, Konya Training and Research Hospital, Konya, Turkey
| | - E Valitova
- Ege Reflux Study Group.,Moscow Gastroenterology Research Institute, Moscow, Russia
| | - B Bayrakci
- Ege Reflux Study Group.,Department of Gastroenterology, Karsiyaka State Hospital, Izmir, Turkey
| | - E Yildirim
- Ege University School of Medicine, Division of Gastroenterology.,Ege Reflux Study Group
| | - S Bor
- Ege University School of Medicine, Division of Gastroenterology.,Ege Reflux Study Group
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29
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Nicolas JM, Bouzom F, Hugues C, Ungell AL. Oral drug absorption in pediatrics: the intestinal wall, its developmental changes and current tools for predictions. Biopharm Drug Dispos 2017; 38:209-230. [PMID: 27976409 PMCID: PMC5516238 DOI: 10.1002/bdd.2052] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 12/14/2022]
Abstract
The dissolution, intestinal absorption and presystemic metabolism of a drug depend on its physicochemical characteristics but also on numerous physiological (e.g. gastrointestinal pH, volume, transit time, morphology) and biochemical factors (e.g. luminal enzymes and flora, intestinal wall enzymes and transporters). Over the past decade, evidence has accumulated indicating that these factors may differ in children and adults resulting in age-related changes in drug exposure and drug response. Thus, drug dosage may require adjustment for the pediatric population to ensure the desired therapeutic outcome and to avoid side-effects. Although tremendous progress has been made in understanding the effects of age on intestinal physiology and function, significant knowledge gaps remain. Studying and predicting pharmacokinetics in pediatric patients remains challenging due to ethical concerns associated with clinical trials in this vulnerable population, and because of the paucity of predictive in vitro and in vivo animal assays. This review details the current knowledge related to developmental changes determining intestinal drug absorption and pre-systemic metabolism. Supporting experimental approaches as well as physiologically based pharmacokinetic modeling are also discussed together with their limitations and challenges. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jean-Marie Nicolas
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
| | - François Bouzom
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
| | - Chanteux Hugues
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
| | - Anna-Lena Ungell
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
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30
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Prediction of Ketoconazole absorption using an updated in vitro transfer model coupled to physiologically based pharmacokinetic modelling. Eur J Pharm Sci 2017; 100:42-55. [DOI: 10.1016/j.ejps.2016.12.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 12/29/2022]
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31
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Van Den Abeele J, Rubbens J, Brouwers J, Augustijns P. The dynamic gastric environment and its impact on drug and formulation behaviour. Eur J Pharm Sci 2017; 96:207-231. [DOI: 10.1016/j.ejps.2016.08.060] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 02/08/2023]
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32
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Elder DP, Holm R, Kuentz M. Medicines for Pediatric Patients-Biopharmaceutical, Developmental, and Regulatory Considerations. J Pharm Sci 2016; 106:950-960. [PMID: 28041968 DOI: 10.1016/j.xphs.2016.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 11/24/2016] [Accepted: 12/14/2016] [Indexed: 01/19/2023]
Abstract
This commentary reflects current developments in pediatric medicine. The underpinning legislation in both Europe and the United States has led to the initiation of an increased number of clinical trials in the pediatric population, but there are still a number of outstanding issues within this field. These include the differences in the physiology between adults and the very heterogeneous nature of pediatric patients. There is an ongoing scientific debate on the applicability of a Pediatric Biopharmaceutical Classification System to define when waivers for bioequivalence studies can be supported by in vitro dissolution. However, a challenge is that in vitro models should adequately mimic the physiology of different pediatric age-groups and dose definition is another critical aspect. There is a tendency for off-label use of established adult medicines, resulting in increased adverse events and decreased efficacy in the target population. Recent advances in physiologically based pharmacokinetic modelling may be used to provide valuable input into these discussions, but there are currently still many knowledge gaps. It is encouraging that there is a global recognition of these deficiencies and substantial funding in the field of basic research is being provided, for example, within Europe the Innovative Medicines Initiative consortium.
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Affiliation(s)
- David P Elder
- GlaxoSmithKline, Park Road, Ware, Hertfordshire SG12 0DP, UK
| | - René Holm
- Drug Product Development, Jansen Research & Development, Johnson & Johnson, Turnhoutseweg 30, Beerse B-2340, Belgium
| | - Martin Kuentz
- University of Applied Sciences and Arts Northwestern Switzerland, Institute of Pharmaceutical Technology, Muttenz CH-4132, Switzerland.
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33
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Liu D, Parker HL, Curcic J, Kozerke S, Steingoetter A. Emulsion Stability Modulates Gastric Secretion and Its Mixing with Emulsified Fat in Healthy Adults in a Randomized Magnetic Resonance Imaging Study. J Nutr 2016; 146:2158-2164. [PMID: 27605407 DOI: 10.3945/jn.116.234955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oil-in-water emulsions have recently become of interest to nutritional sciences because of their ability to influence gastrointestinal digestive processes and ultimately benefit human health. MRI offers the potential to noninvasively characterize the interaction between emulsified lipids and gastric secretion within the stomach. OBJECTIVES We determined noninvasively how emulsion stability modulates volumes of fat and secretion, layering of fat, and the mixing of emulsified fat with secretion within the stomach. This required the development of MRI technology for quantifying fat and secretion concentrations inside the stomach. METHODS Twenty-one healthy adults [13 men, mean ± SD age: 22.5 ± 2.5 y, mean ± SD body mass index (in kg/m2): 22.7 ± 1.8] were analyzed in a single-blind, randomized, parallel design. MRI was used to acquire the distributions of fat and secretion in the stomach after ingestion of 2 emulsions: a stable emulsion (E1) or an unstable emulsion (E4) with 20% fat fraction and ∼0.3 mm droplet sizes. Layer, volume, and mixing variables were fitted to the data and compared between the 2 emulsions. RESULTS The intragastric mixing between fat and secretion was better with the E4 than the E1 [increase in content heterogeneity of 17.1% (95% CI: 12.3%, 21.9%)]. The E4 demonstrated a linear relation [slope 1.57 (95% CI: 0.86, 2.29)] between the degree of layering and mixing. In contrast, no such relation was detected for the E1. Accumulated secretion volume in the stomach was lower with the E4 [decrease in volume variable ks of 2.3 (95% CI: -3.9, -0.7)] and correlated with the degree of layering (r = 0.62, P < 0.001). CONCLUSIONS In healthy adults, intragastric fat layering was influenced mainly by the degree of intragastric mixing, rather than the overall dominance of secretion. The E1 triggered a higher accumulation of gastric secretion, which in turn facilitated homogenization of intragastric content in comparison with its unstable counterpart. This trial was registered at clinicaltrials.gov as NCT02602158.
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Affiliation(s)
- Dian Liu
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; and
| | - Helen L Parker
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena Curcic
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; and Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; and
| | - Andreas Steingoetter
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; and Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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34
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Koziolek M, Grimm M, Schneider F, Jedamzik P, Sager M, Kühn JP, Siegmund W, Weitschies W. Navigating the human gastrointestinal tract for oral drug delivery: Uncharted waters and new frontiers. Adv Drug Deliv Rev 2016; 101:75-88. [PMID: 27037063 DOI: 10.1016/j.addr.2016.03.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 02/07/2023]
Abstract
Many concepts of oral drug delivery are based on our comprehension of human gastrointestinal physiology. Unfortunately, we tend to oversimplify the complex interplay between the various physiological factors in the human gut and, in particular, the dynamics of these transit conditions to which oral dosage forms are exposed. Recent advances in spatial and temporal resolution of medical instrumentation as well as improved access to these technologies have facilitated clinical trials to characterize the dynamic processes within the human gastrointestinal tract. These studies have shown that highly relevant parameters such as fluid volumes, dosage form movement, and pH values in the lumen of the upper GI tract are very dynamic. As a result of these new insights into the human gastrointestinal environment, some common concepts and ideas of oral drug delivery are no longer valid and have to be reviewed in order to ensure efficacy and safety of oral drug therapy.
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35
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Shawahna R. Pediatric Biopharmaceutical Classification System: Using Age-Appropriate Initial Gastric Volume. AAPS J 2016; 18:728-36. [PMID: 26935428 PMCID: PMC5256604 DOI: 10.1208/s12248-016-9885-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023] Open
Abstract
Development of optimized pediatric formulations for oral administration can be challenging, time consuming, and financially intensive process. Since its inception, the biopharmaceutical classification system (BCS) has facilitated the development of oral drug formulations destined for adults. At least theoretically, the BCS principles are applied also to pediatrics. A comprehensive age-appropriate BCS has not been fully developed. The objective of this work was to provisionally classify oral drugs listed on the latest World Health Organization's Essential Medicines List for Children into an age-appropriate BCS. A total of 38 orally administered drugs were included in this classification. Dose numbers were calculated using age-appropriate initial gastric volume for neonates, 6-month-old infants, and children aging 1 year through adulthood. Using age-appropriate initial gastric volume and British National Formulary age-specific dosing recommendations in the calculation of dose numbers, the solubility classes shifted from low to high in pediatric subpopulations of 12 years and older for amoxicillin, 5 years, 12 years and older for cephalexin, 9 years and older for chloramphenicol, 3-4 years, 9-11 and 15 years and older for diazepam, 18 years and older (adult) for doxycycline and erythromycin, 8 years and older for phenobarbital, 10 years and older for prednisolone, and 15 years and older for trimethoprim. Pediatric biopharmaceutics are not fully understood where several knowledge gaps have been recently emphasized. The current biowaiver criteria are not suitable for safe application in all pediatric populations.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine & Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- An-Najah BioSciences Unit, Center for Poison Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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36
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Parker HL, Tucker E, Hoad CL, Pal A, Costigan C, Hudders N, Perkins A, Blackshaw E, Gowland P, Marciani L, Fox MR. Development and validation of a large, modular test meal with liquid and solid components for assessment of gastric motor and sensory function by non-invasive imaging. Neurogastroenterol Motil 2016; 28:554-68. [PMID: 26863609 DOI: 10.1111/nmo.12752] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current investigations of stomach function are based on small test meals that do not reliably induce symptoms and analysis techniques that rarely detect clinically relevant dysfunction. This study introduces the large 'Nottingham Test Meal' (NTM) for assessment of gastric motor and sensory function by non-invasive imaging. METHODS NTM comprises 400 mL liquid nutrient (0.75 kcal/mL) and 12 solid agar-beads (0 kcal) with known breaking strength. Gastric fullness and dyspeptic sensations were documented by 100 mm visual analogue scale (VAS). Gastric emptying (GE) were measured in 24 healthy volunteers (HVs) by gastric scintigraphy (GS) and magnetic resonance imaging (MRI). The contribution of secretion to gastric volume was assessed. Parameters that describe GE were calculated from validated models. Inter-observer agreement and reproducibility were assessed. KEY RESULTS NTM produced moderate fullness (VAS ≥30) but no more than mild dyspeptic symptoms (VAS <30) in 24 HVs. Stable binding of meal components to labels in gastric conditions was confirmed. Distinct early and late-phase GE were detected by both modalities. Liquid GE half-time was median 49 (95% CI: 36-62) min and 68 (57-71) min for GS and MRI, respectively. Differences between GS and MRI measurements were explained by the contribution of gastric secretion. Breaking strength for agar-beads was 0.8 N/m(2) such that median 25 (8-50) % intact agar-beads and 65 (47-74) % solid material remained at 120 min on MRI and GS, respectively. Good reproducibility for liquid GE parameters was present and GE was not altered by agar-beads. CONCLUSIONS & INFERENCES The NTM provided an objective assessment of gastric motor and sensory function. The results were reproducible and liquid emptying was not affected by non-nutrient agar-beads. The method is potentially suitable for clinical practice.
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Affiliation(s)
- H L Parker
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - E Tucker
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK
| | - C L Hoad
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - A Pal
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, India
| | - C Costigan
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - N Hudders
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK
| | - A Perkins
- Radiological Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - E Blackshaw
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - P Gowland
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - L Marciani
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - M R Fox
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Department of Gastroenterology, St. Claraspital, Basel, Switzerland
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37
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Gopirajah R, Anandharamakrishnan C. Advancement of Imaging and Modeling Techniques for Understanding Gastric Physical Forces on Food. FOOD ENGINEERING REVIEWS 2016. [DOI: 10.1007/s12393-016-9140-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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38
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Abstract
Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid pocket explained the paradox of acid reflux occurring more frequently in the postprandial period despite intragastric acidity being low due to the buffering effect of the meal. The acid pocket was first described in 2001 when it was detected as an area of low pH immediately distal to the cardia using dual pH electrode pull-through studies 15 minutes after a meal. It was hypothesized that there was a local pocket of acid close to the gastroesophageal junction that escapes the buffering effect of the meal, and that this is the source of postprandial acidic reflux. The presence of the acid pocket has been confirmed in other studies using different techniques including high-resolution pHmetry, Bravo capsule, magnetic resonance imaging, and scintigraphy. This review aims to describe what we know about the acid pocket including its length, volume, fluid constituents, and its relationship to the lower esophageal sphincter and squamocolumnar junction. We will discuss the possible mechanisms that lead to the formation of the acid pocket and examine what differences exist in patients who suffer from acid reflux. Treatments for reflux disease that affect the acid pocket will also be discussed.
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39
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Steingoetter A, Sauter M, Curcic J, Liu D, Menne D, Fried M, Fox M, Schwizer W. Volume, distribution and acidity of gastric secretion on and off proton pump inhibitor treatment: a randomized double-blind controlled study in patients with gastro-esophageal reflux disease (GERD) and healthy subjects. BMC Gastroenterol 2015; 15:111. [PMID: 26328588 PMCID: PMC4557316 DOI: 10.1186/s12876-015-0343-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/27/2015] [Indexed: 12/15/2022] Open
Abstract
Background Postprandial accumulation of gastric secretions in the proximal stomach above the meal adjacent to the esophagogastric junction (EGJ), referred to as the ‘acid pocket’, has been proposed as a pathophysiological factor in gastro-esophageal reflux disease (GERD) and as a target for GERD treatment. This study assessed the effect of proton pump inhibitor (PPI) therapy on the volume, distribution and acidity of gastric secretions in GERD and healthy subjects (HS). Methods A randomized, double blind, cross-over study in 12 HS and 12 GERD patients pre-treated with 40 mg pantoprazole (PPI) or placebo b.i.d. was performed. Postprandial secretion volume (SV), formation of a secretion layer and contact between the layer and the EGJ were quantified by Magnetic Resonance Imaging (MRI). Multi-channel pH-monitoring assessed intragastric pH. Results A distinct layer of undiluted acid secretion was present on top of gastric contents in almost all participants on and off high-dose acid suppression. PPI reduced SV (193 ml to 100 ml, in HS, 227 ml to 94 ml in GERD; p < 0.01) and thickness of the acid layer (26 mm to 7 mm, 36 mm to 9 mm respectively, p < 0.01). No differences in secretion volume or layer thickness were observed between groups; however, off treatment, contact time between the secretion layer and EGJ was 2.6 times longer in GERD compared to HS (p = 0.012). This was not the case on PPI. Conclusions MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal. The secretion volume and the secretion layer on top of gastric contents is similar in GERD patients and HS; however contact between the layer of undiluted secretion and the EGJ is prolonged in patients. High dose PPI reduced secretion volume by about 50 % and reduced contact time between secretion and EGJ towards normal levels. Trial registration NCT01212614. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0343-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Steingoetter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, CH-8092, Zurich, Switzerland.
| | - Matthias Sauter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Jelena Curcic
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Dian Liu
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, CH-8092, Zurich, Switzerland.
| | - Dieter Menne
- Menne Biomed Consulting, Olgastr. 7, D-72074, Tübingen, Germany.
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Werner Schwizer
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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40
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Kar P, Jones KL, Horowitz M, Chapman MJ, Deane AM. Measurement of gastric emptying in the critically ill. Clin Nutr 2015; 34:557-64. [PMID: 25491245 DOI: 10.1016/j.clnu.2014.11.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Enteral nutrition is important in critically ill patients and is usually administered via a nasogastric tube. As gastric emptying is frequently delayed, and this compromises the delivery of nutrient, it is important that the emptying rate can be quantified. METHODS A comprehensive search of MEDLINE/PubMed, of English articles, from inception to 1 July 2014. References of included manuscripts were also examined for additional studies. RESULTS A number of methods are available to measure gastric emptying and these broadly can be categorised as direct- or indirect-test and surrogate assessments. Direct tests necessitate visualisation of the stomach contents during emptying and are unaffected by liver or kidney metabolism. The most frequently used direct modality is scintigraphy, which remains the 'gold standard'. Indirect tests use a marker that is absorbed in the proximal small intestine, so that measurements of the marker, or its metabolite measured in plasma or breath, correlates with gastric emptying. These tests include drug and carbohydrate absorption and isotope breath tests. Gastric residual volumes (GRVs) are used frequently to quantify gastric emptying during nasogastric feeding, but these measurements may be inaccurate and should be regarded as a surrogate measurement. While the inherent limitations of GRVs make them less suitable for research purposes they are often the only technique that is available for clinicians at the bedside. CONCLUSIONS Each of the available techniques has its strength and limitations. Accordingly, the choice of gastric emptying test is dictated by the particular requirement(s) and expertise of the investigator or clinician.
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Affiliation(s)
- Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia; Intensive Care Unit, Royal Adelaide Hospital, South Australia, Australia.
| | - Karen L Jones
- Centre for Research Excellence, University of Adelaide, South Australia, Australia; Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Michael Horowitz
- Centre for Research Excellence, University of Adelaide, South Australia, Australia; Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia; Intensive Care Unit, Royal Adelaide Hospital, South Australia, Australia; Centre for Research Excellence, University of Adelaide, South Australia, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia; Intensive Care Unit, Royal Adelaide Hospital, South Australia, Australia; Centre for Research Excellence, University of Adelaide, South Australia, Australia
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41
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Banerjee S, Dixit S, Fox M, Pal A. Validation of a rapid, semiautomatic image analysis tool for measurement of gastric accommodation and emptying by magnetic resonance imaging. Am J Physiol Gastrointest Liver Physiol 2015; 308:G652-63. [PMID: 25540229 PMCID: PMC4398843 DOI: 10.1152/ajpgi.00095.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 12/22/2014] [Indexed: 01/31/2023]
Abstract
Magnetic resonance imaging (MRI) has advantages for the assessment of gastrointestinal structures and functions; however, processing MRI data is time consuming and this has limited uptake to a few specialist centers. This study introduces a semiautomatic image processing system for rapid analysis of gastrointestinal MRI. For assessment of simpler regions of interest (ROI) such as the stomach, the system generates virtual images along arbitrary planes that intersect the ROI edges in the original images. This generates seed points that are joined automatically to form contours on each adjacent two-dimensional image and reconstructed in three dimensions (3D). An alternative thresholding approach is available for rapid assessment of complex structures like the small intestine. For assessment of dynamic gastrointestinal function, such as gastric accommodation and emptying, the initial 3D reconstruction is used as reference to process adjacent image stacks automatically. This generates four-dimensional (4D) reconstructions of dynamic volume change over time. Compared with manual processing, this semiautomatic system reduced the user input required to analyze a MRI gastric emptying study (estimated 100 vs. 10,000 mouse clicks). This analysis was not subject to variation in volume measurements seen between three human observers. In conclusion, the image processing platform presented processed large volumes of MRI data, such as that produced by gastric accommodation and emptying studies, with minimal user input. 3D and 4D reconstructions of the stomach and, potentially, other gastrointestinal organs are produced faster and more accurately than manual methods. This system will facilitate the application of MRI in gastrointestinal research and clinical practice.
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Affiliation(s)
- Sreerup Banerjee
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India; and
| | - Sudeepa Dixit
- 1Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India; and
| | - Mark Fox
- 2Nottingham Digestive Diseases Centre and Biomedical Research Unit, University Hospital, Nottingham, United Kingdom
| | - Anupam Pal
- 1Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India; and
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42
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Charoo NA, Cristofoletti R, Dressman JB. Risk assessment for extending the Biopharmaceutics Classification System-based biowaiver of immediate release dosage forms of fluconazole in adults to the paediatric population. J Pharm Pharmacol 2015; 67:1156-69. [PMID: 25828546 DOI: 10.1111/jphp.12411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The paediatric population undergoes developmental changes in gastric pH, gastric emptying, intestinal transit time, membrane permeability, protein binding, body water, distribution and metabolism. It is widely recognised that changes in these parameters may result in an alteration of the plasma profile and thus in key bioequivalence parameters such as Cmax (maximum plasma concentration of drug) and area under the plasma concentration vs time profile curve. The aim of this work is to assess the risk of extending the biowaiver for immediate release dosage formulations of fluconazole from the adult to the paediatric population. METHODS AND KEY FINDINGS Fluconazole exhibits good solubility and very rapid dissolution characteristics in various pH media. The absorption of fluconazole in children is known to be complete (over 90%) and not impaired by elevated pH, which is prevalent during the early days of life. Dose numbers calculated using body surface area are less than 1. Therefore, the risk to drug absorption due to differences in gastric pH, gastric emptying, intestinal transit, membrane permeability and metabolising enzymes between adults and children is considered low. CONCLUSIONS Thus, it can be safely concluded that fluconazole meets highly soluble and highly permeable criteria in the paediatric population and can be allocated to class 1 of the Biopharmaceutics Classification System (BCS) for this population as well as in adults. Additionally, fluconazole has an excellent safety profile in children, similar to that in adults. The BCS-based biowaiver claimed in adults can be safely extended to the paediatric population provided that the requirements in excipient selection and dissolution profile comparison using BCS-based dissolution conditions as stated in the biowaiver monograph for fluconazole immediate release dosage forms in adults are fulfilled.
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Affiliation(s)
- Naseem A Charoo
- Department of Research and Development, AlFalah Life Sciences Pvt Ltd, Budgam, India.,Emirates Pharma, Dubai, United Arab Emirates
| | - Rodrigo Cristofoletti
- Division of Therapeutic Equivalence, Brazilian Health Surveillance Agency (ANVISA), Brasilia, Brazil.,Institute of Pharmaceutical Technology, Goethe University, Frankfurt am Main, Germany
| | - Jennifer B Dressman
- Institute of Pharmaceutical Technology, Goethe University, Frankfurt am Main, Germany
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43
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Hoad CL, Parker H, Hudders N, Costigan C, Cox EF, Perkins AC, Blackshaw PE, Marciani L, Spiller RC, Fox MR, Gowland PA. Measurement of gastric meal and secretion volumes using magnetic resonance imaging. Phys Med Biol 2015; 60:1367-83. [PMID: 25592405 PMCID: PMC4502365 DOI: 10.1088/0031-9155/60/3/1367] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
MRI can assess multiple gastric functions without ionizing radiation. However, time consuming image acquisition and analysis of gastric volume data, plus confounding of gastric emptying measurements by gastric secretions mixed with the test meal have limited its use to research centres. This study presents an MRI acquisition protocol and analysis algorithm suitable for the clinical measurement of gastric volume and secretion volume. Reproducibility of gastric volume measurements was assessed using data from 10 healthy volunteers following a liquid test meal with rapid MRI acquisition within one breath-hold and semi-automated analysis. Dilution of the ingested meal with gastric secretion was estimated using a respiratory-triggered T1 mapping protocol. Accuracy of the secretion volume measurements was assessed using data from 24 healthy volunteers following a mixed (liquid/solid) test meal with MRI meal volumes compared to data acquired using gamma scintigraphy (GS) on the same subjects studied on a separate study day. The mean ± SD coefficient of variance between 3 observers for both total gastric contents (including meal, secretions and air) and just the gastric contents (meal and secretion only) was 3 ± 2% at large gastric volumes (>200 ml). Mean ± SD secretion volumes post meal ingestion were 64 ± 51 ml and 110 ± 40 ml at 15 and 75 min, respectively. Comparison with GS meal volumes, showed that MRI meal only volume (after correction for secretion volume) were similar to GS, with a linear regression gradient ± std err of 1.06 ± 0.10 and intercept -11 ± 24 ml. In conclusion, (i) rapid volume acquisition and respiratory triggered T₁ mapping removed the requirement to image during prolonged breath-holds (ii) semi-automatic analysis greatly reduced the time required to derive measurements and (iii) correction for secretion volumes provided accurate assessment of gastric meal volumes and emptying. Together these features provide the scientific basis of a protocol which would be suitable in clinical practice.
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Affiliation(s)
- C L Hoad
- Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, University Park, Nottingham, NG7 2RD UK. NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals Trust and the University of Nottingham, UK
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44
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Jo YJ. Proton pump inhibitors reduce the size and acidity of the gastric Acid pocket. J Neurogastroenterol Motil 2015; 21:133-4. [PMID: 25611065 PMCID: PMC4288095 DOI: 10.5056/jnm14152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/23/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
- Yun Ju Jo
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea
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45
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Moradi S, Akhavan O, Tayyebi A, Rahighi R, Mohammadzadeh M, Saligheh Rad HR. Magnetite/dextran-functionalized graphene oxide nanosheets for in vivo positive contrast magnetic resonance imaging. RSC Adv 2015. [DOI: 10.1039/c5ra03331d] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In vivo positive contrast MRI by magnetite/dextran-functionalized graphene oxide (SPIO-Dex-FGO) as compared to Magnevist® (the right rat).
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Affiliation(s)
- S. Moradi
- Department of Energy Engineering
- Sharif University of Technology
- Tehran
- Iran
| | - O. Akhavan
- Department of Physics
- Sharif University of Technology
- Tehran
- Iran
- Institute for Nanoscience and Nanotechnology
| | - A. Tayyebi
- Department of Energy Engineering
- Sharif University of Technology
- Tehran
- Iran
| | - R. Rahighi
- Department of Physics
- Sharif University of Technology
- Tehran
- Iran
| | - M. Mohammadzadeh
- Department of Energy Engineering
- Sharif University of Technology
- Tehran
- Iran
- Information Communication Technology (ICT) Faculty
| | - H. R. Saligheh Rad
- Department of Medical Physics and Biomedical Engineering
- Tehran University of Medical Sciences
- Tehran
- Iran
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46
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Bharucha AE, Karwoski RA, Fidler J, Holmes DR, Robb RA, Riederer SJ, Zinsmeister AR. Comparison of manual and semiautomated techniques for analyzing gastric volumes with MRI in humans. Am J Physiol Gastrointest Liver Physiol 2014; 307:G582-7. [PMID: 25012844 PMCID: PMC4182289 DOI: 10.1152/ajpgi.00048.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric emptying, accommodation, and motility can be quantified with magnetic resonance imaging (MRI). The first step in image analysis entails segmenting the stomach from surrounding structures, usually by a time-consuming manual process. We have developed a semiautomated process to segment and measure gastric volumes with MRI. Gastric images were acquired with a three-dimensional gradient echo MRI sequence at 5, 10, 20, and 30 min after ingestion of a liquid nutrient (Ensure, 296 ml) labeled with gadolinium in 20 healthy volunteers and 29 patients with dyspeptic symptoms. The agreement between gastric volumes measured by manual segmentation and our new semiautomated algorithm was assessed with Lin's concordance correlation coefficient (CCC) and the Bland Altman test. At 5 min after a meal, food volumes measured by manual (352 ± 4 ml) and semiautomated (346 ± 4 ml) techniques were correlated {CCC[95% confidence interval (CI)] 0.70 (0.52, 0.81)}; air volumes measured by manual (88 ± 6 ml) and semiautomated (84 ± 6 ml) techniques were also correlated [CCC (95% CI) 0.89 (0.82, 0.94)]. Findings were similar at subsequent time points. The Bland Altman test was not significant. The time required for semiautomated segmentation ranged from an average of 204 s for the 5-min images to 233 s for the 20-min images. These times were appreciably smaller than the typical times of many tens of minutes, even hours, required for manual segmentation. To conclude, a semiautomated process can measure gastric food and air volume using MRI with comparable accuracy and far better efficiency than a manual process.
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Affiliation(s)
- Adil E. Bharucha
- 1Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Ronald A. Karwoski
- 2Biomedical Imaging Resource, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Jeff Fidler
- 3Department of Radiology, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - David R. Holmes
- 2Biomedical Imaging Resource, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Richard A. Robb
- 2Biomedical Imaging Resource, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Stephen J. Riederer
- 4MR Research Laboratory, College of Medicine, Mayo Clinic, Rochester, Minnesota; and
| | - Alan R. Zinsmeister
- 5Division of Biostatistics, College of Medicine, Mayo Clinic, Rochester, Minnesota
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47
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Batchelor H. Paediatric biopharmaceutics classification system: Current status and future decisions. Int J Pharm 2014; 469:251-3. [DOI: 10.1016/j.ijpharm.2014.02.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 11/29/2022]
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48
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Sjögren E, Abrahamsson B, Augustijns P, Becker D, Bolger MB, Brewster M, Brouwers J, Flanagan T, Harwood M, Heinen C, Holm R, Juretschke HP, Kubbinga M, Lindahl A, Lukacova V, Münster U, Neuhoff S, Nguyen MA, Peer AV, Reppas C, Hodjegan AR, Tannergren C, Weitschies W, Wilson C, Zane P, Lennernäs H, Langguth P. In vivo methods for drug absorption – Comparative physiologies, model selection, correlations with in vitro methods (IVIVC), and applications for formulation/API/excipient characterization including food effects. Eur J Pharm Sci 2014; 57:99-151. [DOI: 10.1016/j.ejps.2014.02.010] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 01/11/2023]
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49
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Variation in gastric pH may determine kiwifruit's effect on functional GI disorder: an in vitro study. Nutrients 2014; 6:1488-500. [PMID: 24732018 PMCID: PMC4011047 DOI: 10.3390/nu6041488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/24/2014] [Accepted: 03/27/2014] [Indexed: 01/17/2023] Open
Abstract
Consumption of kiwifruit is reported to relieve symptoms of functional gastrointestinal (GI) disorder. The effect may be related to the proteases in kiwifruit. This in vitro study aimed to measure protein hydrolysis due to kiwifruit protease under gastric and duodenal conditions. A sequence of experiments incubated meat protein, with and without kiwifruit, with varying concentrations of pepsin and hydrochloric acid, at 37 °C for 60 min over the pH range 1.3–6.2 to simulate gastric digestion. Duodenal digestion was simulated by a further 120 min incubation at pH 6.4. Protein digestion efficiency was determined by comparing Kjeldahl nitrogen in pre- and post-digests. Where acid and pepsin concentrations were optimal for peptic digestion, hydrolysis was 80% effective and addition of kiwifruit made little difference. When pH was increased to 3.1 and pepsin activity reduced, hydrolysis decreased by 75%; addition of kiwifruit to this milieu more than doubled protein hydrolysis. This in vitro study has shown, when gastric pH is elevated, the addition of kiwifruit can double the rate of hydrolysis of meat protein. This novel finding supports the hypothesis that consumption of kiwifruit with a meal can increase the rate of protein hydrolysis, which may explain how kiwifruit relieves functional GI disorder.
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50
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Kuyumcu S, Menne D, Curcic J, Goetze O, Klebach M, Abrahamse E, Hofman Z, Fried M, Schwizer W, Steingoetter A. Noncoagulating Enteral Formula Can Empty Faster From the Stomach. JPEN J Parenter Enteral Nutr 2014; 39:544-51. [DOI: 10.1177/0148607114528981] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/01/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Sena Kuyumcu
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jelena Curcic
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, Zurich, Switzerland
| | - Oliver Goetze
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Marianne Klebach
- Nutricia Advanced Medical Nutrition, Nutricia Research, Utrecht, the Netherlands
| | - Evan Abrahamse
- Nutricia Advanced Medical Nutrition, Nutricia Research, Utrecht, the Netherlands
| | - Zandrie Hofman
- Nutricia Advanced Medical Nutrition, Nutricia Research, Utrecht, the Netherlands
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Werner Schwizer
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Andreas Steingoetter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, ETH Zurich, Zurich, Switzerland
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