The gastric emptying of food as measured by gamma-scintigraphy and electrical impedance tomography (EIT) and its influence on the gastric emptying of tablets of different dimensions

Analyzing parametric influences driving age-associated changes in absorption using a PBPK-GSA approach

The advanced age population may be susceptible to an increased risk of adverse effects due to increased drug exposure after oral dosing. Factors such as high-interindividual variability and lack of data has led to poor characterization of absorption's role in pharmacokinetic changes in this population. Physiologically based pharmacokinetic (PBPK) models are increasingly being used during the drug development process, as their unique qualities are advantageous in atypical scenarios such as drug-drug interactions or special populations such as older people. Along with relying on various sources of data, auxiliary tools including parameter estimation and sensitivity analysis techniques are employed to support model development and other applications. However, sensitivity analyses have mostly been limited to localized techniques in the majority of reported PBPK models using them. This is disadvantageous, since local sensitivity analyses are unsuitable for risk analysis, which require assessment of parametric interactions and proper coverage of the input space to better estimate and subsequently mitigate the effects of the phenomenon of interest. For this reason, this study seeks to integrate a global sensitivity analysis screening method with PBPK models based in PK-Sim® to characterize the consequences of potential changes in absorption that are often associated with advanced age. The Elementary Effects (Morris) method and visualization of the results are implemented in R and three model drugs representing Biopharmaceutical Classification System classes I-III that are expected to exhibit some sensitivity to three age-associated hypotheses were successfully tested.

Nanoparticles for oral delivery: targeted therapy for inflammatory bowel disease

As a group of chronic and idiopathic gastrointestinal (GI) disorders, inflammatory bowel disease (IBD) is characterized by recurrent intestinal mucosal inflammation. Oral administration is critical for the treatment of IBD. Unfortunately, it is difficult to target the bowel located in the GI tract due to multiple physical barriers. The unique physicochemical properties of nanoparticle-based drug delivery systems (DDSs) and their enhanced permeability and retention effects in the inflamed bowel, render nanomedicines to be used to implement precise drug delivery at diseased sites in IBD therapy. In this review, we described the pathophysiological features of IBD, and designed strategies to exploit these features for intestinal targeting. In addition, we introduced the types of currently developed nano-targeted carriers, including synthetic nanoparticle-based and emerging naturally derived nanoparticles (e.g., extracellular vesicles and plant-derived nanoparticles). Moreover, recent developments in targeted oral nanoparticles for IBD therapy were also highlighted. Finally, we presented challenges associated with nanotechnology and potential directions for future IBD treatment.

Compressive sensing in electrical impedance tomography for breathing monitoring

OBJECTIVE

Electrical impedance tomography (EIT) is a functional imaging technique in which cross-sectional images of structures are reconstructed based on boundary trans-impedance measurements. Continuous functional thorax monitoring using EIT has been extensively researched. Increasing the number of electrodes, number of planes and frame rate may improve clinical decision making. Thus, a limiting factor in high temporal resolution, 3D and fast EIT is the handling of the volume of raw impedance data produced for transmission and its subsequent storage. Owing to the periodicity (i.e. sparsity in frequency domain) of breathing and other physiological variations that may be reflected in EIT boundary measurements, data dimensionality may be reduced efficiently at the time of sampling using compressed sensing techniques. This way, a fewer number of samples may be taken.

APPROACH

Measurements using a 32-electrode, 48-frames-per-second EIT system from 30 neonates were post-processed to simulate random demodulation acquisition method on 2000 frames (each consisting of 544 measurements) for compression ratios (CRs) ranging from 2 to 100. Sparse reconstruction was performed by solving the basis pursuit problem using SPGL1 package. The global impedance data (i.e. sum of all 544 measurements in each frame) was used in the subsequent studies. The signal to noise ratio (SNR) for the entire frequency band (0 Hz-24 Hz) and three local frequency bands were analysed. A breath detection algorithm was applied to traces and the subsequent error-rates were calculated while considering the outcome of the algorithm applied to a down-sampled and linearly interpolated version of the traces as the baseline.

MAIN RESULTS

SNR degradation was generally proportional with CR. The mean degradation for 0 Hz-8 Hz (of interest for the target physiological variations) was below ~15 dB for all CRs. The error-rates in the outcome of the breath detection algorithm in the case of decompressed traces were lower than those associated with the corresponding down-sampled traces for CR  ⩾  25, corresponding to sub-Nyquist rate for breathing frequency. For instance, the mean error-rate associated with CR  =  50 was ~60% lower than that of the corresponding down-sampled traces.

SIGNIFICANCE

To the best of our knowledge, no other study has evaluated the applicability of compressive sensing techniques on raw boundary impedance data in EIT. While further research should be directed at optimising the acquisition and decompression techniques for this application, this contribution serves as the baseline for future efforts.

Effect of psychological stress on gastric motility assessed by electrical bio-impedance

AIM: To evaluate gastric motility using electrical bio-impedance (EBI) and gastric changes as a result of stress induced by psychological tests.

METHODS: A group of 57 healthy women, aged 40-60 years, was recruited, and a clinical history and physical examination were performed. The women were free from severe anxiety, chronic or acute stress, severe depression, mental diseases and conditions that affect gastric activity. The women were evaluated under fasting conditions, and using a four-electrode configuration, the gastric signals were obtained through a BIOPAC MP-150 system. The volunteers were evaluated using the following paradigm: basal state, recording during the Stroop Test, intermediate resting period, recording during the Raven Test, and a final resting period. We analyzed the relative areas of the frequency spectrum: A1 (1-2 cpm), A2 (2-4 cpm), A3 (4-8 cpm), and A4 (8-12 cpm), as well as the median of area A2 + A3. The data were analyzed by an autoregressive method using a Butterworth filter with MatLab and Origin. Analysis of variance (ANOVA) and Friedman ANOVA (for nonparametric variables) were performed; in addition, pairs of groups were compared using the T dependent and Wilcoxon T tests.

RESULTS: The results of the main values of area A2 were not significantly different comparing the five steps of the experimental paradigm. Nevertheless, there was a tendency of this A2 region to decrease during the stress tests, with recuperation at the final resting step. When an extended gastric region was considered (1-4 cpm), significant differences with the psychological stress tests were present (F = 3.85, P = 0.005). The A3 region also showed significant changes when the stress psychological tests were administered (F = 7.25, P < 0.001). These differences were influenced by the changes in the adjacent gastric region of A2. The parameter that we proposed in previous studies for the evaluation of gastric motility by electrical bio-impedance (EBI) was the median of the area under the region from 2 to 8 cpm (A2 + A3). The mean values of these frequencies (median of the A2 + A3 area) with the stress test showed significant changes (F = 5.5, P < 0.001). The results of the Wilcoxon T test for the A4 area parameter, which is influenced by the breathing response, changed significantly during the Raven stress test (P < 0.05).

CONCLUSION: We confirm that the gastric response to acute psychological stress can be evaluated by short-term EBI.

Dissolution testing of oral modified-release dosage forms

Objectives

The in-vivo performance of oral modified-release dosage forms is determined by the interplay of various physiological- and dosage-form-derived parameters. Thus it is often a challenge to predict the in-vivo drug-release behaviour from modified-release dosage forms based solely on in-vitro release rates.

Key findings

For a long time the most common procedure to obtain in-vitro/in-vivo correlations for modified-release formulations was to apply test conditions typically used for quality control on a retrospective basis. Such so-called ‘compendial approaches’ are typically not biorelevant with respect to volumes, composition and physicochemical properties of the test media and also do not take into consideration the mechanical and hydrodynamic forces that may influence dosage-form behaviour during passage through the gastrointestinal tract.

Summary

This review provides an overview of physiological conditions relevant to in-vivo drug release and of dissolution models which, based on current scientific findings on human gastrointestinal physiology, have been developed to enable a better prediction of the in-vivo performance of oral MR dosage forms.

Electrical bioimpedance and other techniques for gastric emptying and motility evaluation

The aim of this article is to identify non-invasive, inexpensive, highly sensitive and accurate techniques for evaluating and diagnosing gastric diseases. In the case of the stomach, there are highly sensitive and specific methods for assessing gastric motility and emptying (GME). However, these methods are invasive, expensive and/or not technically feasible for all clinicians and patients. We present a summary of the most relevant international information on non-invasive methods and techniques for clinically evaluating GME. We particularly emphasize the potential of gastric electrical bioimpedance (EBI). EBI was initially used mainly in gastric emptying studies and was essentially abandoned in favor of techniques such as electrogastrography and the gold standard, scintigraphy. The current research evaluating the utility of gastric EBI either combines this technique with other frequently used techniques or uses new methods for gastric EBI signal analysis. In this context, we discuss our results and those of other researchers who have worked with gastric EBI. In this review article, we present the following topics: (1) a description of the oldest methods and procedures for evaluating GME; (2) an explanation of the methods currently used to evaluate gastric activity; and (3) a perspective on the newest trends and techniques in clinical and research GME methods. We conclude that gastric EBI is a highly effective non-invasive, easy to use and inexpensive technique for assessing GME.

Physiological parameters for oral delivery and in vitro testing

Pharmaceutical solid oral dosage forms must undergo dissolution in the intestinal fluids of the gastrointestinal tract before they can be absorbed and reach the systemic circulation. Therefore, dissolution is a critical part of the drug-delivery process. The rate and extent of drug dissolution and absorption depend on the characteristics of the active ingredient as well as properties of the dosage form. Just as importantly, characteristics of the physiological environment such as buffer species, pH, bile salts, gastric emptying rate, intestinal motility, and hydrodynamics can significantly impact dissolution and absorption. While significant progress has been made since 1970 when the first compendial dissolution test was introduced (USP apparatus 1), current dissolution testing does not take full advantage of the extensive physiologic information that is available. For quality control purposes, where the question is one of lot-to-lot consistency in performance, using nonphysiologic test conditions that match drug and dosage form properties with practical dissolution media and apparatus may be appropriate. However, where in vitro-in vivo correlations are desired, it is logical to consider and utilize knowledge of the in vivo condition. This publication critically reviews the literature that is relevant to oral human drug delivery. Physiologically relevant information must serve as a basis for the design of dissolution test methods and systems that are more representative of the human condition. As in vitro methods advance in their physiological relevance, better in vitro-in vivo correlations will be possible. This will, in turn, lead to in vitro systems that can be utilized to more effectively design dosage forms that have improved and more consistent oral bioperformance.

Gastric emptying of multi-particulate dosage forms

The evidence in the literature for the concept that multi-particulate dosage forms below a specific size empty from the stomach as if they were liquids and hence have the potential to provide the best solution to the formulation of controlled release oral dosage forms, has been considered. There is some evidence that particles less than 1.0mm provide a more rapid response than larger size particles but there is also evidence that this is not always the case and that rapid and reproducible gastric emptying of small particles does not always occur when they are administered. There is strong evidence that food can delay the gastric emptying of multi-particulate systems. Some of the misconception for gastric emptying performance of multi-particulate system is shown to be related to the limitation of the study design and limitation of the way the data is processed. Nevertheless, there is clear evidence that multi-particulate systems can provide effective oral controlled release dosage forms. There is still some way to go with experimental techniques which would allow a definitive answer to the issue of how the variability of the gastric emptying of multi-particulate systems of less than 2.0mm arises.

Colonic treatments and targets: issues and opportunities

The colon provides a plethora of therapeutic opportunities. There are multiple disease targets, drug molecules, and colon-specific delivery systems to be explored. Clinical studies highlight the potential for systemic delivery via the colon, and the emerging data on the levels of cell membrane transporters and metabolic enzymes along the gut could prove advantageous for this. Often efflux transporters and metabolic enzyme levels are lower in the colon, suggesting a potential for improved bioavailability of drug substrates at this site. The locoregional distribution of multiple metabolic enzymes (including cytochromes), efflux transporters (including P-glycoprotein and breast cancer resistance proteins), and influx transporters (including the solute carrier family) along the intestine is summarized. Local delivery to the colonic mucosa remains a valuable therapeutic option. New therapies that target inflammatory mediators could improve the treatment of inflammatory bowel disease, and old and new anticancer molecules could, when delivered topically, prove to be beneficial adjuncts to the current systemic or surgical treatments. New issues such as pharmacogenomics, chronotherapeutics, and the delivery of prebiotics and probiotics are also discussed in this review. Targeting drugs to the colon utilizes various strategies, each with their advantages and flaws. The most promising systems are considered in the light of the physiological data which influence their in vivo behavior.