The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study

BACKGROUND AND AIM

Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients.

METHODS

Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet, were included. The effect of low FODMAP diet was prospectively evaluated using a symptom questionnaire. Furthermore, questions about adherence and satisfaction with symptom improvement, dietary advice and diet were assessed.

RESULTS

Ninety patients with a mean follow up of 15.7 months were studied. Most symptoms including abdominal pain, bloating, flatulence and diarrhoea significantly improved (p < 0.001 for all). 75.6%, 37.8% and 13.3% of patients had fructose, lactose malabsorption or small intestinal bacterial overgrowth respectively. Fructose malabsorption was significantly associated with symptom improvement (abdominal pain odds ratio (OR) 7.09 [95% confidence interval (CI) 2.01-25.0], bloating OR 8.71 (95% CI 2.76-27.5), flatulence OR 7.64 (95% CI 2.53-23.0) and diarrhoea OR 3.39 (95% CI 1.17-9.78), p < 0.029 for all). Most patients (75.6%) were adherent to the diet, which was associated with symptom improvement (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms.

CONCLUSIONS

The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet.

Mathematical model of the lac operon: inducer exclusion, catabolite repression, and diauxic growth on glucose and lactose

A mathematical model of the lactose (lac) operon was developed to study diauxic growth on glucose and lactose. The model includes catabolite repression, inducer exclusion, lactose hydrolysis to glucose and galactose, and synthesis and degradation of allolactose. Two models for catabolite repression were tested: (i) cyclic AMP (cAMP) synthesis inversely correlated with the external glucose concentration and (ii) synthesis inversely correlated with the glucose transport rate. No significant differences in the two models were observed. In addition to synthesis, degradation and secretion of cAMP were also included in the model. Two models for the phosphorylation of the glucose produced from lactose hydrolysis were also tested: (i) phosphorylation by intracellular hexokinase and (ii) secretion of glucose and subsequent phosphorylation upon transport back into the cell. The latter model resulted in weak catabolite repression when the glucose produced from lactose was transported out of the cell, whereas the former model showed no catabolite repression during growth on lactose. Parameter sensitivity analysis indicates the importance of key parameters to lac operon expression and cell growth: the lactose and allolactose transformation rates by beta-galactosidase and the glucose concentrations that affect catabolite repression and inducer exclusion. Large values of the allolactose hydrolysis rate resulted in low concentrations of allolactose, low-level expression of the lac operon, and slow growth due to limited import and metabolism of lactose; small values resulted in a high concentration of allolactose, high-level expression of the lac operon, and slow growth due to a limiting concentration of glucose 6-phosphate formed from allolactose. Changes in the rates of all beta-galactosidase-catalyzed reactions showed similar behavior, but had more drastic effects on the growth rate. Changes in the glucose concentration that inhibited lactose transport could extend or contract the diauxic growth period during growth in the presence of glucose and lactose. Moreover, changes in the glucose concentration that affected catabolite repression affected the cAMP levels and lac operon expression, but had a lesser effect on the growth rate.

Enteric coated HPMC capsules designed to achieve intestinal targeting

The enteric coating of HPMC capsules containing paracetamol was investigated. Two enteric polymers, Eudragit L 30 D-55 and Eudragit FS 30 D were studied, which are designed to achieve enteric properties and colonic release, respectively. The capsules were coated in an Accela Cota 10, and, as shown by optical microscopy, resulted in capsules with a uniform coating. Scanning electron microscopy of the surface of the capsules illustrate that, in contrast to gelatin, HPMC has a rough surface, which provides for good adhesion to the coating. Dissolution studies demonstrated that capsules coated with Eudragit L 30 D-55 were gastro resistant for 2 h at pH 1.2 and capsules coated with Eudragit FS 30 D were resistant for a further 1 h at pH 6.8. The product visualisation technique of gamma scintigraphy was used to establish the in vivo disintegration properties of capsules coated with 8 mg cm(-2) Eudragit L 30 D-55 and 6 mg cm(-2) Eudragit FS 30 D. For HPMC units coated with Eudragit L 30 D-55, complete disintegration occurred predominately in the small bowel in an average time of 2.4 h post dose. For HPMC capsules coated with Eudragit FS 30 D, complete disintegration did not occur until the distal small intestine and proximal colon in an average time of 6.9 h post dose.

Swelling of hydroxypropyl methylcellulose matrix tablets. 2. Mechanistic study of the influence of formulation variables on matrix performance and drug release

We characterized the effect of hydroxypropyl methylcellulose (HPMC)/lactose ratio and HPMC viscosity grade (molecular weight) on solute release and swelling of matrix tablets. We used a semiquantitative optical imaging method to monitor the swelling of matrices with HPMC content from 20% to 80% (w/w) and four viscosity grades. Several aspects of the swelling process common to all formulations were revealed: (i) swelling is anisotropic with a preferential expansion in the axial direction, (ii) swelling is isotropic with respect to the gel layer thickness and composition in both axial and radial directions, (iii) the gel layer develops in three stages, and (iv) water penetration is Fickian in nature and essentially constant for all formulations. We monitored simultaneously drug, lactose, and HPMC release. Lactose and drug release rates were superimposed, indicating a similar diffusional release mechanism and no interaction with HPMC. The strong dependence of HPMC release on viscosity grade is explained on the basis of the concept of polymer disentanglement concentration. We analyzed drug release rates using a model for a reservoir-type release system that incorporates swelling kinetics. HPMC/lactose ratio modulates drug release rate by altering drug diffusivity, a function of gel composition. In contrast, HPMC viscosity grade impacts matrix dissolution and gel layer thickness development below a critical molecular weight. For slowly dissolving matrices containing high viscosity grade (> 4000 cps) HPMC, similar drug release rates are observed mainly due to the same drug diffusivity as a result of the identical gel composition and thickness. For fast dissolving matrices (< or = 100 cps) swelling inhomogeneity is proposed as being responsible for a higher apparent drug diffusivity and release rate.

Optimisation of floating matrix tablets and evaluation of their gastric residence time

The present investigation concerns the development of the floating matrix tablets, which after oral administration are designed to prolong the gastric residence time, increase the drug bioavailability and diminish the side effects of irritating drugs. The importance of the composition optimisation, the technological process development for the preparation of the floating tablets with a high dose of freely soluble drug and characterisation of those tablets (crushing force, floating properties in vitro and in vivo, drug release) was examined. Tablets containing hydroxypropyl methylcellulose (HPMC), drug and different additives were compressed. The investigation shows that tablet composition and mechanical strength have the greatest influence on the floating properties and drug release. With the incorporation of a gas-generating agent together with microcrystalline cellulose, besides optimum floating (floating lag time, 30 s; duration of floating, >8 h), the drug content was also increased. The drug release from those tablets was sufficiently sustained (more than 8 h) and non-Fickian transport of the drug from tablets was confirmed. Radiological evidence suggests that, that the formulated tablets did not adhere to the stomach mucus and that the mean gastric residence time was prolonged (>4 h).

Intestinal permeability in relation to birth weight and gestational and postnatal age

OBJECTIVE

To determine the relation between intestinal permeability and birth weight, gestational age, postnatal age, and perinatal risk factors in neonates.

STUDY DESIGN

Intestinal permeability was measured by the sugar absorption test within two days of birth and three to six days later in preterm and healthy term infants. In the sugar absorption test, the urinary lactulose/mannitol ratio is measured after oral ingestion of a solution (375 mosm) of lactulose and mannitol.

RESULTS

A first sugar absorption test was performed in 116 preterm (26-36 weeks gestation) and 16 term infants. A second test was performed in 102 preterm and nine term infants. In the preterm infants, the lactulose/mannitol ratio was not related to gestational age (r = -0.09, p = 0.32) or birth weight (r = 0.07, p = 0.43). The median lactulose/mannitol ratio was higher if measured less than two days after birth than when measured three to six days later (0.427 and 0.182 respectively, p<0.001). The lactulose/mannitol ratio was higher in preterm infants than term infants if measured within the first 2 days of life (0.404 and 0.170 respectively, p < 0.001), but not different three to six days later (0.182 and 0.123 respectively, p = 0.08). In multiple regression analysis of perinatal risk factors, only umbilical arterial pH correlated with the lactulose/mannitol ratio in preterm infants less than 2 days of age (T = -1.98, p = 0.05).

CONCLUSIONS

In preterm infants (26-36 weeks gestation), intestinal permeability is not related to gestational age or birth weight but is higher during the first 2 days of life than three to six days later. It is higher in preterm infants than in healthy term infants only if measured within two days of birth. This suggests rapid postnatal adaptation of the small intestine in preterm infants.

Kefir improves lactose digestion and tolerance in adults with lactose maldigestion

OBJECTIVE

Kefir is a fermented milk beverage that contains different cultures than yogurt. The objective of this study was to determine whether kefir improves lactose digestion and tolerance in adults with lactose maldigestion.

DESIGN

Randomized block design.

SUBJECTS

Fifteen healthy, free-living adults with lactose maldigestion.

MAIN OUTCOME MEASURES

Breath hydrogen excretion and lactose intolerance symptoms were monitored hourly for 8 hours after each test meal.

INTERVENTION

Subjects were fed test meals consisting of 20 g lactose portions of milk (2% reduced fat), plain and raspberry flavored kefir, and plain and raspberry flavored yogurt, each following an overnight (12 hour) fast.

STATISTICAL ANALYSIS

Mixed model ANOVA was performed on raw or transformed data, followed by Tukey HSD post hoc tests (when appropriate). Significance was defined as P<.05.

RESULTS

The breath hydrogen area under the curve (AUC) for milk (224+/-39 ppm x h) was significantly greater than for the plain yogurt (76+/-14 ppm x h, P<.001), the plain kefir (87+/-37 ppm x h, P<.001), and the flavored yogurt (76+/-14 ppm x h, P=.005). The flavored kefir had an intermediate response (156+/-26 ppm x h). The yogurts and kefirs all similarly reduced the perceived severity of flatulence by 54% to 71% relative to milk. Abdominal pain and diarrhea symptoms were negligible among the five treatments.

APPLICATIONS/CONCLUSION

Because kefir improved lactose digestion and tolerance in this study, its use may be another potential strategy for overcoming lactose intolerance. Further studies of other types of kefir for improving lactose digestion are warranted.

Global transcriptional analysis of Streptococcus mutans sugar transporters using microarrays

The transport of carbohydrates by Streptococcus mutans is accomplished by the phosphoenolpyruvate-phosphotransferase system (PTS) and ATP-binding cassette (ABC) transporters. To undertake a global transcriptional analysis of all S. mutans sugar transporters simultaneously, we used a whole-genome expression microarray. Global transcription profiles of S. mutans UA159 were determined for several monosaccharides (glucose, fructose, galactose, and mannose), disaccharides (sucrose, lactose, maltose, and trehalose), a beta-glucoside (cellobiose), oligosaccharides (raffinose, stachyose, and maltotriose), and a sugar alcohol (mannitol). The results revealed that PTSs were responsible for transport of monosaccharides, disaccharides, beta-glucosides, and sugar alcohol. Six PTSs were transcribed only if a specific sugar was present in the growth medium; thus, they were regulated at the transcriptional level. These included transporters for fructose, lactose, cellobiose, and trehalose and two transporters for mannitol. Three PTSs were repressed under all conditions tested. Interestingly, five PTSs were always highly expressed regardless of the sugar source used, presumably suggesting their availability for immediate uptake of most common dietary sugars (glucose, fructose, maltose, and sucrose). The ABC transporters were found to be specific for oligosaccharides, raffinose, stachyose, and isomaltosaccharides. Compared to the PTSs, the ABC transporters showed higher transcription under several tested conditions, suggesting that they might be transporting multiple substrates.

Once-daily propranolol extended-release tablet dosage form: formulation design and in vitro/in vivo investigation

The purpose of this study was to develop and optimize the propranolol once-daily extended release formulations containing HPMC, Microcrystalline cellulose (MCC) and lactose. In vitro studies, the response surface methodology and multiple response optimization utilizing the polynomial equation were used to search for the optimal formulation with specific release rate at different time intervals. The constrained mixture experimental design was used to prepare systematic model formulations, which were composed of three formulation variables: the content of HPMC (X(1)) MCC (X(2)) and lactose (X(3)). The drug release percent at 1.5, 4, 8, 14 and 24 h were the target responses and were restricted to 15-30, 35-55, 55-75, 75-90 and 90-110%, respectively. The results showed that the optimized formulation provided a dissolution pattern equivalent to the predicted curve, which indicated that the optimal formulation could be obtained using response surface methodology. The mechanism of drug release from HMPC matrix tablets followed non-Fickian diffusion. In the vivo study, the MRT was prolonged for matrix tablets when compared with commercial immediate release tablets. Furthermore, a linear relationship between in vitro dissolution and in vivo absorption was observed in the beagle dogs.

Finite element study of nutrient diffusion in the human intervertebral disc

STUDY DESIGN

The diffusion of small nutrients in the intervertebral human disc was examined using a finite element model.

OBJECTIVE

To investigate nutrient transport into the disc using a numerical approach.

SUMMARY OF BACKGROUND DATA

The intervertebral disc is the largest avascular tissue in the body. Nutrients necessary for cellular survival diffuse from the blood supply around the disc margins to the cells. Limited analytical studies have been performed and compared with measurements. However, the studies have only considered supply through the center of the nucleus and have only examined single solutes. A more sophisticated model is required to investigate the solute supply.

MATERIALS AND METHODS

An axisymmetric finite element model has been created to study the transport of three solutes, i.e., oxygen, glucose, and lactate, using nonlinear consumption-concentration and production-concentration rates. For each of them, data for the consumption/production rate, diffusivity, and concentration in the blood were taken from experimental measurements and used in the model. The effect of varying disc height, exchange area with the blood supply, solute consumption rates, and diffusivities was investigated.

RESULTS

The model predicted that concentrations of oxygen and glucose, which are consumed by cells, fell towards the disc center. Concentration levels decreased with a decrease in fractional exchange area and diffusivity, or with an increase in disc height and consumption rate. In contrast, the concentration of lactate, produced by the cells, was highest in the center and fell towards the disc-blood vessel interface. The absolute values of concentrations were in agreement with available measurements in vivo and those computed by few available analytical models, indicating the reliability of the finite element simulations.

CONCLUSIONS

Finite element methods can be used to predict concentration gradients of solutes throughout the disc in relation to changes in disc and endplate morphology, disc properties, and cellular activities. This study provides a foundation for investigating the effect of load-induced changes or effects of changes in cellular metabolism on disc nutritional supply.

Biocompatibility of lipid-protein-sugar particles containing bupivacaine in the epineurium

Novel lipid-protein-sugar particles (LPSPs) are potentially biocompatible because they are composed of naturally occurring ingredients and their expected tissue dwell times are relatively short. In this research, we used histological sections to study tissue reaction to LPSPs (4.4-microm median diameter) when used for sciatic nerve block in the rat. As a reference, we compared LPSPs to 60-microm median diameter poly(lactic-co-glycolic) acid (PLGA) microspheres (110,000 MW PLGA, glycolic/lactic ratio 65:35). Four days after injection, both particle types produced acute inflammation within the confines of the injectate, inflammation in adjacent tissues, and myotoxicity. Bupivacaine-free particles did not display myotoxicity, and inflammation in adjacent tissues was reduced. At 2 weeks, inflammation from LPSPs had almost disappeared, whereas PLGA microspheres had a foreign-body giant cell reaction until at least 8 weeks after injection. In contrast, 3.6-microm median diameter, 20,000-MW PLGA microspheres produced a primarily histiocytic reaction 2 weeks after injection. In summary, the LPSPs and PLGA microspheres studied herein have excellent biocompatibility, but tissue reaction to the former is of much shorter duration. Myotoxicity and inflammation of surrounding tissue is largely attributed to bupivacaine. Foreign-body giant cells may be attributed to particle size rather than a specific reaction to PLGA.

In vitro evaluation of pectin-HPMC compression coated 5-aminosalicylic acid tablets for colonic delivery

In this study, we report pectin-HPMC compression coated core tablets of 5-aminosalicylic acid (5-ASA) for colonic delivery. Each 100 mg core tablet contained 5-ASA and was compression coated at 20 kN or 30 kN using 100% pectin, 80% pectin-20% HPMC, or 60% pectin-40% HPMC, at two different coat weights as 400 or 500 mg. Drug dissolution/system erosion/degradation studies were carried out in pH 1.2 and 6.8 buffers using a pectinolytic enzyme. The system was designed based on the gastrointestinal transit time concept, under the assumption of colon arrival times of 6 h. It was found that pectin alone was not sufficient to protect the core tablets and HPMC addition was required to control the solubility of pectin. The optimum HPMC concentration was 20% and such system would protect the cores up to 6 h that corresponded to 25-35% erosion and after that under the influence of pectinase the system would degrade faster and delivering 5-ASA to the colon. The pectin-HPMC envelope was found to be a promising drug delivery system for those drugs to be delivered to the colon.

Drug release from tableted wet granulations comprising cellulosic (HPMC or HPC) and hydrophobic component

The effects of component nature, proportion and processing on the release rate and mechanism were investigated for tablets comprising drug, cellulosic polymer and hydrophobic components. Four drugs differing in solubility (diclofenac sodium, ibuprofen, naproxen and indomethacin), two cellulosic polymers (HPC and HPMC) and hydrophobic Emvelop were used in two levels of mass fraction and weight ratio of drug:carrier and of cellulosic-hydrophobic component. Compression was applied after granulation or physical mixing. Drug release was evaluated in pH 6.5 phosphate buffer BP and elucidation of the release mechanism was attempted by fitting kinetic models. Statistical significance of the effects of formulation variables on the release rate and mechanism expressed by the coefficient, k, and exponent, n, of the power law kinetic model, respectively, was evaluated by ANOVA. It was found that for the release mechanism most significant is the effect of drug solubility followed by cellulosic polymer type, mixing procedure and drug mass fraction. Significant interaction between drug solubility and type of cellulosic polymer indicated that alteration in the swelling of HPMC and HPC is caused by the drug solubility. Weight ratio of cellulosic-hydrophobic component does not affect the release mechanism, but only the release rate. Similarly, for the release rate most significant was found the effect of drug solubility, followed by cellulosic polymer type, weight ratio of cellulosic-hydrophobic component, mixing method and drug mass fraction. Also significant were the interactions of drug solubility with the type and proportion of the cellulosic polymer and the processing applied. Depending on the drug solubility and type of polymer present, wet granulation can increase or decrease the release rate.

Influence of water soluble fillers in hydroxypropylmethylcellulose matrices on in vitro and in vivo drug release

The purpose of this study was to investigate the effect of fillers in gel-forming matrix on in vivo drug release after oral dosing. A further purpose was to predict the in vivo performance from in vitro dissolution test. Three controlled-release acetaminophen tablets containing hydroxypropylmethylcellulose (HPMC) with or without highly water soluble fillers, lactose or polyethylene glycol 6000 (PEG6000), were prepared. Water penetration into the matrix was enhanced by addition of fillers in the matrices, but the three tablets showed similar in vitro dissolution profiles, indicating that fillers in the HPMC matrices little affected the in vitro drug release. In contrast, the fillers in HPMC matrices did affect the in vivo performance in dogs. The absorption profile of HPMC matrix with PEG6000 was the fastest, followed by that with lactose and without water soluble filler, in that order. As the matrix with PEG6000 had a large amount of water and gelated a large portion of the matrix when in contact with water, the gel layer would be disintegrated by the gastrointestinal motility. It was found that dissolution of gel-forming HPMC matrices under mechanical stress by glass beads well correlated with the in vivo performance of the matrix, with little correlation by the conventional paddle method.

Effects of excipients on hydrate formation in wet masses containing theophylline

Transformations between solid phases in dosage forms can lead to instability in drug release. Thus, it is important to understand mechanisms and kinetics of phase transformations and factors that may influence them. During wet granulation theophylline shows pseudopolymorphic changes that may alter its dissolution rate. The aim of this study was to investigate whether excipients, such as alpha-lactose monohydrate or the highly water absorbing silicified microcrystalline cellulose (SMCC) can influence the hydrate formation of theophylline. In particular, the aim was to study if SMCC offers protection against the formation of theophylline monohydrate relative to alpha-lactose monohydrate in wet masses after an overnight equilibration and the stability of final granules during controlled storage. In addition, the aim was to study the use of spectroscopic methods to identify hydrate formation in the formulations containing excipients. Off-line evaluation of materials was performed using X-ray powder diffractometry, near infrared and Raman spectroscopy. alpha-Lactose monohydrate with minimal water absorbing potential was not able to prevent but enhanced hydrate formation of theophylline. Even though SMCC is able to take large amounts of water into its internal structure, it was able to inhibit the formation of theophylline monohydrate only at low moisture contents, not at the amounts of water needed to form granules. Both the spectroscopic methods used could identify the hydrate formation even though there were excipients in the formulation.

Effect of hydroxypropylmethylcellulose (HPMC) on the release profiles and bioavailability of a poorly water-soluble drug from tablets prepared using macrogol and HPMC

The aim of the present study was to investigate the effect of hydroxypropylmethylcellulose (HPMC-2208), used as an excipient for controlled release of drug, on the release profiles and bioavailability of the poorly water-soluble nifedipine (NP) from a tablet prepared using macrogol 6000 (PEG) and HPMC. The crushing tolerance of the NP tablet prepared using PEG and HPMC (NP-PEG-HPMC tablet) was markedly increased with increasing compression force used during the preparation from 20 to 200 MPa. The values reached their maximal levels (approximately 13 kg for the NP-PEG-HPMC tablet and 8 kg for the PEG tablet) at the compression force of 100 MPa. Although NP is a poorly water-soluble drug, it was rapidly dissolved from the NP-PEG tablet (without HPMC) due to the improvement of its dissolution rate in the presence of PEG. NP dissolution was complete at the latest within 1 h. On the other hand, dissolution of NP from the NP-PEG-HPMC tablet was significantly delayed with an increase in the concentration of HPMC in the tablet. The dissolution of NP from the NP-PEG-HPMC tablet containing 50% HPMC-2208 was markedly delayed as the viscosity of HPMC also increased. Interestingly, the same peak plasma NP concentration (C(max)) and the area under the plasma NP concentration-time curve (AUC(0-10)) were observed for both the NP-PEG tablet and NP-PEG-HPMC tablets, however, the time to C(max) (t(max)) for the NP-PEG-HPMC tablet was significantly higher when the NP-PEG-HPMC tablet was orally administered to rabbits. We describe here a preparation method of a new sustained-release NP-PEG-HPMC tablet using a mixture of NP-PEG granules (prepared with PEG) and HPMC.

The effect of carrier surface and bulk properties on drug particle detachment from crystalline lactose carrier particles during inhalation, as function of carrier payload and mixing time

The effect of carrier payload and mixing time on the redispersion of drug particles from adhesive mixtures during inhalation for two different drugs (budesonide and disodium cromoglycate) has been investigated. A special test inhaler which retains carrier crystals during inhalation was used at 30 and 60 l/min. The special inhaler enabled the analysis of residual drug on the carrier yielding so called carrier residue (CR) values. Mixtures with carrier size fractions of 32-45; 150-200 and 250-355 microm, derived from marketed lactose brands, with increasing carrier payload (0.4-6.0% w/w of drug) were prepared. It was found that with increasing carrier payload, the CR increases for the coarse carrier fraction, decreases for the fine fraction and remains roughly constant for the intermediate fraction at 30 l/min. At 60 l/min, the CR decreased for all carrier fractions with increasing payload. The effect of powder bulk properties on the adhesive forces between drug and carrier (during mixing) as well as changes in the balance between adhesion and separation forces (during inhalation) explain the results found. An improved understanding of the different effects is obtained through the recently introduced force distribution concept. The ratio of (mean) separation force to (mean) adhesion force increases with the flow rate. The adhesive forces (during mixing) increase with increasing carrier diameter (higher press-on and kneading forces) and longer mixing time.

Different HPMC viscosity grades as coating agents for an oral time and/or site-controlled delivery system: a study on process parameters and in vitro performances

Currently, delayed/pulsatile release and colon delivery represent topics of remarkable interest. The present paper deals with the study and development of an oral dosage form devised to release drugs following a programmed time period after administration or, when opportune design modifications are introduced, to target the colon. The system is composed of a drug-containing core and a hydrophilic swellable polymeric coating capable of delaying drug release through slow interaction with aqueous fluids. An optional external gastroresistant film is applied to overcome gastric emptying variability, thus allowing colon delivery to be pursued according to the time-dependent approach. The aim of this work was to evaluate different hydroxypropyl methylcellulose (HPMC) viscosity grades as possible materials for the attainment of the system retarding hydrophilic layer. Both the relevant suitability for application onto tablet cores by aqueous spray-coating in fluid bed and capability of delaying drug release for a programmable period were explored and compared. Methocel E50 was found to afford the best balance among different important items, i.e. process time, retarding ability, dimensions of the coated units and possibility of finely tuning the delay duration. Further results pointed out the robustness of Methocel E50-based systems, which have shown to be practically unaffected by the concentration of the employed coating solution and the pH of the release medium, as well as only poorly influenced by ionic strength, at least with regard to values encompassed in the physiological range for gastrointestinal fluids.

Gastrointestinal dysfunction and disaccharide intolerance in children infected with human immunodeficiency virus

Because gastrointestinal dysfunction is a major problem in children with human immunodeficiency virus (HIV) infection, we utilized breath hydrogen measurements to determine the relationship between disaccharide malabsorption and gastrointestinal dysfunction in HIV-infected children. We found a strong association between lactose intolerance and persistent diarrheal disease in this population (p less than 0.007, Mann-Whitney U test). We also found evidence of sucrose malabsorption and persistent diarrheal disease in three of the children. Extensive microbiologic evaluations failed to reveal an etiologic agent related to the occurrence of gastrointestinal symptoms. Our findings indicate that disaccharide intolerance is a common occurrence in HIV-infected children with persistent diarrheal disease. Careful attention to dietary intake may be required to ameliorate clinical symptoms and to maintain adequate nutrition.

Influence of changes in lactase activity and small-intestinal mucosal growth on lactose digestion and absorption in preterm infants

BACKGROUND

Feeding intolerance (ie, achieving and maintaining full enteral feedings) is a significant problem in preterm infants. A relation exists between feeding intolerance and incomplete lactose digestion.

OBJECTIVES

We sought to identify the factors relating to lactose digestion and absorption, lactase activity, and small-intestinal mucosal growth.

DESIGN

Lactose digestion and absorption, lactase-specific activity, and lumen-to-mucosa water flux as a measure of small-intestinal mucosal surface area were determined by using the triple-lumen perfusion technique on 2 occasions 3 wk apart in 10 preterm infants (x+/-SEM gestational age: 28.0+/-0.2 wk).

RESULTS

Lactose digestion and absorption and lactase activity doubled between studies (P=0.035 and P=0.041, respectively). The change in digestion and absorption was related to lactase activity (P=0.034, R2=0.38). Lactase activity correlated with gestational age at birth (P=0.012, R2=0.51). The number of days of feeding explained 80% of the variability in small-intestinal mucosal surface area (P=0.001).

CONCLUSIONS

To our knowledge, this is the first study to measure directly lactose digestion and absorption, lactase activity, and small-intestinal surface area in preterm infants. Changes in lactose absorption relate primarily to lactase activity rather than to mucosal growth. We showed directly a relation between enteral feeding and small-intestinal mucosal growth.

NMR imaging investigations of drug delivery devices using a flow-through USP dissolution apparatus

A system for performing NMR imaging experiments on drug delivery devices within a flow-through dissolution apparatus, USP Apparatus 4, has been developed. The system was used to image the physical changes that occur in solid dosage forms during dissolution in the flow-through apparatus. Simultaneous cumulative drug release measurements were also made. The NMR images obtained under these conditions and the drug release data provide a better understanding of the processes involved in the release of drugs from drug delivery systems based on diffusion, dissolution and osmosis mechanisms.

Effect of lactic acid bacteria on the intestinal production of lactate and short-chain fatty acids, and the absorption of lactose

The characteristic fermentation pattern seen with specific saccharides in incubations with pure cultures of Lactobacillus acidophilus and Bifidobacterium bifidum disappeared when incubated in 16.7% fecal homogenate. The productions of lactate and short-chain fatty acids in mixed bacterial-fecal incubations were similar to productions in fecal homogenates without L acidophilus and B bifidum and were mainly associated with the specific mono-, di-, and polysaccharides added to the incubate. B bifidum was cultured from ileostomic contents in eight of nine ileostomists after oral administration (2.4 x 10(10) cells), but did not influence the concentrations and productions of DL-lactate and short-chain fatty acids in the ileostomic outputs and incubates. Large amounts of ingested lactic acid bacteria (4.2 x 10(10) cells) did not ameliorate lactose malabsorption measured by the breath-hydrogen test in 12 lactose malabsorbers. This study shows that ingested lactic acid bacteria are indeed present in the colon, but it does not support the theory that they change the pattern of colonic fermentation or the degree of intestinal lactose malabsorption.

Pulmonary deposition of lactose carriers used in inhalation powders

Dry powder dosage forms are generally formulated by mixing the micronized drug particles with the larger carrier particles. Lactose is a commonly used carrier. Carriers enhance the flowability of powder mixtures and therefore enable low dosing of active substances. During inhalation, the drug particles are dispersed from the surface of carrier particles. The aim of this study was to compare how different qualities of 99mTc-labelled lactose carrier systems deposit in the lungs. The sizes of the labelled and unlabelled alpha-lactose monohydrate particles were compared by using a laser diffraction method. Distribution of radiolabel between different particle size fractions was determined using the Andersen cascade impactor. The in vivo depositions of lactose carrier systems were investigated in ten healthy men using the technique of gammascintigraphy. In addition, redispersion of budesonide from the carrier materials was evaluated by using the Andersen cascade impactor. According to the validation data the particle size of the lactose carriers remained unchanged during the labelling process. Low pulmonary deposition varying between 2.5 and 3.3% was detected. Only a small amount of lactose was deposited in the lungs, thus pulmonary deposition is not a limiting factor for lactose selection. According to in vitro redispersion data the fine particle fraction of the delivered dose in the impactor varied between 10.3 and 26.0%. Thus, the redispersion of the budesonide particles can be altered by the properties of the carrier system.

Hot-melt extruded ethylcellulose cylinders containing a HPMC–Gelucire® core for sustained drug delivery

The objective of the study was to develop a sustained release system consisting of a hot-melt extruded ethylcellulose pipe surrounding a drug-containing hydroxypropyl methylcellulose (HPMC)-Gelucire 44/14 core, yielding a monolithic matrix system applicable in the domain of sustained drug release. The influence of HPMC substitution type and viscosity grade was investigated through dissolution testing and erosion studies. All sustained release systems showed a nearly constant drug release profile with only 40% of the drug released after 24 h. To achieve complete drug release after 24 h, the core formulation and the dimensions of the hollow pipe were modified. Changing the composition of the core did not result in the intended zero-order drug release. Shortening the length of the ethylcellulose cylinder accelerated drug release, while modifying the diameter did not affect the drug release rate. The drug dissolution profile and the release mechanism were independent of drug solubility. Increasing the drug loading caused a small increase of the drug release rate, but did not alter the release mechanism.

Lactosaminated and intact N-succinyl-chitosans as drug carriers in liver metastasis

The biodistributions of fluorescently labeled N-succinyl-chitosan (Suc-FTC) and lactosaminated N-succinyl-chitosan (Lac-Suc-FTC) after i.v. administration to mice intravenously inoculated with M5076 cells were investigated at 3 and 12 days post-inoculation. At both time points, Lac-Suc-FTC was specifically localized to the liver. However, the area under the concentration-time curve in the liver decreased gradually by progress of the liver metastasis. At 3 days post-inoculation, Suc-FTC showed good retention in the systemic circulation and was little distributed to the liver. However, at 12 days post-inoculation, Suc-FTC was eliminated relatively fast from the systemic circulation and gradually accumulated in the liver. The antitumor effects of mitomycin C (MMC), Lac-Suc-MMC conjugate (Lac-Suc-MMC) and highly succinylated Suc (Suc(II))-MMC conjugate (Suc(II)-MMC) were examined on single i.v. administration for both metastatic stages. For administration at 3 days post-inoculation, Lac-Suc-MMC alone tended to elongate significantly the lifespan at a lower dose (0.4 mg eq. MMC/kg), and MMC, Suc(II)-MMC and Lac-Suc-MMC increased significantly the lifespan at a higher dose (10 mg eq. MMC/kg). However, at 12 days post-inoculation (late stage of metastasis), neither MMC nor the conjugates were effective even at the higher dose (10 mg eq. MMC/kg). Both carriers, Suc showing systemic long-circulation and Lac-Suc with an ability of liver-specific localization, are thought to be drug carriers with potentialities for therapeutics at early stage of metastasis.