Nebojša Pavlović

Probiotics—Interactions with Bile Acids and Impact on Cholesterol Metabolism

The use of probiotics, alone or in interaction with bile acids, is a modern strategy in the prevention and treatment of hypercholesterolemia. Numerous mechanisms for hypocholesterolemic effect of probiotics have been hypothesized, based mostly on in vitro evidence. Interaction with bile acids through reaction of deconjugation catalyzed by bile salt hydrolase enzymes (BSH) is considered as the main mechanism of cholesterol-lowering effects of probiotic bacteria, but it has been reported that microbial BSH activity could be potentially detrimental to the human host. There are several approaches for prevention of possible side effects associated with BSH activity, which at the same time increase the viability of probiotics in the intestines and also in food matrices. The aim of our study was to summarize present knowledge of probiotics—bile acids interactions, with special reference to cholesterol-lowering mechanisms of probiotics, and to report novel biotechnological approaches for increasing the pharmacological benefits of probiotics.

Application of bile acids in drug formulation and delivery

Bile acids are naturally produced in humans and are known to provide human health benefits through their endocrinological, microfloral, metabolic and other åffects that are still to be elucidated. In recent years, there has been a growing interest in using bile acids as absorption enhancers for drug delivery. Bile acids are amphiphilic molecules with a unique ability to facilitate and promote drug permeation through biological membranes. The role of bile acids in promoting drug permeation has been experimentally illustrated in various pharmaceutical formulations including oral, nasal, ocular, buccal, pulmonary and rectal delivery as well as through the blood–brain barrier. Recently, bile acids have drawn attention in the field of drug delivery due to their ability to act as a drug carrier system in the form of mixed micelles, bilosomes and chemical conjugates with drug molecules. Bile acids have demonstrated a unique ability to enhance the epithelial transport of hydrophilic drugs through the paracellular route and that of hydrophobic compounds through both paracellular and transcellular routes. The aim of this review is to discuss various chemical and pharmaceutical aspects of BAs and their potential applications in drug formulation and delivery.

An Insight on Differences in Availability and Reimbursement of Orphan Medicines Among Serbia, Bulgaria and Sweden

ABSTRACT In the European Union (EU), rare diseases are defined as life-threatening or chronically debilitating diseases with prevalence lower than five in 10,000 inhabitants. Although individually rare, together, rare diseases affect a significant part of the population (27–36 million people in the EU). Therefore, patient access to orphan medicines is receiving increasing political attention in the EU. In order to assess the differences in availability of reimbursed orphan medicines among Serbia, Bulgaria and Sweden, National Reimbursement Lists were reviewed and identified orphan medicines were crossed with the List of orphan drugs in Europe, published in July 2011, available from Orphanet. The analysis of regulatory traits was based mainly on a review of the official documents setting out legislation regarding rare diseases and orphan medicines in the studied countries. Only 6.5% (4 out of 61) of the authorised orphan medicines in Europe with prior orphan designation and 25.0% (17 out of 68) without prior orphan designation were available and reimbursed in Serbia. In the Bulgarian Positive Drug List 44.3% (27 out of 61) of the drugs with prior orphan designation and 50.0% (34 out of 68) without prior orphan designation were identified. The share of reimbursed orphan medicines was the highest in Sweden among the observed countries—52.5% (32 out of 61) of the medicines with orphan designation and 60.3% (41 out of 61) without prior orphan designation. According to the first level of the ATC Classification System, most of the reimbursed orphan medicines in the three studied countries belonged to the group L: “Antineoplastic and immunomodulating agents”, while the most common indications for authorised and reimbursed orphan medicines were “Neoplasms” (C00-D48), with 19 available orphan drugs in Serbia, 26 in Sweden and 31 in Bulgaria. Inequities in the access to orphan medicines among Serbia, Bulgaria and Sweden may be explained by the differences in the approaches for registration, pricing and reimbursement of orphan medicines. The low share of reimbursed orphan drugs in Serbia may be due to incomplete compliance with EU legislation and existence of domestic procedure for authorisation as well. The EU legislation and policy on treatment of rare diseases obviously facilitate the penetration of orphan drugs on the EU market, but apparently there is also considerable budget impact on the availability of reimbursed orphan medicines.

Effects of pharmaceutical formulations containing thyme on carbon tetrachloride-induced liver injury in rats

BackgroundHerbal supplements are widely used in the treatment of various liver disases, but some of them may also induce liver injuries. Regarding the infuence of thyme and its constituents on the liver, conflicting results have been reported in the literature. The objective of this study was to examine the influence of two commonly used pharmaceutical formulations containing thyme (Thymus vulgaris L.), tincture and syrup, on carbon tetrachloride-induced acute liver injury in rats.MethodsChemical composition of investigated formulations of thyme was determined by gas chromatography and mass spectrometry. Activities of enzyme markers of hepatocellular damage in serum and antioxidant enzymes in the liver homogenates were measured using the kinetic spectrophotometric methods. Liver morphology was characterized by light microscopy using routine hematoxylin and eosin staining.ResultsThymol was found to be predominant active constituent in both tincture and syrup. Investigated thyme preparations exerted antioxidant effects in liver by preventing carbon tetrachloride-induced increase of lipid peroxidation. Furthermore, co-treatment with thyme preparations reversed the activities of oxidative stress-related enzymes xanthine oxidase, catalase, peroxidase, glutathione peroxidase and glutathione reductase, towards normal values in the liver. Hepatotoxicity induced by carbon tetrachloride was reflected by a marked elevation of AST and ALT activities, and histopathologic alterations. Co-administration of thyme tincture resulted in unexpected exacerbation of AST and ALT values in serum, while thyme syrup managed to reduce activites of aminotransferases, in comparison to carbon tetrachloride-treated animals.ConclusionsDespite demonstrated antioxidant activity, mediated through both direct free radical scavenging and activation of antioxidant defense mechanisms, thyme preparations could not ameliorate liver injury in rats. Molecular mechanisms of diverse effects of thyme preparations on chemical-induced hepatotoxicity should be more in-depth investigated.

Potential Applications of Gliclazide in Treating Type 1 Diabetes Mellitus: Formulation with Bile Acids and Probiotics

Abstract A major advancement in therapy of type 1 diabetes mellitus (T1DM) is the discovery of new treatment which avoids and even replaces the absolute requirement for injected insulin. The need for multiple drug therapy of comorbidities associated with T1DM increases demand for developing novel therapeutic alternatives with new mechanisms of actions. Compared to other sulphonylurea drugs used in the treatment of type 2 diabetes mellitus, gliclazide exhibits a pleiotropic action outside pancreatic β cells, the so-called extrapancreatic effects, such as antiinflammatory and cellular protective effects, which might be beneficial in the treatment of T1DM. Results from in vivo experiments confirmed the positive effects of gliclazide in T1DM that are even more pronounced when combined with other hypoglycaemic agents such as probiotics and bile acids. Even though the exact mechanism of interaction at the molecular level is still unknown, there is a clear synergistic effect between gliclazide, bile acids and probiotics illustrated by the reduction of blood glucose levels and improvement of diabetic complications. Therefore, the manipulation of bile acid pool and intestinal microbiota composition in combination with old drug gliclazide could be a novel therapeutic approach for patients with T1DM.

The Role of Drug Metabolites in the Inhibition of Cytochrome P450 Enzymes

Following the drug administration, patients are exposed not only to the parent drug itself, but also to the metabolites generated by drug-metabolizing enzymes. The role of drug metabolites in cytochrome P450 (CYP) inhibition and subsequent drug–drug interactions (DDIs) have recently become a topic of considerable interest and scientific debate. The list of metabolites that were found to significantly contribute to clinically relevant DDIs is constantly being expanded and reported in the literature. New strategies have been developed for better understanding how different metabolites of a drug candidate contribute to its pharmacokinetic properties and pharmacological as well as its toxicological effects. However, the testing of the role of metabolites in CYP inhibition is still not routinely performed during the process of drug development, although the evaluation of time-dependent CYP inhibition during the clinical candidate selection process may provide information on possible effects of metabolites in CYP inhibition. Due to large number of compounds to be tested in the early stages of drug discovery, the experimental approaches for assessment of CYP-mediated metabolic profiles are particularly resource demanding. Consequently, a large number of in silico or computational tools have been developed as useful complement to experimental approaches. In summary, circulating metabolites may be recognized as significant CYP inhibitors. Current data may suggest the need for an optimized effort to characterize the inhibitory potential of parent drugs metabolites on CYP, as well as the necessity to develop the advanced in vitro models that would allow a better quantitative predictive value of in vivo studies.

The influence of bile salts on the distribution of simvastatin in the octanol/buffer system

Abstract Introduction: Distribution coefficient (D) is useful parameter for evaluating drugs permeability properties across biological membranes, which are of importance for drugs bioavailability. Given that bile acids are intensively studied as drug permeation-modifying and -solubilizing agents, the aim of this study was to estimate the influence of sodium salts of cholic (CA), deoxycholic (DCA) and 12-monoketocholic acids (MKC) on distribution coefficient of simvastatin (SV) (lactone [SVL] and acid form [SVA]) which is a highly lipophilic compound with extremely low water solubility and bioavailability. Methods: LogD values of SVA and SVL with or without bile salts were measured by liquid–liquid extraction in n-octanol/buffer systems at pH 5 and 7.4. SV concentrations in aqueous phase were determined by HPLC-DAD. Chem3D Ultra program was applied for computation of physico-chemical properties of analyzed compounds and their complexes. Results: Statistically significant decrease in both SVA and SVL logD was observed for all three studied bile salts at both selected pH. MKC exerted the most pronounced effect in the case of SVA while there were no statistically significant differences between observed bile salts for SVL. The calculated physico-chemical properties of analyzed compounds and their complexes supported experimental results. Conclusions: Our data indicate that the addition of bile salts into the n-octanol/buffer system decreases the values of SV distribution coefficient at both studied pH values. This may be the result of the formation of hydrophilic complexes increasing the solubility of SV that could consequently impact the pharmacokinetic parameters of SV and the final drug response in patients.

Pharmacokinetics and Pharmacodynamic dosage adaptation of cefaclor in systemic infections

August 2015 e81 PhArmAcokinetics And PhArmAcodynAmic dosAge AdAPtAtion of cefAclor in systemic infections A. Tomas; O. Horvat; M.P. Kusturica; N. Pavlović ; B. Milijašević ; Z. Tomić ; and A. Sabo Medical faculty, University of Novi Sad, Serbia Background: Cefaclor was one of the commonly used antimicrobials in Serbia, but due to fast development of resistance, other oral cephalosporins rapidly upstaged cefaclor and cefaclor was removed from the list of the drugs reimbursed by the National Health Insurance Fund. Use of recommended dosing regimen (250-500mg/812h) is likely to result in sub-therapeutic concentrations for a wide portion of dosing interval due to short half-life of cefaclor, which may facilitate development of resistance. The aim of this study was to determine adequate dosing interval for cefaclor in treatment of systemic infections using Pharmacokinetic (PK) and pharmacodznamic (PD) parameters with special regard to postantibiotic effect (PAE). Material and Methods: PK profile of cefaclor in healthy volunteers and PK/PD indices relating to efficacy of cephalosporins were determined, as well as minimum inhibitory concentration (MIC) and PAE of cefaclor on 4 susceptible bacteria. Results: Cmax of 23.142 ± 5.67 μg/mL was measured after 40-60 minutes. Tmax was 0.72 ± 0.13 hours. Calculated AUC(0-t) was 29.148 ± 9.27 μg/mL/h. MICs were in range of 1-2 μg/mL. Cefaclor induced PAE of 1-2h. There was inconsistency between standard dosing regimen and PK/PD parameters. Main PK/PD index relating to efficacy of cephalosporins (%t> MIC) for the 750mg dose was 33.5–42.1%. PK/PD breakpoints for cefaclor were between 0.3-1μg/mL. Even the maximum doze with standard dosing intervals is not appropriate for eradication of susceptible organisms. Short PAE can’t compensate for sub-inhibitory concentrations at the half of the dosing interval. Conclusions: In reference to PK/PD parameters cefaclor should be administered every 6h for the doses of 500mg and 750mg, and every 4-4.5h for the 250mg dose in order to maximize its therapeutic efficacy and minimize development of resistance. This work was supported by the Ministry of Science and Technological development, Republic of Serbia, project No III 41012.

Remarkably lower consumption of antidepressants in Serbia in comparison with Finland

Background Depression is an important health problem worldwide due to significant disability that it causes, reduction of quality of life, loss of work days, and even suicide. The aim of our survey was to evaluate the overall utilization and pattern of use of antidepressants in Serbia in a comparison with Finland in 2010 and to propose appropriate interventions in Serbia on the basis of the results obtained.

Bile acids and their derivatives as potential modifiers of drug release and pharmacokinetic profiles

Bile acids have received considerable interest in the drug delivery research due to their peculiar physicochemical properties and biocompatibility. The main advantage of bile acids as drug absorption enhancers is their ability to act as both drug solubilizing and permeation-modifying agents. Therefore, bile acids may improve bioavailability of drugs whose absorption-limiting factors include either poor aqueous solubility or low membrane permeability. Besides, bile acids may withstand the gastrointestinal impediments and aid in the transporter-mediated absorption of physically complexed or chemically conjugated drug molecules. These biomolecules may increase the drug bioavailability also at submicellar levels by increasing the solubility and dissolution rate of non-polar drugs or through the partition into the membrane and increase of membrane fluidity and permeability. Most bile acid-induced effects are mediated by the nuclear receptors that activate transcriptional networks, which then affect the expression of a number of target genes, including those for membrane transport proteins, affecting the bioavailability of a number of drugs. Besides micellar solubilization, there are many other types of interactions between bile acids and drug molecules, which can influence the drug transport across the biological membranes. Most common drug-bile salt interaction is ion-pairing and the formed complexes may have either higher or lower polarity compared to the drug molecule itself. Furthermore, the hydroxyl and carboxyl groups of bile acids can be utilized for the covalent conjugation of drugs, which changes their physicochemical and pharmacokinetic properties. Bile acids can be utilized in the formulation of conventional dosage forms, but also of novel micellar, vesicular and polymer-based therapeutic systems. The availability of bile acids, along with their simple derivatization procedures, turn them into attractive building blocks for the design of novel pharmaceutical formulations and systems for the delivery of drugs, biomolecules and vaccines. Although toxic properties of hydrophobic bile acids have been described, their side effects are mostly produced when present in supraphysiological concentrations. Besides, minor structural modifications of natural bile acids may lead to the creation of bile acid derivatives with the reduced toxicity and preserved absorption-enhancing activity.