ABSTRACT
BackgroundVoglibose, an α-glucosidase inhibitor, inhibits breakdown of complex carbohydrates into simple sugar units in intestine. Studies showed that voglibose metabolism in the liver might be negligible due to its poor intestinal absorption. Numerous microorganisms live in intestine and have several roles in metabolism and detoxification of various xenobiotics. Due to the limited information, the possible metabolism of voglibose by intestinal microbiota was investigated in vitro and in vivo.MethodsFor the in vitro study, different concentrations of voglibose were incubated with intestinal contents, prepared from both vehicle- and antibiotics-treated mice, to determine the decreased amount of voglibose over time by using liquid chromatography-mass spectrometry. Similarly, in vivo pharmacodynamic effect of voglibose was determined following the administration of voglibose and starch in vehicle- and antibiotic-pretreated non-diabetic and diabetic mice, by measuring the modulatory effects of voglibose on blood glucose levels.ResultsThe in vitro results indicated that the remaining voglibose could be significantly decreased when incubated with the intestinal contents from normal mice compared to those from antibiotic-treated mice, which had less enzyme activities. The in vivo results showed that the antibiotic pretreatment resulted in reduced metabolism of voglibose. This significantly lowered blood glucose levels in antibiotic-pretreated mice compared to the control animals.ConclusionThe present results indicate that voglibose would be metabolized by the intestinal microbiota, and that this metabolism might be pharmacodynamically critical in lowering blood glucose levels in mice.
ABSTRACT
BackgroundVoglibose, an α-glucosidase inhibitor, inhibits breakdown of complex carbohydrates into simple sugar units in intestine. Studies showed that voglibose metabolism in the liver might be negligible due to its poor intestinal absorption. Numerous microorganisms live in intestine and have several roles in metabolism and detoxification of various xenobiotics. Due to the limited information, the possible metabolism of voglibose by intestinal microbiota was investigated in vitro and in vivo.MethodsFor the in vitro study, different concentrations of voglibose were incubated with intestinal contents, prepared from both vehicle- and antibiotics-treated mice, to determine the decreased amount of voglibose over time by using liquid chromatography-mass spectrometry. Similarly, in vivo pharmacodynamic effect of voglibose was determined following the administration of voglibose and starch in vehicle- and antibiotic-pretreated non-diabetic and diabetic mice, by measuring the modulatory effects of voglibose on blood glucose levels.ResultsThe in vitro results indicated that the remaining voglibose could be significantly decreased when incubated with the intestinal contents from normal mice compared to those from antibiotic-treated mice, which had less enzyme activities. The in vivo results showed that the antibiotic pretreatment resulted in reduced metabolism of voglibose. This significantly lowered blood glucose levels in antibiotic-pretreated mice compared to the control animals.ConclusionThe present results indicate that voglibose would be metabolized by the intestinal microbiota, and that this metabolism might be pharmacodynamically critical in lowering blood glucose levels in mice.
ABSTRACT
PURPOSE: Spinal fusion surgery can be associated with significant blood loss, often requiring blood transfusion. The objective of this retrospective study was to evaluate the efficacy of tranexamic acid in reducing blood loss and transfusion after lumbar spinal fusion. MATERIALS AND METHODS: A total of 75 consecutive patients undergoing spinal fusion surgery for spinal stenosis were included in this study. Thirty-five patients who were administered tranexamic acid were compared with 40 patients who did not receive the drug. Blood loss through drain, amount of blood transfusion, and hematological laboratory findings were evaluated. RESULTS: Blood loss through drain for the first 24 hours after surgery was 548.6+/-192.1 ml in the tranexamic acid group and 1,089.8+/-368.3 ml in the control group with a significant difference (p=0.001). Total blood loss through drain was 1,010.5+/-452.5 ml in the tranexamic acid group and 1,512.7+/-427.8 ml in the control group with a significant difference (p=0.005). Time to removal of drains after surgery was not different, 2.6+/-0.8 days in the tranexamic acid group and 2.5+/-1.1 days in the control group (p=0.885). Packed red blood cell (RBC) transfusion for the postoperative period and the number of patients requiring transfusion was significantly lower in the tranexamic acid group than in the control group. A prolongation of protrombin time was observed in the control group on first postoperative day. There were no complications related to the use of tranexamic acid. CONCLUSION: Tranexamic acid had an effect on reducing blood loss through drain for the first 24 hours and total blood loss after spinal fusion surgery. As a result, there was less of a requirement for RBC transfusion after surgery.