Recent advances in the bio-production of human milk oligosaccharides 2'-FL and 3-FL / 生物工程学报

Human milk oligosaccharides (HMO) are important immunoactive components found in breast milk. Scientific research proves that HMOs are significantly beneficial for infant health. 2'-fucosyllactose (2'-FL) is the major component of HMO, which obtained growing attentions from food industry. Besides, 3-fucosyllactose (3-FL) is another important fucosyllactose and it has a similar synthetic route comparing to 2'-FL. Thus, research of the two HMO components has interactive effects for each other. Recently, numerous publications are available for 2'-FL and 3-FL. The microbial cell factory is able to massively produce fucosyllactose via an efficient way, which will show considerable influences in dairy industry. In this paper, we review recent studies on 2'-FL and 3-FL, and discuss their prospects according to published literature and patents.

Efeito do galactooligossacarídeo sobre os sintomas de constipação / Effect of 4′galactooligosaccharide on constipation symptoms

Resumo Objetivo A adição de frutooligossacarídeos e galactooligossacarídeos a fórmulas infantis pode diminuir a consistência fecal e aumentar a frequência das evacuações. O objetivo do presente estudo foi determinar o efeito do galactooligossacarídeo em crianças com constipação crônica. Métodos Entre 2010 e 2012, 20 pacientes constipados (4-16 anos), atendidos numa unidade básica de saúde, completaram ensaio clínico duplo cego, placebo-controlado e de delineamento crossover. Onze pacientes receberam galactooligossacarídeo (1,7 g) por 30 dias, seguidos por 15 dias de washout, e, após, placebo (maltodextrina) por 30 dias; nove pacientes receberam placebo 30 dias, seguidos de 15 dias de washout e 30 dias de galactooligossacarídeo (1,7 g). Os desfechos primários foram frequência semanal de evacuações, esforço evacuatório e consistência fecal, classificada por escala numérica elaborada para este estudo e compilada no primeiro, 15̊ e 30̊ dias de cada período de crossover. Análise estatística foi feita por método de análise de variância (Anova) para medidas repetidas. Resultados Intensidade dos sintomas nos grupos foi semelhante no início do estudo (p = 0,45). Durante a ingestão de galactooligossacarídeo constatou-se maior frequência de evacuações, p < 0,0001, menor dificuldade evacuatória, p < 0,0001 e diminuição da consistência fecal, p = 0,0014. Efeitos colaterais não foram referidos durante a ingestão do prebiótico. Conclusão Durante a ingestão de galactooligossacarídeo os sintomas clínicos da constipação em crianças e adolescentes foram significantemente aliviados.

Abstract Objective Fructooligosacharides and galactooligosacharides soften fecal bolus and increase frequency of depositions when added to infant formula. This study aimed to determine the effects of galactooligosaccharide in pediatric patients with chronic constipation. Methods From 2010 to 2012, 20 constipated patients (4-16 years of age) attended to at a primary healthcare unit were enrolled in a double-blinded, placebo-controlled crossover trial. Eleven children ingested galactooligosaccharide (1.7 g) for 30 days, followed by a 15-day washout period, and a 30-day period of placebo (maltodextrin). Nine patients ingested maltodextrin for 30 days, followed by 15-day washout period, and galactooligosaccharide (1.7 g) for 30 days. Constipation symptoms were considered as primary outcomes: bowel movements/week, straining during defecation, and stool consistency. Outcome symptoms were ranked according to a numerical scale elaborated for this study. Data were recorded at baseline, and on days 15 and 30 of each 30-day crossover period. Repeated-measures analysis of variance (ANOVA) was used to analyze symptoms along time. Results At baseline, there was no significant difference in symptoms severity between groups (p = 0.45). Galactooligosaccharide ingestion was related to increase of the bowel movement frequency, p < 0.0001; relief of defecation straining, p < 0.0001; and decrease in stool consistency, p = 0.0014, compared to placebo ingestion. Patients reported no side effects from galactooligosaccharide. Conclusion Galactooligosaccharide was effective at improving clinical symptoms in this group of constipated children.

Assessment Method of Remnant α-1, 3-galactosyle Epitopes in Animal Tissue-derived Biomaterials / 生物医学工程学杂志

The aim of this study was to establish an assessment method for determining α-Gal (α-1, 3-galactosyle) epitopes contained in animal tissue or animal tissue-derived biological materials with ELISA inhibition assay. Firstly, a 96 well plate was coated with Gal α-1, 3-Gal/bovine serum albumin (BSA) as a solid phase antigen and meanwhile, the anti-α-Gal M86 was used to react with α-Gal antigens which contained in the test materials. Then, the residual antibodies (M86) in the supernatant of M86-Gal reaction mixture were measured using ELISA inhibition assay by the α-Gal coating plate. The inhibition curve of the ELISA inhibition assay, the R2 = 0.999, was well established. Checking using both α-Gal positive materials (rat liver tissues) and α-Gal negative materials (human placenta tissues) showed a good sensitivity and specificity. Based on the presently established method, the α-Gal expression profile of rat tissues, decellular animal tissue-derived biological materials and porcine dermal before and after decellular treatment were determined. The M86 ELISA inhibition assay method, which can quantitatively determine the α-Gal antigens contained in animal tissues or animal tissue-derived biomaterials, was refined. This M86 specific antibody based-ELISA inhibition assay established in the present study has good sensitivity and specificity, and could be a useful method for determining remnant α-1, 3Gal antigens in animal tissue-derived biomaterials.

Molecular cloning and over-expression of a fructosyltransferase from Aspergillus niger QU10 / 生物工程学报

The main commercial production of fructooligosaccharides (FOS) comes from enzymatic transformation using sucrose as substrate by microbial enzyme fructosyltransferase. A fructosyltransferase genomic DNA was isolated from Aspergillus niger QU10 by PCR. The nucleotide sequence showed a 1 941 bp size, and has been submitted to GenBank (KF699529). The cDNA of the fructosyltransferase, containing an open reading frame of 1 887 bp, was further cloned by RT-PCR. The fructosyltransferase gene from Aspergillus niger was functionally expressed both in Escherichia coli and Pichia pastoris GS 115. The highest activity value for the construction with the α-factor signal peptide reached 431 U/mL after 3 days of incubation. The recombinant enzyme is extensively glycosylated, and the active form is probably represented by a homodimer with an apparent molecular mass of 200 kDa as judged from mobility in seminative PAGE gels. The extracellular recombinant enzyme converted sucrose mostly to FOS, mainly 1-kestose and nystose, liberating glucose. FOS reached a maximal value and represented about 58% of total sugars present in the reaction mixture after 4 h reaction. The results suggest that the availability of recombinant Pichia pastoris as a new source of a FOS-producing enzyme might result of biotechnology interest for industrial application.

Conformation and Linkage Studies of Specific Oligosaccharides Related to H1N1, H5N1, and Human Flu for Developing the Second Tamiflu

The interaction between viral HA (hemagglutinin) and oligosaccharide of the host plays an important role in the infection and transmission of avian and human flu viruses. Until now, this interaction has been classified by sialyl(alpha2-3) or sialyl(alpha2-6) linkage specificity of oligosaccharide moieties for avian or human virus, respectively. In the case of H5N1 and newly mutated flu viruses, classification based on the linkage type does not correlate with human infection and human-to-human transmission of these viruses. It is newly suggested that flu infection and transmission to humans require high affinity binding to the extended conformation with long length sialyl(alpha2-6)galactose containing oligosaccharides. On the other hand, the avian flu virus requires folded conformation with sialyl(alpha2-3) or short length sialyl(alpha2-6) containing trisaccharides. This suggests a potential future direction for the development of new species-specific antiviral drugs to prevent and treat pandemic flu.

The Anti-calcification Effect of Dithiobispropionimidate, Carbodiimide and Ultraviolet Irradiation Cross-linking Compared to Glutaraldehyde in Rabbit Implantation Models

BACKGROUND: Glutaraldehyde (GA) is a widely used cross-linking agent for improving mechanical properties and resistance to enzymatic degradation of collagenous tissue, but it has several drawbacks such as calcification and cytotoxicity. The aim of this study was to find the alternative effective cross-linking methods to GA. MATERIALS AND METHODS: Bovine pericardium was processed with GA with ethanol+octanol and glycine detoxification, and polyethylene glycol (PG) space filler, dimethyl 3,3'-dithiobispropionimidate (DTBP), 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) treatment, and the physical fixation of ultraviolet irradiation were done. The biologic material properties of variously treated pericardial tissues were assessed by biochemical, mechanical and histological tests. Treated pericardial tissues were also implanted subcutaneously or intramuscularly into the rabbit for 10 weeks to assess the xenoreactive antibody response of immunoglobulin G and M, their anti-calcification effect. RESULTS: The biochemical and mechanical properties of EDC fixed pericardial tissues were comparable to the GA fixed tissue. The cytotoxicity was lowest in space filler treated GA fixed group. In rabbit subcutaneous or intramuscular implantation models, decellularization, space filler, EDC treatment group showed significantly lower calcium content than GA only and DTBP treatment group (p<0.05, analysis of variance). The titer of anti Galalpha1-3Galbeta1-4GlcNAc-R antibodies did not change in the postimplantation serial enzyme-linked immunosorbent assay. Hematoxylin and eosin and von Kossa staining showed that decellularization, space filler, EDC, and ultraviolet treatment had less inflammatory cell infiltration and calcium deposits. CONCLUSION: The decellularization process, PG filler, and EDC treatments are good alternative cross-linking methods compared to GA only fixation and primary amine of DTBP treatment for cardiovascular xenograft preservation in terms of the collagen cross-linking stability and in vivo anti-calcification effects.

Simultaneous determination of five constituents in Scrophularia ningpoensis by HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To develop an HPLC method for the simultaneous quantitation of five constituents in Scrophularia ningpoensis.</p><p><b>METHOD</b>Samples were analyzed on an Agilent SB-C18 column(4.6 mm x 250 mm, 5 microm) eluted with acetonitrile and water containing 0.03% phosphate acid as mobile phases in a linear gradient mode. The flow rate was kept at 1.0 mL x min(-1), and the column temperature was set to 30 degrees C. The DAD detector wavelengths were 210, 280, 330 nm.</p><p><b>RESULT</b>The linear ranges were 50-400 mg x L(-1) for harpagide, 1-40 mg x L(-1) for harpagoside, 1-20 mg x L(-1) for cinnamic acid, 0.5-4.5 mg x L(-1) for acteoside,1-60 mg x L(-1) for angoroside C, respectively. The average recoveries of the five constituents were 100.8% (RSD 0.62%), 101.7% (RSD 0.32%), 98.8% (RSD 0.48%), 99.9% (RSD 1.4%), 99.2% (RSD 1.1%), respectively.</p><p><b>CONCLUSION</b>Through the validation, the method was proved to be sensitive, accurate, repeatable, and can be used for quality control of the roots of S. ningpoensis.</p>

Effect of Hyperkalemia and Hemolysis Caused by Hyperacute Rejection on Cardiac Function in Pig to Human Ex Vivo Xenogeneic Cardiac Perfusion Model

BACKGROUND AND OBJECTIVES: Hyperacute rejection (HAR) is a major obstacle to successful xenotransplantation of vascularized organs. This study was conducted to observe the effect of hemolysis of perfused human whole blood on pig heart function, and determine the major risk factors for preservation of xenoperfused cardiac function using ex-vivo pig to human xenogeneic cardiac perfusion model. MATERIALS AND METHODS: Harvested pig hearts were perfused with normal human whole blood (group 1), two different types of pre-treated human whole blood (group 2: immunoglobulins were depleted by plasmapheresis, group 3: pre-treated with plasmapheresis, GAS914, cobra venom factor (CVF) and steroid), and normal porcine whole blood as control (group 4) for 3 hours. RESULTS: Duration of heart beat was significantly prolonged in group 2 and group 3. Histological examination showed widespread HAR features but was gradually delayed in groups 2 and 3 compared to group 1. The absolute levels of serum creatine kinase-MB and Troponin I increased gradually, and was lower in group 3. Serum hemoglobin levels were rapidly increased in groups 3 and 4, compared to group 1. Extracellular potassium level increased sharply from the beginning of blood perfusion in groups 1, 2 and 3, compared to group 4. CONCLUSION: Pretreatment of human whole blood, including immunoglobulin depletion, CVF and steroid reduced and delayed the destruction of pig myocardium by HAR. However, the increased extracellular potassium levels in groups 1, 2 and 3 reflected that these treatments could not prohibit myocardial injury by HAR.

Enzyme-linked immunosorbent assay of phenolic glycolipid-I in patients with Hansen’s disease / Inmunoensayo ligado a enzimas (ELISA) a glicolípido fenólico -1 en pacientes con enfermedad de Hansen

Introduction: Hansen’s disease or leprosy is a contagious-infection entity produced by the Hansen bacillus or Mycobacterium leprae. The phenolic glycolipid is a special trisaccharide found in the bacillus cell wall and proved to be specific and immunogenic species during M. leprae.Objective: To determine the presence of the Hansen bacillus enzyme-linked immunoassay (ELISA) method glycolipid phenolic I in a group of patients in Dermatology Consultation at the Valle del Cauca Health Services; these patients were classified as cures or under watch according to criteria established by the World Health Organization (WHO).Methodology: From the data base of the Dermatology Consultation at the Valle del Cauca Health Services, we studied 159 patients with Hansen’s disease who were tested with the enzyme-linked immunoassay (ELISA) with the phenolic glycolipid I to cross reference information and observe if they were or were not positive to this test. A positive ELISA indicates the bacillus is still present in the patient.Results: As an important fact, we found that of 78 patients cured, when bearing in mind the monitoring period, 9 were positive for the ELISA. When this period was discarded, 81 sick individuals were classified as cured according to WHO criteria but the same 9 continued positive for ELISA.Conclusion: It may be concluded that in spite of meeting WHO criteria, these patients still show presence of the bacillus and the monitoring period is not required as a criterion to discharge a patient. We recommend adding to WHO criteria a negative ELISA, to obtain additional information that helps to certify that a patient is or is not cured.

Introducción: La enfermedad de Hansen o lepra es una entidad infecto-contagiosa producida por el bacilo de Hansen o Mycobacterium leprae. El glicolípido fenólico I es un trisacárido especial que se encuentra en la pared celular del bacilo y ha demostrado ser específico de especie e inmunogénico durante la infección de M. leprae.Objetivo: Determinar la presencia del bacilo de Hansen por el método de inmunoensayo ligado a enzimas (ELISA) a glicolípido fenólico I en un grupo de pacientes del Consultorio Dermatológico del Servicio de Salud del Valle del Cauca clasificados como curados o en vigilancia, según criterios preestablecidos por la Organización Mundial de la Salud (OMS).Metodología: De la base de datos del Consultorio Dermatológico del Servicio de Salud del Valle del Cauca se estudiaron en total 159 pacientes con enfermedad de Hansen a los cuales se les practicó examen de inmunoensayo ligado con enzimas (ELISA) con el glicolípido fenólico I a fin de cruzar información y observar si eran o no positivos a esta prueba. El ELISA positivo dice que el bacilo aún existe en el paciente.Resultados: Se encontró como dato importante que de 78 pacientes curados, al tener en cuenta además el período de vigilancia, 9 fueron positivos para el ELISA. Cuando se descartó este período, a 81 enfermos se les clasificó como curados según criterios de la OMS pero siguieron positivos para ELISA los mismos 9.Conclusión: Se concluye que a pesar de cumplir los criterios de la OMS, estos pacientes aún muestran presencia de bacilo y que el período de vigilancia no se necesita como criterio para dar de alta a un paciente. Se recomienda agregar a los criterios de la OMS el ELISA negativo, con el fin de tener una información más que ayude a certificar que un paciente está curado o no.

Blood glucose analysis in patients on continuous ambulatory peritoneal dialysis with Icodextrin / 대한내과학회지

BACKGROUND/AIMS: Icodextrin (glucose polymer) is metabolized by a-amylase to oligosaccharides such as maltose and maltotriose. The presence of these metabolites could have an effect on the enzymatic glucose measurement especially the glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) based method. Patients treated with icodextrin are at risk for inaccurate blood glucose measurements. In this study we measured the blood glucose with different methods and analyzed the results to determine the test accuracy. METHODS: The blood glucose was measured, in seven outpatients and in seven inpatients using icodextrin, by the glucose hexokinase laboratory technique method as well as the GDH-PQQ method (Accu Chek Active)at the same time. To estimate an icodextrin residual effect, after discontinuing icodextin, the blood glucose was measured by the two methods after 48 hours in 4 inpatients. RESULTS: In seven outpatients the blood glucose was overestimated by the Accu Chek Active method (mean difference 68 mg/dL, p value 0.012). In seven inpatients the mean difference in the glucose was 56 mg/dL at 6am, 52 mg/dL at 11am, 52 mg/dL at 4pm, and 50 mg/dL at 9pm by the two different methods. In the four inpatients after changing their dialysate, the mean difference in the glucose was 58 mg/dL after 10 hours, 45 mg/dL after 24 hours, 24 mg/dL after 34 hours, and 26 mg/dL after 48 hours. CONCLUSION: Blood glucose was overestimated by the GDH-PQQ method and the inaccuracies were observed for more than 48 hours.

Journey from hepatocyte transplantation to hepatic stem cells: a novel treatment strategy for liver diseases.

Acute liver failure (ALF) carries high morbidity and mortality (>80%) even in the best centres. Orthotopic liver transplantation (OLTx) is the only viable approach to the treatment of ALF. This has significantly improved the survival in these patients. The major limitations of OLTx are non availability of the donor liver, requirement of a major surgical procedure, high cost and longterm immunosuppression. Isolated hepatocyte transplantation is emerging as an appealing method for the treatment of ALF because of its technical simplicity and easy availability of cells. Transplantation of allogenic/xenogenic hepatocytes transplantation in experimentally induced ALF has shown an increased survival rate. Clinical studies in acute, chronic liver failure and metabolic disorders have also been undertaken in a few centres and have shown encouraging results. To maintain the continuous supply of cells, xenogenic source of hepatocytes (porcine, rabbit, canine) have offered a hope. A major concern regarding the use of xenogenic donors is the risk of transmission of zoonosis and immunogenicity. Recently, Porcine endogenous retrovirus (PERV) has been shown to infect human tissue in vitro. The problem of immunogenicity of xenogenic hepatocytes can be overcome to some extent by immunoisolation, encapsulation technique, which may also provide protection to the hepatocytes during cryopreservation. The knowledge of adult hepatic stem from tissue offered a new hope for the treatment of various chronic and metabolic diseases. Further, the transdifferentiation potentiality of haematopoietic stem cells to hepatic lineage has strengthened cell therapy.

Saccharide analysis of si-wu-tang by automated multiple development and off-line coupling thin layer chromatography electrospray ionization mass spectrometry techniques / 中国中药杂志

<p><b>OBJECTIVE</b>To make qualitative analysis on saccharide spots in thin layer chromatography (TLC) chromatogram of SI-WU-TANG extract C, which possesses blood-enrichment activity.</p><p><b>METHOD</b>TLC chromatogram of SI-WU-TANG extract C was obtained by using Automated Multiple Development (AMD) method. 4 major spots in the chromatogram were analyzed by off-line coupling TLC electrospray ionization mass spectrometry (ESI-MS) technique. Moreover, composition of monosaccharides in the fraction was analyzed by AMD technique.</p><p><b>RESULT</b>Main constituents of substances from the 4 spots were monosaccharide, disaccharide, trisaccharide and tetrasaccharide respectively. Monosaccharide was mainly composed of fructose and glucose.</p><p><b>CONCLUSION</b>Off-line coupling TLC ESI-MS can simply and rapidly provide qualitative examination of saccharide spots in TLC chromatogram of Traditional Chinese Medicine. AMD method can make good separation of 8 frequently-observed monosaccharides in a regular 10 cm silica gel plate, the process of which was automated, AMD and off-line coupling TLC ESI-MS techniques show good value in saccharides analysis.</p>

Lowering glycemic index of food by acarbose and Plantago psyllium mucilage

Background. Astudy was designed to evaluate the effect o acarbose and Plantago psyllium mucilage on glycemic index (GI) of bread. Methods. Twelve patients with non-insulin-dependent diabetes mellitus (NIDDM) and ten healthy volunteers were studied. Three meal tests with an intake of 90 g of white bread (50 g of carbohydrates) were performed on each subject. In one test, 200 mg of acarbose was given, while 15 g of P. psyllium mucilage was given in another test, and only bread was ingested in the control test. Serum glucose and insulin concentrations were measured every 30 min from 0-180 min. Net area under curve (AUC) concentrations of glucose and insulin, GI and insulinic index were calculated. Results. In NIDDM patients, AUC-glucose in the test with acarbose (1.9 ñ 0.7 mmol/L) and with P. psyllium (4.3 ñ 1.2 mmol/L) were significantly lower than in the control test (7.4 ñ 1.5 mmol/L= (p<0.01). GI of bread plus acarbose was 26 ñ 13, and of bread plus P. psyllium, 59 ñ 10 (p<0.05). AUC-insulin and insulinic index behave similarly. In healthy individuals, AUC-glucose and GI did not significantly change with the treatments; however, insulinic index with acarbose was 17 ñ 16, and with P. syllium decreased GI of bread in NIDDM patients and siminished insulinic index in NIDDM ad in healthy subjects. Conclusions. Adding acarbose or P. syllium to meals may reduce glycemic index of carbohydrate foods and may help diabetic control

Effect of acarbose in treatment of type II diabetes mellitus: a double-blind, crossover, placebo-controlled trial.

This study evaluated the efficacy of acarbose in improvement of metabolic control in patients with fairly, well controlled non-insulin-dependent diabetes mellitus (NIDDM). Fifteen patients with mean age and duration of diabetes of 57.5 +/- 2.6 (SE) and 7.5 +/- 1.5 years, respectively were recruited and completed our study protocol. This study was a double-blind, crossover, placebo-controlled design consisting of two twelve-week treatments of acarbose and placebo separated by an eight-week washout period. Acarbose was effective in lowering of 1-hour and 2-hour postprandial plasma glucose from 251.7 +/- 10.7 and 205.3 +/- 9.1 mg/dl to 197.4 +/- 7.0 (p = 0.001) and 181.5 +/- 8.5 mg/dl (p = 0.03), respectively. Fasting plasma glucose was slightly decreased but without significant change, from 150.8 +/- 7.3 to 140.8 +/- 6.1 mg/dl (p = 0.07). Overall glycemic control tended to improve during the study period as indicated by the falling of HbA1c levels from 7.7 +/- 0.4 to 7.0 +/- 0.2 per cent (p = 0.05). Serum C-peptide both fasting and postprandial as well as serum lipids were not affected by acarbose. Almost half of the patients treated with acarbose had mild and tolerable gastrointestinal adverse effects. In conclusion, acarbose, as combined therapy with other oral hypoglycemic agents, was effective in improvement of glycemic control particularly postprandial hyperglycemia in fairly, well controlled NIDDM patients with mild and acceptable adverse effects.

Plants as hypoglycemic agents

The world over, many plants are being used successfully - mainly in the form of teas - to counteract the effects of diabetes; and Brazil is no exception. This is especially true for patients suffering from noninsulin dependent (type II) diabetes. The article first summarizes the mechanisms reported in the scientific literature which explain hypoglycemic activity in plants. These include: Inhibition of the intestinal absorption of glucose; inhibition of alpha-glucosidase; and protection of the beta-pancreatic cells and of the liberated insulin. Also shown is the hypoglycemic activity of glycans. In a second section experimental results are presented with three plants widely used in Brazil as hypoglycemic agents: Myrcia multiflora (Lam.) D.C. (pedra-ume-caá); Punica granatum L. (roma, pomegranate); and Chrysobalanus icaco (abajeru). The experimental results show the activity of the plant extracts in the inhibition of the intestinal absorption of glucose.

Acarbose: uma breve revisäo / Acarbose: a short review

Até ha algum tempo atras, as únicas opçoes de tratamento farmacológico do diabetes melito nao-insulinodependente eram as sulfoniluréias, as biguanidas e a insulina. Apenas recentemente se introduziu no mercado uma droga com princípio de açao farmacológica diverso, a acarbose, inibidor competitivo das alpha-glicosidases. A acarbose, ao que tudo indica, tem desempenho ao mínimo similar aos farmacos ja existentes, com atuaçao de destaque na reduçao dos níveis de hemoglobina glicosilada. Portanto, surge como uma opçao alternativa na monoterapia dos diabéticos controlados apenas com dieta e como reforço terapêutico bastante efetivo em associaçoes medicamentosas.

Efficacy of acarbose as monotherapy in NIDDM patients.

The efficacy and safety of acarbose (100 mg three times a day for 12 weeks) was investigated in an open study in patients with non-insulin dependent diabetes mellitus who could not achieve satisfactory glycaemic control by diet alone. Acarbose significantly decreased fasting plasma glucose from 165.9 +/- 16.0 mg/dl to 159.5 +/- 16.9 mg/dl (P value < 0.01). The reduction of postprandial plasma glucose was 11.2 per cent and 9.8 per cent for 1 hour and 2 hours respectively. HbAic also significantly decreased from the baseline. The most common side effects were mild to moderate flatulence and abdominal distension. There were no significant changes in body weight, lipid profile and other biochemical parameters. These results indicate that treatment with acarbose is safe and effective in adjunct to dietary therapy for the treatment of NIDDM.

Effects of alpha-glucosidase inhibitor (acarbose) combined with sulfonylurea or sulfonylurea and metformin in treatment of non-insulin-dependent diabetes mellitus.

The effects of alpha-glucosidase inhibitor (acarbose) were studied in 36 patients with non-insulin-dependent diabetes mellitus (NIDDM), aged 34-67 years with a mean duration of diabetes of 8.8 +/- 0.9 years. They were poorly controlled with diet plus sulfonylurea alone or plus sulfonylurea combined with metformin drugs. Acarbose, 100 mg three times daily, was additionally given to these patients for six months. Results showed small but significant decreases (P < 0.001) in postprandial blood glucose level. Glycosylated hemoglobin level was lowered significantly (P < 0.001) and was normalised (level of < 8%) in 17 per cent of the patients. Fasting serum triglycerides level decreased significantly (P < 0.01), whereas, no significant changes in serum total cholesterol and HDL cholesterol levels were seen. Body weight also decreased significantly (P < 0.001) at the end of acarbose trial. Flatulence was the major side effect of acarbose found in 42 per cent of the patients but it was well-tolerated and may be transient and self-limited. We concluded that the addition of acarbose to the therapeutic regimens of diet therapy plus sulfonylurea or plus sulfonylurea combined with metformin drugs led to significant improvement of glycemic control. Acarbose may be a safe and valuable adjunct to diet and sulfonylurea and metformin treatments in obese, poorly-controlled patients with NIDDM.