Gut reaction: impact of systemic diseases on gastrointestinal physiology and drug absorption.

It was in 400 BC that Hippocrates reportedly stated that "death sits in the colon". The growth in our knowledge of the intestinal microbiome, the gut-brain axis and their function and imbalance has distinctly uncovered the complex relationship between the gut to disease predisposition and development, heralding the problem and the solution to disease pathology. Human studies of new drug molecules are typically performed in healthy volunteers and their specific disease indication. Approved drugs, however, are used by patients with diverse disease backgrounds. Here, we review the current literature of the gastrointestinal tract reacting to systemic disease pathology that elicits physiological and functional changes that consequently affect oral drug product performance.

All disease begins in the gut: Influence of gastrointestinal disorders and surgery on oral drug performance.

The term "disease" conjures a plethora of graphic imagery for many, and the use of drugs to combat symptoms and treat underlying pathology is at the core of modern medicine. However, the effects of the various gastrointestinal diseases, infections, co-morbidities and the impact of gastrointestinal surgery on the pharmacokinetic and pharmacodynamic behaviour of drugs have been largely overlooked. The better elucidation of disease pathology and the role of underlying cellular and molecular mechanisms have increased our knowledge as far as diagnoses and prognoses are concerned. In addition, the recent advances in our understanding of the intestinal microbiome have linked the composition and function of gut microbiota to disease predisposition and development. This knowledge, however, applies less so in the context of drug absorption and distribution for orally administered dosage forms. Here, we revisit and re-evaluate the influence of a portfolio of gastrointestinal diseases and surgical effects on the functionality of the gastrointestinal tract, their implications for drug delivery and attempt to uncover significant links for clinical practice.

Gastrointestinal characterisation and drug solubility determination in animals.

OBJECTIVES: To characterise the gastrointestinal (GI) environment in rat, rabbit and pig for the purpose of determining their utility as animal models for drug delivery in humans. METHODS: GI fluid samples were characterised for osmolality, surface tension, pH and buffer capacity. The solubility of two model drugs, mesalazine (ionisable) and prednisolone (unionisable), were also measured and the results were correlated to the physicochemical fluid data. KEY FINDINGS: The solubility of the ionisable drug mesalazine was positively correlated to the GI pH in all three species and was significantly influenced by the pH difference. In contrast, the solubility of the unionisable compound prednisolone was not correlated significantly to the changes in pH, buffer capacity, osmolality or surface tension. In general, the solubility of prednisolone was constant irrespective of the location of the sample in the gut from rabbit and pig; however, an unusual trend was observed for the solubility of prednisolone in rats. CONCLUSIONS: The results suggest that solubility of ionisable drugs or pH-responsive formulations is significantly influenced by the differences in pH along the GI tract and inter-species differences. It was also found that the data on the GI solubility of prednisolone (a neutral compound) in rats might overestimate its true value in humans.

Influence of ageing on the gastrointestinal environment of the rat and its implications for drug delivery.

Age-mediated changes in gut physiology are considerations central to the elucidation of drug performance from oral formulations. Using rats of different age groups we measured the pH, buffer capacity, fluid volume, osmolality, and surface tension of gastrointestinal (GI) fluids, and therein explored the impact of these variables on prednisolone and mesalazine solubility in luminal fluids. We also studied the distribution of gut associated lymphoid tissue (GALT) and mucus layer thickness across the GI tract in rats of different age groups. At a mucosal level, there was an increase in GALT from young to adult rat. Gastrointestinal pH and buffer capacity remained mostly unchanged with age, except some pH differences in stomach and distal small intestine and a higher buffer capacity in the large intestinal fluids of young rats. Osmolality and surface tension also remained unaffected with the exception of a lower osmolality in elderly stomach and a lower surface tension in the small intestine of young rats. The difference in luminal environment on ageing influenced the solubility of studied drugs, for instance prednisolone solubility was shown to be higher in adult rats (mid small intestine and caecum) and solubility of mesalazine was significantly higher in the elderly distal small intestine.