Evaluation of OM3-PL/FFA Pharmacokinetics After Single and Multiple Oral Doses in Healthy Volunteers.

PURPOSE: The US Food and Drug Administration has approved several omega-3 (OM3)-containing prescription drugs for the treatment of severe hypertriglyceridemia (HTG). However, there is still a need to develop formulations with high bioavailability irrespective of the fat content and time of the meal. OM3-phospholipid (PL)/free fatty acid (FFA) is an investigational drug for the treatment of severe HTG containing naturally derived krill oil mixture of OM3, mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as PL esters and as FFA. Both forms in OM3-PL/FFA are believed to be readily bioavailable. Per gram, OM3-PL/FFA contains a lower dose of EPA/DHA in comparison with already approved prescription drugs. The study aim was to evaluate OM3-PL/FFA pharmacokinetic (PK) properties after single and multiple oral doses of 1, 2, and 4 g in healthy subjects when receiving a Therapeutic Lifestyle Change (TLC) diet. The dose proportionality of the study drug, the effect of a high-fat (HF) meal on its PK properties and its safety profile after multiple administration were also explored. METHODS: In this Phase I, open-label, randomized, multiple-dose, single-center, parallel-design study, 42 healthy volunteers following a TLC diet were randomly assigned into 1 of 3 treatment groups in a 1:1:1 ratio to receive a single dose at day 1, followed by multiple oral doses of 1, 2, and 4 g/d for 14 days. At day 15, all subjects received a HF breakfast. FINDINGS: After once-daily dosing, based on graphic assessment, OM3-PL/FFA levels reached steady state within 7-10 days. Exposure of total EPA + DHA, total DHA, and total EPA (Cmax and AUC) appeared to be approximately proportional over the 1-4 g/d dose range. After 14 days of repeated daily dosing, accumulation was observed and was greater at the higher dose of the study product. When administered after a HF breakfast on day 15, median tmax, the geometric mean of AUC0-24 and Cmax were comparable with the values on day 14 across the 3 dose levels. IMPLICATIONS: OM3-PL/FFA was found to be well tolerated in healthy subjects. The study drug PK properties appeared to be approximately dose proportional over the 1-4 g/d dose range. The bioavailability of OM3-PL/FFA did not appear to be meaningfully affected by the fat content of the meal consumed before dose administration. This is clinically relevant because a low-fat diet is part of the management of patients with HTG.

A Single-dose, Comparative Bioavailability Study of a Formulation containing OM3 as Phospholipid and Free Fatty Acid to an Ethyl Ester Formulation in the Fasting and Fed States.

PURPOSE: Formulations of ω (OM)-3 with adequate bioavailability in the low-fat fed state are advantageous in patients with severe hypertriglyceridemia (HTG), as these patients are advised to adhere to a low-fat diet. The OM3-containing prescription drugs approved by the US Food and Drug administration (FDA) provide OM3 in either ethyl ester (EE) or free fatty acid (FFA) forms. The OM3 FFA form and formulations with micelle-forming ability have shown improved bioavailability versus the EE form. OM3 phospholipid (PL)/FFA, a krill oil-derived OM3 mixture containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present as PL esters and FFA, is being developed for the treatment of severe HTG. Both forms of OM3 in OM3-PL/FFA are believed to be digested and absorbed more efficiently as compared to OM3 in EE. This hypothesis was tested by comparing the relative bioavailabilities of EPA and DHA from a single 4-g dose administration of OM3-PL/FFA to those the FDA-approved HTG drug OM3-EE in the fed (high-fat meal) and fasted states. The effects of food on the bioavailability of both drugs were also tested. METHODS: This open-label, randomized, 4-way crossover bioavailability study was conducted in 56 healthy adults who were randomly assigned to receive a single 4-g dose of OM3-PL/FFA or OM3-EE in the fasted and fed (high-fat meal) states. The relative bioavailabilities of EPA and DHA were compared between the 2 formulations using pharmacokinetic analysis. FINDINGS: In the fasted state, the AUC0-72 and Cmax of EPA + DHA were 5- and 2.7-fold higher, respectively, with OM3-PL/FFA versus OM3-EE. These values were 3- and 4-fold lower in the fed state with OM3-PL/FFA versus OM3-EE. On administration of OM3-EE, the AUC0-72 and Cmax of EPA + DHA were 25- and 11-fold higher, respectively, in the fed versus the fasted state. A much lower increase (1.7-fold) in the AUC0-72 of EPA + DHA was observed on administration of OM3-PL/FFA in the fed versus the fasted state, with similar Cmax values. IMPLICATIONS: These results demonstrate that the bioavailabilities of EPA and DHA with OM3-PL/FFA, as FFA and conjugated to PL, are far less affected by the fat content of a meal as compared to the EPA and DHA EEs in OM3-EE. These findings suggest a potential clinical advantage with OM3-PL/FFA, since patients with HTG are advised to follow a fat-restricted diet.

4-Hydroxyisoleucine: a plant-derived treatment for metabolic syndrome.

The plant fenugreek has been used for centuries as a treatment for diabetes. This article presents evidence that the major isomer of 4-hydroxyisoleucine, an atypical branched-chain amino acid derived from fenugreek, is responsible for the effects of this plant on glucose and lipid metabolism. 4-Hydroxyisoleucine was demonstrated to stimulate glucose-dependent insulin secretion by a direct effect on pancreatic islets. In addition to stimulating insulin secretion, 4-hydroxyisoleucine reduced insulin resistance in muscle and/or liver by activating insulin receptor substrate-associated phosphoinositide 3 (PI3) kinase activity. 4-Hydroxyisoleucine also reduced body weight in diet-induced obese mice. The decrease in body weight was associated with a marked decrease in both plasma insulin and glucose levels, both of which are elevated in this animal model. Finally, 4-hydroxyisoleucine decreased elevated plasma triglyceride and total cholesterol levels in a hamster model of diabetes. Based on the beneficial metabolic properties that have been demonstrated, 4-hydroxyisoleucine, a simple, plant-derived amino acid, may represent an attractive new candidate for the treatment of type 2 diabetes, obesity and dyslipidemia, all key components of metabolic syndrome.

A comparison of pravastatin and gemfibrozil in the treatment of dyslipoproteinemia in patients with non-insulin-dependent diabetes mellitus.

The effects of pravastatin (pravachol) compared with gemfibrozil on cholesterol-rich and trigylceride-rich lipoproteins were evaluated in this multi-centered trial. Following an 8-12 week prerandomization phase, 136 patients with NIDDM and hypercholesterolemia were randomized to receive either pravastatin 40 mg or gemfibrozil 1200 mg daily for 16 weeks. The reduction of total cholesterol (TC), betaquant LDL and LDL cholesterol (LDL-C) was significantly greater in patients treated with pravastatin than with gemfibrozil. However, gemofibrozil treatment resulted in a significantly greater reduction of triglyceride (TG) levels than did treatment with pravastatin. Pravastatin reduced the concentration of apoB (-19.3%, P<0.001) and cholesterol-rich Lp-B (Lp-B+Lp-B; E) particles (-19%, P<0.001) to a significantly greater extent (P<-0.001) than gemfibrozil (-4.1 and -1%, respectively). Both gemfibrozil and pravastatin reduced the concentrations of trigylceride-rich Lp-Bc (-12.2 and -13.3%, respectively) and Lp-A-II;B;C;D;E (-19 and -12.7%, respectively) particles and their characteristic apoC-III constituent (-10.0 and -7.0%, respectively). In contrast, gemfibozil has a greater lowering effect compared with pravastatin on TG levels (-29.6 vs. -6.3%, respectively). Both pravastatin and gemfibrozil significantly increased the levels of apoA-I and, with both drugs, the elevated concentrations of apoA-I were due to significantly increased levels of Lp-A-I;A-II particles. By decreasing both cholesterol-rich Lp-B and triglyceride-rich Lp-Bc particles and increasing HDL-C and Lp-A-I;A-II particles in addition to proven efficacy in decreasing coronary events in NIDDM patients, pravastatin appears to be an appropriate choice for monotherapy in a broad range of diabetic patients with Type IIA and Type IIB hyperlipoproteinemias. These results also showed that direct measurement of lipoprotein family of particles provides important information not only about the composition but also the type and number of apoA- and apoB-containing lipoprotein particles.