Loperamide Research Articles

LimosiLactobacillus pentosus Isolated from Mustard Relieves Drug-induced Constipation in Mice Fed a High-fat Diet by Modulating Enteric Neurotransmitter Function.

Functional constipation is one of the most common gastrointestinal disorders. Oxidative stress can aggravate organ dysfunction. Enteric neurotransmitters have significant effects on the regulation of the enteric nervous system and intestinal muscle contraction. Oxidative stress and reduced gastrointestinal motility are considered to be one of the main causes of constipation. This study aimed to investigate whether LimosiLactobacillus pentosus CQZC02 alleviated loperamide hydrochloride (Lop)-induced constipation in mice under high-fat diet (HFD) conditions and to elucidate the underlying mechanism, focusing on enteric neurotransmitters. Four-week-old female BALB/c mice were randomly divided into five groups: normal group (Nor), constipation model group (H-Lop), L. pentosus CQZC02 low-dose group (H-Lop + ZC02L), L. pentosus CQZC02 high-dose group (H-Lop + ZC02H), and LimosiLactobacillus bulgaricus control group (H-Lop + LB). The fecal weight, water content, and total gastrointestinal transit time were measured to determine whether the mice were constipated. Small bowel and colon tissue damage was assessed by hematoxylin and eosin staining, while the degree of damage was determined by double-blind scoring. The levels of serum oxidative stress markers malondialdehyde, superoxide dismutase, glutathione peroxidase, and catalase and neurotransmitters motilin, gastrin, substance P, endothelin, somatostatin, and vasoactive intestinal peptide were measured. The gene expression levels of endothelial nitric oxide synthase, inducible nitric oxide synthase, neuronal nitric oxide synthase, nuclear factor kappa-B, and cyclooxygenase-2 in small intestine tissue were calculated. The constipation symptoms of mice in H-Lop group were manifested by a variety of physiological indicators. In addition, compared with the H-Lop group, H-Lop + ZC02H could effectively relieve the symptoms of constipation in mice. In symptom characterization, the mice in the H-Lop + ZC02H group lost weight and increased feces and water content. In functional experiments, gastrointestinal motility was enhanced; the inflammation score of intestinal tissue was decreased, and gene expression levels were modulated; serum oxidative factor levels were modulated, and oxidative stress levels were decreased.

Effect of Bacillus coagulans SNZ 1969 on the Improvement of Bowel Movement in Loperamide-Treated SD Rats.

Bacillus coagulans SNZ 1969 (B. coagulans SNZ 1969) is a spore-forming bacterium reported to be effective in attenuating constipation. However, there is no study on whether B. coagulans SNZ 1969 could improve constipation through mucin secretion and changes in intestinal hormones. To address this knowledge gap, rats were orally administrated with various treatments for four weeks. The normal control (NOR) group received saline only. There were four constipation-induced groups. The LOP group received only loperamide (LOP), a constipation-inducing agent. The BIS group received both LOP and Bisacodyl (BIS, a constipation treatment agent). The SNZ-L group received both LOP and B. coagulans SNZ 1969 at 1 × 108 CFU/day. The SNZ-H group received LOP and B. coagulans SNZ 1969 at 1 × 1010 CFU/day. As indicators of constipation improvement, fecal pellet weight, fecal water content, gastrointestinal transit time, and intestinal motility were measured. Mucus secretion in the colon was determined by histological colon analysis and mucin-related gene expressions. Gastrointestinal (GI) hormones were also measured. SNZ-L and SNZ-H groups showed significantly increased fecal weights, fecal water contents, and intestinal motility than the LOP group. SNZ-L and SNZ-H groups also showed higher secretion of mucin in the colon and mRNA expression levels of Mucin 2 and Aquaporin 8 than the LOP group. The SNZ-H group showed significantly increased substance P but significantly decreased somatostatin and vasoactive intestinal peptide than the LOP group. The results of this study suggest that B. coagulans SNZ 1969 intake could attenuate constipation through mucin secretion and alteration of GI hormones.

Shouhui Tongbian Capsule ameliorates constipation via gut microbiota-5-HT-intestinal motility axis

Constipation has become an epidemic enteric medical problem, accompanied with increasing long-term sequelae. Gut microbiota and serotonin (5-HT) have been believed as predominant player in the treatment of constipation. In clinical practices, Shouhui Tongbian Capsule (SHTB) was found to effectively improve constipation symptoms and promote gastrointestinal motility. However, the specific mechanism of SHTB is not clearly elucidated. Our current study aims to explore the therapeutic effects of SHTB against the development of constipation and the underlying mechanisms related to gut bacterial and 5-HT. We established loperamide hydrochloride (LH)-induced experimental constipation mouse model to evaluate the effect of SHTB. 16S RNA sequencing, fecal microbiota transplants (FMT), high performance liquid chromatograph, and molecular biological analysis were performed to investigate the potential mechanisms of SHTB. Our data demonstrated that SHTB significantly ameliorated LH-induced experimental constipation and accelerated enteric motility via promoting 5-HT biosynthesis in enterochromaffin cells and enteric neuron growth of the enteric nervous system (ENS) in both the small intestine and colon. Additionally, SHTB significantly modulated gut microbiota dysbiosis and potentially altered microbiota metabolites to enhance intestinal 5-HT production. Finally, FMT study confirmed that the effects of SHTB on 5-HT production and constipation are dependent on modulating intestinal microbiota dysbiosis. In conclusion, our current study deciphered therapeutic mechanism of SHTB in the treatment of experimental constipation from perspectives of gut microbiota-5-HT-intetinal motility axis and provides novel insights into the appropriate and safe application of SHTB in the clinic.

Chinese patent medicine shouhui tongbian capsule attenuated loperamide-induced constipation through modulating the gut microbiota in rat

Ethnopharmacological relevanceShouhui tongbian capsule (SHTC) is a commercial Chinese patent medicine used in the treatment of constipation. However, its mechanism of action remains unclear.Aim of the study: The present study was undertaken to assess SHTC relieved effects on the clinical symptoms of loperamide (LOP) induced constipation in Sprague Dawley (SD) rat model and to clarify the relationship between the protective effect of SHTC on constipation and the gut microbiota. Materials and methodsConstipation male SD rats models were induced with solution of LOP (1.5 mg/kg bw), and rats were treated with an oral dose of SHTC (35, 70 mg/kg bw) three times a day after successful modeling. All rats were assessed weekly by change in body weight, gastric emptying rate, fecal moisture content and wet/dry weight. Hematoxylin and eosin (H&E) were used to observe parts of the rats small intestine. The gut microbiota in colonic contents was analyzed using 16SrRNA gene sequencing. Contents of short-chain fatty acids (SCFAs) were analyzed by gas chromatography-mass spectrometer (GCMS). ResultsThe results confirmed the therapeutic effects of SHTC on constipation. Specifically, SHTC could alleviate the decrease in body weight, gastric emptying rate and fecal moisture content caused by LOP-induced constipation. The pathological damage of small intestine was significantly improved by H&E staining. Notably, SHTC increased the relative abundances of Lactobacillus and the ratio of Firmicutes to Bacteroides (F/B). In addition, the content of acetic acid and propionic acid was significantly increased in constipated rats fed with SHTC. ConclusionSHTC could ameliorate the development of LOP-induced constipation in rats by remodeling the structure of gut microbial community and regulating production of intestinal metabolites.

Extraction and Fractionation of Prokinetic Phytochemicals from Chrozophora tinctoria and Their Bioactivities.

Chrozophora tinctoria is an annual plant of the family Euphorbiaceae, traditionally used as a laxative, a cathartic and an emetic. A methanolic extract of Chrozophora tinctoria (MEC) whole plant and an n-butanol fraction of Chrozophora tinctoria (NBFC) were analyzed by gas chromatography–mass spectrometry (GC-MS) to detect the phytochemicals. MEC and NBFC were tested for in vitro anti acetylcholinesterase (AChE) potential. The effect of both samples on intestinal propulsive movement and spasmolytic activity in the gastrointestinal tract (GIT) was also studied. About twelve compounds in MEC and three compounds in NBFC were tentatively identified through GC-MS. Some of them are compounds with known therapeutic activity, such as toluene; imipramine; undecane; 14-methyl-pentadecanoic acid methyl ester; and hexadecanoic acid. Both NBFC and MEC samples were checked for acute toxicity and were found to be highly toxic in a dose-dependent manner, causing diarrhea and emesis at 1 g/kg concentration in pigeons, with the highest lethargy and mortality above 3 g/kg. Both the samples of Chrozophora tinctoria revealed significant (p ≤ 0.01) laxative activity against metronidazole (7 mg/kg) and loperamide hydrochloride (4 mg/kg)-induced constipation. NBFC (81.18 ± 2.5%) and MEC (68.28 ± 2.4%) significantly increased charcoal meal intestinal transit compared to distal water (41.15 ± 4.3%). NBFC exhibited a significant relaxant effect (EC50 = 3.40 ± 0.20 mg/mL) in spontaneous rabbit jejunum as compared to MEC (EC50 = 4.34 ± 0.68 mg/kg). Similarly, the impact of NBFC on KCl-induced contraction was more significant than that of MEC (EC50 values of 7.22 ± 0.06 mg/mL and 7.47 ± 0.57 mg/mL, respectively). The present study scientifically validates the folk use of Chrozophora tinctoria in the management of gastrointestinal diseases such as constipation. Further work is needed to isolate the phytochemicals that act as diarrheal agents in Chrozophora tinctoria.

Mechanism of Picrorhizae Rhizoma against functional constipation in mice: an exploration based on 16S rDNA and GC-MS

The study was designed to determine the influences of Picrorhizae Rhizoma on gut microbiota and metabolites in mice with functional constipation(FC). ICR mice were divided into the blank control group, model group, and the low-, middle-, and high-dose Picrorhizae Rhizoma groups. Mice in the model and low-, middle-, and high-dose Picrorhizae Rhizoma groups were modeled with loperamide hydrochloride. After successful modeling, the ones in the low-, middle-, and high-dose Picrorhizae Rhizoma groups were gavaged with Picrorhizae Rhizoma at the corresponding doses for seven days. The first appearance time of tarry stool, the total fecal volume within 3 h, the fecal moisture content, and the intestinal transit rate were observed in each group. The pathological changes in intestinal mucosa were detected by HE staining. The flora dynamics in colon content were measured by 16 S rDNA sequencing, followed by the examination of fecal metabolomic profiles by gas chromatography-mass spectrometry(GC-MS). The results showed that the first appearance time of tarry stool in the model group was prolonged. The total fecal volume within 3 h, the fecal moisture content, and the intestinal transit rate were significantly reduced. The colon tissue showed inflammatory cell infiltration. Gut microflora and fecal metabolites changed dramatically. Picrorhizae Rhizoma alleviated the constipation symptoms, repaired intestinal mucosa, and partially restored the gut microbiota and metabolite compositions in mice with constipation. As demonstrated by intestinal microbiota sequencing, Picrorhizae Rhizoma remarkably reduced the Firmicutes/Bacteroidetes ratio and the relative abundance of Lactobacillus, but increased the relative abundance of Muribaculaceae, Enterorhabdus, and Eggerthellaceae. According to the linear discriminant analysis effect size(LefSe), the dominant bacterial species in the Picrorhizae Rhizoma groups were Muribaculaceae, Dubosiella, and Akkermansia. A total of 43 differential metabolites were detected in the feces of mice, involving the D-glutamine and D-glutamate metabolism, glutathione metabolism, arginine biosynthesis, alanine, aspartate and glutamate metabolism, purine metabolism, and pyrimidine metabolism. All these have demonstrated that Picrorhizae Rhizoma enhanced gastrointestinal motility, protectd gastrointestinal mucosa, and alleviated constipation symptoms possibly by regulating the intestinal microbial communities and metabolites and affecting the related metabolic pathways.

Smartphone as a Portable Detector for Thin-Layer Chromatographic Determination of Some Gastrointestinal Tract Drugs.

Thin-layer chromatography (TLC) is an effective and simple technique for screening, evaluating, and quantifying low-quality and counterfeit pharmaceutical products. Smartphones have recently been used as accessible, cheap, and portable detectors that can replace more complicated analytical detectors. In this work, we have developed a simple and sensitive TLC method utilizing a smartphone charged-coupled device (CCD) camera not only to verify and quantify some gastrointestinal tract drugs, namely, loperamide hydrochloride (LOP) and bisacodyl (BIS), but also to detect acetaminophen (ACT) as a counterfeit drug. Both drugs (LOP and BIS) were chromatographed separately on a silica gel 60 F254 plate as a stationary phase under previously reported chromatographic conditions, using ethyl acetate:methanol:ammonium hydroxide (24:3:1, by volume) and ethyl acetate:methanol:glacial acetic acid (85:10:5, by volume) as developing systems to determine LOP and BIS, respectively. Universal stains, namely, iodine vapors and vanillin, were used to visualize the spots on the TLC plates to get a visual image using the smartphone camera and a spotlight as an illumination source with no need for a UV illumination source. The spot intensity was calculated using a commercially available smartphone application for quantitative analysis of the studied drugs utilizing ″acetaminophen″ as an example of a counterfeit substance. Rf values were calculated using the recorded images and found to be 0.77, 0.79, and 0.74 for LOP, BIS, and ACT, respectively, providing drug identity. Linear calibration curves using the smartphone–TLC method were obtained between the luminance and the corresponding concentrations over the ranges of 2.00–10.00 μg/mL and 1.00–10.00 μg/mL with limits of detection of 0.57 and 0.10 μg/mL for LOP and BIS, respectively. The suggested method was validated according to the International Conference of Harmonization (ICH) guidelines. The method was then successfully applied for the qualitative and quantitative determination of LOP or BIS as an example for gastrointestinal tract drugs in pure form and in their pharmaceutical dosage formulations. The proposed method is considered as a perfect alternative to traditional reported densitometric methods due to its simplicity, easy application, and inexpensiveness. No previously reported methods utilizing smartphones have been published for the determination of the studied drugs. The developed approach is considered the first TLC method using smartphones for the determination of some gastrointestinal tract drugs in their pure form and in pharmaceutical formulations.

Based on Network Pharmacology and Gut Microbiota Analysis to Investigate the Mechanism of the Laxative Effect of Pterostilbene on Loperamide-Induced Slow Transit Constipation in Mice

Background: Pterostilbene (PTE) is a natural polyphenol compound that has been proven to improve intestinal inflammation, but its laxative effect on slow transit constipation (STC) has never been studied. This study aims to investigate the laxative effect of PTE on loperamide (LOP)-induced STC mice and its influence on intestinal microbes through a combination of network pharmacological analysis and experimental verification. Material and Methods: PTE was used to treat LOP-exposed mice, and the laxative effect of PTE was evaluated by the total intestinal transit time and stool parameters. The apoptosis of Cajal interstitial cells (ICCs) was detected by immunofluorescence. The mechanism of PTE’s laxative effect was predicted by network pharmacology analysis. We used western blot technology to verify the predicted hub genes and pathways. Malondialdehyde (MDA) and GSH-Px were tested to reflect oxidative stress levels and the changes of gut microbiota were detected by 16S rDNA high-throughput sequencing. Results: PTE treatment could significantly improve the intestinal motility disorder caused by LOP. Apoptosis of ICCs increased in the STC group, but decreased significantly in the PTE intervention group. Through network pharmacological analysis, PTE might reduce the apoptosis of ICCs by enhancing PI3K/AKT and Nrf2/HO-1 signaling, and improve constipation caused by LOP. In colon tissues, PTE improved the Nrf2/HO-1 pathway and upregulated the phosphorylation of AKT. The level of MDA increased and GSH-Px decreased in the STC group, while the level of oxidative stress was significantly reduced in the PTE treatment groups. PTE also promoted the secretion of intestinal hormone and restored the microbial diversity caused by LOP. Conclusion: Pterostilbene ameliorated the intestinal motility disorder induced by LOP, this effect might be achieved by inhibiting oxidative stress-induced apoptosis of ICCs through the PI3K/AKT/Nrf2 signaling pathway.

Newly Developed Nano Sensitive Carbon Paste Electrode Modified with Silver Sulphadiazine and Zinc Oxide for Voltammetric Determination of Loperamide Hydrochloride in Pharmaceutical Formulation and in Human Plasma

A simple electrochemical procedure was developed for the electrochemical determination of Loperamide hydrochloride (LOP). A square wave voltammetric method was applied to determine LOP in its pure form, pharmaceutical formulation, in presence of co-administered drugs omeprazole, trimebutine, and naproxen and in human plasma. In the applied method, a newly fabricated carbon paste electrode chemically modified with silver sulfadiazine and zinc oxide was used. Experimental parameters such as pH of Britton-Robinson buffer, scan rate and applied current potential of the electrode surface were optimized. The morphological structure of the newly fabricated electrode was illustrated using transmission electron microscopy. Using Britton–Robinson buffer of pH 8.00, LOP showed an irreversible anodic peak of 0.827 V. The manufactured sensor displayed high sensitivity and optimum charge/electrode kinetic transmission. Linear calibration curve was obtained between the peak current and the corresponding concentration of LOP over the range (14.00 × 10−12 − 1.00 × 10−4 M) with low detection limit of about (4.00 × 10−12 M) indicating good sensitivity. The proposed method was validated according to the ICH guidelines. The proposed sensor was also applied to determine LOP in human plasma after successfully validating the method according to the FDA bioanalytical methods guidelines. The greenness of the method was assessed using the Analytical Eco-Scale approach and the results reveal that the developed method is not only greener and uses non-hazardous chemicals than the previously reported HPLC methods for LOP determination in biological fluid but also can be used in the quality control laboratories for LOP determination in pharmaceutical formulation and in human plasma.

Nonalcoholic fatty liver disease developed after pancreatoduodenectomy for solid pseudopapillary neoplasm in a 10-year-old girl: a case report

BackgroundSolid pseudopapillary neoplasms of the pancreas are rare. Moreover, pancreatoduodenectomy (PD) and postoperative care are not common in pediatric surgery. Herein, we report a case of PD and nonalcoholic fatty liver disease (NAFLD) after PD and present a literature review.Case presentationA 10-year-old girl with a suspected liver tumor was referred to our hospital. Echography, enhanced computed tomography and magnetic resonance imaging showed that the tumor coexisted with the solid and cystic parts of the pancreatic head. Since the patient was a young woman and the imaging findings were consistent with that of pancreatic solid pseudopapillary neoplasms (SPNs), we diagnosed her with pancreatic SPN. Thereafter, PD was performed, and she was discharged 10 days after the operation. Although her postoperative course was mostly uneventful, she experienced few episodes of abdominal pain and diarrhea before hospital discharge. These symptoms subsequently became more frequent and severe. The patient was urgently readmitted to the hospital for watery steatorrhea and lower abdominal colic pain. Her serum aspartate aminotransferase and alanine aminotransferase levels were elevated, and a fatty liver was detected on echography. The patient was diagnosed with steatorrhea, peristaltic pain, and NAFLD after PD. Pancrelipase (containing pancreatic digestive enzymes), antidiarrheal agents, and probiotics were started. Dosage increase of these drugs reduced the defecation frequency and abdominal pain and switched diarrhea to loose stools. However, more lipids in meals or more meals caused diarrhea and abdominal pain. Therefore, the doses of these drugs were further increased, and another antidiarrheal agent, loperamide hydrochloride, was added. Exocrine pancreatic enzymes supplementation and careful follow-up should prevent NAFLD progression after PD. At present, the patient has occasional abdominal pain, but has tangible soft stools once or twice a day. Although echography still shows a mottled fatty liver, her hepatic enzymes are only mildly elevated.ConclusionsPediatric PD is rare, and residual pancreatic function is usually sufficient, unlike in adult cases. However, we experienced a case of NAFLD after PD for a pediatric pancreatic SPN, in which pancreatic enzyme supplementation effectively improved this condition. Further attention must be paid to worsening of NAFLD that can develop nonalcoholic steatohepatitis.

Probiotic Properties of a Spaceflight-induced Mutant Lactobacillus Plant- arum SS18-50 in Mice

Probiotics are a group of bacteria that play a critical role in intestinal microbiota homeostasis and may help adjunctively treat certain diseases like metabolic and immune disorders. We recently generated a space-flight mutated Lactobacillus plantarum SS18-50 with good in vitro probiotic characteristics. In the current research, we designed two in vivo experiments to evaluate whether L. plantarum SS18-50 had the ability to increase beneficial gut bacteria, regulate oxidative status and ameliorate inflammation in mice. Experiments I: the ICR mice were gavaged with L. plantarum SS18-50 or its wild type L. plantarum GS18 at 107 or 109 CFU/kg BW daily for one month, during which the body weight was recorded weekly. The feces were collected to determine the abundance of two main beneficial bacterial groups including Lactobacillus and Bifidobacterium by selective culturing, while the total triglycerides and cholesterols in sera were determined using commercial kits. Experiment II: the mice were gavaged with loperamide hydrochloride (Lop) to develop oxidative stress and inflammation phenotypes. At the same time, the experimental mice were gavaged with L. plantarum SS18-50 or wild type L. plantarum GS18 at 107 or 109 CFU/kg BW daily for one month. At the end of the experiment, oxidative indicators (SOD and MDA) and inflammatory cytokines (IL-17A and IL-10) were measured by commercial kits. Results showed that L. plantarum SS18-50 increased the abundance of Lactobacillus and Bifidobacterium in mice after one month's administration. L. plantarum SS18-50 also showed the anti-oxidant activity by increasing SOD and decreasing MDA and exerted the anti-inflammatory effect by increasing IL-10 and decreasing IL-17A in Lop treated mice. Both the wild type stain and the space mutant had such biomedical effects, but L. plantarum SS18-50 was better in increasing gut beneficial bacteria and oxidative regulation than the wild type (P<0.05). We conclude that L. plantarum SS18-50 has a great potential to serve as a dietary functional probiotic supplement and/or adjunctive treatment strategy.

24-Year-Old Man With Syncope

A 24-year-old man with a past medical history of tobacco use and generalized anxiety disorder presented to the emergency department by ambulance after being found unresponsive by his mother at home. There was associated loss of consciousness and bladder control. Despite being unresponsive at home, he arrived alert and oriented but appears tired. He reports taking 300 mg of loperamide hydrochloride (maximum recommended dose is 16 mg/d) to achieve a high approximately 10 hours before arrival in the emergency department; he does not take any other medications.

Extraction of Pectin from Orange Peel and Study of Its Protective Effect Against Loperamide-Induced Impaired Gastrointestinal Motor Functions and Oxidative Stress in Rats.

Pectin is a polysaccharide attached to carbohydrates. These are substances exclusively of plant origin. The aim of the present study is to evaluate the laxative effects of orange peel pectin extract (OPPE) against constipation induced by loperamide (LOP) in rats. Rats were equally divided into six groups and treated daily 1 week as follows: Control, LOP (3 mg/kg, body weight [b.w.], Per Os [p.o.]), LOP+yohimbine (2 mg/kg, b.w., i.p.), and LOP+OPPE (6.25, 12.5, and 25 mg/kg, b.w., p.o.). At the end of the experiment, the effects of OPPE were assessed by fecal parameters (numbers, weight, and water content), gastrointestinal transit, gastric emptying, serum metabolic parameter changes, intestinal and colon mucosa oxidative stress, and the histological examination. The defecation test showed that administration of LOP (3 mg/kg, b.w., p.o.) leads to the production of remarkable constipation. Indeed, the number and water content of stools decreased (25.50 [n/24 h] and 29.86%) significantly (P < .05). Acute pretreatment with OPPE significantly and dose dependently accelerated the stool moistening and allowed an increase of stool weight (2.85, 3.61, 3.93 [g/24 h/rat]) as well as the frequency of defecation (47.36, 54.54, and 56.26 [n/24 h]). OPPE also significantly (P < .05) and dose dependently increased the intestinal motility (70.78%, 73.33%, and 75.01%) and gastric emptying. LOP-induced reduction (P < .05) of intestinal secretion was accompanied by a colonic and small bowel oxidative stress status and histological changes, which was attenuated by OPPE treatment. The findings of this study indicate that OPPE possesses an important role in the gastrointestinal motility regulation, and thus lend pharmacological credence to the suggested use of the natural pectin for the treatment, management, and/or control of constipation.

Validation of the HPLC\u2013PDA method for detection of eluxadoline and rifaximin in rat plasma and application in a pharmacokinetic study

BackgroundA precise, simple, accurate, and quick HPLC–PDA method for the determination of eluxadoline and rifaximin in rat plasma was developed and validated in this study. In this method, Loperamide hydrochloride was used as the internal standard and plasma samples were prepared using a liquid–liquid extraction technique for which acetonitrile was a solvent. An Agilent Symmetry C8 column (5 µm, 250 mm × 4.6 mm) at 283 nm and isocratic elution using HPLC grade acetonitrile and 7 mM TEA (pH 2.5) with a ratio of (40: 60 v/v) was used as a mobile phase and the flow rate employed was 1 mL min−1. A satisfactory chromatographic separation was accomplished.ResultsAn HPLC–PDA method for the determination of eluxadoline and rifaximin with retention times of 3.06 and 7.82 min, respectively, was developed. The calibration curves appear linear for both eluxadoline and rifaximin in the range of 5–200 ng mL−1 and 10–400 ng mL−1, and the corresponding correlation coefficient values were found to be 0.9999 and 0.9998 respectively. Lower limits of quantification (LLOQ) for eluxadoline and rifaximin were evaluated to be 5.0 ng mL−1 and 10.0 ng mL−1, respectively. The accuracy and precision results in all validation experiments were within the acceptance limits of FDA guidelines.ConclusionThe developed HPLC–PDA approach was fully validated to meet the USFDA guidelines for bioanalytical method validation in terms of precision, accuracy, and stability. The presented approach could be beneficial for the determination of ELX and RFX in rat plasma, according to validation parameters. This is one of the efficient method to study the pharmacokinetics of ELX and RFX in rats.Graphical abstract

Opioid receptor signaling suppresses leukemia through both catalytic and non-catalytic functions of TET2.

Acute myeloid leukemia (AML) is a genetically heterogeneous and frequently fatal malignancy. The ten-eleven translocation (TET)-mediated DNA demethylation is known to be critically associated with AML pathogenesis. Through chemical compound screening, we find that the opioid receptor agonist, loperamide hydrochloride (OPA1), significantly suppresses AML cell viability. The potential therapeutic effects of opioid receptor agonists, especially OPA1, are verified in AML cells invitro and mouse and human AML models invivo. OPA1-induced activation of OPRM1 signaling enhances the transcription of TET2 and thus activates both catalytic-dependent and -independent functions of TET2. Notably, AMLs with TET2 mutations or chemotherapy resistance are sensitive to OPA1 as well. Our results reveal the OPRM1-TET2 regulatory axis in AML and suggest that opioid agonists, particularly OPA1, a US Food and Drug Administration (FDA)-approved antidiarrheal drug, have therapeutic potential in AML, especially in TET2-mutated and chemotherapy-resistant AMLs, which have a poor prognosis.

ANTIDIARRHEAL ACTIVITY TEST OF ETHANOLIC EXTRACT OF WHITE POMEGRANATE PEEL (PUNICA GRANATUM L.) IN MALE WHITE MICE (MUS MUSCULUS), SWISS WEBSTER LINE USING THE INTESTINAL TRANSIT METHOD

Objective: Diarrheal disease and its complications remain a major cause of morbidity and mortality in children, especially in developing countries. It is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral, parasitic or organisms. The purpose of this study was to determine the activity and dose of white pomegranate peel (Punica granatum L.) ethanol extract as an antidiarrheal in white male mice using the intestinal transit method.&#x0D; Methods: Mice were grouped into 5 groups: negative control (Na CMC 1 %), positive control (loperamide HCl 0.0104 mg/20 g mice BW), and pomegranate peel ethanol extract test group 1, 2, and 3 (dose of 16, 32, and 64 mg/20 g mice BW). The length of the intestine that the ink marker traversed from the pylorus to the end (which is black) was measured using a ruler.&#x0D; Results: Based on statistical analysis, there were significant differences between all groups (&lt;0.05). The highest antidiarrheal activity was in the ethanolic extract of pomegranate peel at a dose of 64 mg/20 g mice BW with an inhibition percentage of 36.44% and higher than the positive control (29.81%). The inhibition percentage was also resulted by dose 1 and 2 (12.46% and 29.53%, respectively).&#x0D; Conclusion: From these results show a correlation that the higher the extract dose, the higher the antidiarrheal potential.

Effects of probiotics on loperamide-induced constipation in rats

The role of probiotics in mitigating constipation, gut immunity, and gut microbiota has not been well studied. We aimed to evaluate the effects of probiotics on loperamide (LP)-induced constipation in Sprague–Dawley rats. Altogether, 150 male Sprague–Dawley rats (age 8 weeks) were used in the experiments following a 12-day acclimatisation period and were randomly divided into three treatment groups (groups 1, 2, and 3). Spastic constipation was induced via oral LP administration (3 mg/kg) for 6 days, 1 h before administering each test compound in groups 1 and 2. A probiotic solution (4 mL/kg body weight) was orally administered once a day for 6 days in group 2. In group 1, a phosphate buffer solution was orally administered once a day for 6 days, 1 h after each LP administration. In group 3, a phosphate buffer solution was orally administered once a day for 6 days. In the probiotic group, faecal parameters improved; faecal n-butyric acid, acetic acid, and IgA concentrations were increased; intestinal transit time was shortened; and disturbance of intestinal microbiota was inhibited. Our findings suggest that this probiotic was useful in improving various symptoms caused by constipation.

Loperamide potentiates doxorubicin sensitivity in triple-negative breast cancer cells by targeting MDR1 and JNK and suppressing mTOR and Bcl-2: In vitro and molecular docking study.

Multidrug resistance (MDR) is the leading cause of treatment failure in triple-negative breast cancer (TNBC) patients treated with doxorubicin (DXR). We aimed to investigate the potential of the antidiarrheal drug Loperamide (LPR) in sensitizing TNBC cells to DXR and elucidate the underlying molecular mechanisms. Therefore, we examined the effects of DXR alone or in combination with LPR on MDA-MD-231 cells viability using MTT assay, cell cycle, and apoptosis by flow cytometry, and the expression of the MDR-related genes (MDR1 and JNK1) and cell cycle/survival genes (p21, mTOR, and Bcl-2) by quantitative reverse transcription polymerase chain reaction. Results showed that adding LPR to DXR potentiated its antiproliferation effect and reduced its IC50 by twofolds compared with DXR alone. The value of the combination index of LPR/DXR was <1 indicating a synergistic effect. Combined DXR/LPR treatment also caused G1 arrest and potentiated apoptosis more than DXR-single treatment. At the molecular levels, LPR/DXR treatment downregulated the mRNA of MDR1 (1.35-folds), JNK1 (2.5-folds), mTOR (6.6-folds), Bcl-2 (9.5-folds); while upregulated p21 gene (8-folds) compared with DXR alone. Molecular docking analyses found LPR antagonizes MDR1 and JNK1 proteins, and hence supports the in vitro studies. In conclusion, the results confirmedthe potential of LPR in sensitizing TNBCs to DXR by targeting MDR1 and JNK1 and suppressing Bcl-2 and mTOR genes, while upregulating the cell cycle inhibitor gene p21. Additionally, LPR could be repurposed to reduce the therapeutic doses of DXR as indicated by the dose reduction index (DRI) and subsequently decrease its side effects.

218 Online Social Listening Surveillance for Earlier Insights About Loperamide Abuse/Misuse, 2015-2021

Loperamide (LOP) is a safe, effective antidiarrheal medication available over-the-counter (OTC) for over 30 years with a maximum dose of 8 mg/day for adults. Intentional LOP abuse/misuse (ingesting 70-200 mg/day to self-treat opioid withdrawal symptoms or achieve euphoria) was first reported in online forums in 2005. Following a 2016 US Food and Drug Administration (FDA) Drug Safety Communication on the potential risk of cardiovascular adverse events with high doses of LOP, the OTC industry initiated a communications campaign (www.LoperamideSafety.org) to educate health professionals, including emergency medicine specialists, about LOP abuse/misuse awareness and prevention. Retrospective surveillance (eg, FDA Adverse Event Reporting System database and National Poison Data System) has traditionally been employed to track reports of drug abuse/misuse. We utilized modern online social listening technology to observe and analyze comments/conversations (posts) about LOP abuse/misuse on various websites and online social media platforms to gain earlier insight into potential LOP abuse/misuse. Utilizing the software tools Crimson Hexagon and Synthesio, we scanned thousands of publicly accessible user posts in online blogs, forums, and social networks – including major platforms such as Twitter, Facebook, YouTube, Reddit, and Forums – from January 2015 to March 2021 to observe posts about LOP abuse/misuse. Listening consisted of keyword-based scrapes of user-generated content using search terms including loperamide, Imodium, overdose, OD, get high, getting high, withdrawal, and related terms/phrases. Findings were analyzed and reported quarterly. From January 2015 to March 2021, there were 27,213 user posts regarding LOP abuse/misuse among all observed online platforms. Annual post volume peaked in 2016 before declining in 2019/2020, consistent with the pattern of annual intentional exposure cases reported by the American Association of Poison Control Centers. Over 2015-2021, there was an average of 390 posts per month. Since May 2018, Reddit contained the majority of posts (70%), followed by Twitter (18%), YouTube (6%), Forums (4%), Facebook (<1%), and other sites (<1%). Reddit and Forums accounted for an increasing percentage of posts over time with a decrease for all other platforms. Posts primarily addressed the use of high-dose LOP for easing withdrawal symptoms (73%) or seeking euphoria (17%). Posts about risks and dangers of misuse/abuse were 16% of Reddit posts from Q2 2020 to Q1 2021, with a peak of 22% in Q2 2020. Spikes in posts coincided with key events, including journal article publications regarding effects of high doses (2,499 posts in May 2016 and 830 posts in January 2017) and FDA Drug Safety Communications regarding abuse/misuse of LOP (650 posts in June 2016 and 1,400 posts in January 2018). Post volume also appeared to increase in relation to US COVID-19 infection rates in 2020/2021 slightly. Online chatter about LOP abuse/misuse rose from 2015 to a peak in 2016 before declining in 2019/2020, consistent with the pattern of reported annual intentional exposure cases. While not a substitute for epidemiological surveillance, online social media listening is a useful adjunct surveillance strategy for earlier insight into potential LOP abuse/misuse by observing and analyzing online comments/conversations, sentiments and contexts.

State-dependent inhibition of BK channels by the opioid agonist loperamide.

Large-conductance Ca2+-activated K+ (BK) channels control a range of physiological functions, and their dysfunction is linked to human disease. We have found that the widely used drug loperamide (LOP) can inhibit activity of BK channels composed of either α-subunits (BKα channels) or α-subunits plus the auxiliary γ1-subunit (BKα/γ1 channels), and here we analyze the molecular mechanism of LOP action. LOP applied at the cytosolic side of the membrane rapidly and reversibly inhibited BK current, an effect that appeared as a decay in voltage-activated BK currents. The apparent affinity for LOP decreased with hyperpolarization in a manner consistent with LOP behaving as an inhibitor of open, activated channels. Increasing LOP concentration reduced the half-maximal activation voltage, consistent with relative stabilization of the LOP-inhibited open state. Single-channel recordings revealed that LOP did not reduce unitary BK channel current, but instead decreased BK channel open probability and mean open times. LOP elicited use-dependent inhibition, in which trains of brief depolarizing steps lead to accumulated reduction of BK current, whereas single brief depolarizing steps do not. The principal effects of LOP on BK channel gating are described by a mechanism in which LOP acts as a state-dependent pore blocker. Our results suggest that therapeutic doses of LOP may act in part by inhibiting K+ efflux through intestinal BK channels.