Efficacy of Oral Mixed Tocotrienols in Diabetic Peripheral Neuropathy: A Randomized Clinical Trial.

Importance: Management of painful diabetic peripheral neuropathy remains challenging. Most therapies provide symptomatic relief with varying degrees of efficacy. Tocotrienols have modulatory effects on the neuropathy pathway and may reduce neuropathic symptoms with their antioxidative and anti-inflammatory activities. Objective: To evaluate the efficacy of oral mixed tocotrienols for patients with diabetic peripheral neuropathy. Design, Setting, and Participants: The Vitamin E in Neuroprotection Study (VENUS) was a parallel, double-blind, placebo-controlled trial that recruited participants from January 30, 2011, to December 7, 2014, with 12 months of follow-up. This trial screened 14 289 patients with diabetes from 6 health clinics and ambulatory care units from 5 public hospitals in Malaysia. A total of 391 patients who reported neuropathic symptoms were further assessed with Total Symptom Score (TSS) and Neuropathy Impairment Score (NIS). Patients 20 years or older with a TSS of 3 or higher and an NIS of 2 or higher were recruited. Interventions: Patients were randomized to receive 200 mg of mixed tocotrienols twice daily or matching placebo for 12 months. Patients with hyperhomocysteinemia (homocysteine level ≥2.03 mg/L) received oral folic acid, 5 mg once daily, and methylcobalamin, 500 µg thrice daily, in both groups. Main Outcomes and Measures: The primary outcome was patient-reported neuropathy TSS (lancinating pain, burning pain, paresthesia, and asleep numbness) changes at 12 months. The secondary outcomes were NIS and sensory nerve conduction test result. Results: Of 391 eligible patients, 300 were recruited (130 [43.3%] male; mean [SD] age, 57.6 [8.9] years; mean [SD] duration of diabetes, 11.4 [7.8] years) and 229 (76.3%) completed the trial. The TSS changes between the tocotrienols and placebo groups at 12 months (-0.30; 95% CI, -1.16 to 0.56; P = .49) were similar. No significant differences in NIS (0.60; 95% CI, -1.37 to 2.65; P = .53) and sensory nerve conduction test assessments were found between both groups. In post hoc subgroup analyses, tocotrienols reduced lancinating pain among patients with hemoglobin A1C levels greater than 8% (P = .03) and normohomocysteinemia (homocysteine level <2.03 mg/L; P = .008) at 1 year. Serious adverse events in both groups were similar, except more infections were observed in the tocotrienols group (6.7% vs 0.7%, P = .04). Results reported were of modified intention-to-treat analyses. Conclusions and Relevance: Supplementation of oral mixed tocotrienols, 400 mg/d for 1 year, did not improve overall neuropathic symptoms. The preliminary observations on lancinating pain among subsets of patients require further exploration. Trial Registration: National Medical Research Registry Identifier: NMRR-10-948-7327 and clinicaltrials.gov Identifier: NCT01973400.

Preparation, in-vitro and in-vivo characterisation of CoQ10 microparticles: electrospraying-enhanced bioavailability.

OBJECTIVES: This study aimed to prepare Coenzyme Q10 (CoQ10) microparticles using electrospraying technology, and evaluate the in-vitro properties and in-vivo oral bioavailability. KEY FINDINGS: Electrospraying was successfully used to prepare CoQ10 to enhance its solubility and dissolution properties. In-vitro evaluation of the electrosprayed microparticles showed bioavailability-enhancing properties such as reduced crystallinity and particle size. The formulation was evaluated using dissolution study and in-vivo oral bioavailability using rat model. The dissolution study revealed enhanced dissolution properties of electrosprayed microparticles compared with physical mixture and raw material. The absorption profiles showed increasing mean plasma levels CoQ10 in the following order: raw material < physical mixture < electrosprayed microparticles. CONCLUSION: Based on the findings in this study, electrospraying is a highly prospective technology to produce functional nano- and micro-structures as delivery vehicles for drugs with poor oral bioavailability due to rate-limiting solubility.

Agrowaste-based nanofibers as a probiotic encapsulant: fabrication and characterization.

This study explored the potential of soluble dietary fiber (SDF) from agrowastes, okara (soybean solid waste), oil palm trunk (OPT), and oil palm frond (OPF) obtained via alkali treatment, in the nanoencapsulation of Lactobacillus acidophilus . SDF solutions were amended with 8% poly(vinyl alcohol) to produce nanofibers using electrospinning technology. The spinning solution made from okara had a higher pH value at 5.39 ± 0.01 and a higher viscosity at 578.00 ± 11.02 mPa·s (P < 0.05), which resulted in finer fibers. FTIR spectra of nanofibers showed the presence of hemicellulose material in the SDF. Thermal behavior of nanofibers suggested possible thermal protection of probiotics in heat-processed foods. L. acidophilus was incorporated into the spinning solution to produce nanofiber-encapsulated probiotic, measuring 229-703 nm, visible under fluorescence microscopy. Viability studies showed good bacterial survivability of 78.6-90% under electrospinning conditions and retained viability at refrigeration temperature during the 21 day storage study.

Characterization of fibrous residues from agrowastes and the production of nanofibers.

Oil palm trunk (OPT), oil palm frond (OPF), and okara are agrowastes generated abundantly by the palm oil and soy industries. There are vast potentials for these fibrous biomass rather than disposal at landfills or incineration. Fibrous materials (FM) and alkali-treated fibrous residues (FR) were produced from the selected wastes and subsequently characterized. Functional properties such as emulsifying properties, mineral-binding capacity, and free radical scavenging activity were also evaluated for possible development of functional products. Supernatants (FS) generated from the alkaline treatment contained soluble fractions of fibers and were also characterized and used for the production of nanofibers. Okara FM had the highest (P < 0.05) protein (31.5%) and fat (12.2%) contents, which were significantly reduced following alkali treatment. The treatment also increased total dietary fiber (TDF) in okara by 107.9%, in OPT by 67.2%, and in OPF by 25.1%. The increased fiber fractions in FR enhanced functional properties such as water-holding capacities and oil-holding capacities. Okara displayed the highest (P < 0.05) emulsifying properties compared to OPT and OPF. High IDF content of OPT and OPF contributed to high antioxidant activities (377.2 and 367.8% higher than that of okara, respectively; P < 0.05). The soluble fraction from alkali treatment of fibers was successfully electrospun into nanofibers, which can be further developed into nanoencapsulants for bioactive compound or drug delivery.

The improvement of hypertension by probiotics: effects on cholesterol, diabetes, renin, and phytoestrogens.

Probiotics are live organisms that are primarily used to improve gastrointestinal disorders such as diarrhea, irritable bowel syndrome, constipation, lactose intolerance, and to inhibit the excessive proliferation of pathogenic intestinal bacteria. However, recent studies have suggested that probiotics could have beneficial effects beyond gastrointestinal health, as they were found to improve certain metabolic disorders such as hypertension. Hypertension is caused by various factors and the predominant causes include an increase in cholesterol levels, incidence of diabetes, inconsistent modulation of renin and imbalanced sexual hormones. This review discusses the antihypertensive roles of probiotics via the improvement and/or treatment of lipid profiles, modulation of insulin resistance and sensitivity, the modulation of renin levels and also the conversion of bioactive phytoestrogens as an alternative replacement of sexual hormones such as estrogen and progesterone.

Optimization of growth of Lactobacillus acidophilus FTCC 0291 and evaluation of growth characteristics in soy whey medium: a response surface methodology approach.

Four strains of probiotics were evaluated for their alpha-galactosidase activity. Lactobacillus acidophilus FTCC 0291 displayed the highest specific alpha-galactosidase activity and was thus selected to be optimized in soy whey medium supplemented with seven nitrogen sources. The first-order model showed that meat extract, vegetable extract, and peptone significantly (P < 0.05) influenced the growth of L. acidophilus. The second-order polynomial regression estimated that maximum growth was obtained from the combination of 7.25% (w/v) meat extract, 4.7% (w/v) vegetable extract, and 6.85% (w/v) peptone. The validation experiment showed that response surface methodology was reliable with a variation of only 1.14% from the actual experimental data. Increased utilization of oligosaccharides and reducing sugars contributed to increased growth of L. acidophilus in the soy whey medium. This was accompanied by increased production of short-chain fatty acids and a decrease in pH.