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Teigen IA, Åm MK, Carlsen SM, Christiansen SC. Pharmacokinetics of glucagon after intravenous, intraperitoneal and subcutaneous administration in a pig model. Basic Clin Pharmacol Toxicol 2022; 130:623-631. [PMID: 35416407 PMCID: PMC9321685 DOI: 10.1111/bcpt.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 12/01/2022]
Abstract
Introduction There is increasing scientific evidence to substantiate using low‐dose glucagon as a supplement to insulin therapy in artificial pancreata for diabetes mellitus type 1. The delivery of both these hormones intraperitoneally would mimic normal physiology. However, our knowledge of the pharmacological properties of glucagon after intraperitoneal administration is limited. This study compared the pharmacokinetics of glucagon after intraperitoneal, subcutaneous and intravenous administration and the pharmacodynamic effects of glucagon on glucose metabolism after intraperitoneal and subcutaneous administration in a pig model. Materials and methods Twelve pigs were included. Glucagon was administered intraperitoneally, subcutaneously and intravenously in a randomised order. Arterial samples were collected every 2–10 min for 150 min to determine plasma glucagon and blood glucose concentrations. Results The bioavailability of glucagon was significantly lower after intraperitoneal compared with subcutaneous administration with a median difference (95% confidence interval) of 13% (4–22). The effect of glucagon on glucose metabolism was equal after intraperitoneal and subcutaneous administration. Conclusions Intraperitoneal glucagon administration resulted in lower systemic glucagon exposure than subcutaneous administration without loss of efficiency. We interpret this as evidence of a major first‐pass metabolism of glucagon in the liver.
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Affiliation(s)
- Ingrid Anna Teigen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Kierulf Åm
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sven Magnus Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sverre Christian Christiansen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Pharmacokinetics of Intraperitoneally Delivered Glucagon in Pigs: A Hypothesis of First Pass Metabolism. Eur J Drug Metab Pharmacokinet 2021; 46:505-511. [PMID: 34100220 PMCID: PMC8298214 DOI: 10.1007/s13318-021-00692-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 01/23/2023]
Abstract
Background and Objective Artificial pancreases administering low-dose glucagon in addition to insulin have the scope to improve glucose control in patients with diabetes mellitus type 1. If such a device were to deliver both hormones intraperitoneally, it would mimic normal physiology, which may be beneficial. However, the pharmacokinetic properties of glucagon after intraperitoneal administration are not well known. Hence, the current study aims to evaluate the relationship between the amount of intraperitoneally delivered glucagon and pharmacokinetic variables in a pig model. Methods Pharmacokinetic data was retrieved from experiments on 19 anaesthetised pigs and analysed post hoc. The animals received a single intraperitoneal bolus of glucagon ranging from 0.30 to 4.46 µg/kg. Plasma glucagon was measured every 2–10 min for 50 min. Results Peak plasma concentration and area under the time–plasma concentration curve of glucagon correlated positively with the administered dose, and larger boluses provided a relatively greater increase. The mean (standard deviation) time to maximum glucagon concentration in plasma was 11 (5) min, and the mean elimination half-life of glucagon in plasma was 19 (7) min. Conclusions Maximum plasma concentration and area under the time–plasma concentration curve of glucagon increase nonlinearly in relation to the intraperitoneally administered glucagon dose. We hypothesise that the results are compatible with a satiable first-pass metabolism in the liver. Time to maximum glucagon concentration in plasma and the elimination half-life of glucagon in plasma seem independent of the drug dose.
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Åm MK, Dirnena-Fusini I, Fougner AL, Carlsen SM, Christiansen SC. Intraperitoneal and subcutaneous glucagon delivery in anaesthetized pigs: effects on circulating glucagon and glucose levels. Sci Rep 2020; 10:13735. [PMID: 32792580 PMCID: PMC7426268 DOI: 10.1038/s41598-020-70813-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Glucagon is a pancreatic hormone and increases the blood glucose levels. It may be incorporated in a dual hormone artificial pancreas, a device to automatically and continuously control blood glucose levels of individuals with diabetes. Artificial pancreas systems have been developed for use in the subcutaneous tissue; however, the systems are not fully automated due to slow dynamics. The intraperitoneal space is therefore investigated as an alternative location for an artificial pancreas. Glucose dynamics after subcutaneous and intraperitoneal glucagon delivery in ten anaesthetized pigs were investigated. The pigs received intraperitoneal boluses of 0.3 µg/kg and 0.6 µg/kg and a subcutaneous bolus of 0.6 µg/kg in randomized order. They also received an intraperitoneal bolus of 1 mg given at the end of the experiments to test the remaining capacity of rapid glucose release. Six pigs were included in the statistical analysis. The intraperitoneal glucagon bolus of 0.6 µg/kg gave a significantly higher glucose response from 14 to 30 min compared with the subcutaneous bolus. The results indicate that glucagon induces a larger glucose response after intraperitoneal delivery compared with subcutaneous delivery and is encouraging for the incorporation of glucagon in an intraperitoneal artificial pancreas.
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Affiliation(s)
- Marte Kierulf Åm
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, 7491, Trondheim, Norway. .,Department of Endocrinology, St Olav's Hospital, Trondheim, Norway.
| | - Ilze Dirnena-Fusini
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, 7491, Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim, Norway
| | - Anders Lyngvi Fougner
- Department of Engineering Cybernetics, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sven Magnus Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, 7491, Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim, Norway
| | - Sverre Christian Christiansen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, 7491, Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim, Norway
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Plettig J, Johnen CM, Bräutigam K, Knöspel F, Wönne EC, Schubert F, Plöger F, Unger JK, Reutzel-Selke A, Bornemann R, Zeilinger K, Gerlach JC. Feasibility study of an active wound dressing based on hollow fiber membranes in a porcine wound model. Burns 2015; 41:778-88. [DOI: 10.1016/j.burns.2014.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 01/25/2023]
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Wang P, Li Y, Li J. Hydroxyethyl starch 130/0.4 prevents the early pulmonary inflammatory response and oxidative stress after hemorrhagic shock and resuscitation in rats. Int Immunopharmacol 2009; 9:347-53. [DOI: 10.1016/j.intimp.2008.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 12/20/2008] [Accepted: 12/22/2008] [Indexed: 11/16/2022]
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Wang P, Li Y, Li J. Protective Roles of Hydroxyethyl Starch 130/0.4 in Intestinal Inflammatory Response and Oxidative Stress After Hemorrhagic Shock and Resuscitation in Rats. Inflammation 2009; 32:71-82. [DOI: 10.1007/s10753-009-9105-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Curry SC, Pizon AF, Riley BD, Gerkin RD, Bikin DS. Effect of intravenous albumin infusion on brain salicylate concentration. Acad Emerg Med 2007; 14:508-14. [PMID: 17449793 DOI: 10.1197/j.aem.2007.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Salicylate poisoning appears to result in death, despite supportive care, once a critical brain salicylate concentration is reached. The binding of salicylate to albumin is saturable; free plasma salicylate concentrations rise disproportionately to total drug levels. Because unbound salicylate distributes into the brain, the authors questioned whether an intravenous (i.v.) infusion of albumin would cause a redistribution of salicylate from the brain back into the plasma, which might allow enough time for hemodialysis to be instituted. OBJECTIVES To determine if i.v. albumin infusion would lower brain salicylate concentrations through redistribution in a porcine model of acute salicylate poisoning. METHODS In a randomized controlled trial, 17 swine under anesthesia and controlled ventilation received 400 mg/kg of sodium salicylate i.v. over 15 minutes. At 60 minutes, nine animals received 1.25 g/kg albumin (25% solution) i.v. over 15 minutes, while eight control animals received an equal volume of normal saline (5 mL/kg). Arterial pH was maintained between 7.45 and 7.55. Serial measurements of serum albumin as well as free and total salicylate concentrations were obtained, and urine was collected for measurement of total salicylate excretion. At 180 minutes, animals were killed and brains harvested for measurement of brain salicylate concentrations. RESULTS Average peak serum total salicylate concentrations of 105.5 and 109 mg/dL were achieved in control and albumin-treated animals, respectively. Albumin infusion was accompanied by statistically significant increases in serum total salicylate concentrations (median from 79.5 to 86.9 mg/dL at 75 minutes), while levels decreased slightly in control animals. Serum free salicylate concentrations decreased slightly in albumin-treated animals, but the difference was not statistically significant. Median brain salicylate concentrations were about 14% lower in the albumin treatment group (17.8 mg/100 g brain) compared with controls (20.5 mg/100 g brain); this approached statistical significance (p = 0.075). Median urinary salicylate excretion was higher in the albumin-treated group (0.83 vs. 0.48 g; p = 0.072), with similar urinary pH and volumes in both groups. CONCLUSIONS In this animal model of salicylate poisoning, i.v. infusion of 1.25 g/kg albumin was accompanied by a 14% decline in median brain salicylate concentrations, which approached statistical significance.
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Affiliation(s)
- Steven C Curry
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA.
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Unger JK, Pietzner K, Francis RC, Birnbaum J, Theisen MM, Lemke AJ, Niehues SM. Dual-lumen catheters for continuous venovenous hemofiltration: limits for blood delivery via femoral vein access and a potential alternative in an experimental setting in anesthetized pigs. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 11:R18. [PMID: 17302971 PMCID: PMC2151875 DOI: 10.1186/cc5693] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 01/23/2007] [Accepted: 02/15/2007] [Indexed: 11/23/2022]
Abstract
Introduction Small intravascular volume, pathophysiological hemorheology, and/or low cardiac output [CO] are assumed to reduce available blood flow rates via common dual-lumen catheters (except for those with a right atrium catheter tip position) in the critically ill patient. We performed an experimental animal study to verify these assumptions. Methods Anesthetized, ventilated pigs (35 to 50 kg) were allocated to different hemorheological conditions based on the application of different volume substitutes (that is, colloids and crystalloids, n = 6 to 7 per volume substitute). In a second step, allocation to the final study group was performed after the determination of the highest values for access flow (Qa) via an axial dual-lumen catheter (11 French, 20 cm long, side holes) placed in the femoral vein. High Qa rates (>300 ml/minute) were allocated to the dual-lumen catheter group; low Qa rates were switched to a 'dual-vein approach' using an alternative catheter (8.5-French sheath) for separate blood delivery. Hemodynamics (CO and central venous pressure [CVP]) and blood composition (blood cell counts, plasma proteins, and colloid osmotic pressure) were measured. Catheter tip positions and vessel diameters were exemplified by computed tomography. Results Forty-four percent of the animals required an alternative vascular access due to only minimal Qa via the dual-lumen catheter. Neither hemorheologically relevant aspects nor CO and CVP correlated with the Qa achievable via the femoral vein access. Even though the catheter tip of the alternative catheter provided common iliac vein but not caval vein access, this catheter type enabled higher Qa than the dual-lumen catheter positioned in the caval vein. Conclusion With respect to the femoral vein approach, none of the commonly assumed reasons for limited Qa via the arterial line of an axial dual-lumen catheter could be confirmed. The 8.5-French sheath, though not engineered for that purpose, performed quite well as an alternative catheter. Thus, in patients lacking right jugular vein access with tip positioning of large-French dual-lumen catheters in the right atrium, it would be of interest to obtain clinical data re-evaluating the 'dual-vein approach' with separate blood delivery via a tip-hole catheter in order to provide high-volume hemofiltration.
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Affiliation(s)
- Juliane K Unger
- Department of Comparative Medicine and Laboratory Animal Sciences, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Klaus Pietzner
- Department of Comparative Medicine and Laboratory Animal Sciences, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Roland C Francis
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Juergen Birnbaum
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Mitte, Universitätsmedizin Berlin, Charitéplatz 1, D-10117 Berlin, Germany
| | - Marc Michael Theisen
- Department of Anesthesiology and Intensive Care, University Hospital, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany
| | - Arne-Joern Lemke
- Department of Radiology, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
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Unger JK, Haltern C, Kobela JB, Francis R, Rossaint R, Grosse-Siestrup C. HYDROXYETHYL STARCH 130 KD/0.4 AND ALBUMIN IMPROVE CVVH BIOCOMPATIBILITY WHEREAS GELATIN AND HYDROXYETHYL STARCH 200 KD/0.5 LEAD TO ADVERSE SIDE EFFECTS OF CVVH IN ANESTHETIZED PIGS. Shock 2006; 25:533-45. [PMID: 16680020 DOI: 10.1097/01.shk.0000221322.98590.99] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Both fluid management and renal replacement therapies play a fundamental role in the treatment of critically ill patients. In a recent in vitro study, we have shown specific interactions of different colloids and the hemocompatibility of hemofilters. The present study was performed to compare the five most common fluids for volume resuscitation, i.e., normal saline (SAL), hydroxyethyl starch 130 kd/0.4 (HES130), hydroxyethyl starch 200 kd/0.5 (HES200), albumin (ALB), and gelatin (GEL) with respect to their interaction with continuous venovenous hemofiltration (CVVH) in anesthetized domestic pigs. METHODS Animals (n = 63) were allocated randomly to the fluid type and the respective subgroups, which were divided into control and CVVH groups (n = 6 ndash; 7 per group). Bolus infusion of group specific fluid was followed by a bolus of heparin and the initiation of hemofiltration in CVVH groups. Thereafter, fluids were infused at constant rates, and heparin application was adjusted to keep the activated clotting time at 200 to 250 s. Hemodynamics, airway pressures, pulmonary gas exchange, diuresis, creatinine clearance, and blood cell counts were investigated during the entire procedure (10 ndash; 12 hours). RESULTS Basics of in vivo effects of SAL, HES130, and ALB were not altered during CVVH. HES130 and ALB enabled stable hemocompatibility, diuresis, and hemodynamics in the respective groups. In contrast, organ functions were significantly different between control and CVVH groups when animals were treated with GEL or HES200. In particular, during CVVH, HES200 led to reduced platelet counts, deteriorated hemodynamics, and increasing airway pressures during CVVH. GEL led to increasing airway pressures, a decrease in pulmonary gas exchange, deteriorated hemodynamics, altered renal histomorphology, reduced platelet counts, and reduced hemoglobin. CONCLUSIONS Direct in vivo effects of colloids in anaesthetized and ventilated pigs are not predictable for their effects during CVVH. Interaction between CVVH and every volume substitute occur in a highly specific manner. This observation could be helpful to explain contradictory study results and should be considered for future study designs.
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Affiliation(s)
- Juliane K Unger
- Department of Comparative Medicine and Experimental Animal Sciences, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany.
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