Three Generations of Bile Acid Sequestrants

1998 ◽  
Vol 550 ◽  
Author(s):  
W. Harry Mandeville ◽  
William Braunlin ◽  
Pradeep Dhal ◽  
Amy Guo ◽  
Chad Huval ◽  
...  
Keyword(s):  
Bile Acid ◽  
Ldl Cholesterol ◽  
Third Generation ◽  
Cholesterol Reduction ◽  
Bile Acid Sequestrants ◽  
Binding Isotherms ◽  
Bile Acid Binding ◽  
Binding Mechanisms ◽  
Site Binding ◽  
Binding Structure

AbstractCholestyramine, the first bile acid sequestrant to be marketed, has been in use for over 20 years. Despite its low potency, requiring 16-24 g of polymer to achieve 20% LDL cholesterol reduction in hypercholesterolemic individuals, only one other sequestrant, colestipol, has come to market in the ensuing period. GelTex Pharmaceuticals has been involved for over six years in the discovery and development of new, more potent polymeric sequestrants. Two binding mechanisms are presented — one that operates via an aggregate binding structure and one that is effective via a defined site binding structure. These two binding mechanisms are compared and contrasted through bile acid binding isotherms. The best of these new sequestrants bind bile acids through a combination of hydrophobicity and ion exchange. Optimization and balancing of each of these interactions led us to more potent materials. The first of these, colesevelam hydrochloride is expected to be three to four times more potent than cholestyramine. A third generation product is still in research at GelTex. With another twofold increase in potency possible, single tablet therapy may become a reality.

Colesevelam Hydrochloride: A Novel Bile Acid-Binding Resin

2001 ◽  
Vol 35 (7-8) ◽  
pp. 898-907 ◽  
Author(s):  
Martha A Aldridge ◽  
Matthew K Ito
Keyword(s):  
Bile Acid ◽  
Adverse Effects ◽  
Reductase Inhibitor ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
Double Blind ◽  
Hmg Coa Reductase ◽  
Bile Acid Binding ◽  
Hmg Coa Reductase Inhibitor ◽  
Coa Reductase

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and adverse effects of colesevelam hydrochloride, a bile acid—binding resin. METHODS: MEDLINE searches (1966–June 2000) and manufacturer prescribing literature were employed to find articles on colesevelam. Additional studies and abstracts were identified from the bibliographies of reviewed literature. STUDY SELECTION AND DATA EXTRACTION: All articles identified from data sources were evaluated, and all information deemed relevant was included in this review. Priority was given to randomized, double-blind, placebo-controlled studies. FINDINGS: Colesevelam HCl is a nonabsorbed hydrogel with bile acid sequestrant properties. Monotherapy using colesevelam in once-daily or two divided daily doses of 1.5–4.5 g has produced significant reductions in total cholesterol and low-density lipoprotein (LDL) cholesterol. Mean LDL cholesterol decreases to 20% have been noted when the patient is on 3.75–4.5 g/d. Increases in high-density lipoprotein (HDL) cholesterol have been observed (up to 9%), whereas triglycerides (TG) have increased significantly to 25% in some studies. In unpublished studies, combined use of colesevelam plus hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor have produced greater reductions in LDL cholesterol than either the statin or colesevelam administered alone. The efficacy of colesevelam monotherapy is slightly less than or similar to cholestyramine or colestipol in decreasing LDL cholesterol, although colesevelam is more potent on a gram-to-gram basis. Adverse effects have been minimal with colesevelam in published studies; this suggests an advantage over cholestyramine or colestipol therapy. Colesevelam appears to be more cost-effective than the packet dosage form of the brand formulation of the older bile acid resins. Care in selection of an appropriate agent should be exercised when considering the issues of adverse effects and palatability. CONCLUSIONS: Colesevelam alone or combined with an HMG-CoA reductase inhibitor is effective in the reduction of total and LDL cholesterol. Since colesevelam is formulated as a tablet, problems with palatability such as with the powder formulation of the bile acid—binding resins are likely to be eliminated.

scholarly journals Oral Lipid-Lowering Treatments Beyond Statins: Too Old and Outdated or Still Useful?

2021 ◽  
Vol 23 (12) ◽  
Author(s):  
Klaus G. Parhofer
Keyword(s):  
Bile Acid ◽  
Ldl Cholesterol ◽  
Treatment Algorithm ◽  
New Drugs ◽  
Lipid Lowering ◽  
Oral Drugs ◽  
Bile Acid Sequestrants ◽  
Risk Patients ◽  
Statin Drugs

Abstract Purpose of Review For many years, the lipid-lowering armamentarium consisted of statins and/or ezetimibe and/or bile acid sequestrants and/or fibrates. Now, with the availability of new drugs mostly injectables, the field has changed and the role of oral non-statin drugs (including bempedoic acid) must be reevaluated. Recent Findings Ezetimibe remains a very important combination partner for statins with continuously increasing treatment numbers. Bempedoic acid is another interesting combination partner for statin/ezetimibe or ezetimibe alone but lacks in contrast to ezetimibe evidence from outcome trials. The role of fibrates is less clear as they have shown disappointing results in outcome trials but may still be used in selected, high-risk patients with combined dyslipidemia. Bile acid sequestrants are now rarely used as there are stronger, better tolerable ways to lower LDL-cholesterol. Summary With the introduction of new injectable lipid-lowering drugs, some oral drugs such as ezetimibe and bempedoic acid still have an important spot in our treatment algorithm others such as fibrates have a less clear role while again others are now rarely used.

scholarly journals Endogenous Estrogens Lower Plasma PCSK9 and LDL Cholesterol But Not Lp(a) or Bile Acid Synthesis in Women

2012 ◽  
Vol 32 (3) ◽  
pp. 810-814 ◽  
Author(s):  
Lena Persson ◽  
Peter Henriksson ◽  
Eli Westerlund ◽  
Outi Hovatta ◽  
Bo Angelin ◽  
...  
Keyword(s):  
Bile Acid ◽  
Ldl Cholesterol ◽  
Acid Synthesis ◽  
Bile Acid Synthesis ◽  
Lower Plasma

scholarly journals Plasma cholesterol lowering action of bile acid binding polymers in experimental animals

1960 ◽  
Vol 1 (5) ◽  
pp. 469-473 ◽  
Author(s):  
DavidM. Tennent ◽  
Henry Siegel ◽  
MaryE. Zanetti ◽  
GuntherW. Kuron ◽  
WaltherH. Ott ◽  
...  
Keyword(s):  
Bile Acid ◽  
Plasma Cholesterol ◽  
Cholesterol Lowering ◽  
Experimental Animals ◽  
Bile Acid Binding

scholarly journals Role of Bile Acids in the Regulation of Food Intake, and Their Dysregulation in Metabolic Disease

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1104
Author(s):  
Cong Xie ◽  
Weikun Huang ◽  
Richard L. Young ◽  
Karen L. Jones ◽  
Michael Horowitz ◽  
...  
Keyword(s):  
Bile Acid ◽  
Bile Acids ◽  
Peptide Yy ◽  
Glycogen Synthesis ◽  
Hormone Secretion ◽  
Gastrointestinal Hormones ◽  
Farnesoid X Receptor ◽  
Gastrointestinal Hormone ◽  
Bile Acid Sequestrants

Bile acids are cholesterol-derived metabolites with a well-established role in the digestion and absorption of dietary fat. More recently, the discovery of bile acids as natural ligands for the nuclear farnesoid X receptor (FXR) and membrane Takeda G-protein-coupled receptor 5 (TGR5), and the recognition of the effects of FXR and TGR5 signaling have led to a paradigm shift in knowledge regarding bile acid physiology and metabolic health. Bile acids are now recognized as signaling molecules that orchestrate blood glucose, lipid and energy metabolism. Changes in FXR and/or TGR5 signaling modulates the secretion of gastrointestinal hormones including glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), hepatic gluconeogenesis, glycogen synthesis, energy expenditure, and the composition of the gut microbiome. These effects may contribute to the metabolic benefits of bile acid sequestrants, metformin, and bariatric surgery. This review focuses on the role of bile acids in energy intake and body weight, particularly their effects on gastrointestinal hormone secretion, the changes in obesity and T2D, and their potential relevance to the management of metabolic disorders.

scholarly journals Validation of Recombinant Chicken Liver Bile Acid Binding Protein as a Tool for Cholic Acid Hosting

Biomolecules ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 645
Author(s):  
Giusy Tassone ◽  
Maurizio Orlandini ◽  
Massimo Olivucci ◽  
Cecilia Pozzi
Keyword(s):  
Bile Acid ◽  
High Resolution ◽  
Affinity Chromatography ◽  
Bile Acids ◽  
Drug Carriers ◽  
Chicken Liver ◽  
Purification Procedure ◽  
Acid Binding Protein ◽  
Bile Acid Binding ◽  
Exogenous Substances

Bile acids (BAs) are hydroxylated steroids derived from cholesterol that act at the intestinal level to facilitate the absorption of several nutrients and also play a role as signaling molecules. In the liver of various vertebrates, the trafficking of BAs is mediated by bile acid-binding proteins (L-BABPs). The ability to host hydrophobic or amphipathic molecules makes BABPs suitable for the distribution of a variety of physiological and exogenous substances. Thus, BABPs have been proposed as drug carriers, and more recently, they have also been employed to develop innovative nanotechnology and biotechnology systems. Here, we report an efficient protocol for the production, purification, and crystallization of chicken liver BABP (cL-BABP). By means of target expression as His6-tag cL-BABP, we obtained a large amount of pure and homogeneous proteins through a simple purification procedure relying on affinity chromatography. The recombinant cL-BABP showed a raised propensity to crystallize, allowing us to obtain its structure at high resolution and, in turn, assess the structural conservation of the recombinant cL-BABP with respect to the liver-extracted protein. The results support the use of recombinant cL-BABP for the development of drug carriers, nanotechnologies, and innovative synthetic photoswitch systems.

Structural and dynamic roles of permanent water molecules in ligand molecular recognition by chicken liver bile acid binding protein

2008 ◽  
Vol 21 (5) ◽  
pp. 348-354 ◽  
Author(s):  
Piero Ricchiuto ◽  
Alessandro Guerini Rocco ◽  
Elisabetta Gianazza ◽  
Dario Corrada ◽  
Tiziana Beringhelli ◽  
...  
Keyword(s):  
Bile Acid ◽  
Molecular Recognition ◽  
Binding Protein ◽  
Chicken Liver ◽  
Water Molecules ◽  
Acid Binding Protein ◽  
Bile Acid Binding
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