Molecular dynamics of amorphous pharmaceutical fenofibrate studied by broadband dielectric spectroscopy

Fenofibrate is mainly used to reduce cholesterol level in patients at risk of cardiovascular disease. Thermal transition study with the help of differential scanning calorimetry （DSC） shows that the aforesaid active pharmaceutical ingredient （API） is a good glass former. Based on our DSC study, the molecular dynamics of this API has been carried out by broadband dielectric spectroscopy （BDS） covering wide temperature and frequency ranges. Dielectric measurements of amorphous fenofibrate were per- formed after its vitrification by fast cooling from a few degrees above the melting point （Tm=354.11 K） to deep glassy state. The sample does not show any crystallization tendency during cooling and reaches the glassy state. The temperature dependence of the structural relaxation has been fitted by single Vogel- Fulcher-Tamman （VFT） equation. From VFT fit, glass transition temperature （Tg） was estimated as 250.56 K and fragility （m） was determined as 94.02. This drug is classified as a fragile glass former. Deviations of experimental data from Kohlrausch-Williams-Watts （KWW） fits on high-frequency flank of α-peak indicate the presence of an excess wing in fenofibrate. Based on Ngai＇s coupling model, we identified the excess wing as true Johari-Goldstein （JG） process. Below the glass transition temperature one can clearly see a secondary relaxation （γ） with an activation energy of 32.67 kJ/mol.

Current role of fenofibrate in the prevention and management of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD) is a common health problem with a high mortality burden due to its liver- and vascular-specific complications. It is associated with obesity, high-fat diet as well as with type 2 diabetes mellitus(T2DM) and metabolic syndrome(MetS).Impaired hepatic fatty acid(FA) turnover together with insulin resistance are key players in NAFLD pathogenesis. Peroxisome proliferator-activated receptors(PPARs)are involved in lipid and glucose metabolic pathways.The novel concept is that the activation of the PPARαsubunit may protect from liver steatosis. Fenofibrate, by activating PPARα, effectively improves the atherogenic lipid profile associated with T2DM and MetS. Experimental evidence suggested various protective effects of the drug against liver steatosis. Namely, fenofibraterelated PPARα activation may enhance the expression of genes promoting hepatic FA β-oxidation. Furthermore, fenofibrate reduces hepatic insulin resistance. It also inhibits the expression of inflammatory mediators involved in non-alcoholic steatohepatitis pathogenesis.These include tumor necrosis factor-α, intercellular cell adhesion molecule-1, vascular cell adhesion molecule-1and monocyte chemoattractant protein-1. Consequently, fenofibrate can limit hepatic macrophage infiltration. Other liver-protective effects include decreased oxidative stress and improved liver microvasculature function. Experimental studies showed that fenofibrate can limit liver steatosis associated with high-fat diet,T2DM and obesity-related insulin resistance. Few studies showed that these benefits are also relevant even in the clinical setting. However, these have certain limitations. Namely, these were uncontrolled, their sample size was small, fenofibrate was used as a part of multifactorial approach, while histological data were absent.In this context, there is a need for large prospective studies, including proper control groups and full assessment of liver histology.

Inhibitory Effects of Fenofibrate on Plasminogen Activator Inhibitor-1 Expression in Human Endothelial Cells

The effects of fenofibrate on plasminogen activator inhibitor-1 （PAI-1） expression in human umbilical endothelial cell-derived transformed cell line--ECV 304 cells were investigated. ECV 304 cells were incubated with different concentrations of fenofibrate （0, 10, 50, 100 μmol/L） for 24 h. PAI-1 mRNA and protein was detected by reverse transcription-polymerase chain reaction （RT-PCR） and Western blot respectively. PAI-1 antigenic content of endothelial cells was measured by using ELISA. Fenofibrate could inhibit the PAI-1 mRNA and protein expression and reduce PAI-1 antigenic content dependently. After treatment with fenofibrate （10 pmol/L）, the expression levels of PAI-1 mRNA and protein were 0. 65±0.05 and 0.96± 0. 11 respectively, significantly lower than in the control group （0.78±0.03 and 1.21±0.15, respectively, P〈0.05）. PAI-1 antigenic contents （24.52±8.39） in ECV304 cells treated with 10 μmol/L fenofibrate were significantly lower than those in the control group （6.98±5.12, P〈0.05）. It was concluded that fenofibrate inhibited the expression of PAF1 mRNA in ECV304 cells, and reduce the protein expression and the antigenic content of PAI-1, suggesting that fenofibrate may have an antiatherosclerotic effect on endothelial cells by PAI-1 pathway.

Preparation and pharmacokinetic study of fenofibrate cubic liquid crystalline

An LCC delivery system for Fenofibrate (Fen) was developed to improve its poorly oral bioavailability. Fen-LCC preparation methods were screened, and the prepared Fen-LCC was then characterized by a polarizing microscope and transmission electron microscopy (TEM).The spray drying technique was selected to dry and solidify particles into powder. The in vitro release of Fen-LCC was measured and in vivo pharmacokinetic experiments were carried out on rats after oral administration. Particles prepared through the high-temperature input method exhibited structural characteristics of LCC, and re-dissolved particles maintained the same features. The LCC delivery system can significantly improve in vitro release outcomes. After oral administration, AUCs of the suspension and LCC systems were measured at 131.6853 μg·h/ml and 1435.72893 μg·h/ml, respectively. The spray drying process presented here better maintains cubic structures, and the LCC system significantly improves bioavailability levels.

Biopsy-confirmed fenofibrate-induced severe jaundice:A case report

BACKGROUND Drug-induced liver injury(DILI)is the leading cause of acute liver failure in the United States.DILI is mainly caused by painkillers and fever reducers,and it is often characterized by the type of hepatic injury(hepatocellular or cholestatic).This report presents a case of fenofibrate-induced severe jaundice in a 65-year-old Korean male with no prior history of liver disease.We offer a strategy for patients who present signs of severe liver injury with jaundice and high elevations in serum transaminases.CASE SUMMARY A 65-year-old male visited the gastroenterology outpatient clinic of a tertiary hospital due to increased levels of liver enzyme and total bilirubin which were incidentally detected through a preoperative screening test.Abdominal ultrasound and computed tomography showed no biliary obstruction or nonspecific findings in the liver.Liver biopsy was performed and the patient was finally diagnosed with acute cholestatic hepatitis.Following the biopsy,steroid therapy was initiated and after 3 wk of treatment,the total bilirubin level was reduced to 7.22 mg/dL.CONCLUSION In patients with hyperlipidemia,treatment including fenofibric acid induces rare complications such as severe jaundice and acute cholestatic hepatitis,warranting clinical attention.

Dissolution improvement of fenofibrate by melting inclusion in mesoporous silica

In this study,using mesoporous silica for the solubility enhancement of poorly watersoluble drug was investigated.Although the incorporating drug into mesoporous silica is generally performed through the solvent method,the new melting method was proposed in the present study.Fenofibrate,a poorly water-soluble drug,was incorporated into mesoporous silica by solvent method and melting method.The obtained samples were observed by SEM and their physicochemical properties were evaluated by PXRD and DSC measurement.The dissolution and supersaturated property were also investigated.The results from SEM,PXRD and DSC measurement showed that drug could be loaded into pore via the melting method as well as by the solvent method.The drug loaded quantity depended on the pore volume.Drug up to 33%could be incorporated into mesoporous silica and existed in amorphous state.When drug was overloaded or difficulty in incorporation into pore was found,recrystallization of drug occurred at the outer surface of mesoporous silica.From the dissolution test,samples prepared by solvent method and melting method gave the supersaturated drug concentration which sample from melting method showed superior dissolution to the one from solvent method.From this study,drug was efficiently incorporated into mesoporous silica by the melting method which is a simple and solvent-free process,and the aqueous solubility enhancement of poorly watersoluble drug was achieved.

Clinical research of fenofibrate and spironolactone for acute central serous chorioretinopathy

AIM：To compare the effectiveness of combined fenofibrate and spironolactone with fenofibrate alone for treatment of central serous chorioretinopathy（CSCR）.METHODS： Totally 60 patients（60 eyes） with a history of acute CSCR were randomed into two groups： group A with combination of fenofibrate（200 mg） and spironolactone（100 mg）,and group B with only fenofibrate（200 mg）.They were taken half an hour before meals and once per day for 8wk.The changes of the visual acuity,subjective symptom,ocular surface disease index（OSDI）,the tear film and optical coherence tomography were observed at 2,4,6,and 8wk before and after treatment.RESULTS： The best corrected visual acuity（BCVA,log MAR） was improved to 0.22 and 0.27 after treatment from baseline of 0.35 and 0.36 in groups A and B（P 〈0.05）,respectively.After 8wk treatment,the central subfield thickness（CST）,and subretinal fluid volumn（SFV） decreased significantly to 49.5% and 78.8% in group A,37.0% and 57.2% in group B.There were significant differences of CST and SFV in both groups（all P 〈0.05）.CONCLUSION：Fenofibratecombinedwithspironolactone may have more clinical efficacy in the treatment of CSCR than fenofibrate only.

Determination of Fenofibrate and the Degradation Product Using Simultaneous UV-Derivative Spectrometric Method and HPLC

Two new selective, precise, and accurate methods were developed for the determination of fenofibrate in the presence of its basic degradation product. In the first method fenofibrate was determined using an algorithm bivariate calibration derivative method, in which an optimum pair of wavelengths was chosen for the determination of different binary mixtures. In the second method (HPLC), separation was achieved on RESTEK Pinnacle II phenyl column (5 μm, 250 × 4.6 mm) and Pinnacle II phenyl (5 μm, 10 × 4 mm) guard cartridge using a mobile phase consisting of methanol –0.1% phosphoric acid (60:40, v/v) at a flow rate 2 mL●min–1, and the column oven temperature was set at 50°C. The UV detector was time programmed at 302 nm and 289 nm for the internal standard (I.S.) and fenofibrate, respectively. The proposed methods were successfully applied for the determination of fenofibrate and its degradation product in the laboratory-prepared mixture and in pharmaceutical formulation. The assay results obtained using the bivariate method were statistically compared to those of the HPLC method and good agreement was observed.

Formulation and Characterization of Fenofibrate Loaded Solid Dispersion with Enhanced Dissolution Profile

Fenofibrate (FF) is an anti-hyperlipidaemic drug belonging to BCS class-II (low solubility, high permeability). Its bioavailability is limited by the dissolution rate. This study was aimed to enhance the rate of dissolution of poorly water soluble drug, FF. Initially, solid dispersions of fenofibrate (SDFs) were formulated with Carplex-80 or PEG-4000 or in combination at various weight ratios and were subjected to dissolution study. On the basis of drug release at various time intervals, the formulation producing maximum drug concentration was evaluated physicochemically using differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). It was observed that the peak drug concentration was obtained at 120 min of dissolution by formulation SDF-7, which contains a mixture of Carplex-80 and PEG-4000 at weight ratio 1:5:6 of FF:PEG-4000:Carplex-80, respectively. Thus, the extent of drug release by SDF-7 was maximized by 2.5-fold than that of pure FF. Physicochemical characterization revealed the reason for this increased drug release as a conversion of crystalline FF to amorphous form and ensured the chemical compatibility among FF and carriers. The results specified the significant improvement of FF release using solid dispersion technique.

Prolonged cholestasis after raloxifene and fenofibrate interaction: A case report

Assigning causality in drug-induced liver injury is challenging particularly when more than one drug could be responsible. We report a woman on long-term therapy with raloxifen who developed acute cholestasis shortly after starting fenofibrate. The picture evolved into chronic cholestasis. We hypothesized that an interaction at the metabolic level could have triggered the presentation of hepatotoxicity after a very short time of exposure to fenofibrate in this patient. The findings of an overexpression of vascular endothelial growth factor in the liver biopsy suggest that angiogenesis might play a role in the persistance of toxic cholestasis.

Spray drying of fenofibrate loaded nanostructured lipid carriers

The conversion of aqueous dispersion of nanostructured lipid carriers(NLCs) into dry powder by spray drying could be a useful approach to render NLCs with better physical chemical stability than the aqueous dispersion. In this study, aqueous NLC dispersion containing fenofibrate was converted into dry, easily reconstitutable powder using spray drying. A central composite face centered design(CCFD) was used to investigate the influence of the ratio of lipid to protectant(mannitol and trehalose) and crystallinity of spray-dried powder on the particle size, yield and residual moisture content of the dried powder. A linear relationship(R2= 0.9915) was established between the crystalline content of the spray-dried powders against the ratio of mannitol to trehalose from 3:7 to 10:0(w/w). Spray drying of NLC aqueous dispersion using a mannitol and trehalose mixture resulted in an increase in particle size of the NLCs after reconstitution in water as compared to that in the initial aqueous dispersion. The decrease in crystallinity of the dry powder by reducing the ratio of mannitol to trehalose could improve the reconstitution of the NLCs in water. However the yield and residual moisture content of dry powder decreased with an increase in the ratio of mannitol to trehalose. Lipid nanoparticles were able to retain the drug incorporation and the prolonged drug release profile after spray drying. The experimental model was robust, and suggested that spray drying is a viable technique for the conversion of NLCs into dry powder.

fenofibrate在缺血再灌注中的作用研究

fenofibrate是降脂药fibrate家族中的一种药物,目前主要临床应用是降低血胆固醇水平[1]。作为PPAR-α的激动剂,fenofibrate以转录因子的角色参与基因表达,调节细胞内糖类和脂肪代谢以及脂肪组织分化[2]。最近研究发现,除了降低血脂以外,fenofibrate还通过抗氧化应激和抗炎,在缺血再灌注模型中发挥减轻损伤的作用。本文就fenofibrate在抗氧化抗炎和缺血再灌注中的研究做一综述。

Anti-Hypertensive Action of Fenofibrate via UCP2 Upregulation Mediated by PPAR Activation in Baroreflex Afferent Pathway

Fenofibrate, an agonist for peroxisome proliferator-activated receptor alpha(PPAR-a), lowers blood pressure, but whether this action is mediated via baroreflex afferents has not been elucidated. In this study, the distribution of PPAR-a and PPAR-c was assessed in the nodose ganglion(NG) and the nucleus of the solitary tract(NTS). Hypertension induced by drinking high fructose(HFD) was reduced, along with complete restoration of impaired baroreceptor sensitivity, by chronic treatment with fenofibrate. The molecular data also showed that both PPAR-a and PPAR-c were dramatically up-regulated in the NG and NTS of the HFD group. Expression of the downstream signaling molecule of PPAR-a, the mitochondrial uncoupling protein 2(UCP2), was up-regulated in the baroreflex afferent pathway under similar experimental conditions, along with amelioration of reduced superoxide dismutase activity and increased superoxide in HFD rats.These results suggest that chronic treatment with fenofibrate plays a crucial role in the neural control of blood pressure by improving baroreflex afferent function due at least partially to PPAR-mediated up-regulation of UCP2 expression and reduction of oxidative stress.

Fenofibrate Pre-treatment Suppressed Inflammation by Activating Phosphoinositide 3 Kinase/Protein Kinase B(PI3K/Akt) Signaling in Renal Ischemia-Reperfusion Injury

The aim of this study was to investigate the possible beneficial effects of Fenofibrate on renal ischemia-reperfusion injury（IRI） in mice and its potential mechanism. IRI was induced by bilateral renal ischemia for 60 min followed by reperfusion for 24 h. Eighteen male C57BL/6 mice were randomly divided into three groups： sham-operated group（sham）, IRI＋saline group（IRI group）, IRI＋Fenofibrate（FEN） group. Normal saline or Fenofibrate（3 mg/kg） was intravenously injected 60 min before renal ischemia in IRI group and FEN group, respectively. Blood samples and renal tissues were collected at the end of reperfusion. The renal function, histopathologic changes, and the expression levels of pro-inflammatory cytokines [interleukin-8（IL-8）, tumor necrosis factor alpha（TNF-α） and IL-6] in serum and renal tissue homogenate were assessed. Moreover, the effects of Fenofibrate on activating phosphoinositide 3 kinase/protein kinase B（PI3K/Akt） signaling and peroxisome proliferator-activated receptor-α（PPAR-α） were also measured in renal IRI. The results showed that plasma levels of blood urea nitrogen and creatinine, histopathologic scores and the expression levels of TNF-α, IL-8 and IL-6 were significantly lower in FEN group than in IRI group. Moreover, Fenofibrate pretreatment could further induce PI3K/Akt signal pathway and PPAR-α activation following renal IRI. These findings indicated PPAR-α activation by Fenofibrate exerts protective effects on renal IRI in mice by suppressing inflammation via PI3K/Akt activation. Thus, Fenofibrate could be a novel therapeutic alternative in renal IRI.

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy:review,consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy(DR),and associated morbidity is high in the Asia-Pacific region.Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR,especially in patients with cardiovascular risk,and pre-existing mild-to-moderate DR.Fenofibrate has also been found to reduce maculopathy,and the need for laser treatment in these patients.Considering these benefits of fenofibrate,a group of experts from the fields of endocrinology and ophthalmology convened in May 2017,to discuss on the the mechanism of action,and clinical efficacy of fenofibrate in DR.The findings from key clinical studies on fenofibrate in DR were reviewed by the experts,and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR.The statements were rated based on the GRADE criteria.An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes(T2D),and the place of fenofibrate was defined in the algorithm.The expert recommendations,and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.

A survey on the efficacy and tolerability of micronized fenofibrate in patients with dyslipidemia

Objective To demonstrate the clinical efficacy of micronized fenofibrate on mildly-moderately elevated LDL-C levels and reduced HDL-C levels.Methods During 1998 - 1999, 2358 patients with type II a, II b and IV hyperlipidemia weremonitored in 16 cities in China. They were treated daily with micronized fenofibrate (micronizedlipanthyl) 200 mg for 8 weeks. Lipid levels before and after the treatment were measured and analyzed.Results Micronized fenofibrate significantly increased HDL-C levels by 12.7%, the effect being inversely correlated to the baseline level of HDL-C. Out of the total patient population, a baseline level of HDL-C <1. 0 mmol/L was found in 837 patients: amongst this group, 510 patients (60. 9%) were observed to have an increase in the level of HDL-C to >1. 0 mmol/L with a mean of 1. 3 mmol/L, after 8-week micronized fenofibrate therapy. Furthermore, the mean LDL-C level decreased by 15. 9% following an 8-week treatment of micronized fenofibrate, an effect positively correlated to the baseline level of LDL In general, all patients tolerated the drug comfortably.Conclusions Short-term treatment of micronized fenofibrate in patients with dyslipidemia significantly increases HDL-C level and reduces mildly-moderately elevated LDL-C level. As expected, it also reduces triglyceride levels.

In vitro dissolution and oral bioavailability study of fenofibrate nanomatrix system prepared by hot-melt extrusion

Solvent evaporation method for preparation of nanomatrix has the disadvantages,such as residual organic solvent,environmental pollution,explosion-proofing and so on.To overcome these shortcomings,a series of fenofibrate nanomatrix drug delivery system(NDDS)consisting of nano-porous silica Sylysia■350(S350)and pH sensitive material Eudragit■L100-55(EL100-55)were prepared using hot-melt extrusion(HME),and their in vitro dissolution and in vivo bioavailability were compared.Finally,the formulation with the highest in vivo bioavailability was selected as the optimized formulation for DSC and PXRD characterization.The results showed that the optimized NDDS showed a higher bioavailability than the reference formulation,although there was crystalline form drug remaining in NDDS.The relative bioavailability of the optimized formulation was 157.1%compared with the commercial product Lipanthyl■.In addition,the relative bioavailability of the optimized formulation was 124.8%in comparison with the formulation prepared by solvent evaporation method,showing that the NDDS prepared by the HME method was effective in improving the bioavailability of fenofibrate.In conclusion,HME was a promising method to prepare NDDS.

Effect of hyperlipidemia on endothelial VCAM-1 expression and the protective role of fenofibrate

The effect of hyperlipidemia and inflammation on endothelial functions was studied.The enrolled included control(basic chow),hyperlipidemia and fenofibrate-treated groups(high fat diet).The hyperlipidemia model was set up by four-week atherogenic diet,followed by a 16-week treat-ment in the fenofibrate-treated group(fenofibrate 40 mg/kg every day)and without treatment in the hyperlipidemia group,respectively.In the 20th week,serum lipid level and NO levels were measured,and the expression of vascular cell adhesion molecule-1(VCAM-1)and cell adhesiveness in aortic endothelia observed by computer-aided system.Com-pared with the control group,hyperlipidemia rats showed lower levels of NO and increases in leukocyte accumulation on the endothelial surface,also stronger and more extensive endothelial expression of VCAM-1.In fenofibrate-treated group,the expression of VCAM-1 and leukocyte accumula-tion on the endothelial surface was decreased,while serum levels of NO were increased as compared with hyperlipidemia group.Hyperlipidemia can inhibit the NO activity and pro-mote the damage of VACA-1 to aortic endothelia.Fenofibrate can effectively prevent the pathogenesis of atherosclerosis by restoring NO levels and down-regulating the VCAM-1 expression.

Impact of fenofibrate on blood glucose and lipids in type 2 diabetes with reduced apoA1

Background ApoA1 as a key part of high density lipoprotein（HDL） has an important role in lipid metabo- lism. Diabetic patients often have disorders of lipid metabolism and apoA1 reduction. However, the benefits of fe- nofibrate in diabetes remain unclear as it increases the expression of apoA1. Methods A total of 80 patients with type 2 diabetes（40 mens, 40 femal） were collected in First Affiliated Hospital of Gannan Medical Universi- ty. According to the level of apoA1, subjects were assigned to apoA1 normal experimental group （A1 group, 20 cases） and apoA1 normal control group （A2 group, 20 cases）, apoA1 reduction experimental group （A3 group, 20 cases）, apoA1 reduction control group （A4 group 20 cases）. The control group was only given conventional hypo- glycemic therapy; Experimental group was given conventional hypoglycemic therapy and fenofibrate 200 mg/d treatment. The blood lipid and glucose were monitored after two-months treatment. Result After treatment with fenofibrate, the level of apoA1 in the experimental group was increased （A1 1.28 ± 0.05 vs. 1.39 ± 0.06; A3 0.81 ± 0.08 vs. 1.00 ± 0.11 ） and the lipid disorder was improved （A1 group TC 5.58 ± 0.32 vs. 5.19 ± 0.34, P= 0.01; TG 2.69 ± 0.07 vs. 2.52 ± 0.11, P= 0.013; HDL 1.30 ± 0.09 vs. 1.38 ± 0.05, P= 0.04; LDL 2.28 ± 0.15 vs. 2.19 ± 0.15, P〈 0.01; A3 group TC 5.88 ± 0.11 vs. 5.62 ± 0.16, P〈 0.01; TG 2.92 ± 0.18 vs. 2.67 ± 0.28, P〈 0.01; HDL 1.14 ± 0.19 vs. 1.22 ± 0.16, P〈 0.01; LDL 2.48 ± 0.13 vs. 2.39 ± 0.11, P= 0.037）. The blood glucose was not changed in all treatment groups. Conclusion Fenofibrate can increase the level of apoA1 and improve lipid me- tabolism in type 2 diabetic patients, without affecting blood glucose.

Fenofibrate可减缓糖尿病患者的病情进展

法国Fournier制药公司的Jean-Claude Ansquer。博士及其同事报道说，fenofibrate(非诺贝特，FB)与2型糖尿病患者的脂类改善及微白蛋白尿症进展的减缓关联；但还需更进一步的研究以确定其对肾功能的长期作用。