These articles [Gross et al., 1988: (http://www.ncbi.nlm.nih.gov/pubmed/3390463); Gross and Savaiano, 1991: (http://www.ncbi.nlm.nih.gov/pubmed/2009279)] are really good and show that the retention, by the intestinal tissues themselves, of intrajejunally-administered nucleosides or nucleic acids can be roughly twice as great in the fasted state as in the "fed" state. Those articles are potentially confusing, because, normally, the retention of nucleosides or nucleotides in the intestines (i.e. the salvage of nucleosides and incorporation into nucleotide pools in the epithelial or smooth muscle cells, etc.) would be less-than desirable, from the standpoint of bioavailability. But what those authors are saying is that xanthine oxidase activity is lower in the fasted state. Those articles tell me that administering purines, in particular, during the fasted state, as discussed below and in past postings [see Carver and Walker, 1995, cited and discussed here: (http://hardcorephysiologyfun.blogspot.com/2009/03/adenosine-and-guanosine-in-animal.html); see here, also: (http://hardcorephysiologyfun.blogspot.com/2009/01/details-on-nucleotides-bioavailability.html)], is likely to produce both greater bioavailability, as discussed in those past postings, and greater salvage, by the target cells that the nucleotides or their metabolites enter, of those purines. That's just my opinion. I didn't know the effect had been shown to be that large. Ho et al. (1979) [Ho et al., 1979: (http://jn.nutrition.org/cgi/reprint/109/8/1377.pdf)(http://www.ncbi.nlm.nih.gov/pubmed/458492)] found even larger increases in the absorption of nucleosides or nucleic acids in the fasted state, although those large, relative increases in tissue content, in the fasted state vs. the fed state, appear to be partially or largely due to increases in the absorption of the nucleotides or nucleic acids (purine bases).
It's important to note that the bioavailability is also likely, in my opinion, to be enhanced in the fasted state. The bioavailability is partly a function of how rapidly a physiological compound, such as a nucleotide, enters solution in the intraluminal fluid. I forget where the reference is, but the intraluminal fluid volume in the stomach or along a segment of the small intestine can be remarkably small and can be something like 15-20 mL. The general concept is that many physiological compounds (nucleotides in particular) can be transported into and metabolized by any cell they come in contact with. If a person takes something like guanosine or adenosine, as a free nucleoside, the low solubilities will, in my opinion, significantly limit the bioavailability of those nucleosides by slowing the rate of dissolution in the GI tract. The undissolved nucleosides will slowly enter solution, as the fraction that is dissolved is transported into cells or has diffused away, by passive diffusion. Savaiano et al. (1980) [Savaiano et al., 1980: (http://jn.nutrition.org/cgi/reprint/110/9/1793.pdf)(http://www.ncbi.nlm.nih.gov/pubmed/7411237)] found evidence suggestive of extreme differences in the bioavailabilities of nucleic acids and nucleosides, such that the intravenous (i.v.) administration produced levels of tissue retention that were 3-59 times the levels produced by oral administration. Usually, the ratio of the i.v. to oral bioavailability of a drug, expressed as the ratio of the areas under the serum concentration vs. time curves [AUC(i.v.)/AUC(oral)], is maybe between 2 and 5 or 7 or something like that. Those differences found by Savaiano et al. (1980) are not especially relevant for human dosing, however, because the solubilities of both nucleic acids and nucleosides are drastically lower than the solubilities of the disodium salts of guanosine monophosphate (GMP and adenosine monophosphate (AMP) or triphosphate (ATP), for example [or the disodium salt of inosine monophosphate (IMP)]. Those solubility differences could essentially mean that most of the nucleic acids or nucleosides would be degraded to uric acid, in humans, or to uric acid and then allantoin, in animals, before they could even enter the portal circulation, etc, in my opinion. Other salts of AMP or GMP or ATP also display deficient solubilities, and those solubility data are freely available on countless sites on the internet. Many of the researchers who have used oral guanosine or GMP as anticonvulsants, in animal experiments, have discussed those solubility issues. The authors of many of those older articles were evidently not aware of those issues, however, in my opinion, and they're very important issues.
Another major problem with oral purine dosing is the use of enteric coatings, and I've discussed this in detail previously (http://hardcorephysiologyfun.blogspot.com/2009/01/details-on-nucleotides-bioavailability.html). Most enteric coatings would be expected to severely and unnecessarily reduce the bioavailabilities of orally-administered nucleotides or nucleosides, in my opinion. Many enteric coated tablets could potentially not dissolve in the GI tract, in my opinion, because the pH in many people would not be expected to be high enough to allow the coatings to dissolve, as discussed by Fallingborg et al. (1999), cited below. Additionally, the use of tablets could be expected to produce the same, drastic slowing of entry into solution that a low level of solubility would be expected to produce, in my opinion. Persky et al. (2003) [Persky et al., 2003: (http://www.pharmacy.unc.edu/pkpd/AMP%20Articles/Persky%20et%20al%20Clin%20Pharmacok%202003.pdf)(http://www.ncbi.nlm.nih.gov/pubmed/12793840)] discussed the fact that the rate of dissolution of physiological substrates, such as creatine, can be an important pharmacokinetic variable to consider, and these types of pharmacokinetic considerations are potentially more important for maximizing the bioavailabilities of nucleotides or other physiological compounds, in my opinion, than those considerations are for maximizing the bioavailabilities of drugs. Many drugs cannot be extensively or even partially metabolized by every cell in the body. With physiological substrates, time (i.e. pharmacokinetics) is of the essence, so to speak, because there is both the rate of uptake, by endothelial cells or cells in the liver, and the rates of degradation by every cell the substrates are available to. Even in the case of creatine, Deldicque et al. (2008) [Deldicque et al., 2008: (http://www.ncbi.nlm.nih.gov/pubmed/17851680)], discussed here (http://hardcorephysiologyfun.blogspot.com/2009/03/adenosine-and-guanosine-in-animal.html), found that the Cmax of plasma creatine, a reflection of an "improvement" in the kinetics of absorption or entry into the systemic circulation, etc., was higher in response to the administration of creatine monohydrate in a water solution (i.e. pre-dissolved) than in response to its administration in foods, which slow the rate of entry of creatine monohydrate into solution. A lower Cmax could be expected, in my opinion, to decrease the fraction of nucleotides, for example, that would gain entry into the brain and be salvaged, as opposed to being degraded into uric acid, by cells in the brain.
Some of the confusion surrounding these issues may be the result of some lingering misconceptions that many people, even researchers, evidently are holding onto. The fasted state in a human means any time 12 or more hours after the previous meal, although I've seen the 10-hour time point used as a marker for the beginning of the "fasted" state. So this means the only true fasted state is likely to be the time period in the morning, before breakfast. Why is this the case? Fallingborg (1999) [Fallingborg et al., 1999: (http://www.ncbi.nlm.nih.gov/pubmed/10421978)] discussed large numbers of studies on the time course with which food moves out of the stomach and into the duodenum and jejunum and so on, and much of the data that Fallingborg (1999) discussed had been collected from experiments using different types of devices that transmit data on the pH and other variables in the gastrointestinal (GI) tract. Some of those are pill-sized devices that have tiny video cameras in them, but I'm not sure those were in use in 1999. After a person eats the first meal of the day, that food may, depending on the sizes and frequencies of the subsequent meals (meaning any food that is eaten), remain in the stomach for between ~2.6 and 14.5 hours (Fallingborg et al., 1999). The gastric residence time (GRT) of tiny, mechanized capsules, with pH sensors in them (the pH is a measure of acidity, such that pH values below or above 7 are "acidic" or "basic"/"alkaline," respectively) is between 1.1 and 1.9 hours in the fasted state, but the GRT for the same capsule can be *up to 14.5 hours* in a person who takes the capsule at breakfast and eats every couple of hours during the rest of the day. Fallingborg (1999) discusses the fact that a single, small meal, eaten in the morning, has been shown to only increase the GRT of the capsule to ~2.6 hours. Fallingborg (1999) discusses the fact that, in the fasted state, the interdigestive migrating myoelectric complex (IMMC), which is phase III of a series of cyclic, contractile events in the smooth muscle that lines the stomach, allows solid food to exit the stomach about every 2 hours. When a person eats a single meal or, in particular, meals every 2-3 hours, the cyclic or "phasic" aspects of these contractions are abolished or "frozen", and food may not exit the stomach for many hours (up to 14 or 14.5). This is very important for understanding the major problems that exist, in my opinion, with enteric coatings for many preparations of (i.e. products containing) SAM-e or ATP disodium, etc., as discussed previously (http://hardcorephysiologyfun.blogspot.com/2009/01/details-on-nucleotides-bioavailability.html).
This residence time applies to solid substances that cannot enter solution and diffuse into the small intestine. If a person eats a water-soluble nutrient or sugar or amino acid or nucleotide, those substances can exit the stomach in aqueous (water) solution very rapidly. But even the slowing effect that is produced by the food in the stomach can limit the bioavailability of a water-soluble substance, such as creatine, in the "fed" state. So the stomach may not be completely empty until ~4 am or even later, if a person eats his or her last meal at 6 pm or something. The paper by Fallingborg (1999) is superb, and the author cites 183 papers and goes into exhaustive detail on all of these considerations.
A major point that Fallingborg (1999) makes is that statements about taking enteric-coated (acid-resistant) tablets "between meals" or "on an empty stomach, between meals" make no sense, because the stomach does not empty between meals. When a person is told to take some of these enteric-coated SAM-e or ATP disodium tablets (or other enteric-coated tablets) "between meals, on an empty stomach," the tablet may not exit the stomach and have any hope of releasing its contents until up to 14.5 hours after the person has taken it and eaten many subsequent meals. More importantly, Fallingborg (1999) discusses research showing that the mean pH in the duodenum of humans is ~6.22. The duodenal pH has been shown to range from 5.66 to 6.4 in other articles (Fallingborg, 1999). In the jejunum, the upper part of the true small intestine proper, is about 4.92 in the fasted state (a median value) and 6.08 after a meal. The pH is thought to only increase to above 7, to 7.4-7.6 (Fallingborg, 1999), in the distal ileum, which is an almost shocking fact that helps to explain the many problems, such as intestinal strictures and so on, with enteric-coated tablets that have been reported in the literature. The pH in the proximal small intestine, therefore, ranges from ~6.08 to ~6.49 (Fallingborg, 1999), when one looks at the data from multiple articles. But many of the enteric coatings do not dissolve until the pH is some amount greater than 7, and yet the jejunum is the site at which enteric-coated tablets are supposed to dissolve. Enteric coatings are polymeric substances, generally, whose solubility is pH-dependent. That means they can't dissolve in fluids that display pH values below some critical range of numbers, and the lower limit of the range may be 7.5 or 8 or some other value and may depend on the particular formulation used by the manufacturer.
Those data on the pH of the intraluminal fluid mean that the dissolution of enteric coatings could be very problematic, in my opinion. One explanation for the misconceptions about the pH in the intraluminal fluid might be that the pH of bile is ~8.03 (Fallingborg, 1999), and maybe people have thought that the pH of bile will be equivalent to the pH of the intraluminal fluid. It's just not the case. There can be a tendency to rely on 30- and 40-year-old data or research in some of these areas, and that tendency can become problematic, in my opinion. I should mention that, in many disease states, such as in people with liver disease, the jejunal pH can be substantially lower than those median or mean values, measured in apparently healthy people and can decrease progressively throughout the day. The pH-sensitivities of something like an enteric coating should obviously, in my opinion, be engineered so as to allow dissolution at the lower range of intraluminal pH values for anyone. This would not be difficult to do, but it's not something that many manufacturers or other people seem to be aware of the need for (if enteric coatings are still going to be used). Here are some articles reporting gastric or intestinal injuries (i.e. obstruction of the pyloric sphincter or intestinal obstructions/strictures) from poorly-formulated enteric-coated tablets (this poor formulation extends to more or less all enteric-coated tablets, in my opinion, when one looks at the data on the pH-dependences of the polymers used in the coatings) [Harris, 1973: (http://www.ncbi.nlm.nih.gov/pubmed/4764749); Sogge et al., 1977: (http://www.ncbi.nlm.nih.gov/pubmed/22308); Davies, 1999: (http://www.ualberta.ca/~csps/JPPS2(1)/N.Davies/NSAID.htm)(http://www.ncbi.nlm.nih.gov/pubmed/10951657); Sherry, 1979: (http://www.ncbi.nlm.nih.gov/pubmed/287936); (http://scholar.google.com/scholar?num=50&hl=en&lr=&safe=off&q=%22enteric+coated%22+stricture+OR+obstruction)]. Obviously, non-enteric-coated aspirin could cause damage to the stomach or small intestine for other reasons, and one should always talk to one's doctor before making any change in any medication. The benefits of enteric-coated preparations may outweigh any potential problems with the preparations, for many people in many specific disease states. But my point is to show the many problems that exist with the approach, in a functional sense, and with many of the individual preparations, in my opinion.
When researchers refer to a "pyloric obstruction" from an enteric-coated aspirin tablet, the researchers mean that the tablet become "stuck" in the valve-like muscle that opens, periodically, to allow food to pass from the stomach into the duodenum. In some cases, minor or not-so-minor surgical procedures are required to remove these obstructions from the undissolved tablets.
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