In cystic fibrosis (CF), pancreatic insufficiency and a diminished bile acid pool cause malabsorption of important nutrients and dietary components leading to deficiency, poor nutritional status, and oxidative stress. Of particular significance is the malabsorption of fat-soluble nutrients and antioxidants, which are important for normal immune and neurologic function. Patients with CF often are deficient in these compounds despite supplementation with the current standard of care therapy. The objective was to compare the pharmacokinetic profile of this water-soluble vitamin E formulation (Aqua-E) with an oil-based softgel formulation in a malabsorbing patient population. Patients with CF who had documented malabsorption were recruited for participation in this pharmacokinetic study. Patients who met inclusion and exclusion criteria discontinued vitamin E supplementation, except for that in a multivitamin, for 7 to 21 days before the day of dosing. Patients were randomized to a single dose of 20 ml of Aqua-E or three oil-based softgels, which contained equivalent amounts of tocopherols. Blood was drawn from patients at time 0, 2, 4, 8, 24, 48, and 168 hr and analyzed for tocopherols. Eight patients were enrolled in the study and randomized to Aqua-E or softgels. The primary outcome, the absorption of γ-tocopherol in Aqua-E (AUC=115 μg/ml*hr), was significantly greater than that of oil-based softgels (AUC=25.3 μg/ml*hr; P=0.013). Total-tocopherols (α+γ+δ) in Aqua-E (AUC=294 μg/ml*hr) showed a strong trend toward increased absorption compared with that of oil-based softgels (AUC=117 μg/ml*hr; P=0.09). In conclusion, this novel, water-soluble formulation showed a marked and statistically significant increase in absorption of γ-tocopherol in malabsorbing patients with CF compared with an oil-based formulation.
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The authors thank Joyce Swift and Valerie Senior for clinical trial coordination and other assistance provided. Assistance with sample collection and processing was provided by the clinical laboratory at East Tennessee State University Physicians and Associates.
The investigation materials were provided by Yasoo Health Inc., Johnson City, TN. Experimental materials were donated by Eisai Food & Chemical Company, and Cargill Health and Food Technologies Eastman Chemical Company, which also conducted the TPGS analysis.
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Papas, K., Kalbfleisch, J. & Mohon, R. Bioavailability of a Novel, Water-Soluble Vitamin E Formulation in Malabsorbing Patients. Dig Dis Sci 52, 347–352 (2007). https://doi.org/10.1007/s10620-006-9489-2
- Vitamin E
- Cystic fibrosis
- Vitamin E deficiency