New development of fat emulsion

As one of the components of parenteral nutrition, fat emulsion can provide energy for the body and prevent the lack of essential fatty acids, which has become a consensus in clinical practice Fat emulsion is generally prepared from long-chain triglycerides and lecithin extracted from soybean oil Compared with long-chain triglyceride (LCT), medium chain triglyceride (MCT) has better solubility, can absorb into plasma faster, oxidize faster, and can enter into mitochondria without carnitine MCT can be mixed with LCT and injected intravenously or in the form of structured fat emulsion In the structured fat emulsion, the triglycerides contain medium chain and long chain fatty acids As with LCT, the formation of lipoproteins will be accompanied by the input of MCT Therefore, MCT will compete with LCT for the hydrolysis site of lipoproteins Compared with LCT, MCT / LCT mixed milk has both increased and decreased plasma clearance MCT can oxidize faster than LCT, and it can save protein effectively However, it has also been reported that protein catabolism is increased The toxicity of MCT has been observed, so it is necessary to further study the safety and effectiveness of fat emulsion containing MCT before recommending it to critical patients Structural triglycerides are expected to be less toxic than physically mixed fat emulsions, and there is no reported tendency to cause metabolic acidosis The results of in vitro experiments show that structured fat emulsion can release fatty acids more effectively than mixed fat emulsion However, in the plasma, the release of fatty acids depends largely on the amount of MCT itself At present, the clinical experiments have proved that the fat emulsion containing structured triglycerides is safe, and its hydrolysis is fast and complete One of the important functions of fat in diet is that it can bind to the structure of cell membrane The content and properties of lipids in cell membrane will affect the permeability of cell membrane and the properties of membrane binding enzymes and receptors Membrane bound phospholipids can be stimulated by enzymes to release chain growing fatty acids, which are precursors for the synthesis of alkanes Arachidonic acid is released when LCT fat emulsion is injected The fat emulsion (LCT) extracted from soybean oil is rich in essential polyunsaturated fatty acids, linoleic acid and a-linolenic acid, which have 18 carbon chains These fatty acids are very effective oxidation substrates, but they also compete with each other for w-6-desaturase During metabolism, linoleic acid and linolenic acid are prolonged and desaturated The main fatty acids derived from linoleic acid (W6 Series) are a-linolenic acid (c18:36), double high linolenic acid (c20:36) and arachidonic acid (c20:46) The fatty acids derived from a-linolenic acid (3 Series) are alkanoic acid (c20:53, EPA) and docosahexaenoic acid (c22:63, DHA) The latter is high in fish oil The input of soy fat emulsion will be accompanied by the increase of fatty acids in the growth chain, resulting in the release of various alkanes In addition to PGI2, alkanes derived from arachidonic acid are more likely to promote coagulation and inflammation than corresponding mediators Fat in diet can produce immune response specific regulators From the understanding of the importance of this role, it leads to a hypothesis that using fish oil to partially replace W6 fatty acid, which is the main component of fat emulsion, and using this fat emulsion in stress patients will produce some positive effects and improve the prognosis of patients At present, fat emulsion containing fish oil has been used in clinical practice abroad The introduction of soybean emulsions will be accompanied by the production of some products due to the use of free radicals as polyunsaturated fatty acids, as well as the consumption of plasma antioxidants such as vite Vite is insufficient in most fat emulsions, so it is recommended to increase the supply of antioxidants The composition of fat emulsion is very similar, but there are some small differences in fatty acid content Different preparation of different phospholipid fatty acids will lead to different media Other factors that have clinical significance and are related to the safety of fat emulsion include the content of phytosterol, lysolecithin and cholesterol Due to the reasons of production technology and raw materials, the content of the above substances in the fat emulsion prepared with the same oil is also different High levels of phytosterols lead to their accumulation in the circulatory system - a pathological condition that can cause fat deposition in various organs and liver function damage There is a certain amount of lysolecithin in phospholipid, which is the hydrolysate of lecithin For all fat emulsions, lysophosphatidic content will increase with the increase of storage time In blood, lysophosphatidylcholine either binds to circulating fat particles or to plasma albumin If a fat emulsion is injected into a patient whose binding capacity of lysophosphatidic decreases, the "free" lysophosphatidic will bind to the erythrocyte membrane and cause hemolysis The content of lysolecithin in different fat emulsion is different Fat emulsion can not only provide energy for the body, but also change the composition of cell membrane and regulate the production of various media, which represents an exciting new progress and stimulates further research But it is also considering the multiple roles of various components of fat emulsion in metabolic response, so we should realize that a study can only focus on a limited number of aspects In 2006, the total sales volume of fat emulsion infusion in 100 top three hospitals in China was about 340 million yuan In addition to the fat emulsion infusion in other hospitals, it is estimated that the total sales volume of fat emulsion infusion in China is about 500-600 million yuan According to the statistics released by the relevant departments, in 2006, the national pharmaceutical enterprises produced 5.26 billion bottles of all kinds of large-scale infusion, with an average of 4 bottles for each Chinese, while the average consumption of infusion in the United States last year was only about 0.04 bags The use of large-scale infusion in China is related to national conditions Many Chinese people believe that after going to the hospital to "hang water", the disease will get better faster, and the effect of oral solid preparation will be slower accordingly On the contrary, Westerners are less willing to accept infusion treatment and more inclined to use oral preparations that are safer for human body Two different concepts of Chinese and Western medicine determine that the market of infusion products in China will keep increasing for a long time in the future There are more than 300 large infusion manufacturers in China, and 80% of the total infusion products are basic low-end products such as glucose and sodium chloride A large number of participants contributed to the fierce competition, coupled with the unreasonable product structure, which led to the adverse situation of low market price However, the mode of "big infusion plus medicine" treatment is still prevalent in hospitals in urban and rural areas of the country Therefore, the domestic big infusion market still maintains a stable development on the whole It is worth noting that although the overall benefit of large infusion products is not very good, fat emulsion infusion has become a new bright spot in domestic infusion products In fact, soybean oil is not the only vegetable oil suitable for fat emulsion production According to the research results, in addition to soybean oil, the vegetable oil suitable for fat emulsion infusion includes sesame oil, flax oil, safflower oil, cottonseed oil, crocus oil and corn oil In addition, fish oil rich in "long chain polyunsaturated fatty acids" is also a raw material for fat emulsion production Last year, Huarui officially launched omega-3 fatty acid infusion with imported fish oil as raw material, with the trade name of "Juve" "Juve" is a new type of therapeutic fat emulsion infusion product, which can reduce excessive inflammatory reaction, protect important organ function, reduce infection and complications and so on Since its IPO last year, the market of "Juve" has reflected well According to another report, Japanese pharmaceutical manufacturers are stepping up the development of a new infusion product of fat emulsion of perilla seed oil, which is processed from Chinese "perilla seed oil" Suzi oil contains up to 60% γ - linolenic acid, which is an excellent unsaturated fatty acid The results of animal experiments confirm that the infusion of perilla oil fat emulsion can not only provide the necessary energy for the body, but also has many therapeutic effects, such as lowering blood fat, lowering blood sugar, anti oxidative damage, anti allergy, anti cell aging and anti cardiovascular sclerosis As perilla oil fat emulsion infusion can combine the energy supply and therapeutic effect, Japanese pharmaceutical experts believe that once it is approved to go on the market, it will cause a "big earthquake" in the international fat emulsion infusion Market in the 21st century "Local specialty" has great potential China has already developed domestic fat emulsion injection products, such as Kanglaite Injection (coix seed oil fat emulsion), Brucea Javanica Emulsion Injection and zedoary turmeric oil fat emulsion (main component is elemene) Among them, Kanglaite fat emulsion injection has a good sales in the domestic market, with a total sales volume of more than 150 million yuan in 2006, and has entered the pharmaceutical market in Russia, Ukraine and other countries According to Zui new report, Kanglaite is doing clinical trials in the United States As it has good effect as an anti-cancer drug in China, Russia and other countries, no toxic and side effects have been found so far, so it is expected to be listed in the United States The American medical community is full of expectations for it If Kanglaite fat emulsion injection can be listed in the world's Zui pharmaceutical market in the United States, it will be a new milestone for China's traditional Chinese medicine preparations to truly enter the international market As far as the treatment scope is concerned, the traditional Chinese fat emulsion injections such as Kanglaite, Brucea Javanica and zedoary turmeric oil, which have been on the market so far in China, are anti-tumor drugs They have been used for more than 10 years in clinical practice in China, and the sales situation is good There are abundant resources of Chinese herbal medicine in China Many Chinese herbal medicines contain a certain amount of vegetable oil or aromatic oil, such as perilla oil, Elsholtzia oil, agastache oil, seabuckthorn oil, Ligusticum chuanxiong oil, angelica oil, blackcurrant oil and so on It is believed that more new fat emulsion infusion products with therapeutic effect can be developed from these Chinese herbal medicines According to the statistical results of relevant departments, in the past few years, the annual sales volume of domestic fat emulsion infusion products has remained between 15 million and 16 million bottles This is because the unit price of fat emulsion infusion is relatively expensive, and the average retail price of fat emulsion infusion per bottle is about 80 yuan, about dozens of times of the basic infusion, which limits its large-scale application in ordinary people With the increase of national income year by year, there will be more and more clinical dosage of nutritional fat emulsion infusion or therapeutic fat emulsion infusion in the future In the past 15 years, the incidence rate of cancer has increased by nearly 1 times Therefore, the market prospect of the anti tumor Chinese traditional medicine injection products is very broad For example, the new sales volume of Omega -3 fatty acid infusion and Chinese medicine fat emulsion injection will continue to rise in the future.