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Actovegin bij diabetische neuropathie

Actovegin is een wat bizar preparaat dat in Duitsland in de handel is. Een grote Duitse studie geeft aan dat de stof een positieve bijdrage kan leveren bij diabetische neuropathie. Pikant is dat Actovegin, een dierlijk preparaat, ook als doping gebruikt wordt door wielrenners.

In een recente (2009) grote studie van de universiteit van Dusseldorf bleek deze stof een duidelijk positief effect te hebben op diabetische neuropathie. [1] Er werden bijna 600 patiënten gerandomiseerd, en die kregen of Actovegin intraveneus (2000 mg per dag) (n=281) of placebo (n=286) en daarna of 3 tabletten Actovegin (1800 mg per dag) of placebo drie maal daags in een periode van ongeveer 5 maanden.

Actovegin is een Oostenrijks product, afkomstig uit kalfsbloed. De producent van het product is Nycomed. Zomaar er mee aan de gang gaan en in de aderen te spuiten lijkt geen goed idee. [2] Het is een product dat vooral in het oostblok duidelijk populair is. [3]

Wij hebben geen ervaring met dit product. De producent geeft de volgende informatie:

Actovegin® is a Deproteinized Hemoderivative of Calf Blood that is obtained by ultra-filtration. The Deproteinized Hemoderivative of Calf Blood contains only physiological components, anorganic substances socle as electrolytes and essential trace elements and 30% of organic components as amino acids, oligopeptides, nucleosides, intermediary products of the carbohydrate and of the fat metabolism, and components of the cellular membranes as glycosphingolipids. One of the physiologic components of Actovegin® is inositol phospho-oligosaccharides ( IPOs ). These compounds are thought to possess central and peripheral insulin effects, suggesting that a therapeutic benefit could be obtained in disorders of impaired glucose utilization. The molecular weight of the organic components is below 6000 Dalton. 

Over de werkzaamheid weet de producent te melden:

Mode of action

Actovegin® produces an organ-unrelated increase of the cellular energy metabolism. The activity is confirmed by measurement of the increased uptake and of the elevated utilization of glucose and oxygen. These two effects are coupled and they result in a rise of the ATP-turnover and thus in a greater provision of energy in the cell. In deficiency states with impairment of the normal functions of the energy metabolism (hypoxia, substrate deficiency) and in states of increased energy requirement (reparation, regeneration) Actovegin® promotes the energy-dependent processes of the functional metabolism and of the conservation metabolism. An increase of the blood supply is seen as a secondary effect.

Effects related to therapeutic indication:

Effects related to glucose transport

  • The IPO fraction of Actovegin® demonstrated a positive effect on glucose carrier activity( GLUT1) in the plasma membrane
  • Actovegin® stimulated glucose uptake in cerebral tissues, as well as other isolated animal tissues

Effects related to glucose utillization

  • The IPO fraction of Actovegin® activated glucose oxidation as well as the PHD complex
  • The IPO fraction of Actovegin® acts indirectly on the citric acid cycle by causing increased formation of acetyl COA

Effects related to oxygen uptake on energy metabolism

  • Actovegin® increased the respiratory capacity of mitochondria
  • Actovegin® improved oxygen uptake in Anesthetized dogs
  • Actovegin® demonstrated a positive effect on cerebral metabolism of rats under conditions of Hypoxia 

 

Prof.dr. Jan M. Keppel Hesselink, MD en DJ Kopsky, MD, versie juli 2009

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Referentie

[1] Ziegler D, Movsesyan L, Mankovsky B, Gurieva I, Abylaiuly Z, Strokov I. | Treatment of symptomatic polyneuropathy with actovegin in type 2 diabetic patients. | Diabetes Care. | 2009 Aug;32(8):1479-84. Epub 2009 May 26.

[2] Maillo L. | Anaphylactic shock with multiorgan failure in a cyclist after intravenous administration of Actovegin. | Ann Intern Med. | 2008 Mar 4;148(5):407.

[3] Derev'yannykh EA, Bel'skaya GN, Knoll EA, Krylova LG, Popov DV. | Experience in the use of Actovegin in the treatment of patients with cognitive disorders in the acute period of stroke. | Neurosci Behav Physiol. | 2008 Oct;38(8):873-5.