1
|
Eliaschewitz FG, Canani LH. Advances in GLP-1 treatment: focus on oral semaglutide. Diabetol Metab Syndr 2021; 13:99. [PMID: 34526121 PMCID: PMC8442336 DOI: 10.1186/s13098-021-00713-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is currently a large arsenal of antidiabetic drugs available to treat type 2 diabetes (T2D). However, this is a serious chronic disease that affects millions of adults worldwide and is responsible for severe complications, comorbidities, and low quality of life when uncontrolled due mainly to delays in initiating treatment or inadequate therapy. This review article aims to clarify the therapeutic role of the oral formulation of the glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide in treating typical T2D patients. The discussion focused on metabolic, glycemic, and weight alteration effects and the safety of the therapy with this drug. MAIN TEXT Therapy with glucagon-like peptide 1 receptor agonist (GLP-1 RA) promotes strategic changes in the pathophysiological pathway of T2D and improves the secretion of glucagon and insulin, which results in a reduction in blood glucose levels and the promotion of weight loss. Until recently, the only route for semaglutide administration was parenteral. However, an oral formulation of GLP-1 RA was recently developed and approved by the Brazilian Health Regulatory Agency (ANVISA) and the Food and Drug Administration (FDA) based on the Peptide Innovation for Early Diabetes Treatment (PIONEER) program results. A sequence of 10 clinical studies compared oral semaglutide with placebo or active standard-of-care medications (empagliflozin 25 mg, sitagliptin 100 mg, or liraglutide 1.8 mg) in different T2D populations. CONCLUSIONS Oral semaglutide effectively reduces glycated hemoglobin (HbA1c) levels and body weight in a broad spectrum of patients with T2D and shows cardiovascular safety. Oral semaglutide broadens therapy options and facilitates the adoption of earlier GLP-1 RA treatment once T2D patients present low rates of treatment discontinuation. The main adverse events reported were related to the gastrointestinal tract, common to GLP-1 RA class drugs.
Collapse
Affiliation(s)
- Freddy G Eliaschewitz
- CPClin/DASA Clinical Research Center, Avenida Angélica, 2162, São Paulo, CEP 01228-200, Brazil.
| | - Luis Henrique Canani
- Endocrinology Division of Hospital de Clínicas de Porto Alegre and Department of Internal Medicine, Medical School of Federal, University of Rio Grande Do Sul, Porto Alegre, Brazil
| |
Collapse
|
2
|
Nauck MA, Wefers J, Meier JJ. Treatment of type 2 diabetes: challenges, hopes, and anticipated successes. Lancet Diabetes Endocrinol 2021; 9:525-544. [PMID: 34181914 DOI: 10.1016/s2213-8587(21)00113-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Abstract
Despite the successful development of new therapies for the treatment of type 2 diabetes, such as glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 inhibitors, the search for novel treatment options that can provide better glycaemic control and at reduce complications is a continuous effort. The present Review aims to present an overview of novel targets and mechanisms and focuses on glucose-lowering effects guiding this search and developments. We discuss not only novel developments of insulin therapy (eg, so-called smart insulin preparation with a glucose-dependent mode of action), but also a group of drug classes for which extensive research efforts have not been rewarded with obvious clinical impact. We discuss the potential clinical use of the salutary adipokine adiponectin and the hepatokine fibroblast growth factor (FGF) 21, among others. A GLP-1 peptide receptor agonist (semaglutide) is now available for oral absorption, and small molecules activating GLP-1 receptors appear on the horizon. Bariatric surgery and its accompanying changes in the gut hormonal milieu offer a background for unimolecular peptides interacting with two or more receptors (for GLP-1, glucose-dependent insulinotropic polypeptide, glucagon, and peptide YY) and provide more substantial glycaemic control and bodyweight reduction compared with selective GLP-1 receptor agonists. These and additional approaches will help expand the toolbox of effective medications needed for optimising the treatment of well delineated subgroups of type 2 diabetes or help develop personalised approaches for glucose-lowering drugs based on individual characteristics of our patients.
Collapse
Affiliation(s)
- Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum, St Josef Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Jakob Wefers
- Diabetes Division, Katholisches Klinikum Bochum, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Juris J Meier
- Diabetes Division, Katholisches Klinikum Bochum, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
3
|
Chronopharmacology of dapagliflozin-induced antihyperglycemic effects in C57BL/6J mice. Obes Res Clin Pract 2019; 13:505-510. [PMID: 31466832 DOI: 10.1016/j.orcp.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 01/07/2023]
Abstract
Chronopharmacology is the study of the varying responses of drugs to changes in biological timing and endogenous periodicities. The selective sodium-glucose cotransporter 2 inhibitor, dapagliflozin, is a globally prescribed antihyperglycemic drug. Although dapagliflozin is usually administered once a day, the specific intake time is generally not mentioned. Therefore, this study aimed at investigating the diurnal effects of dapagliflozin on high-fat diet (HFD)-induced obesity in mice. Five-week-old male C57BL/6J mice were fed a normal (control) diet or HFD for 10 weeks. During the last 2 weeks, the mice were administered olive oil/ethanol emulsion or dapagliflozin (1mg/kg, p.o.) in the light or dark phase. At the end of the experiment, the mice were euthanized after an 18h fasting period, and plasma and tissue samples (epididymal white adipose tissues, liver, and kidney) were collected. Dapagliflozin administration in the light phase significantly decreased plasma glucose levels, insulin levels, adipose adipokines, and decreased the size of adipocytes, compared with the HFD group. In contrast, these parameters remained unchanged in the mice treated during the dark phase. Our data therefore suggests that dapagliflozin portrays definite chronopharmacology, which may provide valuable information on the importance of drug administration timing for maximal pharmacological effects.
Collapse
|
4
|
Wang B, Smyl C, Chen CY, Li XY, Huang W, Zhang HM, Pai VJ, Kang JX. Suppression of Postprandial Blood Glucose Fluctuations by a Low-Carbohydrate, High-Protein, and High-Omega-3 Diet via Inhibition of Gluconeogenesis. Int J Mol Sci 2018; 19:E1823. [PMID: 29933567 PMCID: PMC6073393 DOI: 10.3390/ijms19071823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022] Open
Abstract
Hyperglycemia significantly contributes to the development and progression of metabolic diseases. Managing postprandial blood glucose fluctuations is of particular importance for patients with hyperglycemia, but safe and effective means of reducing blood glucose levels are still lacking. Five diets with varying macronutrient ratios and omega-3 fatty acid amounts were tested for their blood glucose-lowering effects in male C57BL/6J mice. The diets with potent blood glucose-lowering effects were further investigated for their underlying mechanisms and their beneficial effects on hyperglycemia models. Mice given the low-carbohydrate, high-protein, and high-omega-3 (LCHP+3) diet exhibited a rapid reduction of the blood glucose levels that remained consistently low, regardless of feeding. These effects were associated with reduced amino acid gluconeogenesis, due to the inhibition of hepatic alanine transaminase (ALT). Furthermore, the LCHP+3 intervention was effective in reducing the blood glucose levels in several disease conditions, including type 1 diabetes mellitus, hormone-induced hyperglycemia, and diet-induced metabolic syndrome. Our findings identify the LCHP+3 diet as a potent blood glucose-lowering diet that suppresses postprandial blood glucose fluctuations through the inhibition of gluconeogenesis and may have great clinical utility for the management of metabolic diseases with hyperglycemia.
Collapse
Affiliation(s)
- Bin Wang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University, Chongqing 400038, China.
| | - Christopher Smyl
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Chih-Yu Chen
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Xiang-Yong Li
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Wei Huang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
- Biomedical Analysis Center, Third Military Medical University, Chongqing 400038, China.
| | - Hong-Man Zhang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Victor J Pai
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| | - Jing X Kang
- Laboratory for Lipid Medicine and Technology (LLMT), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA.
| |
Collapse
|
5
|
Vilcacundo R, Martínez-Villaluenga C, Hernández-Ledesma B. Release of dipeptidyl peptidase IV, α-amylase and α-glucosidase inhibitory peptides from quinoa (Chenopodium quinoa Willd.) during in vitro simulated gastrointestinal digestion. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.06.024] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
6
|
RETRACTED: Polysaccharide from Angelica sinensis ameliorates high-fat diet and STZ-induced hepatic oxidative stress and inflammation in diabetic mice by activating the Sirt1–AMPK pathway. J Nutr Biochem 2017; 43:88-97. [DOI: 10.1016/j.jnutbio.2017.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/11/2017] [Accepted: 02/07/2017] [Indexed: 12/27/2022]
|
7
|
Lin HTV, Tsou YC, Chen YT, Lu WJ, Hwang PA. Effects of Low-Molecular-Weight Fucoidan and High Stability Fucoxanthin on Glucose Homeostasis, Lipid Metabolism, and Liver Function in a Mouse Model of Type II Diabetes. Mar Drugs 2017; 15:md15040113. [PMID: 28387741 PMCID: PMC5408259 DOI: 10.3390/md15040113] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/27/2017] [Accepted: 04/04/2017] [Indexed: 01/09/2023] Open
Abstract
The combined effects of low-molecular-weight fucoidan (LMF) and fucoxanthin (Fx) in terms of antihyperglycemic, antihyperlipidemic, and hepatoprotective activities were investigated in a mouse model of type II diabetes. The intake of LMF, Fx, and LMF + Fx lowered the blood sugar and fasting blood sugar levels, and increased serum adiponectin levels. The significant decrease in urinary sugar was only observed in LMF + Fx supplementation. LMF and Fx had ameliorating effects on the hepatic tissue of db/db mice by increasing hepatic glycogen and antioxidative enzymes, and LMF was more effective than Fx at improving hepatic glucose metabolism. As for glucose and lipid metabolism in the adipose tissue, the expression of insulin receptor substrate (IRS)-1, glucose transporter (GLUT), peroxisome proliferator-activated receptor gamma (PPARγ), and uncoupling protein (UCP)-1 mRNAs in the adipose tissue of diabetic mice was significantly upregulated by Fx and LMF + Fx, and levels of inflammatory adipocytokines, such as adiponectin, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6), were significantly modulated only by LMF + Fx supplementation. The efficacy of LMF + Fx supplementation on the decrease in urinary sugar and on glucose and lipid metabolism in the white adipose tissue of db/db mice was better than that of Fx or LMF alone, indicating the occurrence of a synergistic effect of LMF and Fx.
Collapse
Affiliation(s)
- Hong-Ting Victor Lin
- Department of Food Science, National Taiwan Ocean University, No. 2, Pei-Ning Road, Keelung 202, Taiwan.
- Center of Excellence for the Oceans, National Taiwan Ocean University, No. 2, Pei-Ning Road, Keelung 202, Taiwan.
| | - Yu-Chi Tsou
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, No. 2, Pei-Ning Road, Keelung 202, Taiwan.
| | - Yu-Ting Chen
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, No. 2, Pei-Ning Road, Keelung 202, Taiwan.
| | - Wen-Jung Lu
- Department of Food Science, National Taiwan Ocean University, No. 2, Pei-Ning Road, Keelung 202, Taiwan.
| | - Pai-An Hwang
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, No. 2, Pei-Ning Road, Keelung 202, Taiwan.
| |
Collapse
|
8
|
Kadouh HC, Sun S, Zhu W, Zhou K. α-Glucosidase inhibiting activity and bioactive compounds of six red wine grape pomace extracts. J Funct Foods 2016; 26:577-584. [PMID: 30381791 PMCID: PMC6205192 DOI: 10.1016/j.jff.2016.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Grape pomace contains considerable amounts of polyphenols and it has been reported to exhibit specific inhibitory activity against mammalian intestinal α-glucosidases. This study aims to investigate the anti-diabetes potential of Chambourcin, Merlot, Norton, Petit Verdot, Syrah and Tinta Cão red wine grape pomaces by assessing their rat intestinal α-glucosidase inhibitory activity in relation to their total phenolic content and individual identified phenolic compounds by HPLC. Among the selected pomaces, Tinta Cão, Syrah and Merlot extracts showed higher potency in inhibiting α-glucosidase, and appeared to have higher respective total phenolic contents. Fifteen phenolic compounds were identified in the pomace samples, however, none of them showed significant inhibition of intestinal α-glucosidases. Red grape pomace, namely Tinta Cão, appears to be a promising functional food for the potential future development of a food-derived α-glucosidase inhibitor for preventing and treating diabetes.
Collapse
Affiliation(s)
- Hoda C. Kadouh
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA
| | - Shi Sun
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA
| | - Wenjun Zhu
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA
| | - Kequan Zhou
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA
| |
Collapse
|
9
|
Sharma SK, Panneerselvam A, Singh KP, Parmar G, Gadge P, Swami OC. Teneligliptin in management of type 2 diabetes mellitus. Diabetes Metab Syndr Obes 2016; 9:251-60. [PMID: 27574456 PMCID: PMC4993264 DOI: 10.2147/dmso.s106133] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Teneligliptin is a recently developed oral dipeptidyl peptidase 4 inhibitor indicated for the management of type 2 diabetes mellitus (T2DM) in adults along with diet and exercise. Teneligliptin has been recently available in Japan (Teneria(®)), Argentina (Teneglucon(®)), and India (Tenepure; Teneza) at relatively affordable price. This is a positive step toward the management of T2DM in developing countries, where the cost of medicine is out-of-pocket expenditure and is a limiting factor for health care. This review evaluates the efficacy and safety of teneligliptin in the management of T2DM. Teneligliptin has been systematically evaluated in T2DM as monotherapy with diet and exercise and in combination with metformin, glimepiride, pioglitazone, and insulin in short-term (12 weeks) and long-term (52 weeks) studies. These studies have reported a reduction in HbA1c of 0.8%-0.9% within 12 weeks of therapy. Two 52-week studies reported sustained improvement in glycemic control with teneligliptin. Teneligliptin has been found to be well tolerated, and the safety profile is similar to other dipeptidyl peptidase 4 inhibitors. Hypoglycemia and constipation are the main adverse events. Teneligliptin can be administered safely to patients with mild, moderate, or severe renal impairment or end-stage renal disease without dose adjustment. Similarly, it can be used in patients with mild-to-moderate hepatic impairment. Teneligliptin is effective and well tolerated and may have an important role in the management of T2DM.
Collapse
Affiliation(s)
| | | | - KP Singh
- Fortis Hospital, Sector 62, Phase VIII, Mohali
| | - Girish Parmar
- Kokilaben Dhirubhai Ambani Hospital, Andheri (W), Mumbai
| | | | - Onkar C Swami
- Unichem Laboratories Ltd, Jogeshwari (W), Mumbai, India
| |
Collapse
|
10
|
Frara S, Maffezzoni F, Mazziotti G, Giustina A. Current and Emerging Aspects of Diabetes Mellitus in Acromegaly. Trends Endocrinol Metab 2016; 27:470-483. [PMID: 27229934 DOI: 10.1016/j.tem.2016.04.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus is a frequent complication of acromegaly, a disease characterized by chronic hypersecretion of growth hormone (GH) by a pituitary adenoma. Diabetes occurs commonly but not only as a consequence of an insulin-resistant state induced by GH excess. The development of diabetes in patients with acromegaly is clinically relevant, since such a complication is thought to increase the already elevated cardiovascular morbidity and mortality risk of the disease. Emerging data suggest that a specific cardiomyopathy can be identified in acromegaly patients with diabetes. Moreover, the presence of diabetes may also influence therapeutic decision making in acromegaly, since traditional and newly developed drugs used in this clinical setting may impact glucose metabolism regardless of control of GH hypersecretion.
Collapse
Affiliation(s)
- Stefano Frara
- Endocrinology and Metabolic Diseases Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Filippo Maffezzoni
- Endocrinology and Metabolic Diseases Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | | | - Andrea Giustina
- Endocrinology and Metabolic Diseases Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy.
| |
Collapse
|
11
|
Sun S, Kadouh HC, Zhu W, Zhou K. Bioactivity-guided isolation and purification of α-glucosidase inhibitor, 6- O- D-glycosides, from Tinta Cão grape pomace. J Funct Foods 2016; 23:573-579. [PMID: 30381790 DOI: 10.1016/j.jff.2016.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bioactivity-guided fractionation methods were used to identify and purify active components in Tinta Cão grape pomace extract (GPE) that inhibit intestinal α-glucosidases. One active α-glucosidase inhibitor and one new natural product determined as 6-O-(p-coumaroyl)-D-glucopyranoside and methyl 6-O-(p-coumaroyl)-β-D-galactopyranoside, respectively, were isolated from GPE that were previously shown to potently inhibit α-glucosidase. Analysis of the relationship between structures and activity suggested that C1-OH of saccharide moiety in phenolic glycosides is necessary for this potent inhibition of intestinal α-glucosidases for the potential development of a novel anti-hyperglycaemic dietary supplement.
Collapse
Affiliation(s)
- Shi Sun
- Department of Nutrition & Food Science, Wayne State University, Detroit, MI 48202, United States
| | - Hoda Chaouki Kadouh
- Department of Nutrition & Food Science, Wayne State University, Detroit, MI 48202, United States
| | - Wenjun Zhu
- Department of Nutrition & Food Science, Wayne State University, Detroit, MI 48202, United States
| | - Kequan Zhou
- Department of Nutrition & Food Science, Wayne State University, Detroit, MI 48202, United States
| |
Collapse
|
12
|
Leiter LA, Shestakova MV, Trubitsyna NP, Piletič M, Satman I. Implementing an optimized glucose-lowering strategy with a novel once daily modified release gliclazide formulation. Diabetes Res Clin Pract 2016; 112:50-56. [PMID: 26653612 DOI: 10.1016/j.diabres.2015.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/12/2015] [Accepted: 11/09/2015] [Indexed: 12/17/2022]
Abstract
AIM The 6-months titration profile of a new scored gliclazide modified release (MR) formulation (MR 60 mg) was explored in individuals with type 2 diabetes. METHODS This international study enrolled 7170 individuals, age ≥ 35 years with HbA1c ≥ 7.5% (59 mmol/mol) and not on insulin. Participants were started on 30-120 mg gliclazide MR 60 mg once daily as a first line (FIRST), add-on (ADD) or switch from a previous oral antihyperglycemic treatment strategy (SWITCH). Uptitration was capped at 120 mg. RESULTS Women comprised 58.5% of the cohort. Mean baseline age was 58.9 years, body mass index 30.1 kg/m(2) and diabetes duration 5.1 years. Mean baseline HbA1c for the FIRST (n=2023), ADD (n=3136) and SWITCH (n=1834) groups was 8.9% (74 mmol/mol), 8.8% (73 mmol/mol) and 8.8% (73 mmol/mol), respectively. Probability of reaching optimal dose at months 1, 2, 3 and 6 was 15%, 39%, 59% and 92%, respectively. Mean HbA1c changes from baseline to month 6 were FIRST: -1.98%, ADD: -1.74% and SWITCH: -1.61% (all p<0.01). Overall, 65.3% achieved HbA1c ≤ 7.0% (53 mmol/mol); average duration for achieving glucose control was 80.1 days. Mean weight loss ranged from -1.45 to -1.27 kg. Severe hypoglycemia was experienced by 0.06% of participants. Most (95.5%) indicated a greater likelihood of adherence with the gliclazide MR 60 mg regime relative to their previous therapy. CONCLUSIONS In this large, real world study, progressive uptitration with gliclazide MR 60 mg once daily appears to be efficacious and safe in individuals with suboptimal glycemic control at various stages of the diabetes continuum.
Collapse
Affiliation(s)
- Lawrence A Leiter
- Divisions of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - Marina V Shestakova
- Endocrinology Research Centre, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | | | - Ilhan Satman
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
13
|
Wang K, Tang Z, Zheng Z, Cao P, Shui W, Li Q, Zhang Y. Protective effects of Angelica sinensis polysaccharide against hyperglycemia and liver injury in multiple low-dose streptozotocin-induced type 2 diabetic BALB/c mice. Food Funct 2016; 7:4889-4897. [DOI: 10.1039/c6fo01196a] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Angelica sinensis polysaccharide (ASP), one of the major active ingredients isolated from the roots of Angelica sinensis (Oliv.) Diels, possesses antidiabetic bioactivity.
Collapse
Affiliation(s)
- Kaiping Wang
- Hubei Key Laboratory of Natural Medicinal Chemistry and Resource Evaluation
- Tongji Medical College of Pharmacy
- Huazhong University of Science and Technology
- Wuhan
- China
| | - Zhuohong Tang
- Hubei Key Laboratory of Natural Medicinal Chemistry and Resource Evaluation
- Tongji Medical College of Pharmacy
- Huazhong University of Science and Technology
- Wuhan
- China
| | - Ziming Zheng
- Union Hospital of Huazhong University of Science and Technology
- Department of Pharmacy
- Wuhan
- China
| | - Peng Cao
- Hubei Key Laboratory of Natural Medicinal Chemistry and Resource Evaluation
- Tongji Medical College of Pharmacy
- Huazhong University of Science and Technology
- Wuhan
- China
| | - Weizhi Shui
- Hubei Key Laboratory of Natural Medicinal Chemistry and Resource Evaluation
- Tongji Medical College of Pharmacy
- Huazhong University of Science and Technology
- Wuhan
- China
| | - Qiang Li
- Union Hospital of Huazhong University of Science and Technology
- Department of Pharmacy
- Wuhan
- China
| | - Yu Zhang
- Union Hospital of Huazhong University of Science and Technology
- Department of Pharmacy
- Wuhan
- China
| |
Collapse
|
14
|
Hong SP, Nam KY, Shin YJ, Kim KW, Ahn SK. Discovery of 11β-hydroxysteroid dehydrogenase type 1 inhibitor. Bioorg Med Chem Lett 2015; 25:3501-6. [DOI: 10.1016/j.bmcl.2015.06.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/15/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
|
15
|
Godman B, Malmström RE, Diogene E, Gray A, Jayathissa S, Timoney A, Acurcio F, Alkan A, Brzezinska A, Bucsics A, Campbell SM, Czeczot J, de Bruyn W, Eriksson I, Yusof FAM, Finlayson AE, Fürst J, Garuoliene K, Guerra Júnior A, Gulbinovič J, Jan S, Joppi R, Kalaba M, Magnisson E, McCullagh L, Miikkulainen K, Ofierska-Sujkowska G, Pedersen HB, Selke G, Sermet C, Spillane S, Supian A, Truter I, Vlahović-Palčevski V, Vien LE, Vural EH, Wale J, Władysiuk M, Zeng W, Gustafsson LL. Are new models needed to optimize the utilization of new medicines to sustain healthcare systems? Expert Rev Clin Pharmacol 2015; 8:77-94. [PMID: 25487078 DOI: 10.1586/17512433.2015.990380] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Medicines have made an appreciable contribution to improving health. However, even high-income countries are struggling to fund new premium-priced medicines. This will grow necessitating the development of new models to optimize their use. The objective is to review case histories among health authorities to improve the utilization and expenditure on new medicines. Subsequently, use these to develop exemplar models and outline their implications. A number of issues and challenges were identified from the case histories. These included the low number of new medicines seen as innovative alongside increasing requested prices for their reimbursement, especially for oncology, orphan diseases, diabetes and HCV. Proposed models center on the three pillars of pre-, peri- and post-launch including critical drug evaluation, as well as multi-criteria models for valuing medicines for orphan diseases alongside potentially capping pharmaceutical expenditure. In conclusion, the proposed models involving all key stakeholder groups are critical for the sustainability of healthcare systems or enhancing universal access. The models should help stimulate debate as well as restore trust between key stakeholder groups.
Collapse
Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Ahmad A, Khan RMA, Alkharfy KM, Raish M, Al-Jenoobi FI, Al-Mohizea AM. Effects of Thymoquinone on the Pharmacokinetics and Pharmacodynamics of Glibenclamide in a Rat Model. Nat Prod Commun 2015. [DOI: 10.1177/1934578x1501000821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Glibenclamide and thymoquinone plasma concentrations were analysed using a sensitive RP-HPLC method, and non-compartmental model pharmacokinetic parameters were calculated. The maximum reduction in blood glucose level was observed 3 hours following glibenclamide administration, which reached 47.4% of baseline, whereas it was reduced by 53.0% to 56.2% when co-administrated with thymoquinone. Plasma concentration of glibenclamide was increased by 13.4% and 21.8% by the co-administration of thymoquinone as single and multiple doses, respectively ( P<0.05). The AUC and T1/2 of glibenclamide were also increased respectively by 32.0% and 17.4% with a thymoquinone single dose, and by 52.5% and 92.8% after chronic treatment. Furthermore, diabetic rats treated with thymoquinone demonstrated a marked decrease in hepatic protein expressions of CYP3A2 and CYP2C11 enzymes that are responsible for the metabolism of glibenclamide. The current data suggest that thymoquinone exhibits a synergistic effect with glibenclamide on glucose level, which could be explained by reducing CYP450 activity at the protein level.
Collapse
Affiliation(s)
- Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Rao Muzaffar A. Khan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Khalid M. Alkharfy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Mohammad Raish
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Fahad I. Al-Jenoobi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Abdullah M. Al-Mohizea
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| |
Collapse
|
17
|
Gu SJ, Chen DH, Guo ZR, Zhou ZY, Hu XS, Wu M. Effect of obesity on the association between common variations in the PPAR gene and C-reactive protein level in Chinese Han population. Endocrine 2015; 48:195-202. [PMID: 24599720 DOI: 10.1007/s12020-014-0218-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/14/2014] [Indexed: 12/29/2022]
Abstract
The peroxisome proliferator-activated receptors (PPARs)-α, -β/δ, and -γ are the ligand-activated transcription factors that function as the master regulators of glucose, fatty acid and lipoprotein metabolism, inflammation, and atherosclerosis. Our aim was to test the association between ten single nucleotide polymorphisms of PPARs and CRP level, as well as their interaction with overweight/obesity. A sample population of 643 subjects was recruited from the prevention of MetS and multi-metabolic disorders in Jiangsu Province of China Study. The selected SNPs in PPAR α (rs135539, rs4253778, rs1800206), PPAR β/δ (rs2016520 and rs9794), and PPAR γ (rs10865710, rs1805192, rs709158, rs3856806, and rs4684847) were genotyped. After adjustment for smoking, alcohol consumption, SBP, DBP, TG, and HDL-C, rs1800206, rs709158, rs1805192, and rs4684847 polymorphisms were significantly associated with CRP level in normal weight subjects (P < 0.05). In the overweight/obese subjects, rs1800206 was also significant associated with CRP level (P<0.01). In addition, the rs709158, rs1805192, and rs4684847 polymorphisms were shown interactions with overweight/obesity to influence CRP level (P<0.05). PPARs polymorphisms are independently associated with CRP levels in Chinese Han population. Further, PPARs polymorphisms interact with overweight/obesity to set CRP levels.
Collapse
Affiliation(s)
- Shu-Jun Gu
- Center for Disease Control of Changshu, Suzhou, 215500, Jiangsu, China
| | | | | | | | | | | |
Collapse
|
18
|
Su B, Sheng H, Zhang M, Bu L, Yang P, Li L, Li F, Sheng C, Han Y, Qu S, Wang J. Risk of bone fractures associated with glucagon-like peptide-1 receptor agonists' treatment: a meta-analysis of randomized controlled trials. Endocrine 2015; 48:107-15. [PMID: 25074632 DOI: 10.1007/s12020-014-0361-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/07/2014] [Indexed: 12/26/2022]
Abstract
Traditional anti-diabetic drugs may have negative or positive effects on risk of bone fractures. Yet the relationship between the new class glucagon-like peptide-1 receptor agonists (GLP-1 RA) and risk of bone fractures has not been established. We performed a meta-analysis including randomized controlled trials (RCT) to study the risk of bone fractures associated with liraglutide or exenatide, compared to placebo or other active drugs. We searched MEDLINE, EMBASE, and clinical trial registration websites for published or unpublished RCTs comparing the effects of liraglutide or exenatide with comparators. Only studies with disclosed bone fracture data were included. Separate pooled analysis was performed for liraglutide or exenatide, respectively, by calculating Mantel-Haenszel odds ratio (MH-OR). 16 RCTs were identified including a total of 11,206 patients. Liraglutide treatment was associated with a significant reduced risk of incident bone fractures (MH-OR=0.38, 95% CI 0.17-0.87); however, exenatide treatment was associated with an elevated risk of incident bone fractures (MH-OR=2.09, 95% CI 1.03-4.21). Publication bias and heterogeneity between studies were not observed. Our study demonstrated a divergent risk of bone fractures associated with different GLP-1 RA treatments. The current findings need to be confirmed by future well-designed prospective or RCT studies.
Collapse
Affiliation(s)
- Bin Su
- Department of Endocrinology, Shanghai Tenth People's Hospital, School of Medicine, Tong-Ji University, 301 Middle Yanchang Road, Shanghai, 200072, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Mikhail N. Effects of incretin-based therapy in patients with heart failure and myocardial infarction. Endocrine 2014; 47:21-8. [PMID: 24493030 DOI: 10.1007/s12020-014-0175-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
Abstract
Studies designed to evaluate the short-term effects of incretin-related drugs in subjects with cardiac disease are still preliminary. In patients with heart failure, two of five studies showed that glucagon-like peptide-1 (GLP-1) infusion was associated with an absolute increase in left ventricular ejection fraction (LVEF) by 6-10 %, whereas no significant benefit was observed in the remaining three studies. In patients with coronary artery disease, single infusion of the GLP-1 receptor analog, exenatide, did not increase LVEF, but this drug may decrease infarct size in patients with myocardial infarction presenting with short duration of ischemic symptoms. Single dose of GLP-1 and the dipeptidyl-peptidase-IV (DPP-IV) inhibitor, sitagliptin, may improve left ventricular function, predominantly in ischemic segments, and attenuate post-ischemic stunning. Nausea, vomiting and hypoglycemia were the most common adverse effects associated with GLP-1 and exenatide administration. Increased heart rate was also observed with exenatide in patients with heart failure. Large randomized trials including diabetic patients with preexisting heart failure and myocardial infarction showed that chronic therapy with the DPP-IV inhibitors saxagliptin and alogliptin did not reduce cardiovascular events or mortality. Moreover, saxagliptin use was associated with significant increase in frequency of heart failure requiring hospitalization, hypoglycemia and angioedema. Overall, short-term preliminary data suggest potential cardioprotective effects of exenatide and sitagliptin in patients with heart failure and myocardial infarction. Meanwhile, long-term randomized trials suggest no benefit of alogliptin, and increased harm associated with the use of saxagliptin.
Collapse
Affiliation(s)
- Nasser Mikhail
- Endocrinology Division, OliveView-UCLA Medical Center, David-Geffen School of Medicine, 14445 Olive View Dr, Sylmar, 91342, CA, USA,
| |
Collapse
|
20
|
Chao PC, Hsu CC, Liu WH. Renal protective effects of Porphyra dentate aqueous extract in diabetic mice. Biomedicine (Taipei) 2014; 4:18. [PMID: 25520931 PMCID: PMC4265010 DOI: 10.7603/s40681-014-0018-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/30/2014] [Indexed: 12/25/2022] Open
Abstract
Background: Purple laver ((Porphyra dentate) is a popular edible seaweed in Asia. This study examined protective effects of extract from purple laver extract (PLE) in diabetic mice. Methods: Content of carotenoids and anthocyanins in PLE was analyzed. PLE at 0.5 and 1% was supplied for 7 weeks. Results: PLE was rich in anthocyanins. PLE intake at 0.5 and 1% lowered plasma glucose level (P<0.05); only at 1% raised plasma insulin level, and decreased plasma triglyceride and total cholesterol levels (P<0.05). PLE treatments at 1% lowered hepatic triglyceride and total cholesterol (P<0.05); it reduced renal reactive oxygen species level (P<0.05); retained renal glutathione level, maintaining renal glutathione peroxidase and catalase activities (P<0.05). Conclusion: Porphyra dentate aqueous extract could attenuate diabetic progression via anti-oxidative and lipid lowering effects. This seaweed could be considered as potent healthy food, and used for personalized medicine.
Collapse
Affiliation(s)
- Pei-Chun Chao
- School of Nutrition, Chung Shan Medical University, Taichung, Taiwan ; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chin Hsu
- School of Nutrition, Chung Shan Medical University, Taichung, Taiwan ; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Hu Liu
- School of Nutrition, Chung Shan Medical University, Taichung, Taiwan ; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
21
|
Giorda CB, Nada E, Tartaglino B. Pharmacokinetics, safety, and efficacy of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes mellitus and renal or hepatic impairment. A systematic review of the literature. Endocrine 2014; 46:406-19. [PMID: 24510630 DOI: 10.1007/s12020-014-0179-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/16/2014] [Indexed: 12/14/2022]
Abstract
Renal or hepatic impairment, often encountered in patients with type 2 diabetes, influences the pharmacokinetics and bioavailability of antihyperglycemic agents. An emerging concern is whether pharmacotherapy with incretin-based agents, the most recent drug classes to be introduced for type 2 diabetes, can be safely used in patients with renal insufficiency or hepatic damage. This literature review examines the results of studies on these novel drug classes, with a view to provide the practitioner with a balanced, evidence-based position when considering incretin-based therapies in patients with type 2 diabetes and impaired kidney or liver function. All currently available dipeptidyl peptidase-4 (DPP-4) inhibitors appear to be appropriate pharmacotherapeutic choices in patients with declining renal function, with linagliptin affording the added advantage of not requiring dose adjustment or periodic monitoring of drug-related kidney function. In contrast, caution is warranted with the use of glucagon-like peptide-1 (GLP-1) receptor agonists in patients with moderate or severe renal impairment. The slightly wider evidence base for liraglutide than for exenatide or lixisenatide is not sufficient to support its use in severe renal impairment. What little evidence there is for incretin-based therapies in hepatic impairment has come from a few past hoc analysis of clinical trials, with most precautions and warnings reflecting the paucity of knowledge about incretin efficacy or safety in this condition.
Collapse
Affiliation(s)
- Carlo B Giorda
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy,
| | | | | |
Collapse
|
22
|
Sebastião I, Candeias E, Santos MS, de Oliveira CR, Moreira PI, Duarte AI. Insulin as a Bridge between Type 2 Diabetes and Alzheimer Disease - How Anti-Diabetics Could be a Solution for Dementia. Front Endocrinol (Lausanne) 2014; 5:110. [PMID: 25071725 PMCID: PMC4086025 DOI: 10.3389/fendo.2014.00110] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/24/2014] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes (T2D) and Alzheimer disease (AD) are two major health issues nowadays. T2D is an ever increasing epidemic, affecting millions of elderly people worldwide, with major repercussions in the patients' daily life. This is mostly due to its chronic complications that may affect brain and constitutes a risk factor for AD. T2D principal hallmark is insulin resistance which also occurs in AD, rendering both pathologies more than mere unrelated diseases. This hypothesis has been reinforced in the recent years, with a high number of studies highlighting the existence of several common molecular links. As such, it is not surprising that AD has been considered as the "type 3 diabetes" or a "brain-specific T2D," supporting the idea that a beneficial therapeutic strategy against T2D might be also beneficial against AD. Herewith, we aim to review some of the recent developments on the common features between T2D and AD, namely on insulin signaling and its participation in the regulation of amyloid β (Aβ) plaque and neurofibrillary tangle formation (the two major neuropathological hallmarks of AD). We also critically analyze the promising field that some anti-T2D drugs may protect against dementia and AD, with a special emphasis on the novel incretin/glucagon-like peptide-1 receptor agonists.
Collapse
Affiliation(s)
- Inês Sebastião
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Emanuel Candeias
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Maria S. Santos
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Catarina R. de Oliveira
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Institute of Biochemistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paula I. Moreira
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana I. Duarte
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| |
Collapse
|
23
|
Watterson KR, Hudson BD, Ulven T, Milligan G. Treatment of type 2 diabetes by free Fatty Acid receptor agonists. Front Endocrinol (Lausanne) 2014; 5:137. [PMID: 25221541 PMCID: PMC4147718 DOI: 10.3389/fendo.2014.00137] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/07/2014] [Indexed: 12/11/2022] Open
Abstract
Dietary free fatty acids (FFAs), such as ω-3 fatty acids, regulate metabolic and anti-inflammatory processes, with many of these effects attributed to FFAs interacting with a family of G protein-coupled receptors. Selective synthetic ligands for free fatty acid receptors (FFA1-4) have consequently been developed as potential treatments for type 2 diabetes (T2D). In particular, clinical studies show that Fasiglifam, an agonist of the long-chain FFA receptor, FFA1, improved glycemic control and reduced HbA1c levels in T2D patients, with a reduced risk of hypoglycemia. However, this ligand was removed from clinical trials due to potential liver toxicity and determining if this is a target or a ligand-specific feature is now of major importance. Pre-clinical studies also show that FFA4 agonism increases insulin sensitivity, induces weight loss, and reduces inflammation and the metabolic and anti-inflammatory effects of short chain fatty acids (SCFAs) are linked with FFA2 and FFA3 activation. In this review, we therefore show that FFA receptor agonism is a potential clinical target for T2D treatment and discuss ongoing drug development programs within industry and academia aimed at improving the safety and effectiveness of these potential treatments.
Collapse
Affiliation(s)
- Kenneth R. Watterson
- Molecular Pharmacology Group, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Brian D. Hudson
- Molecular Pharmacology Group, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Trond Ulven
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Graeme Milligan
- Molecular Pharmacology Group, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- *Correspondence: Graeme Milligan, Molecular Pharmacology Group, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK e-mail:
| |
Collapse
|
24
|
Szlyk B, Braun CR, Ljubicic S, Patton E, Bird GH, Osundiji MA, Matschinsky FM, Walensky LD, Danial NN. A phospho-BAD BH3 helix activates glucokinase by a mechanism distinct from that of allosteric activators. Nat Struct Mol Biol 2013; 21:36-42. [PMID: 24317490 DOI: 10.1038/nsmb.2717] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 10/15/2013] [Indexed: 01/10/2023]
Abstract
Glucokinase (GK) is a glucose-phosphorylating enzyme that regulates insulin release and hepatic metabolism, and its loss of function is implicated in diabetes pathogenesis. GK activators (GKAs) are attractive therapeutics in diabetes; however, clinical data indicate that their benefits can be offset by hypoglycemia, owing to marked allosteric enhancement of the enzyme's glucose affinity. We show that a phosphomimetic of the BCL-2 homology 3 (BH3) α-helix derived from human BAD, a GK-binding partner, increases the enzyme catalytic rate without dramatically changing glucose affinity, thus providing a new mechanism for pharmacologic activation of GK. Remarkably, BAD BH3 phosphomimetic mediates these effects by engaging a new region near the enzyme's active site. This interaction increases insulin secretion in human islets and restores the function of naturally occurring human GK mutants at the active site. Thus, BAD phosphomimetics may serve as a new class of GKAs.
Collapse
Affiliation(s)
- Benjamin Szlyk
- 1] Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. [2]
| | - Craig R Braun
- 1] Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. [2]
| | - Sanda Ljubicic
- 1] Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. [2] Department of Cell Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elaura Patton
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gregory H Bird
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mayowa A Osundiji
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Franz M Matschinsky
- Department of Biochemistry and Biophysics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Loren D Walensky
- 1] Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. [2] Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts, USA. [3] Department of Pediatric Oncology, Children's Hospital, Boston, Massachusetts, USA
| | - Nika N Danial
- 1] Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. [2] Department of Cell Biology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
25
|
Shammas C, Neocleous V, Phelan MM, Lian LY, Skordis N, Phylactou LA. A report of 2 new cases of MODY2 and review of the literature: implications in the search for type 2 diabetes drugs. Metabolism 2013; 62:1535-42. [PMID: 23890519 DOI: 10.1016/j.metabol.2013.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
Glucokinase (GCK) acts as a glucose sensor and stimulates the release of insulin from pancreatic β-cells and any GCK gene mutations can lead to different forms of diabetes, such as GCK-monogenic diabetes of the young type 2 (MODY2), permanent neonatal diabetes and congenital hyperinsulinism. Many MODY2 causing mutations display a variation in the degree of severity, ranging from mild dietary-restricted forms to more detrimental presentation requiring insulin replacement. The present study reviews known and two novel GCK mutations in terms of molecular perturbation of the GCK atomic structure but also emphasizes the inactivating and activating properties of the GCK as treatment for T2DM. In silico analysis demonstrated that the newly discovered mutation p.Arg447Pro causes structural conformational changes that lead to the destabilization of the functional properties of the protein resulting in the reduction of glucose and MgATP2- affinity. The novel p.Glu440Stop nonsense mutation on the other hand inactivates the cytoplasmic enzymatic activity of the protein as it is responsible for the loss of the C-terminal end of the polypeptide that includes vital glucose-releasing residues. Based on the in silico models of existing structural data we identified several classes of GCK mutations and discuss their relation to disease outcome. GCK has a central role in controlling body glucose homeostasis and therefore is considered an outstanding drug target for developing new antidiabetic therapies using small molecular activators (GKAs). This study emphasizes the importance in understanding how inactivating and activating GCK mutations affect the mechanistic properties of this glucose sensor. Such information can become the basis for drug discovery of therapeutic compounds and the treatment of T2DM by targeting the GCK allosteric activator site.
Collapse
Affiliation(s)
- Christos Shammas
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, P.O. Box 23462, 1683 Nicosia, Cyprus
| | | | | | | | | | | |
Collapse
|