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Bokvist K, Ding Y, Landschulz WH, Sinha V, Pastrak A, Belin RM. Gastrin analogue administration adds no significant glycaemic benefit to a glucagon-like peptide-1 receptor agonist acutely or after washout of both analogues. Diabetes Obes Metab 2019; 21:1606-1614. [PMID: 30848033 DOI: 10.1111/dom.13695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/18/2019] [Accepted: 02/28/2019] [Indexed: 01/09/2023]
Abstract
AIM To determine if a 4-week course of 14 mg weekly GLP-1 agonist LY2428757 combined with 3 mg or 2 mg daily gastrin analogue TT223 (LY+TT223) results in long-term glycaemic changes. MATERIALS AND METHODS Patients with in adequately-controlled type 2 diabetes mellitus ±metformin (N=151) were randomized to a 4-week course of LY+TT223 (3 mg), LY+TT223 (2 mg), LY+TT223 placebo (LY-only) or LY placebo+TT223 placebo (placebo). The primary objective was change in HbA1c from baseline to 5 month safter completion of therapy (i.e. at 6 months) and safety and tolerability with LY+TT223 versus LY-only. RESULTS LY groups showed HbA1c reductions during the active treatment phase. These did not persist during follow-up phase. Combining TT223 with LY did not result in additional glycaemic effects during treatment or follow-up. At 6 months, LSM ± SE for change in HbA1c from baseline was: LY+TT223 (3 mg): -0.1 ± 0.2%; LY+TT223 (2 mg): 0.1 ± 0.2%; LY-only: -0.2 ± 0.2%; placebo: 0.04 ± 0.2%. Secondary analyses were consistent with primary results. LY+TT223 was not superior to LY for other time points or end points, including insulin secretory response to mixed meal tolerance tests. The most common adverse events (nausea and vomiting) were more frequent with LY+TT223 versus LY-only. The safety profile was consistent with previous findings. CONCLUSION GLP-1+gastrin combination therapy did not improve glycaemic control versus GLP-1 alone.
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Affiliation(s)
- Krister Bokvist
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Ying Ding
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Vikram Sinha
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
- Quantitative Pharmacology & Pharmacometrics, Merck & Co., Kenilworth, New Jersey
| | - Aleksandra Pastrak
- Clinical Development, Transition Therapeutics ULC - OPKO Subsidiary, Toronto, Canada
| | - Ruth M Belin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
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Brill AL, Wisinski JA, Cadena MT, Thompson MF, Fenske RJ, Brar HK, Schaid MD, Pasker RL, Kimple ME. Synergy Between Gαz Deficiency and GLP-1 Analog Treatment in Preserving Functional β-Cell Mass in Experimental Diabetes. Mol Endocrinol 2016; 30:543-56. [PMID: 27049466 DOI: 10.1210/me.2015-1164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A defining characteristic of type 1 diabetes mellitus (T1DM) pathophysiology is pancreatic β-cell death and dysfunction, resulting in insufficient insulin secretion to properly control blood glucose levels. Treatments that promote β-cell replication and survival, thus reversing the loss of β-cell mass, while also preserving β-cell function, could lead to a real cure for T1DM. The α-subunit of the heterotrimeric Gz protein, Gαz, is a tonic negative regulator of adenylate cyclase and downstream cAMP production. cAMP is one of a few identified signaling molecules that can simultaneously have a positive impact on pancreatic islet β-cell proliferation, survival, and function. The purpose of our study was to determine whether mice lacking Gαz might be protected, at least partially, from β-cell loss and dysfunction after streptozotocin treatment. We also aimed to determine whether Gαz might act in concert with an activator of the cAMP-stimulatory glucagon-like peptide 1 receptor, exendin-4 (Ex4). Without Ex4 treatment, Gαz-null mice still developed hyperglycemia, albeit delayed. The same finding held true for wild-type mice treated with Ex4. With Ex4 treatment, Gαz-null mice were protected from developing severe hyperglycemia. Immunohistological studies performed on pancreas sections and in vitro apoptosis, cytotoxicity, and survival assays demonstrated a clear effect of Gαz signaling on pancreatic β-cell replication and death; β-cell function was also improved in Gαz-null islets. These data support our hypothesis that a combination of therapies targeting both stimulatory and inhibitory pathways will be more effective than either alone at protecting, preserving, and possibly regenerating β-cell mass and function in T1DM.
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Affiliation(s)
- Allison L Brill
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Jaclyn A Wisinski
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Mark T Cadena
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Mary F Thompson
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Rachel J Fenske
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Harpreet K Brar
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Michael D Schaid
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Renee L Pasker
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
| | - Michelle E Kimple
- Department of Medicine (A.L.B., J.A.W., M.T.C., M.F.T., H.K.B., R.L.P., M.E.K.), Division of Endocrinology, Diabetes, and Metabolism; Department of Cell and Regenerative Biology (M.E.K.); and Interdisciplinary Graduate Program in Nutritional Sciences (R.J.F., M.D.S., M.E.K.), University of Wisconsin-Madison, Madison; and Research Service (A.L.B., J.A.W., M.T.C., M.F.T., R.J.F., H.K.B., M.D.S., M.E.K.), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 53705
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Tian J, Dang H, Kaufman DL. Combining antigen-based therapy with GABA treatment synergistically prolongs survival of transplanted ß-cells in diabetic NOD mice. PLoS One 2011; 6:e25337. [PMID: 21966502 PMCID: PMC3178649 DOI: 10.1371/journal.pone.0025337] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/01/2011] [Indexed: 01/13/2023] Open
Abstract
Antigen-based therapies (ABTs) very effectively prevent the development of type 1 diabetes (T1D) when given to young nonobese diabetic (NOD) mice, however, they have little or no ability to reverse hyperglycemia in newly diabetic NOD mice. More importantly, ABTs have not yet demonstrated an ability to effectively preserve residual ß-cells in individuals newly diagnosed with type 1 diabetes (T1D). Accordingly, there is great interest in identifying new treatments that can be combined with ABTs to safely protect ß-cells in diabetic animals. The activation of γ-aminobutyric acid (GABA) receptors (GABA-Rs) on immune cells has been shown to prevent T1D, experimental autoimmune encephalomyelitis (EAE) and rheumatoid arthritis in mouse models. Based on GABA's ability to inhibit different autoimmune diseases and its safety profile, we tested whether the combination of ABT with GABA treatment could prolong the survival of transplanted ß-cells in newly diabetic NOD mice. Newly diabetic NOD mice were untreated, or given GAD/alum (20 or 100 µg) and placed on plain drinking water, or water containing GABA (2 or 6 mg/ml). Twenty-eight days later, they received syngenic pancreas grafts and were monitored for the recurrence of hyperglycemia. Hyperglycemia reoccurred in the recipients given plain water, GAD monotherapy, GABA monotherapy, GAD (20 µg)+GABA (2 mg/ml), GAD (20 µg)+GABA (6 mg/ml) and GAD (100 µg)+GABA (6 mg/ml) about 1, 2-3, 3, 2-3, 3-8 and 10-11 weeks post-transplantation, respectively. Thus, combined GABA and ABT treatment had a synergistic effect in a dose-dependent fashion. These findings suggest that co-treatment with GABA (or other GABA-R agonists) may provide a new strategy to safely enhance the efficacy of other therapeutics designed to prevent or reverse T1D, as well as other T cell-mediated autoimmune diseases.
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Affiliation(s)
- Jide Tian
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hoa Dang
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Daniel L. Kaufman
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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Van Belle TL, Coppieters KT, Von Herrath MG. Type 1 Diabetes: Etiology, Immunology, and Therapeutic Strategies. Physiol Rev 2011; 91:79-118. [DOI: 10.1152/physrev.00003.2010] [Citation(s) in RCA: 673] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease in which destruction or damaging of the beta-cells in the islets of Langerhans results in insulin deficiency and hyperglycemia. We only know for sure that autoimmunity is the predominant effector mechanism of T1D, but may not be its primary cause. T1D precipitates in genetically susceptible individuals, very likely as a result of an environmental trigger. Current genetic data point towards the following genes as susceptibility genes: HLA, insulin, PTPN22, IL2Ra, and CTLA4. Epidemiological and other studies suggest a triggering role for enteroviruses, while other microorganisms might provide protection. Efficacious prevention of T1D will require detection of the earliest events in the process. So far, autoantibodies are most widely used as serum biomarker, but T-cell readouts and metabolome studies might strengthen and bring forward diagnosis. Current preventive clinical trials mostly focus on environmental triggers. Therapeutic trials test the efficacy of antigen-specific and antigen-nonspecific immune interventions, but also include restoration of the affected beta-cell mass by islet transplantation, neogenesis and regeneration, and combinations thereof. In this comprehensive review, we explain the genetic, environmental, and immunological data underlying the prevention and intervention strategies to constrain T1D.
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Affiliation(s)
- Tom L. Van Belle
- Center for Type 1 Diabetes Research, La Jolla Institute for Allergy and Immunology, La Jolla, California
| | - Ken T. Coppieters
- Center for Type 1 Diabetes Research, La Jolla Institute for Allergy and Immunology, La Jolla, California
| | - Matthias G. Von Herrath
- Center for Type 1 Diabetes Research, La Jolla Institute for Allergy and Immunology, La Jolla, California
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