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Liu Z, Yang B. Drug Development Strategy for Type 2 Diabetes: Targeting Positive Energy Balances. Curr Drug Targets 2019; 20:879-890. [DOI: 10.2174/1389450120666181217111500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Newer classes of medications have been proven useful in glycemic control in type 2 diabetes
(T2D), but many do not appear capable to slow down the progressive loss of ß-cell function, or to
improve population-level glycemic control. Positive energy balance, e.g. surplus energy intake over
expenditure, is at the core for developing metabolic syndrome and T2D. Currently available glycemic
control drugs come to the market based on their 1-2 years risk-benefit profiles, but most of them do
not correct positive energy balance and lose efficacy in the long-term. This denouement is destined by
a positive energy balance of T2D. There is continuous endeavor/investment in new drugs for T2D. In
this review, we compared the effects of commonly used oral hypoglycemic agents on energy balance
and discussed several novel therapeutic targets/approaches for T2D that could potentially correct positive
energy balance: changing the composition of intestinal host-microbiota to alleviate excess caloric
consumption, controlling chylomicron uptake into intestinal lacteals to reduce excessive caloric intake,
and activating pyruvate kinase M2 (PKM2) to ameliorate glucose metabolism and increase energy
expenditure. We further reviewed how nicotine affects body weight and ameliorates positive energy
balance, and ways to encourage people to adopt a more healthy lifestyle by exercising more
and/or decreasing caloric intake. These potential targets/approaches may hopefully correct positive
energy balance, delay disease progression, reverse some pathophysiological changes, and eventually
prevent and/or cure the disease. Drug development strategies applying new insights into T2D process
and therapeutic index to correct positive energy balance need to be seriously considered.
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Affiliation(s)
- Zhenqi Liu
- Division of Endocrinology & Metabolism, Department of Medicine, University of Virginia School of Medicine, 450 Ray C. Hunt Dr. Charlottesville, VA 22903, United States
| | - Baichun Yang
- Division of Cardiovascular and Renal Products, Office of New Drugs I, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States
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Jin J, Jin L, Luo K, Lim SW, Chung BH, Yang CW. Effect of Empagliflozin on Tacrolimus-Induced Pancreas Islet Dysfunction and Renal Injury. Am J Transplant 2017; 17:2601-2616. [PMID: 28422431 DOI: 10.1111/ajt.14316] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/10/2017] [Accepted: 04/01/2017] [Indexed: 01/25/2023]
Abstract
An inhibitor of sodium glucose co-transporter type 2 (SGLT-2) is recommended in type 2 diabetes mellitus (DM) but its use is still undetermined in tacrolimus (TAC)-induced DM. We evaluated the effect of empagliflozin (Em) on TAC-induced pancreatic islet dysfunction and renal injury in an experimental model of TAC-induced DM and in vitro. TAC induced a twofold increase in SGLT-2 expression, while Em decreased SGLT-2 expression and further increased urinary glucose excretion compared to the TAC group. Em reduced hyperglycemia and increased plasma insulin level, pancreatic islet size, and glucose-stimulated insulin secretion compared to the TAC group. In kidney, Em alleviated TAC-induced renal dysfunction and decreased albumin excretion and histological injury compared with the TAC group. Increased oxidative stress and apoptotic cell death by TAC was remarkably decreased with Em in serum and pancreatic and renal tissues. In in vitro study, TAC decreased cell viability and increased reactive oxygen species (ROS) production in both insulin-secreting beta-cell derived (INS-1) and human kidney-2 (HK-2) cell lines. Addition of Em increased cell viability and decreased ROS production in HK-2 but not in INS-1 cell lines. This suggests that Em is effective in controlling TAC-induced hyperglycemia and has direct protective effect on TAC-induced renal injury.
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Affiliation(s)
- J Jin
- Transplantation Research Center, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - L Jin
- Transplantation Research Center, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - K Luo
- Transplantation Research Center, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - S W Lim
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - B H Chung
- Transplantation Research Center, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - C W Yang
- Transplantation Research Center, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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