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Fendrych K, Górska-Ratusznik A, Smajdor J. Electrochemical Assays for the Determination of Antidiabetic Drugs-A Review. MICROMACHINES 2023; 15:10. [PMID: 38276837 PMCID: PMC10820374 DOI: 10.3390/mi15010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
This article presents the current state of knowledge regarding electrochemical methods for determining the active substances within drugs that are used in the treatment of type 1 and type 2 diabetes. Electrochemical methods of analysis, due to their sensitivity and easiness, are a great alternative to other, usually more expensive analytical assays. The determination of active substances mentioned in this review is based on oxidation or reduction processes on the surface of the working electrode. A wide variety of working electrodes, often modified with materials such as nanoparticles or conducting polymers, have been used for the highly sensitive analysis of antidiabetic drugs. The presented assays allow us to determine the compounds of interest in various samples, such as pharmaceutical products or different human bodily fluids.
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Affiliation(s)
- Katarzyna Fendrych
- Faculty of Materials Science and Ceramics, AGH University of Krakow, al. Mickiewicza 30, 30-059 Cracow, Poland
| | - Anna Górska-Ratusznik
- Lukasiewicz Research Network—Krakow Institute of Technology, 73 Zakopianska St., 30-418 Krakow, Poland
| | - Joanna Smajdor
- Faculty of Materials Science and Ceramics, AGH University of Krakow, al. Mickiewicza 30, 30-059 Cracow, Poland
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2
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Mechanisms underlying drug-mediated regulation of membrane protein function. Proc Natl Acad Sci U S A 2021; 118:2113229118. [PMID: 34753824 DOI: 10.1073/pnas.2113229118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
The hydrophobic coupling between membrane proteins and their host lipid bilayer provides a mechanism by which bilayer-modifying drugs may alter protein function. Drug regulation of membrane protein function thus may be mediated by both direct interactions with the protein and drug-induced alterations of bilayer properties, in which the latter will alter the energetics of protein conformational changes. To tease apart these mechanisms, we examine how the prototypical, proton-gated bacterial potassium channel KcsA is regulated by bilayer-modifying drugs using a fluorescence-based approach to quantify changes in both KcsA function and lipid bilayer properties (using gramicidin channels as probes). All tested drugs inhibited KcsA activity, and the changes in the different gating steps varied with bilayer thickness, suggesting a coupling to the bilayer. Examining the correlations between changes in KcsA gating steps and bilayer properties reveals that drug-induced regulation of membrane protein function indeed involves bilayer-mediated mechanisms. Both direct, either specific or nonspecific, binding and bilayer-mediated mechanisms therefore are likely to be important whenever there is overlap between the concentration ranges at which a drug alters membrane protein function and bilayer properties. Because changes in bilayer properties will impact many diverse membrane proteins, they may cause indiscriminate changes in protein function.
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Srinivas MG, Prabhakaran P, Mandal SP, Sivamani Y, Guddur P, Kumar BRP. Development of Novel Glitazones as Antidiabetic Agents: Molecular Design, Synthesis, Evaluation of Glucose Uptake Activity and SAR Studies. LETT DRUG DES DISCOV 2020. [DOI: 10.2174/1570180816666191105124535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background:
Thiazolidinediones and its bioisostere, namely, rhodanines have become
ubiquitous class of heterocyclic compounds in drug design and discovery. In the present study, as
part of molecular design, a series of novel glitazones that are feasible to synthesize in our laboratory
were subjected to docking studies against PPAR-γ receptor for their selection.
Methods and Results:
As part of the synthesis of selected twelve glitazones, the core moiety, pyridine
incorporated rhodanine was synthesized via dithiocarbamate. Later, a series of glitazones were
prepared via Knovenageal condensation. In silico docking studies were performed against PPARγ
protein (2PRG). The titled compounds were investigated for their cytotoxic activity against 3T3-L1
cells to identify the cytotoxicity window of the glitazones. Further, within the cytotoxicity window,
glitazones were screened for glucose uptake activity against L6 cells to assess their possible antidiabetic
activity.
Conclusion:
Based on the glucose uptake results, structure activity relationships are drawn for the
title compounds.
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Affiliation(s)
- Mahendra Gowdru Srinivas
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, Mysuru 570 015, India; JSS Academy of Higher Education & Research, Mysuru 570 015, India
| | - Prabitha Prabhakaran
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, Mysuru 570 015, India; JSS Academy of Higher Education & Research, Mysuru 570 015, India
| | - Subhankar Probhat Mandal
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, Mysuru 570 015, India; JSS Academy of Higher Education & Research, Mysuru 570 015, India
| | - Yuvaraj Sivamani
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, Mysuru 570 015, India; JSS Academy of Higher Education & Research, Mysuru 570 015, India
| | - Pranesh Guddur
- Rajiv Gandhi University of Health Sciences, Bengaluru 560 041, India
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4
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Ammazzalorso A, Bruno I, Florio R, De Lellis L, Laghezza A, Cerchia C, De Filippis B, Fantacuzzi M, Giampietro L, Maccallini C, Tortorella P, Veschi S, Loiodice F, Lavecchia A, Cama A, Amoroso R. Sulfonimide and Amide Derivatives as Novel PPARα Antagonists: Synthesis, Antiproliferative Activity, and Docking Studies. ACS Med Chem Lett 2020; 11:624-632. [PMID: 32435362 PMCID: PMC7236056 DOI: 10.1021/acsmedchemlett.9b00666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/03/2020] [Indexed: 12/30/2022] Open
Abstract
An agonist-antagonist switching strategy was performed to discover novel PPARα antagonists. Phenyldiazenyl derivatives of fibrates were developed, bearing sulfonimide or amide functional groups. A second series of compounds was synthesized, replacing the phenyldiazenyl moiety with amide or urea portions. Final compounds were screened by transactivation assay, showing good PPARα antagonism and selectivity at submicromolar concentrations. When tested in cancer cell models expressing PPARα, selected derivatives induced marked effects on cell viability. Notably, 3c, 3d, and 10e displayed remarkable antiproliferative effects in two paraganglioma cell lines, with CC50 lower than commercial PPARα antagonist GW6471 and a negligible toxicity on normal fibroblast cells. Docking studies were also performed to elucidate the binding mode of these compounds and to help interpretation of SAR data.
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Affiliation(s)
- Alessandra Ammazzalorso
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Isabella Bruno
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Rosalba Florio
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Laura De Lellis
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Antonio Laghezza
- Department of Pharmacy-Drug Science, University of Bari “Aldo Moro”, Via E. Orabona 4, 70126 Bari, Italy
| | - Carmen Cerchia
- Department of Pharmacy, “Drug Discovery” Laboratory, University of Napoli “Federico II”, Via D. Montesano 49, 80131 Napoli, Italy
| | - Barbara De Filippis
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Marialuigia Fantacuzzi
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Letizia Giampietro
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Cristina Maccallini
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Paolo Tortorella
- Department of Pharmacy-Drug Science, University of Bari “Aldo Moro”, Via E. Orabona 4, 70126 Bari, Italy
| | - Serena Veschi
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Fulvio Loiodice
- Department of Pharmacy-Drug Science, University of Bari “Aldo Moro”, Via E. Orabona 4, 70126 Bari, Italy
| | - Antonio Lavecchia
- Department of Pharmacy, “Drug Discovery” Laboratory, University of Napoli “Federico II”, Via D. Montesano 49, 80131 Napoli, Italy
| | - Alessandro Cama
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
- Center for Advanced Studies and Technology CAST, Via Luigi Polacchi 11, 66100 Chieti, Italy
| | - Rosa Amoroso
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
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5
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Ammazzalorso A, Maccallini C, Amoia P, Amoroso R. Multitarget PPARγ agonists as innovative modulators of the metabolic syndrome. Eur J Med Chem 2019; 173:261-273. [DOI: 10.1016/j.ejmech.2019.04.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 01/06/2023]
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Synthesis of novel benzothiazole amides: Evaluation of PPAR activity and anti-proliferative effects in paraganglioma, pancreatic and colorectal cancer cell lines. Bioorg Med Chem Lett 2019; 29:2302-2306. [PMID: 31272790 DOI: 10.1016/j.bmcl.2019.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/26/2022]
Abstract
The reduced activation of PPARs has a positive impact on cancer cell growth and viability in multiple preclinical tumor models, suggesting a new therapeutic potential for PPAR antagonists. In the present study, the benzothiazole amides 2a-g were synthesized and their activities on PPARs were investigated. Transactivation assay showed a moderate activity of the novel compounds as PPARα antagonists. Notably, in cellular assays they exhibited cytotoxicity in pancreatic, colorectal and paraganglioma cancer cells overexpressing PPARα. In particular, compound 2b showed the most remarkable inhibition of viability (greater than 90%) in two paraganglioma cell lines, with IC50 values in the low micromolar range. In addition, 2b markedly impaired colony formation capacity in the same cells. Taken together, these results show a relevant anti-proliferative potential of compound 2b, which appears particularly effective in paraganglioma, a rare tumor poorly responsive to chemotherapy.
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7
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De Lellis L, Cimini A, Veschi S, Benedetti E, Amoroso R, Cama A, Ammazzalorso A. The Anticancer Potential of Peroxisome Proliferator-Activated Receptor Antagonists. ChemMedChem 2018; 13:209-219. [PMID: 29276815 DOI: 10.1002/cmdc.201700703] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/17/2017] [Indexed: 12/13/2022]
Abstract
The effects on cancer-cell proliferation and differentiation mediated by peroxisome proliferator-activated receptors (PPARs) have been widely studied, and pleiotropic outcomes in different cancer models and under different experimental conditions have been obtained. Interestingly, few studies report and little preclinical evidence supports the potential antitumor activity of PPAR antagonists. This review focuses on recent findings on the antitumor in vitro and in vivo effects observed for compounds able to inhibit the three PPAR subtypes in different tumor models, providing a rationale for the use of PPAR antagonists in the treatment of tumors expressing the corresponding receptors.
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Affiliation(s)
- Laura De Lellis
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy.,Unit of General Pathology, CeSI-MeT, University of Chieti, Chieti, Italy
| | - Annamaria Cimini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,National Institute for Nuclear Physics (INFN), Gran Sasso National Laboratory (LNGS), Assergi (Aq), Italy.,Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, 1900 N. 12th Street, Philadelphia, PA, 19122, USA
| | - Serena Veschi
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy.,Unit of General Pathology, CeSI-MeT, University of Chieti, Chieti, Italy
| | - Elisabetta Benedetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Amoroso
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Alessandro Cama
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy.,Unit of General Pathology, CeSI-MeT, University of Chieti, Chieti, Italy
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8
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Naidoo P, Wing J, Rambiritch V. Effect of Sitagliptin and Metformin on Prediabetes Progression to Type 2 Diabetes - A Randomized, Double-Blind, Double-Arm, Multicenter Clinical Trial: Protocol for the Sitagliptin and Metformin in PreDiabetes (SiMePreD) Study. JMIR Res Protoc 2016; 5:e145. [PMID: 27491324 PMCID: PMC4990713 DOI: 10.2196/resprot.5073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/23/2016] [Accepted: 01/24/2016] [Indexed: 12/28/2022] Open
Abstract
Background The high prevalence and incidence of type 2 diabetes mellitus (DM), and its associated morbidity and mortality, has prompted growing international interest and effort in the primary prevention of this disease. Primary prevention is possible since type 2 DM is preceded by prediabetes, offering a window opportunity to treat patients, and prevent the emergence of advanced disease. Sitagliptin is an oral dipeptidyl peptidase-IV inhibitor that preserves existing beta cell function and increases beta cell mass. These two effects have been demonstrated both in vitro and in animal studies, and current clinical data show that sitagliptin is safe. Metformin, a biguanide, reduces insulin resistance and inhibits hepatic gluconeogenesis, and has an excellent safety profile. The combination of metformin and sitagliptin, targeting both characteristics of prediabetes (insulin resistance and progressive beta cell degeneration), may potentially slow or halt the progression from prediabetes to type 2 DM. This paper describes the rationale and design of the Sitagliptin and Metformin in PreDiabetes (SiMePreD) study. Objective The aim of this study is to determine the effect of sitagliptin and metformin on progression from prediabetes to type 2 DM. The objectives of the study are to determine the effects of metformin and placebo on glycemic endpoints, the effects of sitagliptin and metformin on glycemic endpoints, the effects of metformin and placebo on incidence of cardiovascular disease and death, and the effects of sitagliptin and metformin on incidence of cardiovascular disease and death. Methods This is a randomized, double-blind, multicenter clinical study that will determine if the combination of metformin and sitagliptin is effective in preventing the progression from prediabetes to type 2 DM. The study will contain two arms (metformin/sitagliptin and metformin/placebo). Primary endpoints include the number of subjects progressing from prediabetes to type 2 DM, the number of cardiovascular events, and the number of deaths. The planned duration of the study is five years, and 410 subjects will be included in each group. Data analyses will include clinically relevant measures (eg, numbers needed to treat and numbers needed to harm) and will be performed according to the intention-to-treat principle. Results This study is currently in the process of acquiring research funding. Conclusions The SiMePreD study is the first study to investigate the utility of sitagliptin in combination with metformin for the primary prevention of type 2 DM.
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Affiliation(s)
- Poobalan Naidoo
- University of Witwatersrand, Faculty of Health Sciences, Department of Endocrinology, Gauteng, South Africa.
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Peuler JD, Phelps LE. Sildenafil does not enhance but rather attenuates vasorelaxant effects of antidiabetic agents. J Smooth Muscle Res 2015; 51:22-36. [PMID: 26004378 PMCID: PMC5137313 DOI: 10.1540/jsmr.51.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Type 2 diabetic men commonly experience erectile dysfunction for which
phosphodiesterase-5 (PDE5) inhibitors like sildenafil (Viagra) are often recommended. By
preventing degradation of cyclic guanosine monophosphate (cGMP) in vascular smooth muscle,
these inhibitors also enhance arterial vasorelaxant effects of nitric oxide donors (which
stimulate cGMP synthesis). In the present work, we confirmed this enhancing effect after
co-administration of sildenafil with nitroprusside to freshly-isolated rat tail arterial
tissues. However, in the same tissues we also observed that sildenafil does not enhance
but rather attenuates vasorelaxant effects of three commonly-used antidiabetic drugs, i.e.
the biguanide metformin and the thiazolidinediones pioglitazone and rosiglitazone. Indeed,
sildenafil completely blocked vasorelaxant effects of low concentrations of these drugs.
In addition, we found that this same novel anti-vasorelaxant interaction of sildenafil
with these agents was abolished by either 1) omitting extracellular glucose or 2)
inhibiting specific smooth muscle glycolytic pathways; pathways known to preferentially
utilize extracellular glucose to fuel certain adenosine triphosphate (ATP)-dependent ion
transporters: e.g. ATP-sensitive K channels, sarcoplasmic reticulum Ca-ATPase, plasma
membrane Ca-ATPase and Na/K-ATPase. Accordingly, we suspect that altered activity of one
or more of these ion transporters mediates the observed attenuating (anti-vasorelaxant)
interaction of sildenafil with the antidiabetic drugs. The present results are relevant
because hypertension is so common and difficult to control in Type 2 diabetes. The present
data suggest that sildenafil might interfere with the known antihypertensive potential of
metformin and the thiazolidinediones. However, they do not suggest that it will interact
with them to cause life-threatening episodes of severe hypotension, as can occur when it
is co-administered with nitrates.
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Affiliation(s)
- Jacob D Peuler
- Department of Pharmacology, Midwestern University, Downers Grove, IL, USA
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10
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Chen YH, Du L, Geng XY, Peng YL, Shen JN, Zhang YG, Liu GJ, Sun X. Effects of sulfonylureas on lipids in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. J Evid Based Med 2015; 8:134-48. [PMID: 26066789 DOI: 10.1111/jebm.12157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 05/27/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Previous studies suggested that dyslipidemia was potentially associated with anti-diabetic medications of sulfonylureas (SUs). The results were, however, inconsistent. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to assess the effects of SUs on the level of lipids in patients with type 2 diabetes mellitus (T2DM). METHODS We searched PubMed, EMBASE, and CENTRAL databases for RCTs that addressed the effects of second- and/or third-generation SUs used in T2DM patients on lipids profiles with study duration of at least 12 weeks. Two reviewers independently screened literature, collected data, and assessed methodological quality of included studies. The meta-analysis was performed by using the RevMan5.1 software. RESULTS A total of 59 RCTs were included, of which 52 were included for final meta-analysis. The results suggested that SUs statistically increased the levels of FFA (SMD = 0.24, 95%CI 0.06 to 0.42) and TG (MD = 0.06, 95%CI 0.02 to 0.10), but decreased HDL-C (MD = -0.07, 95%CI -0.11 to -0.04) and LDL-C (MD = -0.11, 95%CI -0.17 to -0.04); but the SUs had no effect on TC (MD = 0.01, 95%CI -0.05 to 0.08), ApoA1 (MD = 0.01, 95%CI -0.03 to 0.04), and Apo B (MD = -0.01, 95%CI -0.05 to 0.03). When compared to metformin, SUs could increase TC and LDL-C; compared to glinides, SUs increased TC and lowered HDL-C; compared to thiazolidinediones, SUs reduced TC, LDL-C, HDL-C, and increase TG. CONCLUSIONS SUs have a small effect on lipids, although they may statistically increase the level of FFA and TG, and decrease LDL-C and HDL-C.
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Affiliation(s)
- Yue-hong Chen
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xing-yuan Geng
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan-ling Peng
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-ni Shen
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-gang Zhang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guan-jian Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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11
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McCann JC, Shigenaga MK, Mietus-Snyder ML, Lal A, Suh JH, Krauss RM, Gildengorin GL, Goldrich AM, Block DS, Shenvi SV, McHugh TH, Olson DA, Ames BN. A multicomponent nutrient bar promotes weight loss and improves dyslipidemia and insulin resistance in the overweight/obese: chronic inflammation blunts these improvements. FASEB J 2015; 29:3287-301. [PMID: 25900806 DOI: 10.1096/fj.15-271833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022]
Abstract
This study determined if twice-daily consumption of a nutrient-dense bar intended to fill gaps in Western diets, without other dietary/lifestyle requirements, favorably shifted metabolic/anthropometric indicators of dysregulation in a healthy direction. Three 8-wk clinical trials in 43 healthy lean and overweight/obese (OW/OB) adults, who served as their own controls, were pooled for analysis. In less inflamed OW/OB [high-sensitivity C-reactive protein (hsCRP) <1.5], statistically significant decreases occurred in weight (-1.1 ± 0.5 kg), waist circumference (-3.1 ± 1.4 cm), diastolic blood pressure (-4.1 ± 1.6 mmHg), heart rate [HR; -4.0 ± 1.7 beats per minute (bpm)], triglycerides (-72 ± 38.2 mg/dl), insulin resistance (homeostatic model of insulin resistance) (-0.72 ± 0.3), and insulin (-2.8 ± 1.3 mU/L); an increase in HDL-2b (+303 ± 116 nM) and realignment of LDL lipid subfractions toward a less atherogenic profile [decreased small LDL IIIb (-44 ± 23.5 nM), LDL IIIa (-99 ± 43.7 nM), and increased large LDL I (+66 ± 28.0 nM)]. In the more inflamed OW/OB (hsCRP >1.5), inflammation was reduced at 2 wk (-0.66 mg/L), and HR at 8 wk (-3.4 ± 1.3 bpm). The large HDL subfraction (10.5-14.5 nm) increased at 8 wk (+346 ± 126 nM). Metabolic improvements were also observed in lean participants. Thus, favorable changes in measures of cardiovascular health, insulin resistance, inflammation, and obesity were initiated within 8 wk in the OW/OB by replacing deficiencies in Western diets without requiring other dietary or lifestyle modifications; chronic inflammation blunted most improvements.
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Affiliation(s)
- Joyce C McCann
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Mark K Shigenaga
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Michele L Mietus-Snyder
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Ashutosh Lal
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Jung H Suh
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Ronald M Krauss
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Ginny L Gildengorin
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Alisa M Goldrich
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Devan S Block
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Swapna V Shenvi
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Tara H McHugh
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Don A Olson
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Bruce N Ames
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
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Yang HM, Kim BK, Kim JY, Kwon YW, Jin S, Lee JE, Cho HJ, Lee HY, Kang HJ, Oh BH, Park YB, Kim HS. PPARγ modulates vascular smooth muscle cell phenotype via a protein kinase G-dependent pathway and reduces neointimal hyperplasia after vascular injury. Exp Mol Med 2013; 45:e65. [PMID: 24287871 PMCID: PMC3849568 DOI: 10.1038/emm.2013.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 08/01/2013] [Indexed: 01/28/2023] Open
Abstract
Vascular smooth muscle cells (VSMCs) undergo phenotypic changes in response to vascular injury such as angioplasty. Protein kinase G (PKG) has an important role in the process of VSMC phenotype switching. In this study, we examined whether rosiglitazone, a peroxisome proliferator-activated receptor (PPAR)-γ agonist, could modulate VSMC phenotype through the PKG pathway to reduce neointimal hyperplasia after angioplasty. In vitro experiments showed that rosiglitazone inhibited the phenotype change of VSMCs from a contractile to a synthetic form. The platelet-derived growth factor (PDGF)-induced reduction of PKG level was reversed by rosiglitazone treatment, resulting in increased PKG activity. This increased activity of PKG resulted in phosphorylation of vasodilator-stimulated phosphoprotein at serine 239, leading to inhibited proliferation of VSMCs. Interestingly, rosiglitazone did not change the level of nitric oxide (NO) or cyclic guanosine monophosphate (cGMP), which are upstream of PKG, suggesting that rosiglitazone influences PKG itself. Chromatin immunoprecipitation assays for the PKG promoter showed that the activation of PKG by rosiglitazone was mediated by the increased binding of Sp1 on the promoter region of PKG. In vivo experiments showed that rosiglitazone significantly inhibited neointimal formation after balloon injury. Immunohistochemistry staining for calponin and thrombospondin showed that this effect of rosiglitazone was mediated by modulating VSMC phenotype. Our findings demonstrate that rosiglitazone is a potent modulator of VSMC phenotype, which is regulated by PKG. This activation of PKG by rosiglitazone results in reduced neointimal hyperplasia after angioplasty. These results provide important mechanistic insight into the cardiovascular-protective effect of PPARγ.
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Affiliation(s)
- Han-Mo Yang
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Baek-Kyung Kim
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Ju-Young Kim
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Yoo-Wook Kwon
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Sooryeonhwa Jin
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Joo-Eun Lee
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jai Cho
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hae-Young Lee
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Byung-Hee Oh
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Young-Bae Park
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- National Research Laboratory for Stem Cell Niche, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
- Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea
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Ammazzalorso A, De Filippis B, Giampietro L, Amoroso R. Blocking the peroxisome proliferator-activated receptor (PPAR): an overview. ChemMedChem 2013; 8:1609-16. [PMID: 23939910 DOI: 10.1002/cmdc.201300250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Indexed: 12/19/2022]
Abstract
Peroxisome proliferator-activated receptors (PPARs) have been studied extensively over the last few decades and have been assessed as molecular targets for the development of drugs against metabolic disorders. A rapid increase in understanding of the physiology and pharmacology of these receptors has occurred, together with the identification of novel chemical structures that are able to activate the various PPAR subtypes. More recent evidence suggests that moderate activation of these receptors could be favorable in pathological situations due to a decrease in the side effects brought about by PPAR agonists. PPAR partial agonists and antagonists are interesting tools that are currently used to better elucidate the biological processes modulated by this family of nuclear receptors. Herein we present an overview of the various molecular structures that are able to block each of the PPAR subtypes, with a focus on promising therapeutic applications.
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Affiliation(s)
- Alessandra Ammazzalorso
- Dipartimento di Farmacia, Università "G. d'Annunzio" via dei Vestini 31, 66100 Chieti (Italy)
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Diabetes Mellitus: New Challenges and Innovative Therapies. NEW STRATEGIES TO ADVANCE PRE/DIABETES CARE: INTEGRATIVE APPROACH BY PPPM 2013; 3. [PMCID: PMC7120768 DOI: 10.1007/978-94-007-5971-8_3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is a common chronic disease affecting an estimated 285 million adults worldwide. The rising incidence of diabetes, metabolic syndrome, and subsequent vascular diseases is a major public health problem in industrialized countries. This chapter summarizes current pharmacological approaches to treat diabetes mellitus and focuses on novel therapies for diabetes mellitus that are under development. There is great potential for developing a new generation of therapeutics that offer better control of diabetes, its co-morbidities and its complications. Preclinical results are discussed for new approaches including AMPK activation, the FGF21 target, cell therapy approaches, adiponectin mimetics and novel insulin formulations. Gene-based therapies are among the most promising emerging alternatives to conventional treatments. Therapies based on gene silencing using vector systems to deliver interference RNA to cells (i.e. against VEGF in diabetic retinopathy) are also a promising therapeutic option for the treatment of several diabetic complications. In conclusion, treatment of diabetes faces now a new era that is characterized by a variety of innovative therapeutic approaches that will improve quality of life in the near future.
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Lee CY, Huang KH, Lin CC, Tsai TH, Shih HC. A neutral risk on the development of new-onset diabetes mellitus (NODM) in Taiwanese patients with dyslipidaemia treated with fibrates. ScientificWorldJournal 2012; 2012:392734. [PMID: 22919315 PMCID: PMC3417190 DOI: 10.1100/2012/392734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/02/2012] [Indexed: 11/17/2022] Open
Abstract
There are no data on the incidence of new-onset diabetes mellitus (NODM ) in nondiabetic dyslipidaemia patients treated with fibrates. The aim of our study was to clarify these issues, to investigate the relationship between NODM and fibrate and whether the fibrates lead to increased risk for developing NODM. A retrospective cohort study was conducted by analyzing the Longitudinal Health Insurance Database (LHID 2005) of the National Health Insurance Research Database (NHIRD) from 2005 to 2010 to investigate all fibrate prescriptions for patients with dyslipidaemia. We estimated the hazard ratios (HRs) of NODM associated with fibrate use. We identified 145 NODM patients among 3,815 dyslipidaemic patients in the database for the study period. The risk estimates for NODM for users of fenofibrate (HR 1.30; 95% CI 0.82, 2.05) and gemfibrozil (HR 0.771; 95% CI 0.49, 1.22) were not associated with an increased risk of developing NODM (P > 0.05). Our results revealed that patients with dyslipidaemia who took fenofibrate and gemfibrozil had a neutral risk of NODM. The reasons may be associated with the fibrates have the properties that activate PPARα and in some cases also activated PPARγ, leading to showing a neutral risk of NODM.
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Affiliation(s)
- Chien-Ying Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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Lazich I, Sarafidis P, de Guzman E, Patel A, Oliva R, Bakris G. Effects of combining simvastatin with rosiglitazone on inflammation, oxidant stress and ambulatory blood pressure in patients with the metabolic syndrome: the SIROCO study. Diabetes Obes Metab 2012; 14:181-6. [PMID: 21955403 DOI: 10.1111/j.1463-1326.2011.01510.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Individually, statins and thiazolidinediones (TZDs) show positive effects on atherosclerosis progression in cellular and animal models as well as patients with diabetes; however, their combined effects have not been studied. This study examines the effects of simvastatin combined with rosiglitazone on vascular inflammation, oxidant stress, ambulatory blood pressure (BP) and other atherosclerotic factors in patients with the metabolic syndrome. METHODS This is a randomized, double blind, placebo-controlled study in 53 subjects with the metabolic syndrome. Participants were randomized to simvastatin 40 mg/day plus placebo vs. simvastatin 40 mg/day plus rosiglitazone 4 mg/day for 6 months. The primary endpoint was the between-group difference in high-sensitivity C-reactive protein (hs-CRP) and secondary variables including urinary isoprostanes, serum malondialdehyde (MDA), ambulatory BP, adiponectin, and lipid and glycaemic profiles. RESULTS At study end, the group randomized to the simvastatin/rosiglitazone combination had a greater reduction in hs-CRP of 1.33 mg/dl, (p = 0.029) and showed a trend for a greater reduction in urinary isoprostane (-39%), (p = 0.056) compared to simvastatin/placebo group. Changes in MDA levels did not differed between groups (p = 0.81). 24-h systolic blood pressure (SBP) also showed a 4.5 mmHg reduction at 6 months (p = 0.06). Adiponectin levels increased by 3.91 µg/ml in the combination group over placebo, (p = 0.03) and blood glucose decreased in combination group vs. placebo. CONCLUSION Our data show that patients with the metabolic syndrome given a statin/TZD combination manifest greater reductions in markers of vascular inflammation and oxidant stress, 24-h ambulatory BP and increases in adiponectin as well as improved glycaemic indices.
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Affiliation(s)
- I Lazich
- Hypertensive Diseases Unit, Department of Medicine, University of Chicago-Pritzker School of Medicine, Chicago, IL 60637, USA
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Rusinova R, Herold KF, Sanford RL, Greathouse DV, Hemmings HC, Andersen OS. Thiazolidinedione insulin sensitizers alter lipid bilayer properties and voltage-dependent sodium channel function: implications for drug discovery. ACTA ACUST UNITED AC 2012; 138:249-70. [PMID: 21788612 PMCID: PMC3149818 DOI: 10.1085/jgp.201010529] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The thiazolidinediones (TZDs) are used in the treatment of diabetes mellitus type 2. Their canonical effects are mediated by activation of the peroxisome proliferator–activated receptor γ (PPARγ) transcription factor. In addition to effects mediated by gene activation, the TZDs cause acute, transcription-independent changes in various membrane transport processes, including glucose transport, and they alter the function of a diverse group of membrane proteins, including ion channels. The basis for these off-target effects is unknown, but the TZDs are hydrophobic/amphiphilic and adsorb to the bilayer–water interface, which will alter bilayer properties, meaning that the TZDs may alter membrane protein function by bilayer-mediated mechanisms. We therefore explored whether the TZDs alter lipid bilayer properties sufficiently to be sensed by bilayer-spanning proteins, using gramicidin A (gA) channels as probes. The TZDs altered bilayer elastic properties with potencies that did not correlate with their affinity for PPARγ. At concentrations where they altered gA channel function, they also altered the function of voltage-dependent sodium channels, producing a prepulse-dependent current inhibition and hyperpolarizing shift in the steady-state inactivation curve. The shifts in the inactivation curve produced by the TZDs and other amphiphiles can be superimposed by plotting them as a function of the changes in gA channel lifetimes. The TZDs’ partition coefficients into lipid bilayers were measured using isothermal titration calorimetry. The most potent bilayer modifier, troglitazone, alters bilayer properties at clinically relevant free concentrations; the least potent bilayer modifiers, pioglitazone and rosiglitazone, do not. Unlike other TZDs tested, ciglitazone behaves like a hydrophobic anion and alters the gA monomer–dimer equilibrium by more than one mechanism. Our results provide a possible mechanism for some off-target effects of an important group of drugs, and underscore the importance of exploring bilayer effects of candidate drugs early in drug development.
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Affiliation(s)
- Radda Rusinova
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA.
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18
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Bahia HK, Holder JC, Gant TW. Tcap: A novel biomarker of troglitazone induced cardiotoxicity. Toxicology 2011. [DOI: 10.1016/j.tox.2011.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
There is a rising worldwide prevalence of diabetes, especially type 2 diabetes mellitus (T2DM), which is one of the most challenging health problems in the 21st century. The associated complications of diabetes, such as cardiovascular disease, peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure, and blindness result in increasing disability, reduced life expectancy, and enormous health costs. T2DM is a polygenic disease characterized by multiple defects in insulin action in tissues and defects in pancreatic insulin secretion, which eventually leads to loss of pancreatic insulin-secreting cells. The treatment goals for T2DM patients are effective control of blood glucose, blood pressure, and lipids (if elevated) and, ultimately, to avert the serious complications associated with sustained tissue exposure to excessively high glucose concentrations. Prevention and control of diabetes with diet, weight control, and physical activity has been difficult. Treatment of T2DM has centered on increasing insulin levels, either by direct insulin administration or oral agents that promote insulin secretion, improving sensitivity to insulin in tissues, or reducing the rate of carbohydrate absorption from the gastrointestinal tract. This review presents comprehensive and up-to-date information on the mechanism(s) of action, efficacy, pharmacokinetics, pleiotropic effects, drug interactions, and adverse effects of the newer antidiabetic drugs, including (1) peroxisome proliferator-activated-receptor-γ agonists (thiazolidinediones, pioglitazone, and rosiglitazone); (2) the incretin, glucagon-like peptide-) receptor agonists (incretin-mimetics, exenatide. and liraglutide), (3) inhibitors of dipeptidyl-peptidase-4 (incretin enhancers, sitagliptin, and vildagliptin), (4) short-acting, nonsulfonylurea secretagogue, meglitinides (repaglinide and nateglinide), (5) amylin anlog-pramlintide, (6) α-glucosidase inhibitors (miglitol and voglibose), and (7) colesevelam (a bile acid sequestrant). In addition, information is presented on drug candidates in clinical trials, experimental compounds, and some plants used in the traditional treatment of diabetes based on experimental evidence. In the opinion of this reviewer, therapy based on orally active incretins and incretin mimetics with long duration of action that will be efficacious, preserve the β-cell number/function, and block the progression of diabetes will be highly desirable. However, major changes in lifestyle factors such as diet and, especially, exercise will also be needed if the growing burden of diabetes is to be contained.
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20
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Modulation of PPAR subtype selectivity. Part 2: Transforming PPARα/γ dual agonist into α selective PPAR agonist through bioisosteric modification. Bioorg Med Chem Lett 2011; 21:628-32. [DOI: 10.1016/j.bmcl.2010.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/04/2010] [Accepted: 12/07/2010] [Indexed: 12/17/2022]
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Phelps LE, Peuler JD. Evidence of direct smooth muscle relaxant effects of the fibrate gemfibrozil. J Smooth Muscle Res 2010; 46:125-42. [PMID: 20647690 DOI: 10.1540/jsmr.46.125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fibrates are commonly employed to treat abnormal lipid metabolism via their unique ability to stimulate peroxisome proliferator-activated receptor alpha (PPARalpha). Interestingly, they also decrease systemic arterial pressure, despite recent evidence that PPAR alpha may contribute to expression of renin and related hypertension. Yet, mechanisms responsible for their potential antihypertensive activity remain unresolved. Rapid decreases in arterial pressure following bolus intravenous injections of bezafibrate strongly suggest they may relax arterial smooth muscle directly. But since bezafibrate is highly susceptible to photodegradation in aqueous media, it has never been critically tested for this possibility in vitro with isolated arterial smooth muscle preparations. Accordingly, we tested gemfibrozil which is resistant to photodegradation. We examined it over a therapeutically-relevant range (50-400 microM) for both acute and delayed relaxant effects on contractions of the isolated rat tail artery; contractions induced by either depolarizing its smooth muscle cell membranes with high potassium or stimulating its membrane-bound receptors with norepinephrine and arginine-vasopressin. We also examined these same gemfibrozil levels for effects on spontaneously-occurring phasic rhythmic contractile activity, typically not seen in arteries under in vitro conditions but commonly exhibited by smooth muscle of uterus, duodenum and bladder. We found that gemfibrozil significantly relaxed all induced forms of contraction in the rat tail artery, acutely at the higher test levels and after a delay of a few hours at the lower test levels. The highest test level of gemfibrozil (400 microM) also completely abolished spontaneously-occurring contractile activity of the isolated uterus and duodenum and markedly suppressed it in the bladder. This is the first evidence that a fibrate drug can directly relax smooth muscle contractions, either induced by various contractile agents or spontaneously-occurring. These findings are particularly relevant to both the recently renewed concern over the impact of fibrates on hypertension and a new understanding of their gastrointestinal side effects.
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Affiliation(s)
- Laura E Phelps
- Department of Pharmacology, Midwestern University, IL 60515, USA
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Abstract
Diabetes mellitus is an established risk factor for cardiovascular disease and the leading cause of end-stage renal disease in the Western World. Thiazolidinediones (TZDs) represent a class of antidiabetic agents that exert their glucose-lowering effects by reducing insulin resistance, through stimulation of a type of nuclear receptor, called peroxisome proliferator-activated receptor-γ. Apart from improving glycemic control, TZDs were shown to exert beneficial effects on several components of the metabolic syndrome and cardiovascular risk markers. Furthermore, background and human studies have shown that TZDs reduce urinary albumin and protein excretion and interfere with most of the pathogenentic pathways involved in the development and progression of diabetic nephropathy. On the other hand, currently used TZDs have side effects, most important of which is fluid retention leading to wait gain and heart failure deterioration. With regards to cardiovascular outcomes, the anticipated benefit of TZDs was demonstrated for pioglitazone, whereas a series of previous meta-analyses linking rosiglitazone treatment with increased risk of myocardial infarction and cardiovascular death raised uncertainty around the cardiovascular safety of rosiglitazone. This article will discuss the effects of TZDs on established and emerging cardiovascular risk factors, the data on possible beneficial renal effects of these compounds, and the existing evidence from large-scale clinical trials and meta-analyses on their effects on cardiovascular outcomes, aiming to provide an overview of the cardio- and renoprotective properties of these drugs.
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Affiliation(s)
- Pantelis A Sarafidis
- Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
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Sena CM, Bento CF, Pereira P, Seiça R. Diabetes mellitus: new challenges and innovative therapies. EPMA J 2010; 1:138-63. [PMID: 23199048 PMCID: PMC3405309 DOI: 10.1007/s13167-010-0010-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/04/2010] [Indexed: 12/25/2022]
Abstract
Diabetes mellitus is a widespread disease prevalence and incidence of which increases worldwide. The introduction of insulin therapy represented a major breakthrough in type 1 diabetes; however, frequent hyper- and hypoglycemia seriously affects the quality of life of these patients. New therapeutic approaches, such as whole pancreas transplant or pancreatic islet transplant, stem cell, gene therapy and islets encapsulation are discussed in this review. Regarding type 2 diabetes, therapy has been based on drugs that stimulate insulin secretion (sulphonylureas and rapid-acting secretagogues), reduce hepatic glucose production (biguanides), delay digestion and absorption of intestinal carbohydrate (alpha-glucosidase inhibitors) or improve insulin action (thiazolidinediones). This review is also focused on the newer therapeutically approaches such as incretin-based therapies, bariatric surgery, stem cells and other emerging therapies that promise to further extend the options available. Gene-based therapies are among the most promising emerging alternatives to conventional treatments. Some of these therapies rely on genetic modification of non-differentiated cells to express pancreatic endocrine developmental factors, promoting differentiation of non-endocrine cells into β-cells, enabling synthesis and secretion of insulin in a glucose-regulated manner. Alternative therapies based on gene silencing using vector systems to deliver interference RNA to cells (i.e. against VEGF in diabetic retinopathy) are also a promising therapeutic option for the treatment of several diabetic complications. In conclusion, treatment of diabetes faces now a new era that is characterized by a variety of innovative therapeutic approaches that will improve quality-life and allow personalized therapy-planning in the near future.
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Affiliation(s)
- Cristina M. Sena
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Subunit 1, polo 3, Azinhaga de Santa Comba, Celas, 3000-354 Coimbra, Portugal
- IBILI, University of Coimbra, Coimbra, Portugal
| | - Carla F. Bento
- IBILI, University of Coimbra, Coimbra, Portugal
- Centre of Ophthalmology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paulo Pereira
- IBILI, University of Coimbra, Coimbra, Portugal
- Centre of Ophthalmology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raquel Seiça
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Subunit 1, polo 3, Azinhaga de Santa Comba, Celas, 3000-354 Coimbra, Portugal
- IBILI, University of Coimbra, Coimbra, Portugal
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Sarafidis PA, Stafylas PC, Georgianos PI, Saratzis AN, Lasaridis AN. Effect of thiazolidinediones on albuminuria and proteinuria in diabetes: a meta-analysis. Am J Kidney Dis 2010; 55:835-47. [PMID: 20110146 DOI: 10.1053/j.ajkd.2009.11.013] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 11/12/2009] [Indexed: 01/11/2023]
Abstract
BACKGROUND Because of the major clinical and economic burden of diabetic nephropathy, new therapeutic tools to delay its progression are needed. Recent studies suggest that thiazolidinediones have renal benefits. We aimed to evaluate the effect of thiazolidinediones on urinary albumin and protein excretion in patients with diabetes mellitus. STUDY DESIGN Systematic review and meta-analysis by searching MEDLINE/PubMed, EMBASE, and Cochrane CENTRAL databases (1991 to September 2009). SETTING & POPULATION Patients with diabetes mellitus. SELECTION CRITERIA FOR STUDIES Randomized controlled trials. INTERVENTION Thiazolidinediones (rosiglitazone and pioglitazone) compared with placebo or other antidiabetic agents. OUTCOMES Weighted (WMDs) and standardized mean differences (SMDs) for changes in urine albumin or protein excretion between the thiazolidinedione and control groups. RESULTS Of 171 originally identified articles, 15 studies (5 with rosiglitazone and 10 with pioglitazone) involving 2,860 patients were included in the analysis. In participants with baseline normo- or microalbuminuria, the WMD of proportional changes between the thiazolidinedione and control groups in urinary albumin excretion measured using time-specified collections was -64.8% (95% CI, -75.6 to -53.9) and the WMD of changes in albumin-creatinine ratio was -24.8% (95% CI, -39.6 to -10.0). Overall, in participants with normo- and microalbuminuria, thiazolidinedione treatment was associated with a significant decrease in urinary albumin excretion (SMD, -0.6 units of standard deviation [SD]; 95% CI, -0.8 to -0.4). Similarly, thiazolidinediones were associated with a significant decrease in urinary protein excretion in patients with proteinuria (SMD, -1.1 units of SD; 95% CI, -1.8 to -0.4). LIMITATIONS Significant heterogeneity across included studies in several subgroup analyses; patient-level data not available. CONCLUSIONS Treatment with thiazolidinediones significantly decreases urinary albumin and protein excretion in patients with diabetes. This finding calls for clinical trials with hard renal outcomes to elucidate the potential benefits of thiazolidinediones on diabetic nephropathy.
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Affiliation(s)
- Pantelis A Sarafidis
- Section of Nephrology and Hypertension, First Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Reynolds JK. Fixed-dose combination of sitagliptin and metformin for the treatment of type 2 diabetes. Diabetes Metab Syndr Obes 2009; 2:127-34. [PMID: 21437126 PMCID: PMC3048013 DOI: 10.2147/dmsott.s4637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Janumet(TM,) a fixed dose combination of sitagliptin/metformin HCL manufactured by Merck Pharmaceuticals, has received US Food and Drug Administration approval for treatment of patients with type 2 diabetes, that are inadequately controlled, either by sitagliptin or metformin alone or together in free-dose combination form. Sitagliptin, an inhibitor of the enzyme DDP-4, assists patients with type 2 diabetes mellitus to achieve glycemic control. It has been shown to be safe and effective at 100 mg daily doses. The effect of giving sitagliptin in combination with metformin is thought to have a complimentary and possibly additive effect on glycemic control.
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Affiliation(s)
- Jonathan K Reynolds
- Correspondence: Jonathan K Reynolds, Washington State University, College of Pharmacy, PO Box 646710, Pullman, WA 99164-6710, USA, Email
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Cardiovascular consequences of drugs used for the treatment of diabetes: potential promise of incretin—based therapies. ACTA ACUST UNITED AC 2009; 3:245-59. [DOI: 10.1016/j.jash.2009.04.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/23/2009] [Accepted: 04/06/2009] [Indexed: 11/20/2022]
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Stargardt T, Yin DD, Alexander CM. Treatment choice and effectiveness of adding sulphonylurea or glitazones to metformin for the treatment of type 2 diabetes mellitus. Diabetes Obes Metab 2009; 11:491-7. [PMID: 19236437 DOI: 10.1111/j.1463-1326.2008.00991.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study investigates the treatment choice between, and the effectiveness of, adding sulphonylurea or glitazone to ongoing metformin therapy for patients with type 2 diabetes mellitus in the clinical practice setting. METHODS A multicentre observational study using data from clinical records was conducted in Finland, France, Germany, Norway, Poland, Spain and the UK. Data were collected for patients who added sulphonylurea or glitazone to metformin. Effectiveness was defined as a change in haemoglobin A1c (HbA(1c)) from baseline to approximately 1 year after the initiation of additional therapy. To allow for comparisons between the two medication regimens, propensity score matching was employed. Treatment choice was analysed using a probit regression model. We hypothesized that treatment choice was associated with factors reflecting patient's characteristics, patient's experience with diabetes, patient's health or to physician's characteristics at baseline. RESULTS Compared with baseline, adding sulphonylurea to metformin reduced HbA(1c) by 0.8% (p < 0.0001), while adding glitazone to metformin reduced HbA(1c) by 0.9% (p < 0.0001). Percentage at HbA(1c) goal (6.5%) increased from 6.9 to 23.8% for the sulphonylurea group and 8.3 to 33.3% for the glitazone group. Both groups had similar changes in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides. In the probit regression model, age, HbA(1c), weight, treatment for weight reduction, history of macrovascular complications and type of physician were significant factors associated with treatment choice. CONCLUSIONS This study is consistent with the results of long-term randomized clinical trials in a clinical practice setting. Both regimens were able to reduce HbA(1c) by about 1%.
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Affiliation(s)
- T Stargardt
- Department of Health Care Management, WHO Collaborating Centre for Health Systems Research and Management, University of Technology, Berlin, Germany.
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Lin CH, Peng YH, Coumar MS, Chittimalla SK, Liao CC, Lyn PC, Huang CC, Lien TW, Lin WH, Hsu JTA, Cheng JH, Chen X, Wu JS, Chao YS, Lee HJ, Juo CG, Wu SY, Hsieh HP. Design and Structural Analysis of Novel Pharmacophores for Potent and Selective Peroxisome Proliferator-activated Receptor γ Agonists. J Med Chem 2009; 52:2618-22. [DOI: 10.1021/jm801594x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chia-Hui Lin
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Yi-Hui Peng
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Mohane Selvaraj Coumar
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Santhosh Kumar Chittimalla
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Chun-Chen Liao
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Ping-Chiang Lyn
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Chin-Chieh Huang
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Tzu-Wen Lien
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Wen-Hsing Lin
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - John T.-A. Hsu
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Jai-Hong Cheng
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Xin Chen
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Jian-Sung Wu
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Yu-Sheng Chao
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Hwei-Jen Lee
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Chiun-Gung Juo
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Su-Ying Wu
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
| | - Hsing-Pang Hsieh
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, ROC, Departments of Chemistry and Life Sciences, National Tsing Hua University, 101, Section 2, Kuang Fu Road, Hsinchu 300, Taiwan, ROC, Department of Chemistry, Chung Yuan Christian University, 200 Chung-Pei Road, Chungli 320, Taiwan, ROC, Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan, ROC, Department of
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Reynolds JK, Neumiller JJ, Campbell RK. Janumet™: a combination product suitable for use in patients with Type 2 diabetes. Expert Opin Investig Drugs 2008; 17:1559-65. [DOI: 10.1517/13543784.17.10.1559] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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