1
|
Wang Y, Cai F, Li G, Tao Y. Novel dual glucagon-like peptide-1/ glucose-dependent insulinotropic polypeptide receptor agonist attenuates diabetes and myocardial injury through inhibiting hyperglycemia, inflammation and oxidative stress in rodent animals. Bioengineered 2022; 13:9184-9196. [PMID: 35383532 PMCID: PMC9161981 DOI: 10.1080/21655979.2022.2051859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study was aimed to evaluate the therapeutic effects and potent mechanisms of a novel GLP-1/GIP dual agonist on hyperglycemia and myocardial injury in diabetic mice. Novel dual-receptor agonists were designed and then evaluated via in vitro receptor activation assays. Acute hypoglycemic effects were assessed in diabetic mice induced by intraperitoneal injection of streptozotocin. Chronic effects of dual-receptor agonists on diabetes as well as diabetic cardiomyopathy were investigated in DCM model mice. Effects of the in vitro coculture of dual-receptor agonists with or without signaling pathway inhibitors on the cell viability and apoptosis of primary cardiomyocytes under a high-glucose state were assessed via MTT and western blotting methods to investigate the probable mechanism. AP5 exhibited balanced activities of dual-receptor activation in vitro and improved hypoglycemic ability in diabetic mice. Moreover, chronic treatment of AP5 achieved the prominently improved efficacy in reversing the deteriorative diabetic disorders and reducing the myocardial injury markers in DCM mice. Moreover, AP5 also inhibited the apoptosis and improved the survival rate of primary cardiomyocytes under a high-glucose state via increasing the expression levels of antiapoptotic proteins and inhibiting the release of apoptotic proteins, respectively, as well as activating the AMPK/PI3K/Akt signaling pathway. In conclusion, the dual GLP-1/GIP receptor agonist, AP5, can effectively improve diabetic symptoms and exert therapeutic effects on DCM via activating the AMPK/PI3K/Akt pathway, reducing the ROS production, oxidative stress and inflammatory markers in the rodent DCM model.Abbreviation: Diabetes mellitus, DM; diabetic cardiomyopathy, DCM; streptozotocin, STZ; glucagon-like peptide-1, GLP-1; malondialdehyde, MDA; glucose-dependent insulinotropic polypeptide, GIP; creatine kinase, CK; diabetic cardiomyopathy, DCM; serum superoxide dismutase; SOD; total superoxide disumutase, T-SOD; Methyl Thiazolyl Tetrazolium, MTT; lactate dehydrogenase; LDH; Adenosine Monophosphate-Activated Protein Kinase, AMPK; Dulbecco’s modified Eagle medium, DMEM; Fetal Bovine Serum, FBS; Reactive Oxygen Species, ROS; Glyceraldehyde-phosphate dehydrogenase, GAPDH; Surface Plasmon Resonance, SPR; Ethylene Diamine Tetraacetic Acid, EDTA; Interleukin-1β, IL-1β; Phosphoinositol 3-kinase, PI3K; Tumor necrosis factor, TNF-α; Renin-angiotensin-aldosterone system, RAAS; Glucose transporter, GLUT; Dipeptidyl peptidase-IV, DPP-IV; oxygen free radicals, OFR;
Collapse
Affiliation(s)
- Ying Wang
- Department of Cardiology, Nantong Third People's Hospital and the Third People's Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Fei Cai
- Department of Cardiology, Nantong Third People's Hospital and the Third People's Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Gang Li
- Department of Cardiology, Nantong Third People's Hospital and the Third People's Hospital Affiliated to Nantong University, Nantong, People's Republic of China
| | - Yong Tao
- Department of Intensive Care Unit, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, People's Republic of China
| |
Collapse
|
2
|
Zhao X, Liu Y, Liu J, Qin J. Therapeutic effects and mechanism of liraglutide on rats with type 2 diabetes and metabolic-associated fatty liver disease. Endocr Metab Immune Disord Drug Targets 2022; 22:963-969. [PMID: 35081898 DOI: 10.2174/1871530322666220126151141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022]
Abstract
• Background SREBP-1c/Insig/SCAP acts as a lipid de novo synthesis pathway, and its factors are highly expressed in the endoplasmic reticulum[4]. At present, this pathway has become a research hotspot in the development of metabolic-associated fatty liver disease. However, there are few studies on how various factors in this pathway change after endoplasmic reticulum stress; in particular, the role of the insulin-inducing gene-1 (Insig-1) has not been elucidated in detail. • Objective To investigate whether liraglutide has a therapeutic effect on rats with T2DM and MAFLD and to further study its possible mechanism. • Method rats in the control group and modeling group were fed with normal diet and high-sugar and high-fat diet, respectively . After one month, the mice in the modeling group were injected with 35mg/kg STZ intraperitoneally to establish the model of type 2 diabetes mellitus. T2DM and MAFLD rats were randomly divided into three groups: model group, low dose liraglutide group, and high dose liraglutide group. Fasting blood glucose ,fasting insulin, blood lipid profile, alanine aminotransferase, and aspartate aminotransferase were measured at the end of the 8th week. Paraffin sections were obtained from the same part of the liver of rats in each group and observed by electron microscope after HE staining. Western blot was used to detect the expression of endoplasmic reticulum stress index (GRP78) and negative feedback index of lipid synthesis (Insig-1) in each group. • Results of Liver tissue from the drug intervention groups caused a decrease in lipid droplet vacuoles, and the hepatocytes were arranged neatly again. While the expression of GRP78 rose, Insig-1 declined. There were differences with different doses of liraglutide; the higher the dose was, the more obvious the effect. No such changes were observed in T2DM and MAFLD rats after injection of saline. • Conclusion, we show that liraglutide may have a therapeutic effect on rats with T2DM and MAFLD by reducing endoplasmic reticulum stress in the liver and increasing the expression of Insig-1.
Collapse
Affiliation(s)
- Xuanye Zhao
- Department of Endocrinology, Shanxi Provincial People\'s Hospital, No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi Province, China
| | - Yaoji Liu
- Department of Endocrinology, Shanxi Provincial People\\\'s Hospital, No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi Province, China
| | - Jingjin Liu
- Department of Endocrinology, Shanxi Provincial People\'s Hospital, No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi Province, China
| | - Jie Qin
- Department of Endocrinology, Shanxi Provincial People\'s Hospital, No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi Province, China
| |
Collapse
|
3
|
Jøns C, Porta-Sánchez A, Lai PFH, Wauchop M, Massé S, Azam MA, Asta J, Rose RA, Nanthakumar K. Mechanism of and strategy to mitigate liraglutide-mediated positive chronotropy. Life Sci 2021; 282:119815. [PMID: 34256040 DOI: 10.1016/j.lfs.2021.119815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022]
Abstract
AIM An adverse side-effect of Liraglutide (LG), a Glucagon-Like Peptide 1 (GLP1)-analog commonly used in treatments for diabetes, is positive chronotropy. The goal of this study is to investigate on the mechanism of this drug-induced chronotropy and explore potential means to mitigate this side-effect so as to maximize the therapeutic benefits from LG. MAIN METHODS Experiments were conducted with: 1) Isolated rabbit hearts in a Langendorff set-up to assess for direct effects of drug actions and 2) Murine cardiomyocytes isolated from the sino-atrial node (SAN) to assess the effects of LG on spontaneous action potential (AP) firing and the hyperpolarization-activated current If. KEY FINDINGS LG induced a dose-dependent increase in heart rate. Its effects on sinus node automaticity, which were not suppressed during β-blockade with Propranolol, were abolished by If blockade with Ivabradine. In isolated murine SAN myocytes, LG increased spontaneous AP firing frequency by an increase in diastolic depolarization slope without changing other electrophysiological parameters. SIGNIFICANCE LG-induced positive chronotropy is partly due to a direct effect on the SAN and is independent of the adrenergic cascade and extrinsic autonomic reflex mechanisms. The direct LG-associated increase in heart rate should be mitigated with If blockers rather than β-blockade.
Collapse
Affiliation(s)
- Christian Jøns
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Andreu Porta-Sánchez
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain and Hospital Universitario Quirónsalud, Madrid, Spain
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - John Asta
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Robert A Rose
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are becoming more prominent as a therapeutic choice in diabetes management and their use is being expanded to other indications, such as obesity. Dyslipidemia and cardiovascular disease are common co-morbidities in these populations and understanding the impact of this class of medications on the lipid profile may be an important consideration. RECENT FINDINGS Several GLP-1RAs trials demonstrate them to be safe and potentially beneficial for cardiovascular outcomes; improvements in surrogate markers of atherosclerosis have also been observed. Lipid data collected as secondary outcomes from large clinical trials as well as some smaller dedicated trials show that GLP-1RAs can modestly lower low-density lipoprotein (LDL) and total cholesterol (C), and most show modest fasting triglyceride (TG) lowering. Effects on high-density lipoprotein-C have been less consistent. Some have also demonstrated substantial blunting of the postprandial rise in serum TGs. Favorable effects on lipoprotein metabolism, with reduced levels of small dense LDL particles and decreased atherogenic potential of oxidized LDL, have also been seen. Mechanisms underlying these observations have been investigated. SUMMARY This review summarizes the data available on the lipid effects of GLP-1RAs, and explores the current understanding of the mechanisms underlying these observed effects.
Collapse
Affiliation(s)
- Amanda J Berberich
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
5
|
Serina JJC, Castilho PCMF. Using polyphenols as a relevant therapy to diabetes and its complications, a review. Crit Rev Food Sci Nutr 2021; 62:8355-8387. [PMID: 34028316 DOI: 10.1080/10408398.2021.1927977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diabetes is currently a worldwide health concern. Hyperglycemia, hypertension, obesity, and oxidative stress are the major risk factors that inevitably lead to all the complications from diabetes. These complications severely impact the quality of life of patients, and they can be managed, reduced, or even reverted by several polyphenols, plant extracts and foods rich in these compounds. The goal of this review is to approach diabetes not as a single condition but rather an interconnected combination of risk factors and complications. This work shows that polyphenols have multi target action and effects and they have been systematically proven to be relevant in the reduction of each risk factor and improvement of associated complication.
Collapse
|
6
|
Kalra S, Das AK, Sahay RK, Baruah MP, Tiwaskar M, Das S, Chatterjee S, Saboo B, Bantwal G, Bhattacharya S, Priya G, Chawla M, Brar K, Raza SA, Aamir AH, Shrestha D, Somasundaram N, Katulanda P, Afsana F, Selim S, Naseri MW, Latheef A, Sumanatilleke M. Consensus Recommendations on GLP-1 RA Use in the Management of Type 2 Diabetes Mellitus: South Asian Task Force. Diabetes Ther 2019; 10:1645-1717. [PMID: 31359367 PMCID: PMC6778554 DOI: 10.1007/s13300-019-0669-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 12/17/2022] Open
Abstract
The advent of incretin mimetics such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has enriched the armamentarium for diabetes management owing to their glycaemic as well as extra-glycaemic benefits. The approval status and availability of this class of drugs vary widely across the globe. Being a relatively newer class of drug with numerous benefits, several national and international guidelines are working towards addressing clinical questions pertaining to the optimal use of GLP-1 RAs for the management of diabetes. Although the newer class of drugs are associated with significant benefits such as patient-centric approach, these drugs demand the providers to be vigilant and knowledgeable about the medication. The South Asian population is at higher risk of type 2 diabetes mellitus (T2DM) because of their genetic predisposition and lifestyle changes. Hence, prevention and management of T2DM and its associated complications in this population are of paramount importance. The current report aims to present an overview of current knowledge on GLP-1 RAs based on pragmatic review of the available clinical evidence. In addition, this report is a consensus of expert endocrinologists representing South Asian countries including India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan and the Maldives on essential recommendations related to the use of GLP-1 RAs in a real-world scenario.
Collapse
Affiliation(s)
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | | | | | | | - Sambit Das
- Hi Tech Medical College and Hospital, Bhubaneshwar, India
| | | | | | | | | | | | | | | | - Syed Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Centre and National Defence Hospital, Lahore, Pakistan
| | | | | | | | | | | | - Shahjada Selim
- Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | | | - Ali Latheef
- Department of Medicine, Indra Gandhi Hospital, Male, Maldives
| | | |
Collapse
|
7
|
Nolen-Doerr E, Stockman MC, Rizo I. Mechanism of Glucagon-Like Peptide 1 Improvements in Type 2 Diabetes Mellitus and Obesity. Curr Obes Rep 2019; 8:284-291. [PMID: 31124035 DOI: 10.1007/s13679-019-00350-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to emphasize the pivotal role of glucagon-like peptide 1 (GLP-1) in tackling the parallel epidemics of obesity and type 2 diabetes (T2DM). RECENT FINDINGS GLP-1-based therapies and in particular GLP-1 receptor agonists (GLP-1 RA) have proven to be effective in lowering blood glucose and decreasing weight. GLP-1 RA not only mitigate these significant medical burdens but also result in weight loss and weight loss independent factors that decrease cardiovascular disease (CVD) and microvascular complications of T2DM, such as diabetic nephropathy. GLP-1-based therapies are critical for a patient-centered approach in choosing appropriate pharmacotherapy for T2DM and obesity while also taking into consideration comorbidities, such as cardiovascular and chronic kidney diseases.
Collapse
Affiliation(s)
- Eric Nolen-Doerr
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine and Boston Medical Center, 720 Harrison Avenue, Doctor's Office Building, Suite 8100, Boston, MA, 02118, USA.
| | - Mary-Catherine Stockman
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine and Boston Medical Center, 720 Harrison Avenue, Doctor's Office Building, Suite 8100, Boston, MA, 02118, USA.
| | - Ivania Rizo
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine and Boston Medical Center, 720 Harrison Avenue, Doctor's Office Building, Suite 8100, Boston, MA, 02118, USA.
| |
Collapse
|
8
|
Jassim Z, Elajez R, Khudair I, Al Anany R, Al-Adawi RM. Efficacy and safety of once daily liraglutide versus twice daily exenatide in type 2 diabetic patients in Qatar: an observational study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objective
Compare efficacy and safety of liraglutide (1.8 mg subcutaneous once daily) and exenatide (10 mcg subcutaneous twice daily) in uncontrolled type 2 diabetes at 26 and 52 weeks.
Method
A retrospective observation study of uncontrolled type 2 diabetes patients who took liraglutide or exenatide in addition to their anti-diabetic medications. This study was conducted at Hamad Medical Corporation, the predominant public healthcare organization in Qatar. The primary outcome was the change in haemoglobin A1C (HbA1C) after 26 and 52 weeks.
Key finding
Two hundred and two patients were included in this study (liraglutide 98, exenatide 114). There was no significant HbA1C change observed between two groups at either 26 or 52 weeks (P = 0.23 and 0.40 respectively). However, more patients in the liraglutide group achieved HbA1C ≤7% at week 26. Liraglutide reduced the mean Fasting blood glucose (FBG) more than exenatide at week 26 and 52. Although both medications were associated with some benefits in other studied variables at a certain point (e.g. weight losses, blood pressure), neither of them were able to show a significant change from baseline. No patients in either group reported drug-related side effects (e.g. nausea and vomiting) or episodes of hypoglycaemia during the treatment period.
Conclusions
Exenatide and liraglutide resulted in similar glycaemic effects (HbA1C and fasting plasma glucose changes) in patients with type 2 diabetes who were sub-optimally controlled with other anti-diabetic therapy. However, this study supports the effectiveness of both medications for weight reduction at both endpoints. A prospective large-scale study is recommended to overcome the study limitations.
Collapse
|
9
|
Barkas F, Elisaf M, Milionis H. Protection against stroke with glucagon‐like peptide 1 receptor agonists: a systematic review and meta‐analysis. Eur J Neurol 2019; 26:559-565. [DOI: 10.1111/ene.13905] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/08/2019] [Indexed: 01/12/2023]
Affiliation(s)
- F. Barkas
- Department of Internal Medicine School of Medicine University of Ioannina Ioannina Greece
| | - M. Elisaf
- Department of Internal Medicine School of Medicine University of Ioannina Ioannina Greece
| | - H. Milionis
- Department of Internal Medicine School of Medicine University of Ioannina Ioannina Greece
| |
Collapse
|
10
|
Shi C, Zhang R, Bai R, Liu D, Wang Y, Zhang X, Wang H, Du J. Efficacy and safety of sitagliptin added to metformin and insulin compared with voglibose in patients with newly diagnosed type 2 diabetes. Clinics (Sao Paulo) 2019; 74:e736. [PMID: 31038562 PMCID: PMC6474317 DOI: 10.6061/clinics/2019/e736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the efficacy and safety of sitagliptin compared with voglibose added to combined metformin and insulin in patients with newly diagnosed type 2 diabetes (T2DM). METHODS In this 12-week prospective, randomized, parallel trial, 70 newly diagnosed T2DM patients with glycosylated hemoglobin (HbA1c) ≥9% and/or fasting plasma glucose (FPG) ≥11.1 mmol/L were randomized (1:1) to receive sitagliptin 100 mg per day + metformin + insulin glargine or voglibose 0.2 mg three times daily + metformin + insulin glargine. Change in HbA1c at week 12 was the primary endpoint. RESULTS The mean baseline HbA1c was 11.0% in the patients. The changes in HbA1c from baseline were -6.00% in the sitagliptin group and -3.58% in the voglibose group, and the between-group difference was -2.42% (95% CI -1.91 to -2.93, p=0.02). The differences in FPG and homeostatic model assessment of β-cell function (HOMA-β) and the change in body weight between groups from baseline were -2.95 mmol/L (p=0.04), 43.91 (p=0.01) and -2.23 kg (p=0.01), respectively. One patient (2.9%) in the sitagliptin group and three patients (8.6%) in the voglibose group exhibited hypoglycemia. CONCLUSIONS Sitagliptin added to combined metformin and insulin therapy showed greater efficacy and good safety regarding hypoglycemia in patients with newly diagnosed T2DM compared with voglibose.
Collapse
Affiliation(s)
- Chunhong Shi
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Corresponding authors. E-mail: ,
| | - Ru Zhang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Ran Bai
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Corresponding authors. E-mail: ,
| | - Dan Liu
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Yongbo Wang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Xueyang Zhang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Hao Wang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| |
Collapse
|
11
|
Wei ZG, Wang MC, Zhang HH, Wang ZY, Wang GN, Wei FX, Zhang YW, Xu XD, Zhang YC. PRISMA-efficacy and safety of lixisenatide for type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13710. [PMID: 30572502 PMCID: PMC6320179 DOI: 10.1097/md.0000000000013710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We aimed to systematically evaluate the efficacy and safety of lixisenatide in patients with type 2 diabetes mellitus. METHODS PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Google, Web of Science and the Chinese Science Citation Database were searched up to March 2018. Randomized controlled trials determining the efficacy and safety of lixisenatide in patients with type 2 diabetes mellitus were eligible for inclusion. Two authors independently extracted the data in a prespecified Microsoft Excel spreadsheet. A meta-analysis was performed using Review Manager 5.3 software. Weighted mean difference (WMD) and relative risk (RR) together with their corresponding 95% confidence intervals (CIs) were estimated, and only the random effects model was used in order to achieve a more conservative estimate of the efficacy and safety. RESULTS Fourteen multicenter randomized controlled trials involving 11,947 patients were eligible for inclusion. Compared to placebo, lixisenatide could more significantly reduce the level of HbA1c (WMD=-0.44; 95% confidence interval [CI] [-0.55,-0.33]), and a higher proportion of lixisenatide-treated patients achieved the HbA1c level of < 7.0% (RR = 1.89, 95% CI [1.75-2.03]) and < 6.5% (RR = 3.03, 95% CI [2.54-3.63]) than the placebo-treated patients. Lixisenatide was also associated with a significant reduction in fasting plasma glucose and 2-hour postprandial plasma glucose levels. The risks for any adverse events, gastrointestinal adverse events, and symptomatic hypoglycemia significantly increased in the lixisenatide-treatedment group compared to those in the placebo group. However, lixisenatideit did not increase the risks of serious adverse events, death, or severe hypoglycemia. CONCLUSIONS Lixisenatide was more effective than placebo in patients with type 2 diabetes mellitus, and the mild-to-moderate adverse events were found to be tolerated during the follow-up.
Collapse
Affiliation(s)
- Zhen-gang Wei
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Man-cai Wang
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Hui-han Zhang
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Zhe-yuan Wang
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Gen-nian Wang
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Feng-xian Wei
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Ya-wu Zhang
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - Xiao-dong Xu
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| | - You-cheng Zhang
- Department of General Surgery, Lanzhou University Second Hospital
- Hepatobiliary and pancreatic surgery laboratory, Lanzhou University Second Hospital
- Gansu Provincial-level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China
| |
Collapse
|
12
|
Rowlands J, Heng J, Newsholme P, Carlessi R. Pleiotropic Effects of GLP-1 and Analogs on Cell Signaling, Metabolism, and Function. Front Endocrinol (Lausanne) 2018; 9:672. [PMID: 30532733 PMCID: PMC6266510 DOI: 10.3389/fendo.2018.00672] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 12/22/2022] Open
Abstract
The incretin hormone Glucagon-Like Peptide-1 (GLP-1) is best known for its "incretin effect" in restoring glucose homeostasis in diabetics, however, it is now apparent that it has a broader range of physiological effects in the body. Both in vitro and in vivo studies have demonstrated that GLP-1 mimetics alleviate endoplasmic reticulum stress, regulate autophagy, promote metabolic reprogramming, stimulate anti-inflammatory signaling, alter gene expression, and influence neuroprotective pathways. A substantial body of evidence has accumulated with respect to how GLP-1 and its analogs act to restore and maintain normal cellular functions. These findings have prompted several clinical trials which have reported GLP-1 analogs improve cardiac function, restore lung function and reduce mortality in patients with obstructive lung disease, influence blood pressure and lipid storage, and even prevent synaptic loss and neurodegeneration. Mechanistically, GLP-1 elicits its effects via acute elevation in cAMP levels, and subsequent protein kinase(s) activation, pathways well-defined in pancreatic β-cells which stimulate insulin secretion in conjunction with elevated Ca2+ and ATP. More recently, new studies have shed light on additional downstream pathways stimulated by chronic GLP-1 exposure, findings which have direct relevance to our understanding of the potential therapeutic effects of longer lasting analogs recently developed for clinical use. In this review, we provide a comprehensive description of the diverse roles for GLP-1 across multiple tissues, describe downstream pathways stimulated by acute and chronic exposure, and discuss novel pleiotropic applications of GLP-1 mimetics in the treatment of human disease.
Collapse
Affiliation(s)
| | | | - Philip Newsholme
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Perth, WA, Australia
| | - Rodrigo Carlessi
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Perth, WA, Australia
| |
Collapse
|
13
|
Webb N, Orme M, Witkowski M, Nakanishi R, Langer J. A Network Meta-Analysis Comparing Semaglutide Once-Weekly with Other GLP-1 Receptor Agonists in Japanese Patients with Type 2 Diabetes. Diabetes Ther 2018; 9:973-986. [PMID: 29574633 PMCID: PMC5984907 DOI: 10.1007/s13300-018-0397-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Semaglutide once-weekly (QW) is a novel glucagon-like peptide-1 (GLP-1) analogue administered at a 0.5 or 1.0 mg dose. In the absence of head-to-head trials between semaglutide QW and other GLP-1 receptor agonists (GLP-1 RAs) in a Japanese population, a network meta-analysis (NMA) was performed. The objective was to assess the relative efficacy and safety of semaglutide QW vs GLP-1 RAs in Japanese patients with type 2 diabetes (T2DM), with a specific focus on the comparison between semaglutide 0.5 mg QW and dulaglutide 0.75 mg QW. METHODS A systematic review (SR) and supplementary Japanese searches were conducted to identify trials of GLP-1 RAs in Japanese patients on diet and exercise, who have previously received 0-1 oral antidiabetic drugs (OADs). Data at 52-56 weeks were extracted for the following outcomes (feasible for analysis in an NMA): glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), weight, systolic blood pressure (SBP), and overall hypoglycemia. The data were synthesized using an NMA and a Bayesian framework. RESULTS Four trials, identified from the SR and Japanese-specific searches, were relevant for inclusion in the NMA. When compared to dulaglutide 0.75 mg QW, semaglutide 0.5 mg QW was shown to provide significant reductions in HbA1c [- 0.61% (12.3 mmol/mol)], weight (- 1.45 kg), SBP (- 5.03 mmHg), and FPG (- 1.26 mmol/L). No significant differences in the proportion of patients achieving a HbA1c level < 7% (53 mmol/mol) or the risk of overall hypoglycemia were observed between semaglutide 0.5 mg QW and dulaglutide 0.75 mg QW. CONCLUSION Overall, semaglutide 0.5 mg QW was associated with significant reductions from baseline in HbA1c, weight, SBP, and FPG compared with dulaglutide 0.75 mg QW in Japanese patients with T2DM. These data may provide valuable evidence for clinical decision-making, cost-effectiveness analyses, and health technology appraisal (HTA) requirements. FUNDING Novo Nordisk Pharma Ltd.
Collapse
Affiliation(s)
- Neil Webb
- DRG Abacus, Bicester, Oxfordshire, UK
| | | | | | | | | |
Collapse
|
14
|
Katayama S, Hatano M, Issiki M. Clinical features and therapeutic perspectives on hypertension in diabetics. Hypertens Res 2018; 41:213-229. [PMID: 29402981 PMCID: PMC8075885 DOI: 10.1038/s41440-017-0001-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 01/10/2023]
Abstract
Over 50% of patients with diabetes mellitus, either type 1 or 2, ultimately develop hypertension as a complication. In diabetics, this further increases the incidence of cardiovascular disease (CVD) by 2- to 3-fold and accelerates the progression of diabetic nephropathy. Arteriosclerosis, a clinical feature of hypertension in diabetics, develops and advances from a young age. Therefore, in providing treatment, it is necessary to evaluate the degree of arteriosclerosis. Diabetic patients are encouraged to strictly control their blood glucose levels. Recently developed drugs, such as GLP-1 receptor agonists, DPP-4 inhibitors and SGLT2 inhibitors, also have hypotensive actions, making them ideal for use in diabetics with hypertension. SGLT2 inhibitors and GLP-1 receptor agonists reportedly suppress the onset and progression of CVD, as well as diabetic nephropathy. The possibility of hypoglycemia triggering blood pressure elevation and arrhythmia has been noted, so a key point here is not to cause hypoglycemia. In selecting hypotensive agents, we must choose types that do not aggravate insulin resistance and engage in hypotensive treatment that also considers both nocturnal and morning hypertension. In addition, facing the onset of an aging society, there is a growing need for treatments that do not cause excessive blood pressure reduction or hypoglycemia. Favorable lifelong blood pressure and glucose control are increasingly important for the treatment of diabetes accompanied by hypertension.
Collapse
Affiliation(s)
| | - Masako Hatano
- Department of Endocrinology and Diabetes, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Masashi Issiki
- Department of Endocrinology and Diabetes, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| |
Collapse
|
15
|
Chang G, Liu J, Qin S, Jiang Y, Zhang P, Yu H, Lu K, Zhang N, Cao L, Wang Y, Li Y, Zhang D. Cardioprotection by exenatide: A novel mechanism via improving mitochondrial function involving the GLP-1 receptor/cAMP/PKA pathway. Int J Mol Med 2017; 41:1693-1703. [PMID: 29286061 DOI: 10.3892/ijmm.2017.3318] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/24/2017] [Indexed: 11/06/2022] Open
Abstract
Accumulating evidence suggests that glucagon-like peptide-1 (GLP-1) and its analogues exert cardioprotective effects via modulating cardiomyocyte metabolism. Mitochondria play a pivotal role in the regulation of cell metabolism. It was hypothesized that treatment with exenatide, a GLP-1 analogue, may exert cardioprotective effects by improving mitochondrial function in an in vitro model of hypoxia/reoxygenation (H/R). H9c2 cells were employed to establish an in vitro model of H/R. Exenatide was added to the cells for 30 min prior to exposure to hypoxia. The GLP-1 receptor antagonist exendin‑(9‑39), the cyclic adenosine monophosphate (cAMP) inhibitor Rp-cAMPS and the protein kinase A (PKA) inhibitor H-89 were added to the cells for 10 min prior to treatment with exenatide. The release of lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) and cardiomyocyte apoptosis were evaluated. The characteristics of mitochondrial morphology and functions, including ATP synthesis, membrane potential (ΔΨm), mitochondrial permeability transition pore (mPTP), mitochondrial ATPase activity and oxidative stress, were determined. the mitochondrial uncoupling protein-3 (UCP-3) and nuclear respiratory factor-1 (Nrf-1) were also investigated by western blot analysis. Exenatide pretreatment significantly decreased LDH and CK-MB release and cardiomyocyte apoptosis in H9c2 cells subjected to H/R. More importantly, to the best of our knowledge, this is the first report of exenatide pretreatment decreasing mitochondrial abnormalities and reducing oxidative stress, while enhancing ATP synthesis, mitochondrial ATPase activity and ΔΨm in H9c2 cells subjected to H/R. Exenatide pretreatment also decreased mitochondrial calcium overload and inhibited the opening of mPTP in H9c2 cells subjected to H/R. Furthermore, exenatide pretreatment upregulated UCP-3 and Nrf-1 expression in H9c2 cells subjected to H/R. However, the abovementioned observed effects of exenatide were all abolished when exenatide was co-administered with exendin‑(9‑39), Rp-cAMPS and̸or H-89. Therefore, the GLP-1 analogue exenatide was found to exert cardioprotective effects in an in vitro model of H/R, and this cardioprotection may be attributed to the improvement of mitochondrial function. These effects are most likely associated with the activation of the GLP-1 receptor/cAMP/PKA signaling pathway.
Collapse
Affiliation(s)
- Guanglei Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Jian Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Youqin Jiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Peng Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Hui Yu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Kai Lu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Nan Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Li Cao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Ying Wang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| | - Yong Li
- Center for Perinatal Biology, Division of Pharmacology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan 400016, P.R. China
| |
Collapse
|
16
|
Leonardini A, D'Oria R, Incalza MA, Caccioppoli C, Andrulli Buccheri V, Cignarelli A, Paparella D, Margari V, Natalicchio A, Perrini S, Giorgino F, Laviola L. GLP-1 Receptor Activation Inhibits Palmitate-Induced Apoptosis via Ceramide in Human Cardiac Progenitor Cells. J Clin Endocrinol Metab 2017; 102:4136-4147. [PMID: 28938428 DOI: 10.1210/jc.2017-00970] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/11/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Increased apoptosis of cardiomyocytes and cardiac progenitor cells (CPCs) in response to saturated fatty acids (SFAs) can lead to myocardial damage and dysfunction. Ceramides mediate lipotoxicity-induced apoptosis. Glucagonlike peptide-1 receptor (GLP1R) agonists exert beneficial effects on cardiac cells in experimental models. OBJECTIVE To investigate the protective effects of GLP1R activation on SFA-mediated apoptotic death of human CPCs. DESIGN Human CPCs were isolated from cardiac appendages of nondiabetic donors and then exposed to palmitate with or without pretreatment with the GLP1R agonist exendin-4. Ceramide accumulation was evaluated by immunofluorescence. Expression of key enzymes in de novo ceramide biosynthesis was studied by quantitative reverse-transcription polymerase chain reaction and immunoblotting. Apoptosis was evaluated by measuring release of oligonucleosomes, caspase-3 cleavage, caspase activity, and terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling. RESULTS Exposure of the CPCs to palmitate resulted in 2.3- and 1.9-fold higher expression of ceramide synthase 5 (CERS5) and ceramide desaturase-1, respectively (P < 0.05). This was associated with intracellular accumulation of ceramide and activation of c-Jun NH2-terminal protein kinase (JNK) signaling and apoptosis (P < 0.05). Both coincubation with fumonisin B1, a specific ceramide synthase inhibitor, and CERS5 knockdown prevented ceramide accumulation, JNK activation, and apoptosis in response to palmitate (P < 0.05). Exendin-4 also prevented the activation of the ceramide biosynthesis and JNK in response to palmitate, inhibiting apoptosis (P < 0.05). CONCLUSIONS Excess palmitate results in activation of ceramide biosynthesis, JNK signaling, and apoptosis in human CPCs. GLP1R activation counteracts this lipotoxic damage via inhibition of ceramide generation, and this may represent a cardioprotective mechanism.
Collapse
Affiliation(s)
- Anna Leonardini
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Rossella D'Oria
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Maria Angela Incalza
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Cristina Caccioppoli
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Valentina Andrulli Buccheri
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Domenico Paparella
- Department of Emergency and Organ Transplantation, Section of Cardiac Surgery, University of Bari Aldo Moro, I-70124 Bari, Italy
- Cardiac Surgery, Santa Maria Hospital, I-70124 Bari, Italy
| | - Vito Margari
- Cardiac Surgery, Santa Maria Hospital, I-70124 Bari, Italy
| | - Annalisa Natalicchio
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Sebastio Perrini
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Luigi Laviola
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy
| |
Collapse
|
17
|
Hunt B, Kragh N, McConnachie CC, Valentine WJ, Rossi MC, Montagnoli R. Long-term Cost-effectiveness of Two GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus in the Italian Setting: Liraglutide Versus Lixisenatide. Clin Ther 2017. [PMID: 28625506 DOI: 10.1016/j.clinthera.2017.05.354] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Maintaining glycemic control is the key treatment target for patients with type 2 diabetes mellitus. In addition, the glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with other favorable treatment characteristics, such as reduction in body weight and reduced risk of hypoglycemia compared with traditional diabetes interventions. The aim of the present analysis was to compare the long-term cost-effectiveness of 2 GLP-1 receptor agonists, liraglutide 1.8 mg and lixisenatide 20 μg (both administered once daily), in the treatment of patients with type 2 diabetes failing to achieve glycemic control with metformin monotherapy in the Italian setting. METHODS The IMS CORE Diabetes Model was used to project long-term clinical outcomes and subsequent costs (in 2015 Euros [€]) associated with liraglutide 1.8 mg versus lixisenatide 20 μg treatment in a cohort with baseline characteristics derived from the open-label LIRA-LIXI trial (Efficacy and Safety of Liraglutide Versus Lixisenatide as Add-on to Metformin in Subjects With Type 2 Diabetes; NCT01973231) over patient lifetimes from the perspective of a health care payer. Efficacy data were taken from the 26-week end points of the same trial, including changes in glycated hemoglobin, body mass index, serum lipid levels, and hypoglycemic event rates. Outcomes projected included life expectancy, quality-adjusted life expectancy, cumulative incidence and time to onset of diabetes-related complications, and direct medical costs. Outcomes were discounted at 3% annually, and sensitivity analyses were performed. FINDINGS Liraglutide 1.8 mg was associated with improved discounted life expectancy (14.07 vs 13.96 years) and quality-adjusted life expectancy (9.18 vs 9.06 quality-adjusted life years [QALYs]) compared with lixisenatide 20 μg. These improvements were mostly attributable to a greater reduction in glycated hemoglobin level with liraglutide 1.8 mg versus lixisenatide 20 μg, leading to reduced incidence and increased time to onset of diabetes-related complications. Compared with lixisenatide 20 μg, liraglutide 1.8 mg was associated with increased total costs over patient lifetimes (€41,623 vs €41,380), but this was offset by lower costs of treating diabetes-related complications (€26,682 vs €27,476). Liraglutide 1.8 mg was associated with an incremental cost-effectiveness ratio of €2001 per QALY gained versus lixisenatide 20 μg. At a willingness-to-pay threshold of €30,000 per QALY gained, liraglutide 1.8 mg had a probability of 77.2% of being cost-effective. IMPLICATIONS Based on long-term projections, liraglutide 1.8 mg is likely to be considered cost-effective compared with lixisenatide 20 μg for the treatment of patients with type 2 diabetes in Italy.
Collapse
Affiliation(s)
- Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland.
| | | | | | | | - Maria C Rossi
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | | |
Collapse
|
18
|
Yang JS, Lu CC, Kuo SC, Hsu YM, Tsai SC, Chen SY, Chen YT, Lin YJ, Huang YC, Chen CJ, Lin WD, Liao WL, Lin WY, Liu YH, Sheu JC, Tsai FJ. Autophagy and its link to type II diabetes mellitus. Biomedicine (Taipei) 2017; 7:8. [PMID: 28612706 PMCID: PMC5479440 DOI: 10.1051/bmdcn/2017070201] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023] Open
Abstract
Autophagy, a double-edged sword for cell survival, is the research object on 2016 Nobel Prize in Physiology or Medicine. Autophagy is a molecular mechanism for maintaining cellular physiology and promoting survival. Defects in autophagy lead to the etiology of many diseases, including diabetes mellitus (DM), cancer, neurodegeneration, infection disease and aging. DM is a metabolic and chronic disorder and has a higher prevalence in the world as well as in Taiwan. The character of diabetes mellitus is hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and failure of producing insulin on pancreatic beta cells. In T2DM, autophagy is not only providing nutrients to maintain cellular energy during fasting, but also removes damaged organelles, lipids and miss-folded proteins. In addition, autophagy plays an important role in pancreatic beta cell dysfunction and insulin resistance. In this review, we summarize the roles of autophagy in T2DM.
Collapse
Affiliation(s)
- Jai-Sing Yang
-
Department of Medical Research, China Medical University Hospital, China Medical University Taichung
404 Taiwan
| | - Chi-Cheng Lu
-
Department of Medical Research, China Medical University Hospital, China Medical University Taichung
404 Taiwan
| | - Sheng-Chu Kuo
-
School of Pharmacy, China Medical University Taichung
404 Taiwan
| | - Yuan-Man Hsu
-
Department of Biological Science and Technology, China Medical University Taichung
404 Taiwan
| | - Shih-Chang Tsai
-
Department of Biological Science and Technology, China Medical University Taichung
404 Taiwan
| | - Shih-Yin Chen
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Yng-Tay Chen
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Ying-Ju Lin
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Yu-Chuen Huang
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Chao-Jung Chen
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Wei-De Lin
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Wen-Lin Liao
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Wei-Yong Lin
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Yu-Huei Liu
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
| | - Jinn-Chyuan Sheu
-
Institute of Biomedical Sciences, National Sun Yat-sen University Kaohsiung
804 Taiwan
| | - Fuu-Jen Tsai
-
Genetics Center, Department of Medical Research, China Medical University Hospital Taichung
404 Taiwan
-
School of Chinese Medicine, China Medical University Taichung
404 Taiwan
-
Department of Medical Genetics, China Medical University Hospital, China Medical University Taichung
404 Taiwan
| |
Collapse
|
19
|
Hypertension in type 2 diabetes: impact of glucose-lowering medications. Cardiovasc Endocrinol 2016. [DOI: 10.1097/xce.0000000000000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
20
|
Sheta A, Elsakkar M, Hamza M, Solaiman A. Effect of metformin and sitagliptin on doxorubicin-induced cardiotoxicity in adult male albino rats. Hum Exp Toxicol 2016; 35:1227-1239. [PMID: 26818447 DOI: 10.1177/0960327115627685] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The use of doxorubicin (DOX) as an antitumor therapeutic agent is limited due to its cardiotoxic effects. Metformin (Met) and sitagliptin (Sitg) are suggested to improve cardiac function. The present study aimed to determine the potential protective effects of Met and Sitg on DOX-induced cardiotoxicity. Rats were divided into six groups: groups I, II, and III received normal saline, Met, and Sitg, respectively. Groups IV, V, and VI received DOX only, Met + DOX, and Sitg + DOX, respectively. Heart tissue was used for biochemical assays which measured cardiac reduced glutathione (GSH), thiobarbituric acid reactive substances (TBARS), and tumor necrosis factor α (TNF-α). Serum creatinine kinase (CK) and lactate dehydrogenase (LDH) were also measured. The heart apex was prepared for histological (hematoxylin and eosin) and immunohistochemical examination. Intoxication of DOX was associated with a significant elevation in serum CK-MB and LDH, reduction in cardiac GSH, and increased TBARS and TNF-α compared to the controls. Administration of Met or Sitg to DOX-intoxicated rats suppressed serum CK-MB and LDH. Moreover, cardiac GSH was elevated with decreased TBARS and TNF-α. These results were confirmed by histological study. Met and Sitg caused inhibition of caspase 3 and upregulation of B-cell lymphoma 2 (Bcl-2) expression in DOX-intoxicated animals. Sitg was found to exert a significantly better protective effect compared to that of Met. It was concluded that Sitg might be more effective than Met in reducing myocardial injury in DOX-induced cardiotoxicity in rats.
Collapse
Affiliation(s)
- A Sheta
- 1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M Elsakkar
- 2 Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M Hamza
- 2 Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A Solaiman
- 3 Department of Histology and Cell Biology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
21
|
Abstract
There is an urgent need for effective pharmacological therapies to help tackle the growing obesity epidemic and the healthcare crisis it poses. The past 3 years have seen approval of a number of novel anti-obesity drugs. The majority of these influence hypothalamic appetite pathways via dopaminergic or serotoninergic signalling. Some are combination therapies, allowing lower doses to minimize the potential for off-target effects. An alternative approach is to mimic endogenous satiety signals using long-lasting forms of peripheral appetite-suppressing hormones. There is also considerable interest in targeting thermogenesis by brown adipose tissue to increase resting energy expenditure. Obesity pharmacotherapy has seen several false dawns, but improved understanding of the pathways regulating energy balance, and better-designed trials, give many greater confidence that recently approved agents will be both efficacious and safe. Nevertheless, a number of issues from preclinical and clinical development continue to attract debate, and additional large-scale trials are still required to address areas of uncertainty.
Collapse
|
22
|
Henri C, O’Meara E, De Denus S, Elzir L, Tardif JC. Ivabradine for the treatment of chronic heart failure. Expert Rev Cardiovasc Ther 2016; 14:553-61. [DOI: 10.1586/14779072.2016.1165092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Sun F, Wu S, Guo S, Yu K, Yang Z, Li L, Zhang Y, Quan X, Ji L, Zhan S. Impact of GLP-1 receptor agonists on blood pressure, heart rate and hypertension among patients with type 2 diabetes: A systematic review and network meta-analysis. Diabetes Res Clin Pract 2015; 110:26-37. [PMID: 26358202 DOI: 10.1016/j.diabres.2015.07.015] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/01/2015] [Accepted: 07/24/2015] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate current evidence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on blood pressure, heart rate, and hypertension in patients with type 2 diabetes. METHODS Medline, Embase, the Cochrane library, and the website www.clinicaltrials.gov were searched on April 5th, 2014. Randomized-controlled trials with available data were included if they compared GLP-1RAs with placebo and traditional antidiabetic drugs in patients with type 2 diabetes with duration ≥ 12 weeks. Weighted mean difference for blood pressure and heart rate, odds ratio (OR) for hypertension were calculated by random-effect model. Network meta-analysis was performed to supplement direct comparisons. RESULTS Sixty trials with 14 treatments were included. Compared with placebo, insulin, and sulfonylureas, GLP-1RAs decreased systolic blood pressure with range from -1.84 mmHg (95% CI: -3.48 to -0.20) to -4.60 mmHg (95% CI: -7.18 to -2.03). Compared with placebo, a reduction in diastolic blood pressure was detected significantly only for exenatide-10 μg-twice-daily (-1.08 mmHg, 95% CI: -1.78 to -0.33). Exenatide (2 mg once weekly), liraglutide 1.2 mg once daily), and liraglutide (1.8 mg once daily) increased heart rate by 3.35 (95% CI: 1.23-5.50), 2.06 (95% CI: 0.43, 3.74), and 2.35 (95% CI: 0.94-3.76) beats/min versus placebo. This effect was evident compared with active control (range: 2.22-3.62). No significant association between incident hypertension and GLP-1RAs was detected, except for the association between exenatide-10 μg-twice-daily and sulfonylureas (OR, 0.40, 95% CI: 0.16, 0.82). CONCLUSIONS GLP-1RAs were associated with modest reduction on blood pressure, a slight increase in heart rate, yet no significant association with hypertension. Further investigation to explore mechanisms is warranted.
Collapse
Affiliation(s)
- Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China; Department of Preventive Medicine, College of Medicine, Shihezi University, Shihezi 832002, China.
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing 100050, China
| | - Shuxia Guo
- Department of Preventive Medicine, College of Medicine, Shihezi University, Shihezi 832002, China
| | - Kai Yu
- Department of orthopedics, Tianjin Fifth Central Hospital, Tianjing 300450, China
| | - Zhirong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China; Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Guangdong 515041, China
| | - Lishi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China; Department of statistics, Graduate School of Arts and Sciences, Columbia University, New York, NY 10027, USA
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaochi Quan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, People's Hospital, Peking University, Beijing 100044, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| |
Collapse
|
24
|
Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context 2015; 4:212283. [PMID: 26213556 PMCID: PMC4509428 DOI: 10.7573/dic.212283] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Indexed: 02/07/2023] Open
Abstract
The prevalence of type 2 diabetes is increasing at an astounding rate. Many of the agents used to treat type 2 diabetes have undesirable adverse effects of hypoglycemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes, with benefits extending outside glucose control, including positive effects on weight, blood pressure, cholesterol levels, and beta-cell function. They mimic the effects of the incretin hormone GLP-1, which is released from the intestine in response to food intake. Their effects include increasing insulin secretion, decreasing glucagon release, increasing satiety, and slowing gastric emptying. There are currently four approved GLP-1 receptor agonists in the United States: exenatide, liraglutide, albiglutide, and dulaglutide. A fifth agent, lixisenatide, is available in Europe. There are important pharmacodynamic, pharmacokinetic, and clinical differences of each agent. The most common adverse effects seen with GLP-1 therapy include nausea, vomiting, and injection-site reactions. Other warnings and precautions include pancreatitis and thyroid cell carcinomas. GLP-1 receptor agonists are an innovative and effective option to improve blood glucose control, with other potential benefits of preserving beta-cell function, weight loss, and increasing insulin sensitivity. Once-weekly formulations may also improve patient adherence. Overall, these are effective agents for patients with type 2 diabetes, who are either uncontrolled on metformin or intolerant to metformin.
Collapse
Affiliation(s)
| | - Diana Isaacs
- Chicago State University College of Pharmacy, Chicago, IL, USA
| |
Collapse
|
25
|
Lonardo A, Ballestri S, Targher G, Loria P. Diagnosis and management of cardiovascular risk in nonalcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol 2015; 9:629-50. [PMID: 25327387 DOI: 10.1586/17474124.2015.965143] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as an important cardiovascular risk (CVR) factor. This is a narrative clinical review aimed at answering how diagnosis and management of CVR should be conducted in the individual patient with NAFLD. To this end, the authors performed an extensive search of the existing literature on PubMed (1993-2014) using pertinent keywords. To date, CVR among patients with NAFLD might be assessed with the Framingham risk score equation or other risk calculators, to be adapted to the true CVR in the specific population being assessed; however, the use of these CVR calculators needs to be validated by future studies in larger cohorts of NAFLD patients of various ethnic backgrounds in order to substantiate their clinical relevance as a foundation for the primary prevention of cardiovascular diseases in this group of patients. Early and aggressive drug treatment of CVR should be started in NAFLD patients with a history of cardiovascular events, established diabetes or who are at high (calculated) CVR. Whether such an aggressive pharmacological approach is also justified in patients with NAFLD, who are at intermediate or low CVR, remains debatable. Currently, there are no clinical trials showing that the treatment of NAFLD per se (either associated or unassociated with traditional CVR factors) will result in decreased risk of cardiovascular events. Accordingly, drug treatment should be better individualized, aiming at correcting all the coexisting cardio-metabolic risk factors of the individual patient with NAFLD. To this end, an overview of the lifestyle interventions and the available drugs is offered, emphasis being conveyed to statins and metformin, which promise to cover worrying complications of NAFLD such as the risk of developing hepatocellular carcinoma.
Collapse
Affiliation(s)
- Amedeo Lonardo
- Department of Medicine, Division of Internal Medicine, Pavullo Hospital, Pavullo 41026, Italy
| | | | | | | |
Collapse
|
26
|
Ge GH, Dou HJ, Yang SS, Ma JW, Cheng WB, Qiao ZY, Hou YM, Fang WY. Glucagon-like peptide-1 protects against cardiac microvascular endothelial cells injured by high glucose. ASIAN PAC J TROP MED 2015; 8:73-8. [PMID: 25901929 DOI: 10.1016/s1995-7645(14)60191-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/10/2014] [Accepted: 11/15/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the protective effect of glucagon-like peptid-1 (GLP-1) against cardiac microvascular endothelial cell (CMECs) injured by high glucose. METHODS CMECs were isolated and cultured. Superoxide assay kit and dihydroethidine (DHE) staining were used to assess oxidative stress. TUNEL staining and caspase 3 expression were used to assess the apoptosis of CMECs. H89 was used to inhibit cAMP/PKA pathway; fasudil was used to inhibit Rho/ROCK pathway. The protein expressions of Rho, ROCK were examined by Western blot analysis. RESULTS High glucose increased the production of ROS, the activity of NADPH, the apoptosis rate and the expression level of Rho/ROCK in CMECs, while GLP-1 decreased high glucose-induced ROS production, the NADPH activity and the apoptosis rate and the expression level of Rho/ROCK in CMECs, the difference were statistically significant (P<0.05). CONCLUSIONS GLP-1 could protect the cardiac microvessels against oxidative stress and apoptosis. The protective effects of GLP-1 are dependent on downstream inhibition of Rho through a cAMP/PKA-dependent manner, resulting in a subsequent decrease in the expression of NADPH oxidase.
Collapse
Affiliation(s)
- Guang-Hao Ge
- Department of Cardiology, Fengxian District Central Hospital, Shanghai 201499, China; Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China
| | - Hong-Jie Dou
- Department of Intensive Care Unit, Fengxian District Central Hospital, Shanghai 201499, China; Department of Intensive Care Unit, Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China
| | - Shuan-Suo Yang
- Department of Cardiology, Fengxian District Central Hospital, Shanghai 201499, China; Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China
| | - Jiang-Wei Ma
- Department of Cardiology, Fengxian District Central Hospital, Shanghai 201499, China; Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China
| | - Wen-Bo Cheng
- Department of Cardiology, Fengxian District Central Hospital, Shanghai 201499, China; Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China
| | - Zeng-Yong Qiao
- Department of Cardiology, Fengxian District Central Hospital, Shanghai 201499, China; Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China
| | - Yue-Mei Hou
- Department of Cardiology, Fengxian District Central Hospital, Shanghai 201499, China; Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South campus, Shanghai 201499, China.
| | - Wei-Yi Fang
- Department of Cardiology, Shanghai Jiaotong University Affiliated Chest Hospital, Shanghai 200052, China
| |
Collapse
|
27
|
Faber R, Zander M, Pena A, Michelsen MM, Mygind ND, Prescott E. Effect of the glucagon-like peptide-1 analogue liraglutide on coronary microvascular function in patients with type 2 diabetes - a randomized, single-blinded, cross-over pilot study. Cardiovasc Diabetol 2015; 14:41. [PMID: 25896352 PMCID: PMC4407869 DOI: 10.1186/s12933-015-0206-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/27/2015] [Indexed: 12/22/2022] Open
Abstract
Background Impaired coronary microcirculation is associated with a poor prognosis in patients with type 2 diabetes. In the absence of stenosis of major coronary arteries, coronary flow reserve (CFR) reflects coronary microcirculation. Studies have shown beneficial effects of glucagon-like peptide-1 (GLP-1) on the cardiovascular system. The aim of the study was to explore the short-term effect of GLP-1 treatment on coronary microcirculation estimated by CFR in patients with type 2 diabetes. Methods Patients with type 2 diabetes and no history of coronary artery disease were treated with either the GLP-1 analogue liraglutide or received no treatment for 10 weeks, in a randomized, single-blinded, cross-over setup with a 2 weeks wash-out period. The effect of liraglutide on coronary microcirculation was evaluated using non-invasive trans-thoracic Doppler-flow echocardiography during dipyridamole induced stress. Peripheral microvascular endothelial function was assessed by Endo-PAT2000®. Interventions were compared by two-sample t-test after ensuring no carry over effect. Results A total of 24 patients were included. Twenty patients completed the study (15 male; mean age 57 ± 9; mean BMI 33.1 ± 4.4, mean baseline CFR 2.35 ± 0.45). There was a small increase in CFR following liraglutide treatment (change 0.18, CI95% [-0.01; 0.36], p = 0.06) but no difference in effect in comparison with no treatment (difference between treatment allocation 0.16, CI95% [-0.08; 0.40], p = 0.18). Liraglutide significantly reduced glycated haemoglobin (HbA1c) (-10.1 mmol/mol CI95% [-13.9; -6.4], p = 0.01), systolic blood pressure (-10 mmHg CI95% [-17; -3], p = 0.01) and weight (-1.9 kg CI95% [-3.6; -0.2], p = 0.03) compared to no treatment. There was no effect on peripheral microvascular endothelial function after either intervention. Conclusions In this short-term treatment study, 10 weeks of liraglutide treatment had no significant effect on neither coronary nor peripheral microvascular function in patients with type 2 diabetes. Further long-term studies, preferably in patients with more impaired microvascular function and using a higher dosage of GLP-1 analogues, are needed to confirm these findings. Trial registration ClinicalTrials.gov: NCT01931982. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0206-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rebekka Faber
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. .,Department of Endocrinology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Mette Zander
- Department of Endocrinology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Adam Pena
- Department of Cardiology, Gentofte University Hospital, Kildegårdsvej 28, 2900 Hellerup, Copenhagen, Denmark.
| | - Marie M Michelsen
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Naja D Mygind
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| |
Collapse
|
28
|
Sun F, Wu S, Guo S, Yu K, Yang Z, Li L, Zhang Y, Ji L, Zhan S. Effect of GLP-1 receptor agonists on waist circumference among type 2 diabetes patients: a systematic review and network meta-analysis. Endocrine 2015; 48:794-803. [PMID: 25115635 DOI: 10.1007/s12020-014-0373-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/25/2014] [Indexed: 12/19/2022]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in patients with type 2 diabetes. However, the effect on abdominal obesity has not yet been confirmed. The study aimed to systematically evaluate the effect of GLP-1RAs on waist circumference in patients with type 2 diabetes. MEDLINE, EMBASE, the Cochrane library and www.clinicaltrialgov were searched through October 31, 2013. Randomized controlled trials with available data were selected if they compared GLP-1 RAs with placebo and traditional anti-diabetic drugs with a duration≥8 weeks. Weighted mean difference was estimated using random-effect model. Network meta-analysis was performed to supplement direct comparisons. Seventeen trials with 12 treatments were included. Overall, significant reductions on waist circumference following treatment of liraglutide--1.8 mg once daily (-5.24 cm, 95% CI -7.68, -2.93), liraglutide--1.2 mg once daily (-4.73 cm, 95% CI -6.68, -2.65) and exenatide--10 μg twice daily (-1.34 cm, 95 % CI -2.00, -0.75) were detected versus placebo. The reduction effect was more evident when compared with insulin and thiazolidinediones (range -1.71 to -8.03 cm). Compared with exenatide, liraglutide--0.6 mg once daily, taspoglutide, liraglutide--1.2 mg once daily and liraglutide--1.8 mg once daily significantly decreased waist circumference from -3.32 to -6.01 cm. Besides, liraglutide--1.8 mg once daily significantly decreased waist circumference by -1.73 cm (95 % CI -3.04, -0.55) versus sitagliptin, whereas no significant difference following liraglutide--1.2-mg-once-daily treatment was detected compared with liraglutide--1.8 mg once daily and sitagliptin. Reduction was observed with statistical significance for exenatide--10 μg twice daily compared with exenatide--5 μg twice daily (-1.21 cm, 95% CI -2.43, -0.06). Ranking probability analysis indicated liraglutide--1.8 mg once daily and liraglutide--1.2 mg once daily decreased waist circumference most among all 12 treatments with probability of 98.36% and 91.82%, respectively. Some GLP-1RAs, especially liraglutide--1.8 mg once daily and liraglutide--1.2 mg once daily, were associated with a significant reduction in waist circumference.
Collapse
Affiliation(s)
- Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Young MA, Wald JA, Matthews JE, Scott R, Hodge RJ, Zhi H, Reinhardt RR. Clinical Pharmacology of Albiglutide, a GLP-1 Receptor Agonist. Postgrad Med 2015; 126:84-97. [DOI: 10.3810/pgm.2014.11.2836] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
30
|
Edwards KL, Minze MG. Dulaglutide: an evidence-based review of its potential in the treatment of type 2 diabetes. CORE EVIDENCE 2015; 10:11-21. [PMID: 25657615 PMCID: PMC4295897 DOI: 10.2147/ce.s55944] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction As the prevalence of type 2 diabetes mellitus (T2DM) is anticipated to continue to rise worldwide, so too are the treatment options also continuing to expand. Current guidelines recommend individualized treatment plans which allow for provider choice and diversity of pharmacotherapeutic regimens. The glucagon-like peptide-1 receptor agonist (GLP-1 RA) class is rapidly expanding, with dulaglutide (Trulicity™) as a once-weekly agent recently approved. Aims This article examines the evidence currently available on the efficacy and safety of dulaglutide for use in T2DM. Evidence review Dulaglutide has been shown to have similar efficacy and safety to other newer GLP-1 RAs, and better glycemic control than placebo. It lowers glycated hemoglobin (A1c), fasting and postprandial glucose levels, and promotes weight loss when used as first-, second-, or third-line therapy. It has also been shown to improve β-cell function and provide cardiovascular benefits, such as lower blood pressure and improved lipid levels. Dulaglutide also has a low risk for hypoglycemia and a similar adverse effect profile to other GLP-1 RAs in the class, with transient gastrointestinal problems and potential risk for pancreatitis. Place in therapy While long-term data on safety and efficacy are forthcoming, dulaglutide is positioned to be placed at the same level as other GLP-1 RAs in the class: as second-line therapy in addition to diet and exercise in those patients who cannot achieve glycemic control on monotherapy metformin. It may also be useful as first-line therapy instead of metformin. Conclusion Dulaglutide is a once-weekly GLP-1 RA approved for the treatment of T2DM that has shown similar efficacy to other agents in this class.
Collapse
Affiliation(s)
- Krystal L Edwards
- Ambulatory Care Division, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Molly G Minze
- Ambulatory Care Division, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA
| |
Collapse
|
31
|
Sun F, Wu S, Wang J, Guo S, Chai S, Yang Z, Li L, Zhang Y, Ji L, Zhan S. Effect of glucagon-like peptide-1 receptor agonists on lipid profiles among type 2 diabetes: a systematic review and network meta-analysis. Clin Ther 2015; 37:225-241.e8. [PMID: 25554560 DOI: 10.1016/j.clinthera.2014.11.008] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/23/2014] [Accepted: 11/11/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE The goal of this study was to assess the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on lipid profiles in patients with type 2 diabetes. METHODS The MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched from inception through October 31, 2013. Randomized controlled trials with available data were selected if they compared GLP-1 RAs with placebo and traditional antidiabetic drugs with a duration ≥8 weeks. The weighted mean difference for changes in lipid profiles was estimated by using the random effects model, and a network meta-analysis was performed to supplement direct comparisons. FINDINGS Thirty-five trials with 13 treatments were included in the analysis. GLP-1 RAs decreased HDL-C with a range of -0.06 mmol/L (95% CI, -0.11 to -0.01) to -0.13 mmol/L (95% CI, -0.17 to -0.10) compared with thiazolidinediones, whereas thiazolidinediones were associated with a significant increase in HDL-C compared with placebo (0.09 mmol/L [95% CI, 0.06 to 0.12]). A significant reduction in LDL-C was detected for all GLP-1 RAs versus placebo (range, -0.08 to -0.16 mmol/L), insulin (range, -0.10 to -0.19 mmol/L), and thiazolidinediones (range, -0.16 to -0.24 mmol/L). Exenatide, liraglutide 1.8 mg once daily, and taspoglutide decreased total cholesterol with a range of -0.16 mmol/L (95% CI, -0.26 to -0.06) to -0.27 mmol/L (95% CI, -0.41 to -0.12) versus placebo and thiazolidinediones (range, -0.26 to -0.37 mmol/L). The decreased effect was more evident in exenatide long-acting release and liraglutide 1.8 mg once daily. A significant reduction in triglyceride levels was observed with liraglutide 1.8 mg once daily (-0.30 mmol/L [95% CI, -0.49 to -0.11]) and taspoglutide 20 mg once weekly (-0.17 mmol/L [95% CI, -0.31 to -0.01]) versus placebo. IMPLICATIONS GLP-1 RAs were associated with modest reductions in LDL-C, total cholesterol, and triglycerides but no significant improvement in HDL-C. Further evidence is needed to determine if improvements in lipid profiles might translate into reductions in cardiovascular outcomes.
Collapse
Affiliation(s)
- Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Department of Preventive Medicine, College of Medicine, Shihezi University, Shihezi, China
| | - Shanshan Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Shuxia Guo
- Department of Preventive Medicine, College of Medicine, Shihezi University, Shihezi, China
| | - Sanbao Chai
- Department of Physiology, Capital Medical University, Beijing, China
| | - Zhirong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Guangdong, China
| | - Lishi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Department of Statistics, Graduate School of Arts and Sciences, Columbia University, New York, New York
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, People's Hospital, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
| |
Collapse
|
32
|
Ross SA. A multiplicity of targets: evaluating composite endpoint studies of the GLP-1 receptor agonists in type 2 diabetes. Curr Med Res Opin 2015; 31:125-35. [PMID: 25299351 DOI: 10.1185/03007995.2014.973939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Current type 2 diabetes (T2D) treatment guidelines include weight maintenance or loss, avoidance of hypoglycemia, and targets for blood pressure and circulating lipids, in addition to glycemic control. Increasingly, clinical trials and meta-analyses employ composite endpoints to capture the net clinical benefit of a given T2D intervention. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a new class of injected antihyperglycemic agents that may be well suited to reaching many of these targets among patients failing on metformin monotherapy. RESEARCH DESIGNS AND METHODS Using MEDLINE, Embase and Google Scholar, studies were sought that employed composite endpoints and that reported outcomes with exenatide and/or liraglutide. Bibliographies of relevant review articles were consulted to search for additional reports. RESULTS Many trials have used the combination of HbA1c <7%, no weight gain and no hypoglycemic episodes as the composite endpoint in evaluating T2D therapies; however, at least 15 other distinct composite endpoints have been reported. Findings were relatively consistent across studies, regardless of how the composite endpoint was defined. Specifically, the GLP-1 RAs appear to be superior to other agents in their efficacy in providing T2D patients failing on metformin with a net clinical benefit, which can include avoidance of hyperglycemia and maintenance or improvement in body weight. CONCLUSIONS Use of composite endpoints represents an important advance in T2D. While no single such endpoint has achieved dominance in the field, widely used composite endpoints capture efficacy in glycemic control as well as safety and effects on markers of cardiovascular risk.
Collapse
|
33
|
Hanna A, Connelly KA, Josse RG, McIntyre RS. The non-glycemic effects of incretin therapies on cardiovascular outcomes, cognitive function and bone health. Expert Rev Endocrinol Metab 2015; 10:101-114. [PMID: 30289042 DOI: 10.1586/17446651.2015.972370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The incretin therapies, glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors, have been developed to lower blood glucose levels in patients with Type 2 diabetes. However, in addition to being a treatment strategy to improve metabolic control, incretin therapies have shown effects independent of glycemic control, including the potential to positively impact cardiovascular events, cognitive deficits and bone mineral density. This paper outlines the non-glycemic effects of incretin therapies on cardiovascular disease, cognitive function and bone health.
Collapse
Affiliation(s)
- Amir Hanna
- a 1 Department of Medicine, University of Toronto, Toronto, ON, Canada
- b 2 Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Kim A Connelly
- c 3 Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert G Josse
- a 1 Department of Medicine, University of Toronto, Toronto, ON, Canada
- b 2 Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Roger S McIntyre
- d 4 Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
- e 5 Department of Psychiatry and Pharmacology, and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
34
|
Zhou B, Ji K, Peng A, Yang X, Huang K. GLP-1(28-36)amide, a Long Ignored Peptide Revisited. Open Biochem J 2014; 8:107-11. [PMID: 25598850 PMCID: PMC4293754 DOI: 10.2174/1874091x01408010107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 12/13/2022] Open
Abstract
Glucagon-like peptide-1 (GLP-1), which has been extensively applied for treating type 2 diabetes mellitus (T2DM), is an incretin hormone that regulates glucose homeostasis. GLP-1(28-36)amide, a C-terminal nonapeptide (FIAWLVKGRamide) of GLP-1, is a major product derived from the cleavage of GLP-1 by the neutral endopeptidase (NEP). GLP-1(28-36)amide has long been regarded as a metabolically inactive byproduct, however, recent findings reveal that GLP-1(28-36)amide plays multiple novel roles in ameliorating hepatic metabolism, protecting β cells, improving glucose disposal and inhibiting weight gain. Here, we summarize the latest progress on the effects of GLP-1(28-36)amide with a focus on its roles in regulating the Wnt and mitochondrial-mediated signaling pathways.
Collapse
Affiliation(s)
- Bilan Zhou
- Tongji School of Pharmacy, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China, 430030
| | - Kaige Ji
- Tongji School of Pharmacy, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China, 430030
| | - Anlin Peng
- Department of Pharmacy, The Third Hospital of Wuhan, Wuhan, Hubei, P. R. China, 430060
| | - Xin Yang
- Tongji School of Pharmacy, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China, 430030
| | - Kun Huang
- Tongji School of Pharmacy, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China, 430030 ; Centre for Biomedicine Research, Wuhan Institute of Biotechnology, Wuhan, Hubei, P. R. China, 430075
| |
Collapse
|
35
|
O'Meara E, Thibodeau-Jarry N, Ducharme A, Rouleau JL. The Epidemic of Heart Failure: A Lucid Approach to Stemming the Rising Tide. Can J Cardiol 2014; 30:S442-54. [DOI: 10.1016/j.cjca.2014.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023] Open
|
36
|
Cameron-Vendrig A, Mundil D, Husain M. Antiatherothrombotic effects of dipeptidyl peptidase inhibitors. Curr Atheroscler Rep 2014; 16:408. [PMID: 24623180 DOI: 10.1007/s11883-014-0408-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Atherothrombotic cardiovascular events are a leading cause of morbidity and mortality in patients with type 2 diabetes (T2D). A number of factors beyond hyperglycemia contribute to this increased risk of cardiovascular events in T2D, including elevated blood pressure, dyslipidemia, inflammation, endothelial dysfunction, and enhanced platelet activation. Importantly, most currently available antihyperglycemic treatments for T2D do not address these additional mechanisms. Indeed, we posit that this may explain why more intensive treatment of hyperglycemia has not contributed to a reduced incidence of cardiovascular events in subjects with T2D. Incretin-targeted therapies, such as dipeptidyl peptidase 4 inhibitors, are a relatively new class of antidiabetic treatments, and preclinical as well as small mechanistic clinical studies suggest that they exert beneficial cardiovascular effects. This review focuses specifically on the potential antiatherothrombotic effects of dipeptidyl peptidase 4 inhibitors.
Collapse
Affiliation(s)
- Alison Cameron-Vendrig
- Toronto General Research Institute, TMDT 3-909, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | | | | |
Collapse
|
37
|
Walker AM, Cubbon RM, Kearney MT. Contemporary treatment strategies for Type 2 diabetes-related macrovascular disease. Expert Rev Endocrinol Metab 2014; 9:641-658. [PMID: 30736201 DOI: 10.1586/17446651.2014.941356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes mellitus poses a major challenge to healthcare providers in the coming years as its prevalence increases across the globe. The disease doubles the risk of cardiovascular morbidity and mortality, with 70% of sufferers dying from a cardiac cause. Large clinical trials of current glucose-lowering therapies for Type 2 diabetes have shown no benefit in reducing the risk of macrovascular events. Blood pressure control, angiotensin-converting enzyme inhibitor therapy and improvement of dyslipidemia with statins have proven benefit in reducing cardiovascular risk in Type 2 diabetes. A growing understanding of the importance of pathological processes including endothelial dysfunction, abnormal growth factor biology, oxidative stress, dysregulation of adipokines and deficient vascular repair and regeneration in insulin-resistant states promises new treatments to combat the problem.
Collapse
Affiliation(s)
- Andrew Mn Walker
- a Leeds Multidisciplinary Cardiovascular Research Centre, LIGHT laboratories, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | - Richard M Cubbon
- a Leeds Multidisciplinary Cardiovascular Research Centre, LIGHT laboratories, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | | |
Collapse
|
38
|
Evaluating Cardiovascular Safety of Novel Therapeutic Agents for the Treatment of Type 2 Diabetes Mellitus. Curr Cardiol Rep 2014; 16:541. [DOI: 10.1007/s11886-014-0541-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
39
|
Wang Y, Parlevliet ET, Geerling JJ, van der Tuin SJL, Zhang H, Bieghs V, Jawad AHM, Shiri-Sverdlov R, Bot I, de Jager SCA, Havekes LM, Romijn JA, Willems van Dijk K, Rensen PCN. Exendin-4 decreases liver inflammation and atherosclerosis development simultaneously by reducing macrophage infiltration. Br J Pharmacol 2014; 171:723-34. [PMID: 24490861 DOI: 10.1111/bph.12490] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/24/2013] [Accepted: 10/21/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE The aetiology of inflammation in the liver and vessel wall, leading to non-alcoholic steatohepatitis (NASH) and atherosclerosis, respectively, shares common mechanisms including macrophage infiltration. To treat both disorders simultaneously, it is highly important to tackle the inflammatory status. Exendin-4, a glucagon-like peptide-1 (GLP-1) receptor agonist, reduces hepatic steatosis and has been suggested to reduce atherosclerosis; however, its effects on liver inflammation are underexplored. Here, we tested the hypothesis that exendin-4 reduces inflammation in both the liver and vessel wall, and investigated the common underlying mechanism. EXPERIMENTAL APPROACH Female APOE*3-Leiden.CETP mice, a model with human-like lipoprotein metabolism, were fed a cholesterol-containing Western-type diet for 5 weeks to induce atherosclerosis and subsequently treated for 4 weeks with exendin-4. KEY RESULTS Exendin-4 modestly improved dyslipidaemia, but markedly decreased atherosclerotic lesion severity and area (-33%), accompanied by a reduction in monocyte adhesion to the vessel wall (-42%) and macrophage content in the plaque (-44%). Furthermore, exendin-4 reduced hepatic lipid content and inflammation as well as hepatic CD68⁺ (-18%) and F4/80⁺ (-25%) macrophage content. This was accompanied by less monocyte recruitment from the circulation as the Mac-1⁺ macrophage content was decreased (-36%). Finally, exendin-4 reduced hepatic chemokine expression in vivo and suppressed oxidized low-density lipoprotein accumulation in peritoneal macrophages in vitro, effects dependent on the GLP-1 receptor. CONCLUSIONS AND IMPLICATIONS Exendin-4 reduces inflammation in both the liver and vessel wall by reducing macrophage recruitment and activation. These data suggest that exendin-4 could be a valuable strategy to treat NASH and atherosclerosis simultaneously.
Collapse
Affiliation(s)
- Y Wang
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Wei CH, Litwin SE. Hyperglycemia and adverse outcomes in acute coronary syndromes: is serum glucose the provocateur or innocent bystander? Diabetes 2014; 63:2209-12. [PMID: 24962919 DOI: 10.2337/db14-0571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Christina H Wei
- Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Sheldon E Litwin
- Medical College of Georgia, Georgia Regents University, Augusta, GA
| |
Collapse
|
41
|
Bolli GB, Owens DR. Lixisenatide, a novel GLP-1 receptor agonist: efficacy, safety and clinical implications for type 2 diabetes mellitus. Diabetes Obes Metab 2014; 16:588-601. [PMID: 24373190 DOI: 10.1111/dom.12253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/15/2013] [Accepted: 10/24/2013] [Indexed: 01/13/2023]
Abstract
Recent advances in therapies for the treatment of type 2 diabetes mellitus (T2DM) have led to the development of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which, unlike insulin and sulphonylurea, are effective, with a low risk of hypoglycaemia. Lixisenatide is recommended as a once-daily GLP-1 RA for the treatment of T2DM. In persons with T2DM, lixisenatide 20 µg once-daily given by bolus subcutaneous injection improves insulin secretion and suppresses glucagon secretion in a glucose-dependent manner. Compared with the longer-acting GLP-1 RA liraglutide, lixisenatide achieved a significantly greater reduction in postprandial plasma glucose (PPG) during a standardized test breakfast in persons with T2DM otherwise insufficiently controlled on metformin alone. This is primarily due to the greater inhibition of gastric motility by lixisenatide compared with liraglutide. The efficacy and safety of lixisenatide was evaluated across a spectrum of T2DM in a series of phase III, randomized, placebo-controlled trials known as the GetGoal programme. Lixisenatide monotherapy or as add-on to oral antidiabetic agents or basal insulin achieved significant reductions in glycated haemoglobin, PPG and fasting plasma glucose, with either weight loss or no weight gain. The most frequent adverse events were gastrointestinal and transient in nature. Lixisenatide provides an easy, once-daily, single-dose, add-on treatment to oral antidiabetic agents or basal insulin for the management of T2DM, with little or no increased risk of hypoglycaemia and a potential beneficial effect on body weight.
Collapse
Affiliation(s)
- G B Bolli
- Department of Medicine, University of Perugia, Hospital S.M. della Misericordia, Perugia, Italy
| | | |
Collapse
|
42
|
Carrasco-Sánchez FJ, Gomez-Huelgas R, Formiga F, Conde-Martel A, Trullàs JC, Bettencourt P, Arévalo-Lorido JC, Pérez-Barquero MM. Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients: findings from the RICA registry. Diabetes Res Clin Pract 2014; 104:410-9. [PMID: 24768593 DOI: 10.1016/j.diabres.2014.03.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 01/20/2014] [Accepted: 03/22/2014] [Indexed: 02/07/2023]
Abstract
AIMS Heart failure (HF) and diabetes are common clinical conditions that may coexist. The main objective was to analyze the association of type-2 diabetes mellitus (T2DM) on prognosis in hospitalized patients with HF. METHODS We evaluated the association between T2DM with all-cause mortality and readmissions in the Spanish National Registry on Heart Failure-"Registro Nacional de Insuficiencia Cardiaca" (RICA). This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF from 2008 to 2011. Study endpoints were all-cause mortality and hospital readmission. We determined the adjusted hazard ratio (HR) by a multivariable Cox regression model. RESULTS A total of 1082 patients (mean age 77.6±8.5) were included of whom 490 (45.3%) had diabetes and 592 patients (54.7%) had preserved left ventricular ejection fraction (LVEF). During one-year follow-up, 287 patients died (151 patients with diabetes) and 383 patients were readmitted (197 patients with diabetes). After adjusting for baseline characteristics T2DM was significantly associated with all-cause mortality (HR 1.54; 95%CI 1.20-1.97, p=0.001) and readmissions (HR 1.46; 95%CI 1.18-1.80, p<0.001). Age, dementia, peripheral vascular disease, NYHA class, renal insufficiency, hyponatremia and anemia were also independently associated with outcomes. There were no differences in mortality (p=0.415) and readmissions (p=0.514) according to preserved or reduced LVEF. CONCLUSION T2DM is very common in patients hospitalized for HF. This condition is a strong and independent co-morbidity of all-cause mortality and readmission for both HF with preserved and reduced LVEF.
Collapse
Affiliation(s)
| | | | - Francesc Formiga
- Internal Medicine Department, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | | |
Collapse
|
43
|
Liraglutide increases 24-h heart rate by reducing the cardiac parasympathetic activity of patients with type 2 diabetes: power spectral analysis of heart rate variability on 24-h Holter ECG recordings. Diabetol Int 2014. [DOI: 10.1007/s13340-014-0170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
44
|
Pratley RE, Nauck MA, Barnett AH, Feinglos MN, Ovalle F, Harman-Boehm I, Ye J, Scott R, Johnson S, Stewart M, Rosenstock J. Once-weekly albiglutide versus once-daily liraglutide in patients with type 2 diabetes inadequately controlled on oral drugs (HARMONY 7): a randomised, open-label, multicentre, non-inferiority phase 3 study. Lancet Diabetes Endocrinol 2014; 2:289-297. [PMID: 24703047 DOI: 10.1016/s2213-8587(13)70214-6] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND As new members of a drug class are developed, head-to-head trials are an important strategy to guide personalised treatment decisions. We assessed two glucagon-like peptide-1 receptor agonists, once-weekly albiglutide and once-daily liraglutide, in patients with type 2 diabetes inadequately controlled on oral antidiabetic drugs. METHODS We undertook this 32-week, open-label, phase 3 non-inferiority study at 162 sites in eight countries: USA (121 sites), Australia (9 sites), Peru (7 sites), Philippines (7 sites), South Korea (5 sites), UK (5 sites), Israel (4 sites), and Spain (4 sites). 841 adult participants (aged ≥18 years) with inadequately controlled type 2 diabetes and a BMI between 20 and 45 kg/m(2) were enrolled and randomised in a 1:1 ratio to receive albiglutide 30 mg once weekly titrated to 50 mg at week 6, or liraglutide 0·6 mg once daily titrated to 1·2 mg at week 1 and 1·8 mg at week 2. The randomisation schedule was generated by an independent randomisation team by the permuted block method with a fixed block size of 16. Participants and investigators were unmasked to treatment. The primary endpoint was change from baseline in HbA1c for albiglutide versus liraglutide, with a 95% CI non-inferiority upper margin of 0·3%. The primary analysis was by modified intention to treat. The study is registered with ClinicalTrials.gov, number NCT01128894. FINDINGS 422 patients were randomly allocated to the albigultide group and 419 to the liraglutide group; 404 patients in the abliglutide group and 408 in the liraglutide group received the study drugs. The primary endpoint analysis was done on the modified intention-to-treat population, which included 402 participants in the albiglutide group and 403 in the liraglutide group. Model-adjusted change in HbA1c from baseline to week 32 was -0·78% (95% CI -0·87 to -0·69) in the albigludite group and -0·99% (-1·08 to -0·90) in the liraglutide group; treatment difference was 0·21% (0·08-0·34; non-inferiority p value=0·0846). Injection-site reactions occurred in more patients given albiglutide than in those given liraglutide (12·9% vs 5·4%; treatment difference 7·5% [95% CI 3·6-11·4]; p=0·0002), whereas the opposite was the case for gastrointestinal events, which occurred in 49·0% of patients in the liraglutide group versus 35·9% in the albiglutide group (treatment difference -13·1% [95% CI -19·9 to -6·4]; p=0·00013). INTERPRETATION Patients who received once-daily liraglutide had greater reductions in HbA1c than did those who received once-weekly albiglutide. Participants in the albiglutide group had more injection-site reactions and fewer gastrointestinal events than did those in the liraglutide group. FUNDING GlaxoSmithKline.
Collapse
Affiliation(s)
- Richard E Pratley
- Florida Hospital Diabetes and Translational Research Institute, Sanford-Burnham Medical Research Institute, Orlando, FL, USA.
| | | | | | | | - Fernando Ovalle
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - June Ye
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Rhona Scott
- GlaxoSmithKline, Stevenage, Hertfordshire, UK
| | | | | | | | | |
Collapse
|
45
|
Pyke C, Heller RS, Kirk RK, Ørskov C, Reedtz-Runge S, Kaastrup P, Hvelplund A, Bardram L, Calatayud D, Knudsen LB. GLP-1 receptor localization in monkey and human tissue: novel distribution revealed with extensively validated monoclonal antibody. Endocrinology 2014; 155:1280-90. [PMID: 24467746 DOI: 10.1210/en.2013-1934] [Citation(s) in RCA: 542] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Glucagon-like peptide 1 (GLP-1) analogs are increasingly being used in the treatment of type 2 diabetes. It is clear that these drugs lower blood glucose through an increase in insulin secretion and a lowering of glucagon secretion; in addition, they lower body weight and systolic blood pressure and increase heart rate. Using a new monoclonal antibody for immunohistochemistry, we detected GLP-1 receptor (GLP-1R) in important target organs in humans and monkeys. In the pancreas, GLP-1R was predominantly localized in β-cells with a markedly weaker expression in acinar cells. Pancreatic ductal epithelial cells did not express GLP-1R. In the kidney and lung, GLP-1R was exclusively expressed in smooth muscle cells in the walls of arteries and arterioles. In the heart, GLP-1R was localized in myocytes of the sinoatrial node. In the gastrointestinal tract, the highest GLP-1R expression was seen in the Brunner's gland in the duodenum, with lower level expression in parietal cells and smooth muscle cells in the muscularis externa in the stomach and in myenteric plexus neurons throughout the gut. No GLP-1R was seen in primate liver and thyroid. GLP-1R expression seen with immunohistochemistry was confirmed by functional expression using in situ ligand binding with (125)I-GLP-1. In conclusion, these results give important new insight into the molecular mode of action of GLP-1 analogs by identifying the exact cellular localization of GLP-1R.
Collapse
Affiliation(s)
- Charles Pyke
- Department of Histology and Imaging (C.P., R.S.H., R.K.K.), Department of Incretin Biology (C.Ø.), Department of Diabetes Structural Biology (S.R.-R.), Department of Antibody Technology (P.K.), Department of Pharmaceutical Medicine Programme (A.H.), and Department of Diabetes and Pharmacology Management (L.B.K.), Novo Nordisk, 2880 Bagsværd, Denmark; and Department of Surgical Gastroenterology (L.B., D.C.), Rigshospitalet, 2100 Copenhagen Ø, Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Masmiquel L. [Cardiovascular effects and safety of glucose-lowering drugs: current situation]. Semergen 2014; 40:80-8. [PMID: 24655910 DOI: 10.1016/j.semerg.2012.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/23/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
Abstract
Diabetes mellitus is an independent cardiovascular risk factor. Therefore, in addition to normalising blood glucose, the aim of the treatment for diabetes mellitus should be to prevent cardiovascular complications. However, the evidence available on the cardio-protective role of the different glucose-lowering drugs is scarce and poor, particularly as regards with the risk of major cardiovascular events. In this context, the regulatory agencies have modified the regulations for the approval of glucose-lowering drugs, now requiring to demonstrate the glucose-lowering effect together with a robust assessment of the cardiovascular safety. The aim of this work is to review the cardiovascular effects of the different glucose-lowering drugs, focusing on their impact on the risk of major cardiovascular events.
Collapse
Affiliation(s)
- L Masmiquel
- Servicio de Endocrinología, Hospital Son Llàtzer, Palma de Mallorca, España.
| |
Collapse
|
47
|
Eng H, Sharma R, McDonald TS, Landis MS, Stevens BD, Kalgutkar AS. Pharmacokinetics and metabolism studies on the glucagon-like peptide-1 (GLP-1)-derived metabolite GLP-1(9-36)amide in male Beagle dogs. Xenobiotica 2014; 44:842-8. [PMID: 24588343 DOI: 10.3109/00498254.2014.897011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Glucagon-like peptide-1 (GLP-1)(7-36)amide is a 30-amino acid peptide hormone that is secreted from intestinal enteroendocrine L-cells in response to nutrients. GLP-1(7-36)amide possesses potent insulinotropic actions in the augmentation of glucose-dependent insulin secretion. GLP-1(7-36)amide is rapidly metabolized by dipeptidyl peptidase-IV to yield GLP-1(9-36)amide as the principal metabolite. Contrary to the earlier notion that peptide cleavage products of native GLP-1(7-36)amide [including GLP-1(9-36)amide] are pharmacologically inactive, recent studies have demonstrated cardioprotective and insulinomimetic effects with GLP-1(9-36)amide in mice, dogs and humans. In the present work, in vitro metabolism and pharmacokinetic properties of GLP-1(9-36)amide have been characterized in dogs, since this preclinical species has been used as an animal model to demonstrate the in vivo vasodilatory and cardioprotective effects of GLP-1(9-36)amide. A liquid chromatography tandem mass spectrometry assay was developed for the quantitation of the intact peptide in hepatocyte incubations as opposed to a previously reported enzyme-linked immunosorbent assay. Although GLP-1(9-36)amide was resistant to proteolytic cleavage in dog plasma and bovine serum albumin (t1/2>240 min), the peptide was rapidly metabolized in dog hepatocytes with a t1/2 of 110 min. Metabolite identification studies in dog hepatocytes revealed a variety of N-terminus cleavage products, most of which, have also been observed in human and mouse hepatocytes. Proteolysis at the C-terminus was not observed in GLP-1(9-36)amide. Following the administration of a single intravenous bolus dose (20 µg/kg) to male Beagle dogs, GLP-1(9-36)amide exhibited a mean plasma clearance of 15 ml/min/kg and a low steady state distribution volume of 0.05 l/kg, which translated into a short elimination half life of 0.05 h. Following subcutaneous administration of GLP-1(9-36)amide at 50 µg/kg, systemic exposure of GLP-1(9-36)amide as ascertained from maximal plasma concentrations and area under the plasma concentration-time curve from zero to infinity was 44 ng/ml and 32 ng h/ml, respectively. The subcutaneous bioavailability of GLP-1(9-36)amide in dogs was 57%. Our findings raise the possibility that the cardioprotective effects of GLP-1(9-36)amide in the conscious dog model of pacing-induced heart failure might be due, at least in part, to the actions of additional downstream metabolites, which are obtained from proteolytic cleavage of the peptide backbone in the parent compound in the liver.
Collapse
Affiliation(s)
- Heather Eng
- Pfizer Inc. , Eastern Point Road, Groton, CT , USA and
| | | | | | | | | | | |
Collapse
|
48
|
Ballestri S, Lonardo A, Bonapace S, Byrne CD, Loria P, Targher G. Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20:1724-45. [PMID: 24587651 PMCID: PMC3930972 DOI: 10.3748/wjg.v20.i7.1724] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has emerged as a public health problem of epidemic proportions worldwide. Accumulating clinical and epidemiological evidence indicates that NAFLD is not only associated with liver-related morbidity and mortality but also with an increased risk of coronary heart disease (CHD), abnormalities of cardiac function and structure (e.g., left ventricular dysfunction and hypertrophy, and heart failure), valvular heart disease (e.g., aortic valve sclerosis) and arrhythmias (e.g., atrial fibrillation). Experimental evidence suggests that NAFLD itself, especially in its more severe forms, exacerbates systemic/hepatic insulin resistance, causes atherogenic dyslipidemia, and releases a variety of pro-inflammatory, pro-coagulant and pro-fibrogenic mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications. Collectively, these findings suggest that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions to decrease the risk for CHD and other cardiac/arrhythmic complications. The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and cardiovascular, cardiac and arrhythmic complications, to briefly examine the putative biological mechanisms underlying this association, and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmic complications.
Collapse
|
49
|
Monami M, Dicembrini I, Nardini C, Fiordelli I, Mannucci E. Glucagon-like peptide-1 receptor agonists and pancreatitis: a meta-analysis of randomized clinical trials. Diabetes Res Clin Pract 2014; 103:269-75. [PMID: 24485345 DOI: 10.1016/j.diabres.2014.01.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/02/2013] [Accepted: 01/04/2014] [Indexed: 12/23/2022]
Abstract
AIMS Several randomized trials with metabolic outcomes have reported that glucagon like peptide-1 receptor agonists (GLP-1 RA) could be associated with an increased risk of pancreatitis. The present meta-analysis aimed to examine this hypothesis. METHODS An extensive Medline, Embase, and Cochrane Database search for "exenatide", "liraglutide", "albiglutide", "taspoglutide", "dulaglutide", "lixisenatide", and "semaglutide" was performed up to March 31st, 2013. INCLUSION CRITERIA (i) randomized trials, (ii) duration ≥12 weeks; (iii) on type 2 diabetes; and (iv) comparison of GLP-1RA with placebo or active drugs. Mantel-Haenszel odds ratio with 95% confidence interval (MH-OR) was calculated for pancreatitis. RESULTS 80 eligible trials were identified. Of these, 39 had not disclosed their findings or did not report any information on pancreatitis. The remaining 41 trials enrolled 14,972 patients, with a total exposure of 14,333 patient × years (8353 and 5980 patient × years for GLP-1 receptor agonists and comparators, respectively). The overall risk of pancreatitis was not different between GLP-1RA and comparators (MH-OR: 1.01[0.37; 2.76]; p = 0.99). CONCLUSIONS The present meta-analysis does not suggest any increase in the risk of pancreatitis with the use of GLP-1RA. However, it should be recognized that the number of observed cases of incident pancreatitis is very small and the confidence intervals of risk estimates are wide.
Collapse
Affiliation(s)
- Matteo Monami
- Section of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy
| | - Ilaria Dicembrini
- Obesity Agency, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy; Diabetes Agency, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy
| | - Camilla Nardini
- Section of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy
| | - Irene Fiordelli
- Section of Geriatric Cardiology and Medicine, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy
| | - Edoardo Mannucci
- Diabetes Agency, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy.
| |
Collapse
|
50
|
Nadkarni P, Chepurny OG, Holz GG. Regulation of glucose homeostasis by GLP-1. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2014. [PMID: 24373234 DOI: 10.1016/b978-0-12-800101-1.00002-8.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/01/2022]
Abstract
Glucagon-like peptide-1(7-36)amide (GLP-1) is a secreted peptide that acts as a key determinant of blood glucose homeostasis by virtue of its abilities to slow gastric emptying, to enhance pancreatic insulin secretion, and to suppress pancreatic glucagon secretion. GLP-1 is secreted from L cells of the gastrointestinal mucosa in response to a meal, and the blood glucose-lowering action of GLP-1 is terminated due to its enzymatic degradation by dipeptidyl-peptidase-IV (DPP-IV). Released GLP-1 activates enteric and autonomic reflexes while also circulating as an incretin hormone to control endocrine pancreas function. The GLP-1 receptor (GLP-1R) is a G protein-coupled receptor that is activated directly or indirectly by blood glucose-lowering agents currently in use for the treatment of type 2 diabetes mellitus (T2DM). These therapeutic agents include GLP-1R agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, and langlenatide) and DPP-IV inhibitors (sitagliptin, vildagliptin, saxagliptin, linagliptin, and alogliptin). Investigational agents for use in the treatment of T2DM include GPR119 and GPR40 receptor agonists that stimulate the release of GLP-1 from L cells. Summarized here is the role of GLP-1 to control blood glucose homeostasis, with special emphasis on the advantages and limitations of GLP-1-based therapeutics.
Collapse
Affiliation(s)
- Prashant Nadkarni
- Department of Medicine, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA; Joslin Diabetes Center, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Oleg G Chepurny
- Department of Medicine, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - George G Holz
- Department of Medicine, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA; Department of Pharmacology, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA.
| |
Collapse
|