1
|
Andraos J, Muhar H, Smith SR. Beyond glycemia: Comparing tirzepatide to GLP-1 analogues. Rev Endocr Metab Disord 2023; 24:1089-1101. [PMID: 37526853 PMCID: PMC10697893 DOI: 10.1007/s11154-023-09825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
Glucagon-like peptide-1 receptor analogs (GLP-1 RAs) have been an innovative and instrumental drug class in the management of both type 2 diabetes and obesity. Tirzepatide is a novel agent that acts as an agonist for both GLP-1 receptors and gastric inhibitory polypeptide (GIP) receptors, another incretin that lowers glucose and appetite. Although previous studies showed a lack of therapeutic benefit for GIP agonists, current studies show that the glucose lowering and weight loss effects of tirzepatide are at least as effective as GLP-1 RAs with a similar adverse effect profile. Some studies, though not conclusive, predict that tirzepatide may in fact be more potent than GLP-1 RAs at reducing weight. A thorough review of the studies that led to tirzepatide's approval allows for comparisons between tirzepatide and GLP-1 RAs; it also allows for predictions of tirzepatide's eventual place in therapy - an agent used preferentially over GLP-1 RAs in patients with or without diabetes desiring to lose weight.
Collapse
Affiliation(s)
- John Andraos
- College of Pharmacy, Western University of Health Sciences, 91766, Pomona, CA, USA.
| | | | - Shawn R Smith
- College of Pharmacy, Western University of Health Sciences, 91766, Pomona, CA, USA
| |
Collapse
|
2
|
Exendin-4 Exacerbates Burn-Induced Mortality in Mice by Switching to Th2 Response. J Surg Res 2022; 280:333-347. [PMID: 36030610 DOI: 10.1016/j.jss.2022.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To determine if Exendin-4 could be a therapeutic agent for burn-induced hyperglycemia. MATERIALS AND METHODS Male Balb/c mice received a bolus of Exendin-4 intraperitoneally immediately after 15% total body surface area scald injury. Tail glucose levels were recorded and T-cell functions were analyzed at 4 h and 24 h postburn (pb). Pancreatic pathology was observed consecutively. The secretions of cytokines were detected in serum, spleen, and lung. Apoptosis of splenic CD3+ T-cells was examined by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling and flow cytometry. RESULTS Although Exendin-4 could attenuate burn-induced hyperglycemia in mice at 4 h pb, it accelerated their survival dose dependently with progressive depletion of splenocyte number. T-cell function underwent two-phasic changes following Exendin-4 treatment. Compared to placebo mice, T-cell from Exendin-4-treated mice was manifested with increased proliferation, while decreased IL-2 secretion and lower ratio of IL-4/IFN-γ at 4 h pb. However, at 24 h pb, it showed decreased proliferation, while increased IL-2 secretion and higher ratio of IL-4/IFN-γ. Exendin-4 could elicit higher circulating IL-6 and IL-10 levels at 4 h pb, which were pronounced in the lung at 24 h pb. In the meanwhile, severe inflammation could be found in the pancreas. At 24 h pb, the numbers of terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling or caspase-3 positive cells and the apoptosis of CD3+ T-cells were significantly increased in the spleens of Exendin-4 mice relative to placebo mice. CONCLUSIONS These data support a pathogenic role of Exendin-4 signaling during thermal injury, warning against its clinical application in acute insults.
Collapse
|
3
|
Magida JA, Tan Y, Wall CE, Harrison BC, Marr TG, Peter AK, Riquelme CA, Leinwand LA. Burmese pythons exhibit a transient adaptation to nutrient overload that prevents liver damage. J Gen Physiol 2022; 154:213093. [PMID: 35323838 PMCID: PMC8958269 DOI: 10.1085/jgp.202113008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 01/02/2023] Open
Abstract
As an opportunistic predator, the Burmese python (Python molurus bivittatus) consumes large and infrequent meals, fasting for up to a year. Upon consuming a large meal, the Burmese python exhibits extreme metabolic responses. To define the pathways that regulate these postprandial metabolic responses, we performed a comprehensive profile of plasma metabolites throughout the digestive process. Following ingestion of a meal equivalent to 25% of its body mass, plasma lipoproteins and metabolites, such as chylomicra and bile acids, reach levels observed only in mammalian models of extreme dyslipidemia. Here, we provide evidence for an adaptive response to postprandial nutrient overload by the python liver, a critical site of metabolic homeostasis. The python liver undergoes a substantial increase in mass through proliferative processes, exhibits hepatic steatosis, hyperlipidemia-induced insulin resistance indicated by PEPCK activation and pAKT deactivation, and de novo fatty acid synthesis via FASN activation. This postprandial state is completely reversible. We posit that Burmese pythons evade the permanent hepatic damage associated with these metabolic states in mammals using evolved protective measures to inactivate these pathways. These include a transient activation of hepatic nuclear receptors induced by fatty acids and bile acids, including PPAR and FXR, respectively. The stress-induced p38 MAPK pathway is also transiently activated during the early stages of digestion. Taken together, these data identify a reversible metabolic response to hyperlipidemia by the python liver, only achieved in mammals by pharmacologic intervention. The factors involved in these processes may be relevant to or leveraged for remediating human hepatic pathology.
Collapse
Affiliation(s)
- Jason A Magida
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO.,Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - Yuxiao Tan
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO
| | - Christopher E Wall
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO.,Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - Brooke C Harrison
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO
| | | | - Angela K Peter
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO
| | - Cecilia A Riquelme
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO.,Department of Cell and Molecular Biology, Catholic University of Chile, Santiago, Chile
| | - Leslie A Leinwand
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO
| |
Collapse
|
4
|
Zhao D, Ma L, Shen C, Li D, Cheng W, Shang Y, Liu Z, Wang X, Yin K. Long-lasting Glucagon-like Peptide 1 Analogue Exendin-4 Ameliorates the Secretory and Synthetic Function of Islets Isolated From Severely Scalded Rats. J Burn Care Res 2018; 39:545-554. [PMID: 29579298 DOI: 10.1093/jbcr/irx014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dongxu Zhao
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Li Ma
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Chuanan Shen
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Dawei Li
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Wenfeng Cheng
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Yuru Shang
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Zhaoxing Liu
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Xin Wang
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Kai Yin
- Department of Burn and Plastic Surgery, Burns Institute, the First Affiliated Hospital of General Hospital of PLA, Beijing, China
| |
Collapse
|
5
|
Schwartz S, DeFronzo RA. The use of non-insulin anti-diabetic agents to improve glycemia without hypoglycemia in the hospital setting: focus on incretins. Curr Diab Rep 2014; 14:466. [PMID: 24515252 DOI: 10.1007/s11892-013-0466-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with hyperglycemia in hospital have increased adverse outcomes compared with patients with normoglycemia, and the pathophysiological causes seem relatively well understood. Thus, a rationale for excellent glycemic control exists. Benefits of control with intensive insulin regimes are highly likely based on multiple published studies. However, hypoglycemia frequency increases and adverse outcomes of hypoglycemia accrue. This has resulted in a 'push' for therapeutic nihilism, accepting higher glycemic levels to avoid hypoglycemia. One would ideally prefer to optimize glycemia, treating hyperglycemia while minimizing or avoiding hypoglycemia. Thus, one would welcome therapies and processes of care to optimize this benefit/ risk ratio. We review the logic and early studies that suggest that incretin therapy use in-hospital can achieve this ideal. We strongly urge randomized prospective controlled studies to test our proposal and we offer a process of care to facilitate this research and their use in our hospitalized patients.
Collapse
Affiliation(s)
- Stanley Schwartz
- Main Line Health System, University of Pennsylvania, Philadelphia, PA, USA,
| | | |
Collapse
|
6
|
Deane AM, Horowitz M. Dysglycaemia in the critically ill - significance and management. Diabetes Obes Metab 2013; 15:792-801. [PMID: 23368662 DOI: 10.1111/dom.12078] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/18/2012] [Accepted: 01/26/2013] [Indexed: 02/05/2023]
Abstract
Hyperglycaemia frequently occurs in the critically ill, in patients with diabetes, as well as those who were previously glucose-tolerant. The terminology 'stress hyperglycaemia' reflects the pathogenesis of the latter group, which may comprise up to 40% of critically ill patients. For comparable glucose concentrations during acute illness outcomes in stress hyperglycaemia appear to be worse than those in patients with type 2 diabetes. While several studies have evaluated the optimum glycaemic range in the critically ill, their interpretation in relation to clinical recommendations is somewhat limited, at least in part because patients with stress hyperglycaemia and known diabetes were grouped together, and the optimum glycaemic range was regarded as static, rather than dynamic, phenomenon. In addition to hyperglycaemia, there is increasing evidence that hypoglycaemia and glycaemic variability influence outcomes in the critically ill adversely. These three categories of disordered glucose metabolism can be referred to as dysglycaemia. While stress hyperglycaemia is most frequently managed by administration of short-acting insulin, guided by simple algorithms, this does not treat all dysglycaemic categories; rather the use of insulin increases the risk of hypoglycaemia and may exacerbate variability. The pathogenesis of stress hyperglycaemia is complex, but hyperglucagonaemia, relative insulin deficiency and insulin resistance appear to be important. Accordingly, novel agents that have a pathophysiological rationale and treat hyperglycaemia, but do not cause hypoglycaemia and limit glycaemic variability, are appealing. The potential use of glucagon-like peptide-1 (or its agonists) and dipeptyl-peptidase-4 inhibitors is reviewed.
Collapse
Affiliation(s)
- A M Deane
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia.
| | | |
Collapse
|