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Singh AK, Singh A, Singh R. Cardiovascular and Renal Outcomes with SGLT-2 inhibitors and DPP-4 inhibitors Combination Therapy: A Meta-analysis of Randomized Cardiovascular Outcome Trials. Endocr Pract 2023:S1530-891X(23)00367-1. [PMID: 37037286 DOI: 10.1016/j.eprac.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE The cardiovascular (CV) and renal benefits of SGLT-2 inhibitors (SGLT2i) in people with type 2 diabetes (T2D) are well known. However, similar beneficial effects of SGLT2i in combination with DPP-4 inhibitors (DPP4i) are not known. It is of interest to explore a trial-level meta-analysis to find out this knowledge gap. METHODS A literature search was carried out in PubMed and Embase databases until January 31, 2023. All CV outcome trials (CVOTs) reporting the CV and renal outcomes of SGLT2i with or without background DPP4i therapy against the placebo were retrieved. A meta-analysis was subsequently conducted by applying the inverse variance-weighted averages of pooled logarithmic hazard ratio using random effects analysis, primarily. RESULTS This meta-analysis showed that the beneficial three-point major adverse cardiovascular events (3P-MACE) composite (three CVOTs; N = 32,418), the composite of CV death or heart failure hospitalization (hHF) (four CVOTs; N = 37,687), hHF (three CVOTs; N = 27,545), CV death (four CVOTs; N = 34,565), and renal outcomes (two CVOTs; N = 25,406) with SGLT2i are similar with or without background DPP4i therapy against the placebo (Pheterogeneity = 0.71, 0.07, 0.87, 0.72, and 0.25; respectively). However, against the placebo, the summary estimates for 3P-MACE composite, hHF, and renal outcomes were stronger with SGLT2i alone whilst the summary estimates for CV death or hHF composite were larger with SGLT2i with background DPP4i therapy. CONCLUSION Beneficial CV and renal effects of SGLT2i are similar against placebo regardless of background DPP4i therapy.
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Affiliation(s)
- Awadhesh Kumar Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Sun Valley Hospital & Diabetes Research center, Guwahati, Assam, India; Horizon Life Line Multispecialty Hospital, Kolkata, West Bengal India.
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Horizon Life Line Multispecialty Hospital, Kolkata, West Bengal India
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Marques MS, Marinho MAG, Vian CO, Horn AP. The action of curcumin against damage resulting from cerebral stroke: a systematic review. Pharmacol Res 2022; 183:106369. [PMID: 35914679 DOI: 10.1016/j.phrs.2022.106369] [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: 06/07/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/09/2022]
Abstract
Stroke is the second leading cause of morbidity and mortality globally. Treatments for stroke are limited, and preventive treatments are scarce. Curcumin (CUR) has several biological effects, as described in the literature, which highlight its antioxidant and neuroprotective effects. Therefore, this qualitative systematic review aimed to investigate the effects of CUR on damage caused by stroke in rodent models. A systematic search was performed on three databases PubMed, Scopus, and Web of Science. In addition, the risk-of-bias and quality of the studies were assessed using SYRCLE and Collaborative Approach for Meta-Analysis and Review of Animal Data from Experimental Studies, respectively. The selection, inclusion, and exclusion criteria were established by the authors. At the end of our systematic search of the three databases, we found a total of 728 articles. After excluding duplicates and triplicates and reading the abstracts, keywords, and full texts, 53 articles were finally included in this systematic review. CUR exerts several beneficial effects against the damage caused by both ischemic and hemorrhagic stroke, via different pathways. However, because of its low bioavailability, Free-form CUR only exerted significant effects when it was administered at high concentrations. In contrast, when CUR was administered using nanostructured systems, positive responses were observed even at low concentrations. The mechanisms of action of CUR, free or in nanostructure, are extremely important for the recovery of injured brain tissue after a stroke; CUR has neuroprotective, antioxidant, anti-inflammatory, and anti-apoptotic effects and helps to maintain the integrity of the blood-brain barrier. Finally, we concluded that CUR presents an extremely important and significant response profile against the damage caused by stroke, making it a possible therapeutic candidate for individuals affected by this disease.
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Affiliation(s)
- M S Marques
- Programa de Pós-graduação em Ciências Fisiológicas, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, 96210-900, Brazil; Laboratório de Neurociências, Instituto de Ciências Biológicas, FURG, Rio Grande, RS, 96210-900, Brazil.
| | - M A G Marinho
- Programa de Pós-graduação em Ciências Fisiológicas, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, 96210-900, Brazil; Laboratório de Neurociências, Instituto de Ciências Biológicas, FURG, Rio Grande, RS, 96210-900, Brazil
| | - C O Vian
- Programa de Pós-graduação em Ciências Fisiológicas, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, 96210-900, Brazil; Laboratório de Neurociências, Instituto de Ciências Biológicas, FURG, Rio Grande, RS, 96210-900, Brazil
| | - A P Horn
- Programa de Pós-graduação em Ciências Fisiológicas, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, 96210-900, Brazil; Laboratório de Neurociências, Instituto de Ciências Biológicas, FURG, Rio Grande, RS, 96210-900, Brazil
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In vitro and in silico inhibition properties of fucoidan against α-amylase and α-D-glucosidase with relevance to type 2 diabetes mellitus. Carbohydr Polym 2019; 209:350-355. [DOI: 10.1016/j.carbpol.2019.01.039] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 11/21/2022]
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Singh AK, Unnikrishnan AG, Zargar AH, Kumar A, Das AK, Saboo B, Sinha B, Gangopadhyay KK, Talwalkar PG, Ghosal S, Kalra S, Joshi S, Sharma SK, Sriram U, Mohan V. Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians. Diabetes Ther 2019; 10:393-428. [PMID: 30706366 PMCID: PMC6437257 DOI: 10.1007/s13300-019-0562-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications. Some of the unique characteristics associated with SGLT2i, such as reduction in body weight (more visceral fat mass loss than subcutaneous fat loss), reduction in insulin resistance and improvement in β-cell function, as measured by homeostatic model assessment-β (HOMA-β) could be potentially beneficial and help in overcoming some of the challenges faced by Indian patients with diabetes. In addition, a patient-centric approach with individualised treatment during SGLT2i therapy is inevitable in order to reduce diabetic complications and improve quality of life. Despite their broad benefits profile, the risk of genital tract infections, volume depletion, amputations and diabetic ketoacidosis associated with SGLT2i should be carefully monitored. In this compendium, we systematically reviewed the literature from Medline, Cochrane Library, and other relevant databases and attempted to provide evidence-based recommendations for the positioning of SGLT2i in the management of diabetes in the Indian population.Funding: AstraZeneca Pharma India Limited.
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Affiliation(s)
| | | | - Abdul H Zargar
- Advanced Centre for Diabetes and Endocrine Care, Srinagar, Jammu and Kashmir, India
| | - Ajay Kumar
- Diabetes Care and Research Centre, Patna, Bihar, India
| | - Ashok K Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Banshi Saboo
- Diacare-Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | | | | | | | - Samit Ghosal
- Nightingale Hospital, Kolkata, West Bengal, India
| | - Sanjay Kalra
- Bharti Hospital & B.R.I.D.E, Karnal, Haryana, India
| | - Shashank Joshi
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | - Usha Sriram
- Clinical Endocrinology Education and Research (ACEER), Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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Aroor AR, Manrique-Acevedo C, DeMarco VG. The role of dipeptidylpeptidase-4 inhibitors in management of cardiovascular disease in diabetes; focus on linagliptin. Cardiovasc Diabetol 2018; 17:59. [PMID: 29669555 PMCID: PMC5907287 DOI: 10.1186/s12933-018-0704-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 12/15/2022] Open
Abstract
Multiple population based analyses have demonstrated a high incidence of cardiovascular disease (CVD) and cardiovascular (CV) mortality in subjects with T2DM that reduces life expectancy by as much as 15 years. Importantly, the CV system is particularly sensitive to the metabolic and immune derangements present in obese pre-diabetic and diabetic individuals; consequently, CV dysfunction is often the initial CV derangement to occur and promotes the progression to end organ/tissue damage in T2DM. Specifically, diabetic CVD can manifest as microvascular complications, such as nephropathy, retinopathy, and neuropathy, as well as, macrovascular impairments, including ischemic heart disease, peripheral vascular disease, and cerebrovascular disease. Despite some progress in prevention and treatment of CVD, mainly via blood pressure and dyslipidemia control strategies, the impact of metabolic disease on CV outcomes is still a major challenge and persists in proportion to the epidemics of obesity and diabetes. There is abundant pre-clinical and clinical evidence implicating the DPP-4-incretin axis in CVD. In this regard, linagliptin is a unique DPP-4 inhibitor with both CV and renal safety profiles. Moreover, it exerts beneficial CV effects beyond glycemic control and beyond class effects. Linagliptin is protective for both macrovascular and microvascular complications of diabetes in preclinical models, as well as clinical models. Given the role of endothelial-immune cell interactions as one of the key events in the initiation and progression of CVD, linagliptin modulates these cell–cell interactions by affecting two important pathways involving stimulation of NO signaling and potent inhibition of a key immunoregulatory molecule.
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Affiliation(s)
- Annayya R Aroor
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Camila Manrique-Acevedo
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Vincent G DeMarco
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA. .,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA. .,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA. .,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.
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Scheen AJ. Pharmacokinetic Characteristics and Clinical Efficacy of an SGLT2 Inhibitor Plus DPP-4 Inhibitor Combination Therapy in Type 2 Diabetes. Clin Pharmacokinet 2018; 56:703-718. [PMID: 28039605 DOI: 10.1007/s40262-016-0498-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Type 2 diabetes (T2D) generally requires a combination of several pharmacological approaches to control hyperglycaemia. Combining a sodium-glucose cotransporter type 2 inhibitor (SGLT2I, also known as gliflozin) and a dipeptidyl peptidase-4 inhibitor (DPP-4I, also known as gliptin) appears to be an attractive strategy because of complementary modes of action. This narrative review analyzes the pharmacokinetics and clinical efficacy of different combined therapies with an SGLT2I (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, ipragliflozin, luseogliflozin, tofogliflozin) and DPP-4I (linagliptin, saxagliptin, sitagliptin, teneligliptin). Drug-drug pharmacokinetic interaction studies do not show any significant changes in peak concentrations (C max) and total exposure (area under the curve of plasma concentrations [AUC]) of either drug when they were administered together orally compared with corresponding values when each of them was absorbed alone. Two fixed-dose combinations (FDCs) are already available (dapagliflozin-saxagliptin, empagliflozin-linagliptin) and others are in development (ertugliflozin-sitagliptin). Preliminary results show bioequivalence of the two medications administered as FDC tablets when compared with coadministration of the individual tablets. Dual therapy is more potent than either monotherapy in patients treated with diet and exercise or already treated with metformin. SGLT2I and DPP-4I could be used as initial combination or in a stepwise approach. The additional glucose-lowering effect appears to be more marked when a gliflozin is added to a gliptin than when a gliptin is added to a gliflozin. Combining the two pharmacological options is safe and does not induce hypoglycaemia.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, CHU Sart Tilman (B35), 4000, Liège 1, Belgium. .,Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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Xia M, Ye Z, Shi Y, Zhou L, Hua Y. Curcumin improves diabetes mellitus‑associated cerebral infarction by increasing the expression of GLUT1 and GLUT3. Mol Med Rep 2017; 17:1963-1969. [PMID: 29257220 DOI: 10.3892/mmr.2017.8085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/03/2017] [Indexed: 11/05/2022] Open
Abstract
Curcumin is characterized by anti‑inflammatory, anti‑oxidative, antiviral, antifibrotic, anticoagulation and glucose regulatory functions. However, whether it is protective in diabetes mellitus‑associated cerebral infarction remains to be fully elucidated. In the present study, it was demonstrated for the first time, to the best of our knowledge, that curcumin markedly improved neurological deficits, cerebral infarct volume and brain edema rate following middle cerebral artery occlusion (MCAO) surgery. It was also shown that the expression levels of glucose transporter (GLUT)1 and GLUT3 were reduced in the MCAO group. However, following curcumin treatment, the levels of GLUT1 and GLUT3 were markedly increased. In addition, curcumin markedly decreased cell apoptosis, indicating an anti‑apoptotic role of curcumin in the brain. To further evaluate whether curcumin prevented cell apoptosis by modulating the expression of GLUT1 and GLUT3, small interfering RNAs targeting GLUT1 and GLUT3 were selected. It was found that the knockdown of GLUT1 and GLUT3 inhibited the abundance of GLUT1, GLUT3 and B‑cell lymphoma 2, even following incubation with curcumin. These data showed that curcumin protected brain cells from apoptosis and cerebral infarction, predominantly by upregulating GLUT1 and GLUT3.
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Affiliation(s)
- Mingyu Xia
- Vascular Ultrasonography Department, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Zankai Ye
- Structural Heart Disease Department, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, P.R. China
| | - Yanfeng Shi
- Radiology Department, Daqing Longnan Hospital, Daqing, Heilongjiang 163453, P.R. China
| | - Libo Zhou
- Traditional Chinese Medicine Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P.R. China
| | - Yang Hua
- Vascular Ultrasonography Department, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
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Kuang H, Liao L, Chen H, Kang Q, Shu X, Wang Y. Therapeutic Effect of Sodium Glucose Co-Transporter 2 Inhibitor Dapagliflozin on Renal Cell Carcinoma. Med Sci Monit 2017; 23:3737-3745. [PMID: 28763435 PMCID: PMC5549715 DOI: 10.12659/msm.902530] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Patients with type 2 diabetes mellitus (T2DM) have a high incidence of renal cell carcinoma (RCC) and high sodium glucose co-transporters 2 (SGLT2) expressions. The purpose of this study was to evaluate the anticancer activity of dapagliflozin as an SGLT2 inhibitor on RCC cell lines in vitro and in vivo. Material/Methods qRT-PCR and Western blot were used to detect SGLT2 expression on different human renal cells. Then, flow cytometry and immunofluorescence were used to investigate the effects of dapagliflozin on cell cycle, apoptosis, and SGLT2 expression of CaKi-1 cells. Finally, a xenograft model and immunohistochemical staining were used to investigate the function of dapagliflozin in nude mice. Results We proved that SGLT2 is highly expressed in RCC cell lines. We found that dapagliflozin exerts a higher cytotoxic effect on human RCC than on normal human renal cells, regulates the cell cycle and apoptosis, and reduces the glucose uptake and SGLT2 expression of CaKi-1 cells. Moreover, dapagliflozin inhibits tumor growth and reduces SGLT2 expression in vivo. Conclusions Our results indicate that dapagliflozin has high efficiency and low toxicity and could be a new therapeutic target for RCC.
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Affiliation(s)
- Haoyu Kuang
- Department of Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China (mainland)
| | - Liya Liao
- Department of Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China (mainland)
| | - Hongtao Chen
- Department of Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China (mainland)
| | - Qian Kang
- Department of Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China (mainland)
| | - Xiaochun Shu
- Department of Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China (mainland)
| | - Yanan Wang
- Department of Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China (mainland)
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Cuatrecasas G, Goñi-Goicoechea F. Perfil clínico de los pacientes con diabetes mellitus tipo 2 tratados con inhibidores del cotransportador sodio-glucosa tipo 2 y experiencia clínica real en España. Med Clin (Barc) 2016; 147 Suppl 1:30-34. [DOI: 10.1016/s0025-7753(17)30623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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