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Kajani S, Laker RC, Ratkova E, Will S, Rhodes CJ. Hepatic glucagon action: beyond glucose mobilization. Physiol Rev 2024; 104:1021-1060. [PMID: 38300523 DOI: 10.1152/physrev.00028.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Glucagon's ability to promote hepatic glucose production has been known for over a century, with initial observations touting this hormone as a diabetogenic agent. However, glucagon receptor agonism [when balanced with an incretin, including glucagon-like peptide 1 (GLP-1) to dampen glucose excursions] is now being developed as a promising therapeutic target in the treatment of metabolic diseases, like metabolic dysfunction-associated steatotic disease/metabolic dysfunction-associated steatohepatitis (MASLD/MASH), and may also have benefit for obesity and chronic kidney disease. Conventionally regarded as the opposing tag-team partner of the anabolic mediator insulin, glucagon is gradually emerging as more than just a "catabolic hormone." Glucagon action on glucose homeostasis within the liver has been well characterized. However, growing evidence, in part thanks to new and sensitive "omics" technologies, has implicated glucagon as more than just a "glucose liberator." Elucidation of glucagon's capacity to increase fatty acid oxidation while attenuating endogenous lipid synthesis speaks to the dichotomous nature of the hormone. Furthermore, glucagon action is not limited to just glucose homeostasis and lipid metabolism, as traditionally reported. Glucagon plays key regulatory roles in hepatic amino acid and ketone body metabolism, as well as mitochondrial turnover and function, indicating broader glucagon signaling consequences for metabolic homeostasis mediated by the liver. Here we examine the broadening role of glucagon signaling within the hepatocyte and question the current dogma, to appreciate glucagon as more than just that "catabolic hormone."
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Affiliation(s)
- Sarina Kajani
- Early Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, United States
| | - Rhianna C Laker
- Early Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, United States
| | - Ekaterina Ratkova
- Early Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Mölndal, Sweden
| | - Sarah Will
- Early Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, United States
| | - Christopher J Rhodes
- Early Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, United States
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2
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Portillo EC, Maurer MA, Kettner JT, Bhardwaj SD, Zhang Z, Sedgwick C, Gilson AM, Stone JA, Jacobson N, Hennessy-Garza R, Will S, McFarland MS, Ourth H, Chui MA. Applying RE-AIM to examine the impact of an implementation facilitation package to scale up a program for Veterans with chronic obstructive pulmonary disease. Implement Sci Commun 2023; 4:143. [PMID: 37990241 PMCID: PMC10664371 DOI: 10.1186/s43058-023-00520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND US Veterans are four times more likely to be diagnosed with chronic obstructive pulmonary disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based practices to Veterans. To address challenges to scaling this program in the Veterans' Health Administration (VA), the COPD CARE Academy (Academy), an implementation facilitation package comprised of five implementation strategies was designed and implemented. METHODS This evaluation utilized a mixed-methods approach to assess the impact of the Academy's implementation strategies on the RE-AIM framework implementation outcomes and the extent to which they were effective at increasing clinicians' perceived capability to implement COPD CARE. A survey was administered one week after Academy participation and a semi-structured interview conducted 8 to 12 months later. Descriptive statistics were calculated for quantitative items and thematic analysis was used to analyze open-ended items. RESULTS Thirty-six clinicians from 13 VA medical centers (VAMCs) participated in the Academy in 2020 and 2021 and 264 front-line clinicians completed COPD CARE training. Adoption of the Academy was indicated by high rates of Academy session attendance (90%) and high utilization of Academy resources. Clinicians reported the Academy to be acceptable and appropriate as an implementation package and clinicians from 92% of VAMCs reported long-term utilization of Academy resources. Effectiveness of the Academy was represented by clinicians' significant increases (p < 0.05) in their capability to complete ten implementation tasks after Academy participation. CONCLUSIONS This evaluation found that the use of implementation facilitation paired with additional strategies enhanced the capacity of clinicians to implement COPD CARE. Future assessments are needed to explore post-academy resources that would help VAMCs to strategize localized approaches to overcome barriers.
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Affiliation(s)
- Edward C Portillo
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA.
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA.
| | - Martha A Maurer
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
| | - Jordyn T Kettner
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Sonia D Bhardwaj
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Ziting Zhang
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Cassie Sedgwick
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Aaron M Gilson
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
| | - Jamie A Stone
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing, University of Wisconsin - Madison, 4240 Health Sciences Learning Center, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Rose Hennessy-Garza
- Zilber School of Public Health, University of Wisconsin - Milwaukee, 1240 N 10th St, Milwaukee, WI, 53205, USA
| | - Sarah Will
- Kansas City Veterans Affairs Medical Center, 4801 Linwood Blvd, Kansas City, MO, 64128, USA
- Department of Veterans Affairs Pharmacy Benefits Management, Clinical Pharmacy Practice Office, 810 Vermont Avenue NW, Washington, DC, 20571, USA
| | - M Shawn McFarland
- Department of Veterans Affairs Pharmacy Benefits Management, Clinical Pharmacy Practice Office, 810 Vermont Avenue NW, Washington, DC, 20571, USA
| | - Heather Ourth
- Department of Veterans Affairs Pharmacy Benefits Management, Clinical Pharmacy Practice Office, 810 Vermont Avenue NW, Washington, DC, 20571, USA
| | - Michelle A Chui
- School of Pharmacy, University of Wisconsin - Madison, 77 Highland Avenue, Madison, WI, 53705, USA
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3
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Tyagi P, Patel C, Gibson K, MacDougall F, Pechenov SY, Will S, Revell J, Huang Y, Rosenbaum AI, Balic K, Maharoof U, Grimsby J, Subramony JA. Systems Biology and Peptide Engineering to Overcome Absorption Barriers for Oral Peptide Delivery: Dosage Form Optimization Case Study Preceding Clinical Translation. Pharmaceutics 2023; 15:2436. [PMID: 37896196 PMCID: PMC10610252 DOI: 10.3390/pharmaceutics15102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023] Open
Abstract
Oral delivery of peptides and biological molecules promises significant benefits to patients as an alternative to daily injections, but the development of these formulations is challenging due to their low bioavailability and high pharmacokinetic variability. Our earlier work focused on the discovery of MEDI7219, a stabilized, lipidated, glucagon-like peptide 1 agonist peptide, and the selection of sodium chenodeoxycholate (Na CDC) and propyl gallate (PG) as permeation enhancer combinations. We hereby describe the development of the MEDI7219 tablet formulations and composition optimization via in vivo studies in dogs. We designed the MEDI7219 immediate-release tablets with the permeation enhancers Na CDC and PG. Immediate-release tablets were coated with an enteric coating that dissolves at pH ≥ 5.5 to target the upper duodenal region of the gastrointestinal tract and sustained-release tablets with a Carbopol bioadhesive polymer were coated with an enteric coating that dissolves at pH ≥ 7.0 to provide a longer presence at the absorption site in the gastrointestinal tract. In addition to immediate- and enteric-coated formulations, we also tested a proprietary delayed release erodible barrier layer tablet (OralogiKTM) to deliver the payload to the target site in the gastrointestinal tract. The design of tablet dosage forms based on the optimization of formulations resulted in up to 10.1% absolute oral bioavailability in dogs with variability as low as 26% for MEDI7219, paving the way for its clinical development.
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Affiliation(s)
- Puneet Tyagi
- Dosage Form Design and Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Chandresh Patel
- Dosage Form Design and Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | | | | | - Sergei Y. Pechenov
- Dosage Form Design and Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Sarah Will
- Bioscience Metabolism, Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA (J.G.)
| | - Jefferson Revell
- Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB2 0AA, UK
| | - Yue Huang
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, San Francisco, CA 94080, USA (A.I.R.)
| | - Anton I. Rosenbaum
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, San Francisco, CA 94080, USA (A.I.R.)
| | - Kemal Balic
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, San Francisco, CA 94080, USA;
| | - Umar Maharoof
- Dosage Form Design and Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Joseph Grimsby
- Bioscience Metabolism, Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA (J.G.)
| | - J. Anand Subramony
- Biologics Engineering, Oncology R&D, AstraZeneca, Gaithersburg, MD 20878, USA
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4
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Portillo EC, Maurer MA, Kettner JT, Bhardwaj SD, Zhang Z, Sedgwick C, Gilson AM, Stone JA, Jacobson N, Hennessy-Garza R, Will S, McFarland MS, Ourth H, Chui MA. Applying RE-AIM to examine the impact of an implementation facilitation package to scale up a program for Veterans with Chronic Obstructive Pulmonary Disease. Res Sq 2023:rs.3.rs-2809287. [PMID: 37333195 PMCID: PMC10275052 DOI: 10.21203/rs.3.rs-2809287/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background U.S. Veterans are four-times more likely to be diagnosed with Chronic Obstructive Pulmonary Disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based practices to Veterans. To address challenges to scaling this program in the Veterans' Health Administration (VA), the COPD CARE Academy (Academy), an implementation facilitation package comprised of four implementation strategies was designed and implemented. Methods This evaluation utilized a mixed-methods approach to assess the impact of the Academy's implementation strategies on the RE-AIM framework implementation outcomes and the extent to which they were effective at increasing clinicians' perceived capability to implement COPD CARE. A survey was administered one week after Academy participation and a semi-structured interview conducted eight to 12 months later. Descriptive statistics were calculated for quantitative items and thematic analysis was used to analyze open-ended items. Results Thirty-six clinicians from 13 VA medical centers (VAMCs) participated in the Academy in 2020 and 2021 and 264 front-line clinicians completed COPD CARE training. Adoption of the Academy was indicated by high rates of Academy completion (97%), session attendance (90%), and high utilization of Academy resources. Clinicians reported the Academy to be acceptable and appropriate as an implementation package and clinicians from 92% of VAMCs reported long-term utilization of Academy resources. Effectiveness of the Academy was represented by clinicians' significant increases (p < 0.05) in their capability to complete ten implementation tasks after Academy participation. Conclusions This evaluation found that the use of implementation facilitation paired with additional strategies seemed to demonstrate positive implementation outcomes across all RE-AIM domains and identified areas for potential improvement. Future assessments are needed to explore post-academy resources that would help VAMCs to strategize localized approaches to overcome barriers.
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Affiliation(s)
| | | | | | | | - Ziting Zhang
- University of Wisconsin-Madison School of Pharmacy
| | - Cassie Sedgwick
- VA Medical Center Madison: William S Middleton Memorial Veterans Hospital
| | | | | | - Nora Jacobson
- University of Wisconsin-Madison Institute for Clinical and Translational Reserach
| | - Rose Hennessy-Garza
- UWM Joseph J Zilber School of Public Health: University of Wisconsin-Milwaukee Joseph J Zilber School of Public Health
| | - Sarah Will
- Department of Veterans Affairs Pharmacy Benefits Management Clinical Pharmacy Practice Office
| | - M Shawn McFarland
- Department of Veterans Affairs Pharmacy Benefits Management Clinical Pharmacy Practice Office
| | - Heather Ourth
- Department of Veterans Affairs Pharmacy Benefits Management Clinical Pharmacy Practice Office
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5
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Tyagi P, Koskinen M, Mikkola J, Sarkhel S, Leino L, Seth A, Madalli S, Will S, Howard VG, Brant H, Corkill D. Injectable Biodegradable Silica Depot: Two Months of Sustained Release of the Blood Glucose Lowering Peptide, Pramlintide. Pharmaceutics 2022; 14:pharmaceutics14030553. [PMID: 35335929 PMCID: PMC8952239 DOI: 10.3390/pharmaceutics14030553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus is a major healthcare challenge. Pramlintide, a peptide analogue of the hormone amylin, is currently used as an adjunct with insulin for patients who fail to achieve glycemic control with only insulin therapy. However, hypoglycemia is the dominant risk factor associated with such approaches and careful dosing of both drugs is needed. To mitigate this risk factor and compliance issues related to multiple dosing of different drugs, sustained delivery of Pramlintide from silica depot administered subcutaneously (SC) was investigated in a rat model. The pramlintide-silica microparticle hydrogel depot was formulated by spray drying of silica sol-gels. In vitro dissolution tests revealed an initial burst of pramlintide followed by controlled release due to the dissolution of the silica matrix. At higher dosing, pramlintide released from subcutaneously administered silica depot in rats showed a steady concentration of 500 pM in serum for 60 days. Released pramlintide retained its pharmacological activity in vivo, as evidenced by loss of weight. The biodegradable silica matrix offers a sustained release of pramlintide for at least two months in the rat model and shows potential for clinical applications.
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Affiliation(s)
- Puneet Tyagi
- Dosage Form Design and Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20874, USA
- Correspondence: ; Tel.: +1-301-398-5532
| | - Mika Koskinen
- DelSiTech Ltd., PharmaCity, Itäinen Pitkäkatu 4 B, 20520 Turku, Finland; (M.K.); (J.M.); (S.S.); (L.L.)
| | - Jari Mikkola
- DelSiTech Ltd., PharmaCity, Itäinen Pitkäkatu 4 B, 20520 Turku, Finland; (M.K.); (J.M.); (S.S.); (L.L.)
| | - Sanjay Sarkhel
- DelSiTech Ltd., PharmaCity, Itäinen Pitkäkatu 4 B, 20520 Turku, Finland; (M.K.); (J.M.); (S.S.); (L.L.)
| | - Lasse Leino
- DelSiTech Ltd., PharmaCity, Itäinen Pitkäkatu 4 B, 20520 Turku, Finland; (M.K.); (J.M.); (S.S.); (L.L.)
| | - Asha Seth
- Renal BioScience, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB21 6GP, UK; (A.S.); (S.M.)
| | - Shimona Madalli
- Renal BioScience, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB21 6GP, UK; (A.S.); (S.M.)
| | - Sarah Will
- Metabolism BioScience, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA; (S.W.); (V.G.H.)
| | - Victor G. Howard
- Metabolism BioScience, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA; (S.W.); (V.G.H.)
| | - Helen Brant
- Animal Science & Technologies UK, Clinical Pharmacology & Safety Sciences, AstraZeneca, Cambridge CB21 6GP, UK;
| | - Dominic Corkill
- Early R&I BioPharmaceuticals R&D, AstraZeneca, Cambridge CB21 6GP, UK;
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6
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Pechenov S, Revell J, Will S, Naylor J, Tyagi P, Patel C, Liang L, Tseng L, Huang Y, Rosenbaum AI, Balic K, Konkar A, Grimsby J, Subramony JA. Development of an orally delivered GLP-1 receptor agonist through peptide engineering and drug delivery to treat chronic disease. Sci Rep 2021; 11:22521. [PMID: 34795324 PMCID: PMC8602401 DOI: 10.1038/s41598-021-01750-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/01/2021] [Indexed: 01/13/2023] Open
Abstract
Peptide therapeutics are increasingly used in the treatment of disease, but their administration by injection reduces patient compliance and convenience, especially for chronic diseases. Thus, oral administration of a peptide therapeutic represents a significant advance in medicine, but is challenged by gastrointestinal instability and ineffective uptake into the circulation. Here, we have used glucagon-like peptide-1 (GLP-1) as a model peptide therapeutic for treating obesity-linked type 2 diabetes, a common chronic disease. We describe a comprehensive multidisciplinary approach leading to the development of MEDI7219, a GLP-1 receptor agonist (GLP-1RA) specifically engineered for oral delivery. Sites of protease/peptidase vulnerabilities in GLP-1 were removed by amino acid substitution and the peptide backbone was bis-lipidated to promote MEDI7219 reversible plasma protein binding without affecting potency. A combination of sodium chenodeoxycholate and propyl gallate was used to enhance bioavailability of MEDI7219 at the site of maximal gastrointestinal absorption, targeted by enteric-coated tablets. This synergistic approach resulted in MEDI7219 bioavailability of ~ 6% in dogs receiving oral tablets. In a dog model of obesity and insulin resistance, MEDI7219 oral tablets significantly decreased food intake, body weight and glucose excursions, validating the approach. This novel approach to the development of MEDI7219 provides a template for the development of other oral peptide therapeutics.
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Affiliation(s)
- Sergei Pechenov
- Drug Delivery, Dosage Form Design and Development, AstraZeneca, Gaithersburg, MD, USA
| | | | - Sarah Will
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Jacqueline Naylor
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Puneet Tyagi
- Drug Delivery, Dosage Form Design and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Chandresh Patel
- Drug Delivery, Dosage Form Design and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Lihuan Liang
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Leo Tseng
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Yue Huang
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Anton I Rosenbaum
- Integrated Bioanalysis, Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, South San Francisco, CA, USA
| | - Kemal Balic
- Integrated Bioanalysis, Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, South San Francisco, CA, USA
| | - Anish Konkar
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Joseph Grimsby
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
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7
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Boland BB, Laker RC, O'Brien S, Sitaula S, Sermadiras I, Nielsen JC, Barkholt P, Roostalu U, Hecksher-Sørensen J, Sejthen SR, Thorbek DD, Suckow A, Burmeister N, Oldham S, Will S, Howard VG, Gill BM, Newton P, Naylor J, Hornigold DC, Austin J, Lantier L, McGuinness OP, Trevaskis JL, Grimsby JS, Rhodes CJ. Peptide-YY 3-36/glucagon-like peptide-1 combination treatment of obese diabetic mice improves insulin sensitivity associated with recovered pancreatic β-cell function and synergistic activation of discrete hypothalamic and brainstem neuronal circuitries. Mol Metab 2021; 55:101392. [PMID: 34781035 PMCID: PMC8717237 DOI: 10.1016/j.molmet.2021.101392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/22/2021] [Accepted: 11/04/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Obesity-linked type 2 diabetes (T2D) is a worldwide health concern and many novel approaches are being considered for its treatment and subsequent prevention of serious comorbidities. Co-administration of glucagon like peptide 1 (Fc-GLP-1) and peptide YY3-36 (Fc-PYY3-36) renders a synergistic decrease in energy intake in obese men. However, mechanistic details of the synergy between these peptide agonists and their effects on metabolic homeostasis remain relatively scarce. METHODS In this study, we utilized long-acting analogues of GLP-1 and PYY3-36 (via Fc-peptide conjugation) to better characterize the synergistic pharmacological benefits of their co-administration on body weight and glycaemic regulation in obese and diabetic mouse models. Hyperinsulinemic-euglycemic clamps were used to measure weight-independent effects of Fc-PYY3-36 + Fc-GLP-1 on insulin action. Fluorescent light sheet microscopy analysis of whole brain was performed to assess activation of brain regions. RESULTS Co-administration of long-acting Fc-IgG/peptide conjugates of Fc-GLP-1 and Fc-PYY3-36 (specific for PYY receptor-2 (Y2R)) resulted in profound weight loss, restored glucose homeostasis, and recovered endogenous β-cell function in two mouse models of obese T2D. Hyperinsulinemic-euglycemic clamps in C57BLKS/J db/db and diet-induced obese Y2R-deficient (Y2RKO) mice indicated Y2R is required for a weight-independent improvement in peripheral insulin sensitivity and enhanced hepatic glycogenesis. Brain cFos staining demonstrated distinct temporal activation of regions of the hypothalamus and hindbrain following Fc-PYY3-36 + Fc-GLP-1R agonist administration. CONCLUSIONS These results reveal a therapeutic approach for obesity/T2D that improved insulin sensitivity and restored endogenous β-cell function. These data also highlight the potential association between the gut-brain axis in control of metabolic homeostasis.
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Affiliation(s)
- Brandon B Boland
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK; Gubra ApS, Horsholm, Denmark; PRECISIONscientia, Yardley, PA, USA
| | - Rhianna C Laker
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Siobhan O'Brien
- Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Sadichha Sitaula
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Isabelle Sermadiras
- Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | | | | | | | | | | | | | - Arthur Suckow
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK; DTX Pharma, San Diego, CA, USA
| | - Nicole Burmeister
- Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK; Roche, Penzberg, Germany
| | - Stephanie Oldham
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Sarah Will
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Victor G Howard
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Benji M Gill
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Philip Newton
- Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Antibody and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Jacqueline Naylor
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - David C Hornigold
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Jotham Austin
- University of Chicago Advanced Electron Microscopy Core Facility, Chicago, IL, USA
| | - Louise Lantier
- Vanderbilt University Mouse Metabolic Phenotyping Center, Nashville, TN, USA
| | - Owen P McGuinness
- Vanderbilt University Mouse Metabolic Phenotyping Center, Nashville, TN, USA
| | - James L Trevaskis
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK; Gilead Sciences, Foster City, CA, USA
| | - Joseph S Grimsby
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Christopher J Rhodes
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
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8
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Roth E, Benoit S, Quentin B, Lam B, Will S, Ma M, Heeley N, Darwish T, Shrestha Y, Gribble F, Reimann F, Pshenichnaya I, Yeo G, Baker DJ, Trevaskis JL, Blouet C. Behavioural and neurochemical mechanisms underpinning the feeding-suppressive effect of GLP-1/CCK combinatorial therapy. Mol Metab 2021; 43:101118. [PMID: 33221554 PMCID: PMC7720077 DOI: 10.1016/j.molmet.2020.101118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Combinatorial therapies are under intense investigation to develop more efficient anti-obesity drugs; however, little is known about how they act in the brain to produce enhanced anorexia and weight loss. The goal of this study was to identify the brain sites and neuronal populations engaged during the co-administration of GLP-1R and CCK1R agonists, an efficient combination therapy in obese rodents. METHODS We measured acute and long-term feeding and body weight responses and neuronal activation patterns throughout the neuraxis and in specific neuronal subsets in response to GLP-1R and CCK1R agonists administered alone or in combination in lean and high-fat diet fed mice. We used PhosphoTRAP to obtain unbiased molecular markers for neuronal populations selectively activated by the combination of the two agonists. RESULTS The initial anorectic response to GLP-1R and CCK1R co-agonism was mediated by a reduction in meal size, but over a few hours, a reduction in meal number accounted for the sustained feeding suppressive effects. The nucleus of the solitary tract (NTS) is one of the few brain sites where GLP-1R and CCK1R signalling interact to produce enhanced neuronal activation. None of the previously categorised NTS neuronal subpopulations relevant to feeding behaviour were implicated in this increased activation. However, we identified NTS/AP Calcrl+ neurons as treatment targets. CONCLUSIONS Collectively, these studies indicated that circuit-level integration of GLP-1R and CCK1R co-agonism in discrete brain nuclei including the NTS produces enhanced rapid and sustained appetite suppression and weight loss.
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Affiliation(s)
- Emma Roth
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Simon Benoit
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Baptiste Quentin
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Brian Lam
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Sarah Will
- Cardiovascular, Renal, and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, USA
| | - Marcella Ma
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Nick Heeley
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Tamana Darwish
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Yashaswi Shrestha
- Early Oncology, Translational Medicine, MedImmune LLC, Gaithersburg, MD 20878, USA
| | - Fiona Gribble
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - Frank Reimann
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | | | - Giles Yeo
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK
| | - David J Baker
- Cardiovascular, Renal and Metabolic Diseases, MedImmune Ltd., Cambridge, UK
| | - James L Trevaskis
- Cardiovascular, Renal and Metabolic Diseases, MedImmune Ltd., Cambridge, UK
| | - Clemence Blouet
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, WT-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 OQQ, UK.
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9
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Perlitz J, Prihoda F, Bänsch E, Lee G, Will S. Untersuchung der Protein‐Einzeltropfentrocknung in einem akustischen Levitator mithilfe laseroptischer Messmethoden. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J. F. A. Perlitz
- Friedrich-Alexander-Universität Erlangen-Nürnberg Lehrstuhl für Technische Thermodynamik (LTT) Am Weichselgarten 8 91058 Erlangen Deutschland
- Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen Graduate School in Advanced Optical Technologies (SAOT) Paul-Gordan-Str. 6 91052 Erlangen Deutschland
| | - F. Prihoda
- Friedrich-Alexander-Universität Erlangen-Nürnberg Lehrstuhl für Pharmazeutische Technologie (LPT) Cauerstr. 4 91058 Erlangen Deutschland
| | - E. Bänsch
- Friedrich-Alexander-Universität Erlangen-Nürnberg Lehrstuhl für Angewandte Mathematik 3 (AM3) Cauerstr. 11 91058 Erlangen Deutschland
| | - G. Lee
- Friedrich-Alexander-Universität Erlangen-Nürnberg Lehrstuhl für Pharmazeutische Technologie (LPT) Cauerstr. 4 91058 Erlangen Deutschland
| | - S. Will
- Friedrich-Alexander-Universität Erlangen-Nürnberg Lehrstuhl für Technische Thermodynamik (LTT) Am Weichselgarten 8 91058 Erlangen Deutschland
- Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen Graduate School in Advanced Optical Technologies (SAOT) Paul-Gordan-Str. 6 91052 Erlangen Deutschland
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10
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Boland BB, Mumphrey MB, Hao Z, Townsend RL, Gill B, Oldham S, Will S, Morrison CD, Yu S, Münzberg H, Rhodes CJ, Trevaskis JL, Berthoud HR. Combined loss of GLP-1R and Y2R does not alter progression of high-fat diet-induced obesity or response to RYGB surgery in mice. Mol Metab 2019; 25:64-72. [PMID: 31126840 PMCID: PMC6600699 DOI: 10.1016/j.molmet.2019.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/30/2019] [Accepted: 05/04/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Understanding the mechanisms underlying the remarkable beneficial effects of gastric bypass surgery is important for the development of non-surgical therapies or less invasive surgeries in the fight against obesity and metabolic disease. Although the intestinal L-cell hormones glucagon-like peptide-1 (GLP-1) and peptide tyrosine-tyrosine (PYY) have attracted the most attention, direct tests in humans and rodents with pharmacological blockade or genetic deletion of either the GLP1-receptor (GLP1R) or the Y2-receptor (Y2R) were unable to confirm their critical roles in the beneficial effects gastric bypass surgery on body weight and glucose homeostasis. However, new awareness of the power of combinatorial therapies in the treatment of metabolic disease would suggest that combined blockade of more than one signaling pathway may be necessary to reverse the beneficial effects of bariatric surgery. METHODS The metabolic effects of high-fat diet and the ability of Roux-en-Y gastric bypass surgery to lower food intake and body weight, as well as improve glucose handling, was tested in GLP1R and Y2R-double knockout (GLP1RKO/Y2RKO) and C57BL6J wildtype (WT) mice. RESULTS GLP1RKO/Y2RKO and WT mice responded similarly for up to 20 weeks on high-fat diet and 16 weeks after RYGB. There were no significant differences in loss of body and liver weight, fat mass, reduced food intake, relative increase in energy expenditure, improved fasting insulin, glucose tolerance, and insulin tolerance between WT and GLP1RKO/Y2RKO mice after RYGB. CONCLUSIONS Combined loss of GLP1R and Y2R-signaling was not able to negate or attenuate the beneficial effects of RYGB on body weight and glucose homeostasis in mice, suggesting that a larger number of signaling pathways is involved or that the critical pathway has not yet been identified.
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Affiliation(s)
- Brandon B Boland
- Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA
| | | | - Zheng Hao
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Benji Gill
- Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA
| | - Stephanie Oldham
- Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA
| | - Sarah Will
- Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA
| | | | - Sangho Yu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Heike Münzberg
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Christopher J Rhodes
- Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA
| | - James L Trevaskis
- Cardiovascular, Renal and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD, USA
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11
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Perlitz J, Prihoda F, Koch H, Lee G, Will S. In-situ-Untersuchung der Strukturveränderungen von Enzymen während der Trocknung in einem akustischen Levitator. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Perlitz
- Friedrich-Alexander-Universität; Lehrstuhl für Technische Thermodynamik; Am Weichselgarten 8 91058 Erlangen Deutschland
- Friedrich-Alexander-Universität; Graduate School in Advanced Optical Technologies; Paul-Gordan-Straße 6 91052 Erlangen Deutschland
| | - F. Prihoda
- Friedrich-Alexander-Universität; Lehrstuhl für Pharmazeutische Technologie; Cauerstraße 4 91058 Erlangen Deutschland
| | - H. Koch
- Friedrich-Alexander-Universität; Lehrstuhl für Technische Thermodynamik; Am Weichselgarten 8 91058 Erlangen Deutschland
- Friedrich-Alexander-Universität; Graduate School in Advanced Optical Technologies; Paul-Gordan-Straße 6 91052 Erlangen Deutschland
| | - G. Lee
- Friedrich-Alexander-Universität; Lehrstuhl für Pharmazeutische Technologie; Cauerstraße 4 91058 Erlangen Deutschland
| | - S. Will
- Friedrich-Alexander-Universität; Lehrstuhl für Technische Thermodynamik; Am Weichselgarten 8 91058 Erlangen Deutschland
- Friedrich-Alexander-Universität; Graduate School in Advanced Optical Technologies; Paul-Gordan-Straße 6 91052 Erlangen Deutschland
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12
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Hornigold DC, Roth E, Howard V, Will S, Oldham S, Coghlan MP, Blouet C, Trevaskis JL. A GLP-1:CCK fusion peptide harnesses the synergistic effects on metabolism of CCK-1 and GLP-1 receptor agonism in mice. Appetite 2018; 127:334-340. [PMID: 29782892 PMCID: PMC6026274 DOI: 10.1016/j.appet.2018.05.131] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
Combination approaches for the treatment of metabolic diseases such as obesity and diabetes are becoming increasingly relevant. Co-administration of a glucagon-like peptide-1 receptor (GLP-1R) agonist with a cholecystokinin receptor-1 (CCKR1) agonist exert synergistic effects on weight loss in obese rodents. Here, we report on the effects of a novel fusion peptide (C2816) comprised of a stabilized GLP-1R agonist, AC3174, and a CCKR1-selective agonist, AC170222. C2816 was constructed such that AC3174 was linked to the N-terminus of AC170222, thus preserving the C-terminal amide of the CCK moiety. In functional in vitro assays C2816 retained full agonism at GLP-1R and CCKR1 at lower potency compared to parent molecules, whereas a previously reported fusion peptide in the opposite orientation, (pGlu-Gln)-CCK-8/exendin-4, exhibited no activity at either receptor. Acutely, in vivo, C2816 increased cFos in key central nuclei relevant to feeding behavior, and reduced food intake in wildtype (WT), but less so in GLP-1R-deficient (GLP-1RKO), mice. In sub-chronic studies in diet-induced obese (DIO) mice, C2816 exerted superior reduction in body weight compared to co-administration of AC3174 and AC170222 albeit at a higher molar dose. These data suggest that the synergistic pharmacological effects of GLP-1 and CCK pathways can be harnessed in a single therapeutic peptide.
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Affiliation(s)
- David C Hornigold
- Cardiovascular and Metabolic Diseases, MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Emma Roth
- University of Cambridge, Department of Clinical Biochemistry, MRC Metabolic Diseases Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Victor Howard
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Sarah Will
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Stephanie Oldham
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Matthew P Coghlan
- Cardiovascular and Metabolic Diseases, MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Clemence Blouet
- University of Cambridge, Department of Clinical Biochemistry, MRC Metabolic Diseases Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - James L Trevaskis
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA.
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13
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Boland ML, Oldham S, Boland BB, Will S, Lapointe JM, Guionaud S, Rhodes CJ, Trevaskis JL. Nonalcoholic steatohepatitis severity is defined by a failure in compensatory antioxidant capacity in the setting of mitochondrial dysfunction. World J Gastroenterol 2018; 24:1748-1765. [PMID: 29713129 PMCID: PMC5922994 DOI: 10.3748/wjg.v24.i16.1748] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To comprehensively evaluate mitochondrial (dys) function in preclinical models of nonalcoholic steatohepatitis (NASH).
METHODS We utilized two readily available mouse models of nonalcoholic fatty liver disease (NAFLD) with or without progressive fibrosis: Lepob/Lepob (ob/ob) and FATZO mice on high trans-fat, high fructose and high cholesterol (AMLN) diet. Presence of NASH was assessed using immunohistochemical and pathological techniques, and gene expression profiling. Morphological features of mitochondria were assessed via transmission electron microscopy and immunofluorescence, and function was assessed by measuring oxidative capacity in primary hepatocytes, and respiratory control and proton leak in isolated mitochondria. Oxidative stress was measured by assessing activity and/or expression levels of Nrf1, Sod1, Sod2, catalase and 8-OHdG.
RESULTS When challenged with AMLN diet for 12 wk, ob/ob and FATZO mice developed steatohepatitis in the presence of obesity and hyperinsulinemia. NASH development was associated with hepatic mitochondrial abnormalities, similar to those previously observed in humans, including mitochondrial accumulation and increased proton leak. AMLN diet also resulted in increased numbers of fragmented mitochondria in both strains of mice. Despite similar mitochondrial phenotypes, we found that ob/ob mice developed more advanced hepatic fibrosis. Activity of superoxide dismutase (SOD) was increased in ob/ob AMLN mice, whereas FATZO mice displayed increased catalase activity, irrespective of diet. Furthermore, 8-OHdG, a marker of oxidative DNA damage, was significantly increased in ob/ob AMLN mice compared to FATZO AMLN mice. Therefore, antioxidant capacity reflected as the ratio of catalase:SOD activity was similar between FATZO and C57BL6J control mice, but significantly perturbed in ob/ob mice.
CONCLUSION Oxidative stress, and/or the capacity to compensate for increased oxidative stress, in the setting of mitochondrial dysfunction, is a key factor for development of hepatic injury and fibrosis in these mouse models.
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Affiliation(s)
- Michelle L Boland
- Cardiovascular and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, United States
| | - Stephanie Oldham
- Cardiovascular and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, United States
| | - Brandon B Boland
- Cardiovascular and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, United States
| | - Sarah Will
- Cardiovascular and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, United States
| | | | - Silvia Guionaud
- Pathology, Drug Safety and Metabolism, IMED Biotech Unit, AstraZeneca, Cambridge CB22 3AT, United Kingdom
| | - Christopher J Rhodes
- Cardiovascular and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, United States
| | - James L Trevaskis
- Cardiovascular and Metabolic Diseases, MedImmune LLC, Gaithersburg, MD 20878, United States
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14
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Jouihan H, Will S, Guionaud S, Boland ML, Oldham S, Ravn P, Celeste A, Trevaskis JL. Superior reductions in hepatic steatosis and fibrosis with co-administration of a glucagon-like peptide-1 receptor agonist and obeticholic acid in mice. Mol Metab 2017; 6:1360-1370. [PMID: 29107284 PMCID: PMC5681275 DOI: 10.1016/j.molmet.2017.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Nonalcoholic steatohepatitis (NASH) is an unmet need associated with metabolic syndrome. There are no approved therapies for NASH; however, glucagon-like peptide-1 receptor (GLP-1R) and farnesoid-X receptor (FXR) agonists are promising drug targets. We investigated the therapeutic effects of co-administration of a GLP-1R agonist, IP118, with FXR agonist obeticholic acid (OCA) in mice. METHODS OCA and IP118 alone and in combination were sub-chronically administered to Lepob/Lepob mice with diet-induced NASH or diet-induced obese (DIO) mice. Metabolic (body weight and glucose) and liver (biochemical and histological) endpoints were assessed. NASH severity in Lepob/Lepob mice was graded using a customized integrated scoring system. RESULTS OCA reduced liver weight and lipid in NASH mice (both by -17%) but had no effect on plasma ALT or AST levels. In contrast, IP118 significantly reduced liver weight (-21%), liver lipid (-15%), ALT (-29%), and AST (-27%). The combination of OCA + IP118 further reduced liver weight (-29%), liver lipid (-22%), ALT (-39%), and AST (-36%). Combination therapy was superior to monotherapies in reducing hepatic steatosis, inflammation, and fibrosis. Hepatic improvements with IP118 and OCA + IP118 were associated with reduced body weight (-4.3% and -3.5% respectively) and improved glycemic control in OCA + IP118-treated mice. In DIO mice, OCA + IP118 co-administration reduced body weight (-25.3%) to a greater degree than IP118 alone (-12.5%) and further improved glucose tolerance and reduced hepatic lipid. CONCLUSION Our data suggest a complementary or synergistic therapeutic effect of GLP-1R and FXR agonism in mouse models of metabolic disease and NASH.
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Affiliation(s)
- Hani Jouihan
- Cardiovascular and Metabolic Diseases, MedImmune, LLC, Gaithersburg, MD, USA
| | - Sarah Will
- Cardiovascular and Metabolic Diseases, MedImmune, LLC, Gaithersburg, MD, USA
| | | | - Michelle L Boland
- Cardiovascular and Metabolic Diseases, MedImmune, LLC, Gaithersburg, MD, USA
| | - Stephanie Oldham
- Cardiovascular and Metabolic Diseases, MedImmune, LLC, Gaithersburg, MD, USA
| | - Peter Ravn
- Antibody Discovery and Protein Engineering, MedImmune Ltd, Cambridge, UK
| | | | - James L Trevaskis
- Cardiovascular and Metabolic Diseases, MedImmune, LLC, Gaithersburg, MD, USA.
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15
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Koch H, Polepil S, Eisen K, Will S. Raman microspectroscopy and multivariate data analysis: optical differentiation of aqueous d- and l-tryptophan solutions. Phys Chem Chem Phys 2017; 19:30533-30539. [DOI: 10.1039/c7cp02321a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The combination of Raman spectroscopy as a sensitive and selective optical measurement technique and multivariate data analysis forms a powerful tool for probing intermolecular interactions between enantiomers.
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Affiliation(s)
- H. Koch
- Lehrstuhl für Technische Thermodynamik (LTT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91052 Erlangen
| | - S. Polepil
- Lehrstuhl für Technische Thermodynamik (LTT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
| | - K. Eisen
- Lehrstuhl für Technische Thermodynamik (LTT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91052 Erlangen
| | - S. Will
- Lehrstuhl für Technische Thermodynamik (LTT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91052 Erlangen
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16
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Henderson SJ, Konkar A, Hornigold DC, Trevaskis JL, Jackson R, Fritsch Fredin M, Jansson‐Löfmark R, Naylor J, Rossi A, Bednarek MA, Bhagroo N, Salari H, Will S, Oldham S, Hansen G, Feigh M, Klein T, Grimsby J, Maguire S, Jermutus L, Rondinone CM, Coghlan MP. Robust anti-obesity and metabolic effects of a dual GLP-1/glucagon receptor peptide agonist in rodents and non-human primates. Diabetes Obes Metab 2016; 18:1176-1190. [PMID: 27377054 PMCID: PMC5129521 DOI: 10.1111/dom.12735] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/20/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023]
Abstract
AIMS To characterize the pharmacology of MEDI0382, a peptide dual agonist of glucagon-like peptide-1 (GLP-1) and glucagon receptors. MATERIALS AND METHODS MEDI0382 was evaluated in vitro for its ability to stimulate cAMP accumulation in cell lines expressing transfected recombinant or endogenous GLP-1 or glucagon receptors, to potentiate glucose-stimulated insulin secretion (GSIS) in pancreatic β-cell lines and stimulate hepatic glucose output (HGO) by primary hepatocytes. The ability of MEDI0382 to reduce body weight and improve energy balance (i.e. food intake and energy expenditure), as well as control blood glucose, was evaluated in mouse models of obesity and healthy cynomolgus monkeys following single and repeated daily subcutaneous administration for up to 2 months. RESULTS MEDI0382 potently activated rodent, cynomolgus and human GLP-1 and glucagon receptors and exhibited a fivefold bias for activation of GLP-1 receptor versus the glucagon receptor. MEDI0382 produced superior weight loss and comparable glucose lowering to the GLP-1 peptide analogue liraglutide when administered daily at comparable doses in DIO mice. The additional fat mass reduction elicited by MEDI0382 probably results from a glucagon receptor-mediated increase in energy expenditure, whereas food intake suppression results from activation of the GLP-1 receptor. Notably, the significant weight loss elicited by MEDI0382 in DIO mice was recapitulated in cynomolgus monkeys. CONCLUSIONS Repeated administration of MEDI0382 elicits profound weight loss in DIO mice and non-human primates, produces robust glucose control and reduces hepatic fat content and fasting insulin and glucose levels. The balance of activities at the GLP-1 and glucagon receptors is considered to be optimal for achieving weight and glucose control in overweight or obese Type 2 diabetic patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - S. Will
- MedImmune LLCGaithersburgMDUSA
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Boch T, Spiess B, Cornely O, Vehreschild J, Rath P, Steinmann J, Heinz W, Hahn J, Krause S, Kiehl M, Egerer G, Liebregts T, Koldehoff M, Klein M, Nolte F, Mueller M, Merker N, Will S, Mossner M, Popp H, Hofmann WK, Reinwald M, Buchheidt D. Diagnosis of invasive fungal infections in haematological patients by combined use of galactomannan, 1,3-β-D-glucan, Aspergillus PCR, multifungal DNA-microarray, and Aspergillus azole resistance PCRs in blood and bronchoalveolar lavage samples: results of a prospective multicentre study. Clin Microbiol Infect 2016; 22:862-868. [DOI: 10.1016/j.cmi.2016.06.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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Koch H, Noack K, Will S. Raman excess spectroscopy vs. principal component analysis: probing the intermolecular interactions between chiral molecules and imidazolium-based ionic liquids. Phys Chem Chem Phys 2016; 18:28370-28375. [DOI: 10.1039/c6cp04372k] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PCA: Optical separation of glucose enantiomers based on enantioselective interactions.
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Affiliation(s)
- H. Koch
- Lehrstuhl für Technische Thermodynamik (LTT) and Erlangen Graduate School in Advanced Optical Technologies (SAOT)
- Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
| | - K. Noack
- Lehrstuhl für Technische Thermodynamik (LTT) and Erlangen Graduate School in Advanced Optical Technologies (SAOT)
- Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
| | - S. Will
- Lehrstuhl für Technische Thermodynamik (LTT) and Erlangen Graduate School in Advanced Optical Technologies (SAOT)
- Friedrich-Alexander-Universität Erlangen-Nürnberg
- 91058 Erlangen
- Germany
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Boch T, Reinwald M, Postina P, Cornely OA, Vehreschild JJ, Heußel CP, Heinz WJ, Hoenigl M, Eigl S, Lehrnbecher T, Hahn J, Claus B, Lauten M, Egerer G, Müller MC, Will S, Merker N, Hofmann WK, Buchheidt D, Spiess B. Identification of invasive fungal diseases in immunocompromised patients by combining an Aspergillus specific PCR with a multifungal DNA-microarray from primary clinical samples. Mycoses 2015; 58:735-45. [PMID: 26497302 DOI: 10.1111/myc.12424] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 12/21/2022]
Abstract
The increasing incidence of invasive fungal diseases (IFD), most of all invasive aspergillosis (IA) in immunocompromised patients emphasises the need to improve the diagnostic tools for detection of fungal pathogens. We investigated the diagnostic performance of a multifungal DNA-microarray detecting 15 different fungi [Aspergillus, Candida, Fusarium, Mucor, Rhizopus, Scedosporium and Trichosporon species (spp.)] in addition to an Aspergillus specific polymerase chain reaction (PCR) assay. Biopsies, bronchoalveolar lavage and peripheral blood samples of 133 immunocompromised patients (pts) were investigated by a multifungal DNA-microarray as well as a nested Aspergillus specific PCR assay. Patients had proven (n = 18), probable (n = 29), possible (n = 48) and no IFD (n = 38) and were mostly under antifungal therapy at the time of sampling. The results were compared to culture, histopathology, imaging and serology, respectively. For the non-Aspergillus IFD the microarray analysis yielded in all samples a sensitivity of 64% and a specificity of 80%. Best results for the detection of all IFD were achieved by combining DNA-microarray and Aspergillus specific PCR in biopsy samples (sensitivity 79%; specificity 71%). The molecular assays in combination identify genomic DNA of fungal pathogens and may improve identification of causative pathogens of IFD and help overcoming the diagnostic uncertainty of culture and/or histopathology findings, even during antifungal therapy.
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Affiliation(s)
- T Boch
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Reinwald
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Postina
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - O A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, Centre for Integrated Oncology CIO Köln Bonn, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - J J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
| | - C P Heußel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - W J Heinz
- Department II of Internal Medicine, Würzburg University Hospital, Würzburg, Germany
| | - M Hoenigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - S Eigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - T Lehrnbecher
- Pediatric Hematology and Oncology, Children's Hospital, University of Frankfurt, Frankfurt, Germany
| | - J Hahn
- Regensburg University Hospital, Regensburg, Germany
| | - B Claus
- Ludwigshafen General Hospital, Ludwigshafen, Germany
| | - M Lauten
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - G Egerer
- Department V of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - M C Müller
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Will
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - N Merker
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - W-K Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - D Buchheidt
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - B Spiess
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Koch H, Noack K, Kiefer J, Kaspereit M, Will S. Experimentelle und theoretische Untersuchung optisch aktiver Moleküle zur Online-Analyse der Enantiomerentrennung mittels Raman-Spektroskopie. CHEM-ING-TECH 2014. [DOI: 10.1002/cite.201450407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
An intensifier based Raman measuring strategy is introduced which allows for a phase-specific signal detection of one single phase in segmented flows at droplet generation frequencies of potentially up to several kHz.
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Affiliation(s)
- S K Luther
- Lehrstuhl für Technische Thermodynamik (LTT) and Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Opitz A, Paulus W, Will S, Thielscher A. P652: Where do we stimulate with tDCS? Anatomical determinants of the electric field during transcranial direct current stimulation. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50746-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Chambe J, Will S, Lefebvre F, Bourgeois-Jacquet M, Ruppert E, Bourgin P. Insomnie chronique des médecins généralistes : prévalence, automédication et son impact sur leur prescription. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Perreault M, Feng G, Will S, Gareski T, Kubasiak D, Marquette K, Vugmeyster Y, Unger TJ, Jones J, Qadri A, Hahm S, Sun Y, Rohde CM, Zwijnenberg R, Paulsen J, Gimeno RE. Activation of TrkB with TAM-163 results in opposite effects on body weight in rodents and non-human primates. PLoS One 2013; 8:e62616. [PMID: 23700410 PMCID: PMC3659094 DOI: 10.1371/journal.pone.0062616] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/23/2013] [Indexed: 01/09/2023] Open
Abstract
Strong genetic data link the Tyrosine kinase receptor B (TrkB) and its major endogenous ligand brain-derived neurotrophic factor (BDNF) to the regulation of energy homeostasis, with loss-of-function mutations in either gene causing severe obesity in both mice and humans. It has previously been reported that peripheral administration of the endogenous TrkB agonist ligand neurotrophin-4 (NT-4) profoundly decreases food intake and body weight in rodents, while paradoxically increasing these same parameters in monkeys. We generated a humanized TrkB agonist antibody, TAM-163, and characterized its therapeutic potential in several models of type 2 diabetes and obesity. In vitro, TAM-163 bound to human and rodent TrkB with high affinity, activated all aspects of the TrkB signaling cascade and induced TrkB internalization and degradation in a manner similar to BDNF. In vivo, peripheral administration of TAM-163 decreased food intake and/or body weight in mice, rats, hamsters, and dogs, but increased food intake and body weight in monkeys. The magnitude of weight change was similar in rodents and non-human primates, occurred at doses where there was no appreciable penetration into deep structures of the brain, and could not be explained by differences in exposures between species. Rather, peripherally administered TAM-163 localized to areas in the hypothalamus and the brain stem located outside the blood-brain barrier in a similar manner between rodents and non-human primates, suggesting differences in neuroanatomy across species. Our data demonstrate that a TrkB agonist antibody, administered peripherally, causes species-dependent effects on body weight similar to the endogenous TrkB ligand NT-4. The possible clinical utility of TrkB agonism in treating weight regulatory disorder, such as obesity or cachexia, will require evaluation in man.
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MESH Headings
- Administration, Intravenous
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/pharmacology
- Appetite Depressants/administration & dosage
- Appetite Depressants/pharmacokinetics
- Appetite Depressants/pharmacology
- Body Weight/drug effects
- Cricetinae
- Diet, High-Fat/adverse effects
- Dogs
- Drug Evaluation, Preclinical
- Energy Intake/drug effects
- Female
- HEK293 Cells
- Humans
- Hypothalamus/metabolism
- Macaca fascicularis
- Macaca mulatta
- Male
- Mesocricetus
- Mice
- Mice, Inbred C57BL
- Obesity/etiology
- Obesity/pathology
- Rats
- Rats, Sprague-Dawley
- Rats, Zucker
- Receptor, trkB/agonists
- Receptor, trkB/metabolism
- Tissue Distribution
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Affiliation(s)
- Mylène Perreault
- Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc., Cambridge, Massachusetts, USA.
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Tremblay F, Huard C, Dow J, Gareski T, Will S, Richard AM, Syed J, Bailey S, Brenneman KA, Martinez RV, Perreault M, Lin Q, Gimeno RE. Loss of coiled-coil domain containing 80 negatively modulates glucose homeostasis in diet-induced obese mice. Endocrinology 2012; 153:4290-303. [PMID: 22753645 DOI: 10.1210/en.2012-1242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Coiled-coil domain containing 80 (Ccdc80) is a secreted protein highly enriched in mouse and human white adipose tissue (WAT) that plays an important role during adipocyte differentiation in vitro. To investigate the physiological function of Ccdc80 in energy and glucose homeostasis, we generated mice in which the gene encoding Ccdc80 was disrupted. Mice lacking Ccdc80 showed increased sensitivity to diet-induced hyperglycemia and glucose intolerance while displaying reduced glucose-stimulated insulin secretion in vivo. Gene expression analysis by microarray revealed that only 10 transcripts were simultaneously altered in pancreas, skeletal muscle, and WAT from Ccdc80(-/-) mice, including some components of the circadian clock. Expression of the core clock member Arntl/Bmal1 was reduced whereas that of the oscillating transcription factors Dbp and Tef was increased in all tissues examined. Furthermore, knockdown of Ccdc80 in 3T3-L1 cells led to an increase of Dbp mRNA levels during adipocyte differentiation, suggesting that Ccdc80 might be involved in the regulation of this gene in a cell-autonomous manner. Importantly, transcriptional alterations in Ccdc80(-/-) mice were associated with changes in feeding behavior, increased caloric intake, decreased energy expenditure, and obesity. Taken together, our results suggest that Ccdc80 is a novel modulator of glucose and energy homeostasis during diet-induced obesity.
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Affiliation(s)
- Frédéric Tremblay
- Centers for Therapeutic Innovation, Pfizer Inc., 3 Blackfan Circle, Boston, Massachusetts 02115, USA.
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Herdan A, Roth R, Grass D, Klimek M, Will S, Schauf B, Rossaint R, Heesen M. Improvement of quality of reporting in randomised controlled trials to prevent hypotension after spinal anaesthesia for caesarean section. ACTA ACUST UNITED AC 2010; 8:121-127. [PMID: 21654900 PMCID: PMC3083505 DOI: 10.1007/s10397-010-0648-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/03/2010] [Indexed: 01/22/2023]
Abstract
Hypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of RCTs using the Consolidated Standards of Reporting Trials (CONSORT) statement since low quality can lend false credibility to a study and overestimate the effect of an intervention. We performed a systematic literature search in PubMed to identify relevant RCTs in a pre-CONSORT period (1990-1994) and a post-CONSORT period (2004-2008). A comparative evaluation was done between the two periods, and the trials were assessed for compliance with each of the 22 CONSORT items. A total of 37 RCTs was identified. The CONSORT score increased significantly (p < 0.05) from 66.7% (±12.5%) in the pre-CONSORT period to 87.4% (±6.9%) in the post-CONSORT period. A statistically significant improvement was found for eight items, including randomization, blinding and intention-to-treat analysis. The CONSORT score in the post-CONSORT era was fairly good, also in comparison to other medical fields. In the post-CONSORT era, reporting of important items improved, in particular in the domains that are crucial to avoid bias and to improve internal validity. Use of CONSORT should be encouraged in order to keep or even improve the reporting quality.
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Affiliation(s)
- A. Herdan
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - R. Roth
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - D. Grass
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - M. Klimek
- Department of Anesthesia, Erasmus Medical Center, Dr. Molewaterplein, 1101 Rotterdam, The Netherlands
| | - S. Will
- Department of Obstetrics, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - B. Schauf
- Department of Obstetrics, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - R. Rossaint
- Department of Anesthesia, University Hospital of RWTH Aachen, Pauwelsstr. 50, 52074 Aachen, Germany
| | - M. Heesen
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
- Klinik für Anästhesie, Klinikum Bamberg, Buger Str.80, 96049 Bamberg, Germany
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Charov O, Rathke B, Will S. Untersuchungen zu Bildungskinetik und Wachstum von CO2-Gas-Hydraten. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Oltmann H, Altenhoff M, Reimann J, Will S. Lichtstreuung zur Online-Charakterisierung von Nanopartikeln. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rathke B, Will S, Hammerschmidt U. Bestimmung der Wärmeleitfähigkeit ionischer Flüssigkeiten mit der Transient Hot-Bridge (THB) Methode. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schmeken L, Glade H, Will S. Gekoppelte Produktion von Strom und Wasser mit Brennstoffzellen und Entsalzungsanlagen. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Perreault M, Will S, Panza D, Gareski T, Harding K, Kubasiak D, Jalenak M, Gartrell K, Wang S, Bollag G, Artis DR, Ibrahim PN, Womack P, Lin JJ, Saiah E, Mansour TS, Vlasuk GP, Erbe DV, Tobin JF. Modulation of nutrient sensing nuclear hormone receptors promotes weight loss through appetite suppression in mice. Diabetes Obes Metab 2010; 12:234-45. [PMID: 20152000 DOI: 10.1111/j.1463-1326.2009.01157.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Peroxisome proliferator activated receptors (PPARs) are nuclear receptors involved in glucose and lipid metabolism. Three isoforms of PPARs have been identified with different tissue distribution and biological functions. Although the pharmacology of each receptor is well studied, the physiological effect of simultaneous activation of PPARalpha, gamma and delta is only starting to emerge. We sought to determine the biological effects of a novel PPAR pan activator and elucidate the physiological mechanisms involved. METHODS Ob/ob, diet-induced obese (DIO) or PPARalpha knockout mice were administered a novel agonist that activates all PPARs to various degrees to determine the effect on body weight, body composition, food intake and energy expenditure. In addition, serum parameters including glucose, insulin, triglycerides and ketone bodies as well as tissue acylcarnitine were evaluated. The effect of the novel agonist on liver and skeletal muscle histopathology was also studied. RESULTS We report that simultaneous activation of all PPARs resulted in substantial weight loss in ob/ob and DIO mice. Consistent with known PPAR pharmacology, we observed that agonist treatment increased lipid oxidation, although appetite suppression was mainly responsible for the weight loss. Agonist-induced weight loss was completely absent in PPARalpha knockout mice suggesting that PPARalpha pharmacology was the major contributor to weight regulation in mice. CONCLUSIONS Our work provides evidence that simultaneous activation of PPARalpha, gamma and delta decreases body weight by regulating appetite. These effects of the pan agonist were completely absent in PPARalpha knockout mice, suggesting that PPARalpha pharmacology was the major contributor to weight loss.
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Affiliation(s)
- M Perreault
- Metabolic Disease and Hemophilia Research, Wyeth Research, Cambridge, MA 02140, USA.
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Vale V, Rathke B, Will S, Schröer W. Eigenschaften von CnmimNTf2/ n-Alkanol Mischungen. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Krömer K, Glade H, Will S, Nied S, Montero Pancera S, Schürmann G. Reduktion von Kristallisationsfouling in Mehreffekt-Verdampfern zur Meerwasserentsalzung in einem erweiterten Prozessparameterbereich. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Reimann J, Kuhlmann SA, Oltmann H, Will S. 2D-Messung gasgetragener Rußpartikel durch kombinierte optische Messverfahren. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Erbe DV, Klaman LD, Wilson DP, Wan ZK, Kirincich SJ, Will S, Xu X, Kung L, Wang S, Tam S, Lee J, Tobin JF. Prodrug delivery of novel PTP1B inhibitors to enhance insulin signalling. Diabetes Obes Metab 2009; 11:579-88. [PMID: 19383031 DOI: 10.1111/j.1463-1326.2008.01022.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A growing percentage of the population is resistant to two key hormones - insulin and leptin - as a result of increased obesity, often leading to significant health consequences such as type 2 diabetes. Protein tyrosine phosphatase 1B (PTP1B) is a key negative regulator of signalling by both of these hormones, so that inhibitors of this enzyme may provide promise for correcting endocrine abnormalities in both diabetes and obesity. As with other tyrosine phosphatases, identification of viable drug candidates targeting PTP1B has been elusive because of the nature of its active site. Beginning with novel phosphotyrosine mimetics, we have designed some of the most potent PTP1B inhibitors. However, their highly acidic structures limit intrinsic permeability and pharmacokinetics. Ester prodrugs of these inhibitors improve their drug-like properties with the goal of delivering these nanomolar inhibitors to the cytoplasm of cells within target tissues. In addition to identifying prodrugs that is able to deliver active drugs into cells to inhibit PTP1B and increase insulin signalling, these compounds were further modified to gain a variety of cleavage properties for targeting activity in vivo. One such prodrug candidate improved insulin sensitivity in ob/ob mice, with lowered fasting blood glucose levels seen in the context of lowered fasting insulin levels following 4 days of intraperitoneal dosing. The results presented in this study highlight the potential for design of orally active drug candidates targeting PTP1B, while also delineating the considerable challenges remaining.
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Affiliation(s)
- D V Erbe
- Departments of Metabolic Diseases and Chemical Sciences, Wyeth Research, Cambridge, MA 02140, USA.
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Abstract
GPR39 is a G protein-coupled receptor expressed in liver, gastrointestinal tract, adipose tissue, and pancreas. We have recently shown that young GPR39(-/-) mice have normal body weight, food intake, and fasting glucose and insulin levels. In this study, we examined the role of GPR39 in aging and diet-induced obese mice. Body weight and food intake were similar in wild-type and GPR39(-/-) mice as they aged from 12 to 52 wk or when fed a low-fat/high-sucrose or high-fat/high-sucrose diet. Fifty-two-week-old GPR39(-/-) mice showed a trend toward decreased insulin levels after oral glucose challenge. When fed either a low-fat/high-sucrose or high-fat/high-sucrose diet, GPR39(-/-) mice had increased fed glucose levels and showed decreased serum insulin levels during an oral glucose tolerance test in the face of unchanged insulin tolerance. Pancreas morphology and glucose-stimulated insulin secretion in isolated islets from wild-type and GPR39(-/-) mice were comparable, suggesting that GPR39 is not required for pancreas development or ex vivo insulin secretion. Small interfering RNA-mediated knockdown of GPR39 in clonal NIT-1 beta-cells revealed that GPR39 regulates the expression of insulin receptor substrate-2 and pancreatic and duodenal homeobox-1 in a cell-autonomous manner; insulin receptor substrate-2 mRNA was also significantly decreased in the pancreas of GPR39(-/-) mice. Taken together, our data indicate that GPR39 is required for the increased insulin secretion in vivo under conditions of increased demand, i.e. on development of age-dependent and diet-induced insulin resistance. Thus, GPR39 agonists may have potential for the treatment of type 2 diabetes.
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Affiliation(s)
- Frédéric Tremblay
- Department of Metabolic Diseases,Wyeth Research, Cambridge, Massachusetts 02140, USA
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Best T, Will S, Schneider U, Hackermüller L, van Oosten D, Bloch I, Lühmann DS. Role of interactions in 87Rb-40K Bose-Fermi mixtures in a 3D optical lattice. Phys Rev Lett 2009; 102:030408. [PMID: 19257334 DOI: 10.1103/physrevlett.102.030408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Indexed: 05/27/2023]
Abstract
We investigate the effect of interspecies interaction on a degenerate mixture of bosonic 87Rb and fermionic 40K atoms in a three-dimensional optical lattice potential. Using a Feshbach resonance, the 87Rb-40K interaction is tuned over a wide range. Through an analysis of the 87Rb momentum distribution, we find a pronounced asymmetry between strong repulsion and strong attraction. In the latter case, we observe a marked shift in the superfluid to Mott insulator transition, which we attribute to a renormalization of the Bose-Hubbard parameters due to self-trapping.
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Affiliation(s)
- Th Best
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudinger Weg 7, 55128 Mainz, Germany
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Schneider U, Hackermuller L, Will S, Best T, Bloch I, Costi TA, Helmes RW, Rasch D, Rosch A. Metallic and Insulating Phases of Repulsively Interacting Fermions in a 3D Optical Lattice. Science 2008; 322:1520-5. [DOI: 10.1126/science.1165449] [Citation(s) in RCA: 579] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Behrens S, Bönnemann H, Modrow H, Kempter V, Riehemann W, Wiedenmann A, Odenbach S, Will S, Thrams L, Hergt R, Müller R, Landfester K, Schmidt A, Schüler D, Hempelmann R. Synthesis and Characterization. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/978-3-540-85387-9_1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Rathke B, Milchsack J, Will S. Das Phasenverhalten der Systeme n-Heptan/P666, 14Cl und n-Heptan/P666, 14Br. CHEM-ING-TECH 2008. [DOI: 10.1002/cite.200750630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Patzke J, Rathke B, Will S. Dynamische Lichtstreuuntersuchungen an Ferrofluiden. CHEM-ING-TECH 2007. [DOI: 10.1002/cite.200750322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jo GB, Shin Y, Will S, Pasquini TA, Saba M, Ketterle W, Pritchard DE, Vengalattore M, Prentiss M. Long phase coherence time and number squeezing of two Bose-Einstein condensates on an atom chip. Phys Rev Lett 2007; 98:030407. [PMID: 17358668 DOI: 10.1103/physrevlett.98.030407] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Indexed: 05/14/2023]
Abstract
We measure the relative phase of two Bose-Einstein condensates confined in a radio frequency induced double-well potential on an atom chip. We observe phase coherence between the separated condensates for times up to approximately 200 ms after splitting, a factor of 10 longer than the phase diffusion time expected for a coherent state for our experimental conditions. The enhanced coherence time is attributed to number squeezing of the initial state by a factor of 10. In addition, we demonstrate a rotationally sensitive (Sagnac) geometry for a guided atom interferometer by propagating the split condensates.
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Affiliation(s)
- G-B Jo
- MIT-Harvard Center for Ultracold Atoms, Research Laboratory of Electronics, Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Erbe DV, Gartrell K, Zhang YL, Suri V, Kirincich SJ, Will S, Perreault M, Wang S, Tobin JF. Molecular activation of PPARγ by angiotensin II type 1-receptor antagonists. Vascul Pharmacol 2006; 45:154-62. [PMID: 16765099 DOI: 10.1016/j.vph.2006.05.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 04/13/2006] [Accepted: 05/02/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE AND DESIGN Elevated blood pressure and insulin resistance are strongly associated in patients. We explored the potential for the anti-hypertensive angiotensin II type 1-receptor (ATR(1)) antagonists to improve insulin sensitivity through modulation of the nuclear receptor PPARgamma, in vitro and in vivo compared to the potent insulin sensitizer, rosiglitazone. METHODS PPARgamma modulation by ATR(1) antagonists was measured first by direct recruitment of PGC-1, followed by trans-activation reporter assays in cells, and promotion of adipogenesis in fibroblast and pre-adipocyte cell lines. Improvement of insulin sensitivity was measured as changes in levels of glucose, insulin, and adiponectin in ob/ob mice. RESULTS Telmisartan, candesartan, irbesartan, and losartan (but not valsartan or olmesartan) each served as bona fide PPARgamma ligands in vitro, with EC(50) values between 3 and 5 micro mol/l. However, only telmisartan, and to a lesser extent candesartan, resulted in significant PPARgamma agonism in cells. In vivo, although rosiglitazone significantly lowered both glucose (33%, p<0.01) and insulin (61%, p<0.01) levels and increased expression of adiponectin (74%, p<0.001), sartan treatment had no effect. CONCLUSIONS Many members of the sartan family of ATR(1) antagonists are PPARgamma ligands in cell-free assays but their modulation of PPARgamma in cells is relatively weak. Furthermore, none appear to improve insulin sensitivity in a rodent model under conditions where other insulin sensitizers, including rosiglitazone, do. These results question whether reported effects of sartans on insulin sensitivity may be through other means, and should guide further efforts to develop dual agents to treat hypertension and insulin resistance.
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Erbe DV, Gartrell K, Will S, Perreault M, Wang S, Tobin JF. Activation of PPARγ by Sartans. Drug Dev Res 2006. [DOI: 10.1002/ddr.20126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abahji TN, Tató F, Rieger J, Offner A, Will S, Hoelscher G, Weiss N, Hoffmann U. Stenting of the superficial femoral artery after suboptimal balloon angioplasty: one-year results. INT ANGIOL 2006; 25:184-9. [PMID: 16763537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM The aim of this study was to analyze the intermediate results of selective stenting of superficial femoral artery (SFA) lesions after a suboptimal balloon angioplasty result. METHODS We analyzed 70 consecutive patients with claudication or critical limb ischemia due to peripheral arterial occlusive disease who underwent stent implantation of the SFA after unsuccessful balloon-angioplasty. All patients were followed-up immediately after the procedure and 3, 6 and 12 months thereafter. Restenosis was defined as an increase of peak systolic velocity-index >2 as determined by duplex sonography. RESULTS Primary patency rates at 3, 6 and 12 months were 83.4%, 66.2% and 59%, respectively. Successful reinterventions were performed for 17 reobstructions, resulting in a secondary patency rate at 3, 6 and 12 months of 91%, 89.3%, and 83.8%, respectively. At 12 months 68.6% of the patients were asymptomatic, 21.6% complained of mild (Fontaine class II a), 5.9% of severe (Fontaine class II b) claudication and 2.9% were in critical limb ischemia. CONCLUSIONS Our data indicate that selective stenting of the SFA after suboptimal balloon angioplasty results in intermediate patency rates similar to that reported for primarily successful PTA, thereby supporting the widely accepted policy of selective stenting as a rescue procedure after unsuccessful balloon angioplasty.
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Affiliation(s)
- T N Abahji
- Division of Vascular Medicine, Medical Polyclinic, Ludwig-Maximilians-University, Munich, Germany
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Dankers S, Leipertz A, Will S, Arndt J, Vogel K, Schraml S, Hemm A. In-situ Measurement of Primary Particle Sizes during Carbon Black Production. Chem Eng Technol 2003. [DOI: 10.1002/ceat.200302955] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Dankers S, Schraml S, Will S, Leipertz A. Application of Laser-Induced Incandescence for the Determination of Primary Particle Sizes of Nanoparticles Demonstrated Using Carbon Blacks. Chem Eng Technol 2002. [DOI: 10.1002/1521-4125(20021210)25:12<1160::aid-ceat1160>3.0.co;2-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Meier F, Will S, Ellwanger U, Schlagenhauff B, Schittek B, Rassner G, Garbe C. Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 2002; 147:62-70. [PMID: 12100186 DOI: 10.1046/j.1365-2133.2002.04867.x] [Citation(s) in RCA: 239] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is known that two-thirds of patients who develop clinical metastases following treatment of a primary cutaneous melanoma initially present with locoregional metastases and one-third initially present with distant metastases. However, few reports in the literature give detailed figures on different metastatic pathways in cutaneous melanoma. OBJECTIVES The aim of the present study was to perform a detailed analysis of the different metastatic pathways, the time course of the development of metastases and the factors influencing them. METHODS In a series of 3001 patients with primary cutaneous melanoma at first presentation, 466 subsequently developed metastasis and were followed-up over the long term at the University of Tuebingen, Germany between 1976 and 1996. Different pathways of metastatic spread were traced. Associated risk factors for the different pathways were assessed. Differences in survival probabilities were calculated by the Kaplan-Meier method and evaluated by the log-rank test. RESULTS In 50.2% of the patients the first metastasis after treatment of the primary tumour developed in the regional lymph nodes. In the remaining half of the patient sample the first metastasis developed in the lymphatic drainage area in front of the regional lymph nodes, as satellite or in-transit metastases (21.7%) or as direct distant metastases (28.1%). Anatomical location, sex and tumour thickness were significant risk factors for the development of metastasis by different pathways. The most important risk factor appeared to be the location of the primary tumour. The median intervals elapsing before the first metastasis differed significantly between the different metastatic pathways. The direct distant metastases became manifest after a median period of 25 months, thus later than the direct regional lymph node metastases (median latency period, 16 months) and the direct satellite and in-transit metastases (median latency period, 17 months). In patients who developed distant metastases the period of development was independent of the metastatic route. The time at which the distant metastases developed was roughly the same (between 24 and 30 months after the detection of the primary tumour), irrespective of whether satellite or in-transit metastases, lymph node metastases or distant metastases were the first to occur. CONCLUSIONS The time course of the development of distant metastasis was more or less the same irrespective of the metastatic pathway; this suggests that in patients with in-transit or satellite metastasis or regional lymph node metastasis, haematogenic metastatic spread had already taken place. Thus, the diagnostic value of sentinel lymph node biopsy and the therapeutic benefit of elective lymph node dissection may be limited, as satellite and in-transit metastases or direct distant metastases will not be detected and haematogenous spread may already have taken place when the intervention is performed.
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Affiliation(s)
- F Meier
- Department of Dermatology, Eberhard-Karls-University, Liebermeisterstr. 25, 72076 Tuebingen, Germany.
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