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Lee MK, Kim SG, Watkins E, Moon MK, Rhee SY, Frias JP, Chung CH, Lee SH, Block B, Cha BS, Park HK, Kim BJ, Greenway F. A novel non-PPARgamma insulin sensitizer: MLR-1023 clinicalproof-of-concept in type 2 diabetes mellitus. J Diabetes Complications 2020; 34:107555. [PMID: 32019723 DOI: 10.1016/j.jdiacomp.2020.107555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
AIM MLR-1023, called Tolimidone when evaluated unsuccessfully by Pfizer for gastric ulcer disease, has been repurposed as a novel oral insulin sensitizer with its effects mediated by selective activation of Lyn kinase. We aimed to evaluate the optimal dose, efficacy and safety of MLR-1023 in patients with type 2 diabetes. METHODS Type 2 diabetes patients (18-75 years) on diet/exercise therapy were randomized and double-blinded to receive MLR-1023 (100-mg or 200-mg, once-daily [qd] or twice-daily [bid]) or matching placebo for 28 days. The primary endpoint was postprandial glucose (PPG) area under the curve (AUC0-3h) in a mixed meal tolerance test (MMTT) at day 29. Secondary endpoints included changes in fasting plasma glucose (FPG), insulin, HbA1c, lipids and body weight and adverse events. ANCOVA model was used for efficacy analysis. RESULTS The placebo-corrected least-squares mean differences (ΔLSM) in MMTT PPG AUC0-3 h (mmol/L) were -5.96 and -5.6 (both p = 0.03) in the MLR-1023 100-mg qd and 100-mg bid groups, respectively. The placebo-corrected ΔLSM in FPG (mmol/L) was -2.34 (p = 0.003) in the MLR-1023 100-mg qd group. Triglycerides improved with MLR-1023 (ΔLSM, -0.56 mmol/L, p = 0.07 and -0.59 mmol/L, p = 0.05) in the 200mgqd and 200 mg bid groups, respectively. Reductions in fasting insulin, HbA1c and body weight were not statistically significant. Most common adverse events with MLR-1023 treatment were headache (4.2%) and somnolence (2.5%). CONCLUSIONS MLR-1023 100-mg once-daily for 4 weeks was the most effective dose with significant reduction in PPG AUC following a MMTT. MLR-1023 was safe and well-tolerated in patients with type 2 diabetes. Clinical Trials Registration Number: NCT02317796.
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Affiliation(s)
- Moon-Kyu Lee
- Sungkyunkwan University School of Medicine, Samsung Medical Center, (06351) 81 Irwon-ro, Irwon-dong, Gangnam-gu, Seoul, South Korea.
| | - Sin Gon Kim
- Korea University Anam Hospital, Goryeodae-ro Seongbuk-gu, Seoul 02841, Republic of Korea.
| | - Elaine Watkins
- ProSciento, Inc., 855 Third Ave #3340, Chula Vista, CA 91911, USA
| | - Min Kyong Moon
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Sindaebang-dong, Dongjak-gu, Seoul, South Korea.
| | - Sang Youl Rhee
- Kyung Hee University Medical Center, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Juan P Frias
- National Research Institute, 2010 Wilshire Blvd Ste 302, Los Angeles, CA 90057, USA.
| | - Choon Hee Chung
- Yonsei University Wonju Severance Christian Hospital, 20 Ilsan-ro, Ilsan-dong, Weonju, Gangwon-do, South Korea.
| | - Seung-Hwan Lee
- The Catholic Univ. of Korea, College of Medicine, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Bradley Block
- Compass Research East, LLC, 100 West Gore St # 202, Orlando, FL 32806, USA.
| | - Bong Soo Cha
- Yonsei University Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Hyeong Kyu Park
- Soon Chun Hyang University Hospital, 22, Daesagwan-gil (657 Hannam-dong), Yongsan-gu, Seoul, Republic of Korea.
| | - Byung Joon Kim
- Gachon University Gil Hospital, 21 Namdong-daero 774beon-gil, Guwol 1(il)-dong, Namdong-gu, Incheon, South Korea.
| | - Frank Greenway
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA.
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