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Winkler G, Kis JT, Arapovicsné Kiss K, Schandl L. [From GLP1 receptor agonists to triple hormone receptor activation supplemented with glucagon receptor agonism.]. Orv Hetil 2023; 164:1656-1664. [PMID: 37865924 DOI: 10.1556/650.2023.32894] [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: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 10/24/2023]
Abstract
Following the introduction of mono- and then dual hormone (incretin) receptor agonists into therapy, attention was turned to multiple receptor stimulation, with the additional activation of the glucagon receptor, as a new option for the pharmaceutical treatment of type 2 diabetes and obesity. In addition to its role in carbohydrate metabolism, the article reviews the other important physiological tasks of glucagon, especially its participation in intrainsular paracrine regulation, energy expenditure and the shaping of appetite and food consumption. It covers the potential benefits of the triple combination and briefly touches data on the efficacy and safety of the first triple receptor agonist drug, retatrutide, in preclinical human studies. Further confirmation of the promising results may represent progress in the treatment of these forms of disease and their accompanying conditions, such as steatosis hepatis. Orv Hetil. 2023; 164(42): 1656-1664.
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Affiliation(s)
- Gábor Winkler
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
- 2 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - János Tibor Kis
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Krisztina Arapovicsné Kiss
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
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Li Y, Zhou Q, Dai A, Zhao F, Chang R, Ying T, Wu B, Yang D, Wang MW, Cong Z. Structural analysis of the dual agonism at GLP-1R and GCGR. Proc Natl Acad Sci U S A 2023; 120:e2303696120. [PMID: 37549266 PMCID: PMC10438375 DOI: 10.1073/pnas.2303696120] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/15/2023] [Indexed: 08/09/2023] Open
Abstract
Glucagon-like peptide-1 receptor (GLP-1R) and glucagon receptor (GCGR), two members of class B1 G protein-coupled receptors, play important roles in glucose homeostasis and energy metabolism. They share a high degree of sequence homology but have different functionalities. Unimolecular dual agonists of both receptors developed recently displayed better clinical efficacies than that of monotherapy. To study the underlying molecular mechanisms, we determined high-resolution cryo-electron microscopy structures of GLP-1R or GCGR in complex with heterotrimeric Gs protein and three GLP-1R/GCGR dual agonists including peptide 15, MEDI0382 (cotadutide) and SAR425899 with variable activating profiles at GLP-1R versus GCGR. Compared with related structures reported previously and supported by our published pharmacological data, key residues responsible for ligand recognition and dual agonism were identified. Analyses of peptide conformational features revealed a difference in side chain orientations within the first three residues, indicating that distinct engagements in the deep binding pocket are required to achieve receptor selectivity. The middle region recognizes extracellular loop 1 (ECL1), ECL2, and the top of transmembrane helix 1 (TM1) resulting in specific conformational changes of both ligand and receptor, especially the dual agonists reshaped ECL1 conformation of GLP-1R relative to that of GCGR, suggesting an important role of ECL1 interaction in executing dual agonism. Structural investigation of lipid modification showed a better interaction between lipid moiety of MEDI0382 and TM1-TM2 cleft, in line with its increased potency at GCGR than SAR425899. Together, the results provide insightful information for the design and development of improved therapeutics targeting these two receptors simultaneously.
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Affiliation(s)
- Yang Li
- Department of Medical Microbiology and Parasitology, Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences, Fudan University, Shanghai200032, China
| | - Qingtong Zhou
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai200032, China
| | - Antao Dai
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
- The National Center for Drug Screening, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
| | - Fenghui Zhao
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
- The National Center for Drug Screening, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
| | - Rulue Chang
- School of Pharmacy, Fudan University, Shanghai201203, China
| | - Tianlei Ying
- Department of Medical Microbiology and Parasitology, Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences, Fudan University, Shanghai200032, China
| | - Beili Wu
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
| | - Dehua Yang
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
- The National Center for Drug Screening, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai201203, China
- Research Center for Deepsea Bioresources, Sanya, Hainan572025, China
| | - Ming-Wei Wang
- Department of Medical Microbiology and Parasitology, Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences, Fudan University, Shanghai200032, China
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai200032, China
- Research Center for Deepsea Bioresources, Sanya, Hainan572025, China
- Department of Chemistry, School of Science, The University of Tokyo, Tokyo113-0033, Japan
- School of Pharmacy, Hainan Medical College, Haikou570228, China
| | - Zhaotong Cong
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai200032, China
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Vishnoi S, Bhattacharya S, Walsh EM, Okoh GI, Thompson D. Computational Peptide Design Cotargeting Glucagon and Glucagon-like Peptide-1 Receptors. J Chem Inf Model 2023; 63:4934-4947. [PMID: 37523325 PMCID: PMC10428222 DOI: 10.1021/acs.jcim.3c00752] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 08/02/2023]
Abstract
Peptides are sustainable alternatives to conventional therapeutics for G protein-coupled receptor (GPCR) linked disorders, promising biocompatible and tailorable next-generation therapeutics for metabolic disorders including type-2 diabetes, as agonists of the glucagon receptor (GCGR) and the glucagon-like peptide-1 receptor (GLP-1R). However, single agonist peptides activating GLP-1R to stimulate insulin secretion also suppress obesity-linked glucagon release. Hence, bioactive peptides cotargeting GCGR and GLP-1R may remediate the blood glucose and fatty acid metabolism imbalance, tackling both diabetes and obesity to supersede current monoagonist therapy. Here, we design and model optimized peptide sequences starting from peptide sequences derived from earlier phage-displayed library screening, identifying those with predicted molecular binding profiles for dual agonism of GCGR and GLP-1R. We derive design rules from extensive molecular dynamics simulations based on peptide-receptor binding. Our newly designed coagonist peptide exhibits improved predicted coupled binding affinity for GCGR and GLP-1R relative to endogenous ligands and could in the future be tested experimentally, which may provide superior glycemic and weight loss control.
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Affiliation(s)
- Shubham Vishnoi
- Department
of Physics, Bernal Institute, University
of Limerick, Limerick V94T9PX, Ireland
| | - Shayon Bhattacharya
- Department
of Physics, Bernal Institute, University
of Limerick, Limerick V94T9PX, Ireland
| | | | | | - Damien Thompson
- Department
of Physics, Bernal Institute, University
of Limerick, Limerick V94T9PX, Ireland
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Jastreboff AM, Kaplan LM, Frías JP, Wu Q, Du Y, Gurbuz S, Coskun T, Haupt A, Milicevic Z, Hartman ML. Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial. N Engl J Med 2023; 389:514-526. [PMID: 37366315 DOI: 10.1056/nejmoa2301972] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [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: 06/28/2023]
Abstract
BACKGROUND Retatrutide (LY3437943) is an agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors. Its dose-response relationships with respect to side effects, safety, and efficacy for the treatment of obesity are not known. METHODS We conducted a phase 2, double-blind, randomized, placebo-controlled trial involving adults who had a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 30 or higher or who had a BMI of 27 to less than 30 plus at least one weight-related condition. Participants were randomly assigned in a 2:1:1:1:1:2:2 ratio to receive subcutaneous retatrutide (1 mg, 4 mg [initial dose, 2 mg], 4 mg [initial dose, 4 mg], 8 mg [initial dose, 2 mg], 8 mg [initial dose, 4 mg], or 12 mg [initial dose, 2 mg]) or placebo once weekly for 48 weeks. The primary end point was the percentage change in body weight from baseline to 24 weeks. Secondary end points included the percentage change in body weight from baseline to 48 weeks and a weight reduction of 5% or more, 10% or more, or 15% or more. Safety was also assessed. RESULTS We enrolled 338 adults, 51.8% of whom were men. The least-squares mean percentage change in body weight at 24 weeks in the retatrutide groups was -7.2% in the 1-mg group, -12.9% in the combined 4-mg group, -17.3% in the combined 8-mg group, and -17.5% in the 12-mg group, as compared with -1.6% in the placebo group. At 48 weeks, the least-squares mean percentage change in the retatrutide groups was -8.7% in the 1-mg group, -17.1% in the combined 4-mg group, -22.8% in the combined 8-mg group, and -24.2% in the 12-mg group, as compared with -2.1% in the placebo group. At 48 weeks, a weight reduction of 5% or more, 10% or more, and 15% or more had occurred in 92%, 75%, and 60%, respectively, of the participants who received 4 mg of retatrutide; 100%, 91%, and 75% of those who received 8 mg; 100%, 93%, and 83% of those who received 12 mg; and 27%, 9%, and 2% of those who received placebo. The most common adverse events in the retatrutide groups were gastrointestinal; these events were dose-related, were mostly mild to moderate in severity, and were partially mitigated with a lower starting dose (2 mg vs. 4 mg). Dose-dependent increases in heart rate peaked at 24 weeks and declined thereafter. CONCLUSIONS In adults with obesity, retatrutide treatment for 48 weeks resulted in substantial reductions in body weight. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT04881760.).
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Affiliation(s)
- Ania M Jastreboff
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Lee M Kaplan
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Juan P Frías
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Qiwei Wu
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Yu Du
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Sirel Gurbuz
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Tamer Coskun
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Axel Haupt
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Zvonko Milicevic
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Mark L Hartman
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
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Jungnik A, Arrubla Martinez J, Plum-Mörschel L, Kapitza C, Lamers D, Thamer C, Schölch C, Desch M, Hennige AM. Phase I studies of the safety, tolerability, pharmacokinetics and pharmacodynamics of the dual glucagon receptor/glucagon-like peptide-1 receptor agonist BI 456906. Diabetes Obes Metab 2023; 25:1011-1023. [PMID: 36527386 DOI: 10.1111/dom.14948] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 10/06/2022] [Revised: 11/21/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
AIM To report two phase I studies of the novel subcutaneous glucagon-like peptide-1 receptor/glucagon receptor (GLP-1R/GCGR) dual agonist BI 456906 versus placebo in healthy volunteers and people with overweight/obesity. MATERIALS AND METHODS A phase Ia study (NCT03175211) investigated single rising doses (SRDs) of BI 456906 in 24 males with a body mass index (BMI) of 20-<30 kg/m2 . A phase Ib study (NCT03591718) investigated multiple rising doses (MRDs) of BI 456906 (escalated over 6 [Part A] or 16 [Part B] weeks) in 125 adults with a BMI of 27-40 kg/m2 . RESULTS In the SRD study (N = 24), mean body weight decreased with increasing BI 456906 dose. In the MRD study, the maximum decreases in placebo-corrected mean body weight were at week 6 (-5.79%, dosage schedule [DS] 1; Part A) and week 16 (-13.8%, DS7; Part B). BI 456906 reduced plasma amino acids and glucagon, indicating target engagement at GCGRs and GLP-1Rs. Drug-related adverse events (AEs) increased with BI 456906 dose. The most frequent drug-related AE with SRDs was decreased appetite (n = 9, 50.0%), and two subjects (8.3%) did not complete the trial because of AEs (nausea and vomiting). During MRD Part A (N = 80), 10 subjects (12.5%) discontinued BI 456906, most commonly because of a cardiac or vascular AE (n = 6, 7.5%); during Part B (N = 45), eight subjects (17.8%) discontinued BI 456906, mainly because of AEs (n = 6, 13.3%), most commonly gastrointestinal disorders. CONCLUSIONS BI 456906 produced a placebo-corrected body weight loss of 13.8% (week 16), highlighting its potential to promote clinically meaningful body weight loss in people with overweight/obesity.
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Affiliation(s)
| | | | | | - Christoph Kapitza
- Profil Institute for Metabolic Research, Neuss, Germany
- Profil Mainz GmbH & Co. KG, Mainz, Germany
| | | | - Claus Thamer
- Boehringer Ingelheim Pharma GmbH, Biberach, Germany
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6
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Corbin KD, Carnero EA, Allerton TD, Tillner J, Bock CP, Luyet PP, Göbel B, Hall KD, Parsons SA, Ravussin E, Smith SR. Glucagon-like peptide-1/glucagon receptor agonism associates with reduced metabolic adaptation and higher fat oxidation: A randomized trial. Obesity (Silver Spring) 2023; 31:350-362. [PMID: 36695055 PMCID: PMC9881753 DOI: 10.1002/oby.23633] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/16/2022] [Accepted: 10/02/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study tested the hypothesis that treatment with the glucagon-like peptide-1/glucagon receptor agonist SAR425899 would lead to a smaller decrease in sleeping metabolic rate (SMR; kilocalories/day) than expected from the loss of lean and fat mass (metabolic adaptation). METHODS This Phase 1b, double-blind, randomized, placebo-controlled study was conducted at two centers in inpatient metabolic wards. Thirty-five healthy males and females with overweight and obesity (age = 36.5 ± 7.1 years) were randomized to a calorie-reduced diet (-1000 kcal/d) and escalating doses (0.06-0.2 mg/d) of SAR425899 (n = 17) or placebo (n = 18) for 19 days. SMR was measured by whole-room calorimetry. RESULTS Both groups lost weight (-3.68 ± 1.37 kg placebo; -4.83 ± 1.44 kg SAR425899). Those treated with SAR425899 lost more weight, fat mass, and fat free mass (p < 0.05) owing to a greater achieved energy deficit than planned. The SAR425899 group had a smaller reduction in body composition-adjusted SMR (p = 0.002) as compared with placebo, but not 24-hour energy expenditure. Fat oxidation and ketogenesis increased in both groups, with significantly greater increases with SAR425899 (p < 0.05). CONCLUSIONS SAR425899 led to reduced selective metabolic adaptation and increased lipid oxidation, which are believed to be beneficial for weight loss and weight-loss maintenance.
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Affiliation(s)
- Karen D Corbin
- AdventHealth Translational Research Institute, Orlando, Florida, USA
| | - Elvis A Carnero
- AdventHealth Translational Research Institute, Orlando, Florida, USA
| | | | | | | | | | | | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | | | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Steven R Smith
- AdventHealth Translational Research Institute, Orlando, Florida, USA
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Darbalaei S, Chang RL, Zhou QT, Chen Y, Dai AT, Wang MW, Yang DH. Effects of site-directed mutagenesis of GLP-1 and glucagon receptors on signal transduction activated by dual and triple agonists. Acta Pharmacol Sin 2023; 44:421-433. [PMID: 35953646 PMCID: PMC9889767 DOI: 10.1038/s41401-022-00962-y] [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: 04/21/2022] [Accepted: 07/17/2022] [Indexed: 02/04/2023] Open
Abstract
The paradigm of one drug against multiple targets, known as unimolecular polypharmacology, offers the potential to improve efficacy while overcoming some adverse events associated with the treatment. This approach is best exemplified by targeting two or three class B1 G protein-coupled receptors, namely, glucagon-like peptide-1 receptor (GLP-1R), glucagon receptor (GCGR) and glucose-dependent insulinotropic polypeptide receptor for treatment of type 2 diabetes and obesity. Some of the dual and triple agonists have already shown initial successes in clinical trials, although the molecular mechanisms underlying their multiplexed pharmacology remain elusive. In this study we employed structure-based site-directed mutagenesis together with pharmacological assays to compare agonist efficacy across two key signaling pathways, cAMP accumulation and ERK1/2 phosphorylation (pERK1/2). Three dual agonists (peptide 15, MEDI0382 and SAR425899) and one triple agonist (peptide 20) were evaluated at GLP-1R and GCGR, relative to the native peptidic ligands (GLP-1 and glucagon). Our results reveal the existence of residue networks crucial for unimolecular agonist-mediated receptor activation and their distinct signaling patterns, which might be useful to the rational design of biased drug leads.
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Affiliation(s)
- Sanaz Darbalaei
- The National Center for Drug Screening and CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), Shanghai, 201203, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Ru-Lue Chang
- School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Qing-Tong Zhou
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Yan Chen
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - An-Tao Dai
- The National Center for Drug Screening and CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), Shanghai, 201203, China
| | - Ming-Wei Wang
- School of Pharmacy, Fudan University, Shanghai, 201203, China.
- Department of Pharmacology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China.
- Research Center for Deepsea Bioresources, Sanya, 572025, China.
- Department of Chemistry, School of Science, The University of Tokyo, Tokyo, 113-0033, Japan.
| | - De-Hua Yang
- The National Center for Drug Screening and CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), Shanghai, 201203, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Research Center for Deepsea Bioresources, Sanya, 572025, China.
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8
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Scheen AJ, Lefèbvre PJ. Glucagon, from past to present: a century of intensive research and controversies. Lancet Diabetes Endocrinol 2023; 11:129-138. [PMID: 36566754 DOI: 10.1016/s2213-8587(22)00349-7] [Citation(s) in RCA: 1] [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] [Received: 10/27/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Abstract
2022 corresponds to the 100th anniversary of the discovery of glucagon. This TimeCapsule aims to recall the main steps leading to the discovery, characterisation, and clinical importance of the so-called second pancreatic hormone. We describe the early historical findings in basic research (ie, discovery, purification, structure, α-cell origin, radioimmunoassay, glucagon gene [GCG], and glucagon receptor [GLR]), in which three future Nobel Prize laureates were actively involved. Considered as an anti-insulin hormone, glucagon was rapidly used to treat insulin-induced hypoglycaemic coma episodes in people with type 1 diabetes. A key step in the story of glucagon was the discovery of its role and the role of α cells in the physiology and pathophysiology (ie, paracrinopathy) of type 2 diabetes. This concept led to the design of different strategies targeting glucagon, among which GLP-1 receptor (GLP1R) agonists were a major breakthrough, and combination of inhibition of glucagon secretion with stimulation of insulin secretion (both in a glucose-dependent manner). Taking advantage of the glucagon-induced increase in energy metabolism, biased coagonists were developed. Besides the GLP-1 receptor, these coagonists also target the glucagon receptor to further promote weight loss. Thus, the 100-year story of glucagon has most probably not come to an end.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of medicine, CHU Liège, Liège University, Liège, Belgium.
| | - Pierre J Lefèbvre
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of medicine, CHU Liège, Liège University, Liège, Belgium
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Malik IHO, Petersen MC, Klein S. Glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, and glucagon receptor poly-agonists: a new era in obesity pharmacotherapy. Obesity (Silver Spring) 2022; 30:1718-1721. [PMID: 35872608 PMCID: PMC9420816 DOI: 10.1002/oby.23521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 12/26/2022]
Abstract
Achieving successful long-term weight loss with lifestyle modification in people with obesity is difficult and underscores the need for effective pharmacotherapy. Since 1947, a total of 18 medications have been approved by the US Food and Drug Administration for treating obesity; however, only 5 remain available for long-term use in the US. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist approved in 2021, demonstrated much greater weight loss than previous medications, which stimulated the development of poly-agonists that combine GLP-1 receptor agonism with glucose-dependent insulinotropic polypeptide (GIP) and glucagon receptor agonism. The potential of this approach was recently demonstrated by the extraordinary weight loss achieved by tirzepatide, a GLP-1/GIP receptor dual agonist. The therapeutic efficacy of poly-agonists is likely to change the treatment paradigm for obesity. However, the use of medications for obesity, as for other chronic diseases, will likely require lifelong treatment, which makes it important to analyze the long-term efficacy, safety, and economic implications of chronic pharmacotherapy.
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Affiliation(s)
- Is-haq O. Malik
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | - Max C. Petersen
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO
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10
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Bossart M, Wagner M, Elvert R, Evers A, Hübschle T, Kloeckener T, Lorenz K, Moessinger C, Eriksson O, Velikyan I, Pierrou S, Johansson L, Dietert G, Dietz-Baum Y, Kissner T, Nowotny I, Einig C, Jan C, Rharbaoui F, Gassenhuber J, Prochnow HP, Agueusop I, Porksen N, Smith WB, Nitsche A, Konkar A. Effects on weight loss and glycemic control with SAR441255, a potent unimolecular peptide GLP-1/GIP/GCG receptor triagonist. Cell Metab 2022; 34:59-74.e10. [PMID: 34932984 DOI: 10.1016/j.cmet.2021.12.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [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: 05/03/2021] [Revised: 08/13/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
Unimolecular triple incretins, combining the activity of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon (GCG), have demonstrated reduction in body weight and improved glucose control in rodent models. We developed SAR441255, a synthetic peptide agonist of the GLP-1, GCG, and GIP receptors, structurally based on the exendin-4 sequence. SAR441255 displays high potency with balanced activation of all three target receptors. In animal models, metabolic outcomes were superior to results with a dual GLP-1/GCG receptor agonist. Preclinical in vivo positron emission tomography imaging demonstrated SAR441255 binding to GLP-1 and GCG receptors. In healthy subjects, SAR441255 improved glycemic control during a mixed-meal tolerance test and impacted biomarkers for GCG and GIP receptor activation. Single doses of SAR441255 were well tolerated. The results demonstrate that integrating GIP activity into dual GLP-1 and GCG receptor agonism provides improved effects on weight loss and glycemic control while buffering the diabetogenic risk of chronic GCG receptor agonism.
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Affiliation(s)
- Martin Bossart
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany.
| | - Michael Wagner
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany
| | | | - Andreas Evers
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany
| | | | | | - Katrin Lorenz
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany
| | | | - Olof Eriksson
- Antaros Medical AB, Mölndal, Sweden; Science For Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Irina Velikyan
- Science For Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden; PET Centre, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden
| | | | | | | | | | | | - Irene Nowotny
- Translational Medicine & Early Development, Sanofi, Frankfurt, Germany
| | | | - Christelle Jan
- Clinical Sciences & Operations, Sanofi, Chilly-Mazarin, France
| | - Faiza Rharbaoui
- Translational Medicine & Early Development, Sanofi, Frankfurt, Germany
| | | | | | | | | | - William B Smith
- NOCCR Alliance for Multispecialty Research (AMR), Knoxville, TN, USA
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11
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Hinds CE, Owen BM, Hope DCD, Pickford P, Jones B, Tan TM, Minnion JS, Bloom SR. A glucagon analogue decreases body weight in mice via signalling in the liver. Sci Rep 2021; 11:22577. [PMID: 34799628 PMCID: PMC8604983 DOI: 10.1038/s41598-021-01912-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022] Open
Abstract
Glucagon receptor agonists show promise as components of next generation metabolic syndrome pharmacotherapies. However, the biology of glucagon action is complex, controversial, and likely context dependent. As such, a better understanding of chronic glucagon receptor (GCGR) agonism is essential to identify and mitigate potential clinical side-effects. Herein we present a novel, long-acting glucagon analogue (GCG104) with high receptor-specificity and potent in vivo action. It has allowed us to make two important observations about the biology of sustained GCGR agonism. First, it causes weight loss in mice by direct receptor signalling at the level of the liver. Second, subtle changes in GCG104-sensitivity, possibly due to interindividual variation, may be sufficient to alter its effects on metabolic parameters. Together, these findings confirm the liver as a principal target for glucagon-mediated weight loss and provide new insights into the biology of glucagon analogues.
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Affiliation(s)
- Charlotte E Hinds
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Bryn M Owen
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - David C D Hope
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Philip Pickford
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Ben Jones
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Tricia M Tan
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - James S Minnion
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Stephen R Bloom
- Section of Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK.
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12
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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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13
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Abstract
Obesity and Type 2 diabetes represent global health challenges, and there is an unmet need for long-lasting and effective pharmacotherapies. Although long-acting glucagon-like peptide-1 (GLP-1) analogues are now in routine use for diabetes and are now being utilised for obesity per se, the need for ever better treatments has driven the development of co-agonists, with the theoretical advantages of improved efficacy by targeting multiple pathways and reduced adverse effects. In this review, we highlight the past and present progress in our understanding and development of treatments based on GLP-1/glucagon co-agonism. We also reflect on the divergent effects of varying the GLP-1:glucagon activity and ratio in the context of pre-clinical and human clinical trial findings. In particular, the multiple metabolic actions of glucagon highlight the importance of understanding the contributions of individual hormone action to inform the safe, effective and tailored use of GLP-1/glucagon co-agonists to target weight loss and metabolic disease in the future.
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Affiliation(s)
| | | | - Tricia M. M. Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
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14
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Pickford P, Lucey M, Rujan RM, McGlone ER, Bitsi S, Ashford FB, Corrêa IR, Hodson DJ, Tomas A, Deganutti G, Reynolds CA, Owen BM, Tan TM, Minnion J, Jones B, Bloom SR. Partial agonism improves the anti-hyperglycaemic efficacy of an oxyntomodulin-derived GLP-1R/GCGR co-agonist. Mol Metab 2021; 51:101242. [PMID: 33933675 PMCID: PMC8163982 DOI: 10.1016/j.molmet.2021.101242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/08/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Glucagon-like peptide-1 and glucagon receptor (GLP-1R/GCGR) co-agonism can maximise weight loss and improve glycaemic control in type 2 diabetes and obesity. In this study, we investigated the cellular and metabolic effects of modulating the balance between G protein and β-arrestin-2 recruitment at GLP-1R and GCGR using oxyntomodulin (OXM)-derived co-agonists. This strategy has been previously shown to improve the duration of action of GLP-1R mono-agonists by reducing target desensitisation and downregulation. METHODS Dipeptidyl dipeptidase-4 (DPP-4)-resistant OXM analogues were generated and assessed for a variety of cellular readouts. Molecular dynamic simulations were used to gain insights into the molecular interactions involved. In vivo studies were performed in mice to identify the effects on glucose homeostasis and weight loss. RESULTS Ligand-specific reductions in β-arrestin-2 recruitment were associated with slower GLP-1R internalisation and prolonged glucose-lowering action in vivo. The putative benefits of GCGR agonism were retained, with equivalent weight loss compared to the GLP-1R mono-agonist liraglutide despite a lesser degree of food intake suppression. The compounds tested showed only a minor degree of biased agonism between G protein and β-arrestin-2 recruitment at both receptors and were best classified as partial agonists for the two pathways measured. CONCLUSIONS Diminishing β-arrestin-2 recruitment may be an effective way to increase the therapeutic efficacy of GLP-1R/GCGR co-agonists. These benefits can be achieved by partial rather than biased agonism.
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Affiliation(s)
- Phil Pickford
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Maria Lucey
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Roxana-Maria Rujan
- Centre for Sport, Exercise, and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Alison Gingell Building, CV1 5FB, UK
| | - Emma Rose McGlone
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Stavroula Bitsi
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Fiona B Ashford
- Institute of Metabolism and Systems Research (IMSR) and Centre of Membrane Proteins and Receptors (COMPARE), University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | | | - David J Hodson
- Institute of Metabolism and Systems Research (IMSR) and Centre of Membrane Proteins and Receptors (COMPARE), University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Alejandra Tomas
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Giuseppe Deganutti
- Centre for Sport, Exercise, and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Alison Gingell Building, CV1 5FB, UK
| | - Christopher A Reynolds
- Centre for Sport, Exercise, and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Alison Gingell Building, CV1 5FB, UK; School of Life Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
| | - Bryn M Owen
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Tricia M Tan
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - James Minnion
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Ben Jones
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK.
| | - Stephen R Bloom
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, W12 0NN, UK
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15
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Kaur S, Chen Y, Shenoy SK. Agonist-activated glucagon receptors are deubiquitinated at early endosomes by two distinct deubiquitinases to facilitate Rab4a-dependent recycling. J Biol Chem 2020; 295:16630-16642. [PMID: 32967969 PMCID: PMC7864061 DOI: 10.1074/jbc.ra120.014532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/24/2020] [Revised: 09/17/2020] [Indexed: 01/08/2023] Open
Abstract
The glucagon receptor (GCGR) activated by the peptide hormone glucagon is a seven-transmembrane G protein-coupled receptor (GPCR) that regulates blood glucose levels. Ubiquitination influences trafficking and signaling of many GPCRs, but its characterization for the GCGR is lacking. Using endocytic colocalization and ubiquitination assays, we have identified a correlation between the ubiquitination profile and recycling of the GCGR. Our experiments revealed that GCGRs are constitutively ubiquitinated at the cell surface. Glucagon stimulation not only promoted GCGR endocytic trafficking through Rab5a early endosomes and Rab4a recycling endosomes, but also induced rapid deubiquitination of GCGRs. Inhibiting GCGR internalization or disrupting endocytic trafficking prevented agonist-induced deubiquitination of the GCGR. Furthermore, a Rab4a dominant negative (DN) that blocks trafficking at recycling endosomes enabled GCGR deubiquitination, whereas a Rab5a DN that blocks trafficking at early endosomes eliminated agonist-induced GCGR deubiquitination. By down-regulating candidate deubiquitinases that are either linked with GPCR trafficking or localized on endosomes, we identified signal-transducing adaptor molecule-binding protein (STAMBP) and ubiquitin-specific protease 33 (USP33) as cognate deubiquitinases for the GCGR. Our data suggest that USP33 constitutively deubiquitinates the GCGR, whereas both STAMBP and USP33 deubiquitinate agonist-activated GCGRs at early endosomes. A mutant GCGR with all five intracellular lysines altered to arginines remains deubiquitinated and shows augmented trafficking to Rab4a recycling endosomes compared with the WT, thus affirming the role of deubiquitination in GCGR recycling. We conclude that the GCGRs are rapidly deubiquitinated after agonist-activation to facilitate Rab4a-dependent recycling and that USP33 and STAMBP activities are critical for the endocytic recycling of the GCGR.
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Affiliation(s)
- Suneet Kaur
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuqing Chen
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Sudha K Shenoy
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Department of Cell Biology, Duke University Medical Center, Durham, North Carolina, USA.
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16
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Wang W, Wen X, Duan W, Wang X, Chen Y, Dong J, Yang Z, Fang J, Zhou Z, Yao G, Fang Y, Huang Y. DR10601, a novel recombinant long-acting dual glucagon-like peptide-1 and glucagon receptor agonist for the treatment of obesity and type 2 diabetes mellitus. J Endocrinol Invest 2020; 43:653-662. [PMID: 31786794 DOI: 10.1007/s40618-019-01153-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/18/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Both glucagon-like peptide-1 (GLP-1) and glucagon (GCG) belong to the incretin family. This study aimed to investigate the pharmacokinetics and pharmacodynamics of DR10601, a fully recombinant hybrid peptide with dual GLP-1/GCG receptor agonistic activity. METHODS The agonistic ability of DR10601 was indirectly assessed by inducing cAMP accumulation in Chinese hamster ovary cells transfected with GLP-1R or GCGR in vitro. Following s.c. administration, the plasma pharmacokinetics of DR10601 were analysed in male Sprague-Dawley rats. The antiobesity effects and improved glycaemic control of DR10601 in vivo were evaluated by administering DR10601 to high-fat DIO mice and ICR mice as a single dose or repeated s.c. doses once every 4 days for 24 days. RESULTS DR10601 exhibits dual agonistic activity on GLP-1 and glucagon receptors. The plasma half-life of DR10601 in Sprague-Dawley rats following s.c. administration was 51.9 ± 12.2 h. In an IPGTT, a single s.c. dose of DR10601 (30 nmol/kg) produced similar glycaemic control effects and a longer duration of action compared to dulaglutide (10 nmol/kg). Compared with that achieved with liraglutide (40 nmol/kg) s.c. administered daily, DR10601 administered s.c. once every 4 days at 90 nmol/kg exerted a nearly equivalent effect on food intake and significantly reduced the body weights of high-fat DIO mice at 24 days. CONCLUSIONS Repeated administration of DR1060 provides potent and sustained glycemic control and body weight loss effect in high-fat DIO mice. DR10601 is a promising long-acting agent deserving further investigation for the treatment of type 2 diabetes and obesity.
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Affiliation(s)
- W Wang
- Department of Pharmacy, College of Life Sciences, China Jiliang University, Hangzhou, Zhejiang, China
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - X Wen
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - W Duan
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - X Wang
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - Y Chen
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - J Dong
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - Z Yang
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - J Fang
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - Z Zhou
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - G Yao
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - Y Fang
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China
| | - Y Huang
- Zhejiang Doer Biologics Corporation, No. 452 Avenue 6, Hangzhou Economic and Technological Development Zone, Hangzhou, 310018, Zhejiang, China.
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17
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Osaka N, Kushima H, Mori Y, Saito T, Hiromura M, Terasaki M, Yashima H, Ohara M, Fukui T, Matsui T, Hirano T, Yamagishi SI. Anti-inflammatory and atheroprotective properties of glucagon. Diab Vasc Dis Res 2020; 17:1479164120965183. [PMID: 33076703 PMCID: PMC7919216 DOI: 10.1177/1479164120965183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 01/02/2023] Open
Abstract
Although glucagon has been shown to exert pleiotropic actions in various types of cells and organs through the interaction with its receptor, its pathophysiological role in atherosclerotic cardiovascular disease remains unclear. Here, we examined whether and how glucagon could attenuate the progression of atherosclerotic plaques in apolipoprotein E-deficient mice (ApoE-/-), an animal model of atherosclerosis. Glucagon (138 or 413 nmol/kg/day) or vehicle was infused to mice at 16 weeks of age. After 4-week treatment, vascular samples were collected for histological and RT-PCR analyses. Human monocytic THP-1 cells were pre-incubated with or without a glucagon receptor antagonist L-168049, and then treated with or without glucagon for 7 h. Gene and protein expressions were determined by RT-PCR and western blot analyses, respectively. High-dose glucagon infusion significantly decreased aortic plaque area and volume in ApoE-/- mice, both of which were inversely correlated with plasma glucagon levels. Glucagon infusion also reduced the ratio of pro-inflammatory interleukin-1β to anti-inflammatory interleukin-10 gene expression in aortae. Glucagon receptor was expressed in THP-1 cells, and 1 nM glucagon decreased the ratio of interleukin-1β to interleukin-10 gene expression, which was significantly prevented by L-168049. Our present findings suggest that glucagon could exert atheroprotection partly via its anti-inflammatory property.
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Affiliation(s)
- Naoya Osaka
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Hideki Kushima
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Yusaku Mori
- Anti-glycation Research Section, Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
- Yusaku Mori, Anti-glycation Research Section, Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8555, Japan.
| | - Tomomi Saito
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Munenori Hiromura
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Michishige Terasaki
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Hironori Yashima
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Makoto Ohara
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Tomoyasu Fukui
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Takanori Matsui
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tsutomu Hirano
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
- Diabetes Center, Ebina General Hospital, Ebina, Kanagawa, Japan
| | - Sho-ichi Yamagishi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
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18
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Knerr PJ, Mowery SA, Finan B, Perez-Tilve D, Tschöp MH, DiMarchi RD. Selection and progression of unimolecular agonists at the GIP, GLP-1, and glucagon receptors as drug candidates. Peptides 2020; 125:170225. [PMID: 31786282 DOI: 10.1016/j.peptides.2019.170225] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/22/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023]
Abstract
The continued global growth in the prevalence of obesity coupled with the limited number of efficacious and safe treatment options elevates the importance of innovative pharmaceutical approaches. Combinatorial strategies that harness the metabolic benefits of multiple hormonal mechanisms have emerged at the preclinical and more recently clinical stages of drug development. A priority has been anti-obesity unimolecular peptides that function as balanced, high potency poly-agonists at two or all the cellular receptors for the endocrine hormones glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon. This report reviews recent progress in this area, with emphasis on what the initial clinical results demonstrate and what remains to be addressed.
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Affiliation(s)
- Patrick J Knerr
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN, USA
| | | | - Brian Finan
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN, USA
| | - Diego Perez-Tilve
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Matthias H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Garching, Germany
| | - Richard D DiMarchi
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN, USA; Department of Chemistry, Indiana University, Bloomington, IN, USA.
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19
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Parker VER, Robertson D, Wang T, Hornigold DC, Petrone M, Cooper AT, Posch MG, Heise T, Plum-Moerschel L, Schlichthaar H, Klaus B, Ambery PD, Meier JJ, Hirshberg B. Efficacy, Safety, and Mechanistic Insights of Cotadutide, a Dual Receptor Glucagon-Like Peptide-1 and Glucagon Agonist. J Clin Endocrinol Metab 2020; 105:5586886. [PMID: 31608926 DOI: 10.1210/clinem/dgz047] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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] [Received: 05/14/2019] [Accepted: 09/20/2019] [Indexed: 02/03/2023]
Abstract
CONTEXT Cotadutide is a dual receptor agonist with balanced glucagon-like peptide-1 and glucagon activity. OBJECTIVE To evaluate different doses of cotadutide and investigate underlying mechanisms for its glucose-lowering effects. DESIGN/SETTING Randomized, double-blind, phase 2a study conducted in 2 cohorts at 5 clinical trial sites. PATIENTS Participants were 65 adult overweight/obese patients with type 2 diabetes mellitus; 63 completed the study; 2 were withdrawn due to AEs. INTERVENTION Once-daily subcutaneous cotadutide or placebo for 49 days. Doses (50-300 µg) were uptitrated weekly (cohort 1) or biweekly (cohort 2). MAIN OUTCOME MEASURES Co-primary end points (cohort 1) were percentage changes from baseline to end of treatment in glucose (area under the curve from 0 to 4 hours [AUC0-4h]) post-mixed-meal tolerance test (MMTT) and weight. Exploratory measures included postprandial insulin and gastric emptying time (GET; cohort 2). RESULTS Patients received cotadutide (cohort 1, n = 26; cohort 2, n = 20) or placebo (cohort 1, n = 13; cohort 2, n = 6). Significant reductions were observed with cotadutide vs placebo in glucose AUC0-4h post MMTT (least squares mean [90% CI], -21.52% [-25.68, -17.37] vs 6.32% [0.45, 12.20]; P < 0.001) and body weight (-3.41% [-4.37, -2.44] vs -0.08% [-1.45, 1.28]; P = 0.002). A significant increase in insulin AUC0-4h post MMTT was observed with cotadutide (19.3 mU.h/L [5.9, 32.6]; P = 0.008) and GET was prolonged on day 43 with cotadutide vs placebo (t½: 117.2 minutes vs -42.9 minutes; P = 0.0392). CONCLUSION These results suggest that the glucose-lowering effects of cotadutide are mediated by enhanced insulin secretion and delayed gastric emptying. TRIAL REGISTRATION ClinicalTrials.gov, NCT03244800.
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Affiliation(s)
| | | | - Tao Wang
- AstraZeneca, Gaithersburg, MD, USA
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20
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Wang ZJ, Han YF, Zhao F, Yang GZ, Yuan L, Cai HY, Yang JT, Holscher C, Qi JS, Wu MN. A dual GLP-1 and Gcg receptor agonist rescues spatial memory and synaptic plasticity in APP/PS1 transgenic mice. Horm Behav 2020; 118:104640. [PMID: 31765661 DOI: 10.1016/j.yhbeh.2019.104640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/20/2019] [Revised: 11/16/2019] [Accepted: 11/16/2019] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease that severely affects the health and lifespan of the elderly worldwide. Recently, the correlation between AD and type 2 diabetes mellitus (T2DM) has received intensive attention, and a promising new anti-AD strategy is the use of anti-diabetic drugs. Oxyntomodulin (Oxm) is a peptide hormone and growth factor that acts on neurons in the hypothalamus. OXM activates glucagon-like peptide 1 (GLP-1) and glucagon (Gcg) receptors, facilitates insulin signaling and has neuroprotective effects against Aβ1-42-induced cytotoxicity in primary hippocampal neurons. Here, we tested the effects of the protease-resistant analogue (D-Ser2)Oxm on spatial memory and synaptic plasticity and the underlying molecular mechanisms in the APP/PS1 transgenic mouse model of AD. The results showed that (D-Ser2)Oxm not only alleviated the impairments of working memory and long-term spatial memory, but also reduced the number of Aβ plaques in the hippocampus, and reversed the suppression of hippocampal synaptic long-term potentiation (LTP). Moreover, (D-Ser2)Oxm administration significantly increased p-PI3K/p-AKT1 expression and decreased p-GSK3β levels in the hippocampus. These results are the first to show an in vivo neuroprotective role of (D-Ser2)Oxm in APP/PS1 mice, and this role involves the improvement of synaptic plasticity, clearance of Aβ and normalization of PI3K/AKT/GSK3β cell signaling in the hippocampus. This study suggests that (D-Ser2)Oxm holds promise for the prevention and treatment of AD.
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Affiliation(s)
- Zhao-Jun Wang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, PR China
| | - Yu-Fei Han
- Guangzhou Kingmed Diagnostics, Guangzhou, PR China
| | - Fang Zhao
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, PR China
| | - Guang-Zhao Yang
- Department of Cardiovascular Medicine, The First Hospital of Shanxi Medical University, Taiyuan, PR China
| | - Li Yuan
- Department of Physiology, Changzhi Medical College, Changzhi, PR China
| | - Hong-Yan Cai
- Department of Microbiology and Immunology, Shanxi Medical University, Taiyuan, PR China
| | - Jun-Ting Yang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, PR China
| | - Christian Holscher
- Neuroscience research group, Henan university of Chinese medicine, Zhengzhou, PR China
| | - Jin-Shun Qi
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, PR China.
| | - Mei-Na Wu
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, PR China.
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21
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Graham GV, Conlon JM, Abdel-Wahab YH, Flatt PR. Glucagon-like peptides-1 from phylogenetically ancient fish show potent anti-diabetic activities by acting as dual GLP1R and GCGR agonists. Mol Cell Endocrinol 2019; 480:54-64. [PMID: 30312651 DOI: 10.1016/j.mce.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/06/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 12/24/2022]
Abstract
Glucagon-like peptides-1 (GLP-1)from phylogenetically ancient fish (lamprey, dogfish, ratfish, paddlefish and bowfin) and from a teleost, the rainbow trout produced concentration-dependent stimulations of insulin release from clonal β-cells and isolated mouse islets. Lamprey and paddlefish GLP-1 were the most potent and effective. Incubation of BRIN-BD11 cells with GLP-1 receptor (GLP1R) antagonist, exendin-4 (9-39) attenuated insulinotropic activity of all peptides whereas glucagon receptor (GCGR) antagonist [des-His1,Pro4,Glu9] glucagon amide significantly decreased the activities of lamprey and paddlefish GLP-1 only. The GIP receptor antagonist GIP (6-30) Cex-K40 [Pal] attenuated the activity of bowfin GLP-1. All peptides (1 μM) produced significant increases in cAMP concentration in CHL cells transfected with GLP1R but only lamprey and paddlefish GLP-1 stimulated cAMP production in HEK293 cells transfected with GCGR. Intraperitoneal administration of lamprey and paddlefish GLP-1 (25 nmol/kg body weight) in mice produced significant decreases in blood glucose and increased insulin concentrations comparable to the effects of human GLP-1. Lamprey and paddlefish GLP-1 display potent insulinotropic activity in vitro and glucose-lowering activity in vivo that is mediated through GLP1R and GCGR so that these peptides may constitute templates for design of new antidiabetic drugs.
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Affiliation(s)
- Galyna V Graham
- SAAD Centre for Pharmacy and Diabetes, School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK
| | - J Michael Conlon
- SAAD Centre for Pharmacy and Diabetes, School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK.
| | - Yasser H Abdel-Wahab
- SAAD Centre for Pharmacy and Diabetes, School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK
| | - Peter R Flatt
- SAAD Centre for Pharmacy and Diabetes, School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK
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22
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Tillner J, Posch MG, Wagner F, Teichert L, Hijazi Y, Einig C, Keil S, Haack T, Wagner M, Bossart M, Larsen PJ. A novel dual glucagon-like peptide and glucagon receptor agonist SAR425899: Results of randomized, placebo-controlled first-in-human and first-in-patient trials. Diabetes Obes Metab 2019; 21:120-128. [PMID: 30091218 DOI: 10.1111/dom.13494] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [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: 02/07/2018] [Revised: 07/27/2018] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the safety, pharmacokinetics and pharmacodynamics of SAR425899, a novel polypeptide, active as an agonist at both the glucagon-like peptide-1 receptor (GLP-1R) and the glucagon receptor (GCR), in healthy volunteers and in overweight/obese patients with type 2 diabetes (T2D). METHODS Subcutaneous administrations of SAR425899 were tested in two randomized, placebo-controlled, double-blind clinical trials. In the first trial, healthy overweight volunteers (body mass index [BMI] 25-30 kg/m2 ; n = 32) received single-ascending doses (0.01-0.1 mg) of SAR425899 or placebo. In the second, a multiple-ascending-dose trial (NCT02411825), healthy normal- to overweight volunteers (BMI 20-30 kg/m2 ; n = 40) and overweight/obese patients with T2D (BMI 28-42 kg/m2 ; n = 36) received daily doses of SAR425899 or placebo over 21 or 28 days, respectively. RESULTS The most frequently reported adverse events were gastrointestinal; gastrointestinal side effects were less pronounced in patients with T2D compared with healthy volunteers. SAR425899 significantly reduced levels of fasting plasma glucose (P < 0.05 vs. placebo) and glycated haemoglobin (P < 0.001 versus placebo) in patients with T2D. Additionally, SAR425899 led to reductions in body weight, with a maximal reduction of 5.32 kg in healthy volunteers and 5.46 kg in patients with T2D (P < 0.001 vs. placebo) at end of treatment. CONCLUSIONS SAR425899 was well tolerated and led to favourable glycaemic effects in patients with T2D and weight reduction in both healthy volunteers and patients. Whether dual GLP-1R/GCR agonism represents a treatment method that is superior to pure GLP-1R agonists for obesity and diabetes treatment remains to be confirmed.
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Affiliation(s)
| | | | - Frank Wagner
- Charité Research Organisation GmbH, Berlin, Germany
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23
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Kim T, Holleman CL, Nason S, Arble DM, Ottaway N, Chabenne J, Loyd C, Kim JA, Sandoval D, Drucker DJ, DiMarchi R, Perez-Tilve D, Habegger KM. Hepatic Glucagon Receptor Signaling Enhances Insulin-Stimulated Glucose Disposal in Rodents. Diabetes 2018; 67:2157-2166. [PMID: 30150304 PMCID: PMC6198333 DOI: 10.2337/db18-0068] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
Glucagon receptor (GCGR) agonists cause hyperglycemia but also weight loss. However, GCG-like peptide 1 receptor (GLP1R)/GCGR mixed agonists do not exhibit the diabetogenic effects often attributed to GCGR activity. Thus, we sought to investigate the effect of glucagon agonism on insulin action and glucose homeostasis. Acute GCGR agonism induced immediate hyperglycemia, followed by improved glucose tolerance and enhanced glucose-stimulated insulin secretion. Moreover, acute GCGR agonism improved insulin tolerance in a dose-dependent manner in both lean and obese mice. Improved insulin tolerance was independent of GLP1R, FGF21, and hepatic glycogenolysis. Moreover, we observed increased glucose infusion rate, disposal, uptake, and suppressed endogenous glucose production during euglycemic clamps. Mice treated with insulin and GCGR agonist had enhanced phosphorylation of hepatic AKT at Ser473; this effect was reproduced in isolated mouse primary hepatocytes and resulted in increased AKT kinase activity. These data reveal that GCGR agonism enhances glucose tolerance, in part, by augmenting insulin action, with implications for the use of GCGR agonism in therapeutic strategies for diabetes.
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Affiliation(s)
- Teayoun Kim
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Cassie L Holleman
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Shelly Nason
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Deanna M Arble
- Department of Biological Sciences, Marquette University, Milwaukee, WI
| | - Nickki Ottaway
- Metabolic Diseases Institute and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | | | - Christine Loyd
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jeong-A Kim
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Daniel J Drucker
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard DiMarchi
- Novo Nordisk Research Center, Indianapolis, IN
- Department of Chemistry, Indiana University, Bloomington, IN
| | - Diego Perez-Tilve
- Metabolic Diseases Institute and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | - Kirk M Habegger
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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24
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Ambery PD, Klammt S, Posch MG, Petrone M, Pu W, Rondinone C, Jermutus L, Hirshberg B. MEDI0382, a GLP-1/glucagon receptor dual agonist, meets safety and tolerability endpoints in a single-dose, healthy-subject, randomized, Phase 1 study. Br J Clin Pharmacol 2018; 84:2325-2335. [PMID: 29926478 PMCID: PMC6138475 DOI: 10.1111/bcp.13688] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 04/10/2018] [Revised: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 01/20/2023] Open
Abstract
AIMS MEDI0382 is a balanced glucagon-like peptide-1/glucagon receptor dual agonist under development for the treatment of type 2 diabetes mellitus and non-alcoholic steatohepatitis. The primary objective was to assess the safety of MEDI0382 in healthy subjects. METHODS In this placebo-controlled, double-blind, Phase 1 study, healthy subjects (aged 18-45 years) were randomized (3:1) to receive a single subcutaneous dose of MEDI0382 or placebo after ≥8 h of fasting. The study consisted of six cohorts that received study drug at 5 μg, 10 μg, 30 μg, 100 μg, 150 μg or 300 μg. The primary objective was safety and tolerability. Secondary endpoints included assessments of pharmacokinetics and immunogenicity. All subjects were followed for up to 28 days. RESULTS A total of 36 subjects received MEDI0382 (n = 6 per cohort) and 12 subjects received placebo (n = 2 per cohort). Treatment-emergent adverse events (TEAEs) occurred more frequently with MEDI0382 vs. placebo, which was mostly due to an increased occurrence at MEDI0382 doses ≥150 μg. All TEAEs were mild or moderate in severity. The most common TEAEs were vomiting, nausea and dizziness. There appeared to be a dose-dependent increase in heart rate with MEDI0382 treatment. MEDI0382 showed linear pharmacokinetic profile (time to maximum plasma concentration: 4.50-9.00 h; elimination half-life: 9.54-12.07 h). No immunogenicity was observed in the study. CONCLUSIONS In this single-dose, Phase 1 study in healthy subjects, the safety and pharmacokinetic profiles of MEDI0382 support once-daily dosing and further clinical development of MEDI0382.
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Affiliation(s)
- Philip D. Ambery
- Cardiovascular, Renal, and Metabolism iMEDMedImmune LtdCambridgeUK
| | | | | | - Marcella Petrone
- Cardiovascular, Renal, and Metabolism iMEDMedImmune LtdCambridgeUK
| | - Wenji Pu
- Cardiovascular, Renal, and Metabolism iMEDMedImmune IncGaithersburgMDUSA
| | - Cristina Rondinone
- Cardiovascular, Renal, and Metabolism iMEDMedImmune IncGaithersburgMDUSA
| | - Lutz Jermutus
- Cardiovascular, Renal, and Metabolism iMEDMedImmune LtdCambridgeUK
| | - Boaz Hirshberg
- Cardiovascular, Renal, and Metabolism iMEDMedImmune IncGaithersburgMDUSA
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25
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Kim T, Nason S, Holleman C, Pepin M, Wilson L, Berryhill TF, Wende AR, Steele C, Young ME, Barnes S, Drucker DJ, Finan B, DiMarchi R, Perez-Tilve D, Tschöp M, Habegger KM. Glucagon Receptor Signaling Regulates Energy Metabolism via Hepatic Farnesoid X Receptor and Fibroblast Growth Factor 21. Diabetes 2018; 67:1773-1782. [PMID: 29925501 PMCID: PMC6110317 DOI: 10.2337/db17-1502] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
Glucagon, an essential regulator of glucose and lipid metabolism, also promotes weight loss, in part through potentiation of fibroblast growth factor 21 (FGF21) secretion. However, FGF21 is only a partial mediator of metabolic actions ensuing from glucagon receptor (GCGR) activation, prompting us to search for additional pathways. Intriguingly, chronic GCGR agonism increases plasma bile acid levels. We hypothesized that GCGR agonism regulates energy metabolism, at least in part, through farnesoid X receptor (FXR). To test this hypothesis, we studied whole-body and liver-specific FXR-knockout (Fxr∆liver) mice. Chronic GCGR agonist (IUB288) administration in diet-induced obese (DIO) Gcgr, Fgf21, and Fxr whole-body or liver-specific knockout (∆liver) mice failed to reduce body weight when compared with wild-type (WT) mice. IUB288 increased energy expenditure and respiration in DIO WT mice, but not Fxr∆liver mice. GCGR agonism increased [14C]palmitate oxidation in hepatocytes isolated from WT mice in a dose-dependent manner, an effect blunted in hepatocytes from Fxr∆liver mice. Our data clearly demonstrate that control of whole-body energy expenditure by GCGR agonism requires intact FXR signaling in the liver. This heretofore-unappreciated aspect of glucagon biology has implications for the use of GCGR agonism in the therapy of metabolic disorders.
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MESH Headings
- Adiposity/drug effects
- Animals
- Anti-Obesity Agents/therapeutic use
- Calorimetry, Indirect
- Cells, Cultured
- Diet, High-Fat/adverse effects
- Energy Metabolism/drug effects
- Fibroblast Growth Factors/genetics
- Fibroblast Growth Factors/metabolism
- Gene Expression Regulation/drug effects
- Liver/drug effects
- Liver/metabolism
- Liver/pathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Mitochondria, Liver/drug effects
- Mitochondria, Liver/enzymology
- Mitochondria, Liver/metabolism
- Obesity/drug therapy
- Obesity/etiology
- Obesity/metabolism
- Obesity/pathology
- Organ Specificity
- Oxidative Phosphorylation/drug effects
- Peptides/therapeutic use
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
- Receptors, Glucagon/agonists
- Receptors, Glucagon/genetics
- Receptors, Glucagon/metabolism
- Signal Transduction/drug effects
- Weight Gain/drug effects
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Affiliation(s)
- Teayoun Kim
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Shelly Nason
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Cassie Holleman
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mark Pepin
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, AL
| | - Landon Wilson
- Department of Pharmacology, University of Alabama at Birmingham, Birmingham, AL
| | - Taylor F Berryhill
- Department of Pharmacology, University of Alabama at Birmingham, Birmingham, AL
| | - Adam R Wende
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, AL
| | - Chad Steele
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Martin E Young
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen Barnes
- Department of Pharmacology, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel J Drucker
- Department of Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Brian Finan
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN
| | - Richard DiMarchi
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN
- Department of Chemistry, Indiana University, Bloomington, IN
| | - Diego Perez-Tilve
- Division of Endocrinology, Diabetes and Metabolism, Metabolic Diseases Institute, University of Cincinnati, Cincinnati, OH
| | - Matthias Tschöp
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - Kirk M Habegger
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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26
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Elvert R, Bossart M, Herling AW, Weiss T, Zhang B, Kannt A, Wagner M, Haack T, Evers A, Dudda A, Keil S, Lorenz M, Lorenz K, Riz M, Hennerici W, Larsen PJ. Team Players or Opponents: Coadministration of Selective Glucagon and GLP-1 Receptor Agonists in Obese Diabetic Monkeys. Endocrinology 2018; 159:3105-3119. [PMID: 29992313 DOI: 10.1210/en.2018-00399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Received: 04/26/2018] [Accepted: 07/03/2018] [Indexed: 01/06/2023]
Abstract
We assessed the therapeutic contribution of the individual components of glucagon-like peptide-1 receptor (GLP-1R) and glucagon receptor (GCGR) agonists alone and in combination upon energy homeostasis and glycemic control in diet-induced obese, diabetic nonhuman primates. The pharmacological active dose ranges of selective agonists were established through a dose-finding study, followed by a 6-week chronic study. Repeated subcutaneous administration of a selective GCGR agonist (30 µg/kg once daily) did not affect food intake or body weight, whereas the selective GLP-1R agonist (3 µg/kg once daily) alone decreased energy intake by 18% and body weight by 3.8% ± 0.9%. Combination of both agonists reduced significantly cumulative food intake by 27% and body weight by 6.6% ± 0.9%. Fasting plasma glucose (FPG) was improved by GLP-1R agonist (baseline vs end of study, 176.7 ± 34.0 vs 115.9 ± 16.1 mg/dL). In contrast, groups exposed to GCGR agonist experienced nonsignificant elevations of FPG. More accurate assessment of therapeutic interventions on glucose homeostasis was tested by an IV glucose tolerance test. Glucose excursion was significantly elevated by chronic GCGR agonist administration, whereas it was significantly decreased in GLP-1R agonist-treated monkeys. In the combination group, a nonsignificant increase of glucose excursion was seen, concomitantly with significantly increased insulin secretion. We conclude that chronic glucagon agonism does not affect energy homeostasis in nonhuman primates. In combination with GLP-1R agonism, glucagon agonism synergistically enhances negative energy balance with resulting larger body weight loss. However, adding GCGR to GLP-1R agonism diminishes glycemic control in diabetic monkeys. Therefore, long-term therapeutic implications of using GLP-1R/GCGR coagonists for weight management in diabetes warrants further scrutiny.
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Affiliation(s)
- Ralf Elvert
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Martin Bossart
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Andreas W Herling
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Tilo Weiss
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | | | - Aimo Kannt
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Wagner
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Torsten Haack
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Andreas Evers
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Angela Dudda
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Stefanie Keil
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Martin Lorenz
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Katrin Lorenz
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Michela Riz
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Wolfgang Hennerici
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Philip J Larsen
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
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27
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Elvert R, Herling AW, Bossart M, Weiss T, Zhang B, Wenski P, Wandschneider J, Kleutsch S, Butty U, Kannt A, Wagner M, Haack T, Evers A, Dudda A, Lorenz M, Keil S, Larsen PJ. Running on mixed fuel-dual agonistic approach of GLP-1 and GCG receptors leads to beneficial impact on body weight and blood glucose control: A comparative study between mice and non-human primates. Diabetes Obes Metab 2018; 20:1836-1851. [PMID: 29938884 PMCID: PMC6055720 DOI: 10.1111/dom.13212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/09/2017] [Revised: 12/11/2017] [Accepted: 12/25/2017] [Indexed: 12/17/2022]
Abstract
AIM We performed acute and chronic studies in healthy and diet-induced obese animals using mouse-specific or monkey-specific dual GLP-1R/GCGR agonists to investigate their effects on food intake, body weight, blood glucose control and insulin secretion. The selective GLP-1R agonist liraglutide was used as comparator. METHODS The mouse-specific dual agonist and liraglutide were tested in lean wild type, GLP-1R knockout and diet-induced obese mice at different doses. A chronic study was performed in DIO mice to investigate the effect on body weight, food consumption and total energy expenditure (TEE) in obese and diabetic monkeys with a focus on body weight and energy intake. RESULTS The mouse-specific dual agonist and liraglutide similarly affected glycaemic control. A higher loss in body weight was measured in dual agonist-treated obese mice. The dual agonist significantly enhanced plasma glucose excursion in overnight fed GLP-1R-/- mice, probably reflecting a potent GCGR agonist activity. It increased TEE and enhanced fat and carbohydrate oxidation, while liraglutide produced no effect on TEE. In obese and diabetic monkeys, treatment with the monkey-specific dual agonist reduced total energy intake to 60%-70% of baseline TEI during chronic treatment. A decrease in body weight and significant improvement in glucose tolerance was observed. CONCLUSIONS In DIO mice and non-human primates, dual agonists elicited robust glycaemic control, similar to the marketed GLP-1R agonist, while eliciting greater effects on body weight. Results from DIO mice suggest that the increase in TEE is caused not only by increased fat oxidation but also by an increase in carbohydrate oxidation.
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MESH Headings
- Animals
- Animals, Outbred Strains
- Appetite Depressants/administration & dosage
- Appetite Depressants/adverse effects
- Appetite Depressants/therapeutic use
- Body Weight/drug effects
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diet, High-Fat/adverse effects
- Dose-Response Relationship, Drug
- Drug Therapy, Combination/adverse effects
- Energy Intake/drug effects
- Energy Metabolism/drug effects
- Female
- Glucagon-Like Peptide-1 Receptor/agonists
- Glucagon-Like Peptide-1 Receptor/genetics
- Glucagon-Like Peptide-1 Receptor/metabolism
- Hyperglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Insulin Secretion/drug effects
- Macaca fascicularis
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Obesity/blood
- Obesity/drug therapy
- Obesity/etiology
- Obesity/metabolism
- Random Allocation
- Receptors, Glucagon/agonists
- Receptors, Glucagon/metabolism
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Affiliation(s)
- Ralf Elvert
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
| | | | | | - Tilo Weiss
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
| | | | | | | | | | - Uwe Butty
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
| | - Aimo Kannt
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
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28
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Shankar SS, Shankar RR, Mixson LA, Miller DL, Pramanik B, O'Dowd AK, Williams DM, Frederick CB, Beals CR, Stoch SA, Steinberg HO, Kelley DE. Native Oxyntomodulin Has Significant Glucoregulatory Effects Independent of Weight Loss in Obese Humans With and Without Type 2 Diabetes. Diabetes 2018; 67:1105-1112. [PMID: 29545266 DOI: 10.2337/db17-1331] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/06/2018] [Indexed: 12/20/2022]
Abstract
Oxyntomodulin (OXM), an enteroendocrine hormone, causes appetite suppression, increased energy expenditure, and weight loss in obese humans via activation of GLP-1 and glucagon receptors. However, the effects of OXM on glucose homeostasis remain ill defined. To address this gap, we evaluated the effects of an i.v. infusion of native OXM on insulin secretion rates (ISRs) and glycemic excursion in a graded glucose infusion (GGI) procedure in two separate randomized, placebo (PBO)-controlled, single-dose crossover trials in 12 overweight and obese subjects without diabetes and in 12 obese subjects with type 2 diabetes mellitus (T2DM), using the GLP-1 analog liraglutide (LIRA) as a comparator in T2DM. In both groups, in the GGI, 3.0 pmol/kg/min of OXM significantly increased ISR and blunted glycemic excursion relative to PBO. In T2DM, the effects of OXM were comparable to those of LIRA, including restoration of β-cell glucose responsiveness to that of nonobese subjects without diabetes. Our findings indicate that native OXM significantly augments glucose-dependent insulin secretion acutely in obese subjects with and without diabetes, with effects comparable to pharmacologic GLP-1 receptor activation and independent of weight loss. Native OXM has potential to improve hyperglycemia via complementary and independent induction of insulin secretion and weight loss.
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29
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Abstract
Glucagon is a peptide hormone secreted from the pancreatic alpha cells in response to hypoglycemia but in some patients with type 2 diabetes a paradoxical hypersecretion results from the intake of glucose. In rodent, antagonizing the actions of glucagon have been shown to be effective for lowering blood glucose levels and this has recently have been solidified in patients with type 2 diabetes. Although the reported increases of liver enzymes, hyperglucagonemia, and alpha cell hyperplasia resulting from glucagon receptor antagonism may potentially limit the clinical applicability of glucagon receptor antagonists, they may serve as an instrumental toolbox for delineating the physiology of glucagon. Agonizing glucagon receptor signaling may be relevant, in particular when combined with glucagon-like peptide-1 receptor analogues in the perspective of body weight lowering therapy. Here, we will focus on new conceptual aspects of glucagon biology and how this may led to new diagnostics and treatment of metabolic diseases.
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Affiliation(s)
- Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, and the Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
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30
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Nunez DJ, D'Alessio D. Glucagon receptor as a drug target: A witches' brew of eye of newt (peptides) and toe of frog (receptors). Diabetes Obes Metab 2018; 20:233-237. [PMID: 28842950 DOI: 10.1111/dom.13102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
MESH Headings
- Animals
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Drugs, Investigational/adverse effects
- Drugs, Investigational/pharmacology
- Drugs, Investigational/therapeutic use
- Glucagon-Like Peptide-1 Receptor/agonists
- Glucagon-Like Peptide-1 Receptor/metabolism
- Humans
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/pharmacology
- Hypoglycemic Agents/therapeutic use
- Molecular Targeted Therapy
- Receptors, Glucagon/agonists
- Receptors, Glucagon/antagonists & inhibitors
- Receptors, Glucagon/metabolism
- Signal Transduction/drug effects
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Affiliation(s)
- Derek J Nunez
- Division of Endocrinology, Metabolism and Nutrition, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - David D'Alessio
- Division of Endocrinology, Metabolism and Nutrition, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
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31
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Abstract
Upon lowered blood glucose occurring during fasting, glucagon is secreted from pancreatic islets, exerting various metabolic effects to normalize glucose levels. A considerable portion of these effects is mediated by glucagon-activated transcription factors (TFs) in liver. Glucagon directly activates several TFs via immediate cyclic adenosine monophosphate (cAMP)- and calcium-dependent signaling events. Among these TFs, cAMP response element-binding protein (CREB) is a major factor. CREB recruits histone-modifying enzymes and cooperates with other TFs on the chromatin template to increase the rate of gene transcription. In addition to direct signal transduction, the transcriptional effects of glucagon are also influenced by dynamic TF cross talk. Specifically, assisted loading of one TF by a companion TF leads to increased binding and activity. Lastly, transcriptional regulation by glucagon is also exerted by TF cascades by which a primary TF induces the gene expression of secondary TFs that bring about their activity a few hours after the initial glucagon signal. This mechanism of a delayed response may be instrumental in establishing the temporal organization of the fasting response by which distinct metabolic events separate early from prolonged fasting. In this mini-review, we summarize recent advances and critical discoveries in glucagon-dependent gene regulation with a focus on direct TF activation, dynamic TF cross talk, and TF cascades.
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Affiliation(s)
- Ido Goldstein
- Laboratory of Receptor Biology and Gene Expression, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Correspondence: Gordon L. Hager, PhD, Laboratory of Receptor Biology and Gene Expression, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 41, Room B602, Bethesda, Maryland 20892. E-mail: ; or Ido Goldstein, PhD, Laboratory of Receptor Biology and Gene Expression, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 41, Room B307, Bethesda, Maryland 20892. E-mail:
| | - Gordon L Hager
- Laboratory of Receptor Biology and Gene Expression, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Correspondence: Gordon L. Hager, PhD, Laboratory of Receptor Biology and Gene Expression, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 41, Room B602, Bethesda, Maryland 20892. E-mail: ; or Ido Goldstein, PhD, Laboratory of Receptor Biology and Gene Expression, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 41, Room B307, Bethesda, Maryland 20892. E-mail:
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32
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Sánchez-Garrido MA, Brandt SJ, Clemmensen C, Müller TD, DiMarchi RD, Tschöp MH. GLP-1/glucagon receptor co-agonism for treatment of obesity. Diabetologia 2017; 60:1851-1861. [PMID: 28733905 PMCID: PMC6448809 DOI: 10.1007/s00125-017-4354-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [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: 11/09/2016] [Accepted: 03/28/2017] [Indexed: 12/25/2022]
Abstract
Over a relatively short period, obesity and type 2 diabetes have come to represent a large medical and economic burden to global societies. The epidemic rise in the prevalence of obesity has metabolic consequences and is paralleled by an increased occurrence of other diseases, such as diabetes, cancer and cardiovascular complications. Together, obesity and type 2 diabetes constitute one of the more preventable causes of premature death and the identification of novel, safe and effective anti-obesity drugs is of utmost importance. Pharmacological attempts to treat obesity have had limited success, with notable adverse effects, rendering bariatric surgery as the only current therapy for substantially improving body weight. Novel unimolecular, multifunctional peptides have emerged as one of the most promising medicinal approaches to enhance metabolic efficacy and restore normal body weight. In this review, we will mainly focus on the discovery and translational relevance of dual agonists that pharmacologically function at the receptors for glucagon and glucagon-like peptide-1. Such peptides have advanced to clinical evaluation and inspired the pursuit of multiple related approaches to achieving polypharmacy within single molecules.
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Affiliation(s)
- Miguel A Sánchez-Garrido
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Business Campus Garching, Parkring 13, 85748, Garching, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sara J Brandt
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Business Campus Garching, Parkring 13, 85748, Garching, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Christoffer Clemmensen
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Business Campus Garching, Parkring 13, 85748, Garching, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Timo D Müller
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Business Campus Garching, Parkring 13, 85748, Garching, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Richard D DiMarchi
- Department of Chemistry, Indiana University, 800 E Kirkwood Ave, Bloomington, IN, 47405, USA.
| | - Matthias H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Business Campus Garching, Parkring 13, 85748, Garching, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
- Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany.
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33
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Jiao JJ, Hölscher C, Li T, Dong XF, Qu XS, Cao Y, Wu MN, Wang ZJ, Qi JS. [GLP-1/GIP/Gcg receptor Triagonist improves the cognitive behaviors in triple-transgenic mice of Alzheimer's disease]. Sheng Li Xue Bao 2017; 69:135-145. [PMID: 28435972] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Alzheimer's disease (AD) is a progressively neurodegenerative disorder, which seriously affects human health but is still irreversible up to now. Recent studies indicate that type 2 diabetes mellitus (T2DM) is an important risk factor for AD, and the drugs used for treatment of T2DM have shown some neuroprotective effects in the treatment of AD. Glucagon-like peptide-1 (GLP-1)/ glucose-dependent insulinotropic polypeptide (GIP)/glucagon (Gcg) receptor Triagonist is a new monomeric polypeptide equally activating the GLP-1/GIP/Gcg receptors, which is built on the basis of GLP-1/Gcg receptor coagonist core sequence, and incorporated with partial amino acids of GIP. Recently, the Triagonist has been reported to be effective in alleviating diabetic complications in rodent models of obesity. The present study observed for the first time the cognitive improvement effects of the Triagonist in the triple-transgenic AD mice (3xTg-AD) by using multiple behavioral techniques, and explored its probable molecular mechanisms using ELISA and Western blot. The results showed that the chronic treatment with the Triagonist (i.p.) significantly reversed the impairments in working memory of 3xTg-AD mice, with an obvious increase in the percentage of correct spontaneous alternation in the Y maze; the Triagonist treatment also improved long-term spatial memory and re-learning ability of 3xTg-AD mice in classical Morris water maze and reverse water maze tests, with decreased escape latency in under water platform tests and increased swimming time in probe tests. ELISA and Western blot experiments showed that the Triagonist up-regulated the levels of cAMP, PKA and p-CREB in the hippocampus of 3xTg-AD mice. These results indicate that GLP-1/GIP/Gcg receptor Triagonist can improve the cognitive behaviors in 3xTg-AD mice, and the up-regulation of hippocampal cAMP/PKA/CREB signal pathway may mediate the neuroprotection of the Triagonist, suggesting that the GLP-1/GIP/Gcg receptor Triagonist may be a novel therapeutic strategy for the treatment of AD.
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Affiliation(s)
- Juan-Juan Jiao
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Christian Hölscher
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YQ, UK
| | - Tian Li
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Xue-Fan Dong
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Xue-Song Qu
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Yue Cao
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Mei-Na Wu
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Zhao-Jun Wang
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Jin-Shun Qi
- Department of Physiology, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan 030001, China.
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34
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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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35
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Abstract
Diabesity is a new term for obesity-dependent diabetes, which is also associated with cardiovascular and other comorbidities with rising epidemic. Traditional treatments (sulfonylureas and thiazolidinediones) of diabetes are associated with weight gain, except metformin. Newer agents such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Sodium glucose co-transporter 2 inhibitors (SGLT2i) are causing a modest weight reduction, whereas dipeptidyl peptidase-4 inhibitors (DPP-4i) are weight neutral. Oxyntomodulin, a native GLP-1/glucagon receptor agonist produced a superior weight loss and antihyperglycemic effects in obese mice and humans. Recent findings with synthetic dual GLP-1/glucagon receptor agonists have shown a good weight loss and antihyperglycemic profile in diet-induced obese (DIO) mice. Targeting combinations of GLP-1 receptor and glucagon receptor simultaneously with a single peptide may be the better strategy to achieve marked weight loss and considerable glycemic control in diabesity. Cardiovascular safety is very important with new antidiabetic agents due to rosiglitazone controversy. Current on-going clinical trials will clarify the cardiovascular effects of incretin-based therapies in near future. Based on current knowledge and rapid progress in the field, there is a strong possibility that the GLP-1/glucagon receptor co-agonists will likely be the new therapeutic treatment for diabesity for decades to come.
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Affiliation(s)
- Hitesh Soni
- Department of Physiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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36
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Muppidi A, Zou H, Yang PY, Chao E, Sherwood L, Nunez V, Woods A, Schultz PG, Lin Q, Shen W. Design of Potent and Proteolytically Stable Oxyntomodulin Analogs. ACS Chem Biol 2016; 11:324-8. [PMID: 26727558 PMCID: PMC4861236 DOI: 10.1021/acschembio.5b00787] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Incretin-based peptides are effective therapeutics for treating type 2 diabetes mellitus (T2DM). Oxyntomodulin (OXM), a dual agonist of GLP-1R and GCGR, has shown superior weight loss and glucose lowering effects, compared to single GLP-1R agonists. To overcome the short half-life and rapid renal clearance of OXM, which limit its therapeutic potential, both lipid and PEG modified OXM analogs have been reported. However, these approaches often result in reduced potency or PEG-associated toxicity. Herein, we report a new class of cross-linked OXM analogs that show increased plasma stability and higher potency in activating both GLP-1R and GCGR. Moreover, the extended in vivo half-life results in superior antihyperglycemic activity in mice compared to the wild-type OXM.
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Affiliation(s)
- Avinash Muppidi
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
- Department of Chemistry, State University of New York at Buffalo, Buffalo, New York 14260-3000, United States
| | - Huafei Zou
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Peng Yu Yang
- Department of Chemistry, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California 92037, United states
| | - Elizabeth Chao
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Lance Sherwood
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Vanessa Nunez
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Ashley Woods
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Peter G Schultz
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
- Department of Chemistry, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California 92037, United states
| | - Qing Lin
- Department of Chemistry, State University of New York at Buffalo, Buffalo, New York 14260-3000, United States
| | - Weijun Shen
- California Institute for Biomedical Research (Calibr), 11119 North Torrey Pines Road, La Jolla, California 92037, United States
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37
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Roussel R, Lorraine J, Rodriguez A, Salaun-Martin C. Overview of Data Concerning the Safe Use of Antihyperglycemic Medications in Type 2 Diabetes Mellitus and Chronic Kidney Disease. Adv Ther 2015; 32:1029-64. [PMID: 26581749 DOI: 10.1007/s12325-015-0261-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 07/23/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION It can be a challenge to manage glycemic control in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), due to both patient and medication issues. Although most antihyperglycemic medications can be used in mild kidney disease, many medications are either not advised or require dose adjustments in more advanced CKD. This review summarizes product label information, pharmacokinetic and clinical studies, and clinical guidelines relevant to use of antihyperglycemic medications in CKD. METHODS Product labels and guidelines from North America and Europe, as well as pharmacokinetic and clinical studies of diabetes medication use in CKD were identified through Medline and PubMed searches, up to February 2015. Available data are summarized and correlations between treatment recommendations and available research are discussed, as are glycemic targets for patients with CKD. RESULTS Newer medications have significantly more data available than older medications regarding use in CKD, although larger clinical studies are still lacking for some drugs. As CKD advances, dose adjustment is needed for many medications [numerous dipeptidyl peptidase-4 inhibitors, some insulins, sodium glucose co-transporter 2 (SGLT2) inhibitors], although not for others (thiazolidinediones, meglitinides). Some medications are not recommended for use in more advanced CKD (metformin, SGLT2 inhibitors, some glucagon-like protein-1 receptor agonists) for safety or efficacy reasons. There is not always good alignment between label recommendations, pharmacokinetic or clinical studies, and guideline recommendations for use of these drugs in CKD. In particular, controversy remains about the use of metformin in moderate CKD and appropriate use of liraglutide and sulfonylureas in advanced CKD. CONCLUSION Considerable variability exists with respect to recommendations and clinical data for the many antihyperglycemic drugs used in patients with T2DM and CKD. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Ronan Roussel
- Division of Endocrinology Diabetes and Nutrition, DHU FIRE, Groupe Hospitalier Bichat-Claude Bernard, AP-HP, Paris, France.
- INSERM U 1138, Cordeliers Research Center, Paris, France.
- University Paris Diderot-Paris 7, Paris, France.
| | | | | | - Carole Salaun-Martin
- Eli Lilly, Neuilly Cedex, France
- Division of Endocrinology Diabetes and Nutrition, Hopital Max Fourestier, Nanterre, France
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Iepsen EW. Response to the Letter by Napoli N., et al. J Clin Endocrinol Metab 2015; 100:L94-5. [PMID: 26439159 DOI: 10.1210/jc.2015-3142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Conte C, Cecere A, Guglielmi G, Napoli N. Letter to the Editor: "GLP-1 Receptor Agonist Treatment Increases Bone Formation and Prevents Bone Loss in Weight-Reduced Obese Women" by Iepsen E.W., et al. J Clin Endocrinol Metab 2015; 100:L92-3. [PMID: 26439158 DOI: 10.1210/jc.2015-2970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caterina Conte
- Division of Endocrinology and Metabolic Diseases (C.C.), Policlinico Agostino Gemelli-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Radiology (A.C., G.G.), University of Foggia, 71100 Foggia, Italy; Department of Radiology (G.G.), Scientific Institute Hospital "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, FG, Italy; and Division of Endocrinology and Diabetes (N.N.), Università Campus Bio-Medico di Roma, 00128 Rome, Italy; and Division of Bone and Mineral Diseases (N.N.), Washington University, St Louis, Missouri 63110 E-mail:
| | - Annagrazia Cecere
- Division of Endocrinology and Metabolic Diseases (C.C.), Policlinico Agostino Gemelli-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Radiology (A.C., G.G.), University of Foggia, 71100 Foggia, Italy; Department of Radiology (G.G.), Scientific Institute Hospital "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, FG, Italy; and Division of Endocrinology and Diabetes (N.N.), Università Campus Bio-Medico di Roma, 00128 Rome, Italy; and Division of Bone and Mineral Diseases (N.N.), Washington University, St Louis, Missouri 63110 E-mail:
| | - Giuseppe Guglielmi
- Division of Endocrinology and Metabolic Diseases (C.C.), Policlinico Agostino Gemelli-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Radiology (A.C., G.G.), University of Foggia, 71100 Foggia, Italy; Department of Radiology (G.G.), Scientific Institute Hospital "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, FG, Italy; and Division of Endocrinology and Diabetes (N.N.), Università Campus Bio-Medico di Roma, 00128 Rome, Italy; and Division of Bone and Mineral Diseases (N.N.), Washington University, St Louis, Missouri 63110 E-mail:
| | - Nicola Napoli
- Division of Endocrinology and Metabolic Diseases (C.C.), Policlinico Agostino Gemelli-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Radiology (A.C., G.G.), University of Foggia, 71100 Foggia, Italy; Department of Radiology (G.G.), Scientific Institute Hospital "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, FG, Italy; and Division of Endocrinology and Diabetes (N.N.), Università Campus Bio-Medico di Roma, 00128 Rome, Italy; and Division of Bone and Mineral Diseases (N.N.), Washington University, St Louis, Missouri 63110 E-mail:
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Dineen SL, McKenney ML, Bell LN, Fullenkamp AM, Schultz KA, Alloosh M, Chalasani N, Sturek M. Metabolic Syndrome Abolishes Glucagon-Like Peptide 1 Receptor Agonist Stimulation of SERCA in Coronary Smooth Muscle. Diabetes 2015; 64:3321-7. [PMID: 25845661 PMCID: PMC4542436 DOI: 10.2337/db14-1790] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/29/2015] [Indexed: 12/21/2022]
Abstract
Metabolic syndrome (MetS) doubles the risk of adverse cardiovascular events. Glucagon-like peptide 1 (GLP-1) receptor agonists induce weight loss, increase insulin secretion, and improve glucose tolerance. Studies in healthy animals suggest cardioprotective properties of GLP-1 receptor agonists, perhaps partially mediated by improved sarco-endoplasmic reticulum Ca(2+) ATPase (SERCA) activity. We examined the acute effect of GLP-1 receptor agonists on coronary smooth muscle cells (CSM) enzymatically isolated from lean, healthy Ossabaw miniature swine. Intracellular Ca(2+) handling was interrogated with fura-2. The GLP-1 receptor agonist exenatide activated SERCA but did not alter other Ca(2+) transporters. Further, we tested the hypothesis that chronic, in vivo treatment with GLP-1 receptor agonist AC3174 would attenuate coronary artery disease (CAD) in swine with MetS. MetS was induced in 20 swine by 6 months' feeding of a hypercaloric, atherogenic diet. Swine were then randomized (n = 10/group) into placebo or AC3174 treatment groups and continued the diet for an additional 6 months. AC3174 treatment attenuated weight gain, increased insulin secretion, and improved glucose tolerance. Intravascular ultrasound and histology showed no effect of AC3174 on CAD. MetS abolished SERCA activation by GLP-1 receptor agonists. We conclude that MetS confers vascular resistance to GLP-1 receptor agonists, partially through impaired cellular signaling steps involving SERCA.
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Affiliation(s)
- Stacey L Dineen
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
| | - Mikaela L McKenney
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
| | - Lauren N Bell
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kyle A Schultz
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
| | - Mouhamad Alloosh
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
| | - Naga Chalasani
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Michael Sturek
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
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Affiliation(s)
- Mark G Davies
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
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Affiliation(s)
- Muhammed Kizilgul
- Department of Endocrinology and Metabolism (M.K., S.B., T.D.), Diskapi Teaching and Research Hospital, Ankara, Turkey; Department of Endocrinology and Metabolism (S.K.), Ankara Teaching and Research Hospital, Ankara, Turkey; and Department of Internal Medicine (T.D.), School of Medicine (Kastamonu), Hacettepe University, Ankara, Turkey
| | - Seyfullah Kan
- Department of Endocrinology and Metabolism (M.K., S.B., T.D.), Diskapi Teaching and Research Hospital, Ankara, Turkey; Department of Endocrinology and Metabolism (S.K.), Ankara Teaching and Research Hospital, Ankara, Turkey; and Department of Internal Medicine (T.D.), School of Medicine (Kastamonu), Hacettepe University, Ankara, Turkey
| | - Selvihan Beysel
- Department of Endocrinology and Metabolism (M.K., S.B., T.D.), Diskapi Teaching and Research Hospital, Ankara, Turkey; Department of Endocrinology and Metabolism (S.K.), Ankara Teaching and Research Hospital, Ankara, Turkey; and Department of Internal Medicine (T.D.), School of Medicine (Kastamonu), Hacettepe University, Ankara, Turkey
| | - Tuncay Delibasi
- Department of Endocrinology and Metabolism (M.K., S.B., T.D.), Diskapi Teaching and Research Hospital, Ankara, Turkey; Department of Endocrinology and Metabolism (S.K.), Ankara Teaching and Research Hospital, Ankara, Turkey; and Department of Internal Medicine (T.D.), School of Medicine (Kastamonu), Hacettepe University, Ankara, Turkey
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Iepsen EW. Response to the Letter by Kizilgul M., et al. J Clin Endocrinol Metab 2015; 100:L72. [PMID: 26339738 DOI: 10.1210/jc.2015-2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Iepsen EW, Lundgren JR, Hartmann B, Pedersen O, Hansen T, Jørgensen NR, Jensen JEB, Holst JJ, Madsbad S, Torekov SS. GLP-1 Receptor Agonist Treatment Increases Bone Formation and Prevents Bone Loss in Weight-Reduced Obese Women. J Clin Endocrinol Metab 2015; 100:2909-17. [PMID: 26043228 DOI: 10.1210/jc.2015-1176] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [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: 12/13/2022]
Abstract
CONTEXT Recent studies indicate that glucagon-like peptide (GLP)-1 regulates bone turnover, but the effects of GLP-1 receptor agonists (GLP-1 RAs) on bone in obese weight-reduced individuals are unknown. OBJECTIVE To investigate the role of GLP-1 RAs on bone formation and weight loss-induced bone mass reduction. DESIGN Randomized control study. SETTING Outpatient research hospital clinic. PARTICIPANTS Thirty-seven healthy obese women with body mass index of 34 ± 0.5 kg/m(2) and age 46 ± 2 years. INTERVENTION After a low-calorie-diet-induced 12% weight loss, participants were randomized to treatment with or without administration of the GLP-1 RA liraglutide (1.2 mg/d) for 52 weeks. In case of weight gain, up to two meals per day could be replaced with a low-calorie-diet product to maintain the weight loss. MAIN OUTCOME MEASURES Total, pelvic, and arm-leg bone mineral content (BMC) and bone markers [C-terminal telopeptide of type 1 collagen (CTX-1) and N-terminal propeptide of type 1 procollagen (P1NP)] were investigated before and after weight loss and after 52-week weight maintenance. Primary endpoints were changes in BMC and bone markers after 52-week weight maintenance with or without GLP-1 RA treatment. RESULTS Total, pelvic, and arm-leg BMC decreased during weight maintenance in the control group (P < .0001), but not significantly in the liraglutide group. Thus, total and arm-leg BMC loss was four times greater in the control group compared to the liraglutide group (estimated difference, 27 g; 95% confidence interval, 5-48; P = .01), although the 12% weight loss was maintained in both groups. In the liraglutide group, the bone formation marker P1NP increased by 16% (7 ± 3 μg/L) vs a 2% (-1 ± 4 μg/L) decrease in the control group (P < .05). The bone resorption marker CTX-1 collagen did not change during the weight loss maintenance phase. CONCLUSIONS Treatment with a long-acting GLP-1 RA increased bone formation by 16% and prevented bone loss after weight loss obtained through a low-calorie diet, supporting its role as a safe weight-lowering agent.
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Affiliation(s)
- Eva W Iepsen
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Julie R Lundgren
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Oluf Pedersen
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Torben Hansen
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Niklas R Jørgensen
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Jens-Erik B Jensen
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Sten Madsbad
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
| | - Signe S Torekov
- Department of Biomedical Sciences (E.W.I., J.R.L., B.H., J.J.H., S.S.T.), and NNF Center for Basic Metabolic Research (E.W.I., J.R.L., B.H., O.P., T.H., J.J.H., S.S.T.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark; Department of Endocrinology (J.-E.B.J., S.M.), Hvidovre University Hospital, 2650 Hvidovre, Denmark; Department of Diagnostics (N.R.J.), Glostrup University Hospital, DK-2600 Glostrup, Denmark; and Institute of Clinical Medicine (N.R.J.), Faculty of Health and Medical Sciences, University of Copenhagen, DKK-2200 Copenhagen, Denmark
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Xiao C, Dash S, Morgantini C, Adeli K, Lewis GF. Gut Peptides Are Novel Regulators of Intestinal Lipoprotein Secretion: Experimental and Pharmacological Manipulation of Lipoprotein Metabolism. Diabetes 2015; 64:2310-8. [PMID: 26106188 DOI: 10.2337/db14-1706] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with metabolic syndrome and frank type 2 diabetes are at increased risk of atherosclerotic cardiovascular disease, partially due to the presence of lipid and lipoprotein abnormalities. In these conditions, the liver and intestine overproduce lipoprotein particles, exacerbating the hyperlipidemia of fasting and postprandial states. Incretin-based, antidiabetes therapies (i.e., glucagon-like peptide [GLP]-1 receptor agonists and dipeptidyl peptidase-4 inhibitors) have proven efficacy for the treatment of hyperglycemia. Evidence is accumulating that these agents also improve fasting and postprandial lipemia, the latter more significantly than the former. In contrast, the gut-derived peptide GLP-2, cosecreted from intestinal L cells with GLP-1, has recently been demonstrated to enhance intestinal lipoprotein release. Understanding the roles of these emerging regulators of intestinal lipoprotein secretion may offer new insights into the regulation of intestinal lipoprotein assembly and secretion and provide new opportunities for devising novel strategies to attenuate hyperlipidemia, with the potential for cardiovascular disease reduction.
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Affiliation(s)
- Changting Xiao
- Departments of Medicine and Physiology and Banting & Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Departments of Medicine and Physiology and Banting & Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Morgantini
- Departments of Medicine and Physiology and Banting & Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
| | - Khosrow Adeli
- Program in Molecular Structure & Function, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary F Lewis
- Departments of Medicine and Physiology and Banting & Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
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Vahle JL, Byrd RA, Blackbourne JL, Martin JA, Sorden SD, Ryan T, Pienkowski T, Wijsman JA, Smith HW, Rosol TJ. Effects of Dulaglutide on Thyroid C Cells and Serum Calcitonin in Male Monkeys. Endocrinology 2015; 156:2409-16. [PMID: 25860028 DOI: 10.1210/en.2014-1717] [Citation(s) in RCA: 9] [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: 12/30/2022]
Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists, used for the treatment of type 2 diabetes, have caused hyperplasia/neoplasia of thyroid C cells in rodent carcinogenicity studies. Studies in monkeys have not identified an effect of GLP-1 receptor agonists on thyroid C cells; however, group sizes were small. Dulaglutide is a once-weekly, long-acting human GLP-1 receptor agonist recently approved in the United States and the European Union. The objective of this study was to determine whether dulaglutide altered C-cell mass in monkeys. Male cynomolgus monkeys (20 per group) were sc injected with dulaglutide 8.15 mg/kg (∼500-fold maximum human plasma exposure) or a vehicle control twice weekly for 52 weeks. Basal and calcium gluconate-stimulated serum calcitonin concentrations were obtained at 3, 6, 9, and 12 months. Thyroid glands were weighed, fixed, and sectioned at 500-μm intervals. C-cell volumes were measured using an automated image analysis. C-cell proliferation was estimated using Ki67/calcitonin colabeling and cell counting. Administration of dulaglutide 8.15 mg/kg twice weekly for 52 weeks did not increase serum calcitonin in monkeys or affect thyroid weight, histology, C-cell proliferation, or absolute/relative C-cell volume. This study represents a comprehensive evaluation of the monkey thyroid C cells after dosing with a GLP-1 receptor agonist, with a large group size, and measurement of multiple relevant parameters. The lack of effect of dulaglutide on C cells is consistent with other studies in monkeys using GLP-1 receptor agonists and suggests that nonhuman primates are less sensitive than rodents to the induction of proliferative changes in thyroid C cells by GLP-1 receptor agonists.
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Affiliation(s)
- John L Vahle
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Richard A Byrd
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Jamie L Blackbourne
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Jennifer A Martin
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Steven D Sorden
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Thomas Ryan
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Thomas Pienkowski
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - John A Wijsman
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Holly W Smith
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
| | - Thomas J Rosol
- Department of Toxicology, Pathology, and Drug Disposition (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Eli Lilly and Company (J.L.V., R.A.B., J.L.B., J.A.M., J.A.W., H.W.S.), Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P.), Covance Laboratories, Madison, Wisconsin 53704; and Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210
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Affiliation(s)
- Julie Lovshin
- Division of Endocrinology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Cherney
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Byrd RA, Sorden SD, Ryan T, Pienkowski T, LaRock R, Quander R, Wijsman JA, Smith HW, Blackbourne JL, Rosol TJ, Long GG, Martin JA, Vahle JL. Chronic Toxicity and Carcinogenicity Studies of the Long-Acting GLP-1 Receptor Agonist Dulaglutide in Rodents. Endocrinology 2015; 156:2417-28. [PMID: 25860029 DOI: 10.1210/en.2014-1722] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/04/2023]
Abstract
The tumorigenic potential of dulaglutide was evaluated in rats and transgenic mice. Rats were injected sc twice weekly for 93 weeks with dulaglutide 0, 0.05, 0.5, 1.5, or 5 mg/kg corresponding to 0, 0.5, 7, 20, and 58 times, respectively, the maximum recommended human dose based on plasma area under the curve. Transgenic mice were dosed sc twice weekly with dulaglutide 0, 0.3, 1, or 3 mg/kg for 26 weeks. Dulaglutide effects were limited to the thyroid C-cells. In rats, diffuse C-cell hyperplasia and adenomas were statistically increased at 0.5 mg/kg or greater (P ≤ .01 at 5 mg/kg), and C-cell carcinomas were numerically increased at 5 mg/kg. Focal C-cell hyperplasia was higher compared with controls in females given 0.5, 1.5, and 5 mg/kg. In transgenic mice, no dulaglutide-related C-cell hyperplasia or neoplasia was observed at any dose; however, minimal cytoplasmic hypertrophy of C cells was observed in all dulaglutide groups. Systemic exposures decreased over time in mice, possibly due to an antidrug antibody response. In a 52-week study designed to quantitate C-cell mass and plasma calcitonin responses, rats received twice-weekly sc injections of dulaglutide 0 or 5 mg/kg. Dulaglutide increased focal C-cell hyperplasia; however, quantitative increases in C-cell mass did not occur. Consistent with the lack of morphometric changes in C-cell mass, dulaglutide did not affect the incidence of diffuse C-cell hyperplasia or basal or calcium-stimulated plasma calcitonin, suggesting that diffuse increases in C-cell mass did not occur during the initial 52 weeks of the rat carcinogenicity study.
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Affiliation(s)
- Richard A Byrd
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Steven D Sorden
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Thomas Ryan
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Thomas Pienkowski
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Richard LaRock
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Ricardo Quander
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - John A Wijsman
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Holly W Smith
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Jamie L Blackbourne
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Thomas J Rosol
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Gerald G Long
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - Jennifer A Martin
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
| | - John L Vahle
- Department of Toxicology, Pathology, and Drug Disposition (R.A.B., J.A.W., H.W.S., J.L.B., J.A.M., J.L.V.), Eli Lilly and Company, Indianapolis, Indiana 46285; Early Development (S.D.S., T.R., T.P., R.L., R.Q.), Covance Laboratories, Madison, Wisconsin 53704; Department of Veterinary Biosciences (T.J.R.), The Ohio State University, Columbus, Ohio 43210; and Experimental Pathology Laboratories, Inc (G.G.L.), Sterling, Virginia 20166
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Koska J, Sands M, Burciu C, D'Souza KM, Raravikar K, Liu J, Truran S, Franco DA, Schwartz EA, Schwenke DC, D'Alessio D, Migrino RQ, Reaven PD. Exenatide Protects Against Glucose- and Lipid-Induced Endothelial Dysfunction: Evidence for Direct Vasodilation Effect of GLP-1 Receptor Agonists in Humans. Diabetes 2015; 64:2624-35. [PMID: 25720388 PMCID: PMC4477348 DOI: 10.2337/db14-0976] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/17/2015] [Indexed: 01/24/2023]
Abstract
GLP-1 receptor (GLP-1R) agonists may improve endothelial function (EF) via metabolic improvement and direct vascular action. The current study determined the effect of GLP-1R agonist exenatide on postprandial EF in type 2 diabetes and the mechanisms underlying GLP-1R agonist-mediated vasodilation. Two crossover studies were conducted: 36 participants with type 2 diabetes received subcutaneous exenatide or placebo for 11 days and EF, and glucose and lipid responses to breakfast and lunch were determined; and 32 participants with impaired glucose tolerance (IGT) or diet-controlled type 2 diabetes had EF measured before and after intravenous exenatide, with or without the GLP-1R antagonist exendin-9. Mechanisms of GLP-1R agonist action were studied ex vivo on human subcutaneous adipose tissue arterioles and endothelial cells. Subcutaneous exenatide increased postprandial EF independent of reductions in plasma glucose and triglycerides. Intravenous exenatide increased fasting EF, and exendin-9 abolished this effect. Exenatide elicited eNOS activation and NO production in endothelial cells, and induced dose-dependent vasorelaxation and reduced high-glucose or lipid-induced endothelial dysfunction in arterioles ex vivo. These effects were reduced with AMPK inhibition. In conclusion, exenatide augmented postprandial EF in subjects with diabetes and prevented high-glucose and lipid-induced endothelial dysfunction in human arterioles. These effects were largely direct, via GLP-1R and AMPK activation.
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Affiliation(s)
- Juraj Koska
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Michelle Sands
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Camelia Burciu
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Karen M D'Souza
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | | | - James Liu
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Seth Truran
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Daniel A Franco
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Eric A Schwartz
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - Dawn C Schwenke
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
| | - David D'Alessio
- Division of Endocrinology, Diabetes and Metabolism, Duke University, Durham, NC
| | | | - Peter D Reaven
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ
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50
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Affiliation(s)
- Wilfredo Rosario
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC
| | - David D'Alessio
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC david.d'
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