An Update in Incretin-Based Therapy: A Focus on Glucagon-Like Peptide-1 Receptor Agonists
1 School of Pharmacy, Texas Tech University Health Sciences Center , Dallas, Texas. Diabetes Technology & Therapeutics
(Impact Factor: 2.11).
07/2012; 14(10):951-67. DOI: 10.1089/dia.2012.0098.edw
Abstract The glucagon-like peptide-1 receptor agonists, exenatide and liraglutide, offer a unique mechanism in the treatment of type 2 diabetes mellitus (T2DM) as part of the incretin system. Their mechanism of action is to increase insulin secretion, decrease glucagon release, reduce food intake, and slow gastric emptying. They target postprandial blood glucose values and have some effect on fasting levels as well. In addition, they promote weight loss and may help to preserve β-cell function, both major problems in T2DM patients. Changes in hemoglobin A1c are similar to those produced by other T2DM agents, including thiazolidinediones, low-dose metformin, and sulfonylureas, and better than those caused by α-reductase inhibitors and dipeptidyl peptidase-4 inhibitors. These agents have been safely studied in combination with metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin therapy. Overall, data are limited for head-to-head comparisons, but it appears that liraglutide may have better efficacy and tolerability compared with exenatide; however, more studies are needed. They are overall well tolerated, with the main adverse events being similar to those with metformin (gastrointestinal intolerances that are transient and dose dependent). However, patients must be monitored for pancreatitis as a rare but possible side effect. For T2DM patients willing to use an injectable agent, exenatide and liraglutide offer another therapeutic option to control hyperglycemia with the potential for weight loss and may be combined with other agents safely.
Available from: Teesta Banerjee
- "These receptors have been targeted for the treatment of Type 2 diabetes mellitus and several GLP-1 peptide agonists which are not easily broken down by the enzyme dipeptidyl peptidase-4 (DPP -4) are highly effective for diabetes treatment. They lower blood glucose, and also have added salutary effects of weight loss and may offer additional protection for the heart and myocardium . "
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ABSTRACT: G protein-coupled receptors (GPCRs) constitute several membrane proteins that are turned on by hormones and neurotransmitters to trigger cellular signaling pathways. GPCRs have been targeted in the development of several drugs but the therapeutic potential of these proteins remains underutilized. Most drugs to date have targeted the class A, or the rhodopsin family of GPCRs, but recently the Class B, i.e., the secretin family of G protein receptors has been targeted for the treatment of metabolic diseases such as diabetes mellitus. Class B G protein-coupled receptors (GPCRs) have also been targeted for managing several clinical conditions such as diabetes mellitus, bone disorders, malignancies, neurodegeneration, cardiovascular diseases, neuropsychiatric disorders, etc. In this article, we review the medicinal chemistry and potential clinical role of targeting GPCRs with a special emphasis on cardiovascular pharmacology.
Available from: Benoit Cudennec
- "In addition, these authors also demonstrated that apelin expression was upregulated in beta cells of diabetic mice and rats . The intestinal incretin glucagon-like peptide-1 (GLP-1) is the most powerful GI hormone to control ␤-cell function and to promote insulin secretion during the postprandial period when blood glucose is elevated . As apelin was shown to modulate the glucose flux through enterocytes as well as insulin secretion, we evaluated in vitro and in vivo in rats, if apelin is able to stimulate the release of the enteric incretin GLP-1 in addition to its well-described stimulatory action on CCK secretion . "
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ABSTRACT: Apelin is an enteric peptide that exerts several digestive functions such as stimulation of cell proliferation and cholecystokinin (CCK) secretion. We investigated using murine enteroendocrine cell line (STC-1) and rats if apelin-13 stimulates both CCK and glucagon-like peptide 1 (GLP-1) secretions. We demonstrated that, in vitro and in vivo, apelin-13 increases the release of these two hormones in a dose-dependent manner. Present data suggest that apelin may modulate digestive functions, food intake behavior and glucose homoeostasis via apelin-induced release of enteric CCK but also through a new incretin-releasing activity on enteric GLP-1.
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ABSTRACT: Many questions must be considered with regard to consuming food, including when to eat, what to eat and how much to eat. Although eating is often thought to be a homeostatic behaviour, little evidence exists to suggest that eating is an automatic response to an acute shortage of energy. Instead, food intake can be considered as an integrated response over a prolonged period of time that maintains the levels of energy stored in adipocytes. When we eat is generally determined by habit, convenience or opportunity rather than need, and meals are preceded by a neurally-controlled coordinated secretion of numerous hormones that prime the digestive system for the anticipated caloric load. How much we eat is determined by satiation hormones that are secreted in response to ingested nutrients, and these signals are in turn modified by adiposity hormones that indicate the fat content of the body. In addition, many nonhomeostatic factors, including stress, learning, palatability and social influences, interact with other controllers of food intake. If a choice of food is available, what we eat is based on pleasure and past experience. This article reviews the hormones that mediate and influence these processes.
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