GLP-1与2型糖尿病:生理学和临床研究进展

胰高血糖素样肽-1(GLP-1)是由食物刺激肠道而释放的肠促胰岛素,具有促进餐后胰岛素分泌的作用,而在糖尿病患者中此作用则显著降低。GLP-1通过多种途径发挥降糖作用;促进β细胞增殖再生增强胰岛β细胞群功能,具有治疗2型糖尿病的前景。针对体内GLP-1迅速被二肽基肽酶Ⅳ(DPPIV)降解的问题,研制可耐受DPPIV的GLP-1类似物及DPPIV抑制剂是主要的解决办法。胰高血糖素原基因经表达加工合成GLP-1,由L细胞分泌。分泌由食物诱导,随进食量呈正比增加。进食后啮齿类动物GLP-1分泌呈双相性:即神经内分泌通路间接介导的早期分泌时相和由胃…     

利拉鲁肽临床研究进展

利拉鲁肽是一种胰高血糖素样肽-1(GLP-1)类似物,通过激活GLP-1受体,以葡萄糖依赖性刺激胰岛素分泌并抑制胰高血糖素分泌,临床用于治疗2型糖尿病。本文综述利拉鲁肽的临床研究进展。     

GLP-1改善内质网应激研究进展

胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)主要由肠道L细胞产生和分泌,可以促进胰岛素分泌、抑制胰高血糖素分泌、延缓胃排空及促进胰岛β细胞分化和增殖。内质网应激(endoplasmic reticulum stress,ERS)是2型糖尿病发生发展中重要的环节,近年,GLP-1临床应用于糖尿病日益增多,有关它改善胰岛β细胞功能机制研究不断深入,尤其是有关内质网应激方面的研究,现对此综述如下。     

胰高血糖素样肽1与糖尿病的治疗

胰高血糖素样肽1(glucagon-like peptide-1,GLP-1)是由肠道L细胞分泌的一种重要的肠促胰岛素激素,其在体内的主要生理作用有刺激胰岛素的分泌和释放、抑制胰高血糖素的分泌、促进胰腺β细胞的增殖并抑制其凋亡、抑制胃的排空、促进饱食感的产生等。GLP-1对糖尿病和肥胖具有很好的治疗前景。由于GLP-1在体内很快被二肽酰基肽酶Ⅳ降解,血浆半衰期很短,因而限制了其临床应用。现已发现了促进GLP-1分泌的物质,开发了多种GLP-1的衍生物和二肽酰基肽酶Ⅳ抑制剂,为开发新型糖尿病治疗药物开辟了新的天地。     

降糖新药艾塞那肽临床研究进展

胰高血糖素样肽-1（Glucagon like peptide-1,GLP-1）是肠道在食物尤其是碳水化合物刺激下分泌入血的一种肠促胰岛素,进入循环后通过特异性激动GLP-1受体发挥作用,抑制餐后血糖的上升。在2型糖尿病患者中,     

GLP-1受体激动剂索马鲁肽的药理与临床评价

目前,基于肠促胰岛素-胰高血糖素样肽-1(GLP-1)是2型糖尿病治疗新选择。GLP-1受体激动剂(GLP-1RA)以葡萄糖依赖的方式,刺激胰岛素分泌并降低胰高血糖素分泌,从而降低血糖。此外,GLP-1RA也通过延迟胃排空降低血糖。索马鲁肽为GLP-1受体激动剂(GLP-1类似物),每周注射1次,用于治疗2型糖尿病,可降低糖化血红蛋白和体重。本文通过Medline对Semaglutide进行文献检索,并对其药理作用、药效学、药动学、临床评价、安全性等进行了综述。     

葡萄糖依赖性促胰岛素释放多肽/胰高血糖素样肽-1与天然产物的研究进展

近年来研究表明,肠道激素可通过一系列信号通路改善糖尿病患者的糖脂代谢紊乱,从而改善2型糖尿病患者的发病情况。肠道激素中对糖、脂代谢产生重要调节作用的主要依赖于葡萄糖依赖性促胰岛素释放多肽(GIP)及胰高血糖素样肽-1(GLP-1)2种激素,两者皆以葡萄糖依赖性的方式分泌,并极少发生低血糖风险,因而受到极大的关注,成为近年来2型糖尿病药物研究的热点。本文就相关天然产物对这2种激素的调节作用作一概述。     

治糖尿病的长效新药——利拉鲁肽

胰岛B细胞分泌功能缺陷是2型糖尿病发病的主要病理生理机制。不少2型糖尿病患者存在胰高血糖素样肽1（GLP-1）分泌减少,以及葡萄糖依赖性胰岛素释放肽（GIP）效应减低,这是胰岛素分泌减少的原因之一。     

胰高血糖素样肽-1--2型糖尿病治疗的新策略

胰高血糖素样肽-1(GLP-1)由胰岛α细胞和肠道L细胞分泌,具有葡萄糖依赖性促胰岛素分泌、抑制胰高血糖素产生、增加β细胞数量及延缓胃排空等作用。易被二肽基肽酶IV(DPP-IV)降解,半衰期(t1/2)仅数分钟。近来,GLP-1类似物和DPP-IV抑制剂的研发为2型糖尿病的治疗提供了新策略。     

利拉鲁肽的药理及临床研究进展

 利拉鲁肽是一种酰化胰高血糖素样肽-1（GLP-1）类似物,通过激活GLP-1受体,以葡萄糖依赖性刺激胰岛素分泌并抑制胰高血糖素分泌,临床用于2型糖尿病的二线治疗,可与其他口服降糖药联合使用,但不用于1型糖尿病的治疗。文中通过Medline对利拉鲁肽进行文献检索,并对其药理作用、药动学、临床研究、安全性和药物相互作用等进行综述。     

Bitter substances from plants used in traditional Chinese medicine exert biased activation of human bitter taste receptors

The number and variety of bitter compounds originating from plants are vast. Whereas some bitter chemicals are toxic and should not be ingested, other compounds exhibit health beneficial effects, which is manifest in the cross‐cultural believe that the bitterness of medicine is correlated with the desired medicinal activity. The bitter taste receptors in the oral cavity serve as sensors for bitter compounds and, as they are expressed in numerous extraoral tissues throughout the body, may also be responsible for some physiological effects exerted by bitter compounds. Chinese herbal medicine uses bitter herbs since ancient times for the treatment of various diseases; however, the routes by which these herbs modify physiology are frequently not well understood. We therefore screened 26 bitter substances extracted from medical herbs for the activation of the 25 human bitter taste receptors. We identified six receptors activated by in total 17 different bitter compounds. Interestingly, we observed a bias in bitter taste receptor activation with 10 newly identified agonists for the broadly tuned receptor TAS2R46, seven agonists activating the TAS2R14 and two compounds activating narrowly tuned receptors, suggesting that these receptors play dominant roles in the evaluation and perhaps physiological activities of Chinese herbal medicines.     

药物制剂中苦味掩盖方法的研究进展

药物具有较好的口感是提高患者服药顺应性的重要参数。为了使终产品具有较好的市场前景,应该将掩盖药物的不良气味(通常是苦味)作为处方设计时考虑的重要因素之一。现综述近年来有关文献资料中掩盖药物苦味的各种方法以及这些方法的掩味机制,从而为掩味技术的发展提供参考。     

Bitter taste receptors on airway smooth muscle as targets for novel bronchodilators

Introduction: There is an unmet need for a new class of direct bronchodilators for the treatment of asthma and chronic obstructive lung disease. Unexpectedly, bitter taste receptors (TAS2Rs) have been localized on airway smooth muscle and when activated cause marked smooth muscle relaxation through a mechanism that is distinct from β₂-adrenegic receptors. Thus TAS2R agonists have emerged as a novel class of bronchodilator.

Areas covered: A synopsis of the TAS2R family and its biology for bitter taste perception on the tongue is provided, followed by a review of the identification and molecular and physiological characterization of TAS2R subtypes on human and mouse airway smooth muscle. The proposed molecular mechanisms leading to the relaxation response are provided, along with gaps in our understanding at certain points in the signaling cascade. Unresolved issues that may need to be considered for drug development are discussed.

Expert opinion: TAS2R agonists show promise as a new class of highly efficacious bronchodilators for treatment of obstructive lung disease. With tens of thousands of known natural and synthetic bitter compounds, there is substantial diversity within the known agonists, and, a ready source of agents for screening and further development of an inhaled TAS2R agonist for therapeutic purposes.     

Potential new approaches to modifying intestinal GLP-1 secretion in patients with type 2 diabetes mellitus: focus on bile acid sequestrants

Type 2 diabetes mellitus is associated with a progressive decline in insulin-producing pancreatic β-cells, an increase in hepatic glucose production, and a decrease in insulin sensitivity. The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) stimulate glucose-induced insulin secretion; however, in patients with type 2 diabetes, the incretin system is impaired by loss of the insulinotropic effects of GIP as well as a possible reduction in secretion of GLP-1. Agents that modify GLP-1 secretion may have a role in the management of type 2 diabetes. The currently available incretin-based therapies, GLP-1 receptor agonists (incretin mimetics) and dipeptidyl peptidase-4 (DPP-4) inhibitors (CD26 antigen inhibitors) [incretin enhancers], are safe and effective in the treatment of type 2 diabetes. However, they may be unable to halt the progression of type 2 diabetes, perhaps because they do not increase secretion of endogenous GLP-1. Therapies that directly target intestinal L cells to stimulate secretion of endogenous GLP-1 could possibly prove more effective than treatment with GLP-1 receptor agonists and DPP-4 inhibitors. Potential new approaches to modifying intestinal GLP-1 secretion in patients with type 2 diabetes include G-protein-coupled receptor (GPCR) agonists, α-glucosidase inhibitors, peroxisome proliferator-activated receptor (PPAR) agonists, metformin, bile acid mimetics and bile acid sequestrants. Both the GPCR agonist AR231453 and the novel bile acid mimetic INT-777 have been shown to stimulate GLP-1 release, leading to increased insulin secretion and improved glucose tolerance in mice. Similarly, a study in insulin-resistant rats demonstrated that the bile acid sequestrant colesevelam increased GLP-1 secretion and improved glucose levels and insulin resistance. In addition, the bile acid sequestrant colestimide (colestilan) has been shown to increase GLP-1 secretion and decrease glucose levels in patients with type 2 diabetes; these results suggest that the glucose-lowering effects of bile acid sequestrants may be partly due to their ability to increase endogenous GLP-1 levels. Evidence suggests that GPCR agonists, α-glucosidase inhibitors, PPAR agonists, metformin, bile acid mimetics and bile acid sequestrants may represent a new approach to management of type 2 diabetes via modification of endogenous GLP-1 secretion.     

掩盖药物苦味技术的新进展

目的为掩盖药物苦味提供参考依据。方法将近年来国内外的有关文献分类、整理,归纳。结果和结论近年来涌现出许多掩盖药物苦味的新技术,如流化床技术、熔融制粒技术等;这些技术可有效掩盖药物的苦味,增加患者尤其是儿童和老年患者服药时的顺应性。     

流化床包衣法制备100μm级马来酸氯苯那敏掩味微囊

目的制备100μm级马来酸氯苯那敏掩味微囊。方法以自制的2种单体量比为9∶9∶10(Ⅰ)和8∶10∶8(Ⅱ)的聚(丙烯酸乙酯甲基丙烯酸甲酯甲基丙烯酸2羟乙酯)三元丙烯酸类树脂[poly(EA MMA HEMA)]乳胶液作为包衣液,采用Wurster式流化床包衣制备微囊Ⅰ和微囊Ⅱ。测定了2种乳胶液的平均粒径、玻璃转化温度(tg)。通过测定微囊粒度分布、释放度及显微观察和志愿者口尝来评价制备的微囊及掩味效果。结果自制的2种包衣液的平均粒子径为83.4 nm和78.8 nm,tg为64.9℃和67.8℃。质量分数为50%的包衣水平微囊中超过90%的粒径小于106μm,质量分数为50%的包衣水平微囊Ⅰ和微囊Ⅱ的平均掩味时间分别为(33±12)s(n=6)和(51±16)s(n=6),30 min释放度90.1%、84.8%。结论合成的2种poly(EA MMA HEMA)适合制备100μm级的微囊,制得的微囊掩味时间大于30 s,且30 min药物释放度良好。     

Development of oral acetaminophen chewable tablets with inhibited bitter taste

Various formulations with some matrix bases and corrigents were examined for development of oral chewable tablets which suppressed the bitter taste of acetaminophen, often used as an antipyretic for infants. Corn starch/lactose, cacao butter and hard fat (Witepsol H-15) were used for matrix bases, and sucrose, cocoa powder and commercial bitter-masking powder mixture made from lecithin (Benecoat BMI-40) were used for corrigents against bitter taste. The bitter taste intensity was evaluated using volunteers by comparison of test samples with standard solutions containing quinine at various concentrations. For the tablets made of matrix base and drug, Witepsol H-15 best inhibited the bitter taste of the drug, and the bitter strength tended to be suppressed with increase in the Witepsol H-15 amount. When the inhibitory effect on the bitter taste of acetaminophen solution was compared among the corrigents, each tended to suppress the bitter taste; especially, Benecoat BMI-40 exhibited a more inhibitory effect. Further, chewable tablets were made of one matrix base and one corrigent, and of one matrix base and two kinds of corrigents, their bitter taste intensities after chewing were compared. As a result, the tablets made of Witepsol H-15/Benecoat BMI-40/sucrose, of Witepsol H-15/cocoa powder/sucrose and of Witepsol H-15/sucrose best masked the bitter taste so that they were tolerable enough to chew and swallow. The dosage forms best masking bitter taste showed good release of the drug, indicating little change in bioavailability by masking.     

Modulation of cyclic nucleotides and cyclic nucleotide phosphodiesterases in pancreatic islet beta-cells and intestinal L-cells as targets for treating diabetes mellitus

Cyclic 3'5'-AMP (cAMP) is an important physiological amplifier of glucose-induced insulin secretion by the pancreatic islet beta-cell. In the beta-cell, cAMP is formed by the activity of adenylyl cyclase, especially in response to the incretin hormones glucagon-like peptide (GLP)-1 and glucose-dependent insulinotropic peptide. cAMP may also play a similar role in regulating GLP-1 secretion from intestinal L-cells. cAMP influences many steps involved in glucose-induced insulin secretion and may be important in regulating pancreatic islet beta-cell differentiation, growth and survival. cAMP itself is rapidly degraded in the pancreatic islet beta-cell by cyclic nucleotide phosphodiesterase enzymes. This review will discuss the possibility of targeting cAMP mechanisms in the treatment of type 2 diabetes mellitus, in which insulin release in response to glucose is impaired.     

Pleiotropic effects of glucagon-like peptide-1 (GLP-1)-based therapies on vascular complications in diabetes

Accelerated atherosclerosis and microvascular complications are the leading causes of coronary heart disease, end-stage renal failure, acquired blindness and a variety of neuropathies, which could account for disabilities and high mortality rates in patients with diabetes. Glucagon-like peptide-1 (GLP-1) belongs to the incretin hormone family. L cells in the small intestine secrete GLP-1 in response to food intake. GLP-1 not only enhances glucose-evoked insulin release from pancreatic β-cells, but also suppresses glucagon secretion from pancreatic α-cells. In addition, GLP-1 slows gastric emptying. Therefore, enhancement of GLP-1 secretion is a potential therapeutic target for the treatment of type 2 diabetes. Dipeptidyl peptidase-4 (DPP-4) is a responsible enzyme that mainly degrades GLP-1, and the half-life of circulating GLP-1 is very short. Recently, DPP-4 inhibitors and DPP-4-resistant GLP-1 receptor (GLP-1R) agonists have been developed and clinically used for the treatment of type 2 diabetes as a GLP-1-based medicine. GLP-1R is shown to exist in extra-pancreatic tissues such as vessels, kidney and heart, and could mediate the diverse biological actions of GLP-1 in a variety of tissues. So, in this paper, we review the pleiotropic effects of GLP-1-based therapies and its clinical utility in vascular complications in diabetes.