Challenges and opportunities with glycogen synthase kinase-3 inhibitors for insulin resistance and Type 2 diabetes treatment

The role of the serine/threonine protein kinase, glycogen synthase kinase-3 (GSK-3), in attenuating the insulin signalling pathway has led to the concept that inhibition of GSK-3 may have therapeutic benefits in the treatment of insulin resistance and Type 2 diabetes. Indeed, various selective GSK-3 inhibitors have been developed recently and have proven to promote insulin-like effects and to act as insulin sensitisers in both in vitro and in vivo systems. GSK-3 inhibition may thus present a new, effective approach for the treatment of insulin resistance and Type 2 diabetes. This review describes the qualifications of GSK-3 as a novel drug-discovery target for Type 2 diabetes and discusses the strategies and challenges in developing small-molecule inhibitors for this important protein kinase.     

The role of glycogen synthase kinase-3 in insulin resistance and type 2 diabetes

Glycogen synthase kinase-3 (GSK-3) is a ubiquitous cytosolic serine/threonine protein kinase that has been implicated in multiple receptor-mediated intracellular processes. Its unique feature, which distinguishes it from other protein kinases, is that it is constitutively active in resting conditions and acts as a suppressor of signalling pathways. The fact that the function of two key targets of insulin action, glycogen synthase and insulin receptor substrate-1, are suppressed by GSK-3, as well as the fact that GSK-3 activity is higher in diabetic tissues, makes it a promising drug discovery target for insulin resistance and Type 2 diabetes. Thus, the development of GSK-3 inhibitors has received attention as an attempt to control both the spread of the disease and its severity.     

糖尿病治疗新靶点糖原合成酶激酶-3抑制剂的研究进展

糖原合成酶激酶-3(glycogen synthase kinase-3，GSK-3)属丝氨酸/苏氨酸类激酶，最早是作为一种能磷酸化并抑制糖原合成酶活性的蛋白激酶而被发现的。已发现在某些人类疾病中GSK-3的活性异常升高，如糖尿病、阿尔茨海默病及其他一些神经退行性疾病。现已找到了一些小分子GSK-3抑制剂主要是通过使GSK-3的丝氨酸位点磷酸化，从而抑制其活性。GSK-3活性被抑制后，能影响胰岛素信号传导、葡萄糖代谢及糖原的合成。因此开发GSK-3抑制剂已成为研究抗糖尿病药物的一个新思路。本文主要介绍GSK-3与糖尿病的联系及近年来GSK-3抑制剂在抗糖尿病作用方面的研究进展。     

Targeting glycogen synthase kinase-3 in insulin signalling

The renewed interest in an enzyme first discovered over 25 years ago stems from the potential of inhibitors of this enzyme to treat conditions as diverse as diabetes, Alzheimer's disease, stroke and bipolar disorder, and even to enhance the repopulating capacity of transplanted haematopoietic stem cells. The emergence of the first few potent and specific glycogen synthase kinase-3 (GSK-3) inhibitors will end years of speculation on their potential and finally allow the impact of GSK-3 inhibitors to be evaluated clinically. The next few years are likely to be particularly exciting ones for fans of this old enzyme. This review focuses on the role of GSK-3 in the insulin signalling pathway and highlights the evidence implicating the enzyme in insulin resistance. Pharmacological in vitro and in vivo proof-of-concept studies are also discussed, which establish the therapeutic potential of GSK-3 inhibitors as agents for the treatment of Type 2 diabetes.     

Targeting glycogen synthase kinase-3 in insulin signalling

The renewed interest in an enzyme first discovered over 25 years ago stems from the potential of inhibitors of this enzyme to treat conditions as diverse as diabetes, Alzheimer’s disease, stroke and bipolar disorder, and even to enhance the repopulating capacity of transplanted haematopoietic stem cells. The emergence of the first few potent and specific glycogen synthase kinase-3 (GSK-3) inhibitors will end years of speculation on their potential and finally allow the impact of GSK-3 inhibitors to be evaluated clinically. The next few years are likely to be particularly exciting ones for fans of this old enzyme. This review focuses on the role of GSK-3 in the insulin signalling pathway and highlights the evidence implicating the enzyme in insulin resistance. Pharmacological in vitro and in vivo proof-of-concept studies are also discussed, which establish the therapeutic potential of GSK-3 inhibitors as agents for the treatment of Type 2 diabetes.     

Glycogen synthase kinase-3--a promising therapeutic target: Dr Hagit Eldar-Finkelman interviewed by Emma Quigley

Dr Hagit Eldar-Finkelman (Sackler School of Medicine, Israel) was interviewed by Emma Quigley (Commissioning Editor, Expert Opinion on Therapeutic Targets) on 16th February 2006. Born in Jerusalem, Dr Eldar-Finkelman received her BSc in Chemistry in 1984 and both her MSc in Physical Chemistry (1986) and PhD in Life Science (1993) from the Weizmann Institute of Science. She was a recipient of the British Council Award, which allowed her to conduct research in biological nuclear magnetic resonance at the University of Oxford in the laboratory of Professor George K Radda. Following postdoctoral work at the School of Medicine of the University of Washington with Nobel Laureate Professor Edwin G Krebs, she became an Assistant Professor in the Department of Medicine at Harvard Medical School. Dr Eldar-Finkelman joined the Sackler School of Medicine at Tel Aviv University in 1999. Dr Eldar-Finkelman's research focuses on the molecular mechanisms regulating the protein kinase glycogen synthase kinase-3 (GSK-3), and their implications in negative regulation of signalling pathways. In particular, her work aims to develop specific inhibitors for GSK-3 and to test their functions in vitro and in vivo, considering the concept that such inhibitors may be useful in insulin resistance and Type 2 diabetes. These studies provide a conceptual basis for development of GSK-3 inhibitors and may lead to design of small molecules for treatment of diabetes and or neurodegenerative disorders.     

The possible involvement of glycogen synthase kinase-3 (GSK-3) in diabetes, cancer and central nervous system diseases

Glycogen synthase kinase (GSK-3) is a key enzyme in multiple cell processes. Since many pharmacological compounds that have effects on common metabolic pathways may have uses in many different diseases, we review here the possible involvement of glycogen synthase kinase 3 in diabetes, cancer and CNS diseases. Moreover, diabetes has recently been strongly linked to CNS diseases such as schizophrenia and bipolar illness. GSK-3 is both directly and indirectly inhibited by lithium, a key compound for treatment of bipolar disorder. Several antipsychotic drugs also affect the GSK-3 mediated pathways and postmortem study of brain in schizophrenia led to reports of alterations of GSK-3 activity or mRNA message. However, other reports are contradictory. Development of GSK-3 inhibitors for CNS diseases is complicated by the importance of GSK-3 in glucose metabolism and pancreas function and the possible effect of GSK-3 inhibition to be oncogenic. Further development of GSK-3 inhibitors for clinical trials should be approached with caution.     

Glycogen synthase kinase-3 – a promising therapeutic target: interview with Hagit Eldar-Finkelman

Dr Hagit Eldar-Finkelman (Sackler School of Medicine, Israel) was interviewed by Emma Quigley (Commissioning Editor, Expert Opinion on Therapeutic Targets) on 16th February 2006.

Born in Jerusalem, Dr Eldar-Finkelman received her BSc in Chemistry in 1984 and both her MSc in Physical Chemistry (1986) and PhD in Life Science (1993) from the Weizmann Institute of Science. She was a recipient of the British Council Award, which allowed her to conduct research in biological nuclear magnetic resonance at the University of Oxford in the laboratory of Professor George K Radda. Following postdoctoral work at the School of Medicine of the University of Washington with Nobel Laureate Professor Edwin G Krebs, she became an Assistant Professor in the Department of Medicine at Harvard Medical School. Dr Eldar-Finkelman joined the Sackler School of Medicine at Tel Aviv University in 1999. Dr Eldar-Finkelman’s research focuses on the molecular mechanisms regulating the protein kinase glycogen synthase kinase-3 (GSK-3), and their implications in negative regulation of signalling pathways. In particular, her work aims to develop specific inhibitors for GSK-3 and to test their functions in vitro and in vivo, considering the concept that such inhibitors may be useful in insulin resistance and Type 2 diabetes. These studies provide a conceptual basis for development of GSK-3 inhibitors and may lead to design of small molecules for treatment of diabetes and or neurodegenerative disorders.     

GSK-3 inhibitors and their potential in the treatment of Alzheimer’s disease

Glycogen synthase kinase-3 (GSK-3) is a ubiquitously expressed kinase that has emerged as a promising drug target for several diseases, including various neurological conditions, Type 2 diabetes and cancer. For this reason, a number of drug candidates are being developed to achieve very different goals, any of which could have therapeutic value in the treatment of Alzheimer’s disease (AD). The importance of GSK-3 in so many processes, however, also suggests that issues of side effects will need to be addressed before GSK-3 inhibitors can be used in the clinic. This review discusses the role of GSK-3 in the development of AD, the various approaches that have been used to inhibit GSK-3 activity and the patents describing the use of GSK-3 inhibitors in the treatment of AD.     

PTP1B inhibitors as potential therapeutics in the treatment of Type 2 diabetes and obesity

Coordinated tyrosine phosphorylation is essential for signalling pathways regulated by insulin and leptin. Type 2 diabetes and obesity are characterised by resistance to hormones insulin and leptin, possibly due to attenuated or diminished signalling from the receptors. Pharmacological agents capable of inhibiting the negative regulator(s) of the signalling pathways are expected to potentiate the action of insulin and leptin and therefore be beneficial for the treatment of Type 2 diabetes and obesity. A large body of data from cellular, biochemical, mouse and human genetic and chemical inhibitor studies have identified protein tyrosine phosphatase 1B (PTP1B) as a major negative regulator of both insulin and leptin signalling. In addition, evidence suggests that insulin and leptin action can be enhanced by the inhibition of PTP1B. Consequently, PTP1B has emerged as an attractive novel target for the treatment of both Type 2 diabetes and obesity. The link between PTP1B and diabetes and obesity has led to an avalanche of research dedicated to finding inhibitors of this phosphatase. With the combined use of structure and medicinal chemistry, several groups have demonstrated that it is feasible to obtain small-molecule PTP1B inhibitors with the requisite potency and selectivity. The challenge for the future will be to transform potent and selective small molecule PTP1B inhibitors into orally available drugs with desirable physicochemical properties and in vivo efficacies.     

PTP1B inhibitors as potential therapeutics in the treatment of type 2 diabetes and obesity

Coordinated tyrosine phosphorylation is essential for signalling pathways regulated by insulin and leptin. Type 2 diabetes and obesity are characterised by resistance to hormones insulin and leptin, possibly due to attenuated or diminished signalling from the receptors. Pharmacological agents capable of inhibiting the negative regulator(s) of the signalling pathways are expected to potentiate the action of insulin and leptin and therefore be beneficial for the treatment of Type 2 diabetes and obesity. A large body of data from cellular, biochemical, mouse and human genetic and chemical inhibitor studies have identified protein tyrosine phosphatase 1B (PTP1B) as a major negative regulator of both insulin and leptin signalling. In addition, evidence suggests that insulin and leptin action can be enhanced by the inhibition of PTP1B. Consequently, PTP1B has emerged as an attractive novel target for the treatment of both Type 2 diabetes and obesity. The link between PTP1B and diabetes and obesity has led to an avalanche of research dedicated to finding inhibitors of this phosphatase. With the combined use of structure and medicinal chemistry, several groups have demonstrated that it is feasible to obtain small-molecule PTP1B inhibitors with the requisite potency and selectivity. The challenge for the future will be to transform potent and selective small molecule PTP1B inhibitors into orally available drugs with desirable physicochemical properties and in vivo efficacies.     

Resistin induces insulin resistance, but does not affect glucose output in rat-derived hepatocytes

AIM: The aim of the present study was to observe the effects of resistin on insulin sensitivity and glucose output in rat-derived hepatocytes. METHODS: The rat hepatoma cell line H4IIE was cultured and stimulated with resistin; supernant glucose and glycogen content were detected. The insulin receptor substrate (IRS)-1 and IRS-2, protein kinase B/Akt, glycogen synthase kinase-3beta(GSK-3 beta), the suppressor of cytokine signaling 3 (SOCS-3) protein content, as well as the phosphorylation status were assessed by Western blotting. Specific antisense oligodeoxynucleotides directed against SOCS-3 were used to knockdown SOCS-3. RESULTS: Resistin induced insulin resistance, but did not affect glucose output in rat hepatoma cell line H4IIE. Resistin attenuated multiple effects of insulin, including insulin-stimulated glycogen synthesis and phosphorylation of IRS, protein kinase B/Akt, as well as GSK-3beta. Resistin treatment markedly induced the gene and protein expression of SOCS-3, a known inhibitor of insulin signaling. Furthermore, a specific antisense oligodeoxynucleotide directed against SOCS-3 treatment prevented resistin from antagonizing insulin action. CONCLUSION: The major function of resistin on liver is to induce insulin resistance. SOCS-3 induction may contribute to the resistin-mediated inhibition of insulin signaling in H4IIE hepatocytes.     

Recent advances in protein tyrosine phosphatase 1B inhibitors

Type 2 diabetes and obesity are characterised by insulin and leptin resistance. Studies suggest that these may be due to defects in the insulin and leptin signalling pathways. Over the last decade, a considerable body of evidence has been amassed indicating that protein tyrosine phosphatase 1B (PTP1B) is involved in the downregulation of insulin and leptin signalling. Consequently, compounds that inhibit PTP1B have potential as therapeutics for treating Type 2 diabetes and obesity. This review covers recent advances in PTP1B inhibitors with an emphasis on recent attempts to create potent, selective and cell-permeable small-molecule inhibitors.     

Recent advances in protein tyrosine phosphatase 1B inhibitors

Type 2 diabetes and obesity are characterised by insulin and leptin resistance. Studies suggest that these may be due to defects in the insulin and leptin signalling pathways. Over the last decade, a considerable body of evidence has been amassed indicating that protein tyrosine phosphatase 1B (PTP1B) is involved in the downregulation of insulin and leptin signalling. Consequently, compounds that inhibit PTP1B have potential as therapeutics for treating Type 2 diabetes and obesity. This review covers recent advances in PTP1B inhibitors with an emphasis on recent attempts to create potent, selective and cell-permeable small-molecule inhibitors.     

Mitochondrial inhibitor as a new class of insulin sensitizer

Insulin resistance is a major risk factor for type 2 diabetes. AMP-activated protein kinase (AMPK) is a drug target in the improvement of insulin sensitivity. Several insulin-sensitizing medicines are able to activate AMPK through inhibition of mitochondrial functions. These drugs, such as metformin and STZ, inhibit ATP synthesis in mitochondria to raise AMP/ATP ratio in the process of AMPK activation. However, chemicals that activate AMPK directly or by activating its upstream kinases have not been approved for treatment of type 2 diabetes in humans. In an early study, we reported that berberine inhibited oxygen consumption in mitochondria, and increased AMP/ATP ratio in cells. The observation suggests an indirect mechanism for AMPK activation by berberine. Berberine stimulates glycolysis for ATP production that offsets the cell toxicity after mitochondria inhibition. The study suggests that mitochondrial inhibition is an approach for AMPK activation. In this review article, literature is critically reviewed to interpret the role of mitochondria function in the mechanism of insulin resistance, which supports that mitochondria inhibitors represent a new class of AMPK activator. The inhibitors are promising candidates for insulin sensitizers. This review provides a guideline in search for small molecule AMPK activators in the drug discovery for type 2 diabetes.     

Physiological roles of glycogen synthase kinase-3: potential as a therapeutic target for diabetes and other disorders

Glycogen synthase kinase-3 (GSK-3) has perplexed signal transduction researchers since its detection in skeletal muscle 25 years ago. The enzyme confounds most of the rules normally associated with protein kinases in that it exhibits significant activity, even in resting, unstimulated cells. However, the protein is highly regulated and potently inactivated in response to signals such as insulin and polypeptide growth factors. The enzyme also displays a distinct and unusual preference for substrates that have been previously phosphorylated by other protein kinases which provides obvious opportunities for cross-talk. Its substrates are diverse and are predominantly regulatory molecules. The molecular cloning of the kinase revealed it to be encoded by two related but distinct genes. Moreover, the mammalian proteins showed remarkable similarity to a fruitfly protein isolated on the basis of its role in cell fate determination. From these humble beginnings, study of the enzyme has accrued further surprises such as its inhibition by lithium, its regulation by serine and tyrosine phosphorylation and its implication in several human disorders including Alzheimers disease, bipolar disorder, cancer and diabetes. Most recently, small molecule inhibitors of GSK-3 have been developed and assessed for therapeutic potential in several of models of pathophysiology. The question is whether modulation of such an "involved" enzyme could lead to selective restoration of defects without multiple unwanted side effects. This review summarizes current knowledge of GSK-3 with respect to its known functions, together with an assessment of its real-life potential as a drug target for chronic conditions such as type 2 diabetes.     

A cellular assay for measuring the modulation of glucose production in H4IIE cells

Type II diabetes and its associated complications are a major health concern of the developed world. One of the hallmarks of diabetes is insulin resistance, where secreted insulin no longer has any effect on its target tissues, namely, liver, muscle, and fat. An important therapeutic strategy is to modulate blood glucose levels using pharmacological agents. Glycogen synthase kinase-3 (GSK3) is a serine-threonine protein kinase that plays important roles in regulating glucose metabolism. It is a key negative regulator of insulin action and is an important contributing factor to insulin resistance in liver, muscle, and adipose tissue. We describe the development of a cell-based assay designed to measure glucose production in rat hepatoma cell line H4IIE liver cells in response to treatment with small molecule inhibitors, including GSK3 inhibitors. The assay is set up in a 96-well format, and glucose production is assessed using a convenient fluorescence-based readout. This disease-relevant cellular assay is a valuable tool for the progression of small molecules that modulate glucose production.