选择性PPARγ调节剂治疗二型糖尿病的分子机制研究进展

第一类胰岛素增敏剂——过氧化物酶体增殖体激活受体γ(PPARγ)激动剂噻唑烷二酮类药物(TZDs)曾在二型糖尿病(T2DM)治疗中具有不可替代的作用。但由于TZDs类药物存在增重、水肿、骨折、充血性心力衰竭等严重副作用,保留TZDs类药物的胰岛素增敏效果而无其副作用的选择性PPARγ调节剂(SPPARγM)是新型胰岛素增敏剂的发展方向。现有实验主要对SPPARγM候选分子影响PPARγ受体构象改变、受体磷酸化、受体对共调节因子的选择性募集和PPARγ下游靶基因选择性开启等几个层次的分子作用机制作了初步探讨。该文综述了SPPARγM治疗二型糖尿病的分子机制研究进展。     

PPAR- γ agonist in treatment of diabetes: cardiovascular safety considerations

The peroxisome proliferator-activated receptors (PPARs) are nuclear fatty acid receptors, which contain a type II zinc finger DNA binding motif and a hydrophobic ligand binding pocket. These receptors are thought to play an important role in metabolic diseases such as obesity, insulin resistance, and coronary artery disease. Three subtypes of PPAR receptors have been described: PPARα, PPARδ/β, and PPARγ. PPARα is found in the liver, muscle, kidney, and heart. In the liver, its role is to up-regulate genes involved in fatty acid uptake, binding, β-oxidation and electron transport, and oxidative phosphorylation in subcutaneous fat but not in skeletal muscle. PPARδ/β is expressed in many tissues but markedly in brain, adipose tissue, and skin. PPARγ has high expression in fat, low expression in the liver, and very low expression in the muscle. The thiazolidinediones (TZD) are synthetic ligands of PPARγ. By activating a number of genes in tissues, PPARγ increases glucose and lipid uptake, increases glucose oxidation, decreases free fatty acid concentration, and decreases insulin resistance. Although, there is a rationale for the use of TZDs in patients with type 2 diabetes mellitus, clinical studies have produced conflicting data. While currently used TZDs are clearly associated with heart failure (HF) worsening; with regards to cardiovascular outcomes, pioglitazone seems to be related to a trend toward reduction in cardiovascular morbidity and mortality, whereas rosiglitazone may actually increase risk of cardiovascular events. We review the existing literature on TZDs and discuss role and cardiovascular safety of these agents for the contemporary treatment of diabetes. Other side effects of these agents i.e. increase in osteoporosis and possible risk of bladder cancer is also discussed.     

PPAR与胰岛素抵抗

PPAR即过氧化物酶体增殖物激活受体 ,是核受体超家族成员之一 ,它可以促进脂肪细胞分化 ,在脂肪代谢中起重要作用。近年来随着对胰岛素增敏剂噻唑烷二酮 (TZD)类药物作用机制的深入研究 ,发现PPARγ是该类药物的主要功能受体 ,于是展开了对于PPAR与胰岛素抵抗之间关系的研究。TZD类药物激活PPARγ ,可以改善胰岛素抵抗 ,而在基因敲除的PPARγ+ / -中 ,却发现胰岛素敏感性增加。所以 ,PPAR激活与改善胰岛素抵抗之间不是简单的正相关关系。对二者关系的进一步明确 ,对于以PPAR为靶点寻找更加有效安全的治疗Ⅱ型糖尿病药物具有关键意义     

Submaximal PPARγ activation and endothelial dysfunction: new perspectives for the management of cardiovascular disorders

PPARγ activation plays an important role in glucose metabolism by enhancing insulin sensitization. PPARγ is a primary target for thiazolidinedione-structured insulin sensitizers like pioglitazone and rosiglitazone employed for the treatment of type 2 diabetes mellitus. Additionally, PPARγ activation inhibits adhesion cascades and detrimental vascular inflammatory events. Importantly, activation of PPARγ plays a distinctive role in regulating the physiology and expression of endothelial nitric oxide synthase (eNOS) in the endothelium, resulting in enhanced generation of vascular nitric oxide. The PPARγ activation-mediated vascular anti-inflammatory and direct endothelial functional regulatory actions could, therefore, be beneficial in improving the vascular function in patients with atherosclerosis and hypertension with or without diabetes mellitus. Despite the disappointing cardiac side effect profile of rosiglitazone-like PPARγ full agonists, the therapeutic potential of novel pharmacological agents targeting PPARγ submaximally cannot be ruled out. This review discusses the potential regulatory role of PPARγ on eNOS expression and activation in improving the function of vascular endothelium. We argue that partial/submaximal activation of PPARγ could be a major target for vascular endothelial functional improvement. Interestingly, newly synthesized partial agonists of PPARγ such as balaglitazone, MBX-102, MK-0533, PAR-1622, PAM-1616, KR-62776 and SPPARγM5 are devoid of or have a reduced tendency to cause the adverse effects associated with full agonists of PPARγ. We propose that the vascular protective properties of pharmacological agents, which submaximally activate PPARγ, should be investigated. Moreover, the therapeutic opportunities of agents that submaximally activate PPARγ in preventing vascular endothelial dysfunction (VED) and VED-associated cardiovascular disorders are discussed.     

Activation of peroxisome proliferator-activated receptor-γ downregulates soluble epoxide hydrolase in cardiomyocytes

1. The antidiabetic agents, thiazolidinediones (TZD), ligands for peroxisome proliferator-activated receptor-γ (PPARγ), have been reported to reduce cardiac hypertrophy. However, the underlying mechanism is still elusive. 2. We previously reported that soluble epoxide hydrolase (sEH) was specifically upregulated by angiotensin-II (AngII), which directly mediated AngII-induced cardiac hypertrophy. In the present study, we examined the role of sEH in PPARγ inhibiting AngII-induced cardiac hypertrophy. 3. The protein level of sEH was elevated in the left ventricle of AngII-infused Sprague-Dawley rats. Administration of the TZD rosiglitazone decreased this induction. In vitro, AngII upregulated the expression of sEH and hypertrophy markers, including atrial natriuretic factor and β-myosin heavy chain, in rat neonatal cardiomyocytes and H9c2 cells, which was attenuated by rosiglitazone and pioglitazone. An elevated level of sEH was also found in the left ventricle of heterozygous PPARγ-deficient mice. The effect of TZD on sEH level could be reversed by treatment with the PPARγ antagonists, GW9662 and BADGE, which suggests PPARγ activation. In elucidating the mechanisms by which PPARγ inhibited AngII-induced sEH expression, we found that rosiglitazone inhibited AngII-induced sEH promoter activity in H9c2 cells. In contrast, the activity of the human sEH 3'UTR was not affected by AngII and TZD. 4. Our results suggest that the protective role of PPARγ activation in AngII-induced cardiac hypertrophy is, at least in part, through downregulating sEH.     

Multitargeted bioactive ligands for PPARs discovered in the last decade

Type 2 diabetes took insulin resistance as the main clinical manifestation. PPARs have been reported to be the therapeutic targets of metabolic disorders, such as obesity, hypertension, diabetes, and cardiovascular disease. Previously, PPARγ agonist rosiglitazone was restricted in clinic due to cardiomyocytes infarction, weight gain, and other serious side‐effects, which were mainly due to the single and selective PPARγ agonism. In recent years, multitarget‐directed PPAR agonists with synergistic reaction as well as fewer side‐effect have been the hot topic in designing promising agents. In this review, we updated and generalized the development of PPARγ partial agonists, PPARγ antagonists, PPARα/γ dual agonists, PPARδ partial agonists, PPARδ antagonists, PPARα/δ dual agonists, PPARγ/δ dual agonists, and PPARα/γ/δ pan‐agonists published in recent decade. Most of these molecules were modified from known structures or came from high‐throughput screening. Among these molecules, some were expected to be promising drugs against metabolic disorders, while others seemed to provide new insight for designing novel PPAR agents.     

Therapeutic approaches to insulin resistance

Insulin resistance is now acknowledged to be a significant predictor of cardiovascular morbidity and mortality as well as the primary defect in Type 2 diabetes. Such pathologies are set to pose an ever greater socio-economic burden in developed and developing nations, especially in the light of evidence that insulin resistance may be acquired through the (Western) diet. Given the recognition of the central role of insulin resistance in the progression of syndrome X and diabetes, improving insulin sensitivity has become a major clinical focus. The traditional ‘first line of defence’ approach to restoring glycaemic control in diabetes involving dietary and exercise regimens, may now be supplemented with insulin-sensitising pharmacotherapy. This therapeutic modality, which was clinically pioneered with the biguanide metformin, is also today provided by the thiazolidinedione (TZD) class of anti-hyperglycaemic agent, exemplified by rosiglitazone and pioglitazone. More TZD derivatives are to be expected, along with novel, non-TZD ligands of their common therapeutic target: the peroxisome proliferator-activated receptor-γ (PPARγ). In addition, the role of PPARα activation in the regulation of insulin sensitivity is gaining attention. There is also the theoretical prospect at least of creating a therapeutic synergy by co-administering retinoid X receptor (RXR) agonists or so-called rexinoids with these PPAR ligands. Furthermore, interest has been registered in a nutraceutical approach to insulin resistance concerning supranutritional levels of chromium and biotin. While TZDs are currently only licensed for use in established Type 2 diabetes, such insulin-sensitising interventions have the potential to delay or prevent both cardiovascular and diabetic disease progression in insulin resistant individuals.     

Discovery and development of selective PPARγ modulators as safe and effective antidiabetic agents

Importance of the field: PPARγ full agonists (pioglitazone and rosiglitazone) are the mainstay drugs for the treatment of type 2 diabetes; however, mechanism-based side effects have limited their full therapeutic potential. In recent years, much progress has been achieved in the discovery and development of selective PPARγ modulators (SPPARγMs) as safer alternatives to PPARγ full agonists.

Areas covered in this review: This review focuses on the preclinical and clinical data of all the SPPARγMs discovered so far, retrieved by searching PubMed, Prous Integrity database and company news updates from 1999 to date.

What the reader will gain: Here we thoroughly discuss SPPARγMs' mode of action, briefly examine new ways to identify superior SPPARγMs, and finally, compare and contrast the pharmacological and safety profile of various agents.

Take home message: The preclinical and clinical findings clearly suggest that selective PPARγ modulators have the potential to become the next generation of PPARγ agonists: effective insulin sensitizers with a superior safety profile to that of PPARγ full agonists.     

选择性PPARγ调节剂治疗糖尿病的研究新进展

过氧化物酶体增殖物激活受体γ是一类主要调控糖脂代谢与脂肪细胞分化的核受体,与肥胖、胰岛素抵抗和糖尿病的发生发展密切相关,其激动剂作为胰岛素增敏剂治疗2型糖尿病也被临床广泛应用。近年来,随着对PPARγ信号通路和胰岛素增敏剂的深入研究,使我们对选择性PPARγ调节剂类胰岛素增敏剂的认识不断完善和更新。该文主要阐述选择性PPARγ调节剂类胰岛素增敏剂的作用机制和药物研究的最新进展。     

A novel natural Nrf2 activator with PPARγ-agonist (monascin) attenuates the toxicity of methylglyoxal and hyperglycemia

Methylglyoxal (MG) is a toxic-glucose metabolite and a major precursor of advanced glycation endproducts (AGEs). MG has been reported to result in inflammation by activating receptor for AGEs (RAGE). We recently found that Monascus-fermented metabolite monascin acts as a novel natural peroxisome proliferator-activated receptor-γ (PPARγ) agonist that improves insulin sensitivity. We investigated the metabolic, biochemical, and molecular abnormalities characteristic of type 2 diabetes in MG-treated Wistar rats treated with oral administration of monascin or rosiglitazone. Monascin (a novel PPARγ agonist) activated nuclear factor-erythroid 2-related factor 2 (Nrf2) and down-regulated hyperinsulinmia in oral glucose tolerance test (OGTT). Monascin was able to elevate glyoxalase-1 expression via activation of hepatic Nrf2, hence, resulting in MG metabolism to d-lactic acid and protected from AGEs production in MG-treated rats. Rosiglitazone did not activate Nrf2 nor glyoxalase expression to lower serum and hepatic AGEs levels. Monascin acts as a novel natural Nrf2 activator with PPARγ-agonist activity were confirmed by Nrf2 and PPARγ reporter assays in Hep G2 cells. These findings suggest that monascin acts as an anti-diabetic and anti-oxidative stress agent to a greater degree than rosiglitazone and thus may have therapeutic potential for the prevention of diabetes.     

Anti-inflammatory and antioxidant properties of a new arylidene-thiazolidinedione in macrophages

Thiazolidinediones (TZDs) are a class of drugs used for treatment of type 2 diabetes. However, the therapy with currently available TDZs (e.g. rosiglitazone) is associated with important side effects, such as edema and weight gain, suggesting that the investigation of alternative TZDs with better pharmacological properties is warranted. In this study, we investigated both anti-inflammatory and antioxidant properties of a new chemically modified TZD, the arylidene-thiazolidinedione 5-(4-methanesulfonyl-benzylidene)-3-(4-nitrobenzyl)-thiazolidine-2,4-dione (SF23), and compared the results to those obtained with rosiglitazone. We found that our SF23 displays a weaker affinity for PPARγ, up-regulating in a lower magnitude the expression of both PPARγ and CD36 compared to rosiglitazone. In lipopolysaccharide (LPS)-stimulated macrophages, SF23 decreased nitrite production and attenuated the mRNA expression of both iNOS and COX-2. These anti-inflammatory effects were comparable to those obtained with rosiglitazone. Interestingly, SF23, but not rosiglitazone, prevented LPS-induced mitochondrial membrane hyperpolarization, apoptosis, reactive oxygen species (ROS) generation, and the expression of NADPH oxidase subunits, Nox1 and Nox2. In addition, in macrophages from Nrf2?/? mice, SF23 protected against LPSinduced cellular death and ROS production, whereas rosiglitazone was only able to protect normal Nrf2?/? cells against oxidative injury, suggesting that, unlike rosiglitazone, the antioxidant activity of SF23 might be Nrf2-independent. Finally, in macrophages exposed to high concentrations of glucose, SF23 induced significant increases in the mRNA expression of glucose transporters, insulin receptor substrate and mitoNEET. Altogether, our data indicate that our new chemically modified TDZ displays similar anti-inflammatory properties, but superior antioxidant effects on the LPS-stimulated macrophages compared to rosiglitazone.     

Mode of peroxisome proliferator-activated receptor γ activation by luteolin

The peroxisome proliferator-activated receptor γ (PPARγ) is a target for treatment of type II diabetes and other conditions. PPARγ full agonists, such as thiazolidinediones (TZDs), are effective insulin sensitizers and anti-inflammatory agents, but their use is limited by adverse side effects. Luteolin is a flavonoid with anti-inflammatory actions that binds PPARγ but, unlike TZDs, does not promote adipocyte differentiation. However, previous reports suggested variously that luteolin is a PPARγ agonist or an antagonist. We show that luteolin exhibits weak partial agonist/antagonist activity in transfections, inhibits several PPARγ target genes in 3T3-L1 cells (LPL, ORL1, and CEBPα) and PPARγ-dependent adipogenesis, but activates GLUT4 to a similar degree as rosiglitazone, implying gene-specific partial agonism. The crystal structure of the PPARγ ligand-binding domain (LBD) reveals that luteolin occupies a buried ligand-binding pocket (LBP) but binds an inactive PPARγ LBD conformer and occupies a space near the β-sheet region far from the activation helix (H12), consistent with partial agonist/antagonist actions. A single myristic acid molecule simultaneously binds the LBP, suggesting that luteolin may cooperate with other ligands to bind PPARγ, and molecular dynamics simulations show that luteolin and myristic acid cooperate to stabilize the Ω-loop among H2', H3, and the β-sheet region. It is noteworthy that luteolin strongly suppresses hypertonicity-induced release of the pro-inflammatory interleukin-8 from human corneal epithelial cells and reverses reductions in transepithelial electrical resistance. This effect is PPARγ-dependent. We propose that activities of luteolin are related to its singular binding mode, that anti-inflammatory activity does not require H12 stabilization, and that our structure can be useful in developing safe selective PPARγ modulators.     

Benzimidazolones: a new class of selective peroxisome proliferator-activated receptor γ (PPARγ) modulators

A series of benzimidazolone carboxylic acids and oxazolidinediones were designed and synthesized in search of selective PPARγ modulators (SPPARγMs) as potential therapeutic agents for the treatment of type II diabetes mellitus (T2DM) with improved safety profiles relative to rosiglitazone and pioglitazone, the currently marketed PPARγ full agonist drugs. Structure-activity relationships of these potent and highly selective SPPARγMs were studied with a focus on their unique profiles as partial agonists or modulators. A variety of methods, such as X-ray crystallographic analysis, PPARγ transactivation coactivator profiling, gene expression profiling, and mutagenesis studies, were employed to reveal the differential interactions of these new analogues with PPARγ receptor in comparison to full agonists. In rodent models of T2DM, benzimidazolone analogues such as (5R)-5-(3-{[3-(5-methoxybenzisoxazol-3-yl)benzimidazol-1-yl]methyl}phenyl)-5-methyloxazolidinedione (51) demonstrated efficacy equivalent to that of rosiglitazone. Side effects, such as fluid retention and heart weight gain associated with PPARγ full agonists, were diminished with 51 in comparison to rosiglitazone based on studies in two independent animal models.     

PAM-1616, a selective peroxisome proliferator-activated receptor γ modulator with preserved anti-diabetic efficacy and reduced adverse effects

Peroxisome proliferator-activated receptor (PPAR) γ is known to be a key regulator of insulin resistance. PAM-1616 is a novel, non-thiazolidinedione small molecule compound synthesized in Dong-A Research Center. In this study, we characterized the pharmacological and safety profiles of PAM-1616 as a selective PPARγ modulator. PAM-1616 selectively binds to human PPARγ (IC(50), 24.1±5.6 nM) and is a partial agonist for human PPARγ with an EC(50) of 83.6±43.7 nM and a maximal response of 24.9±7.1% relative to the full agonist, rosiglitazone. PAM-1616 was selective for human PPARγ than for human PPARα (EC(50), 2658±828 nM) without activating human PPARδ, which makes it a selective modulator of PPARγ. Treatment of high fat diet-induced obese C57BL/6J mice with PAM-1616 for 21 days improved HOMA-IR. Furthermore, PAM-1616 significantly improved hyperglycemia in db/db mice with little side effect when orally administered at a dose of 1 mg/kg/day for 28 days. Intriguingly, PAM-1616 was seen to increase the gene expression of inducible glucose transporter (GLUT4), while it partially induced that of a fatty acid carrier, aP2 in 3T3-L1 adipocytes, and it also showed partial recruitment of an adipogenic cofactor, TRAP220 as compared to rosiglitazone. PAM-1616 did not cause a significant increase in plasma volume of ICR mice when orally administered at a dose of 10 mg/kg/day for 9 days. PAM-1616 increased the expression of fluid retention-inducing genes such as serum/glucocorticoid-regulated kinase (SGK)-1 to a lesser extent as compared to rosiglitazone in human renal epithelial cells. These results suggest that PAM-1616 acts as a selective modulator of PPARγ with excellent antihyperglycemic property. The differential modulation of target gene by PAM-1616 might contribute to the improved side effect profiles.     

Energy restriction mimetic agents to target cancer cells: Comparison between 2-deoxyglucose and thiazolidinediones

The use of energy restriction mimetic agents (ERMAs) to selectively target cancer cells addicted to glycolysis could be a promising therapeutic approach. Thiazolidinediones (TZDs) are synthetic agonists of the nuclear receptor peroxisome proliferator-activated receptor (PPAR)γ that were developed to treat type II diabetes. These compounds also display anticancer effects which appear mainly to be independent of their PPARγ agonist activity but the molecular mechanisms involved in the anticancer action are not yet well understood. Results obtained on ciglitazone derivatives, mainly in prostate cancer cell models, suggest that these compounds could act as ERMAs. In the present paper, we introduce how compounds like 2-deoxyglucose target the Warburg effect and then we discuss the possibility that the PPARγ-independent effects of various TZD could result from their action as ERMAs.     

基于报告基因和PPARγ信号通路的药物筛选模型的建立

目的　建立基于报告基因和PPARγ(peroxisomeprolif erator activatedreceptorγ)信号通路的药物筛选模型,用此模型筛选具有胰岛素增敏活性的小分子化合物。方法　五种细胞分别进行瞬时转染,将含有目的片段PPRE(peroxisomeproliferatorresponseelement)和报告基因荧光素酶(Luc)的质粒及表达PPARγ的质粒共转染到细胞中,通过测定荧光素酶活力来考察马来酸罗格列酮对PPARγ信号通路的影响,选取诱导表达倍数最高的细胞株建立模型。用其他类型核受体激动剂对此模型进行特异性考察。结果　293T细胞中,荧光素酶的表达受马来酸罗格列酮的诱导倍数最高,可达4 9倍,并呈现一定的剂量依赖关系,Z′因子为0 .72。而其他各类核受体激动剂的诱导表达率均在1倍左右。马来酸罗格列酮在转染剂量范围内无促进细胞增殖的作用。结论　马来酸罗格列酮对共转染报告基因质粒和表达PPARγ质粒的293T细胞Luc的表达具有较强的诱导作用,此模型具有较好的特异性和稳定性,适用于建立筛选PPARγ激动剂的高通量筛选模型。     

PPARγ配体罗格列酮及其激动剂GW9662对脂肪细胞因子表达的影响

目的：脂肪组织是一个内分泌器官已逐渐得到了肯定,它能分泌多种信号分子如：脂联素和抵抗素。过氧化物酶体增殖物激活受体（peroxisome pro-liferator activated receptorγ,PPARγ）在脂肪组织高水平表达,胰岛素增敏剂-噻唑烷二酮类药物是它的选择性激动剂,噻唑烷二酮类药物如罗格列酮的胰岛素增敏作用部分是通过激活PPARγ调节脂联素（胰岛素增敏分子）和抵抗素（涉及胰岛素抵抗）表达介导的。但现在不同研究发现PPARγ激动剂对抵抗素的表达调控方向存在矛盾,我们的问题是当抵抗素表达增加的情况下脂联素的表达还能否上调。方法：用3T3-L1细胞株作为研究模型,分别用溶媒对照、罗格列酮（10μmol/L）、GW9662（5μmol/L）或罗格列酮＋GW9662作用细胞,然后检测脂联素和抵抗素 mRNA表达变化情况。结果：与对照组相比,罗格列酮分别增加脂联素和抵抗素 mRNA水平1.77和1.66倍,其差异具有统计学意义（P〈0.05） ;重要的是GW9662也增加脂联素水平（1.57倍,P〈0.05）但对抵抗素无影响。罗格列酮和GW9662两者合用时,仍上调adiponectin mRNA水平（对照组的1.87倍,P〈0.05） ,抵抗素的增加与罗格列酮单用比弱下降（对照组的1.31倍,P〈0.05）。结论：本研究为PPARγ激动剂（罗格列酮）和拮抗剂（GW9662）都上调脂联素的转录提供了新的证据,两者合用时GW9662不阻断罗格列酮诱导的脂联素上调作用。综合这些数据提示噻唑烷二酮类药上调脂联素的机制可能不依赖于PPARγ。并且, GW9662在增加脂联素水平的同时不上调抵抗素水平的特性进一步支持PPARγ拮抗剂用于临床治疗胰岛素抵抗的可能性。降低抵抗素表达可能不是罗格列酮胰岛素增敏作用的重要机制。我们的结果为将来研究噻唑烷二酮类药物对人脂肪细胞因子表达在剂量和时间上提供了一定的基础。