阿必鲁肽：一种超长效Ⅱ型糖尿病治疗新药

阿必鲁肽(Albiglutide)为新型GLP-1受体激动剂,可通过与胰岛β细胞表面的GLP-1受体结合,激活由细胞膜偶联G蛋白调控的胞内信号传导系统,修复及促进胰岛β细胞功能,增加胰岛素的分泌,从而降低血糖浓度及糖化血红蛋白(Hb A1c)水平,是治疗Ⅱ型糖尿病的理想药物。目前开发的各种长效GLP-1受体激动剂成为近二十年糖尿病药物的研究热点。本文对一种极具市场潜力的新型GLP-1受体激动剂阿必鲁肽(Albiglutide)的分子结构、作用机制、剂量研究、药代动力学、药效学以及副作用等临床试验研究进展进行综述。     

长效GLP-1受体激动剂的研发进展

胰高血糖素样肽-1(glucagon-like Peptide-1,GLP-1)是机体在葡萄糖等刺激下释放的一类肠促胰岛素。GLP-1具有促进葡萄糖依赖性胰岛素分泌,促进胰岛β细胞增殖并抑制其凋亡、抑制摄食、减慢胃排空和减轻体重等作用。GLP-1在体内极不稳定,易被二肽基肽酶-IV(dipeptidyl peptidase-IV,DPP-IV)降解,半衰期短。从墨西哥巨蜥蜴唾液中分离得到GLP-1的天然类似物Exendin-4与其有着相似的作用,且不易被DPP-IV降解。以GLP-1及Exendin-4为基础,研发长效GLP-1受体激动剂,已成为研发新型糖尿病治疗药物的热点之一。本文就长效GLP-1受体激动剂的研发现状予以综述。     

胰高血糖素样肽-1在胰腺中作用机制的研究进展

胰高血糖素样肽-1（GLP-1）是胰高血糖素原基因编码的一种激素,主要由肠道L细胞产生并分泌进入血液。GLP-1能激活胰腺、肾脏、肺、胃、心脏和脑等组织中存在的特异性G蛋白偶联受体（GPCR）。通过GLP-1受体（GLP-1R）的激活,活化腺苷酸环化酶,产生3＇,5＇-环腺苷酸,随后通过cAMP依赖性第二信使途径激活蛋白激酶A和鸟苷酸交换因子。大量围绕胰岛素产生细胞——β细胞开展的研究证明,GLP-1短期作用能够加强葡萄糖依赖性的胰岛素分泌作用,持续的GLP-1R激活也能增加胰岛素的合成,促进β细胞的增殖和新生,抑制β细胞凋亡。GLP-1在胰岛素和胰高血糖素分泌方面的独特作用引发了大量针对GLP-1受体激动剂的研究。我们对胰腺中GLP-1R激活所产生作用的机制进行简要综述。     

胰高血糖素样肽-1保护胰岛β细胞相关分子机制的研究进展

胰高血糖素样肽-1(Glucagon-like peptide-1,GLP-1)是肠道L细胞分泌的一种重要的肠促胰岛素.大量研究表明,除刺激胰岛素分泌外,GLP-1可通过促进胰岛β细胞增殖,抑制β细胞凋亡而增加胰岛β细胞量,本文就其相关分子信号转导机制进行综述.     

运动增加肥胖和2型糖尿病患者体内GLP-1水平的机制及意义

胰高血糖素样肽-1 (glucagon-like peptide-1, GLP-1)的减少在肥胖和2型糖尿病(type 2 diabetes mellitus, T2DM)中的重要作用为运动降低体重和血糖、改善胰岛素敏感性,以及防治肥胖及T2DM的机制研究提供了一个新视角。近年来的研究发现,运动可能通过谷氨酰胺(glutamine, Gln)、白介素-6 (interleukin-6,IL-6)、游离脂肪酸(free fatty acid, FFA)、交感-肾上腺髓质系统介导GLP-1的增加。增加的GLP-1可发挥改善胰岛β细胞功能,促进β细胞增殖、抑制β细胞凋亡、抑制食欲和胃排空以及降低chemerin等作用,从而提高胰岛素敏感性、减少能量摄入和改善血糖水平。这可能是运动防治肥胖、T2DM的机制之一,但仍需更多研究证实。该文就运动增加肥胖和2型糖尿病患者体内GLP-1水平的作用、机制及其生物学意义做一综述。     

GFP荧光标记GLP-1受体细胞系的建立

为建立胰高血糖素样肽1受体(glucagon-like peptide 1 receptor,GLP-1R)药物筛选模型,真核表达载体pCMV6/GFP/GLP-1R构建好后,转染至U2OS细胞,转染后的细胞经G418筛选获得单克隆细胞株。该细胞株经Western-blot和GLP-1类似物检测,结果表明GLP-1R在该细胞株高表达并对GLP-1类似物有着高灵敏度与特异性的反应,可以用于GLP-1受体激动剂的筛选。     

GLP-1及其受体激动剂在缺血再灌注损伤中的研究进展

GLP-1受体激动剂是一种新型的降糖药物,具有有效降低糖化血红蛋白、减轻体重和避免低血糖的发生等特点,目前在2型糖尿病的临床治疗中应用越来越广泛。近年来,许多临床前和人体生理研究已经证明GLP-1受体激动剂对多种组织器官的缺血再灌注损伤具有保护作用。本文主要就GLP-1及其在心、脑、肾脏及肝脏等重要脏器缺血再灌注损伤中的作用及机制的研究进展作一综述。     

GLP-1合成与分泌的分子机制及其影响因素北大核心CSCD

肠促胰素之一的胰高血糖素样肽(GLP-1)是胰高血糖素原基因在肠道L细胞中编码的产物。研究发现GLP-1具有抑制摄食、刺激胰岛素分泌从而降低餐后血糖等重要生物学功能,而GLP-1类似物和受体激动剂等已作为糖尿病治疗主要药物用于临床。本文总结近年关于GLP-1合成与分泌的研究进展,简要介绍胰高血糖素原基因转录、翻译后修饰及其相关调控机制,并从营养物质、激素、自主神经系统、机体生理状态和病理状态等方面,介绍影响GLP-1水平的一些主要因素。     

胰高血糖素样肽-1受体激动剂抑制大鼠进食效应的比较研究（英文）

胰高血糖素样肽-1 (glucagon-like peptide-1, GLP-1)在小肠细胞和脑干神经元中都有表达,起着抑制进食的作用。然而,目前对生理状态下影响进食的GLP-1的来源或是GLP-1受体激动剂(GLP-1 receptor agonists, GLP-1RA)的相关作用机制尚不明确。本研究选择即刻早期基因产物c-Fos作为特异抗原进行免疫组化染色以显示被GLP-1RA激活的中枢神经系统特定区域。将30只正常SD大鼠随机分为3组,分别一次性腹腔注射利拉鲁肽(200μg/kg)、艾塞那肽(10μg/kg)和生理盐水,检测给药后早期大鼠的摄食总量和血糖。结果显示,急性腹腔注射药理浓度的GLP-1RA能显著地影响摄食。然而,血糖的比较研究显示,在正常大鼠,GLP-1RA抑制进食的作用可能与血糖的变化相分离。与对照组相比,GLP-1RA组c-Fos表达主要在与摄食相关的核团中显著升高,并且在脊髓中发现了c-Fos的表达。以上结果果提示,急性注射药理浓度的GLP-1可以通过循环和迷走神经的途径影响中枢神经系统,尤其是作用于弓状核(arcuate nucleus, ARC)和孤束核(nucleus of solitary tract, NTS),GLP-1能同时调节自主神经的活动。     

胰高血糖素样肽1与干细胞定向分化

糖尿病已经成为21世纪严重威胁人类健康的疾病之一。胰岛移植被认为是治疗Ⅰ型和部分Ⅱ型糖尿病的最有效方法。然而,供体组织来源的匮乏限制了其应用。随着细胞移植和组织工程的日益发展,干细胞研究为新型胰岛的来源开辟了新的途径。干细胞定向诱导分化的关键是筛选合适的诱导剂以及优化诱导微环境,使干细胞培养微环境尽可能接近体内正常细胞发育分化的微环境,从而有利于干细胞适宜生长及定向分化。最近研究证实,胰高血糖素样肽1（Glucagon- Like PeptideⅠ,GLP-1）在干细胞向胰岛样细胞诱导分化中具有显著作用。因此,为了更好地应用GLP-1在干细胞定向分化中的潜能、促进应用干细胞治疗糖尿病新疗法研究的进程及干细胞定向分化技术逐渐成熟,本文就胰高血糖素样肽-1及它诱导干细胞定向分化胰岛样细胞的研究进展作一阐述。     

The contribution of serotonin 5-HT2C and melanocortin-4 receptors to the satiety signaling of glucagon-like peptide 1 and liragultide, a glucagon-like peptide 1 receptor agonist, in mice

Glucagon-like peptide 1 (GLP-1), an insulinotropic gastrointestinal peptide produced mainly from intestinal endocrine L-cells, and liraglutide, a GLP-1 receptor (GLP-1R) agonist, induce satiety. The serotonin 5-HT2C receptor (5-HT2CR) and melanoroctin-4 receptor (MC4R) are involved in the regulation of food intake. Here we show that systemic administration of GLP-1 (50 and 200 μg/kg)-induced anorexia was blunted in mice with a 5HT2CR null mutation, and was attenuated in mice with a heterozygous MC4R mutation. On the other hand, systemic administration of liraglutide (50 and 100 μg/kg) suppressed food intake in mice lacking 5-HT2CR, mice with a heterozygous mutation of MC4R and wild-type mice matched for age. Moreover, once-daily consecutive intraperitoneal administration of liraglutide (100 μg/kg) over 3 days significantly suppressed daily food intake and body weight in mice with a heterozygous mutation of MC4R as well as wild-type mice. These findings suggest that GLP-1 and liraglutide induce anorexia via different central pathways.     

Molecular modeling of the three-dimensional structure of GLP-1R and its interactions with several agonists

Glucagon-like peptide-1 receptor (GLP-1R) is a promising molecular target for developing drugs treating type 2 diabetes. We have predicted the complete three-dimensional structure of GLP-1R and the binding modes of several GLP-1R agonists, including GLP-1, Boc5, and Cpd1, through a combination of homology modeling, molecular docking, and long-time molecular dynamics simulation on a lipid bilayer. Our model can reasonably interpret the results of a number of mutation experiments regarding GLP-1R as well as the successful modification to GLP-1 by Liraglutide. Our model is also validated by a recently revealed crystal structure of the extracellular domain of GLP-1R. An activation mechanism of GLP-1R agonists is proposed based on the principal component analysis and normal mode analysis on our predicted GLP-1R structure. Before the complete structure of GLP-1R is determined through experimental means, our model may serve as a valuable reference for characterizing the interactions between GLP-1R and its agonists. Figure Comparison of our predicted model of rGLP-1R (left) with the recently revealed crystal structure of hGLP-1R (right)     

Recent progress and future options in the development of GLP-1 receptor agonists for the treatment of diabesity

The dramatic rise of the twin epidemics, type 2 diabetes and obesity is associated with increased mortality and morbidity worldwide. Based on this global development there is clinical need for anti-diabetic therapies with accompanied weight reduction. From the approved therapies, the injectable glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the only class of agents which are associated with a modest weight reduction. Physiological effects of the gastro-intestinal hormone GLP-1 are improvement of glycemic control as well as a reduction in appetite and food intake. Different approaches are currently under clinical evaluation to optimize the therapeutic potential of GLP-1 RAs directed to once-weekly up to once-monthly administration. The next generation of peptidic co-agonists comprises the activity of GLP-1 plus additional gastro-intestinal hormones with the potential for increased therapeutic benefits compared to GLP-1 RAs.     

Lipid derivatives activate GPR119 and trigger GLP-1 secretion in primary murine L-cells

Aims/hypothesisGlucagon-like peptide-1 (GLP-1) is an incretin hormone derived from proglucagon, which is released from intestinal L-cells and increases insulin secretion in a glucose dependent manner. GPR119 is a lipid derivative receptor present in L-cells, believed to play a role in the detection of dietary fat. This study aimed to characterize the responses of primary murine L-cells to GPR119 agonism and assess the importance of GPR119 for the detection of ingested lipid.MethodsGLP-1 secretion was measured from murine primary cell cultures stimulated with a panel of GPR119 ligands. Plasma GLP-1 levels were measured in mice lacking GPR119 in proglucagon-expressing cells and controls after lipid gavage. Intracellular cAMP responses to GPR119 agonists were measured in single primary L-cells using transgenic mice expressing a cAMP FRET sensor driven by the proglucagon promoter.ResultsL-cell specific knockout of GPR119 dramatically decreased plasma GLP-1 levels after a lipid gavage. GPR119 ligands triggered GLP-1 secretion in a GPR119 dependent manner in primary epithelial cultures from the colon, but were less effective in the upper small intestine. GPR119 agonists elevated cAMP in ∼70% of colonic L-cells and 50% of small intestinal L-cells.Conclusions/interpretationGPR119 ligands strongly enhanced GLP-1 release from colonic cultures, reflecting the high proportion of colonic L-cells that exhibited cAMP responses to GPR119 agonists. Less GPR119-dependence could be demonstrated in the upper small intestine. In vivo, GPR119 in L-cells plays a key role in oral lipid-triggered GLP-1 secretion.     

A PEGylated analog of the gut hormone oxyntomodulin with long-lasting antihyperglycemic,insulinotropic and anorexigenic activity

Peptide agonists of the glucagon-like peptide 1 (GLP-1) receptor (GLP1R) are rapidly gaining favor as antidiabetic agents, since in addition to increasing glucose-dependent insulin secretion, they also cause weight loss. Oxyntomodulin (OXM), a natural peptide with sequence homology to both glucagon and GLP-1, has glucose-lowering activity in rodents and anorectic activity in rodents and humans, but its clinical utility is limited by a short circulatory half-life due to rapid renal clearance and degradation by dipeptidyl peptidase IV (DPP-IV). Here, we describe the development of a novel DPP-IV-resistant, long-acting GLP1R agonist, based on derivatization of a suitably chosen OXM analog with high molecular weight polyethylene glycol (PEG) (‘PEGylation’). PEG-OXM exerts an anti-hyperglycemic effect in diet-induced obese (DIO) mice in a glucose-dependent manner, with a maximally efficacious dose of 0.1 mg/kg, and reduces food intake and body weight with a minimally efficacious dose of 1 mg/kg. If this pharmacology is recapitulated in patients with type 2 diabetes, these results indicate PEG-OXM as a potential novel once-weekly GLP-1 mimetic with both glucose-lowering activity and weight loss efficacy.     

Glucagon-like peptide 1 (7-36) amide (GLP-1) and exendin-4 stimulate serotonin release in rat hypothalamus

Glucagon-like peptide 1 (7-36) amide (GLP-1) and exendin-4 are gastrointestinal hormones as well as neuropeptides involved in glucose homeostasis and feeding regulation, both peripherally and at the central nervous system (CNS), acting through the same GLP-1 receptor. Aminergic neurotransmitters play a role in the modulation of feeding in the hypothalamus and we have previously found that peripheral hormones and neuropeptides, which are known to modulate feeding in the central nervous system, are able to modify catecholamine and serotonin release in the hypothalamus. In the present paper we have evaluated the effects of GLP-1 and exendin-4 on dopamine, norepinephrine, and serotonin release from rat hypothalamic synaptosomes, in vitro. We found that glucagon-like peptide 1 (7-36) amide and exendin-4 did not modify either basal or depolarization-induced dopamine and norepinephrine release; on the other hand glucagon-like peptide 1 (7-36) amide and exendin-4 stimulated serotonin release, in a dose dependent manner. We can conclude that the central anorectic effects of GLP-1 agonists could be partially mediated by increased serotonin release in the hypothalamus, leaving the catecholamine release unaffected.     

Synthesis and in vitro biological evaluation of new pyrimidines as glucagon-like peptide-1 receptor agonists

The therapeutic success of peptide glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of type 2 diabetes mellitus has inspired discovery efforts aimed at developing orally available small-molecule GLP-1 receptor agonists. In this study, two series of new pyrimidine derivatives were designed and synthesized using an efficient route, and were evaluated in terms of GLP-1 receptor agonist activity. In the first series, novel pyrimidines substituted at positions 2 and 4 with groups varying in size and electronic properties were synthesized in a good yield (78–90%). In the second series, the designed pyrimidine templates included both urea and Schiff base linkers, and these compounds were successfully produced with yields of 77–84%. In vitro experiments with cultured cells showed that compounds 3a and 10a (10^?15–10^?9 M) significantly increased insulin secretion compared to that of the control cells in both the absence and presence of 2.8 mM glucose; compound 8b only demonstrated significance in the absence of glucose. These findings represent a valuable starting point for the design and discovery of small-molecule GLP-1 receptor agonists that can be administered orally.     

Novel insights into the dynamics behavior of glucagon-like peptide-1 receptor with its small molecule agonists

Abstract

The glucagon-like peptide-1 receptor (GLP-1R) is a well-known target of therapeutics industries for the treatment of various metabolic diseases like type 2 diabetes and obesity. The structural–functional relationships of small molecule agonists and GLP-1R are yet to be understood. Therefore, an attempt was made on structurally known GLP-1R agonists (Compound 1, Compound 2, Compound A, Compound B, and (S)-8) to study their interaction with the extracellular domain of GLP-1R. In this study, we explored the dynamics, intrinsic stability, and binding mechanisms of these molecules through computational modeling, docking, molecular dynamics (MD) simulations and molecular mechanics Poisson–Boltzmann surface area (MM/PBSA) binding free energy estimation. Molecular docking study depicted that hydrophobic interaction (pi–pi stacking) plays a crucial role in maintaining the stability of the complex, which was also supported by intermolecular analysis from MD simulation study. Principal component analysis suggested that the terminal ends along with the turns/loops connecting adjacent helix and strands exhibit a comparatively higher movement of main chain atoms in most of the complexes. MM/PBSA binding free energy study revealed that non-polar solvation (van der Waals and electrostatic) energy subsidizes significantly to the total binding energy, and the polar solvation energy opposes the binding agonists to GLP-1R. Overall, we provide structural features information about GLP-1R complexes that would be conducive for the discovery of new GLP-1R agonists in the future for the treatment of various metabolic diseases.

Communicated by Ramaswamy H. Sarma     

Molecular physiology of glucagon-like peptide-1 insulin secretagogue action in pancreatic β cells

Insulin secretion from pancreatic β cells is stimulated by glucagon-like peptide-1 (GLP-1), a blood glucose-lowering hormone that is released from enteroendocrine L cells of the distal intestine after the ingestion of a meal. GLP-1 mimetics (e.g., Byetta) and GLP-1 analogs (e.g., Victoza) activate the β cell GLP-1 receptor (GLP-1R), and these compounds stimulate insulin secretion while also lowering levels of blood glucose in patients diagnosed with type 2 diabetes mellitus (T2DM). An additional option for the treatment of T2DM involves the administration of dipeptidyl peptidase-IV (DPP-IV) inhibitors (e.g., Januvia, Galvus). These compounds slow metabolic degradation of intestinally released GLP-1, thereby raising post-prandial levels of circulating GLP-1 substantially. Investigational compounds that stimulate GLP-1 secretion also exist, and in this regard a noteworthy advance is the demonstration that small molecule GPR119 agonists (e.g., AR231453) stimulate L cell GLP-1 secretion while also directly stimulating β cell insulin release. In this review, we summarize what is currently known concerning the signal transduction properties of the β cell GLP-1R as they relate to insulin secretion. Emphasized are the cyclic AMP, protein kinase A, and Epac2-mediated actions of GLP-1 to regulate ATP-sensitive K⁺ channels, voltage-dependent K⁺ channels, TRPM2 cation channels, intracellular Ca²⁺ release channels, and Ca²⁺-dependent exocytosis. We also discuss new evidence that provides a conceptual framework with which to understand why GLP-1R agonists are less likely to induce hypoglycemia when they are administered for the treatment of T2DM.     

取代环丁烷结构的非肽类胰高血糖素样肽-1受体激动剂

应用胰高血糖素样肽-1（glucagon-like peptide-1,GLP-1）及其类似物治疗2型糖尿病是代谢性疾病研究领域近年来的热点,尤其是胰高血糖素样肽-1独特的作用机制倍受业界的关注。它能同时作用于2型糖尿病的多个发病环节,在有效降低血糖的同时,避免低血糖的发生并能减轻体重。但这类药物因其多肽性质而存在诸多的使用限制（如需反复注射）。简要介绍一类取代环丁烷结构的新型非肽类胰高血糖素样肽-1受体小分子激动剂的发现过程、基本药理学特征和体内抗糖尿病和抗肥胖症效应。