国际抗糖尿病药物研发新进展

根据美国药物研究与生产商协会( PhRMA) 发布的相关报告和新药数据库中的数据,对2013 年至今进入Ⅲ期临床试验或递交新药申请(NDA)/ 生物制剂许可申请（BLA）的用于治疗糖尿病及其相关疾病的65 种候选新药的临床研发情况进行综述。将这些候选新药分为非胰岛素类、胰岛素类和复方制剂类抗糖尿病药,并重点对递交NDA/BLA 或已获得批准的抗糖尿病新药开发进行了分析和讨论。     

GLP-1及其受体激动剂Exendin-4临床适应症的扩展

GLP-1及其受体激动剂Exendin-4是治疗糖尿病的一种理想药物,是近年来新的研究热点之一。近年发现,该类药物可从多个生理角度发挥功能,揭示其临床适应症可能有进一步的扩展空间。对GLP-1及Exendin-4的各种已知和潜在的临床适应症进行了概述,这些适应症除了各型糖尿病外,还包括肥胖症、神经系统和心脏的疾病以及其他各种潜在适应症。     

调节GLUT4转位化合物及相关的信号通路研究进展

葡萄糖转位载体4(GLUT4)转位的受损与2型糖尿病密切相关,所以筛选促进GLUT4转位的药物并研究其相关的信号通路对治疗2型糖尿病具有十分重要的意义。药物促进GLUT4转位主要通过AMP活化蛋白激酶(AMPK)、磷脂酰肌醇3激酶/蛋白激酶B(PI3K/Akt)和蛋白激酶C(PKC)信号通路。本文分别介绍了这三种信号通路与GLUT4转位的关系以及相关的促进GLUT4转位的药物,为寻找治疗2型糖尿病的潜在新药提供参考。     

抗糖尿病天然药物的PPARγ活性部位筛选

PPARγ是过氧化物酶体增殖物激活受体(PPARs)的其中一个亚型,与糖尿病等代谢疾病在内的慢性疾病密切相关,近年来,PPARγ已成为糖尿病类新药研发的热门靶点。本文利用在He La细胞上构建以PPARγ为靶点的高通量筛选模型,从12种天然药物的58种不同极性提取物中筛选和评价出了对PPARγ具有高活性的8个部位,分别是绿萝花的乙酸乙酯萃取物(EB1)、正己烷提取物(EA)和正丁醇萃取物(EB2),黄连的EB1部分,翼首草的EA、乙醇提取物剩余部分(EB3)和水提物去多糖部分(EC)以及猪牙皂的EB1部分,其最高激活倍数分别相当于阳性对照0.5μg/m L罗格列酮的253%、199%、121%、127%、121%、107%、109%和105%。为开发用于治疗糖尿病及其并发症的新型、安全和高效的天然药物提供了理论和实验依据。     

嗜粘蛋白阿克曼菌在糖尿病和肥胖中的作用

肠道微生物在平衡健康与疾病的过程中起着重要作用。嗜粘蛋白阿克曼菌(Akkermansia muciniphila)是肠道微生物中的一种,其在降解肠道粘蛋白方面的特性使其成为肠腔与宿主细胞黏膜界面的关键生物。嗜粘蛋白阿克曼菌与肥胖、糖尿病、心血管代谢疾病和低度炎症呈负相关。口服嗜粘蛋白阿克曼菌可改善小鼠代谢疾病的相关症状,嗜粘蛋白阿克曼菌有望成为治疗2型糖尿病和肥胖的候选药物。本综述通过总结现有关于嗜粘蛋白阿克曼菌在糖尿病和肥胖症中发挥作用的研究,指出嗜粘蛋白阿克曼菌调节宿主和肠道微生物群之间相互作用可能存在的机制,为嗜粘蛋白阿克曼菌的进一步研究和糖尿病的新药研发提供思路。     

抗乳腺癌新药 palbociclib

Palbociclib 是 2015 年 2 月 3 日获美国食品药品监督管理局加速批准的乳腺癌新药,联合来曲唑作为以内分泌治疗为基础的初 始方案,用于治疗绝经期女性雌激素受体阳性（ER+）、人表皮生长因子受体 2 阴性（HER2-）的绝经期女性晚期乳腺癌。Palbociclib 是首个口服、靶向性 CDK4/6 抑制剂,阻止细胞周期从生长期（G1 期）到 DNA 复制期（S1 期）的转变,从而抑制肿瘤增殖,其上市为 晚期乳腺癌患者提供了新的治疗选择。介绍 palbociclib 的化学合成、临床前药理学研究、临床研究及专利保护情况等 , 为抗乳腺癌新药 研发提供参考。     

GDF15及其受体GFRAL在肥胖治疗上的相关研究进展

肥胖症是一种由于营养物质过剩导致体内脂肪堆积而引起的代谢性疾病,与糖尿病、心脏病等一系列疾病相关。近年来肥胖症的发病率不断攀升,严重威胁人类健康。药物是治疗肥胖症的重要手段,目前治疗肥胖症的药物多为小分子化学药物,存在较严重的副反应,亟待开发更加安全有效的新型药物。生长与分化因子15(GDF15)属于TGF-β超家族,是一类具有抗炎和抗细胞凋亡效应的细胞因子,近年来被发现具有强大的改善能量代谢和控制体重的作用,从而成为潜在治疗肥胖症的新型药物。简要综述了GDF15及其特异性受体——胶质细胞源性神经营养因子家族受体α相似蛋白(GFRAL)在治疗肥胖症中的研究进展。     

糖尿病和肥胖症治疗新靶点PTP1B抑制剂的研究进展

蛋白酪氨酸磷酸酯酶1B(protein tyrosine phosphatase 1B,PTP1B)是典型的非受体型PTPase家族的成员之一。PTP1B在胰岛素信号通路中起着重要的负调控作用,是治疗糖尿病和肥胖症的新靶点。寻找PTP1B的特异性抑制剂,通过抑制PTP1B的活性来提高胰岛素信号通路的敏感性,对糖尿病和肥胖症治疗有着重要的应用前景。     

2 型糖尿病治疗药物研究进展

2 型糖尿病（T2DM）是一种代谢障碍性疾病。传统抗糖尿病药物具有不同程度的副作用,如低血糖、胃肠道反应、体重增加、 心血管风险等,因此开发作用于新靶点和新作用机制的T2DM 治疗新药成为当前研究的热点。目前基于新靶点设计的糖尿病治疗新药有 些已上市,且获得良好的降糖效果,但大部分药物仍处于临床或临床前研究阶段,其疗效和安全性有待进一步临床验证。综述传统抗糖 尿病药物、T2DM 药物新靶点及基于新靶点设计的抗糖尿病新药的研究进展。     

连接肥胖和糖尿病的激素——抵抗素

2型糖尿病的发生主要是因为组织对胰岛素抵抗的缘故,往往与肥胖症相伴随,肥胖引起胰岛素抵抗的确切机制尚不清楚。抵抗素（resistin)是新近发现的一种由脂肪细胞分泌的激素,其作用是对抗胰岛素,使血糖水平升高,脂肪细胞增生繁殖而致肥胖,是糖尿病和肥胖症研究领域的突破性进展。抵抗素的发现对于糖尿病的治疗具有重要的指导意义。     

Why do we need drugs to treat the patient with obesity?

Objective:

Obesity is a public health problem, which increases the risk of chronic diseases and mortality. Weight loss can reduce mortality and improve most of the detrimental health consequences of obesity.

Design and Methods:

This paper was developed from two presentations to the US Food and Drug Administration (FDA), which has responsibility for reviewing and approving drugs to treat obesity.

Results:

A weight loss of 5% or more is sufficient to significantly reduce health risks in individuals with impaired glucose tolerance, hypertension, or nonalcoholic fatty liver disease. Slightly more weight loss (16% on average, achieved by surgery) reduces mortality. The goal of medicating for obesity is to help more patients achieve more weight loss. A barrier to drug approval has been the concern that weight loss medications might be used by individuals with little or no health risks, thus mandating a low side effect profile for approval of any drug. This limits the options for patients who have obesity‐related health problems that could improve with weight loss. Recently the FDA signaled interest in identifying health benefits in higher risk patients that might justify medications with higher risk; however, the potential impact on a large segment of the population has led the FDA to consider requiring a cardiovascular outcome trial for all obesity medications, either prior to or after approval.

Conclusion:

This review argues that drugs are needed for obesity because they enhance behaviorally induced weight loss and that new medications for obesity are needed in the approval process.     

Obestatin, obesity and diabetes

The high prevalence of obesity and diabetes will lead to higher rates of morbidity and mortality. It is well known that ghrelin plays a potential role in obesity and diabetes. Obestatin, a novel 23 amino acid amidated peptide encoded by the same gene that encodes ghrelin, was initially reported to have opposite actions to ghrelin in the regulation of food intake, emptying of the stomach and body weight. Recent work suggests that obestatin also regulate beta-cell survival and insulin secretion. The ghrelin-obestatin system is, therefore, a promising target for the developing of new drugs for the treatment of obesity and diabetes. This review summarizes the interrelationship between obestatin, obesity and diabetes.     

半乳糖苷凝集素-3与肥胖及2型糖尿病

肥胖及2型糖尿病是代谢紊乱相关的慢性低度系统炎症状态。半乳糖苷凝集素-3（galectin-3）是一种β-半乳糖苷结合蛋白,在炎症、信号转导、细胞增殖与分化等过程中发挥重要作用。新近的研究表明,半乳糖苷凝集素-3在患肥胖和2型糖尿病的人及鼠类体内高表达,对鼠类体脂的沉积、脂肪细胞分化、血糖浓度、胰岛素敏感性、葡萄糖耐受性和系统炎症等具有重要影响。本文综述了半乳糖苷凝集素-3的结构、分布及其对肥胖和2型糖尿病的调控作用与分子机制,以期为研发针对半乳糖苷凝集素-3靶点的新药提供重要思路和参考。     

Time required for approval of new drugs in Canada,Australia, Sweden,the United Kingdom and the United States in 1996-1998

BACKGROUND: The timeliness with which national regulatory agencies approve new drugs for marketing affects health care professionals and patients. An unnecessarily long approval process delays access to new medications that may improve patients'' health status. The author compared drug approval times in Canada, Australia, Sweden, the United Kingdom and the United States. METHODS: Application and approval dates of new chemical or biological substances (excluding diagnostic products, and new salts, esters, dosage forms and combinations of previously approved substances) approved for marketing in the 5 countries from January 1996 to December 1998 were requested from the relevant pharmaceutical companies. Data on new drug approvals during the study period were also obtained from the national drug regulatory agencies in Canada, Australia and Sweden and from publications of the US Food and Drug Administration. RESULTS: A total of 219 new drugs were identified as being approved in at least one of the countries during the study period: 23 (10.5%) in all 5 countries, 23 (10.5%) in 4, 27 (12.3%) in 3, 42 (19.2%) in 2, and 104 (47.5%) in 1 country. By individual nation, 97 drugs were identified as being approved in Canada, 94 in Australia, 107 in Sweden, 55 in the UK and 123 in the US. Approval times in Canada and Australia were similar (medians 518 and 526 days respectively), but both countries had significantly longer approval times than Sweden (median 371 days), the UK (median 308 days) and the US (median 369 days). This pattern was consistent across all 3 years and for the 23 new drugs approved in all 5 countries during the 3-year period. Median approval times in Canada were similar in all of the reviewing divisions of Health Canada''s Therapeutic Product Program (539-574 days) except the Central Nervous System Division (428 days) and the Bureau of Biologics and Radiopharmaceuticals (698 days). INTERPRETATION: Median drug approval times during 1996-1998 decreased by varying amounts from the 1995 values in all 5 countries. However, the median approval time in Canada continues to be significantly longer than the times achieved in Sweden, the UK and the US, and it remains considerably longer than Canada''s own target of 355 days for all new drugs.     

Addictive Genes and the Relationship to Obesity and Inflammation

There is increasing evidence that the same brain reward circuits involved in perpetuating drug abuse are involved in the hedonic urges and food cravings observed clinically in overweight and obese subjects. A polymorphism of the D2 dopamine receptor which renders it less sensitive to dopamine stimulation has been proposed to promote self-stimulatory behavior such as consuming alcohol, abusing drugs, or binging on foods. It is important to determine how this polymorphism may interact with other well-known candidate genes for obesity including polymorphisms of the leptin receptor gene and the opiomelanocortin gene. Leptin is a proinflammatory cytokine as well as a long-term signal maintaining body fat. Upper-body obesity stimulates systemic inflammation through the action of multiple cytokines including leptin throughout many organs including the brain. The association of numerous diseases including diabetes mellitus, heart disease, as well as depression with chronic low-grade inflammation due to abdominal obesity has raised the possibility that obesity-associated inflammation affecting the brain may promote addictive behaviors leading to a self-perpetuating cycle that may affect not only foods but addictions to drugs, alcohol, and gambling. This new area of interdisciplinary research holds the promise of developing new approaches to treating drug abuse and obesity.     

Protein tyrosine phosphatase 1B inhibitors as antidiabetic agents – A brief review

Diabetes mellitus and obesity are one of the most common health issues spread throughout world and raised the medical attention to find the new effective agents to treat these disease state. Occurrence of the drug resistance to the insulin and leptin receptor is also challenging major issues. The molecules that can overcome this resistance problem could be effective for the treatment of both type II diabetes and obesity. Protein Tyrosine Phosphatase (PTP) has emerged as new promising targets for therapeutic purpose in recent years. Protein Tyrosine Phosphatase 1B (PTP 1B) act as a negative regulator of insulin and leptin receptor signalling pathways. Several approaches have been successfully applied to find out potent and selective inhibitors. This article reviews PTP 1B inhibitors; natural, synthetic and semi-synthetic that showed inhibition towards enzyme as a major target for the management of type II diabetes. These studies could be contributing the future development of PTP 1B inhibitors as drugs.     

抗炎药物用于 2 型糖尿病预防与治疗的研究进展

近年来,炎症反应在2型糖尿病发病机制中的作用受到广泛关注。流行病学和实验动物研究均证明,肥胖及其诱发的慢性炎症 与2型糖尿病有密切的关系。基于诸多临床流行病学调查及大型前瞻性研究结果,目前已形成对糖尿病胰岛素耐受性的炎症发病机制的 共识。到目前为止,多种具有抗炎作用机制的活性小分子药物已经上市或进入临床研究阶段,这些药物单独治疗或与传统降糖药物联用 均取得了令人满意的效果,显示了糖尿病抗炎治疗的前景。主要综述近年来慢性炎症在2型糖尿病发生发展过程中的分子机制以及抗炎 药物用于治疗2型糖尿病的研究进展     

Electroacupuncture in the Treatment of Obesity

Obesity is becoming one of the most common health problems in the world. Many other disorders, such as hypertension and diabetes are considered as the consequences of obesity. Since effective remedies are rare (only two drugs, Orlistat and Sibutramine, were officially approved by the US Food and Drug Administration for long-term obesity treatment so far), researchers are trying to discover new therapies for obesity, and acupuncture is among the most popular alternative approaches. To facilitate weight reduction, one can use manual acupuncture, electroacupuncture (EA) or transcutaneous electrical acupoint stimulation (TEAS). As the parameters of the EA or TEAS can be precisely characterized and the results are more or less reproducible, this review will focus on EA as a treatment modality for obesity. Results obtained in this laboratory in recent five years will be summarized in some detail. Special issue article in honor of Dr. Ji-Sheng Han.     

MicroRNAs: Emerging roles in adipogenesis and obesity

Obesity is a serious health problem worldwide associated with an increased risk of life-threatening diseases such as type 2 diabetes, atherosclerosis, and certain types of cancer. Understanding the molecular basis of adipogenesis and fat cell development in obesity is essential to identify new biomarkers and therapeutic targets for the development of anti-obesity drugs. Recent computational and experimental studies have shown that microRNAs (miRNAs) appear to play regulatory roles in many biological processes associated with obesity, including adipocyte differentiation and lipid metabolism. In addition, many miRNAs are dysregulated in metabolic tissues from obese animals and humans, which potentially contributes to the pathogenesis of obesity-associated complications. The discovery of circulating miRNAs has highlighted their potential as both endocrine signaling molecules and disease markers. The potential of miRNA based therapeutics targeting obesity is highlighted as well as recommendations for future research which could lead to a breakthrough in the treatment of obesity.