Mechanisms to elevate endogenous GLP-1 beyond injectable GLP-1 analogs and metabolic surgery

DA Briere, AB Bueno, EJ Gunn, MD Michael… - Diabetes, 2018 - Am Diabetes Assoc
DA Briere, AB Bueno, EJ Gunn, MD Michael, KW Sloop
Diabetes, 2018Am Diabetes Assoc
Therapeutic engineering of glucagon-like peptide 1 (GLP-1) has enabled development of
new medicines to treat type 2 diabetes. These injectable analogs achieve robust glycemic
control by increasing concentrations of “GLP-1 equivalents”(∼ 50 pmol/L). Similar levels of
endogenous GLP-1 occur after gastric bypass surgery, and mechanistic studies indicate
glucose lowering by these procedures is driven by GLP-1. Therefore, because of the
remarkable signaling and secretory capacity of the GLP-1 system, we sought to discover …
Therapeutic engineering of glucagon-like peptide 1 (GLP-1) has enabled development of new medicines to treat type 2 diabetes. These injectable analogs achieve robust glycemic control by increasing concentrations of “GLP-1 equivalents” (∼50 pmol/L). Similar levels of endogenous GLP-1 occur after gastric bypass surgery, and mechanistic studies indicate glucose lowering by these procedures is driven by GLP-1. Therefore, because of the remarkable signaling and secretory capacity of the GLP-1 system, we sought to discover mechanisms that increase GLP-1 pharmacologically. To study active GLP-1, glucose-dependent insulinotropic polypeptide receptor (Gipr)–deficient mice receiving background dipeptidyl peptidase 4 (DPP4) inhibitor treatment were characterized as a model for evaluating oral agents that increase circulating GLP-1. A somatostatin receptor 5 antagonist, which blunts inhibition of GLP-1 release, and agonists for TGR5 and GPR40, which stimulate GLP-1 secretion, were investigated alone and in combination with the DPP4 inhibitor sitagliptin; these only modestly increased GLP-1 (∼5–30 pmol/L). However, combining molecules to simultaneously intervene at multiple regulatory nodes synergistically elevated active GLP-1 to unprecedented concentrations (∼300–400 pmol/L), drastically reducing glucose in Gipr null and Leprdb/db mice in a GLP-1 receptor–dependent manner. Our studies demonstrate that complementary pathways can be engaged to robustly increase GLP-1 without invasive surgical or injection regimens.
Am Diabetes Assoc