Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Inhibitors of the protease dipeptidyl peptidase IV (DPP-IV) are promising new drugs for the treatment of type 2 diabetes. They are thought to act by inhibiting the breakdown of glucagon-like peptide-1 and, thereby, selectively enhancing insulin release under conditions when it is physiologically required. These drugs are selective for DPP-IV, but the enzyme itself has a broad range of substrates other than glucagon-like peptide-1. Other high affinity substrates of DPP-IV including peptide YY may also play a role in the regulation of energy homeostasis. Moreover, DPP-IV is also known as CD26 and considered to be a moonlighting protein because it has a wide range of other functions unrelated to energy homeostasis, e.g. in immunity. The potential role of DPP-IV inhibition on substrates other than glucagon-like peptide-1 in diabetes patients remains to be elucidated.
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PMID:Dipeptidyl peptidase IV inhibitors in diabetes: more than inhibition of glucagon-like peptide-1 metabolism? 1839 99

Since its discovery glucagon-like peptide-1 (GLP-1) is investigated as a treatment for type II diabetes based on its major function as insulin secretagogue. A therapeutic use is, however, limited by its short biological half-life in the range of minutes, predominantly caused via degradation catalyzed by dipeptidyl peptidase IV (DPP-IV). Therefore, we aimed to design a GLP-1 analogue exhibiting resistance against DPP-IV-catalyzed inactivation while retaining its biological activity. By means of matrix-assisted laser desorption/ionization mass spectrometry (MALDI MS) we have studied the stability of the N-terminally blocked new analogue Ac-GLP-1-(7-34)-amide against DPP-IV and compared it with both unblocked GLP-1-(7-34)-amide and the major naturally occurring form GLP-1-(7-36)-amide. GLP-1-(7-36)-amide and the C-terminally two amino acid residues shorter GLP-1-(7-34)-amide rapidly generated peptide fragments truncated by the N-terminal dipeptide. In contrast, the N-terminal blocked Ac-GLP-1-(7-34)-amide was not degraded in the presence of DPP-IV over a period of at least two hours. Ac-GLP-1-(7-34)-amide induced a concentration-dependent increase of intracellular cAMP production and insulin release from rat insulinoma RIN-m5F cells to an extent comparable to that found for the N-terminally unblocked peptides GLP-1-(7-34)-amide and GLP-1-(7-36)-amide. Ac-GLP-1-(7-34)-amide may thus have the potential to act as a new long-acting GLP-1 analogue with significant resistance against DPP-IV and retained biological activity in vitro. Further research is required to investigate whether Ac-GLP-1-(7-34)-amide also exhibits its characteristics in animal models and humans.
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PMID:N-terminal acetylation protects glucagon-like peptide GLP-1-(7-34)-amide from DPP-IV-mediated degradation retaining cAMP- and insulin-releasing capacity. 1842 66

Type 2 diabetes is a chronic disease characterized by impaired insulin action, progressive beta cell dysfunction as well as abnormalities in pancreatic alpha cell function and postprandial substrate delivery. These pathophysiologic defects result in both persistent and progressive hyperglycemia, resulting in increased risk of both microvascular and cardiovascular complications. Traditional treatments for type 2 diabetes have focused on impaired insulin secretion and insulin resistance. These strategies are typically used in a stepwise manner: employing oral glucose lowering agents, followed by insulin therapy. This traditional approach fails to address the progressive decline in beta cell function. Moreover, these therapies are often associated with weight gain in overweight or obese patients with type 2 diabetes. Both exogenous insulin and insulin secretagogues are associated with an increased risk of hypoglycemia. Recently, new treatments that leverage the glucoregulatory effects of incretin hormones, such as glucagon like peptide 1 have been introduced. Both incretin mimetics and DPP-4 inhibitors address both the underlying pathophysiology and overcome several of the limitations of established therapies by providing improvements in glycemia, and control of body weight with minimal risk of hypoglycemia.
Curr Diabetes Rev 2008 May
PMID:Emerging incretin based therapies for type 2 diabetes: incretin mimetics and DPP-4 inhibitors. 1847 57

The improved understanding of glucoregulatory hormones has driven the development of new pharmacologic agents to treat type 2 diabetes. One new class of antihyperglycemic medication is incretin mimetics (IMs). Incretin hormones potentiate insulin secretion following meal ingestion, a process that is impaired in patients with type 2 diabetes. GLP-1, a 30-amino acid peptide incretin hormone, is produced in the L cells of the ileum and colon. Studies have shown that a 6-week continuous GLP-1 infusion in patients with type 2 diabetes improved glycemic control and beta-cell function and delayed gastric emptying. Despite the rapid degradation and inactivation of GLP-1 by the enzyme dipeptidyl peptidase IV (DPP-IV), agents that mimic the actions of GLP-1 are of great clinical interest. First-in-class IM exenatide, a GLP-1 receptor agonist resistant to DPP-IV inactivation, mimics many beneficial glucoregulatory effects of GLP-1, such as suppressing glucagon secretion, regulating gastric emptying and satiety, and increasing glucose-dependent insulin secretion. Exenatide is an adjunctive therapy for patients who take metformin, a sulfonylurea, a thiazolidinedione, or a combination of these oral medications but have not achieved glycemic control. An 82-week, open-label extension trial has shown that exenatide is well tolerated and that the benefits, including improved glycemic control, weight loss, and mitigation of cardiovascular risk factors, are sustained.
Diabetes Educ
PMID:Beyond glycemic control: the effects of incretin hormones in type 2 diabetes. 1852 67

Inhibition of dipeptidyl peptidase-4 (DPP-4) as a novel therapy for type 2 diabetes is based on prevention of the inactivation process of bioactive peptides, the most important in the context of treatment of diabetes of which is glucagon-like peptide-1 (GLP-1). Most clinical experience with DPP-4 inhibition is based on vildagliptin (GalvusR, Novartis) and sitagliptin (JanuviaR, Merck). These compounds improve glycemic control both in monotherapy and in combination with other oral hyperglycemic agents. Both have also been shown to efficiently improve glycemic control when added to ongoing metformin therapy in patients with inadequate glycemic control. Under that condition, they reduce HbA1C levels by 0.65%-1.1% (baseline HbA1C 7.2-8.7%) in studies up to 52 weeks of duration in combination versus continuous therapy with metformin alone. Sitagliptin has also been examined in initial combination therapy with metformin have; HbA1 was reduced by this combination by 2.1% (baseline HbA1C 8.8%) after 24 weeks of treatment. Both fasting and prandial glucose are reduced by DPP-4 inhibition in combination with metformin in association with improvement of insulin secretion and insulin resistance and increase in concentrations of active GLP-1. The combination of DPP-4 inhibition and metformin has been shown to be highly tolerable with very low risk of hypoglycemia. Hence, DPP-4 inhibition in combination with metformin is an efficient, safe and tolerable combination therapy for type 2 diabetes.
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PMID:Novel combination treatment of type 2 diabetes DPP-4 inhibition + metformin. 1856 13

New therapeutic agents are needed to combat the ever-increasing prevalence of diabetes. The two incretins glucagon-like peptide-1 (7-36) (GLP-1(7-36)) amide and glucose-dependent insulinotropic peptide (GIP) are released from the small intestine in response to the ingestion of nutrients and regulate glucose homeostasis in a glucose-dependent fashion; however, the action of both incretins is terminated by the rapid N-terminal cleavage of two amino acid residues of GLP-1 and GIP by dipeptidyl peptidase-IV (DPP-IV). The preservation of active GLP-1 and GIP by inhibiting DPP-IV activity is an attractive strategy for the treatment of diabetes in patients who exhibit a reduced incretin response. This strategy has resulted in the launch of two DPP-IV inhibitor drugs; sitagliptin in North America, several European territories, and various other countries, and vildagliptin in the EU as well as various countries. This article provides an overview of the recent advances in and the lessons learned from the design of potent and selective small-molecule inhibitors of DPP-IV for the treatment of type 2 diabetes.
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PMID:From the bench to the bedside: dipeptidyl peptidase IV inhibitors, a new class of oral antihyperglycemic agents. 1860 May 68

The goal of this review is to think about how to incorporate the GLP-1 based agents, represented by the dipeptidyl peptidase-4 (DPP-4) inhibitors or the glucagon-like peptide-1 (GLP-1) analogs, in the guidelines for the management of type 2 diabetes (T2DM). Orally administered DPP-4 inhibitors, such as sitagliptin and vildagliptin, reduce HbA(1c) (absolute values) by 0.5-1.1% (5 to 12%, relative values), with few adverse events and no weight gain. The sub-cutaneous injected GLP-1 analogs show larger reductions in HbA(1c) (0.8-1.7%, absolute values; 9.4-20.0%, relative values), associated with weight loss (1.75-3.8 kg); their most common adverse events are gastrointestinal symptoms which contribute to a substantial treatment interruption. If they do not challenge the use of metformin as the initial therapy of T2DM, several studies argue in favour of the use of DPP-4 inhibitors, either in combination with metformin as the initial treatment or, in add-on therapy to metformin. The advantages of this combination over others currently used are reviewed. In patients not tolerating metformin, DPP-4 inhibitors seem to be an excellent alternative as a monotherapy. As long as oral triple therapy is concerned, the choice for the association metformin + thiazolidinedione + incretin-based drug, has again several theoretical advantages against other triple therapy combinations. Finally, in patients with T2DM inadequately controlled with maximal tolerated oral multi-therapies, GLP-1 agonists are a good alternative to insulin therapy, allowing reaching a better glycaemic control together with a weight loss. However, for patients who do not tolerate GLP-1 agonist treatment, and for those not reaching the HbA(1c) target, insulin will remain necessary, allowing getting a better metabolic control, with few adverse events. The long-term effect of these new agents on glycaemic control has not yet been established, and their potential impact on beta-cell function in humans remains an area of active investigation. So, further studies are needed and will allow progressively refining the use of incretin-based agents in T2DM treatment strategy.
Diabetes Metab 2008 Feb
PMID:Therapeutic approach of type 2 diabetes mellitus with GLP-1 based therapies. 1864 May 90

This review tries to delineate how to insert the GLP-1 based agents, DPP4-inhibitors (sitagliptin and vildagliptin) and GLP-1 analogues (exenatide and liraglutide), in the guidelines and the daily practice for the management of type 2 diabetes (T2DM). Orally administered DPP-4 inhibitors reduce HbA(1c) by 0.5-1.1%, without hypoglycaemic events and no weight gain. The subcutaneous injected GLP-1 analogues show larger reductions in HbA(1c) by 0.8-1.7% and a weight loss (1.75-3.8 kg) with most gastrointestinal common adverse events contributing to a significant treatment interruption. Regarding the efficacy, the cost and the safety of these drugs they will no challenge the use of metformin as the initial therapy of T2DM. In patients'not tolerating metformin or in older patients, DPP-4 inhibitors seem to be an excellent alternative monotherapy. Several studies argue in favour of the use of DPP-4 inhibitors in combination with metformin as a promising second line treatment. This combination offers advantages when compared to others currently used, particularly if one considers the more stringent guidelines with a higher risk of hypoglycaemic events in patient receiving sulfonylureas and mild hyperglycaemia or weight gain with thiazolidinedione (TZD). Oral triple therapy, metformin + TZD + incretin-based drug, has several theoretical advantages but is not supported by any published trial. Finally, obtaining the acceptance of injections once to twice daily vs. oral administration of OADs will probably remain difficult during the first years of treatment in many patients. Nevertheless a long-acting release exenatide formulation (i.e. once weekly), for subcutaneous injection in patients with type 2 diabetes under development shows promising preliminary results. If confirmed, the use of this new class of drugs should be largely developed from monotherapy to combinations (bitherapy or tritherapy), and even instead of insulin or in association with insulin. The long-term effect of GLP-1 based agents on glycaemic control has not yet been established, and their potential impact on beta-cell function in humans remains an area of active investigation. So, further studies are required and will allow progressively determining the use of incretin-based agents in T2DM treatment strategy. Their efficacy, safety and their cost vs. older strategies, will be really evaluated by physicians in the real daily practice and by large and long term systematic surveys, as recently shown in other therapeutic fields.
Diabetes Metab 2008 Feb
PMID:DPP-4 inhibitors and GLP-1 analogues: for whom? Which place for incretins in the management of type 2 diabetic patients? 1864 May 91

1. Dipeptidyl peptidase IV (DPP-IV) is a new drug target in the treatment of Type 2 diabetes. Dipeptidyl peptidase IV enzyme activity is significantly altered in Type 2 diabetic patients with hyperglycaemia, but the underlying molecular mechanisms remain unclear. 2. The first aim of the present study was to clarify whether glucose regulates DPP-IV enzyme activity. To address this, DPP-IV gene expression and enzyme activity were measured in Caco2 cells cultured in the presence of low (2.5 mmol/L) or high (16.7 mmol/L) concentrations of glucose. We observed that high glucose inhibited DPP-IV gene expression and enzyme activity. 3. The second aim of the present study was to investigate whether hepatocyte nuclear factor (HNF)-1alpha contributes to glucose regulation of DPP-IV gene expression. To explore this question, associations between the gene expression of DPP-IV and HNF-1alpha were examined in Caco-2 cells cultured in the presence of low (2.5 mmol/L) or high (16.7 mmol/L) glucose. We found that the pattern of glucose-regulated DPP-IV gene expression is similar to that of HNF-1alpha. Moreover, to elucidate whether glucose regulation of DPP-IV gene expression is affected when HNF-1alpha is inhibited, we produced two stable cell lines in which a dominant-negative mutant HNF-1alphaR271G or basic vectors were stably expressed. We found that glucose regulation of DPP-IV gene expression was compromised in HNF-1alphaR271G cells, but was well maintained in basic vector cells. 4. These results suggest that glucose regulation of DPP-IV gene expression is mediated by HNF-1alpha.
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PMID:Glucose regulation of dipeptidyl peptidase IV gene expression is mediated by hepatocyte nuclear factor-1alpha in epithelial intestinal cells. 1867 16

The intensive lifestyle intervention of the DPP (Diabetes Prevention Program) showed weight loss to be a dominant predictor of reduced diabetes incidence for those at high risk for the disease. The intensive lifestyle intervention of Look AHEAD (Action for Health in Diabetes) has also shown that weight loss is associated with improved diabetes control and cardiovascular risk factors and reduced medicine for those with the disease. DPP and Look AHEAD implemented the use of motivational incentives and campaigns to assist participants in their commitment to lifestyle change. Other studies have also used incentives as effective strategies to engage individuals in weight loss and in making positive physical activity and dietary changes. Special consideration should be given to implementing various incentive strategies to assist overweight and obese individuals with weight loss. Using these motivational incentive strategies can be an effective means to help individuals succeed with their weight loss efforts.
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PMID:Lifestyle intervention strategies to prevent and control type 2 diabetes. 1877 91


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