l-783281 and Insulin-Resistance

The increasing prevalence, variable pathogenesis, progressive natural history, and complications of type 2 diabetes emphasise the urgent need for new treatment strategies. Longacting (eg, once weekly) agonists of the glucagon-like-peptide-1 receptor are advanced in development, and they improve prandial insulin secretion, reduce excess glucagon production, and promote satiety. Trials of inhibitors of dipeptidyl peptidase 4, which enhance the effect of endogenous incretin hormones, are also nearing completion. Novel approaches to glycaemic regulation include use of inhibitors of the sodium-glucose cotransporter 2, which increase renal glucose elimination, and inhibitors of 11β-hydroxysteroid dehydrogenase 1, which reduce the glucocorticoid effects in liver and fat. Insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, and metabolic inhibitors of hepatic glucose output are being assessed. Early proof of principle has been shown for compounds that enhance and partly mimic insulin action and replicate some effects of bariatric surgery.

Topics: 11-beta-Hydroxysteroid Dehydrogenase Type 1; Allylamine; Anticholesteremic Agents; Bariatric Surgery; Bile Acids and Salts; Cardiovascular System; Colesevelam Hydrochloride; Comorbidity; Diabetes Mellitus, Type 2; Dipeptidyl-Peptidase IV Inhibitors; Exenatide; Glucagon-Like Peptide 1; Glucokinase; Humans; Hyperglycemia; Hypoglycemic Agents; Indoles; Insulin; Insulin Resistance; Insulin-Secreting Cells; Liver; Obesity; Peptides; Randomized Controlled Trials as Topic; Receptors, Dopamine D2; Signal Transduction; Sodium-Glucose Transporter 2 Inhibitors; Treatment Outcome; Venoms

Topics: Administration, Oral; Animals; Diabetes Mellitus, Type 2; Humans; Hypoglycemic Agents; Indoles; Insulin; Insulin Resistance; Molecular Mimicry; Receptor, Insulin; Structure-Activity Relationship

Orally available anti-diabetic candidates, reported by Merck researchers, are reviewed. The lead, asterriquinone B1(1a), was discovered in a fungal extract by screening with the cell line CHO.IR. An analog, 2,5-dihydroxy-3-(1-methylindol-3-yl)-6-phenyl-1,4-benzoquinone(2h), was selected by studying structure-activity relationships with various in vitro and in vivo tests. Analog 2h exhibited selective tyrosin kinase activity to an insulin receptor and a glucose-lowering effect by testing on diabetic rodent models. However, on the basis of the results of in vivo tests on streptozotocin-induced and on normal lean mice, the activity of 2h was attributed to a sensitizing effect on insulin together with an insulin mimetic effect in part. These studies shed light on the search for new anti-diabetic agents by targeting insulin receptors.

Topics: Administration, Oral; Animals; Benzoquinones; Diabetes Mellitus; Humans; Hypoglycemic Agents; Indolequinones; Indoles; Insulin Resistance; Structure-Activity Relationship

Epidemiological studies suggest a positive relationship between phthalate exposure and diabetes. However, little is known about the impact of dibutyl phthalate (DBP) exposure on the development of diabetes. To determine the role of DBP exposure on the development of type 2 diabetes, mice were orally exposed to DBP dosages of 0.5, 5, 50 mg/kg/day for 7 weeks, combined with a high fat diet and injections of a low dose of streptozotocin (STZ). The results showed that exposure to 50 mg/kg/day DBP alone induced a marked decrease in insulin secretion and glucose intolerance, but had no influence on insulin resistance. However, combined with a high fat diet and STZ treatment, DBP exposure markedly aggravated glucose intolerance, insulin tolerance and insulin resistance and induced lesions in the pancreas and kidney. Investigation of the role of DBP on the insulin signaling pathway, we found that DBP exposure could disrupt the PI3K expression and AKT phosphorylation, and decrease the level of GLUT-2 in the pancreas. Administering demethylasterriquinone B1, significantly increased the level of PI3K, AKT phosphorylation and GLUT-2 expression, effectively inhibiting the aggravation of diabetes. Our results suggested that DBP aggravated type 2 diabetes by disrupting the insulin signaling pathway and impairing insulin secretion.

Topics: Animals; Blood Glucose; Body Weight; Diabetes Mellitus, Type 2; Dibutyl Phthalate; Indoles; Insulin; Insulin Resistance; Insulin Secretion; Male; Mice; Mice, Inbred BALB C; Pancreas; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins c-akt; Signal Transduction

Insulin resistance clusters with hyperlipidemia, impaired glucose tolerance, and hypertension as metabolic syndrome X. We tested a low molecular weight insulin receptor activator, demethylasterriquinone B-1 (DMAQ-B1), and a novel indole peroxisome proliferator-activated receptor gamma agonist, 2-(2-(4-phenoxy-2-propylphenoxy)ethyl)indole-5-acetic acid (PPEIA), in spontaneously hypertensive obese rats (SHROB), a genetic model of syndrome X. Agents were given orally for 19 days. SHROB showed fasting normoglycemia but impaired glucose tolerance after an oral load, as shown by increased glucose area under the curve (AUC) [20,700 mg x min/ml versus 8100 in lean spontaneously hypertensive rats (SHR)]. Insulin resistance was indicated by 20-fold excess fasting insulin and increased insulin AUC (6300 ng x min/ml versus 990 in SHR). DMAQ-B1 did not affect glucose tolerance (glucose AUC = 21,300) but reduced fasting insulin 2-fold and insulin AUC (insulin AUC = 4300). PPEIA normalized glucose tolerance (glucose AUC = 9100) and reduced insulin AUC (to 3180) without affecting fasting insulin. PPEIA also increased food intake, fat mass, and body weight gain (81 +/- 12 versus 45 +/- 8 g in untreated controls), whereas DMAQ-B1 had no effect on body weight but reduced subscapular fat mass. PPEIA but not DMAQ-B1 reduced blood pressure. In skeletal muscle, insulin-stimulated phosphorylation of the insulin receptor and insulin receptor substrate protein 1-associated phosphatidylinositol 3-kinase activity were decreased by 40 to 55% in SHROB relative to lean SHR. PPEIA, but not DMAQ-B1, enhanced both insulin actions. SHROB also showed severe hypertriglyceridemia (355 +/- 42 mg/dl versus 65 +/- 3 in SHR) attenuated by both agents (DMAQ-B1, 228 +/- 18; PPEIA, 79 +/- 3). Both these novel antidiabetic agents attenuate insulin resistance and hypertriglyceridemia associated with metabolic syndrome but via distinct mechanisms.

Topics: Acetates; Adipose Tissue; Animals; Blood Pressure; Body Weight; Eating; Female; Glucose Tolerance Test; Hyperinsulinism; Indoles; Insulin; Insulin Receptor Substrate Proteins; Insulin Resistance; Lipids; Male; Metabolic Syndrome; Obesity; Phosphatidylinositol 3-Kinases; Phosphoproteins; PPAR gamma; Rats; Rats, Inbred SHR; Receptor, Insulin; Signal Transduction