mirabegron and Insulin-Resistance

BACKGROUNDMirabegron is a β3-adrenergic receptor (β3-AR) agonist approved only for the treatment of overactive bladder. Encouraging preclinical results suggest that β3-AR agonists could also improve obesity-related metabolic disease by increasing brown adipose tissue (BAT) thermogenesis, white adipose tissue (WAT) lipolysis, and insulin sensitivity.METHODSWe treated 14 healthy women of diverse ethnicities (27.5 ± 1.1 years of age, BMI of 25.4 ± 1.2 kg/m2) with 100 mg mirabegron (Myrbetriq extended-release tablet, Astellas Pharma) for 4 weeks in an open-label study. The primary endpoint was the change in BAT metabolic activity as measured by [18F]-2-fluoro-d-2-deoxy-d-glucose (18F-FDG) PET/CT. Secondary endpoints included resting energy expenditure (REE), plasma metabolites, and glucose and insulin metabolism as assessed by a frequently sampled intravenous glucose tolerance test.RESULTSChronic mirabegron therapy increased BAT metabolic activity. Whole-body REE was higher, without changes in body weight or composition. Additionally, there were elevations in plasma levels of the beneficial lipoprotein biomarkers HDL and ApoA1, as well as total bile acids. Adiponectin, a WAT-derived hormone that has antidiabetic and antiinflammatory capabilities, increased with acute treatment and was 35% higher upon completion of the study. Finally, an intravenous glucose tolerance test revealed higher insulin sensitivity, glucose effectiveness, and insulin secretion.CONCLUSIONThese findings indicate that human BAT metabolic activity can be increased after chronic pharmacological stimulation with mirabegron and support the investigation of β3-AR agonists as a treatment for metabolic disease.TRIAL REGISTRATIONClinicaltrials.gov NCT03049462.FUNDINGThis work was supported by grants from the Intramural Research Program of the NIDDK, NIH (DK075112, DK075116, DK071013, and DK071014).

Topics: Acetanilides; Adipose Tissue, Brown; Adolescent; Adult; Apolipoprotein A-I; Biomarkers; Cholesterol, HDL; Female; Humans; Insulin Resistance; Positron Emission Tomography Computed Tomography; Thiazoles; Urinary Bladder, Overactive

Metabolic syndrome (MetS) is a global health and economic burden. Finding a suitable pharmacological approach for managing this syndrome is crucial. We explored the therapeutic potential of mirabegron (MIR), a β. Thirty Watanabe heritable hyperlipidemic rabbits (WHHL) were divided into 3 groups: control, high-fructose high-fat diet (HFFD) and HFFD + MIR that received a chow diet, HFFD and HFFD along with MIR treatment, respectively. The protocol lasted for 12 weeks, during which weight and abdominal circumference were monitored; plasma fasting levels of lipids, glucose and insulin were measured and an intravenous glucose tolerance test (IVGTT) was performed. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Cardiac function was assessed using in-vivo and ex-vivo approaches. Vascular reactivity was estimated via isolated carotid arteries method. Aortic atherosclerosis was evaluated using histological and immuno-histochemical techniques.. In contrast to the HFFD group, MIR-treated rabbits showed fasting insulin, HOMA-IR and TG levels stabilization and exhibited improved cardiac inotropy and lusitropy, while on the other hand, displayed aggravated atheroma plaque development.. Long-term treatment with MIR prevented the increase in TG levels and the establishment of IR and enhanced the cardiac function of a rabbit animal model of MetS with combined dyslipidemia and IR.

Topics: Acetanilides; Animals; Atherosclerosis; Blood Glucose; Diet, High-Fat; Fructose; Insulin; Insulin Resistance; Rabbits; Thiazoles

BACKGROUNDBeige and brown adipose tissue (BAT) are associated with improved metabolic homeostasis. We recently reported that the β3-adrenergic receptor agonist mirabegron induced beige adipose tissue in obese insulin-resistant subjects, and this was accompanied by improved glucose metabolism. Here we evaluated pioglitazone treatment with a combination pioglitazone and mirabegron treatment and compared these with previously published data evaluating mirabegron treatment alone. Both drugs were used at FDA-approved dosages.METHODSWe measured BAT by PET CT scans, measured beige adipose tissue by immunohistochemistry, and comprehensively characterized glucose and lipid homeostasis and insulin sensitivity by euglycemic clamp and oral glucose tolerance tests. Subcutaneous white adipose tissue, muscle fiber type composition and capillary density, lipotoxicity, and systemic inflammation were evaluated by immunohistochemistry, gene expression profiling, mass spectroscopy, and ELISAs.RESULTSTreatment with pioglitazone or the combination of pioglitazone and mirabegron increased beige adipose tissue protein marker expression and improved insulin sensitivity and glucose homeostasis, but neither treatment induced BAT in these obese subjects. When the magnitude of the responses to the treatments was evaluated, mirabegron was found to be the most effective at inducing beige adipose tissue. Although monotherapy with either mirabegron or pioglitazone induced adipose beiging, combination treatment resulted in less beiging than either alone. The 3 treatments also had different effects on muscle fiber type switching and capillary density.CONCLUSIONThe addition of pioglitazone to mirabegron treatment does not enhance beiging or increase BAT in obese insulin-resistant research participants.TRIAL REGISTRATIONClinicalTrials.gov NCT02919176.FUNDINGNIH DK112282 and P20GM103527 and Clinical and Translational Science Awards grant UL1TR001998.

Topics: Acetanilides; Adipose Tissue, Beige; Drug Synergism; Female; Glucose; Glucose Tolerance Test; Humans; Hypoglycemic Agents; Insulin Resistance; Male; Middle Aged; Obesity; Pioglitazone; Thiazoles

Brown and beige adipose tissues contain thermogenic fat cells that can be activated by β3-adrenergic receptor agonists. In rodents, such drugs both diminish obesity and improve glucose homeostasis. In this issue of the JCI, O'Mara et al. and Finlin and Memetimin et al. report that chronic administration of the approved β3 agonist mirabegron to human subjects was without effect on body weight or fat mass, but improved several measures of glucose homeostasis. Though the mechanisms mediating these metabolic effects are uncertain, the data suggest that β3 agonists could have therapeutic utility in disorders of glucose homeostasis.

Topics: Acetanilides; Adipose Tissue, Brown; Adrenergic beta-3 Receptor Agonists; Adrenergic beta-Agonists; Cholesterol, HDL; Glucose; Homeostasis; Humans; Insulin Resistance; Thiazoles