Gut peptides and type 2 diabetes mellitus treatment.
The gut expresses peptide hormones in endocrine cells and neuropeptides in autonomic nerves. Several of these peptides have the ability to stimulate insulin secretion. Gut hormones that are released after meal ingestion and stimulate insulin secretion postprandially are called incretins. In humans, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the most important incretins. The potential use of these insulinotropic gut peptides for the treatment of diabetes has been considered. This has been most successful for GLP-1, which exerts antidiabetogenic properties in subjects with type 2 diabetes by stimulating insulin secretion, increasing beta-cell mass, inhibiting glucagon secretion, delaying gastric emptying, and inducing satiety. However, GLP-1 is rapidly degraded by the enzyme dipeptidyl peptidase IV (DPPIV), making it unattractive as a therapeutic agent because of a very short half-life. Successful strategies to overcome this difficulty are the use of DPPIV-resistant GLP-1 receptor agonists, such as NN2211 or exendin-4, and the use of inhibitors of DPPIV, such as NVPDPP728 and P32/98. These two approaches are explored in clinical investigations.
Ahrén
Bo
B
Department of Medicine, Lund University, B11 BMC, LUND SE-221 84, Sweden. Bo.Ahren@med.lu.se
D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000628:therapy; D005746:Gastric Emptying; D005749:Gastric Inhibitory Polypeptide / Q000502:physiology; D005768:Gastrointestinal Hormones / Q000502:physiology*; D005934:Glucagon / Q000378:metabolism / Q000502:physiology / Q000627:therapeutic use; D052216:Glucagon-Like Peptide 1; D006801:Humans; D007515:Islets of Langerhans / Q000502:physiology; D010446:Peptide Fragments / Q000502:physiology / Q000627:therapeutic use; D011498:Protein Precursors / Q000502:physiology / Q000627:therapeutic use; D012527:Satiation
D005768:Gastrointestinal Hormones; D010446:Peptide Fragments; D011498:Protein Precursors; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D005934:Glucagon