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Effects of the novel oral antidiabetic agent HQL-975 on glucose and lipid metabolism in diabetic db/db mice.

The antidiabetic effects of 3-¿4-[2-(5-methyl-2-phenyl-oxazol-4- yl)ethoxy]phenyl¿-2S-propylamino-propionic acid (CAS 185679-16-7, HQL-975), a novel oral agent, on a genetically obese non-insulin-dependent diabetes mellitus (NIDDM) model (db/db mice) were examined. HQL-975 administration (3.7-34.1 mg/kg/d for 7 days) decreased the levels of plasma glucose, triglyceride, total cholesterol, non-esterified fatty acid and insulin in the mice. In an intraperitoneal glucose tolerance test (IPGTT), HQL-975 administration decreased the fasting plasma glucose level and improved the glucose tolerance in the mice. The HQL-975 administration also significantly increased the glycogenesis and lipogenesis from 14C-glucose in liver, but did not alter the glycogenesis in the diaphragm or the lipogenesis in adipose tissues at 2 h after the glucose loading. In the HQL-975-treated db/db mice, the radioactivity of 14C-glucose incorporated into hepatic glycogen was higher than that incorporated into hepatic total lipids. After the administration of HQL-975 (34.1 mg/kg/d for 7 days) to db/db mice, the hepatic hexokinase and fatty acid synthetase activities were significantly increased, the glycogen synthase I activity was increased but not significantly, and the glucose-6-phosphatase and the phosphoenolpyruvate carboxykinase activities were decreased. These results suggest that HQL-975 increases the hepatic glucose utilization and decreases the hepatic glucose production. Since hepatic glycogenesis is regulated by glucose itself but not by insulin in normoglycemic ICR mice, HQL-975 is thought to enhance the effect of glucose on the stimulation of hepatic glycogenesis. It is concluded that the enhancement of the hepatic glucose utilization played an important role in the hypoglycemic action of HQL-975.

Animals↗

[The present and future of treatment with oral antidiabetic agents].

Oral antidiabetics (PAD) are still the most frequent pharmacotherapeutic intervention in NIDDM, characterized by insulin deficiency and in particular by insulin resistance in the liver and peripheral tissues. Depending on the site of action, they are divided into substances retarding carbohydrate breakdown in the small intestine (alpha-glucosidase inhibitors), substances stimulating B-cells of the islets of Langerhans (beta-cytotropic substances) and substances acting in the periphery. The authors discuss PAD, in particular SU and biguanides which have been used for treatment for some years and more recent preparations--acarbose (Glucobay) and miglitol. Attention is paid to perspective preparation which are in the research stage, among them in particular troglitazone which belongs into the group of substances which improve the sensitivity of insulin receptors (insulin sensitizers) which will soon be on the market. As to other possibilities the authors discuss the role of fatty acid oxidation and its inhibitors and new non-sulphonyl urea insulin secretagogues. All these preparations, despite certain limitations, offer exciting therapeutic perspectives. Further research will reveal to what extent this potential can be implemented in practice.

Administration, Oral↗

Specific activation of the nuclear receptors PPARgamma and RORA by the antidiabetic thiazolidinedione BRL 49653 and the antiarthritic thiazolidinedione derivative CGP 52608.

The thiazolidinedione BRL 49653 and the thiazolidinedione derivative CGP 52608 are lead compounds of two pharmacologically different classes of compounds. BRL 49653 is a high affinity ligand of peroxisome proliferator-activated receptor gamma (PPARgamma) and a prototype of novel antidiabetic agents, whereas CGP 52608 activates retinoic acid receptor-related orphan receptor alpha (RORA) and exhibits potent antiarthritic activity. Both receptors belong to the superfamily of nuclear receptors and are structurally related transcription factors. We tested BRL 49653 and CGP 52608 for receptor specificity on PPARgamma, RORA, and retinoic acid receptor alpha, a closely related receptor to RORA, and compared their pharmacological properties in in vitro and in vivo models in which these compounds have shown typical effects. BRL 49653 specifically induced PPARgamma-mediated gene activation, whereas CGP 52608 specifically activated RORA in transiently transfected cells. Both compounds were active in nanomolar concentrations. Leptin production in differentiated adipocytes was inhibited by nanomolar concentrations of BRL 49653 but not by CGP 52608. BRL 49653 antagonized weight loss, elevated blood glucose levels, and elevated plasma triglyceride levels in an in vivo model of glucocorticoid-induced insulin resistance in rats, whereas CGP 52608 exhibited steroid-like effects on triglyceride levels and body weight in this model. In contrast, potent antiarthritic activity in rat adjuvant arthritis was shown for CGP 52608, whereas BRL 49653 was nearly inactive. Our results support the concept that transcriptional control mechanisms via the nuclear receptors PPARgamma and RORA are responsible at least in part for the different pharmacological properties of BRL 49653 and CGP 52608. Both compounds are prototypes of interesting novel therapeutic agents for the treatment of non-insulin-dependent diabetes mellitus and rheumatoid arthritis.

3T3 Cells↗

Antidiabetic effects of a dietary supplement "Pancreas Tonic".

Pancreas Tonic, a dietary supplement, contains plant products shown to possess hypoglycemic activity. This study investigated the effect of Pancreas Tonic on serum glucose, glycosylated hemoglobin, and pancreatic islet cell regeneration of rats. Results showed that body weights of three groups of rats were not significantly different from each other before the study period, and after the 12 week study, weights increased with nonsignificant difference among the groups. The diabetic group had significantly higher serum glucose levels compared with controls, and the diet-treated group had significantly lower serum glucose levels compared with the diabetic group. The diabetic group's glycosylated hemoglobin was significantly higher compared with the control group, and the diet-treated group had significantly lower glycosylated hemoglobin levels compared with the diabetic and control groups. Histological analysis of the pancreas showed a generalized reduction in size and number of islets in the diabetic group and regeneration of islet cells in the diet-treated group compared with the diabetic group. The diabetic group had a significant reduction in the number of cells compared with controls. The diet-treated group contained a significantly increased number of cells compared with the diabetic group. These data suggest that Pancreas Tonic induced an antidiabetic effect through pancreatic islet cell regeneration in experimental rats.

Animals↗

20beta-hydroxysteroid dehydrogenase catalyzes ketone-reduction of acetohexamide, an oral antidiabetic drug, in liver microsomes of adult male rats.

We examined the catalytic properties and physiological function of an enzyme responsible for the ketone-reduction of acetohexamide, an oral antidiabetic drug, in liver microsomes of adult male rats. Progesterone, 17alpha-hydroxyprogesterone, cortisone and cortisol, which have a ketone group at 20-position of C21-steroids, were potent inhibitors for ketone-reduction of acetohexamide in liver microsomes of adult male rats. Progesterone was also found to inhibit competitively the ketone-reduction of acetohexamide, suggesting that the ketone-reduction of acetohexamide and progesterone is catalyzed by the same enzyme. When progesterone was used as a substrate, 20beta-hydroxysteroid dehydrogenase present in liver microsomes of adult rats, such as acetohexamide reductase, exhibited a male-specific and androgen-dependent activity. Furthermore, a significant correlation was observed between the activities of 20beta-hydroxysteroid dehydrogenase and acetohexamide reductase in liver microsomes of individual male rats at various ages. Based on all results, we conclude that 20beta-hydroxysteroid dehydrogenase catalyzes the ketone-reduction of acetohexamide in liver microsomes of adult male rats.

Acetohexamide↗

[Oral antidiabetic drugs].

Type II diabetes includes various pathophysiologic entities. Glycoregulatory disorders are due to multiple mechanisms, associated to different degrees. Identical response to treatment is not observed among patients or at different times of treatment, early or later in the disease. Until very recently, the treatment available was insufficient. It now has gained new classes of drugs that act on the secretion of insulin, the sensitivity to insulin and the rate of intestinal glucide absorption. Approaches to treatment are often complementary and oral antidiabetic drugs can be associated. Hygienic and dietary measures remain indispensable to reinforce drug efficacity and to prevent complications in these patients.

Administration, Oral↗

The NEPI antidiabetes study (NANSY). 1: short-term dose-effect relations of glimepiride in subjects with impaired fasting glucose.

AIM: NANSY is a randomised, placebo-controlled Swedish-Norwegian study which aims to include 2 x 1112 male and female subjects with impaired fasting glucose (IFG), to assess whether conversion to type 2 diabetes can be delayed by addition of sulphonylurea to dietary regulation and increased exercise. This pilot study was conducted to find the optimum dose of glimepiride in NANSY. METHODS: In a double blind trial in primary care 25 IFG subjects were in random order exposed to single doses and one-week treatments with 0 (placebo), 0.5, 1.0 and 2.0 mg glimepiride once daily. The optimum dose was assessed by measuring blood glucose during oral 75 g glucose tolerance test (OGTT), comparing fasting blood glucose, and the area under the blood glucose curve (AUC), and by monitoring hypoglycaemic events. RESULTS: With single doses, there was a clear dose-response relationship for the reduction in AUC, with a statistically significant difference only between placebo (mean 1981, 95% confidence intervals (CI) 1883-2078) and 2 mg glimepiride (mean 1763, 95% CI 1665-1861). However, following 1-week treatments, the only significant difference was between placebo (mean 1934, 95% CI 1856-2012) and 1 mg glimepiride (mean 1714, 95% CI 1637-1792). Correspondingly, the only statistically significant difference in fasting blood glucose day 7 was between placebo (5.87 mmol/l, 95% CI 5.68-6.05 mmol/l) and 1 mg glimepiride (5.42 mmol/l, 95% CI 5.21-5.62 mmol/l). Chemical hypoglycaemia was common but hypoglycaemic symptoms were rare and similar between the active doses, and easily countered by the subjects. CONCLUSIONS: The sulphonylurea dose-effect curve may be bell-shaped, perhaps due to down regulation of sulphonylurea receptors during chronic exposure. Alternatively, the finding could be a rebound phenomenon, secondary to preceding hypoglycaemia. The optimum dose for NANSY was found to be 1 mg glimepiride.

Blood Glucose↗

Oral antidiabetics.

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Hypoglycemic Agents↗