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重新探讨二甲双胍在肝脏中的作用机制。

Revisiting the mechanisms of metformin action in the liver.

机构信息

Département endocrinologie, métabolisme et cancer, Inserm, U1016, Institut Cochin, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France.

出版信息

Ann Endocrinol (Paris). 2013 May;74(2):123-9. doi: 10.1016/j.ando.2013.03.006. Epub 2013 Apr 10.

Abstract

Although considerable efforts have been made since the 1950s to better understand the action of metformin, the first line therapeutic for type 2 diabetes, its mechanisms of action has not been fully elucidated. The main antidiabetic effect of this drug is to decrease hepatic glucose production. A plausible molecular mechanism of action now emerges from recent breakthroughs that place metformin at the control of energy homeostasis. Metformin was shown to induce a mild and transient inhibition of the mitochondrial respiratory chain complex 1. The resulting decrease in hepatic energy state activates the AMP-activated protein kinase (AMPK), a cellular metabolic sensor, and provided a generally accepted mechanism for metformin action on hepatic gluconeogenic program. However, the role of AMPK activation in metformin action has recently been challenged by loss-of-function experiments. Recent evidence showed that metformin-induced inhibition of hepatic glucose output is mediated by reducing cellular energy charge rather than direct inhibition of gluconeogenic gene expression. Furthermore, recent data support a novel mechanism of action for metformin involving antagonism of glucagon signaling pathways by inducing the accumulation of AMP, which inhibits adenylate cyclase and reduced levels of cAMP.

摘要

尽管自 20 世纪 50 年代以来,人们已经做出了相当大的努力来更好地了解二甲双胍(治疗 2 型糖尿病的一线药物)的作用机制,但它的作用机制尚未完全阐明。这种药物的主要抗糖尿病作用是减少肝脏葡萄糖的产生。最近的突破为二甲双胍在能量平衡的控制方面提供了一个合理的作用机制,表明它可以诱导线粒体呼吸链复合物 1 的轻微和短暂抑制。由此导致的肝能量状态下降会激活 AMP 激活的蛋白激酶(AMPK),这是一种细胞代谢传感器,并为二甲双胍对肝糖异生程序的作用提供了一个普遍接受的机制。然而,AMPK 激活在二甲双胍作用中的作用最近受到了功能丧失实验的挑战。最近的证据表明,二甲双胍诱导的肝葡萄糖输出减少是通过降低细胞能量电荷来介导的,而不是直接抑制糖异生基因表达。此外,最近的数据支持二甲双胍的一种新作用机制,通过诱导 AMP 的积累来拮抗胰高血糖素信号通路,从而抑制腺苷酸环化酶并降低 cAMP 水平。

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