Novikoff Aaron, Müller Timo D
Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Munich, Neuherberg, Germany.
German Center for Diabetes Research (DZD), Neuherberg, Germany.
Physiology (Bethesda). 2024 May 1;39(3):142-156. doi: 10.1152/physiol.00032.2023. Epub 2024 Feb 14.
The prevalence of obesity continues to rise in both adolescents and adults, in parallel obesity is strongly associated with the increased incidence of type 2 diabetes, heart failure, certain types of cancer, and all-cause mortality. In relation to obesity, many pharmacological approaches of the past have tried and failed to combat the rising obesity epidemic, particularly due to insufficient efficacy or unacceptable side effects. However, while the history of antiobesity medication is plagued by failures and disappointments, we have witnessed over the last 10 years substantial progress, particularly in regard to biochemically optimized agonists at the receptor for glucagon-like peptide-1 (GLP-1R) and unimolecular coagonists at the receptors for GLP-1 and the glucose-dependent insulinotropic polypeptide (GIP). Although the GIP receptor:GLP-1R coagonists are being heralded as premier pharmacological tools for the treatment of obesity and diabetes, uncertainty remains as to why these drugs testify superiority over best-in-class GLP-1R monoagonists. Particularly with regard to GIP, there remains great uncertainty if and how GIP acts on systems metabolism and if the GIP system should be activated or inhibited to improve metabolic outcome in adjunct to GLP-1R agonism. In this review, we summarize recent advances in GLP-1- and GIP-based pharmacology and discuss recent findings and open questions related to how the GIP system affects systemic energy and glucose metabolism.
青少年和成年人中肥胖症的患病率持续上升,与此同时,肥胖与2型糖尿病、心力衰竭、某些类型癌症的发病率增加以及全因死亡率密切相关。关于肥胖症,过去许多药物治疗方法都试图对抗肥胖症流行趋势,但均告失败,尤其是因为疗效不足或副作用难以接受。然而,尽管抗肥胖药物的历史充满失败和失望,但在过去10年中我们见证了重大进展,特别是在胰高血糖素样肽-1受体(GLP-1R)的生物化学优化激动剂以及GLP-1和葡萄糖依赖性促胰岛素多肽(GIP)受体的单分子共激动剂方面。尽管GIP受体:GLP-1R共激动剂被誉为治疗肥胖症和糖尿病的首要药物工具,但这些药物为何比同类最佳的GLP-1R单激动剂更具优势仍存在不确定性。特别是关于GIP,GIP是否以及如何作用于全身代谢系统,以及在GLP-1R激动作用的辅助下,激活或抑制GIP系统是否以及如何改善代谢结果,仍然存在很大的不确定性。在本综述中,我们总结了基于GLP-1和GIP的药理学的最新进展,并讨论了与GIP系统如何影响全身能量和葡萄糖代谢相关的最新发现和未解决问题。