Ding Hanting, Wang Mengtian, Zhang Jian, Wan Chenchen, Huang Zhaohuan, Liu Ling, Liu Ji
Department of Endocrinology, The First Affiliated Hospital of USTC, Institute of Advanced Technology, University of Science and Technology of China, Hefei, China.
Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.
Am J Physiol Endocrinol Metab. 2025 Aug 1;329(2):E254-E265. doi: 10.1152/ajpendo.00174.2025. Epub 2025 Jul 7.
Although glucagon-like peptide-1 (GLP-1) analogs have been clinically approved for type 2 diabetes mellitus (T2DM) and obesity treatment for an extended period, their associated adverse effects of nausea and vomiting remain unsolved. To elucidate the neural mechanisms underlying GLP-1-induced emesis, we investigated how GLP-1 signaling in the area postrema (AP) modulates retching-like behavior in mice. Our experiments demonstrated that intraperitoneal administration of the GLP-1 receptor agonist Exendin-4 (Exn4) induced dose-dependent retching-like behavior, which was replicated by direct Exn4 administration into the AP. Notably, while vagal afferent denervation failed to attenuate Exn4-induced retching-like behavior, genetic ablation of GLP-1 receptor (GLP-1R) expression in the AP completely abolished this response, establishing AP GLP-1R as the critical mediator of GLP-1-associated emesis. Further mechanistic studies revealed that Exn4 enhances AP GLP-1R neuronal activity through a postsynaptic pathway dependent on AMPA receptor signaling. These findings provide a neural circuit basis for GLP-1-induced emesis and identify a potential therapeutic target for mitigating this clinically significant side effect. Here, we used a mouse-based paradigm to identify that the retching-like behavioral effects are caused by direct central GLP-1R neurons activation in the caudal brainstem, independent of the vagal afferent pathway. Importantly, the activation of AP is mediated by postsynaptic AMPA receptors, which strengthen excitatory currents. Thus, we revealed the target and neural basis of GLP-1 analog-induced vomiting effect, which highlights a potential intervening site for clinical treatment.
尽管胰高血糖素样肽-1(GLP-1)类似物已被临床批准用于2型糖尿病(T2DM)和肥胖症治疗很长一段时间,但其相关的恶心和呕吐不良反应仍未得到解决。为了阐明GLP-1诱导呕吐的神经机制,我们研究了最后区(AP)中的GLP-1信号如何调节小鼠的干呕样行为。我们的实验表明,腹腔注射GLP-1受体激动剂艾塞那肽-4(Exn4)可诱导剂量依赖性的干呕样行为,将Exn4直接注射到AP中也可复制该行为。值得注意的是,虽然迷走神经传入去神经支配未能减弱Exn4诱导的干呕样行为,但AP中GLP-1受体(GLP-1R)表达的基因敲除完全消除了这种反应,确立了AP GLP-1R是GLP-1相关呕吐的关键介质。进一步的机制研究表明,Exn4通过依赖于AMPA受体信号传导的突触后途径增强AP GLP-1R神经元活性。这些发现为GLP-1诱导的呕吐提供了神经回路基础,并确定了减轻这种具有临床意义的副作用的潜在治疗靶点。在这里,我们使用基于小鼠的范式来确定干呕样行为效应是由延髓尾部直接的中枢GLP-1R神经元激活引起的,与迷走神经传入途径无关。重要的是,AP的激活由突触后AMPA受体介导,其增强兴奋性电流。因此,我们揭示了GLP-1类似物诱导呕吐效应的靶点和神经基础,这突出了临床治疗的潜在干预位点。