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Heal DJ, Gosden J, Smith SL. Stimulant prodrugs: A pharmacological and clinical assessment of their role in treating ADHD and binge-eating disorder. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 99:251-286. [PMID: 38467483 DOI: 10.1016/bs.apha.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
In this review, we critically evaluate the contribution of prodrugs to treating two related psychiatric disorders, attention-deficit hyperactivity disorder (ADHD) and binge-eating disorder (BED). ADHD is characterized by inattentiveness, distractibility, impulsiveness, and hyperactivity. BED is also an impulse-control disorder which leads to frequent, compulsive episodes of excessive eating (binges). Lisdexamfetamine (LDX; prodrug of d-amphetamine) is approved to treat both ADHD and BED. Serdexmethylphenidate (SDX; prodrug of d-threo-methylphenidate) is not clinically approved as monotherapy but, in a fixed-dose combination with immediate release d-threo-methylphenidate (Azstarys™), SDX is approved for managing ADHD in children/adolescents. The pharmacological actions of a stimulant mediate both its efficacy and side-effects. Therefore, daily management of ADHD or BED to maintain optimum efficacy and tolerability places highly restrictive requirements on the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of stimulant medications, especially prodrugs. Prodrugs must have good bioavailability and rapid metabolism to provide therapeutic efficacy soon after morning dosing combined with providing stimulant coverage throughout the day/evening. A wide selection of dosages and linear PK for the prodrug and its active metabolite are essential requirements for treatment of these conditions. The proposed neurobiological causes of ADHD and BED are described. The chemical, pharmacological and PK/PD properties responsible for the therapeutic actions of the prodrugs, LDX and SDX, are compared and contrasted. Finally, we critically assess their contribution as ADHD and BED medications, including advantages over their respective active metabolites, d-amphetamine and d-threo-methylphenidate, and also their potential for misuse and abuse.
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Affiliation(s)
- David J Heal
- DevelRx Limited, BioCity, Pennyfoot Street, Nottingham, United Kingdom; Department of Life Sciences, University of Bath, Bath, United Kingdom.
| | - Jane Gosden
- DevelRx Limited, BioCity, Pennyfoot Street, Nottingham, United Kingdom
| | - Sharon L Smith
- DevelRx Limited, BioCity, Pennyfoot Street, Nottingham, United Kingdom
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Hornigold DC, Roth E, Howard V, Will S, Oldham S, Coghlan MP, Blouet C, Trevaskis JL. A GLP-1:CCK fusion peptide harnesses the synergistic effects on metabolism of CCK-1 and GLP-1 receptor agonism in mice. Appetite 2018; 127:334-340. [PMID: 29782892 PMCID: PMC6026274 DOI: 10.1016/j.appet.2018.05.131] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
Combination approaches for the treatment of metabolic diseases such as obesity and diabetes are becoming increasingly relevant. Co-administration of a glucagon-like peptide-1 receptor (GLP-1R) agonist with a cholecystokinin receptor-1 (CCKR1) agonist exert synergistic effects on weight loss in obese rodents. Here, we report on the effects of a novel fusion peptide (C2816) comprised of a stabilized GLP-1R agonist, AC3174, and a CCKR1-selective agonist, AC170222. C2816 was constructed such that AC3174 was linked to the N-terminus of AC170222, thus preserving the C-terminal amide of the CCK moiety. In functional in vitro assays C2816 retained full agonism at GLP-1R and CCKR1 at lower potency compared to parent molecules, whereas a previously reported fusion peptide in the opposite orientation, (pGlu-Gln)-CCK-8/exendin-4, exhibited no activity at either receptor. Acutely, in vivo, C2816 increased cFos in key central nuclei relevant to feeding behavior, and reduced food intake in wildtype (WT), but less so in GLP-1R-deficient (GLP-1RKO), mice. In sub-chronic studies in diet-induced obese (DIO) mice, C2816 exerted superior reduction in body weight compared to co-administration of AC3174 and AC170222 albeit at a higher molar dose. These data suggest that the synergistic pharmacological effects of GLP-1 and CCK pathways can be harnessed in a single therapeutic peptide.
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Affiliation(s)
- David C Hornigold
- Cardiovascular and Metabolic Diseases, MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Emma Roth
- University of Cambridge, Department of Clinical Biochemistry, MRC Metabolic Diseases Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Victor Howard
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Sarah Will
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Stephanie Oldham
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Matthew P Coghlan
- Cardiovascular and Metabolic Diseases, MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Clemence Blouet
- University of Cambridge, Department of Clinical Biochemistry, MRC Metabolic Diseases Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - James L Trevaskis
- Cardiovascular and Metabolic Diseases, MedImmune LLC, One MedImmune Way, Gaithersburg, MD 20878, USA.
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Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, Kushner RF, Daniels SR, Wadden TA, Tsai AG, Hu FB, Jakicic JM, Ryan DH, Wolfe BM, Inge TH. The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocr Rev 2018; 39:79-132. [PMID: 29518206 PMCID: PMC5888222 DOI: 10.1210/er.2017-00253] [Citation(s) in RCA: 429] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/19/2022]
Abstract
The prevalence of obesity, measured by body mass index, has risen to unacceptable levels in both men and women in the United States and worldwide with resultant hazardous health implications. Genetic, environmental, and behavioral factors influence the development of obesity, and both the general public and health professionals stigmatize those who suffer from the disease. Obesity is associated with and contributes to a shortened life span, type 2 diabetes mellitus, cardiovascular disease, some cancers, kidney disease, obstructive sleep apnea, gout, osteoarthritis, and hepatobiliary disease, among others. Weight loss reduces all of these diseases in a dose-related manner-the more weight lost, the better the outcome. The phenotype of "medically healthy obesity" appears to be a transient state that progresses over time to an unhealthy phenotype, especially in children and adolescents. Weight loss is best achieved by reducing energy intake and increasing energy expenditure. Programs that are effective for weight loss include peer-reviewed and approved lifestyle modification programs, diets, commercial weight-loss programs, exercise programs, medications, and surgery. Over-the-counter herbal preparations that some patients use to treat obesity have limited, if any, data documenting their efficacy or safety, and there are few regulatory requirements. Weight regain is expected in all patients, especially when treatment is discontinued. When making treatment decisions, clinicians should consider body fat distribution and individual health risks in addition to body mass index.
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Affiliation(s)
- George A Bray
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - William E Heisel
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | | | - William H Dietz
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Michael Long
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | - Stephen R Daniels
- Department of Pediatrics, University of Colorado Children Hospital, Denver, Colorado
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adam G Tsai
- Kaiser Permanente Colorado, Denver, Colorado
| | - Frank B Hu
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Donna H Ryan
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Bruce M Wolfe
- Oregon Health and Science University, Portland, Oregon
| | - Thomas H Inge
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
- Children’s Hospital Colorado, Aurora, Colorado
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Voigt JP, Fink H. Serotonin controlling feeding and satiety. Behav Brain Res 2015; 277:14-31. [DOI: 10.1016/j.bbr.2014.08.065] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 02/06/2023]
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Food addiction: an evolving nonlinear science. Nutrients 2014; 6:5370-91. [PMID: 25421535 PMCID: PMC4245594 DOI: 10.3390/nu6115370] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/12/2014] [Accepted: 10/13/2014] [Indexed: 12/12/2022] Open
Abstract
The purpose of this review is to familiarize readers with the role that addiction plays in the formation and treatment of obesity, type 2 diabetes and disorders of eating. We will outline several useful models that integrate metabolism, addiction, and human relationship adaptations to eating. A special effort will be made to demonstrate how the use of simple and straightforward nonlinear models can and are being used to improve our knowledge and treatment of patients suffering from nutritional pathology. Moving forward, the reader should be able to incorporate some of the findings in this review into their own practice, research, teaching efforts or other interests in the fields of nutrition, diabetes, and/or bariatric (weight) management.
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Higgins GA, Desnoyer J, Van Niekerk A, Silenieks LB, Lau W, Thevarkunnel S, Izhakova J, DeLannoy IA, Fletcher PJ, DeLay J, Dobson H. Characterization of the 5-HT2C receptor agonist lorcaserin on efficacy and safety measures in a rat model of diet-induced obesity. Pharmacol Res Perspect 2014; 3:e00084. [PMID: 25692009 PMCID: PMC4317222 DOI: 10.1002/prp2.84] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/07/2014] [Accepted: 08/11/2014] [Indexed: 12/19/2022] Open
Abstract
The 5-HT2C receptor agonist lorcaserin (Belviq®) has been Food and Drug Administration (FDA) approved for the treatment of obesity. The present study is a back translational investigation into the effect of 28-day lorcaserin treatment in a diet-induced obesity (DIO) model using male, Sprague-Dawley rats. An assessment of drug effect on efficacy and multiple safety endpoints including cardiac function was undertaken. Lorcaserin (1-2 mg/kg SC b.i.d.) significantly reduced percentage body weight gain compared to vehicle-treated controls (VEH: 10.6 ± 0.4%; LOR 1: 7.6 ± 1.2%; LOR 2: 5.4 ± 0.6%). Measurement of body composition using quantitative magnetic resonance (QMR) imaging indicated this change was due to the selective reduction in body fat mass. Modest effects on food intake were recorded. At the completion of the treatment phase, echocardiography revealed no evidence for valvulopathy, that is, no aortic or mitral valve regurgitation. The pharmacokinetics of the present treatment regimen was determined over a 7-day treatment period; plasma C min and C max were in the range 13-160 ng/mL (1 mg/kg b.i.d.) and 34-264 ng/mL (2 mg/kg b.i.d.) with no evidence for drug accumulation. In sum, these studies show an effect of lorcaserin in the DIO model, that in the context of the primary endpoint measure of % body weight change was similar to that reported clinically (i.e., 3.0-5.2% vs. 3.2%). The present studies highlight the translational value of obesity models such as DIO, and suggest that assuming consideration is paid to nonspecific drug effects such as malaise, the DIO model has reasonable forward translational value to help predict clinical outcomes of a new chemical entity.
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Affiliation(s)
- Guy A Higgins
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2 ; Department of Pharmacology & Toxicology, University of Toronto Toronto, Ontario, Canada
| | - Jill Desnoyer
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2
| | | | - Leo B Silenieks
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2
| | - Winnie Lau
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2
| | - Sandy Thevarkunnel
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2
| | - Julia Izhakova
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2
| | - Ines Am DeLannoy
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2
| | - Paul J Fletcher
- Section of Biopsychology, Clarke Division, Centre for Addiction and Mental Health 250 College St., Toronto, Ontario, Canada, M5T 1R8 ; Department of Psychiatry & Psychology, University of Toronto Toronto, Ontario, Canada
| | - Josepha DeLay
- Animal Health Laboratory, U. Guelph Guelph, Ontario, Canada
| | - Howard Dobson
- InterVivo Solutions Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2 ; CanCog Technologies Inc. 120 Carlton St., Toronto, Ontario, Canada, M5A 4K2 ; Department of Clinical Studies, University of Guelph Guelph, Ontario, Canada ; Department of Biomedical Physics, University of Western Ontario London, Ontario, Canada
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Caixàs A, Albert L, Capel I, Rigla M. Naltrexone sustained-release/bupropion sustained-release for the management of obesity: review of the data to date. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:1419-27. [PMID: 25258511 PMCID: PMC4174046 DOI: 10.2147/dddt.s55587] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obesity is an emerging disease worldwide. Changes in living habits, especially with increased consumption of high-calorie foods and decreased levels of physical activity, lead to an energy imbalance that brings weight gain. Overweight and obesity are major risk factors for several chronic diseases (including cardiovascular diseases, diabetes, and cancer), reduce quality of life, and are associated with higher mortality. For all these reasons, it is of the utmost importance that the trend be reversed and obese people enabled to lose weight. It is known that eating a healthy diet and exercising regularly can help prevent obesity, but data show that in many cases these steps are not enough. This is the reason why, over the last few decades, several antiobesity drugs have been developed. However, the disappointing results demonstrated for the vast majority of them have not discouraged the pharmaceutical industry from continuing to look for an effective drug or combination of drugs. The systematic review presented here focuses on naltrexone sustained-release/bupropion sustained-release combination (Contrave®). We conclude from the current published reports that its effectiveness in the treatment of obesity can be estimated as a placebo-subtracted weight loss of around 4.5%. This weight reduction is moderate but similar to other antiobesity drugs. The safety profile of this combination is acceptable, despite additional data regarding cardiovascular disease being needed.
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Affiliation(s)
- Assumpta Caixàs
- Endocrinology and Nutrition Department, Parc Tauli Sabadell University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Lara Albert
- Endocrinology and Nutrition Department, Parc Tauli Sabadell University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Ismael Capel
- Endocrinology and Nutrition Department, Parc Tauli Sabadell University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Mercedes Rigla
- Endocrinology and Nutrition Department, Parc Tauli Sabadell University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Abstract
INTRODUCTION Over the past 3 years, several patents appeared dealing with the discovery of compounds able to modulate ghrelin actions: agonists for the treatment of cachexia, as diagnostic agents for GH deficiency or for the increase in gastrointestinal motility, antagonists and inverse agonists as anorexigenic agents for the treatment of obesity and type 2 diabetes. This research has been conducted by several pharmaceutical companies and some compounds have entered clinical trials, but, to date, compounds acting on the ghrelin receptor do not represent clinical options yet. AREAS COVERED A comprehensive description and categorization of patents related to each type of compounds is provided, together with data related to these compounds that appeared in the scientific literature. EXPERT OPINION Ghrelin appears to mediate a myriad of actions, and some of these appear to be due to unknown mechanisms (a second putative ghrelin receptor, putative receptors for unacylated ghrelin); several agonists, antagonists and inverse agonists at ghrelin receptor have been developed but their mechanism of action into CNS is poorly understood. The therapeutic potential of compounds acting on ghrelin receptor is still to be fully assessed, but the results obtained to date are encouraging for the successful clinical translation of compounds able to treat several pathologies.
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Affiliation(s)
- Luca Costantino
- University of Modena and Reggio Emilia, Dipartimento di Scienze della Vita , Via Campi 183, 41100 Modena , Italy +39 059 2055749 ; +39 059 2055131 ;
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Jackson VM, Price DA, Carpino PA. Investigational drugs in Phase II clinical trials for the treatment of obesity: implications for future development of novel therapies. Expert Opin Investig Drugs 2014; 23:1055-66. [DOI: 10.1517/13543784.2014.918952] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- V Margaret Jackson
- Cardiovascular and Metabolic Diseases Research Unit, Pfizer Worldwide Research and Development, 610 Main Street, Cambridge, MA 02139, USA
| | - David A Price
- Cardiovascular and Metabolic Diseases Medicinal Chemistry, Pfizer Worldwide Research and Development, 610 Main Street, Cambridge, MA 02139, USA
| | - Philip A Carpino
- Cardiovascular and Metabolic Diseases Medicinal Chemistry, Pfizer Worldwide Research and Development, 610 Main Street, Cambridge, MA 02139, USA
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Storer RI, Brennan PE, Brown AD, Bungay PJ, Conlon KM, Corbett MS, DePianta RP, Fish PV, Heifetz A, Ho DKH, Jessiman AS, McMurray G, de Oliveira CAF, Roberts LR, Root JA, Shanmugasundaram V, Shapiro MJ, Skerten M, Westbrook D, Wheeler S, Whitlock GA, Wright J. Multiparameter Optimization in CNS Drug Discovery: Design of Pyrimido[4,5-d]azepines as Potent 5-Hydroxytryptamine 2C (5-HT2C) Receptor Agonists with Exquisite Functional Selectivity over 5-HT2A and 5-HT2B Receptors. J Med Chem 2014; 57:5258-69. [DOI: 10.1021/jm5003292] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | | | | | | | | | - Matthew S. Corbett
- Pfizer Worldwide Research and Development, Eastern Point Road, Groton, Connecticut 06340, United States
| | - Robert P. DePianta
- Pfizer Worldwide Research and Development, Eastern Point Road, Groton, Connecticut 06340, United States
| | | | - Alexander Heifetz
- Evotec (UK) Ltd., 114 Innovation
Drive, Milton Park, Abingdon, Oxfordshire, OX14 4RZ, United Kingdom
| | | | | | | | | | | | | | | | - Michael J. Shapiro
- Pfizer Worldwide Research and Development, Eastern Point Road, Groton, Connecticut 06340, United States
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Hochkogler CM, Rohm B, Hojdar K, Pignitter M, Widder S, Ley JP, Krammer GE, Somoza V. The capsaicin analog nonivamide decreases total energy intake from a standardized breakfast and enhances plasma serotonin levels in moderately overweight men after administered in an oral glucose tolerance test: A randomized, crossover trial. Mol Nutr Food Res 2014; 58:1282-90. [DOI: 10.1002/mnfr.201300821] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/21/2013] [Accepted: 12/24/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Christina M. Hochkogler
- Christian Doppler Laboratory for Bioactive Aroma Compounds; University of Vienna; Vienna Austria
| | - Barbara Rohm
- Christian Doppler Laboratory for Bioactive Aroma Compounds; University of Vienna; Vienna Austria
| | - Karin Hojdar
- Christian Doppler Laboratory for Bioactive Aroma Compounds; University of Vienna; Vienna Austria
| | - Marc Pignitter
- Department of Nutritional and Physiological Chemistry; University of Vienna; Vienna Austria
| | | | | | | | - Veronika Somoza
- Christian Doppler Laboratory for Bioactive Aroma Compounds; University of Vienna; Vienna Austria
- Department of Nutritional and Physiological Chemistry; University of Vienna; Vienna Austria
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Improved glucose control and reduced body weight in rodents with dual mechanism of action peptide hybrids. PLoS One 2013; 8:e78154. [PMID: 24167604 PMCID: PMC3805588 DOI: 10.1371/journal.pone.0078154] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/18/2013] [Indexed: 01/26/2023] Open
Abstract
Combination therapy is being increasingly used as a treatment paradigm for metabolic diseases such as diabetes and obesity. In the peptide therapeutics realm, recent work has highlighted the therapeutic potential of chimeric peptides that act on two distinct receptors, thereby harnessing parallel complementary mechanisms to induce additive or synergistic benefit compared to monotherapy. Here, we extend this hypothesis by linking a known anti-diabetic peptide with an anti-obesity peptide into a novel peptide hybrid, which we termed a phybrid. We report on the synthesis and biological activity of two such phybrids (AC164204 and AC164209), comprised of a glucagon-like peptide-1 receptor (GLP1-R) agonist, and exenatide analog, AC3082, covalently linked to a second generation amylin analog, davalintide. Both molecules acted as full agonists at their cognate receptors in vitro, albeit with reduced potency at the calcitonin receptor indicating slightly perturbed amylin agonism. In obese diabetic Lepob/Lepob mice sustained infusion of AC164204 and AC164209 reduced glucose and glycated haemoglobin (HbA1c) equivalently but induced greater weight loss relative to exenatide administration alone. Weight loss was similar to that induced by combined administration of exenatide and davalintide. In diet-induced obese rats, both phybrids dose-dependently reduced food intake and body weight to a greater extent than exenatide or davalintide alone, and equal to co-infusion of exenatide and davalintide. Phybrid-mediated and exenatide + davalintide-mediated weight loss was associated with reduced adiposity and preservation of lean mass. These data are the first to provide in vivo proof-of-concept for multi-pathway targeting in metabolic disease via a peptide hybrid, demonstrating that this approach is as effective as co-administration of individual peptides.
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Ionut V, Burch M, Youdim A, Bergman RN. Gastrointestinal hormones and bariatric surgery-induced weight loss. Obesity (Silver Spring) 2013; 21:1093-103. [PMID: 23512841 PMCID: PMC4423817 DOI: 10.1002/oby.20364] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Obesity continues to be a major public health problem in the United States and worldwide. While recent statistics have demonstrated that obesity rates have begun to plateau, more severe classes of obesity are accelerating at a faster pace with important implications in regards to treatment. Bariatric surgery has a profound and durable effect on weight loss, being to date one of the most successful interventions for obesity. OBJECTIVE To provide updates to the possible role of gut hormones in post bariatric surgery weight loss and weight loss maintenance. DESIGN AND METHODS The current review examines the changes in gastro-intestinal hormones with bariatric surgery and the potential mechanisms by which these changes could result in decreased weight and adiposity. RESULTS The mechanism by which bariatric surgery results in body weight changes is incompletely elucidated, but it clearly goes beyond caloric restriction and malabsorption. CONCLUSION Changes in gastro-intestinal hormones, including increases in GLP-1, PYY, and oxyntomodulin, decreases in GIP and ghrelin, or the combined action of all these hormones might play a role in induction and long-term maintenance of weight loss.
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Affiliation(s)
- Viorica Ionut
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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