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Fineman MS, Bryant CLN, Colbert K, Jozefiak TH, Petersen JS, Horowitz M, Vora J, Rayner CK, Wabnitz P, Nimgaonkar A. First-in-human study of a pharmacological duodenal exclusion therapy shows reduced postprandial glucose and insulin and increased bile acid and gut hormone concentrations. Diabetes Obes Metab 2023. [PMID: 37380614 DOI: 10.1111/dom.15066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 06/30/2023]
Abstract
AIMS To address the need for noninvasive alternatives to metabolic surgery or duodenal exclusion devices for the management of type 2 diabetes (T2D) and obesity by developing an orally administered therapeutic polymer, GLY-200, designed to bind to and enhance the barrier function of mucus in the gastrointestinal tract to establish duodenal exclusion noninvasively. MATERIALS AND METHODS A Phase 1, randomized, double-blind, placebo-controlled, single- (SAD) and multiple-ascending-dose (MAD) healthy volunteer study was conducted. In the SAD arm, four cohorts received a single dose of 0.5 g up to 6.0 g GLY-200 or placebo, while in the MAD arm, four cohorts received 5 days of twice-daily or three-times-daily dosing (total daily dose 2.0 g up to 6.0 g GLY-200 or placebo). Assessments included safety and tolerability (primary) and exploratory pharmacodynamics, including serum glucose, insulin, bile acids and gut hormones. RESULTS No safety signals were observed; tolerability signals were limited to mild to moderate dose-dependent gastrointestinal events. In the MAD arm (Day 5), reductions in glucose and insulin and increases in bile acids, glucagon-like peptide-1, peptide YY and glicentin, were observed following a nonstandardized meal in subjects receiving twice-daily dosing of 2.0 g GLY-200 (N = 9) versus those receiving placebo (N = 8). CONCLUSIONS GLY-200 is safe and generally well tolerated at doses of ≤2.0 g twice daily. Pharmacodynamic results mimic the biomarker signature observed after Roux-en-Y gastric bypass and duodenal exclusion devices, indicating a pharmacological effect in the proximal small intestine. This study represents the first clinical demonstration that duodenal exclusion can be achieved with an oral drug and supports further development of GLY-200 for the treatment of obesity and/or T2D.
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Affiliation(s)
| | | | - Kevin Colbert
- Glyscend Therapeutics, Inc., Lowell, Massachusetts, USA
| | | | | | - Michael Horowitz
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jiten Vora
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Christopher K Rayner
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul Wabnitz
- CALHN Integrated Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Transform Clinical Pty Ltd, CO-HAB Tonsley, St Marys, South Australia, Australia
| | - Ashish Nimgaonkar
- Glyscend Therapeutics, Inc., Lowell, Massachusetts, USA
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Ruiz-Esparza GU, Wang X, Zhang X, Jimenez-Vazquez S, Diaz-Gomez L, Lavoie AM, Afewerki S, Fuentes-Baldemar AA, Parra-Saldivar R, Jiang N, Annabi N, Saleh B, Yetisen AK, Sheikhi A, Jozefiak TH, Shin SR, Dong N, Khademhosseini A. Nanoengineered Shear-Thinning Hydrogel Barrier for Preventing Postoperative Abdominal Adhesions. Nanomicro Lett 2021; 13:212. [PMID: 34664123 PMCID: PMC8523737 DOI: 10.1007/s40820-021-00712-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
More than 90% of surgical patients develop postoperative adhesions, and the incidence of hospital re-admissions can be as high as 20%. Current adhesion barriers present limited efficacy due to difficulties in application and incompatibility with minimally invasive interventions. To solve this clinical limitation, we developed an injectable and sprayable shear-thinning hydrogel barrier (STHB) composed of silicate nanoplatelets and poly(ethylene oxide). We optimized this technology to recover mechanical integrity after stress, enabling its delivery though injectable and sprayable methods. We also demonstrated limited cell adhesion and cytotoxicity to STHB compositions in vitro. The STHB was then tested in a rodent model of peritoneal injury to determine its efficacy preventing the formation of postoperative adhesions. After two weeks, the peritoneal adhesion index was used as a scoring method to determine the formation of postoperative adhesions, and STHB formulations presented superior efficacy compared to a commercially available adhesion barrier. Histological and immunohistochemical examination showed reduced adhesion formation and minimal immune infiltration in STHB formulations. Our technology demonstrated increased efficacy, ease of use in complex anatomies, and compatibility with different delivery methods, providing a robust universal platform to prevent postoperative adhesions in a wide range of surgical interventions.
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Affiliation(s)
- Guillermo U Ruiz-Esparza
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Xichi Wang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Xingcai Zhang
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Sofia Jimenez-Vazquez
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- School of Engineering and Science, Tecnologico de Monterrey, Campus Monterrey, Monterrey, Nuevo Leon, 64849, Mexico
- School of Medicine and Health Science, Campus Guadalajara, Zapopan, Jalisco, 45201, Mexico
| | - Liliana Diaz-Gomez
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- School of Engineering and Science, Tecnologico de Monterrey, Campus Monterrey, Monterrey, Nuevo Leon, 64849, Mexico
- School of Medicine and Health Science, Campus Guadalajara, Zapopan, Jalisco, 45201, Mexico
| | - Anne-Marie Lavoie
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Samson Afewerki
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Andres A Fuentes-Baldemar
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- School of Engineering and Science, Tecnologico de Monterrey, Campus Monterrey, Monterrey, Nuevo Leon, 64849, Mexico
- School of Medicine and Health Science, Campus Guadalajara, Zapopan, Jalisco, 45201, Mexico
| | - Roberto Parra-Saldivar
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- School of Engineering and Science, Tecnologico de Monterrey, Campus Monterrey, Monterrey, Nuevo Leon, 64849, Mexico
- School of Medicine and Health Science, Campus Guadalajara, Zapopan, Jalisco, 45201, Mexico
| | - Nan Jiang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Nasim Annabi
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Bahram Saleh
- Department of Chemical Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Amir Sheikhi
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Thomas H Jozefiak
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Su Ryon Shin
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA.
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Blvd, Los Angeles, CA, 90024, USA.
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