• Journal of Yeungnam Medical Science
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• 제38권1호
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• pp.27-33
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• 2021

The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

• Biomolecules & Therapeutics
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• 제26권2호
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• pp.201-209
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• 2018

G protein-coupled receptor 119 (GPR119) is expressed in the pancreas and gastrointestinal tract, and its activation promotes insulin secretion in the beta cells of the pancreatic islets as well as the secretion of glucagon-like peptide-1 (GLP-1) in intestinal L cells, consequently improving glucose-stimulated insulin secretion. Due to this dual mechanism of action, the development of small-molecule GPR119 agonists has received significant interest for the treatment of type 2 diabetes. We newly synthesized 1,2,4-triazolone derivatives of GPR119 agonists, which demonstrated excellent outcomes in a cyclic adenosine monophosphate (cAMP) assay. Among the synthesized derivatives, YH18968 showed cAMP=2.8 nM; in GLUTag cell, GLP-1secretion=2.3 fold; in the HIT-T15 cell, and insulin secretion=1.9 fold. Single oral administration of YH18968 improved glucose tolerance and combined treatment with a dipeptidyl peptidase 4 (DPP-4) inhibitor augmented the glucose lowering effect as well as the plasma level of active GLP-1 in normal mice. Single oral administration of YH18968 improved glucose tolerance in a diet induced obese mice model. This effect was maintained after repeated dosing for 4 weeks. The results indicate that YH18968 combined with a DPP-4 inhibitor may be an effective therapeutic candidate for the treatment of type 2 diabetes.

• 비만대사연구학술지
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• 제1권2호
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• pp.78-82
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• 2022

Liraglutide (Saxenda^R) is prescribed to induce and sustain weight loss in obese patients. The starting dose of liraglutide is 0.6 mg/day for 1 week, which is increased by 0.6 mg/day every week until the full maintenance dose of 3 mg/day is achieved. Such dose titration is needed to prevent side effects, which primarily include gastrointestinal problems such as nausea, diarrhea, constipation, vomiting, dyspepsia, and abdominal pain. A 35-year-old, reportedly healthy obese man receiving liraglutide treatment for obesity visited the emergency room complaining of generalized weakness and dizziness accompanied by repeated diarrhea and vomiting. He reported over 20 episodes of diarrhea starting the day after liraglutide dose escalation from 1.2 mg/day to 1.8 mg/day. Laboratory findings suggested pre-renal acute kidney injury, including serum creatinine 4.77 mg/dl, blood urea nitrogen (BUN) 37 mg/dl, estimated glomerular filtration rate (eGFR) 15 ml/min/1.73 m², and Fractional excretion of sodium 0.08. After volume repletion therapy, his renal function recovered to a normal range with laboratory values of creatinine 1.08 mg/dl, BUN 14 mg/dl, and eGFR 88 ml/min/1.73 m². This case emphasizes the need for caution when prescribing glucagon-like peptide-1 receptor agonists, including liraglutide, given the risk of serious renal impairments induced by volume depletion and dehydration through severe-grade diarrhea and vomiting.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.256-266
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• 2020

Purpose: This study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer. Materials and Methods: Forty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured. The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index. Results: The postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013-0.649; P=0.017). Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy. Conclusions: Early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.

• 동의생리병리학회지
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• 제26권2호
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• pp.166-174
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• 2012

To determine the effects of Mahaengeuigam-tang(MHEGT) on obesity, the obesity-related factors (gastrin, CGRP, ghrelin, glucagon-like peptide-1, insulin, orexin, leptin, serotonin, NPY) were investigated in the stomach, pancreas, brain of mice by immunohistochemical methods for 4 weeks after Mahaengeuigam-tang(MHEGT) administration. The change of boy weight decreased in MHEGT administered group than that of control group. The immunohistochemical density of the gastrin and CGRP positive cells on pylorus of stomach increased in MHEGT administered group than that of control group. The number of ghrelin immunoreactive cells on stomach decreased in MHEGT administered groups than that of control group. The immunohistochemical density of GLP-1 in the pancreas decreased in MHEGT administered group than that of control group. The immunohistochemical density of insulin positive cells in the pancreas decreased in MHEGT administered group than that of control group. The immunohistochemical density of orexin and NPY positive neurons in the diencephalon was slightly stronger in MHEGT administered group than that of control group. The immunohistochemical density of serotonin and leptin positive neurons was stronger in MHEGT administered group than that of control group. These results demonstrate that Mahaengeuigam-tang(MHEGT) increased the immunohistochemical density of factors related to appetite inhibitors, and decreased the immunohistochemical density of factors related to stimulator of food intake in stomach, pancreas and brain.

• 사상체질의학회지
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• 제27권1호
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• pp.125-137
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• 2015

Objectives The aim of this study was to investigate clinical factors of SQD syndrome by tracking plasma gut hormone (active ghrelin, active Glucagon-like peptide-1(GLP-1), pancreatic polypeptide(PP), total peptide YY(PYY)) profiling of pre-post prandial standard meal between SQD group and normal group. Methods A total of 24 adult participants were consecutively recruited on April 2014. They were diagnosed as either by SQD syndrome or normal by Spleen Qi Deficiency Questionnaire (SQDQ). On the experimental day, blood samplings of 2 ml were repeatedly collected at 6 points from 2 groups for measuring plasma levels of gut hormones. At every point, subjective appetite sensations were self-registered. Results & Conclusions 1. There were significantly lower subjective 'Appetite' (p=0.012) and higher 'Satiety' (p=0.012) in SQD group. At each time point, subjective 'Appetite' was significantly lower at 60 min after breakfast (p=0.034) and 'Satiety' were significantly higher at 15 min (p=0.020) and 120 min (p=0.044) after breakfast in SQD group. 2. There were no significant differences in plasma levels of gut hormones (active ghrelin, active GLP-1, PP, total PYY) between SQD and normal group. Also at each time point, there were no significant differences of plasma levels of gut hormones between SQD and normal group. 3. Changes in plasma levels of gut hormones compared to baseline were not significantly different at each time point between SQD and normal group. Plasma PYY levels compared to baseline increased in SQD group following 15 min and 30 min after breakfast but decreased in normal group. 4. Further investigation is needed to construct gut hormone profiling and in this perspective, we can approach evaluation tool on variable appetite in Traditional Korean Medicine (TKM) syndrome in the future.

• 한국식품과학회지
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• 제46권5호
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• pp.630-635
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• 2014

본 연구에서는 성분분석을 통해 품질이 확인된 PNO의 항비만효과를 세포수준에서 확인하고 기능성소재로서의 연구 가능성을 제시하고자 수행하였다. 그 결과 PNO는 기존에 알려진 바와 같이 linoleic acid, oleic acid, pinolenic acid, 및 palmitic acid가 분석되었으며 정량을 위한 표준물질인 undecanoic acid의 함량을 기준으로 확인한 결과 linoleic acid 43.4%, oleic acid 25.7%, pinolenic acid로 예측되는 11번 unknown peak 12.8%, palmitic acid 5.2% 및 다수의 미량 성분을 함유하고 있었다. 세포독성 실험을 통해 0.2 mg/mL 농도 까지 독성이 관찰되지 않음을 확인하였으며 그 이상의 농도에서도 PNO보다는 용매 DMSO에 의한 독성이 관찰되었다. PNO를 이용하여 항비만 효과에 대한 잠재적 기능 및 기전을 연구하기 위해 Oil Red O staining, $PPAR{\gamma}$ 및 aP2 mRNA 발현 확인 그리고 leptin의 분비량 측정을 진행하였다. 그 결과 PNO는 MDI solution 처리를 통해 분화가 유도된 mature adipocyte에서 지방적(lipid droplet) 형성을 유의하게 억제하는 것을 확인할 수 있었으며 이는 PNO가 항비만 활성에 잠재적으로 기능을 할 수 있음을 의미한다. 또한 $PPAR{\gamma}$와 aP2 mRNA 발현을 확인한 결과, 두 유전자가 유의한 수준으로 MDI control 대비 감소하는 반면 SREBP-1c, $C/EBP{\alpha}$, glucokinase, phosphoenolpyruvate carboxykinase 및 perilipin에는 영향이 없는 것을 확인할 수 있었다(data not shown). RT-PCR 결과는 PNO의 처리가 지방대사 및 축적을 단백질 및 유전자 발현조절 기전에 의해 억제할 수 있음을 제시하여 주며, 추가적인 연구가 필요함을 시사한다. 마지막으로 확인한 PNO의 leptin 방출유도 실험을 통해 leptin이 PNO의 처리에 의해 농도 의존적으로 방출량이 증가됨을 확인할 수 있었다. Leptin은 식욕억제 효과가 있는 호르몬으로 잘 알려져 있다. 이는 PNO가 기존에 알려진 cholecystokinin과 glucagon like peptide-1 (GLP-1)의 분비증가를 통해 식욕을 억제할 뿐만 아니라 leptin의 방출을 유도하여 추가적인 식욕억제작용을 유도할 수 있음을 의미한다. 위의 연구결과를 종합하면 PNO는 불포화지방산이 다량 함유된 우수한 식물성유지이며 기능적으로 항비만 효능을 잠재적으로 가지는 우수한 소재임을 확인할 수 있었다. 따라서 본 연구결과를 기초자료로 하여 효과적인 기능성 식품 및 소재의 개발을 위해 체계적이고 과학적인 연구가 필요할 것으로 판단된다.

• 식품과학과 산업
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• 제40권2호
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• pp.46-58
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• 2007

제2형 당뇨병은 대사성 질환으로 간, 근육 그리고 지방 조직 세포에서 인슐린 작용의 장애로 나타나는 인슐린 저항성으로 혈당의 이용이 감소하여 혈당이 높아짐에도 불구하고 췌장의 베타세포에서 인슐린 분비가 충분하지 못할 때 유발된다. 서구에서는 비만 등으로 인해 인슐린 저항성이 증가하면 인슐린 분비가 높은 고인슐린혈증을 나타내어 당뇨병으로의 진전은 늦다. 하지만 우리나라를 비롯한 아시아의 사람들은 인슐린 저항성이 증가할 때 인슐린 분비가 충분치 못해 혈청 인슐린 농도가 정상인과 비슷하거나 더 낮은 상태에서 당뇨병으로 진전된다. 이러한 차이는 우리나라를 비롯한 아시아 사람들에게서 제2형 당뇨병의 발생이 급격하게 증가할 것이라는 보고되었다. 결국 당뇨병은 간, 근육 및 지방조직에서의 인슐린 작용의 장애와 췌장의 베타세포에서 인슐린 분비의 부족의 복합적인 장애에 의해서 나타나고 이것은 공통적으로 각 조직에서의 인슐린/insulin growth factor (IGF)-1 신호전달의 장애와 관련이 있다. 베타세포에서의 인슐린분비 자체는 인슐린/IGF-1 신호전달과 관계가 없지만 간접적으로 관련이 있다. 인슐린 분비능은 베타세포의 증식과 생존에 의한 베타세포의 양과 밀접한 관련이 있는데 인슐린/IGF-1 신호전달은 베타세포의 증식과 생존을 조절한다. 그러므로 혈당 조절에 관여하는 기능성 식품은 인슐린 작용을 향상시키는 인슐린 민감성 특성을 가지거나, 혈당이 높아질 때 인슐린 분비를 촉진시키는 insulinotropic 작용을 하는 성질을 가지고 있어야 하겠다. 전자의 대표적인 약은 1999년에 미국 FDA에서 승인 받은 peroxisome proliferator-activated receptor $(PPAR)-{\gamma}$ agonist 인 thiazolidinedione 계통의 약물인 troglitazone, pioglitazone, rosiglitazone 등이 있고, 후자는 2007년에 승인 받은 Exenatide는 glucagon like peptide (GLP)-1 agonist이다. 이 두 가지 약은 모두 자연계에 존재하는 동식물에서 유래된 것으로 식품에도 많이 다양한 종류의 인슐린 민감성 물질이나 insulinotropic 작용을 하는 물질이 함유되어 있을 것이다. 이러한 기능 이외에 혈당조절 약이나 식품으로 사용되는 것은 탄수화물의 소화를 방해하는 것으로 탄수화물 소화효소인 a-amylase 또는 maltase의 활성을 억제하여 식후 혈당의 급격한 상승을 방지하는 것이 있다. 우리나라 사람들은 탄수화물의 섭취가 너무 많아서 실제로 이러한 식품이나 약의 효능이 높지 않을 것이다. 혈당을 조절하는 기능성 식품은 이 세 가지 효능 중 일부를 가지고 있는 것이 될 수 있다. 이러한 기능을 스크리닝하기 위해서 3가지 단계를 거쳐야 한다. 먼저 시험관에서 또는 세포 실험을 통해서 앞서 언급한 3가지 기능을 가지고 있는 지 여부를 각각 조사한다. 이중에서 효과가 있는 것은 당뇨 동물 모델을 사용하여 in vivo에서 혈당 강하기능과 혈당 강하기전을 조사하는 실험을 한다. 효과가 있는 식품이 우리가 전통적으로 식품으로 섭취해 왔다면 독성 검사를 거쳐야 할 필요가 없지만 한약재이거나 특수 식품의 경우에는 in vivo 실험 전에 GLP 기관에서 반드시 독성 실험을 거쳐 독성 유무를 확인할 필요가 있다. 동물 실험에서 효과적인 것은 인체 실험을 거쳐 혈당 조절 기능성 식품으로 식약청에서 허가를 받을 수 있겠다. 결론적으로 식품에는 항당뇨 특성을 가진 물질들이 함유되어 있는 것들이 상당히 많다. 혈당 조절기능이 있는 기능성 식품으로 개발할 때 고려해야 할 것은 1) 그 양이 혈당 강하 기능성 식품으로 지정받을 수 있을 정도로 충분히 함유되어 있느냐, 2) 혈당을 강하시키는 기전이 단순히 당의 배설을 촉진시켜서 혈당을 저하시키는 것이 아니라, 인슐린 작용을 촉진시키거나, 포도당 자극에 의한 인슐린 분비를 촉진시키거나 탄수화물의 소화 흡수를 억제시킴으로 혈당을 강하시키는 지 등을 파악하는 것이다. 이러한 조건을 만족시키는 식품은 지속적으로 섭취할 때 당뇨병을 예방하거나 진전을 지연시킬 수 있는 혈당조절기능이 있는 기능성 식품으로 개발 가능성이 있겠다.

• Experimental and Molecular Medicine
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• 제50권12호
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• pp.2.1-2.12
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• 2018

Glucagon-like peptide-1 (GLP-1) has a broad spectrum of biological activity by regulating metabolic processes via both the direct activation of the class B family of G protein-coupled receptors and indirect nonreceptor-mediated pathways. GLP-1 receptor (GLP-1R) agonists have significant therapeutic effects on non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) in animal models. However, clinical studies indicated that GLP-1 treatment had little effect on hepatic steatosis in some NAFLD patients, suggesting that GLP-1 resistance may occur in these patients. It is well-known that the gut metabolite sodium butyrate (NaB) could promote GLP-1 secretion from intestinal L cells. However, it is unclear whether NaB improves hepatic GLP-1 responsiveness in NAFLD. In the current study, we showed that the serum GLP-1 levels of NAFLD patients were similar to those of normal controls, but hepatic GLP-1R expression was significantly downregulated in NAFLD patients. Similarly, in the NAFLD mouse model, mice fed with a high-fat diet showed reduced hepatic GLP-1R expression, which was reversed by NaB treatment and accompanied by markedly alleviated liver steatosis. In addition, NaB treatment also upregulated the hepatic p-AMPK/p-ACC and insulin receptor/insulin receptor substrate-1 expression levels. Furthermore, NaB-enhanced GLP-1R expression in HepG2 cells by inhibiting histone deacetylase-2 independent of GPR43/GPR109a. These results indicate that NaB is able to prevent the progression of NAFL to NASH via promoting hepatic GLP-1R expression. NaB is a GLP-1 sensitizer and represents a potential therapeutic adjuvant to prevent NAFL progression to NASH.

• The Korean Journal of Physiology and Pharmacology
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• 제18권4호
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• pp.333-339
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• 2014

Exendin-4 (Ex-4), a glucagon-like peptide-1 receptor (GLP-1R) agonist, has been known to reverse hepatic steatosis in ob/ob mice. Although many studies have evaluated molecular targets of Ex-4, its mechanism of action on hepatic steatosis and fibrosis has not fully been determined. In the liver, glucose transporter 4 (GLUT4) is mainly expressed in hepatocytes, endothelial cells and hepatic stellate cells (HSCs). In the present study, the effects of Ex-4 on GLUT4 expression were determined in the liver of ob/ob mice. Ob/ob mice were treated with Ex-4 for 10 weeks. Serum metabolic parameters, hepatic triglyceride levels, and liver tissues were evaluated for hepatic steatosis. The weights of the whole body and liver in ob/ob mice were reduced by long-term Ex-4 treatment. Serum metabolic parameters, hepatic steatosis, and hepatic fibrosis in ob/ob mice were reduced by Ex-4. Particularly, Ex-4 improved hepatic steatosis by enhancing GLUT4 via GLP-1R activation in ob/ob mice. Ex-4 treatment also inhibited hepatic fibrosis by decreasing expression of connective tissue growth factor in HSCs of ob/ob mice. Our data suggest that GLP-1 agonists exert a protective effect on hepatic steatosis and fibrosis in obesity and type 2 diabetes.