• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.57-65
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• 2011

Incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide delay gastric emptying, increasing satiety, and enhance insulin secretion. Two new classes of treatments related to incretin hormones for the management of type 2 diabetes mellitus have emerged: GLP-1 receptor agonists (e.g., exenatide, liraglutide) and the dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., sitagliptin, saxagliptin, vildagliptin, alogliptin), which prevent the degradation of GLP-1. A MEDLINE search was conducted in order to evaluate the efficacy and safety of incretin-based therapies and publications were reviewed. Data from clinical trials indicated incretin-based treatment showed clinically significant reductions in hemoglobin A1c with low risk of hypoglycemia. Weight reductions were observed with GLP-1 receptor agonists where as DPP-4 inhibitors are weight neutral.

• The Korean Journal of Medicine
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• v.99 no.2
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• pp.78-83
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• 2024

Incretin-based obesity treatments are making remarkable progress, marking a new era in the field of obesity pharmacotherapy. These treatments not only meet the long-standing demands for safety and sustainability in obesity medications but also go beyond, significantly improving complications associated with obesity, such as cardiovascular diseases. This review explores the advancement in obesity treatments through the latest research findings on semaglutide and tirzepatide, two incretin-based obesity treatments currently receiving considerable attention.

• Microbiology and Biotechnology Letters
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• v.40 no.3
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• pp.180-185
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• 2012

Type 2 Diabetes Mellitus, a chronic metabolic disorder which results from a high blood glucose level, is one of the most prevalent and costly diseases of our time. Considering increasing rates of obesity and the aging population in Korea, the number of diabetic patients is likely to rise rapidly in the future. There are five conventional diabetic drugs which work through different mechanisms; sulfonylureas, biguanide, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione. Although they all have antidiabetic effects, some side effects such as hypoglycemia, weight gain and gastrointestinal intolerance are associated with them. Incretin based therapies, utilizing glucagon-like peptide-1 (GLP-1) and dipeptidyl peptidase-4 (DPP-4) inhibitors, which have a lower risk of adverse side effects, have recently been introduced. At present PPAR-targeting drugs are being actively developed. In this research review, particular emphasis has been placed on the current trends and possible biological targets for the new generation of antidiabetic drugs.

• Proceedings of the Korean Society of Applied Pharmacology
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• 2008.04a
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• pp.5-20
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• 2008

GLP-1-based drugs (GLP-1 analogues and DPP IV inhibitors) and incretin mimetics are currently one of the most exciting classes of agents for type II diabetes. GLP-1, a gut peptide, is an incretin that potentiates glucose-dependent insulin release from the pancreas, slows GI-transit and stimulates the proliferation of beta-cells. DPP IV inhibitors act like incretins by inhibiting DPP IV which inactivates GLP-1. LC15-0133 is a competitive, reversible DPP IV inhibitor ($IC_{50}$ = 24 nM, Ki=0.247 nM) with excellent selectivity over other critical human proteases such as DPP II, DPP 8, elastase, trypsin. and urokinase. LC15-0133 showed long half-life and good bioavailability in rats and dogs. Inhibition of plasma DPP IV activity by LC15-0133 was kept more than 50% 24 hours after oral dosing in rats and dogs at 0.1 mg/kg and 0.02 mg/kg, respectively. The Minimum effective doses of LC15-0133 were 0.01 mg/kg for lowering blood glucose excursion during oral glucose tolerance test and 0.1 mg/kg for increasing glucose-induced GLP-1 response in C57BL/6 mice. Repeat oral administration of LC15-0133 for 1 month delayed the progression to diabetes and reduced HbA1c levels in a dose-dependent manner in Zucker Diabetic Fatty rats. In conclusion, LC15-0133 is a novel, potent, selective and orally active DPP IV inhibitor and showed an excellent blood glucose lowering effects in various animal models.

• Food Science and Industry
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• v.51 no.4
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• pp.302-312
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• 2018

Bioactive peptides generated from milk proteins play an important role in the prevention and alleviation of diabetes. Whey proteins possess direct insulinotropic effect by amino acids (especially branch chain amino acids) produced through its gastrointestinal digestion. Additionally, blood glucose level can be lowered by gut hormone which called incretin [glucose dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)]. However, physiological effects of incretin readily disappeared by dipeptidyl peptidase-4 (DPP-4) causing degradation of GLP-1. Several DPP-4 inhibitors are currently used as therapeutic medicines for the treatment of type II diabetes. More than 60 natural peptide (2-14 amino acids) DPP-4 inhibitors were identified in milk proteins. Peptide DPP-4 inhibitors act as substrate inhibitor and delay breakdown of GLP-1 both in vitro and in vivo. This review summarizes nutritional quality of milk proteins, absorption and mode of action of bioactive peptides, and finally up-to-dated knowledge on DPP-4 inhibitory peptides derived from milk proteins.

• Korean Journal of Agricultural Science
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• v.41 no.3
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• pp.237-243
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• 2014

Human Glucagon like peptide-1 (GLP-1) is an incretin hormone that promotes secretion of insulin. In order to eliminate the formation of the soluble aggregate, Ala19 in GLP-1 was substituted with Thr, resulting in a GLP-1 mutant GLP-1A19T. The gene synthesis of GLP-1A19T and the fusion of 6-lysine tagged ubiquitin gene were accomplished by using the overlap extension polymerase chain reaction. The ubiquitin fused GLP-1A19T (K6UbGLP-1A19T) is expressed as form of inclusion body with little formation of the soluble aggregation in recombinant E. coli. In order to produce K6UbGLP-1A19T in large amounts, fed-batch fermentation was carried out in a pH-stat feeding strategy. Maximum dry cell weight of 87.7 g/L and 20.4% of specific K6UbGLP-1A19T content were obtained. Solid-phase refolding using a cation exchanger was carried out to renature K6UbGLP-1A19T. The refolded K6UbGLP-1A19T aggregated little and was released GLP-1A19T by on-column cleavage with ubiquitin-specific protease-1. The molecular mass of GLP-1A19T showed an accurate agreement with its theoretical molecular mass.

• Safety and Health at Work
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• v.2 no.1
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• pp.9-16
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• 2011

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, selfmonitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.

• The Korean Journal of Physiology and Pharmacology
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• v.26 no.3
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• pp.219-225
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• 2022

Glucagon like peptide-1 (GLP-1) released from enteroendocine L-cells in the intestine has incretin effects due to its ability to amplify glucose-dependent insulin secretion. Promotion of an endogenous release of GLP-1 is one of therapeutic targets for type 2 diabetes mellitus. Although the secretion of GLP-1 in response to nutrient or neural stimuli can be triggered by cytosolic Ca²⁺ elevation, the stimulus-secretion pathway is not completely understood yet. Therefore, the aim of this study was to investigate the role of reverse Na⁺/Ca²⁺ exchanger (rNCX) in Ca²⁺ entry induced by muscarinic stimulation in NCI-H716 cells, a human enteroendocrine GLP-1 secreting cell line. Intracellular Ca²⁺ was repetitively oscillated by the perfusion of carbamylcholine (CCh), a muscarinic agonist. The oscillation of cytosolic Ca²⁺ was ceased by substituting extracellular Na⁺ with Li⁺ or NMG⁺. KB-R7943, a specific rNCX blocker, completely diminished CCh-induced cytosolic Ca²⁺ oscillation. Type 1 Na⁺/Ca²⁺ exchanger (NCX₁) proteins were expressed in NCI-H716 cells. These results suggest that rNCX might play a crucial role in Ca²⁺ entry induced by cholinergic stimulation in NCI-H716 cells, a GLP-1 secreting cell line.

• Molecules and Cells
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• v.47 no.1
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• pp.100004.1-100004.11
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• 2024

Insulin is essential for maintaining normoglycemia and is predominantly secreted in response to glucose stimulation by β-cells. Incretin hormones, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide, also stimulate insulin secretion. However, as obesity and type 2 diabetes worsen, glucose-dependent insulinotropic polypeptide loses its insulinotropic efficacy, whereas GLP-1 receptor (GLP-1R) agonists continue to be effective owing to its signaling switch from Gs to Gq. Herein, we demonstrated that endoplasmic reticulum (ER) stress induced a transition from Gs to Gq in GLP-1R signaling in mouse islets. Intriguingly, chemical chaperones known to alleviate ER stress, such as 4-PBA and TUDCA, enforced GLP-1R's Gq utilization rather than reversing GLP-1R's signaling switch induced by ER stress or obese and diabetic conditions. In addition, the activation of X-box binding protein 1 (XBP1) or activating transcription factor 6 (ATF6), 2 key ER stress-associated signaling (unfolded protein response) factors, promoted Gs utilization in GLP-1R signaling, whereas Gq employment by ER stress was unaffected by XBP1 or ATF6 activation. Our study revealed that ER stress and its associated signaling events alter GLP-1R's signaling, which can be used in type 2 diabetes treatment.

• YAKHAK HOEJI
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• v.56 no.2
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• pp.136-143
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• 2012

Type 2 Diabetes Mellitus (T2DM) is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and dietary modification. As the condition progresses, medications may be needed such as oral sulfonylurea or others. Recently, dipeptidyl peptidase 4 (DPP- 4) Inhibitor is new drug which can control blood glucose by increasing the active levels of incretin hormone in the body. However, researches have been carried out for mostly Caucasian and Japanese, not for Koreans at all. Therefore, this study was to evaluate the efficacy and safety of DPP-4 inhibitor (Sitagliptin, Vildagliptin) in patients with T2DM in Koreans. This study was carried out retrospectively with reviewing of medical records from the 141 patients who received sitagliptin or vildagliptin over 24 week periods from January 2009, to December 2009. Information including demographics, concomitant medication, disease duration, and exercise was evaluated. $HbA_{1c}$, random blood glucose, post prandial 2 hour glucose, blood pressure, AST, ALT, serum creatinine, total cholesterol, triglyceride levels were also collected at baseline and endpoint (at 24 weeks). In each post-treatment group, $HbA_{1c}$, random blood glucose and post prandial 2 hour glucose levels were decreased significantly from baseline in the sitagliptin group (-0.82%, -28.76 mg/dl, -46.65 mg/dl) and vildagliptin group(-1.22%, -27.96 mg/dl, -67.2 mg/dl). Greater $HbA_{1c}$ mean reductions from baseline to 24 weeks were seen in patients with higher baseline values (>7.0%), with shorter disease durations (${\leq}1$ year) compared with those with lower baseline values (<7.0%), with longer disease durations (>1 year) in both sitagliptin and vildagliptin groups. The incidences of hypoglycemia, headache and upper respiratory infection were 0%, 8.7%, 5.8% in sitagliptin group and 2.8%, 8.3%, 6.9% in vildagliptin group. In conclusion, our results showed DPP-4 inhibitor provided similar efficacy compared with sulfonylurea after 24 weeks of treatment and were safer than sulfonylurea in hypoglycemia for Korean T2DM. Also vildagliptin was associated with significant improvement in $HbA_{1c}$ reduction in Korean patient with subgroup (body mass index<25 $kg/m^2$, metformin dose${\geq}$1000 mg, p<0.05) compared to sitagliptin. Therefore, even though DPP-4 inhibitor use for Korean needs to be studied more consistently in the future, DPP-4 inhibitor is a safe and effective drug for Korean T2DM based on our result.