Efficacy and Safety of Pioglitazone versus Glimepiride after Metformin and Alogliptin Combination Therapy: A Randomized, Open-Label, Multicenter, Parallel-Controlled Study

BACKGROUND: There is limited information regarding the optimal third-line therapy for managing type 2 diabetes mellitus (T2DM) that is inadequately controlled using dual combination therapy. This study assessed the efficacy and safety of pioglitazone or glimepiride when added to metformin plus alogliptin treatment for T2DM.METHODS: This multicenter, randomized, active-controlled trial (ClinicalTrials.gov: NCT02426294) recruited 135 Korean patients with T2DM that was inadequately controlled using metformin plus alogliptin. The patients were then randomized to also receive pioglitazone (15 mg/day) or glimepiride (2 mg/day) for a 26-week period, with dose titration was permitted based on the investigator's judgement.RESULTS: Glycosylated hemoglobin levels exhibited similar significant decreases in both groups during the treatment period (pioglitazone: −0.81%, P<0.001; glimepiride: −1.05%, P<0.001). However, the pioglitazone-treated group exhibited significantly higher high density lipoprotein cholesterol levels (P<0.001) and significantly lower homeostatic model assessment of insulin resistance values (P<0.001). Relative to pioglitazone, adding glimepiride to metformin plus alogliptin markedly increased the risk of hypoglycemia (pioglitazone: 1/69 cases [1.45%], glimepiride: 14/66 cases [21.21%]; P<0.001).CONCLUSION: Among patients with T2DM inadequately controlled using metformin plus alogliptin, the addition of pioglitazone provided comparable glycemic control and various benefits (improvements in lipid profiles, insulin resistance, and hypoglycemia risk) relative to the addition of glimepiride.

Peroxisome proliferator-activated receptors and thiazolidinediones in diabetic nephropathy

Diabetic nephropathy is global problem with several drugs into trial without much success the current article highlights the role of thiazolidinedione’s in diabetic nephropathy by scrutinizing and reconnoitring the cellular and intracellular mechanism and shielding action and the role of peroxisome proliferator-activated gamma receptors (PPAR?) receptors. Not only anti-diabetic action but renal protective effect with evidence based study has been highlighted. PPAR ?-is versatile target having numerous benefits and mainly preventing fibrosis in diabetic experimental model and some clinical case report yet, the benefits are not up to mark, since renal failure itself causes volume expansion and the thiazolidinedione’s (TZDs) also preserve salt and water and lead to congestive heart failure which constraints its clinical application. Dual activators and balaglitazone selective PPAR modulator are having upcoming potential for treatment of diabetic nephropathy. Further detail investigation on such drug is needed to explore. However adverse effect like heart failure, osteoporosis and volume expansion effect over-rides the beneficial effect thus limiting its clinical use of currently available TZDs.

Effects of a new thiazolidine compound (GQ-11) on tissue repair process in models of insulin resistance and ischemia-reperfusion / Efeitos de um novo derivado tiazolidínico (GQ-11) no processo de reparo tecidual em modelos de resistência à insulina e isquemia-reperfusão

The thiazolidinediones (TZDs) class comprises drugs with hypoglycemic effects, reducing insulin resistance in peripheral tissues. Our group has demonstrated in preliminary in vivo studies that a new TZD, GQ-11, improves insulin resistance as well as modulates cytokines involved in inflammatory process, suggesting an interesting approach for therapeutic alternatives in tissue repair, especially in metabolic decompensation cases, as insulin resistance and ischemia-reperfusion. In this context, the aim of this study was to investigate GQ-11 effects in tissue repair in three different models: insulin resistance in db/db mice, reconstructed human epidermis (RHE) in glycated collagen matrix and ischemia/reperfusion induced by aorta clamping in Wistar rats. In insulin resistance context, GQ-11 treatment upregulated the expression of anti-inflammatory mediators, such as IL-10, TGF-ß and Arg-1, downregulated the expression of pro-inflammatory cytokines both in db/db mice wounds and in macrophage, besides increasing re-epithelization and collagen deposition. In addition, the treatment also induced keratinocytes proliferation and fibroblasts differentiation in RHE. In ischemia-reperfusion model, the same anti-inflammatory effect was observed along with anti-oxidant properties through regulation of enzymes, such as catalase and GPx, as well as by decreasing TBARS formation. Animals imaging by positron emission tomography (PET) indicated significant less 18F-FDG uptake in animal treated with GQ-11 compared to controls, suggesting decrease of the inflammation process related to reperfusion after aorta clamping. Concluding, the dual PPARα/γ agonist GQ-11 has an important antiinflammatory effect, suggesting a new approach to tissue repair management in diabetes and in prevention of ischemia-reperfusion syndrome post-surgery

As tiazolidinadionas (TZDs) compreendem uma classe de fármacos hipoglicemiantes que reduzem a resistência à insulina pelos tecidos periféricos. Dados preliminares in vivo obtidos em nosso grupo de pesquisa mostraram que um dos novos derivados tiazolidínicos, GQ-11, além de aumentar a resposta à insulina, pode inibir citocinas pró-inflamatórias, o que a torna uma alternativa terapêutica promissora no reparo tecidual, em especial, nos casos de descompensação metabólica como ocorre na resistência à insulina e na isquemia/reperfusão. Nesse contexto, o objetivo deste trabalho foi investigar os efeitos da GQ-11 nas etapas do processo de reparo tecidual em três modelos: resistência à insulina utilizando camundongos db/db, epiderme humana reconstruída em matriz de colágeno glicado e isquemia/reperfusão induzida por clampeamento da aorta em ratos Wistar. No contexto de resistência à insulina, o tratamento com GQ-11 induziu a expressão de mediadores anti-inflamatórios como IL-10, TGF-ß e Arg-1 e diminuiu a expressão de citocinas pró-inflamatórias em lesões de camundongos db/db e em macrófagos, além de aumentar a capacidade de re-epitelização e a deposição de colágeno. Além disso, o tratamento também induziu a proliferação de queratinócitos e a diferenciação de fibroblastos em epiderme humana reconstruída em matriz de colágeno glicado. No modelo de isquemia-reperfusão, o mesmo efeito anti-inflamatório da GQ-11 foi observado ao lado de efeitos anti-oxidantes através da regulação de enzimas como catalase, GPx e diminuição de TBARS. O imageamento dos animais através de tomografia por emissão de pósitrons (PET) demonstrou menor captação de 18F-FDG (18F-fluordesoxiglicose), indicando diminuição do processo inflamatório decorrente da reperfusão pós clampeamento aórtico. Dessa forma, conclui-se que GQ-11, um agonista dual de PPARα/γ, tem efeito anti-inflamatório importante, podendo ser um candidato à fármaco com possível aplicação no reparo tecidual no diabetes e na prevenção da síndrome de isquemia-reperfusão desenvolvida após procedimentos cirúrgicos

Effects of Thiazolidinedione and New Antidiabetic Agents on Stroke / 대한뇌졸중학회지

Patients with hyperglycemia are at a high risk of cardio- and cerebrovascular diseases. Diabetes patients also have poor outcomes after cerebrovascular disease development. Several classes of drugs are used for diabetes management in clinical practice. Thiazolidinedione (TZD) was introduced in the late 1990s, and new antidiabetic agents have been introduced since 2000. After issues with rosiglitazone in 2007, the U.S. Food and Drug Administration strongly recommended that trials investigating cardiovascular risk associated with new antidiabetic medications should be conducted before drug approval in the United States, to prove the safety of these new drugs and to determine their superiority to previous medications. Currently, results are available from two studies with TZD focusing on cardiovascular diseases, including stroke, and from 12 cardiovascular outcome trials focusing on major adverse cardiovascular events associated with new antidiabetic agents (four with dipeptidyl peptidase-4 inhibitors, three with sodium-glucose cotransporter-2 inhibitors, and five with glucagon-like peptide-1 analogues). These studies showed different results for primary cardiovascular outcomes and stroke prevention. It is important to determine whether prescription of TZD or new antidiabetic medications compared to conventional treatment, such as sulfonylurea or insulin, is better for stroke management. Furthermore, it is unclear whether drugs in the same class show greater safety and efficacy than other drugs for stroke management.

Pioglitazone Induces Cardiomyocyte Apoptosis and Inhibits Cardiomyocyte Hypertrophy Via VEGFR-2 Signaling Pathway / Pioglitazona Induz Apoptose e Inibe Hipertrofia de Cardiomiócitos pela Via de Sinalização do VEGFR-2

Abstract Background: Pioglitazone has been widely used as an insulin-sensitizing agent for improving glycemic control in patients with type 2 diabetes mellitus. However, cardiovascular risk and protective effects of pioglitazone remain controversial. Objectives: In this study, we investigated whether pioglitazone affects cardiomyocyte apoptosis and hypertrophy by regulating the VEGFR-2 signaling pathway. Methods: Cardiomyocytes were enzymatically isolated from 1- to 3-day-old Sprague-Dawley rat ventricles. Effects of pioglitazone and the VEGFR-2-selective inhibitor apatinib on cardiomyocyte apoptotic rate was determined using flow cytometry, and hypertrophy was evaluated using [3H]-leucine incorporation. The protein expressions of unphosphorylated and phosphorylated VEGFR-2, Akt, P53, and mTOR were determined by Western-Blotting. Analysis of variance (ANOVA) was used to assess the differences between groups. Results: Pioglitazone and VEGFR-2-selective inhibitor apatinib reduced rat cardiomyocyte viability and cardiomyocyte hypertrophy induced by angiotensin II in vitro. Furthermore, in the same in vitro model, pioglitazone and apatinib significantly increased the expression of Bax and phosphorylated P53 and decreased the expression of phosphorylated VEGFR-2, Akt, and mTOR, which promote cardiomyocyte hypertrophy. Conclusions: These findings indicate that pioglitazone induces cardiomyocyte apoptosis and inhibits cardiomyocyte hypertrophy by modulating the VEGFR-2 signaling pathway.

Resumo Fundamento: A pioglitazona tem sido amplamente utilizada como droga sensibilizadora da insulina para melhorar o controle glicêmico em pacientes com diabetes mellitus tipo 2. No entanto, o risco cardiovascular bem como os efeitos protetores da pioglitazona ainda são controversos. Objetivos: Neste estudo, investigamos se os efeitos da pioglitazona sobre a apoptose e a hipertrofia de cardiomiócitos ocorrem via regulação da via de sinalização do VEGFR-2. Métodos: os cardiomiócitos foram isolados enzimaticamente dos ventrículos de ratos Sprague-Dawley de 1-3 anos de vida. Os efeitos da pioglitazona e do inibidor seletivo de VEGFR-2 apatinib sobre a taxa de apoptose dos cardiomiócitos foram avaliados por citometria de fluxo, e a hipertrofia avaliada por incorporação de leucina-[3H]. As expressões de VEGFR-2, Akt, P53, e mTOR fosforiladas e não fosforiladas foram determinadas por Western Blotting. Análise de variância (ANOVA) foi usada para avaliar diferenças entre os grupos. Resultados: a pioglitazona e o apatinib reduziram a viabilidade e a hipertrofia de cardiomiócitos induzida por angiotensina II in vitro. Além disso, no mesmo modelo in vitro, a pioglitazona e o apatinib aumentaram significativamente a expressão de Bax e P53 fosforilada, e diminuiu a expressão de VEGFR-2, Akt, e mTOR, que promove hipertrofia de cardiomiócitos. Conclusões: Esses resultados indicam que a pioglitazona induz a apoptose e inibe a hipertrofia de cardiomiócitos pela modulação da via de sinalização de VEGFR-2.

Actualización del efecto de los antihiperglicemiantes en la función renal en diabetes mellitus tipo 2 / Update of the effect of antihyperglycemic agents on renal function in type 2 diabetes mellitus

Resumen La diabetes mellitus tipo 2 es una de las enfermedades metabólicas que afecta a diferentes órganos, uno en el cual es el riñón. Una de las principales complicaciones microvasculares es la nefropatía diabética, siendo la principal causa de insuficiencia renal crónica a nivel mundial. De ahí la importancia de las recomendaciones en la utilización o no de los fármacos antihiperglicemiantes, basadas en sus efectos beneficiosos a nivel de la función renal en relación con la tasa de filtración glomerular estimada y la relación albumina/creatinina en pacientes con diabetes mellitus tipo 2 y enfermedad renal. En estudios recientes se han evaluado antihiperglicemiantes con un impacto beneficioso a nivel de desenlaces cardiovascular y renal. En el presente artículo se revisan las acciones y los efectos de los diferentes grupos de medicamentos como la metformina, los inhibidores de la dipeptidil peptidasa 4, los agonistas de la GLP-1, tiazolidinedionas, sulfonilureas, inhibidores del cotransportador de sodio-glucosa tipo 2 e insulinas en la función renal en cuanto a las dosis de cada fármaco, tanto el uso de dosis establecidas, disminución de la dosis o el no uso del medicamento con base en el empeoramiento de la tasa de filtración glomerular estimada. Con respecto a la metodología aplicada para el desarrollo del artículo, se seleccionó artículos a partir de palabras claves como diabetes mellitus tipo 2, antihiperglicemiantes en la función renal, tasa de filtración glomerular estimada y relación albumina/creatinina; se emplearon artículos de revistas reconocidas que no superaran 5 años en su publicación, sin embargo, se utilizaron artículos que superaran este tiempo, dado que aportaban datos importantes para el artículo de revisión.

Abstract Type 2 diabetes mellitus is one of the metabolic diseases that affects different organs, one of which is the kidney. One of the main microvascular complications is diabetic nephropathy, being the main cause of chronic renal failure worldwide. Hence the importance of recommendations on the use or non-use of antihyperglycemic drugs based on their beneficial effects on kidney function, expressed by the estimated glomerular filtration rate and the albumin / creatinine ratio in patients with type 2 diabetes mellitus and kidney disease. Recent studies have shown antihyperglycemic agents with beneficial impact in cardiovascular and renal endpoints. In the present article we will review the actions and effects of different groups of drugs such as metformin, inhibitors of dipeptidyl peptidase 4, GLP-1 agonists, thiazolidinediones, sulfonylureas, SGLT-2 inhibitors and insulins in renal function in relation to the doses of each drug, both the use of established doses, reduction of the dose or non-use of the drug based on the worsening of the estimated glomerular filtration rate. With respect to the methodology applied for the development of the article, a selection of articles was made based on key words such as type 2 diabetes mellitus, antihyperglycemic agents in renal function, estimated glomerular filtration rate and albumin/ creatinine ratio. Prestigious journal articles were used with less than 5 years since its publication, however articles that exceed this time were used as they provided important data in the review article.

Glucose-Lowering Agents in the Management of Nonalcoholic Fatty Liver Disease / 임상당뇨병

Nonalcoholic fatty liver disease (NAFLD) is more prevalent in diabetic patients than in non-diabetic subjects, because the two diseases share a common pathophysiological mechanism. Associated abnormalities can be observed from the pre-diabetic stage. Lifestyle intervention, including diet, exercise, and weight loss, is the primary recommended therapy for NAFLD. Among the therapeutic drugs for NAFLD treatment, anti-diabetic agents are aimed at improving or slowing the progression of NAFLD in addition to lowering blood glucose. In this paper, we systemically review the evidence surrounding antidiabetic medications and their ability to improve disease progression in patients with NAFLD.

Effects of Lobeglitazone, a New Thiazolidinedione, on Osteoblastogenesis and Bone Mineral Density in Mice

BACKGROUND: Bone strength is impaired in patients with type 2 diabetes mellitus despite an increase in bone mineral density (BMD). Thiazolidinedione (TZD), a peroxisome proliferator activated receptor γ agonist, promotes adipogenesis, and suppresses osteoblastogenesis. Therefore, its use is associated with an increased risk of fracture. The aim of this study was to examine the in vitro and in vivo effects of lobeglitazone, a new TZD, on bone. METHODS: MC3T3E1 and C3H10T1/2 cells were cultured in osteogenic medium and exposed to lobeglitazone (0.1 or 1 µM), rosiglitazone (0.4 µM), or pioglitazone (1 µM) for 10 to 14 days. Alkaline phosphatase (ALP) activity, Alizarin red staining, and osteoblast marker gene expression were analyzed. For in vivo experiments, 6-month-old C57BL/6 mice were treated with vehicle, one of two doses of lobeglitazone, rosiglitazone, or pioglitazone. BMD was assessed using a PIXImus2 instrument at the baseline and after 12 weeks of treatment. RESULTS: As expected, in vitro experiments showed that ALP activity was suppressed and the mRNA expression of osteoblast marker genes RUNX2 (runt-related transcription factor 2) and osteocalcin was significantly attenuated after rosiglitazone treatment. By contrast, lobeglitazone at either dose did not inhibit these variables. Rosiglitazone-treated mice showed significantly accelerated bone loss for the whole bone and femur, but BMD did not differ significantly between the lobeglitazone-treated and vehicle-treated mice. CONCLUSION: These findings suggest that lobeglitazone has no detrimental effects on osteoblast biology and might not induce side effects in the skeletal system.

Effects of Vildagliptin or Pioglitazone on Glycemic Variability and Oxidative Stress in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A 16-Week, Randomised, Open Label, Pilot Study

BACKGROUND: Glycemic variability is associated with the development of diabetic complications through the activation of oxidative stress. This study aimed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor, vildagliptin, or a thiazolidinedione, pioglitazone, on glycemic variability and oxidative stress in patients with type 2 diabetes. METHODS: In this open label, randomised, active-controlled, pilot trial, individuals who were inadequately controlled with metformin monotherapy were assigned to either vildagliptin (50 mg twice daily, n=17) or pioglitazone (15 mg once daily, n=14) treatment groups for 16 weeks. Glycemic variability was assessed by calculating the mean amplitude of glycemic excursions (MAGE), which was obtained from continuous glucose monitoring. Urinary 8-iso prostaglandin F₂α, serum oxidised low density lipoprotein, and high-sensitivity C-reactive protein were used as markers of oxidative stress or inflammation. RESULTS: Both vildagliptin and pioglitazone significantly reduced glycated hemoglobin and mean plasma glucose levels during the 16-week treatment. Vildagliptin also significantly reduced the MAGE (from 93.8±38.0 to 70.8±19.2 mg/dL, P=0.046), and mean standard deviation of 24 hours glucose (from 38±17.3 to 27.7±6.9, P=0.026); however, pioglitazone did not, although the magnitude of decline was similar in both groups. Markers of oxidative stress or inflammation including urinary 8-iso prostaglandin F₂α did not change after treatment in both groups. CONCLUSION: In this 16-week treatment trial, vildagliptin, but not pioglitazone, reduced glycemic variability in individuals with type 2 diabetes who was inadequately controlled with metformin monotherapy, although a reduction of oxidative stress markers was not observed.

Effects of Lobeglitazone, a Novel Thiazolidinedione, on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus over 52 Weeks

BACKGROUND: The aim of this multicenter, randomized, double-blind study was to examine the effect of lobeglitazone, a novel thiazolidinedione, on the changes in bone mineral density (BMD) in patients with type 2 diabetes mellitus. METHODS: A 24-week, double-blinded phase was followed by a 28-week, open-label phase, in which the placebo group also started to receive lobeglitazone. A total of 170 patients aged 34 to 76 years were randomly assigned in a 2:1 ratio to receive lobeglitazone 0.5 mg or a matching placebo orally, once daily. BMD was assessed using dual-energy X-ray absorptiometry at week 24 and at the end of the study (week 52). RESULTS: During the double-blinded phase, the femur neck BMD showed decreasing patterns in both groups, without statistical significance (−0.85%±0.36% and −0.78%±0.46% in the lobeglitazone and placebo groups, respectively). The treatment difference between the groups was 0.07%, which was also not statistically significant. Further, minimal, nonsignificant decreases were observed in both groups in the total hip BMD compared to values at baseline, and these differences also did not significantly differ between the groups. During the open-label phase, the BMD was further decreased, but not significantly, by −0.32% at the femur neck and by −0.60% at the total hip in the lobeglitazone group, and these changes did not significantly differ compared with the original placebo group switched to lobeglitazone. CONCLUSION: Our results indicate that treatment with lobeglitazone 0.5 mg over 52 weeks showed no detrimental effect on the BMD compared to the placebo.

Retrospective Observational Dose-Titration Study of Subjects with Type 2 Diabetes Mellitus with Inadequate Glycemic Control on 15 mg of Pioglitazone / 임상당뇨병

BACKGROUND: The 30 mg pioglitazone tablet was recently introduced in Korea; no study has yet compared its glucose-lowering or weight gain effects to the 15 mg tablet in Korean patients with type 2 diabetes mellitus (T2DM). METHODS: The electronic medical records of 45 patients with T2DM with glycated hemoglobin (HbA1c) levels > 7.0%, despite taking 15 mg/day pioglitazone and a stable dose of other diabetes drugs for 3 months, were retrospectively reviewed. RESULTS: After dose up-titration, HbA1c levels decreased at 3- and 6-month follow-ups compared with baseline (8.5% at baseline vs. 8.2% at 3 months vs. 7.9% at 6 months; baseline vs. 3 months, P = 0.106; baseline vs. 6 months, P = 0.005; 3 months vs. 6 months, P = 0.096). In the subgroup analysis of 36 patients taking pioglitazone, sulfonylurea, and metformin, HbA1c levels also decreased at 3- and 6-month follow-ups compared with baseline (8.5 % vs. 8.2 % vs. 7.9%; baseline vs. 3 months, P = 0.289; baseline vs. 6 months, P = 0.014; 3 months vs. 6 months, P = 0.232). There was no significant body weight change (70.8 kg vs. 70.7 kg vs. 71.0 kg). CONCLUSION: Up-titrating from 15 mg to 30 mg of pioglitazone in patients with inadequate glycemic control (HbA1c > 9%) who were also taking sulfonylurea and metformin showed additive glucose-lowering effects without significant weight gain in Korean patients with T2DM.

Effects of rosiglitazone on ventilator-associated lung injury in mice / 中华麻醉学杂志

Objective To evaluate the effects of rosiglitazone on ventilator-associated lung injury (VALI) in mice.Methods Twenty-four healthy male C57 mice,weighing 20-25 g,aged 6-8 weeks,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (group S);group VALI;rosiglitazone group (group RGZ).The mice only underwent tracheotomy in group S.In group VALI,the mice were ventilated (respiratory rate 80 breaths/min,duration 4 h,tidal volume 40 ml/kg,fraction of inspired oxygen 21％,inspiratory/expiratory ratio 1:2,PEEP 0).In group RGZ,30 mg/kg rosiglitazone was given orally at 30 min before ventilation,and the other treatments were similar to those previously described in group VALI.At the end of ventilation,the mice were sacrificed,and the left lung was lavaged,and the broncho-alveolar lavage fluid (BALF) was collected for determination of neutrophil count.The pulmonary specimens were collected from the upper lobe of right lungs for microscopic examination of the pathological changes which were scored.The pulmonary specimens were obtained from the middle lobe of right lungs for measurement of the contents of interleukin-lbeta (IL-1β),tumor necrosis factor-alpha (TNF-α),high mobility group box-1 (HMGB-1) and receptor for advanced glycation end-products (RAGE) by enzyme-linked immunosorbent assay.Results Compared with group S,the neutrophil counts in BALF,contents of IL-1β,TNF-α,HMGB1 and RAGE,and lung injury score were significantly increased in VALI group (P＜0.01),and no significant change was found in the parameters mentioned above in group RGZ (P＞0.05).Compared with group VALI,the neutrophil counts in BALF,contents of IL-1β,TNF-α,HMGB1 and RAGE,and lung injury score were significantly decreased in group RGZ (P＜0.01).Conclusion Rosiglitazone can mitigate VALI in mice.

Comparison of Vildagliptin and Pioglitazone in Korean Patients with Type 2 Diabetes Inadequately Controlled with Metformin

BACKGROUND: We compared the efficacies of vildagliptin (50 mg twice daily) relative to pioglitazone (15 mg once daily) as an add-on treatment to metformin for reducing glycosylated hemoglobin (HbA1c) levels in Korean patients with type 2 diabetes. METHODS: The present study was a multicenter, randomized, active-controlled investigation comparing the effects of vildagliptin and pioglitazone in Korean patients receiving a stable dose of metformin but exhibiting inadequate glycemic control. Each patient underwent a 16-week treatment period with either vildagliptin or pioglitazone as an add-on treatment to metformin. RESULTS: The mean changes in HbA1c levels from baseline were -0.94% in the vildagliptin group and -0.6% in the pioglitazone group and the difference between the treatments was below the non-inferiority margin of 0.3%. The mean changes in postprandial plasma glucose (PPG) levels were -60.2 mg/dL in the vildagliptin group and -38.2 mg/dL in the pioglitazone group and these values significantly differed (P=0.040). There were significant decreases in the levels of total, low density lipoprotein, high density lipoprotein (HDL), and non-HDL cholesterol in the vildagliptin group but increases in the pioglitazone group. The mean change in body weight was -0.07 kg in the vildagliptin group and 0.69 kg in the pioglitazone group, which were also significantly different (P=0.002). CONCLUSION: As an add-on to metformin, the efficacy of vildagliptin for the improvement of glycemic control is not inferior to that of pioglitazone in Korean patients with type 2 diabetes. In addition, add-on treatment with vildagliptin had beneficial effects on PPG levels, lipid profiles, and body weight compared to pioglitazone.

Effect of oral hypoglycaemic agents on bone metabolism in patients with type 2 diabetes mellitus & occurrence of osteoporosis.

Background & objectives: Type 2 diabetes mellitus (T2DM) is considered to be a protective factor against development of osteoporosis. But oral hypoglycaemic agents (OHA) are likely to increase the risk of osteoporosis. This study was carried out to evaluate the effect of various OHA on bone mineral density (BMD) in patients with T2DM. Methods: Forty one patients (study group) with T2DM (mean age 51.9±5.5 yr; 31 females) receiving treatment with oral hypoglycaemic agents (OHA) [thiazolidinediones alone (n=14) or in combination with other OHA (n=27)] for a period of at least three consecutive years and 41 age- and gender-matched healthy controls (mean age 51.4±5.1 yr) were included in the study. A detailed clinical history was taken and all were subjected to physical examination and recording of anthropometric data. BMD was assessed for both patients and controls. Results: The mean body mass index (kg/m2) (26.5±4.90 vs 27.3 ±5.33) and median [inter-quartile range (IQR)] duration of menopause (yr) among women [6(2-12) vs 6(1-13)] were comparable between both groups. The bone mineral density (BMD; g/cm2) at the level of neck of femur (NOF) (0.761±0.112 vs 0.762±0.110), lumbar spine antero-posterior view (LSAP) (0.849±0.127 vs 0.854±0.135); median Z-score NOF {0.100[(-0.850)-(0.550)] vs -0.200[(-0.800)-(0.600)]}, LSAP {-1.200[(-1.700)-(-0.200)] vs -1.300 [(-1.85)-(-0.400)]} were also similar in study and control groups. Presence of normal BMD (9/41 vs 8/41), osteopenia (16/41 vs 18/41) and osteoporosis (16/41 vs 15/41) were comparable between the study and control groups. No significant difference was observed in the BMD, T-scores and Z-scores at NOF and LSAP among T2DM patients treated with thiazolidinediones; those treated with other OHA and controls. Interpretation & conclusions: The present findings show that the use of OHA for a period of three years or more does not significantly affect the BMD in patients with T2DM.

The effects of pioglitazone on the Kupffer cells of nonalcoholic fatty liver disease in rats / 中国医师杂志

Objective To explore the preventive effect and mechanism of pioglitazone on nonalcoholic fatty liver disease in rats.Methods Thirty six male Sprague-Dawley ( SD) rats were randomly divided into normal control group , high-fat diet group , and pioglitazone intervention group , with 12 rats in each group .Normal control group fed with standard diet for eight weeks , and the rest two groups fed with high fat diet .Pioglitazone intervention group fed with pioglitazone in the four to eight weeks , the rest two groups in the same period fed with distilled water .Fasting serum alanine aminotransferase , aspartate aminotransferase , total cholesterol , triglyc-erides, fasting glucose , and fasting blood insulin levels were determined .The fasting insulin resistance index was calculated .Routine histological features of hepatic section were observed by hematoxylin eosin (HE) staining.The shape change of Kupffer cells in the liv-er was detected .The levels of tumor necrosis factor ( TNF)-αand nitric oxide ( NO) secreted by Kupffer cells were measured .Results The fasting insulin resistance index , triglycerides , and total cholesterol in rats of high-fat diet group were significantly higher than in normal control group ( P <0.05 ) .Histopathological examination showed hepatocellular macrove sicular steatosis , lobular inflammatory cell infiltration, and inflammatory cell infiltration .Hepatic Kupffer cell morphology change , its produced TNF, NO and liver tissue pa-thology changes were positively correlated ( P <0.05 ) .The fasting insulin resistance index , triglycerides , total cholesterol was signifi-cantly lower in rats of pioglitazone intervention group than the high-fat diet group ( P <0.05 ) .The liver tissue structure was obviously improved pioglitazone intervention group rats , morphology and function of liver Kupffer cells were normal .Conclusions Pioglitazone can prevent the nonalcoholic fatty liver disease induced by high fat diet .The mechanism may be related to improve insulin resistance , reduce blood fat , and regulate function of Kupffer cells .

Inhibition of rotavirus ECwt infection in ICR suckling mice by N-acetylcysteine, peroxisome proliferator-activated receptor gamma agonists and cyclooxygenase-2 inhibitors

Live attenuated vaccines have recently been introduced for preventing rotavirus disease in children. However, alternative strategies for prevention and treatment of rotavirus infection are needed mainly in developing countries where low vaccine coverage occurs. In the present work, N-acetylcysteine (NAC), ascorbic acid (AA), some nonsteroidal anti-inflammatory drugs (NSAIDs) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists were tested for their ability to interfere with rotavirus ECwt infectivity as detected by the percentage of viral antigen-positive cells of small intestinal villi isolated from ECwt-infected ICR mice. Administration of 6 mg NAC/kg every 8 h for three days following the first diarrhoeal episode reduced viral infectivity by about 90%. Administration of AA, ibuprofen, diclofenac, pioglitazone or rosiglitazone decreased viral infectivity by about 55%, 90%, 35%, 32% and 25%, respectively. ECwt infection of mice increased expression of cyclooxygenase-2, ERp57, Hsc70, NF-κB, Hsp70, protein disulphide isomerase (PDI) and PPARγ in intestinal villus cells. NAC treatment of ECwt-infected mice reduced Hsc70 and PDI expression to levels similar to those observed in villi from uninfected control mice. The present results suggest that the drugs tested in the present work could be assayed in preventing or treating rotaviral diarrhoea in children and young animals.

Propriedades antiaterogênicas de novas tiazolidino-2, 4-dionas / Antiatherogenic properties of new thiazolidin-2, 4-diones

Tiazolidinadionas (TZDs) são agentes sensibilizadores de insulina que agem por ligação ao receptor gama ativado por proliferador de peroxissomos (PPARγ). Elas têm apresentado efeitos cardioprotetores em humanos e propriedades anti-aterogênicas em modelos animais. Estudos in vitro têm sugerido que esses efeitos anti-aterogênicos da ativação de PPARγ ocorrem por inibição da expressão de genes pro-inflamatórios e por aumentar o efluxo de colesterol via ativação dos receptores LXR-ABCA1. Entretanto, vários efeitos colaterais são associados ao tratamento com as TZDs, tornando necessária a pesquisa por novos compostos desta classe. Neste estudo, 14 novas tiazolidina-2,4- dionas, que são TZDs modificadas por bioisosterismo, foram avaliadas quanto à expressão de fatores aterogênicos e inflamatórios em linhagens de macrófagos J774 e RAW 264.7 e em camundongos com deleção genética para o receptor de LDL (LDLr-/-). Após a avaliação da citotoxicidade em macrófagos, foram eleitas cinco TZDs, denominadas de GQ-11, GQ-97, GQ-177, GQ-145 e LYSO-7. Três destas TZDs (GQ- 145, GQ-177 e LYSO-7) aumentaram significativamente a expressão de RNAm dos fatores de transcrição PPARγ1, PPARγ2 e do receptor CD36, assim como também aumentaram a expressão gênica de ABCA1 em 2.9, 3.5 e 6.7 vezes, respectivamente. Em adição, estas TZDs diminuíram a expressão gênica de iNOS, COX2, VCAM e IL-6 associado a redução na produção de nitritos, mas apenas a LYSO-7 reduziu significativamente a expressão desses genes quando comparada à rosiglitazona (RSG), além de diminuir a expressão da proteína-1 quimiotática para monócitos (MCP-1). No estudo experimental, os camundongos LDLr-/- machos foram alimentados com dieta hipercolesterolêmica por 16 semanas e quatro semanas antes da eutanásia receberam os derivados tiazolidínicos (20 mg/kg/dia) por gavagem. GQ-177 inibiu a progressão da placa aterosclerótica associada à aumento nas concentrações plasmáticas de HDL-C, com elevação na expressão de ABCA1, e redução da via inflamatória CD40-CD40L. LYSO-7 também mostrou inibição da aterogênese associada à redução das concentrações plasmáticas de colesterol total e triacilgliceróis, com diminuição na interação entre CD40-CD40L e expressão de citocinas inflamatórias. A GQ-145 não alterou os níveis plasmáticos dos lipídeos, mas aumentou a expressão de todos os genes pró-aterogênicos e pró-inflamatórios. Adicionalmente, as vias de ativação destas novas TZDs também foram estudadas por ensaio de luciferase, como gene repórter. A GQ-177 induziu ativação de PPARγ e ligação ao seu domínio, enquanto a LYSO-7 estimulou ativação de PPARα e PPARδ. Portanto, conclui-se que as novas TZDs, especialmente a GQ-177 e a LYSO-7, podem apresentar propriedades ateroprotetoras associadas ao transporte reverso de colesterol e aos efeitos antiinflamatórios, e poderiam ser uma alternativa promissora para o tratamento da aterosclerose. Porém, estudos complementares são requeridos para caracterizar as vias de sinalização intracelular, visto que as duas demonstraram ativar diferentes isotipos do fator de transcrição PPAR

Thiazolidinediones (TZDs) are insulin-sensitizing agents that act by binding to peroxisome proliferator-activated receptor-γ (PPARγ). They have been demonstrated to possess cardioprotective effects in humans and antiatherogenic properties in animal models. In vitro studies have also suggested that these antiatherogenic effects of PPARγ activation occur by inhibiting the inflammatory gene expression and by increasing cholesterol efflux via LXR-ABCA1 activation. However, several side effects are associated with TZDs treatment making necessary the search for new compounds. In this study, 14 new thiazolidine-2,4-diones, modified TZDs by bioisosterism, were tested for aterogenic and inflammtary factors in RAW 264.7 macrophages and in low-density lipoprotein receptor-deficient mice. After the citotoxicity evaluation in RAW 264.7 macrophages the TZDs named GQ-11, GQ-97, GQ-177, GQ-145 e LYSO-7 were selected for this study. Three of these TZDs (GQ-177, GQ-145 and LYSO-7) significantly increased the expression of PPARγ1, PPARγ2 and CD36 mRNA, and enhanced the expression of ABCA1 mRNA in 2.9, 3.5 and 6.7 fold, respectively. Moreover, they also significantly decreased the expression of iNOS, COX2, VCAM and IL-6 mRNA in relation to control, and these results are associated to reduction on nitrits concentration. In addition, LYSO-7 significantly reduced the expression of these genes when compared to rosiglitazone, and decreased expression of MCP1 mRNA. In the experimental study, male LDLr-/- mice were fed an atherogenic diet containing 0.5% cholesterol for 16 weeks, and 4 weeks before euthanasia they received TZDs (20mg/kg/ per day) by gavage. GQ-177 treatment inhibited progression of atherosclerotic plaque associated to increased plasma concentrations of HDL-C, with enhance of ABCA1 expression and reduction on CD40-CD40L interaction. LYSO-7 treatment also showed inhibition of the atherogenesis associated to decreased plasma concentrations of total cholesterol and TAG, with reduction on CD40-CD40L pathway and inflammatory cytokines expression.GQ-145 did not alter the lipid plasma levels and increased the expression of all pro-atherogenic and pro-inflammatory genes. Furthermore, the activation of PPARs has also been studied, by luciferase assay as reporter gene. GQ-177 induced activation of PPARγ, whereas LYSO-7 stimulated activation of PPARα and PPARß/δ. Altogether, our data suggest that the new TZDs derivatives, specially GQ- 177 and LYSO-7, may have atheroprotective properties associated with the reverse cholesterol transport and anti-inflammatory effects, and could be a promising alternative for the treatment of atherosclerosis. However, further studies are warranted in order to characterize the pathways of intracellular signaling since both have demonstrated to activate different isotypes of PPAR

Effect of pioglitazone on white matter lesions and spatial memory function in chronic hypertensive rats / 国际脑血管病杂志

Objective To investigate the effect of peroxisome proliferator-activated receptor γ (PPARγ) agonist pioglitazone on white matter lesions and spatial memory function in chronic hypertensive rats.Methods Thirty-six male Sprague-Dawley rats were randomly divided into a sham operation group (n =6),a hypertensive group,(n =15),and a pinglitazone group (n =15).A model of stroke-prone renovascular hypertensive rat (RHRSP) was induced by the two-kidney two clip method in the hypertensive group and pioglitazone group.At 8 weeks after procedure,the rats were administered intragastrically.10 mg/(kg · d) pioglitazone was given in the pioglitazone group and an equal volume of saline was given in the hypertensive group.Blood pressure was monitored via caudal artery every 2 weeks before procedure,before administration,and after administration,respectively.After 12 weeks of continuous administration,Loyez staining was used to observe the degree of leukoaraiosis,and Morris water maze test was used to detect spatial memory function.Results After modeling,the blood pressure of RHRSP increased gradually.It was significantly higher than the sham operation group (all P =0.001).There was no significant difference in blood pressure between the hypertensive group and the pioglitazone group (P =0.897).The Morris water maze test showed that escape latencies of the sham operation group and the pioglitazone group were significantly shorter than the hypertensive group (all P ＜0.05).The numbers of crossing hidden platform in the 3 groups of rats were 5.200 ± 1.798,4.560 ± 1.592,and 2.333 ± 1.978 times,respectively.There were significantly differences (F =8.143,P =0.001).Both the sham operation group and the pioglitazone group were significantly more than the hypertensive group (all P ＜0.05).Loyez staining showed that the grades of white matter lesions in corpus callosum of the sham operation group,the hypertensive group,and the pioglitazone group were 0.333 ± 0.516,2.600 ± 0.507,and 0.500 ± 0.522,respectively.There were significantly differences among the 3 groups (F =25.652,P =0.000).The grade of the sham operation group and the pioglitazone group was significantly lower than the hypertensive group (all P＜ 0.05).Conclusions PPARγ agonist pioglitazone may protect the spatial memory function by relieving white matter lesions of the chronic hypertensive rats.

Effect of pioglitazone on pancreatic apoptosis in rats with acute necrotizing pancreatitis / 中华胰腺病杂志

Objective To investigate the effect of pioglitazone on the activation of pancreatic apoptosis in the pathogenesis of rats with acute necrotizing pancreatitis.Methods Eighty Sprague-Dawley (SD) rats were randomly divided into four groups,including acute necrotizing pancreatitis (ANP),sham operation (SO),solvent control (Solvent),pioglitazone intervention (pioglitazone) group,with 20 rats in each group.ANP model was induced by retrograde injection of 4％ sodium taurocholate (1ml/kg body weight) into the biliary-pancreatic duct.The rats in pioglitazone group were injected pioglitazone (40 mg/kg body weight) into the ANP abdominalcavity 30 min before mldel induction.The rats were sacrificed at 1 h,3 h,6 h,and 12 h after ANP model induction.The pancreatic tissues were harvested.Routine HE staining was used to evaluate pancreatic pathological damage.The apoptosis was determined by TUNEL method.The expression of PPARγ was determined by using immunohistochemistry and Western-blot methods.The activity of caspase3 in pancreatic tissues was detected by using spectrophotometry.Results The pancreatic pathological damage was attenuated in rats in pioglitazone group compared with that in rats of ANP group,and the difference between the two groups was statistically significant (P ＜ 0.05).The PPARγ expression of pioglitazone group was 1.34 ± 0.09,which was significantly higher than that in ANP group (0.75 ± 0.05),and the difference between the two groups was statistically significant (P ＜ 0.05).The apoptotic index in pioglitazone group at 3 h was 8.35 ± 0.95,which was significantly higher than that in ANP group at 3 h (4.37 ± 1.22) ; the caspase3 activity was 9.24 ± 1.78,which was significantly higher than that in ANP group (5.04 ± 0.86),and the difference between the two groups was statistically significant (P ＜0.05).Conclusions Pioglitazone intervention attenuates pancreatic inflammation,increases PPARγ expression and caspase3 activity and induces apoptosis in pancreas of rats with acute necrotizing pancreatitis.

Effects of rapamycin combined with rosiglitazone on lung injury in septic rats / 中华麻醉学杂志

Objective To evaluate the effects of rapamycin combined with rosiglitazone on lung injury in septic rats.Methods One hundred and twenty healthy male Wistar rats were randomly divided into 5 groups (n =6 each):sham operation group (group S); cecum ligation and punture (CLP) group; rapamycin group (group RPM) ; rosiglitazone group (group RGZ) ; rapamycin plus rosiglitazone group (group RPM + RGZ).The rats were anesthetized with intraperitoneal 10% chloral hydrate 100 mg/kg.Sepsis was induced by CLP in groups CLP,RPM,RGZ and RPM + RGZ.At 30 min before CLP,rapamycin 0.4 mg/kg was injected subcutaneously in RPM group,rosiglitazone 0.3 mg/kg was injected via the femoral vein in RGZ group,and rapamycin 0.4 mg/kg was injected subcutaneously and rosiglitazone 0.3 mg/kg was injected via the femoral vein in group RPM + RGZ.While the equal volume of normal saline was given instead in CLP group.Six rats were sacrificed at 2,6,24 and 48 h after CLP in each group,and lungs were removed and cut into sections which were stained with haematoxylin and eosin and examined under microscope.The pathological changes of lungs were scored.The myeloperoxidase (MPO) activity and signal transducer and activator of transcription 3 (STAT3)-DNA binding activity in lung tissues were measured.Results Compared with group S,the pathological scores,MPO activity and STAT3-DNA binding activity were significantly increased in groups CLP,RPM,RGZ,RPM + RGZ (P ＜ 0.05).The pathological scores,MPO activity and STAT3-DNA binding activity were significantly lower in groups RPM,RGZ and RPM +RGZ than in group CLP,and in group RPM + RGZ than in groups RPM and RGZ (P ＜ 0.05).Conclusion Rapamycin combined with rosiglitazone offers additional benefit to attenuating lung injury induced by sepsis over rapamycin or rosiglitazone alone,and inhibition of activation of STAT3 pathway is involved in the mechanism.