A GLP-1/glucagon (GCG)/CCK2 receptors tri-agonist provides new therapy for obesity and diabetes.

BACKGROUND AND PURPOSE: Glucagon-like peptide-1 (GLP-1) and glucagon (GCG) receptor dual agonist have promising therapeutic effects in the treatment of obesity and diabetes. Moreover, GLP-1 and cholecystokinin 2 (CCK2 ) dual agonists have been shown to restore pancreas function and improve glycaemic control in preclinical studies. We describe, for the first time, the beneficial effects of GLP-1/glucagon receptor and GLP-1/CCK2 dual agonists, which can be integrated into one peptide, resulting in significant anti-diabetes and anti-obesity effectiveness. EXPERIMENTAL APPROACH: The in vitro potency of this novel peptide Xenopus (x) GLP-1/GCG/CCK2 tri-agonist (xGLP/GCG/gastrin) against GLP-1, GCG, CCK1 and CCK2 receptors was determined on cells expressing the corresponding receptors by cAMP accumulation or ERK1/2 phosphorylation assays. The in vivo anti-diabetes and anti-obesity effects of this tri-agonist xGLP/GCG/gastrin were studied in both db/db and diet induced obesity (DIO) mice. KEY RESULTS: xGLP/GCG/gastrin was a potent and selective GLP-1, GCG and CCK2 tri-agonist. In DIO mice, the metabolic benefits of xGLP-1/GCG/gastrin, such as reduction of body weight and hepatic lipid contents were significantly better than those of the peptide ZP3022 (GLP-1/CCK-2 dual agonist) and liraglutide. In a short-term study in db/db mice, xGLP/GCG/gastrin treatment had considerable effects, increasing islet numbers, islet areas and insulin content. In a long-term treatment study using db/db mice, xGLP-1/GCG/gastrin showed a significantly and sustained improvement in glucose tolerance and glucose control compared with that of liraglutide, ZP3022, cotadutide (GLP-1/GCG dual agonist) and xGLP/GCG-15. CONCLUSIONS AND IMPLICATIONS: These results demonstrate the therapeutic potential of xGLP-1/GCG/gastrin for the treatment of obesity and diabetes.

The anti-diabetic effects of GLP-1-gastrin dual agonist ZP3022 in ZDF rats.

AIMS/HYPOTHESIS: Combination treatment with exendin-4 and gastrin has proven beneficial in treatment of diabetes and preservation of beta cell mass in diabetic mice. Here, we examined the chronic effects of a GLP-1-gastrin dual agonist ZP3022 on glycemic control and beta cell dysfunction in overtly diabetic Zucker Diabetic Fatty (ZDF) rats. METHODS: ZDF rats aged 11 weeks were dosed s.c., b.i.d. for 8 weeks with vehicle, ZP3022, liraglutide, exendin-4, or gastrin-17 with or without exendin-4. Glycemic control was assessed by measurements of HbA1c and blood glucose levels, as well as glucose tolerance during an oral glucose tolerance test (OGTT). Beta cell dynamics were examined by morphometric analyses of beta and alpha cell fractions. RESULTS: ZP3022 improved glycemic control as measured by terminal HbA1c levels (6.2±0.12 (high dose) vs. 7.9±0.07% (vehicle), P<0.001), as did all treatments, except gastrin-17 monotherapy. In contrast, only ZP3022, exendin-4 and combination treatment with exendin-4 and gastrin-17 significantly improved glucose tolerance and increased insulin levels during an OGTT. Moreover, only ZP3022 significantly enhanced the beta cell fraction in ZDF rats, a difference of 41%, when compared to the vehicle group (0.31±0.03 vs. 0.22±0.02%, respectively, P<0.05). CONCLUSION: These data suggest that ZP3022 may have therapeutic potential in the prevention/delay of beta cell dysfunction in type 2 diabetes.

The novel GLP-1-gastrin dual agonist ZP3022 improves glucose homeostasis and increases ß-cell mass without affecting islet number in db/db mice.

Antidiabetic treatments aiming to preserve or even to increase ß-cell mass are currently gaining increased interest. Here we investigated the effect of chronic treatment with the novel glucagon-like peptide-1 (GLP-1)-gastrin dual agonist ZP3022 (HGEGTFTSDLSKQMEEEAVRLFIEWLKN-8Ado-8Ado-YGWLDF-NH2) on glycemic control, ß-cell mass and proliferation, and islet number. Male db/db mice were treated with ZP3022, liraglutide, or vehicle for 2, 4, or 8 weeks, with terminal assessment of hemoglobin A1c, basal blood glucose, and plasma insulin concentrations. Pancreata were removed for immunohistochemical staining and stereological quantification of ß-cell mass, islet numbers, proliferation, and apoptosis. Treatment with ZP3022 or liraglutide led to a significant improvement in glycemic control. ZP3022 treatment resulted in a sustained increase in ß-cell mass after 4 and 8 weeks of treatment, whereas the effect of liraglutide was transient. The expansion in ß-cell mass observed in the ZP3022-treated mice appeared to be driven by increased ß-cell proliferation in existing islets rather than by formation of new islets, as mean islet mass increased but the number of islets remained constant. Our data demonstrate that the GLP-1-gastrin dual agonist ZP3022 causes a sustained improvement in glycemic control accompanied by an increase in ß-cell mass, increased proliferation, and increased mean islet mass. The results highlight that the GLP-1-gastrin dual agonist increases ß-cell mass more than liraglutide and that dual agonists could potentially be developed into a new class of antidiabetic treatments.

The novel GLP-1-gastrin dual agonist, ZP3022, increases ß-cell mass and prevents diabetes in db/db mice.

AIM: Diabetes is characterized by ß-cell deficiency, and therefore restoration of ß-cell function has been suggested as a potential therapy. We hypothesized that a novel glucagon-like peptide-1 (GLP-1)-gastrin dual agonist, ZP3022, improves glycaemic control via improvement of ß-cell status in db/db mice. METHODS: Diabetic mice were studied following short- or long-term treatment with either the GLP-1-gastrin dual agonist or the commercially available GLP-1 agonists (exendin-4 and liraglutide). The effects on glycaemic control were addressed by repeated glucose tolerance tests and/or measurements of HbA1c levels, and pancreatic islet and ß-cell masses were determined by stereology. RESULTS: ZP3022 and the pure GLP-1 agonists improved glycaemic control after both short- and long-term treatment compared with vehicle. Interestingly, the effect was sustainable only in mice treated with ZP3022. Stereology data displayed a dose-dependent increase of ß-cell mass (p < 0.05) following treatment with ZP3022, whereas no significant effect of liraglutide was observed (ß-cell mass: vehicle 3.7 ± 0.2 mg; liraglutide (30 nmol/kg) 3.4 ± 0.5 mg; ZP3022 (30 nmol/kg) 4.3 ± 0.4 mg and ZP3022 (100 nmol/kg) 5.2 ± 0.4 mg). CONCLUSION: The novel GLP-1-gastrin dual agonist, ZP3022, improved glycaemic control in db/db mice, and pancreatic islet and ß-cell mass increased significantly following treatment with ZP3022 compared with vehicle.

E1-INT (Transition Therapeutics/Novo Nordisk).

Transition Therapeutics (through its acquisition of Waratah Pharmaceuticals), in collaboration with Novo Nordisk, is developing E1-INT, an injectable islet neogenesis therapy comprising an epidermal growth factor analog and a gastrin analog, for the treatment of insulin-dependent (type 1) and non-insulin-dependent (type 2) diabetes. The compound is currently undergoing phase II clinical trials.

Gastrin agonists and antagonists.

This review generally describes work in the area of CCK2 or gastrin receptor agonists and antagonists before focussing on highlights of studies in these areas carried out at the James Black Foundation over the last dozen years. Thus, an alanine scan of BOC-tetragastrin coupled with a bioassay in the isolated mouse stomach led to new insights as to the nature of the function of the various residues of the peptide. This in turn produced molecules such as the peptoid, JB 90118 which was an antagonist in all in vitro systems explored but was found to be CCK1 selective and an agonist still in vivo. We then go on to describe attempts to mimic a putative 3(10) helical conformation for BOC-tetragastrin which had been suggested by fluorescence studies. Structures based on the dibenzobicylo[2.2.2]octane skeleton appeared to fulfil the requirements of the pharmacophore and promising initial results were obtained after the requisite molecules were synthesised. Optimisation of this series led to compounds with affinities in the nanomolar range but which were lacking in consistency when examined in vivo. Further manipulation, this time of the skeleton, led to molecules such as JB 93182 which were of equivalent affinity but with a better profile of action in vivo. It was found during exploration of the SAR of this new series that even relatively small alterations to the structure could give rise to molecules which behaved as agonists. Attempts to improve the oral bioavailability of JB 93182 by reduction of its molecular weight were aided by a molecular modelling approach which ultimately gave rise to another new series, some imidazole derivatives, exemplified by JB 98248.

Coffee and gastrointestinal function: facts and fiction. A review.

BACKGROUND: Effects of coffee on the gastrointestinal system have been suggested by patients and the lay press, while doctors tend to discourage its consumption in some diseases. METHODS: The literature on the effects of coffee and caffeine on the gastrointestinal system is reviewed with emphasis on gastrointestinal function. RESULTS: Although often mentioned as a cause of dyspeptic symptoms, no association between coffee and dyspepsia is found. Heartburn is the most frequently reported symptom after coffee drinking. It is demonstrated that coffee promotes gastro-oesophageal reflux. Coffee stimulates gastrin release and gastric acid secretion, but studies on the effect on lower oesophageal sphincter pressure yield conflicting results. Coffee also prolongs the adaptive relaxation of the proximal stomach, suggesting that it might slow gastric emptying. However, other studies indicate that coffee does not affect gastric emptying or small bowel transit. Coffee induces cholecystokinin release and gallbladder contraction, which may explain why patients with symptomatic gallstones often avoid drinking coffee. Coffee increases rectosigmoid motor activity within 4 min after ingestion in some people. Its effects on the colon are found to be comparable to those of a 1000 kCal meal. Since coffee contains no calories, and its effects on the gastrointestinal tract cannot be ascribed to its volume load, acidity or osmolality, it must have pharmacological effects. Caffeine cannot solely account for these gastrointestinal effects. CONCLUSIONS: Coffee promotes gastro-oesophageal reflux, but is not associated with dyspepsia. Coffee stimulates gallbladder contraction and colonic motor activity.

Evaluation of biologic gastrin activity of compound CI-988 in the isolated, vascularly perfused rat stomach.

BACKGROUND: The peptoid CI-988 has previously been shown to have high affinity for the cholecystokinin (CCK)-B/gastrin receptor and has been reported to be a powerful CCK antagonist in many systems, although it has agonist activity on histidine decarboxylase in the rat. METHODS: In the present study the effect of CI-988 on acid secretion and histamine release in the totally isolated, vascularly perfused rat stomach was assessed. RESULTS: CI-988 was found to be a gastrin agonist with regard to the stimulation of both histamine release and acid secretion. CONCLUSION: Thus, in this stomach model CI-988 behaved as a CCKB/gastrin agonist. The present study underlines the importance of testing the biologic activity of ligands in models with sufficient sensitivity.

Cytosolic Ca2+ evaluation in rabbit parietal cells: a novel method to screen gastrin receptor antagonists.

We have evaluated the application of the fura-2 method to detect cytosolic Ca2+ increase in gastric cells expressing CCKB/gastrin receptors, in order to screen gastrin receptor antagonists, as an alternative to functional studies. We have characterized the receptors on parietal cell suspension from rabbit gastric mucosa and validated the method using both the CCKB and CCKA receptor agonists and antagonists. Human gastrin I (gastrin) (0.1 nM-4 microM) and sulfated cholecystokinin 26-33 (CCK-8) (0.01 nM-2 microM) dose-dependently augmented cytosolic Ca2+. The efficacies of the two agonists were similar, but the potency of CCK-8 (EC50 1.03 nM) was about 10-fold greater than that of gastrin (11 nM). Response to a submaximal dose of gastrin (50 nM) was dose-dependently blocked by the CCKB-receptor antagonists CAM-1028 (4-[[2-[[3-(1 H-indol-3-yl)-2-methyl-1-oxo-2-[[[1,7,7-trimethylbicyclo[2, 2,1]hept-2-yl)oxy]carbonyl]amino]propyl]amino]-1-phenylethyl]amino-4-oxo -[1 S-1 alpha, 2 beta [S'(S')4 alpha]]-butanoate-N-methyl-D-glucamine) (IC50 1.9 nM), L-365,260 (3 R(+)-N-(2,3-dihydro-1-methyl-2-oxo-5-phenyl-1 H-1, 4-benzodiazepin-3-yl)-N'-(3-methylphenyl)urea) (IC50 10 nM) and spiroglumide ((R)-4-(3,5-dichlorobenzamido)-5-(8-azaspiro[4.5]decan -8-yl)-5-oxopentanoic acid) (IC50 2 microM). The results were in agreement with those obtained from binding studies in guinea-pig cortical membranes. The model was employed to optimize the synthesis of a new class of spiroglumide analogues which led to a new molecule, (S)-4-¿(R)-4'-(3,5-dichlorobenzoylamino)-5'-(8-azaspiro[4.5] decan-8-yl)-5'-oxo)-pentanoylamino-5-(1-naphthylamino)-5-oxo pentanoic acid (CR 2622), whose potency was about 100-fold greater than that of spiroglumide. CR 2622, as well as the other CCKB receptor antagonists tested, exhibited no effect on basal [Ca2+]i. The simplicity and the reproducibility of this method suggest that it is a useful model to screen gastrin and antigastrin activity in parallel or as an alternative to binding studies.