Semaglutide combined with empagliflozin vs. monotherapy for non-alcoholic fatty liver disease in type 2 diabetes: Study protocol for a randomized clinical trial.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes mellitus (T2DM). Lifestyle intervention remains a preferred treatment modality for NAFLD. The glucagon-like peptide (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been developed as new glucose-lowering drugs, which can improve fatty liver via an insulin-independent glucose-lowering effect. However, studies exploring the efficacy of GLP-1 receptor agonists combined with SGLT-2 inhibitors in patients with NAFLD and T2DM are scanty. Thus, the present randomised controlled trial aims at comparing the efficacy and safety of semaglutide plus empagliflozin with each treatment alone in patients with NAFLD and T2DM. METHODS: This 52-week double-blinded, randomised, parallel-group, active-controlled trial evaluates the effects of semaglutide, empagliflozin and semaglutide + empagliflozin in 105 eligible overweight/obese subjects with NAFLD and T2DM. The primary outcome will be a change from baseline to week 52 in the controlled attenuation parameter, free fatty acid and glucagon. Secondary endpoints include changes in liver stiffness measurement, liver enzymes, blood glucose, lipid levels, renal function, electrolyte balances, minerals and bone metabolism, cytokines, high-sensitivity C-reactive protein, ferritin, anthropometric indicators, nonalcoholic fatty liver fibrosis score, fibrosis 4 score and homeostatic model assessment for insulin resistance. In addition, intention-to-treat, interim analysis and safety analysis will be performed. DISCUSSION: This double-blinded, randomised, clinical trial involves a multi-disciplinary approach and aims to explore the synergistic effects of the combination of semaglutide and empagliflozin. The results can provide important insights into mechanisms of GLP-1 receptor agonists and/or SGLT-2 inhibitors in patients with NAFLD and T2DM. TRIAL REGISTRATION: This study has been registered with Chinese Clinical Trial Registry (ChiCTR2300070674).

CaZn(HPO3)2 and Ba2Zn(HPO3)3: novel alkaline-earth zincophosphites with diversified anionic frameworks.

Two novel alkaline-earth zincophosphites, namely CaZn(HPO3)2 and Ba2Zn(HPO3)3, were successfully synthesized under hydrothermal conditions. CaZn(HPO3)2 exhibits a three-dimensional (3D) anionic framework with a 6-connected uni-nodal pcu α-Po primitive cubic topology, constructed by unique Zn2O8 dimers and HPO3 pseudo-tetrahedra, while Ba2Zn(HPO3)3 displays one-dimensional (1D) [Zn(HPO3)3]4- anionic chains. It is worth mentioning that CaZn(HPO3)2 represents the first example of an alkaline-earth zincophosphite compound with a 3D framework structure. Our research also revealed the importance of both alkaline earth cation sizes and Zn/P ratios in anionic open-framework formation. The crystal structures of both compounds were further verified by energy dispersive spectroscopy, IR spectroscopy and Raman spectroscopy. Optical diffuse reflectance spectra, coupled with Tauc's fitting, revealed direct bandgaps with energy values of 4.33 and 4.48 eV for CaZn(HPO3)2 and Ba2Zn(HPO3)3, respectively, which differ from the prediction of theoretical calculations. Density of states calculations were conducted to reveal the origin of the bandgaps and bond interactions. Both compounds exhibited moderate birefringence values. This work may have implications for the design and synthesis of novel metal phosphites with desired properties.