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The Search for the Causes of Common Hyperandrogenism, 1965 to Circa 2015. 寻找常见雄激素过多症的原因,1965 年至 2015 年左右。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-12 DOI: 10.1210/endrev/bnae007
Robert L Rosenfield

From 1965 to 2015, immense strides were made into understanding the mechanisms underlying the common androgen excess disorders, premature adrenarche and polycystic ovary syndrome (PCOS). The author reviews the critical discoveries of this era from his perspective investigating these disorders, commencing with his early discoveries of the unique pattern of plasma androgens in premature adrenarche and the elevation of an index of the plasma free testosterone concentration in most hirsute women. The molecular genetic basis, though not the developmental biologic basis, for adrenarche is now known and 11-oxytestosterones shown to be major bioactive adrenal androgens. The evolution of the lines of research into the pathogenesis of PCOS is historically traced: research milestones are cited in the areas of neuroendocrinology, insulin resistance, hyperinsulinism, type 2 diabetes mellitus, folliculogenesis, androgen secretion, obesity, phenotyping, prenatal androgenization, epigenetics, and complex genetics. Large-scale genome-wide association studies led to the 2014 discovery of an unsuspected steroidogenic regulator DENND1A (differentially expressed in normal and neoplastic development). The splice variant DENND1A.V2 is constitutively overexpressed in PCOS theca cells in long-term culture and accounts for their PCOS-like phenotype. The genetics are complex, however: DENND1A intronic variant copy number is related to phenotype severity, and recent data indicate that rare variants in a DENND1A regulatory network and other genes are related to PCOS. Obesity exacerbates PCOS manifestations via insulin resistance and proinflammatory cytokine excess; excess adipose tissue also forms testosterone. Polycystic ovaries in 40 percent of apparently normal women lie on the PCOS functional spectrum. Much remains to be learned.

从 1965 年到 2015 年,人们在了解常见的雄激素过多疾病--过早性腺发育和多囊卵巢综合征(PCOS)的发病机制方面取得了巨大进步。作者从他研究这些疾病的角度回顾了这一时期的重要发现,首先是他早期发现早衰性肾上腺皮质激素的独特模式,以及大多数多毛女性血浆游离睾酮浓度指数的升高。现在,人们已经知道了肾上腺早熟的分子遗传学基础(尽管不是发育生物学基础),并证明 11-氧睾酮是具有生物活性的主要肾上腺雄激素。多囊卵巢综合症发病机制研究路线的演变可追溯到历史:在神经内分泌学、胰岛素抵抗、高胰岛素血症、2 型糖尿病、卵泡生成、雄激素分泌、肥胖、表型、产前雄激素化、表观遗传学和复杂遗传学等领域的研究具有里程碑意义。大规模的全基因组关联研究促使人们在2014年发现了一种未被察觉的类固醇生成调节因子DENND1A(在正常和肿瘤性发育过程中差异表达)。剪接变体DENND1A.V2在长期培养的多囊卵巢综合征(PCOS)绒毛膜细胞中构成性过表达,并导致其多囊卵巢综合征样表型。然而,遗传学是复杂的:DENND1A 内含子变异拷贝数与表型严重程度有关,最近的数据表明,DENND1A 调控网络和其他基因中的罕见变异与多囊卵巢综合症有关。肥胖会通过胰岛素抵抗和促炎症细胞因子过多加剧多囊卵巢综合症的表现;过多的脂肪组织还会形成睾酮。四分之一表面上正常的女性患有多囊卵巢综合症,这属于多囊卵巢综合症的功能范围。还有许多问题有待了解。
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引用次数: 0
Preclinical Rodent Models for Human Bone Disease, Including a Focus on Cortical Bone. 人类骨病的临床前啮齿动物模型,包括皮质骨。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-12 DOI: 10.1210/endrev/bnae004
Natalie Y Y Koh, Justyna J Miszkiewicz, Mary Louise Fac, Natalie K Y Wee, Natalie A Sims

Preclinical models (typically ovariectomized rats and genetically altered mice) have underpinned much of what we know about skeletal biology. They have been pivotal for developing therapies for osteoporosis and monogenic skeletal conditions, including osteogenesis imperfecta, achondroplasia, hypophosphatasia, and craniodysplasias. Further therapeutic advances, particularly to improve cortical strength, require improved understanding and more rigorous use and reporting. We describe here how trabecular and cortical bone structure develop, are maintained, and degenerate with aging in mice, rats, and humans, and how cortical bone structure is changed in some preclinical models of endocrine conditions (eg, postmenopausal osteoporosis, chronic kidney disease, hyperparathyroidism, diabetes). We provide examples of preclinical models used to identify and test current therapies for osteoporosis, and discuss common concerns raised when comparing rodent preclinical models to the human skeleton. We focus especially on cortical bone, because it differs between small and larger mammals in its organizational structure. We discuss mechanisms common to mouse and human controlling cortical bone strength and structure, including recent examples revealing genetic contributors to cortical porosity and osteocyte network configurations during growth, maturity, and aging. We conclude with guidelines for clear reporting on mouse models with a goal for better consistency in the use and interpretation of these models.

临床前模型(通常是切除卵巢的大鼠和基因改变的小鼠)为我们了解骨骼生物学奠定了基础。它们在开发骨质疏松症和单基因骨骼疾病(包括成骨不全症、软骨发育不全症、软骨发育不全症和颅骨发育不全症)的疗法方面发挥了关键作用。要取得进一步的治疗进展,尤其是改善皮质强度,就必须加深了解并更严格地使用和报告。我们在此描述小鼠、大鼠和人类骨小梁和骨皮质结构是如何发育、维持和随着年龄增长而退化的,以及在内分泌疾病(如绝经后骨质疏松症、慢性肾病、甲状旁腺功能亢进、糖尿病)的临床前模型中骨皮质结构是如何变化的。我们将举例说明用于确定和测试当前骨质疏松症疗法的临床前模型,并讨论将啮齿动物临床前模型与人体骨骼进行比较时常见的问题。我们尤其关注皮质骨,因为小型哺乳动物和大型哺乳动物的皮质骨在组织结构上有所不同。我们讨论了小鼠和人类控制皮质骨强度和结构的共同机制,包括最近揭示了生长、成熟和老化过程中皮质孔隙率和骨细胞网络配置的遗传因素。最后,我们提出了明确报告小鼠模型的指导原则,目的是更好地统一这些模型的使用和解释。
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引用次数: 0
The Immune Landscape of Pheochromocytoma and Paraganglioma: Current Advances and Perspectives. 嗜铬细胞瘤和副神经节瘤的免疫格局:当前进展与前景。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-12 DOI: 10.1210/endrev/bnae005
Ondrej Uher, Katerina Hadrava Vanova, David Taïeb, Bruna Calsina, Mercedes Robledo, Roderick Clifton-Bligh, Karel Pacak

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors derived from neural crest cells from adrenal medullary chromaffin tissues and extra-adrenal paraganglia, respectively. Although the current treatment for PPGLs is surgery, optimal treatment options for advanced and metastatic cases have been limited. Hence, understanding the role of the immune system in PPGL tumorigenesis can provide essential knowledge for the development of better therapeutic and tumor management strategies, especially for those with advanced and metastatic PPGLs. The first part of this review outlines the fundamental principles of the immune system and tumor microenvironment, and their role in cancer immunoediting, particularly emphasizing PPGLs. We focus on how the unique pathophysiology of PPGLs, such as their high molecular, biochemical, and imaging heterogeneity and production of several oncometabolites, creates a tumor-specific microenvironment and immunologically "cold" tumors. Thereafter, we discuss recently published studies related to the reclustering of PPGLs based on their immune signature. The second part of this review discusses future perspectives in PPGL management, including immunodiagnostic and promising immunotherapeutic approaches for converting "cold" tumors into immunologically active or "hot" tumors known for their better immunotherapy response and patient outcomes. Special emphasis is placed on potent immune-related imaging strategies and immune signatures that could be used for the reclassification, prognostication, and management of these tumors to improve patient care and prognosis. Furthermore, we introduce currently available immunotherapies and their possible combinations with other available therapies as an emerging treatment for PPGLs that targets hostile tumor environments.

嗜铬细胞瘤和副神经节瘤(PPGLs)是一种罕见的神经内分泌肿瘤,分别来自肾上腺髓质绒毛组织或肾上腺外副神经节的神经嵴细胞。虽然目前治疗 PPGLs 的方法是手术,但晚期和转移性病例的最佳治疗方案却很有限。因此,了解免疫系统在 PPGL 肿瘤发生过程中的作用可为制定更好的治疗和肿瘤管理策略提供必要的知识,尤其是对晚期和转移性 PPGL 患者而言。本综述的第一部分概述了免疫系统和肿瘤微环境的基本原理,以及它们在癌症免疫调节中的作用,特别强调了 PPGLs。我们将重点讨论 PPGLs 独特的病理生理学,如其高度的分子、生化和成像异质性以及多种肿瘤代谢产物的产生,是如何形成肿瘤特异性微环境和免疫学上 "冷 "的肿瘤的。随后,我们将讨论近期发表的基于免疫特征对 PPGLs 进行再聚类的相关研究。综述的第二部分讨论了 PPGL 管理的未来前景,包括将 "冷 "肿瘤转化为免疫活跃或 "热 "肿瘤的免疫诊断和有前景的免疫治疗方法,这些肿瘤因其更好的免疫治疗反应和患者预后而闻名。我们特别强调了有效的免疫相关成像策略和免疫特征,可用于这些肿瘤的重新分类、预后和管理,以改善患者护理和预后。此外,我们还介绍了目前可用的免疫疗法及其与其他可用疗法的可能组合,作为针对恶劣肿瘤环境的新兴 PPGLs 治疗方法。
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引用次数: 0
The Glucocorticoid Receptor: Isoforms, Functions, and Contribution to Glucocorticoid Sensitivity. 糖皮质激素受体:同工型、功能和对糖皮质激素敏感性的贡献。
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-12 DOI: 10.1210/endrev/bnae008
Jack Lockett, Warrick J Inder, Vicki L Clifton

Glucocorticoids exert pleiotropic effects on all tissues to regulate cellular and metabolic homeostasis. Synthetic forms are used therapeutically in a wide range of conditions for their anti-inflammatory benefits, at the cost of dose and duration-dependent side effects. Significant variability occurs between tissues, disease states, and individuals with regard to both the beneficial and deleterious effects. The glucocorticoid receptor (GR) is the site of action for these hormones and a vast body of work has been conducted understanding its function. Traditionally, it was thought that the anti-inflammatory benefits of glucocorticoids were mediated by transrepression of pro-inflammatory transcription factors, while the adverse metabolic effects resulted from direct transactivation. This canonical understanding of the GR function has been brought into question over the past 2 decades with advances in the resolution of scientific techniques, and the discovery of multiple isoforms of the receptor present in most tissues. Here we review the structure and function of the GR, the nature of the receptor isoforms, and the contribution of the receptor to glucocorticoid sensitivity, or resistance in health and disease.

糖皮质激素对所有组织都有多方面的影响,可调节细胞和新陈代谢的平衡。合成糖皮质激素可用于治疗多种疾病,具有抗炎作用,但其副作用与剂量和持续时间有关。不同组织、不同疾病状态和不同个体之间,糖皮质激素的益处和副作用都存在显著差异。糖皮质激素受体是这些激素的作用部位,人们已对其功能进行了大量研究。传统上,人们认为糖皮质激素的抗炎作用是通过转抑促炎转录因子介导的,而对代谢的不利影响则是直接转激活的结果。过去二十年来,随着科学技术分辨率的提高和大多数组织中糖皮质激素受体多种异构体的发现,这种对糖皮质激素受体功能的传统认识受到了质疑。在此,我们回顾了糖皮质激素受体的结构和功能、受体异构体的性质以及受体对糖皮质激素的敏感性或在健康和疾病中的抵抗力的贡献。
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引用次数: 0
Appetite- and Weight-Regulating Neuroendocrine Circuitry in Hypothalamic Obesity. 下丘脑肥胖的食欲和体重调节神经内分泌回路。
IF 20.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-07 DOI: 10.1210/endrev/bnad033
Hoong-Wei Gan, Manuela Cerbone, Mehul Tulsidas Dattani

Since hypothalamic obesity (HyOb) was first described over 120 years ago by Joseph Babinski and Alfred Fröhlich, advances in molecular genetic laboratory techniques have allowed us to elucidate various components of the intricate neurocircuitry governing appetite and weight regulation connecting the hypothalamus, pituitary gland, brainstem, adipose tissue, pancreas, and gastrointestinal tract. On a background of an increasing prevalence of population-level common obesity, the number of survivors of congenital (eg, septo-optic dysplasia, Prader-Willi syndrome) and acquired (eg, central nervous system tumors) hypothalamic disorders is increasing, thanks to earlier diagnosis and management as well as better oncological therapies. Although to date the discovery of several appetite-regulating peptides has led to the development of a range of targeted molecular therapies for monogenic obesity syndromes, outside of these disorders these discoveries have not translated into the development of efficacious treatments for other forms of HyOb. This review aims to summarize our current understanding of the neuroendocrine physiology of appetite and weight regulation, and explore our current understanding of the pathophysiology of HyOb.

自从120多年前Joseph Babinski和Alfred Fröhlich首次描述下丘脑肥胖(HyOb)以来,分子遗传实验室技术的进步使我们能够阐明控制食欲和体重调节的复杂神经回路的各种组成部分,这些神经回路连接着下丘脑、脑垂体、脑干、脂肪组织、胰腺和胃肠道。在人口水平普遍肥胖日益流行的背景下,由于早期诊断和管理以及更好的肿瘤治疗,先天性(如视隔发育不良、普瑞德-威利综合征)和获得性(如中枢神经系统肿瘤)下丘脑疾病的幸存者人数正在增加。尽管到目前为止,几种食欲调节肽的发现已经导致了一系列针对单基因肥胖综合征的靶向分子疗法的发展,但除了这些疾病之外,这些发现还没有转化为对其他形式的肥胖的有效治疗的发展。本文旨在总结我们目前对食欲和体重调节的神经内分泌生理学的认识,并探讨我们目前对HyOb病理生理学的认识。
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引用次数: 0
What Is Carcinoid Syndrome? A Critical Appraisal of Its Proposed Mediators. 什么是类癌综合征?对其提议的调解人的批判性评价。
IF 20.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-07 DOI: 10.1210/endrev/bnad035
Merijn C F Mulders, Wouter W de Herder, Johannes Hofland

Carcinoid syndrome (CS) is a debilitating disease that affects approximately 20% of patients with neuroendocrine neoplasms (NEN). Due to the increasing incidence and improved overall survival of patients with NEN over recent decades, patients are increasingly suffering from chronic and refractory CS symptoms. At present, symptom control is hampered by an incomplete understanding of the pathophysiology of this syndrome. This systematic review is the first to critically appraise the available evidence for the various hormonal mediators considered to play a causative role in CS. Overall, evidence for the putative mediators of CS was scarce and often of poor quality. Based on the available literature, data are only sufficient to agree on the role of serotonin as a mediator of CS-associated diarrhea and fibrosis. A direct role for tachykinins and an indirect role of catecholamines in the pathogenesis of CS is suggested by several studies. Currently, there is insufficient evidence to link histamine, bradykinin, kallikrein, prostaglandins, or motilin to CS. To summarize, available literature only sufficiently appoints serotonin and suggests a role for tachykinins and catecholamines as mediators of CS, with insufficient evidence for other putative mediators. Descriptions of CS should be revised to focus on these proven hormonal associations to be more accurate, and further research is needed into other potential mediators.

类癌综合征(CS)是一种使人衰弱的疾病,影响了大约20%的神经内分泌肿瘤(NEN)患者。近几十年来,由于NEN患者的发病率增加和总体生存率提高,患者越来越多地患有慢性难治性CS症状。目前,由于对该综合征病理生理的不完全了解,阻碍了症状控制。本系统综述首次批判性地评估了各种激素介质被认为在CS中起致病作用的现有证据。总的来说,关于假定的CS介质的证据很少,而且往往质量很差。根据现有文献,数据仅足以同意5 -羟色胺作为cs相关性腹泻和纤维化介质的作用。一些研究表明,快激素在CS的发病机制中起直接作用,儿茶酚胺在CS的发病机制中起间接作用。目前,没有足够的证据将组胺、缓激肽、缓激肽、前列腺素或动蛋白与CS联系起来。综上所述,现有文献仅充分确定了5 -羟色胺,并提出了速激素和儿茶酚胺作为CS的介质的作用,而其他假定的介质的证据不足。对CS的描述应进行修订,将重点放在这些已证实的激素关联上,以使其更加准确,并需要对其他潜在介质进行进一步研究。
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引用次数: 0
Endotrophin, a Key Marker and Driver for Fibroinflammatory Disease. 内营养素--纤维炎症性疾病的关键标志物和驱动因素
IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-07 DOI: 10.1210/endrev/bnad036
Kim Henriksen, Federica Genovese, Alexander Reese-Petersen, Laurent P Audoly, Kai Sun, Morten A Karsdal, Philipp E Scherer

Our overview covers several key areas related to recent results obtained for collagen type VI and endotrophin (ETP). (1) An introduction to the history of ETP, including how it was identified, how it is released, and its function and potential receptors. (2) An introduction to the collagen family, with a focus on what differentiates collagen type VI from an evolutionary standpoint. (3) An overview of collagen type VI, the 6 individual chains (COL6A1, A2, A3, A4, A5, and A6), their differences and similarities, as well as their expression profiles and function. (4) A detailed analysis of COL6A3, including the cleaved product endotrophin, and what separates it from the other 5 collagen 6 molecules, including its suggested function based on insights gained from knockout and gain of function mouse models. (5) The pathology of ETP. What leads to its presence and release and what are the consequences thereof? (6) Functional implications of circulating ETP. Here we review the data with the functional roles of ETP in mind. (7) We propose that ETP is a mediator for fibrotic (or fibroinflammatory) disorders. Based on what we know about ETP, we have to consider it as a target for the treatment of fibrotic (or fibroinflammatory) disorders. What segment(s) of the patient population would most dramatically respond to an ETP-targeted intervention? How can we find the population that would profit most from an intervention? We aim to present a broad overview over the ETP field at large, providing an assessment of where the future research efforts need to be placed to tap into the vast potential of ETP, both as a marker and as a target in different diseases.

我们的概述涵盖与 VI 型胶原蛋白和内营养素 (ETP) 的最新研究成果有关的几个关键领域:i) ETP 的历史介绍,包括它是如何被发现的、它是如何被释放的以及它的功能和潜在受体。 iii) VI 型胶原蛋白概述,六条单独的链(COL6A1、A2、A3、A4、A5 和 A6)、它们的异同以及它们的表达谱和功能。iv) 详细分析 COL6A3,包括其裂解产物内营养素(endotrophin),以及它与其他五种胶原蛋白 6 分子的区别,包括根据基因敲除和功能增益小鼠模型得出的功能建议。 v) 介绍 ETP 的历史,包括它是如何被发现的、如何释放以及它的功能和潜在受体。是什么导致了 ETP 的存在和释放?)循环 ETP 的功能影响。viii) 我们认为 ETP 是纤维化(或纤维炎症?根据我们对 ETP 的了解,我们必须将其视为治疗纤维化(或纤维炎症)疾病的靶点。哪些患者群体会对以 ETP 为靶点的干预措施产生最显著的反应?我们如何才能找到从干预措施中获益最多的人群?我们的目标是对整个 ETP 领域进行全面概述,评估未来研究工作的重点,以挖掘 ETP 作为不同疾病的标记物和靶点的巨大潜力。
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引用次数: 0
Correction to: "ER Stress in Cardiometabolic Diseases: From Molecular Mechanisms to Therapeutics". 更正:"ER应激在心脏代谢疾病中的作用:从分子机制到治疗"。
IF 20.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-07 DOI: 10.1210/endrev/bnae006
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引用次数: 0
Correction to: "The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa". 更正:"每周胰岛素疗法的基础:胰岛素 Icodec 和胰岛素 Efsitora Alfa 的演变证据"。
IF 20.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-07 DOI: 10.1210/endrev/bnae012
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引用次数: 0
The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa. 每周胰岛素疗法的基础:胰岛素 Icodec 和胰岛素 Efsitora Alfa 的演变证据。
IF 20.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-07 DOI: 10.1210/endrev/bnad037
Julio Rosenstock, Rattan Juneja, John M Beals, Julie S Moyers, Liza Ilag, Rory J McCrimmon

Basal insulin continues to be a vital part of therapy for many people with diabetes. First attempts to prolong the duration of insulin formulations were through the development of suspensions that required homogenization prior to injection. These insulins, which required once- or twice-daily injections, introduced wide variations in insulin exposure contributing to unpredictable effects on glycemia. Advances over the last 2 decades have resulted in long-acting, soluble basal insulin analogues with prolonged and less variable pharmacokinetic exposure, improving their efficacy and safety, notably by reducing nocturnal hypoglycemia. However, adherence and persistence with once-daily basal insulin treatment remains low for many reasons including hypoglycemia concerns and treatment burden. A soluble basal insulin with a longer and flatter exposure profile could reduce pharmacodynamic variability, potentially reducing hypoglycemia, have similar efficacy to once-daily basal insulins, simplify dosing regimens, and improve treatment adherence. Insulin icodec (Novo Nordisk) and insulin efsitora alfa (basal insulin Fc [BIF], Eli Lilly and Company) are 2 such insulins designed for once-weekly administration, which have the potential to provide a further advance in basal insulin replacement. Icodec and efsitora phase 2 clinical trials, as well as data from the phase 3 icodec program indicate that once-weekly insulins provide comparable glycemic control to once-daily analogues, with a similar risk of hypoglycemia. This manuscript details the technology used in the development of once-weekly basal insulins. It highlights the clinical rationale and potential benefits of these weekly insulins while also discussing the limitations and challenges these molecules could pose in clinical practice.

基础胰岛素仍然是许多糖尿病患者治疗的重要组成部分。为了延长胰岛素制剂的持续时间,人们首先开发了需要在注射前均质化的悬浮液。这些胰岛素需要每天注射一次或两次,导致胰岛素暴露量差异很大,对血糖的影响难以预测。过去二十年来,长效、可溶性基础胰岛素类似物取得了进展,其药代动力学暴露时间更长且变化更小,从而提高了其疗效和安全性,尤其是减少了夜间低血糖的发生。然而,由于低血糖问题和治疗负担等多种原因,每日一次基础胰岛素治疗的依从性和持续性仍然很低。可溶性基础胰岛素的暴露曲线更长、更平滑,可减少药效学变异性,从而有可能减少低血糖的发生,其疗效与每日一次基础胰岛素相似,可简化给药方案,提高治疗依从性。胰岛素 icodec(诺和诺德)和胰岛素 efsitora alfa(基础胰岛素 Fc [BIF],礼来公司)就是这样两种设计为每周给药一次的胰岛素,它们有可能进一步推动基础胰岛素的替代。Icodec和efsitora的2期临床试验以及icodec项目3期的数据表明,每周一次的胰岛素可提供与每日一次的类似物相当的血糖控制效果,而且发生低血糖的风险相似。本手稿详细介绍了用于开发每周一次基础胰岛素的技术。它强调了这些每周胰岛素的临床原理和潜在优势,同时也讨论了这些分子在临床实践中可能带来的局限性和挑战。
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引用次数: 0
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Endocrine reviews
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