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A comprehensive overview on the crosstalk between microRNAs and viral pathogenesis and infection. 全面概述 microRNA 与病毒发病和感染之间的相互关系。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-26 DOI: 10.1002/med.22073
Seyedeh Zahra Bahojb Mahdavi, Asiyeh Jebelli, Parisa Shiri Aghbash, Behzad Baradaran, Mohammad Amini, Fatemeh Oroojalian, Nasser Pouladi, Hossein Bannazadeh Baghi, Miguel de la Guardia, Amir Ali Mokhtarzadeh

Infections caused by viruses as the smallest infectious agents, pose a major threat to global public health. Viral infections utilize different host mechanisms to facilitate their own propagation and pathogenesis. MicroRNAs (miRNAs), as small noncoding RNA molecules, play important regulatory roles in different diseases, including viral infections. They can promote or inhibit viral infection and have a pro-viral or antiviral role. Also, viral infections can modulate the expression of host miRNAs. Furthermore, viruses from different families evade the host immune response by producing their own miRNAs called viral miRNAs (v-miRNAs). Understanding the replication cycle of viruses and their relation with host miRNAs and v-miRNAs can help to find new treatments against viral infections. In this review, we aim to outline the structure, genome, and replication cycle of various viruses including hepatitis B, hepatitis C, influenza A virus, coronavirus, human immunodeficiency virus, human papillomavirus, herpes simplex virus, Epstein-Barr virus, Dengue virus, Zika virus, and Ebola virus. We also discuss the role of different host miRNAs and v-miRNAs and their role in the pathogenesis of these viral infections.

病毒作为最小的传染源,其引起的感染对全球公共卫生构成了重大威胁。病毒感染利用不同的宿主机制来促进自身的传播和致病。微小核糖核酸(miRNA)作为非编码 RNA 小分子,在包括病毒感染在内的各种疾病中发挥着重要的调控作用。它们可以促进或抑制病毒感染,具有促病毒或抗病毒的作用。此外,病毒感染还能调节宿主 miRNA 的表达。此外,不同家族的病毒通过产生自己的 miRNAs(病毒 miRNAs,v-miRNAs)来逃避宿主的免疫反应。了解病毒的复制周期及其与宿主 miRNAs 和 v-miRNAs 的关系,有助于找到抗病毒感染的新疗法。在这篇综述中,我们旨在概述各种病毒的结构、基因组和复制周期,包括乙型肝炎病毒、丙型肝炎病毒、甲型流感病毒、冠状病毒、人类免疫缺陷病毒、人类乳头瘤病毒、单纯疱疹病毒、Epstein-Barr 病毒、登革热病毒、寨卡病毒和埃博拉病毒。我们还讨论了不同宿主 miRNA 和 v-miRNA 的作用及其在这些病毒感染发病机制中的作用。
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引用次数: 0
Deciphering the enigmas of non-nucleoside reverse transcriptase inhibitors (NNRTIs): A medicinal chemistry expedition towards combating HIV drug resistance. 破解非核苷类逆转录酶抑制剂(NNRTIs)之谜:对抗艾滋病抗药性的药物化学探险。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-26 DOI: 10.1002/med.22080
Kun Zhang, Yu-Jie Zhang, Min Li, Christophe Pannecouque, Erik De Clercq, Shuai Wang, Fen-Er Chen

The pivotal involvement of reverse transcriptase activity in the pathogenesis of the progressive HIV virus has stimulated gradual advancements in drug discovery initiatives spanning three decades. Consequently, nonnucleoside reverse transcriptase inhibitors (NNRTIs) have emerged as a preeminent category of therapeutic agents for HIV management. Academic institutions and pharmaceutical companies have developed numerous NNRTIs, an essential component of antiretroviral therapy. Six NNRTIs have received Food and Drug Administration approval and are widely used in clinical practice, significantly improving the quality of HIV patients. However, the rapid emergence of drug resistance has limited the effectiveness of these medications, underscoring the necessity for perpetual research and development of novel therapeutic alternatives. To supplement the existing literatures on NNRTIs, a comprehensive review has been compiled to synthesize this extensive dataset into a comprehensible format for the medicinal chemistry community. In this review, a thorough investigation and meticulous analysis were conducted on the progressions achieved in NNRTIs within the past 8 years (2016-2023), and the experiences and insights gained in the development of inhibitors with varying chemical structures were also summarized. The provision of a crucial point of reference for the development of wide-ranging anti-HIV medications is anticipated.

逆转录酶活性在艾滋病病毒的致病过程中起着至关重要的作用,这促使药物研发工作在长达三十年的时间里逐步取得进展。因此,非核苷类逆转录酶抑制剂(NNRTIs)已成为治疗艾滋病病毒的主要药物。学术机构和制药公司已开发出多种 NNRTIs,它们是抗逆转录病毒疗法的重要组成部分。六种 NNRTIs 已获得食品和药物管理局批准,并广泛应用于临床实践,大大改善了艾滋病患者的质量。然而,耐药性的迅速出现限制了这些药物的疗效,凸显了不断研究和开发新型替代治疗药物的必要性。为了对现有的 NNRTIs 文献进行补充,我们编写了一篇综合综述,将这一广泛的数据集归纳成一种便于药物化学界理解的格式。在这篇综述中,我们对过去 8 年(2016-2023 年)中 NNRTI 取得的进展进行了深入调查和细致分析,并总结了在开发具有不同化学结构的抑制剂过程中获得的经验和启示。预计这将为开发广泛的抗艾滋病毒药物提供重要的参考依据。
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引用次数: 0
Unveiling gut microbiota's role: Bidirectional regulation of drug transport for improved safety. 揭示肠道微生物群的作用:双向调节药物运输,提高安全性。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-24 DOI: 10.1002/med.22077
Jinyi Wang, Tingting Zhou

Drug safety is a paramount concern in the field of drug development, with researchers increasingly focusing on the bidirectional regulation of gut microbiota in this context. The gut microbiota plays a crucial role in maintaining drug safety. It can influence drug transport processes in the body through various mechanisms, thereby modulating their efficacy and toxicity. The main mechanisms include: (1) The gut microbiota directly interacts with drugs, altering their chemical structure to reduce toxicity and enhance efficacy, thereby impacting drug transport mechanisms, drugs can also change the structure and abundance of gut bacteria; (2) bidirectional regulation of intestinal barrier permeability by gut microbiota, promoting the absorption of nontoxic drugs and inhibiting the absorption of toxic components; (3) bidirectional regulation of the expression and activity of transport proteins by gut microbiota, selectively promoting the absorption of effective components or inhibiting the absorption of toxic components. This bidirectional regulatory role enables the gut microbiota to play a key role in maintaining drug balance in the body and reducing adverse reactions. Understanding these regulatory mechanisms sheds light on novel approaches to minimize toxic side effects, enhance drug efficacy, and ultimately improve drug safety. This review systematically examines the bidirectional regulation of gut microbiota in drug transportation from the aforementioned aspects, emphasizing their significance in ensuring drug safety. Furthermore, it offers a prospective outlook from the standpoint of enhancing therapeutic efficacy and reducing drug toxicity, underscoring the importance of further exploration in this research domain. It aims to provide more effective strategies for drug development and treatment.

药物安全性是药物开发领域最关注的问题,在这方面,研究人员越来越关注肠道微生物群的双向调节。肠道微生物群在维护药物安全方面发挥着至关重要的作用。它可以通过各种机制影响药物在体内的转运过程,从而调节药物的疗效和毒性。主要机制包括(1)肠道微生物群直接与药物相互作用,改变药物的化学结构,降低毒性,提高药效,从而影响药物的转运机制,药物还可以改变肠道细菌的结构和丰度;(2)肠道微生物群双向调节肠道屏障的通透性,促进无毒药物的吸收,抑制有毒成分的吸收;(3)肠道微生物群双向调节转运蛋白的表达和活性,选择性地促进有效成分的吸收或抑制有毒成分的吸收。这种双向调节作用使肠道微生物群在维持体内药物平衡和减少不良反应方面发挥关键作用。了解这些调控机制有助于找到新的方法来最大限度地减少毒副作用、提高药物疗效并最终改善药物安全性。本综述从上述几个方面系统地研究了肠道微生物群在药物运输过程中的双向调节作用,强调了它们在确保药物安全方面的重要意义。此外,它还从提高疗效和降低药物毒性的角度进行了前瞻性展望,强调了在这一研究领域进行进一步探索的重要性。它旨在为药物开发和治疗提供更有效的策略。
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引用次数: 0
Indirect influence on the BDNF/TrkB receptor signaling pathway via GPCRs, an emerging strategy in the treatment of neurodegenerative disorders. 通过 GPCRs 间接影响 BDNF/TrkB 受体信号通路,这是治疗神经退行性疾病的一种新兴策略。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-24 DOI: 10.1002/med.22075
Mirjana Antonijevic, Patrick Dallemagne, Christophe Rochais

Neuronal survival depends on neurotrophins and their receptors. There are two types of neurotrophin receptors: a nonenzymatic, trans-membrane protein of the tumor necrosis factor receptor (TNFR) family-p75 receptor and the tyrosine kinase receptors (TrkR) A, B, and C. Activation of the TrkBR by brain-derived neurotrophic factor (BDNF) or neurotrophin 4/5 (NT-4/5) promotes neuronal survival, differentiation, and synaptic function. It is shown that in the pathogenesis of several neurodegenerative conditions (Alzheimer's disease, Parkinson's disease, Huntington's disease) the BDNF/TrkBR signaling pathway is impaired. Since it is known that GPCRs and TrkR are regulating several cell functions by interacting with each other and generating a cross-communication in this review we have focused on the interaction between different GPCRs and their ligands on BDNF/TrkBR signaling pathway.

神经元的存活依赖于神经营养素及其受体。脑源性神经营养因子(BDNF)或神经营养素 4/5(NT-4/5)激活 TrkBR 可促进神经元的存活、分化和突触功能。研究表明,在几种神经退行性疾病(阿尔茨海默病、帕金森病、亨廷顿病)的发病机制中,BDNF/TrkBR 信号通路受到了损害。众所周知,GPCRs 和 TrkR 通过相互作用并产生交叉通信来调节多种细胞功能,因此在本综述中,我们重点讨论了不同 GPCRs 及其配体与 BDNF/TrkBR 信号通路之间的相互作用。
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引用次数: 0
The recent advance and prospect of poly(ADP-ribose) polymerase inhibitors for the treatment of cancer. 聚(ADP-核糖)聚合酶抑制剂治疗癌症的最新进展和前景。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-24 DOI: 10.1002/med.22069
Yi-Ru Bai, Wei-Guang Yang, Rui Jia, Ju-Shan Sun, Dan-Dan Shen, Hong-Min Liu, Shuo Yuan

Chemotherapies are commonly used in cancer therapy, their applications are limited to low specificity, severe adverse reactions, and long-term medication-induced drug resistance. Poly(ADP-ribose) polymerase (PARP) inhibitors are a novel class of antitumor drugs developed to solve these intractable problems based on the mechanism of DNA damage repair, which have been widely applied in the treatment of ovarian cancer, breast cancer, and other cancers through inducing synthetic lethal effect and trapping PARP-DNA complex in BRCA gene mutated cancer cells. In recent years, PARP inhibitors have been widely used in combination with various first-line chemotherapy drugs, targeted drugs and immune checkpoint inhibitors to expand the scope of clinical application. However, the intricate mechanisms underlying the drug resistance to PARP inhibitors, including the restoration of homologous recombination, stabilization of DNA replication forks, overexpression of drug efflux protein, and epigenetic modifications pose great challenges and desirability in the development of novel PARP inhibitors. In this review, we will focus on the mechanism, structure-activity relationship, and multidrug resistance associated with the representative PARP inhibitors. Furthermore, we aim to provide insights into the development prospects and emerging trends to offer guidance for the clinical application and inspiration for the development of novel PARP inhibitors and degraders.

化疗是癌症治疗的常用手段,但其应用局限于特异性低、不良反应严重、长期用药会产生耐药性等问题。聚(ADP-核糖)聚合酶(PARP)抑制剂是一类新型抗肿瘤药物,它基于DNA损伤修复机制,通过在BRCA基因突变的癌细胞中诱导合成致死效应和捕获PARP-DNA复合物来解决这些棘手的问题,已被广泛应用于卵巢癌、乳腺癌等癌症的治疗。近年来,PARP 抑制剂与多种一线化疗药物、靶向药物和免疫检查点抑制剂联合应用,扩大了临床应用范围。然而,PARP抑制剂耐药的机制错综复杂,包括同源重组的恢复、DNA复制叉的稳定、药物外排蛋白的过度表达以及表观遗传学修饰等,这给新型PARP抑制剂的开发带来了巨大的挑战和发展前景。在这篇综述中,我们将重点介绍具有代表性的 PARP 抑制剂的机制、结构-活性关系和多药耐药性。此外,我们还将深入探讨开发前景和新兴趋势,为新型 PARP 抑制剂和降解剂的临床应用提供指导和启发。
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引用次数: 0
Fenamates: Forgotten treasure for cancer treatment and prevention: Mechanisms of action, structural modification, and bright future. 非那明酸盐:被遗忘的癌症治疗和预防宝藏:作用机制、结构改造和光明前景。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-22 DOI: 10.1002/med.22079
Junfang Li, Xiaodong Wang, Honghua Zhang, Xiaoling Hu, Xue Peng, Weifan Jiang, Linsheng Zhuo, Yan Peng, Guo Zeng, Zhen Wang

Fenamates as classical nonsteroidal anti-inflammatory agents are widely used for relieving pain. Preclinical studies and epidemiological data highlight their chemo-preventive and chemotherapeutic potential for cancer. However, comprehensive reviews of fenamates in cancer are limited. To accelerate the repurposing of fenamates, this review summarizes the results of fenamates alone or in combination with existing chemotherapeutic agents. This paper also explores targets of fenamates in cancer therapy, including COX, AKR family, AR, gap junction, FTO, TEAD, DHODH, TAS2R14, ion channels, and DNA. Besides, this paper discusses other mechanisms, such as regulating Wnt/β-catenin, TGF-β, p38 MAPK, and NF-κB pathway, and the regulation of the expressions of Sp, EGR-1, NAG-1, ATF-3, ErbB2, AR, as well as the modulation of the tumor immune microenvironment. Furthermore, this paper outlined the structural modifications of fenamates, highlighting their potential as promising leads for anticancer drugs.

非氨酯类药物作为经典的非甾体抗炎药物,被广泛用于缓解疼痛。临床前研究和流行病学数据都强调了它们对癌症的化学预防和化学治疗潜力。然而,有关非那明酸盐在癌症中应用的全面综述却十分有限。为了加快非那明酸盐的再利用,本综述总结了非那明酸盐单独使用或与现有化疗药物联合使用的结果。本文还探讨了非那西丁在癌症治疗中的靶点,包括 COX、AKR 家族、AR、间隙连接、FTO、TEAD、DHODH、TAS2R14、离子通道和 DNA。此外,本文还讨论了其他机制,如调节 Wnt/β-catenin、TGF-β、p38 MAPK 和 NF-κB 通路,调节 Sp、EGR-1、NAG-1、ATF-3、ErbB2、AR 的表达,以及调节肿瘤免疫微环境。此外,本文还概述了非那西丁酸盐的结构修饰,强调了它们作为抗癌药物潜在线索的潜力。
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引用次数: 0
Canonical effects of cytokines on glomerulonephritis: A new outlook in nephrology. 细胞因子对肾小球肾炎的典型影响:肾脏病学的新前景
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-20 DOI: 10.1002/med.22074
Sepideh Zununi Vahed, Seyed Mahdi Hosseiniyan Khatibi, Mohammadreza Ardalan

Glomerulonephritis (GN) is an important cause of renal inflammation resulting from kidney-targeted adaptive and innate immune responses and consequent glomerular damage. Given the lack of autoantibodies, immune complexes, or the infiltrating immune cells in some forms of GN, for example, focal segmental glomerulosclerosis and minimal change disease, along with paraneoplastic syndrome and a special form of renal involvement in some viral infections, the likeliest causative scenario would be secreted factors, mainly cytokine(s). Since cytokines can modulate the inflammatory mechanisms, severity, and clinical outcomes of GN, it is rational to consider the umbrella term of cytokine GN as a new outlook to reclassify a group of previously known GN. We focus here, particularly, on cytokines that have the central "canonical effect" in the development of GN.

肾小球肾炎(GN)是肾脏靶向适应性免疫反应和先天性免疫反应引起肾脏炎症并导致肾小球损伤的重要原因。鉴于某些形式的 GN(如局灶节段性肾小球硬化症和微小病变)缺乏自身抗体、免疫复合物或浸润性免疫细胞,加上副肿瘤综合征和某些病毒感染的特殊形式的肾脏受累,最可能的致病情况是分泌因子,主要是细胞因子。由于细胞因子可以调节 GN 的炎症机制、严重程度和临床结果,因此有理由将细胞因子 GN 作为一个总称,作为一种新的观点来重新分类一组以前已知的 GN。我们在此特别关注在 GN 发展过程中具有核心 "典型效应 "的细胞因子。
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引用次数: 0
Targeting tumor microenvironment with photodynamic nanomedicine. 用光动力纳米药物靶向肿瘤微环境。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-16 DOI: 10.1002/med.22072
Suraj Kumar Modi, Pragyan Mohapatra, Priya Bhatt, Aishleen Singh, Avanish Singh Parmar, Aniruddha Roy, Vibhuti Joshi, Manu Smriti Singh

Photodynamic therapy (PDT) is approved for the treatment of certain cancers and precancer lesions. While early Photosensitizers (PS) have found their way to the clinic, research in the last two decades has led to the development of third-generation PS, including photodynamic nanomedicine for improved tumor delivery and minimal systemic or phototoxicity. In terms of nanoparticle design for PDT, we are witnessing a shift from passive to active delivery for improved outcomes with reduced PS dosage. Tumor microenvironment (TME) comprises of a complex and dynamic landscape with myriad potential targets for photodynamic nanocarriers that are surface-modified with ligands. Herein, we review ways to improvise PDT by actively targeting nanoparticles (NPs) to intracellular organelles such as mitochondria or lysosomes and so forth, overcoming the limitations caused by PDT-induced hypoxia, disrupting the blood vascular networks in tumor tissues-vascular targeted PDT (VTP) and targeting immune cells for photoimmunotherapy. We propose that a synergistic outlook will help to address challenges such as deep-seated tumors, metastasis, or relapse and would lead to robust PDT response in patients.

光动力疗法(PDT)已被批准用于治疗某些癌症和癌前病变。虽然早期的光敏剂(PS)已进入临床,但过去二十年的研究已导致第三代光敏剂的开发,包括用于改善肿瘤给药和最小全身或光毒性的光动力纳米药物。在用于光动力疗法的纳米粒子设计方面,我们正在见证从被动给药到主动给药的转变,从而在减少 PS 用量的同时提高疗效。肿瘤微环境(TME)是一个复杂而动态的过程,它具有无数潜在的光动力纳米载体目标,这些载体表面都有配体修饰。在此,我们回顾了通过主动将纳米粒子(NPs)靶向线粒体或溶酶体等细胞内细胞器、克服光动力疗法引起的缺氧所造成的限制、破坏肿瘤组织中的血管网络--血管靶向光动力疗法(VTP)以及靶向免疫细胞进行光免疫疗法来改进光动力疗法的方法。我们认为,协同前景将有助于解决深部肿瘤、转移或复发等难题,并能使患者对光化学疗法产生强有力的反应。
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引用次数: 0
Natural and synthetic 5-(3'-indolyl)oxazoles: Biological activity, chemical synthesis and advanced molecules. 天然和合成的 5-(3'-吲哚基)恶唑:生物活性、化学合成和高级分子。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-16 DOI: 10.1002/med.22078
Jing-Rui Liu, En-Yu Jiang, Otgonpurev Sukhbaatar, Wei-Hua Zhang, Ming-Zhi Zhang, Guang-Fu Yang, Yu-Cheng Gu

5-(3'-Indolyl)oxazole moiety is a privileged heterocyclic scaffold, embedded in many biologically interesting natural products and potential therapeutic agents. Compounds containing this scaffold, whether from natural sources or synthesized, have demonstrated a wide array of biological activities. This has piqued the interest of synthetic chemists, leading to a large number of reported synthetic approaches to 5-(3'-indolyl)oxazole scaffold in recent years. In this review, we comprehensively overviewed the different biological activities and chemical synthetic methods for the 5-(3'-indolyl)oxazole scaffold reported in the literatures from 1963 to 2024. The focus of this study is to highlight the significance of 5-(3'-indolyl)oxazole derivatives as the lead compounds for the lead discovery of anticancer, pesticidal, antimicrobial, antiviral, antioxidant and anti-inflammatory agents, to summarize the synthetic methods for the 5-(3'-indolyl)oxazole scaffold. In addition, the reported mechanism of action of 5-(3'-indolyl)oxazoles and advanced molecules studied in animal models are also reviewed. Furthermore, this review offers perspectives on how 5-(3'-indolyl)oxazole scaffold as a privileged structure might be exploited in the future.

5-(3'-吲哚基)恶唑分子是一种特殊的杂环支架,蕴含在许多具有生物学意义的天然产品和潜在的治疗药物中。无论是天然来源还是人工合成的含有这种支架的化合物,都显示出广泛的生物活性。这引起了合成化学家的兴趣,导致近年来报道了大量 5-(3'-吲哚基)恶唑支架的合成方法。在这篇综述中,我们全面综述了从 1963 年到 2024 年文献中报道的 5-(3'-吲哚基)恶唑支架的不同生物活性和化学合成方法。本研究的重点是强调 5-(3'-吲哚基)噁唑衍生物作为先导化合物在发现抗癌、杀虫、抗菌、抗病毒、抗氧化和抗炎药物方面的重要意义,总结 5-(3'-吲哚基)噁唑支架的合成方法。此外,还综述了所报道的 5-(3'-吲哚基)恶唑的作用机制以及在动物模型中研究的先进分子。此外,本综述还对未来如何利用 5-(3'-吲哚基)恶唑支架这一特殊结构提出了展望。
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引用次数: 0
Incretin-based therapies for the management of cardiometabolic disease in the clinic: Past, present, and future. 临床上治疗心脏代谢疾病的胰岛素疗法:过去、现在和未来。
IF 10.9 1区 医学 Q1 CHEMISTRY, MEDICINAL Pub Date : 2024-08-14 DOI: 10.1002/med.22070
James P Psaltis, Jessica A Marathe, Mau T Nguyen, Richard Le, Christina A Bursill, Chinmay S Marathe, Adam J Nelson, Peter J Psaltis

Among newer classes of drugs for type 2 diabetes mellitus (T2DM), glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are incretin-based agents that lower both blood sugar levels and promote weight loss. They do so by activating pancreatic GLP-1 receptors (GLP-1R) to promote glucose-dependent insulin release and inhibit glucagon secretion. They also act on receptors in the brain and gastrointestinal tract to suppress appetite, slow gastric emptying, and delay glucose absorption. Phase 3 clinical trials have shown that GLP-1 RAs improve cardiovascular outcomes in the setting of T2DM or overweight/obesity in people who have, or are at high risk of having atherosclerotic cardiovascular disease. This is largely driven by reductions in ischemic events, although emerging evidence also supports benefits in other cardiovascular conditions, such as heart failure with preserved ejection fraction. The success of GLP-1 RAs has also seen the evolution of other incretin therapies. Tirzepatide has emerged as a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA, with more striking effects on glycemic control and weight reduction than those achieved by isolated GLP-1R agonism alone. This consists of lowering glycated hemoglobin levels by more than 2% and weight loss exceeding 15% from baseline. Here, we review the pharmacological properties of GLP-1 RAs and tirzepatide and discuss their clinical effectiveness for T2DM and overweight/obesity, including their ability to reduce adverse cardiovascular outcomes. We also delve into the mechanistic basis for these cardioprotective effects and consider the next steps in implementing existing and future incretin-based therapies for the broader management of cardiometabolic disease.

在治疗 2 型糖尿病(T2DM)的新型药物中,胰高血糖素样肽 1 受体激动剂(GLP-1 RAs)是一种基于增量素的药物,既能降低血糖水平,又能促进减肥。它们通过激活胰腺 GLP-1 受体(GLP-1R)来促进葡萄糖依赖性胰岛素的释放并抑制胰高血糖素的分泌。它们还作用于大脑和胃肠道中的受体,抑制食欲,减缓胃排空,延缓葡萄糖吸收。3 期临床试验显示,GLP-1 RAs 可改善患有或极有可能患有动脉粥样硬化性心血管疾病的 T2DM 或超重/肥胖症患者的心血管预后。这主要是由于缺血性事件的减少,尽管新出现的证据也支持在其他心血管疾病中的益处,如射血分数保留的心力衰竭。GLP-1 RA 的成功也见证了其他增量素疗法的发展。替扎帕肽是一种葡萄糖依赖性促胰岛素多肽(GIP)/GLP-1 RA 双重疗法,对血糖控制和减轻体重的效果比单独使用 GLP-1R 激动剂更为显著。这包括糖化血红蛋白水平降低 2% 以上,体重从基线下降 15% 以上。在此,我们回顾了 GLP-1 RA 和替哌肽的药理特性,并讨论了它们对 T2DM 和超重/肥胖症的临床疗效,包括它们减少不良心血管后果的能力。我们还将深入探讨这些心血管保护作用的机理基础,并考虑下一步如何将现有和未来的增量素疗法用于更广泛的心血管代谢疾病管理。
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引用次数: 0
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