Biguanides

The biguanides are derivatives of the compound biguanide (guanylguanidine) that exert a blood glucose-lowering effect in type 2 (non-insulin dependent) diabetes mellitus. The main biguanides are metformin (dimethylbiguanide) and phenformin (phenethylbiguanide), which were described in 1957 and buformin (butylbiguaninde), which was described in 1958 .... © 2007 Elsevier Inc. All rights reserved.

Interaction of cationic amphiphilic drugs with lipid A: Implications for development of endotoxin antagonists

This report presents evidence for the interactions of several classes of cationic amphiphilic drugs including the phenothiazines, aminoquinolines, biguanides, and aromatic diamidines, with lipid A, the endotoxic principle of lipopolysaccharides. The interactions of the drugs were quantitatively assessed by fluorescence methods. The affinities of the drugs for lipid A parallel their endotoxin-antagonistic effects in the Limulus gelation assay. Dicationic compounds bind lipid A with greater affinity; the affinity of such molecules increases exponentially as a function of the distance between the basic moieties. The bis-amidine drug - pentamidine - examined in greater detail, binds lipid A with high affinity (apparent K-d: 0.12 mu M), and LPS, probably due to simultaneous interactions of the terminal amidine groups with the anionic phosphates on lipid A. The sequestration of endotoxin by pentamidine reduces its propensity to bind to cells, and the complex exhibits attenuated toxicity in biological assays. These results have implications in the development of therapeutic strategies against endotoxin-related disease states.

Pharmacological targeting of the mitochondrial phosphatase PTPMT1.

The dual-specificity protein tyrosine phosphatases (PTPs) play integral roles in the regulation of cell signaling. There is a need for new tools to study these phosphatases, and the identification of inhibitors potentially affords not only new means for their study, but also possible therapeutics for the treatment of diseases caused by their dysregulation. However, the identification of selective inhibitors of the protein phosphatases has proven somewhat difficult. PTP localized to mitochondrion 1 (PTPMT1) is a recently discovered dual-specificity phosphatase that has been implicated in the regulation of insulin secretion. Screening of a commercially available small-molecule library yielded alexidine dihydrochloride, a dibiguanide compound, as an effective and selective inhibitor of PTPMT1 with an in vitro concentration that inhibits response by 50% of 1.08 microM. A related dibiguanide analog, chlorhexidine dihydrochloride, also significantly inhibited PTPMT1, albeit with lower potency, while a monobiguanide analog showed very weak inhibition. Treatment of isolated rat pancreatic islets with alexidine dihydrochloride resulted in a dose-dependent increase in insulin secretion, whereas treatment of a pancreatic beta-cell line with the drug affected the phosphorylation of mitochondrial proteins in a manner similar to genetic inhibition of PTPMT1. Furthermore, knockdown of PTPMT1 in rat islets rendered them insensitive to alexidine dihydrochloride treatment, providing evidence for mechanism-based activity of the inhibitor. Taken together, these studies establish alexidine dihydrochloride as an effective inhibitor of PTPMT1, both in vitro and in cells, and support the notion that PTPMT1 could serve as a pharmacological target in the treatment of type II diabetes.

Mechanisms underlying the metabolic actions of galegine that contribute to weight loss in mice

Background and purpose: Galegine and guanidine, originally isolated from Galega officinalis, led to the development of the biguanides. The weight-reducing effects of galegine have not previously been studied and the present investigation was undertaken to determine its mechanism(s) of action.

Experimental approach: Body weight and food intake were examined in mice. Glucose uptake and acetyl-CoA carboxylase activity were studied in 3T3-L1 adipocytes and L6 myotubes and AMP activated protein kinase (AMPK) activity was examined in cell lines. The gene expression of some enzymes involved in fat metabolism was examined in 3T3-L1 adipocytes.

Key results: Galegine administered in the diet reduced body weight in mice. Pair-feeding indicated that at least part of this effect was independent of reduced food intake. In 3T3-L1 adipocytes and L6 myotubes, galegine (50 µm-3 mm) stimulated glucose uptake. Galegine (1–300 µm) also reduced isoprenaline-mediated lipolysis in 3T3-L1 adipocytes and inhibited acetyl-CoA carboxylase activity in 3T3-L1 adipocytes and L6 myotubes. Galegine (500 µm) down-regulated genes concerned with fatty acid synthesis, including fatty acid synthase and its upstream regulator SREBP. Galegine (10 µm and above) produced a concentration-dependent activation of AMP activated protein kinase (AMPK) in H4IIE rat hepatoma, HEK293 human kidney cells, 3T3-L1 adipocytes and L6 myotubes.

Conclusions and implications: Activation of AMPK can explain many of the effects of galegine, including enhanced glucose uptake and inhibition of acetyl-CoA carboxylase. Inhibition of acetyl-CoA carboxylase both inhibits fatty acid synthesis and stimulates fatty acid oxidation, and this may to contribute to the in vivo effect of galegine on body weight.

Prevalence, awareness and treatment of type 2 diabetes mellitus in Switzerland: the CoLaus study.

ABSTRACT: Aims To assess the prevalence, awareness and treatment levels of Type 2 diabetes in a Swiss city. Methods Population-based cross-sectional study of 6181 subjects (3246 women) aged 35-75 years living in Lausanne, Switzerland. Type 2 diabetes was defined as fasting plasma glucose >/= 7 mmol/l and/or oral hypoglycaemic treatment and/or insulin. Results Total prevalence of Type 2 diabetes was 6.3% (95% confidence interval: 5.7-7.0%), higher in men (9.1%) than in women (3.8%, P < 0.001) and increased with age. Two-thirds (65.3%; 60.4-70.0%) of participants with Type 2 diabetes were aware of their status and among those aware 86.0% (81.5-90.3%) were treated. Treatment was more frequent in men (91.3%) than in women (75.9%, P < 0.001). Two-thirds of those treated for Type 2 diabetes were on monotherapy. Biguanides were prescribed in 65.0% of Type 2 diabetes patients and represented 48% of all antidiabetic drugs. Multivariable analysis showed male gender, increasing age, waist or BMI to be positively associated with prevalence of Type 2 diabetes, while leisure-time physical activity and alcohol consumption were negatively associated. Among participants presenting with Type 2 diabetes, increasing age was positively associated with awareness of Type 2 diabetes. Among subjects diagnosed with Type 2 diabetes, male gender and increasing age were positively associated with treatment. Conclusion Prevalence of Type 2 diabetes in Switzerland is estimated to be between 5.7% and 7.0%. Two-thirds of patients with Type 2 diabetes are aware of their status, and over three quarters of those aware are treated.

Effets directs et aigus de médicaments insulinosensibilisateurs sur la cellule bêta des îlots pancréatiques : de l’outil de recherche à l’identification de la décélération métabolique comme mode d’action

Le diabète de type 2 (DT2) apparaît lorsque la sécrétion d’insuline par les cellules β des îlots du pancréas ne parvient plus à compenser la résistance à l’insuline des organes cibles. Parmi les médicaments disponibles pour traiter le DT2, deux classes agissent en améliorant la sensibilité à l’insuline : les biguanides (metformine) et les thiazolidinediones (pioglitazone et rosiglitazone). Des études suggèrent que ces médicaments protègent également la fonction des cellules β. Dans le but d’identifier des mécanismes par lesquels les médicaments insulinosensibilisateurs protègent les cellules β, nous avons étudié les effets aigus de la metformine et de la pioglitazone sur le métabolisme et la fonction des cellules INS 832/13, sécrétrices d’insuline et des îlots pancréatiques isolés de rats. Nous avons aussi validé in vivo avec des rats Wistar les principales observations obtenues en présence de pioglitazone grâce à des clamps glucidiques et par calorimétrie indirecte. Le traitement aigu des cellules β avec de la pioglitazone ou de la metformine inhibe la sécrétion d’insuline induite par le glucose en diminuant la sensibilité des cellules au glucose (inhibition en présence de concentrations intermédiaires de glucose seulement). Dans les mêmes conditions, les traitements inhibent aussi plusieurs paramètres du métabolisme mitochondrial des nutriments et, pour la pioglitazone, du métabolisme des lipides. Les composés affectent le métabolisme en suivant un patron d’inhibition similaire à celui observé pour la sécrétion d’insuline, que nous avons nommé « décélération métabolique ». La capacité de la pioglitazone à inhiber la sécrétion d’insuline et à ralentir le métabolisme mitochondrial de façon aigüe se confirme in vivo. En conclusion, nous avons identifié la décélération métabolique de la cellule β comme nouveau mode d’action pour les médicaments insulinosensibilisateurs. La décélération métabolique causée par les agents insulinosensibilisateurs les plus utilisés semble provenir d’une inhibition du métabolisme mitochondrial et pourrait être impliquée dans les bienfaits de ceux-ci dans un contexte de stress métabolique. Le fait que les deux agents insulinosensibilisateurs étudiés agissent à la fois sur la sensibilité à l’insuline et sur la sécrétion d’insuline, les deux composantes majeures du DT2, pourrait expliquer pourquoi ils sont parmi les agents antidiabétiques les plus efficaces. La décélération métabolique est une approche thérapeutique à considérer pour le traitement du DT2 et d’autres maladies métaboliques.

The impact of obesity on drug prescribing in primary care

Background

Healthcare costs attributable to obesity have previously involved estimations based on costs of diseases commonly considered as having obesity as an underlying factor.

Aim

To quantify the impact of obesity on total primary care drug prescribing.

Design of study

Review of computer generated and handwritten prescriptions to determine total prescribing volume for all drug classes.

Setting

Twenty-three general practice surgeries in the UK.

Method

Stratified random selection of 1150 patients who were obese (body mass index [BMI]>30 kg/m2) and 1150 age- and sex-matched controls of normal weight (BMI 18.5–<25 kg/m2). Retrospective review of medical records over an 18-month period.

Results

A higher percentage of patients who were obese, compared with those of normal weight, were prescribed at least one drug in the following disease categories: cardiovascular (36% versus 20%), central nervous system (46% versus 35%), endocrine (26% versus 18%), and musculoskeletal and joint disease (30% versus 22%). All of these categories had a P-value of <0.001. Other categories, such as gastrointestinal (24% versus 18%), infections (42% versus 35%), skin (24% versus 19%) had a P-value of <0.01, while respiratory diseases (18% versus 21%) had a P-value of <0.05. Total prescribing volume was significantly higher for the group with obesity and was increased in the region of two- to fourfold in a wide range of prescribing categories: ulcer healing drugs, lipid regulators, β-adrenoreceptor drugs, drugs affecting the rennin angiotensin system, calcium channel blockers, antibacterial drugs, sulphonylureas, biguanides, non-steroidal anti-inflammatories (NSAIDs) (P<0.001) and fibrates, angiotensin II antagonists, and thyroid drugs (P<0.05). The main impact on prescribing volumes is from numbers of patients treated, although in some areas there is an effect from greater dosage or longer treatment in those who are obese including calcium channel blockers, antihistamines, hypnotics, drugs used in the treatment of nausea and vertigo, biguanides, and NSAIDs (P<0.05) reflected in significantly increased defined daily dose prescribing.

Anti-diabetic activity of Bauhinia forficata decoction in streptozotocin-diabetic rats

The effects of using Bauhinia forficata leaf decoction (150 g leaf/l water; 35.2+/-7.8 ml/100 g body weight mean daily dose) as a drinking-water substitute for about I month on streptozotocin-diabetes (STZ-diabetes) in male Wistar rats were investigated. The physico-metabolic parameters measured were: body weight, food and liquid intake, urinary volume, hepatic glycogen, serum triglycerides and cholesterol, plasma glucose, urinary glucose and urea, and the weight of epididymal and retroperitoneal adipose tissue and soleus and extensor digitorum longus muscles. The STZ-diabetic rats treated with decoction showed a significant reduction in serum and urinary glucose and urinary urea as compared to the STZ-diabetic control, no difference being seen between decoction-treated and -untreated non-diabetic rats. The other physico-metabolic factors showed no changes in treated STZ-diabetic rats. The improvement in carbohydrate metabolism seen in the rats treated with Bauhinia forficata decoction does not appear to be linked to the inhibition of glycogenolysis or the stimulation of glycogenesis nor does it appear to act in a way similar to insulin or the sulfonylureas, although it may act by the inhibition of neoglycogenesis in a manner similar to that of the biguanides. (C) 2002 Elsevier B.V. Ireland Ltd. All rights reserved.

Ionenleitfähigkeit in polymeren Matrizes – Synthese, Charakterisierung und Untersuchung dynamischer Prozesse von neuen Lithium- und Protonenleitern

Die vorliegende Dissertation befasst sich mit der Synthese, physikochemischen und polymerspezifischen Charakterisierung und insbesondere der impedanzspektroskopischen Untersuchung von sowohl neuartigen, solvensfreien lithiumionen- als auch protonenleitfähigen Polymermaterialien für potentielle Anwendungen in sekundären Lithiumionenbatterien bzw. in Hochtemperatur-Protonenaustauschmembran-Brennstoffzellen (engl.: proton exchange membrane fuel cell, auch: polymer electrolyte membrane fuel cell, PEMFC). Beiden Typen von ionenleitfähigen Membranen liegt das gängige Prinzip der chemischen Anbindung einer für den Ionentransport verantwortlichen Seitengruppe an eine geeignete Polymerhauptkette zugrunde („Entkopplung“; auch Immobilisierung), welcher hinsichtlich Glasübergangstemperatur (Tg), elektrochemischer und thermischer Stabilität (Td) eine dynamisch entkoppelte, aber nicht minder bedeutsame Rolle zukommt. Die Transportaktivierung erfolgt in beiden Fällen thermisch. Im Falle der Protonenleiter liegt die zusätzliche Intention darin, eine Alternative aufzuzeigen, in der die Polymerhauptkette gekoppelt direkt am Protonentransportmechanismus beteiligt ist, d.h., dass der translatorisch diffusive Ionentransport entlang der Hauptkette stattfindet und nicht zwischen benachbarten Seitenketten. Ein Hauptaugenmerk der Untersuchungen liegt sowohl bei den lithiumionen- als auch den protonenleitfähigen Polymermembranen auf temperaturabhängigen dynamischen Prozessen der jeweiligen Ionenspezies in der polymeren Matrix, was die Ionenleitfähigkeit selbst, Relaxationsphänomene, die translatorische Ionendiffusion und im Falle der Protonenleiter etwaige mesomere Grenzstrukturübergänge umfasst. Lithiumionenleiter: Poly(meth)acrylate mit (2-Oxo-1,3-dioxolan)resten (Cyclocarbonat-) in der Seitenkette unterschiedlicher Spacerlänge wurden synthetisiert und charakterisiert. Die Leitfähigkeit s(,T) erreicht bei Poly(2-oxo-[1,3]dioxolan-4-yl)methylacrylat (PDOA): Lithium-bis-trifluormethansulfonimid (LiTFSI) (10:3) ca. 10^-3,5 S cm^-1 bei 150 °C. Weichmachen (Dotieren) mit äquimolaren Mengen an Propylencarbonat (PC) bewirkt in allen Fällen einen enormen Anstieg der Leitfähigkeit. Die höchsten Leitfähigkeiten von Mischungen dieser Polymere mit LiTFSI (und LiBOB) werden nicht beim System mit der niedrigsten Tg gefunden. Auch dient Tg nicht als Referenztemperatur (Tref) nach Williams-Landel-Ferry (WLF), so dass eine WLF-Anpassung der Leitfähigkeitsdaten nur über einen modifizierten WLF-Algorithmus gelingt. Die ermittelten Tref liegen deutlich unterhalb von Tg bei Temperaturen, die charakteristisch für die Seitenkettenrelaxation sind („Einfrieren“). Dies legt nahe, dass der Relaxation der Seitenketten eine entscheidende Rolle im Li^+-Leitfähigkeitsmechanismus zukommt. Die Li^+-Überführungszahlen tLi^+ in diesen Systemen schwanken zwischen 0,13 (40 °C) und 0,55 (160 °C). Protonenleiter: Polymere mit Barbitursäure- bzw. Hypoxanthinresten in der Seitenkette und Polyalkylenbiguanide unterschiedlicher Spacerlänge wurden synthetisiert und charakterisiert. Die Leitfähigkeit s(,T) erreicht bei Poly(2,4,6(1H,3H,5H)-trioxopyrimidin-5-yl)methacrylat (PTPMA) maximal ca. 10^-4,4 S cm^-1 bei 140 °C. Höhere Leitfähigkeiten sind nur durch Mischen mit aprotischen Lösungsmitteln erreichbar. Die höchste Leitfähigkeit wird im Falle der Polyalkylenbiguanide bei Polyethylenbiguanid (PEB) erzielt. Sie erreicht 10^-2,4 S cm^-1 bei 190 °C. Die Aktivierungsenergien EA der Polyalkylenbiguanide liegen (jeweils unterhalb von Tg) zwischen ca. 3 – 6 kJ mol^-1. In allen beobachteten Fällen dient Tg als Tref, so dass eine konventionelle WLF-Behandlung möglich ist und davon auszugehen ist, dass die Leitfähigkeit mit dem freien Volumen Vf korreliert.

[Drug therapy of type-II diabetes: tablets, insulin or a combination of these]

Optimal therapy of diabetes has to be based on the known pathophysiology of metabolic disturbances and should eventually alleviate reduced secretion of insulin as well as reduce the usually present resistance to insulin in order to normalize the average blood glucose levels. In less than 30% of patients with type-II diabetes, dietetic measures combined with increased physical activity alone, are sufficient for metabolic control, thus increasing the importance of pharmacologic treatment immensely. Biguanides are the therapeutic choice in patients with massive overweight, because they usually do not induce weight gain; however, specific contraindications (renal failure in particular) have to be taken into consideration. The effect of blood glucose lowering by biguanides is not due to increased secretion of insulin, thus neither hypoglycemias nor hyperinsulinism are induced or increased, respectively. Patients with normal or slightly increased body weight should profit best from sulfonylureas that stimulate insulin production. Combinations of sulfonylurea and biguanides or of insulin and oral antidiabetics or insulin alone have to be taken into account when monotherapy with oral antidiabetics is too inefficient; however, clear and generally accepted guidelines for correct indications of these therapeutic modalities are lacking. Particularly in long-lasting diabetes and for patients with distinct overweight an adequate therapeutic success is often not obtained with the currently available therapeutic means. Possibly, future developments will provide new therapeutic ways with drugs that increase insulin sensitivity or reduce gluconeogenesis.

[Oral hypoglycaemic agents in 2009]

Various new oral hypoglycaemic agents have been developed recently and have changed the therapy of type 2 diabetes mellitus. Six different classes of agents are available: Biguanides, sulfonylureas, glinides, glitazones, alpha-glucosidase inhibitors and dipeptidyl peptidase-4 inhibitors. The increasing number of these drugs does not facilitate the choice of the best medication for an individual patient. In the article we describe the specific mechanisms of action, side effects, advantages and disadvantages of the different agents. Every drug therapy should be supported by lifestyle changes. Despite all the new drugs type 2 diabetes is still a chronic and slowly progressive disease without chance of cure. Therefore, it is important to prevent type 2 diabetes by normalizing body weight and increasing physical exercise.

Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies.

Síntese de biguanidas e avaliação da sua atividade biológica em linhas de células tumorais

As biguanidas são um grupo de compostos com diversas atividades biológicas. Recentemente, esta família de compostos tem sido estudada não só pela sua atividade hipoglicemiante, mas também pela sua atividade anti-proliferativa. Um dos objetivos deste estudo foi a síntese de biguanidas, com cadeias laterais com diferentes estruturas e grupos funcionais. O trabalho desenvolvido permitiu a síntese de diversas biguanidas, tendo sido isolados quatro compostos. Outro dos objetivos deste estudo foi avaliar a atividade anti-proliferativa de biguanidas, na linha celular MDST8. Para esse efeito, foi desenvolvido inicialmente um método de quantificação celular com base na atividade ATPásica, testado nas linhas celulares MDST8, MCF7 e BRIN-BD11, tendo sido utilizado como referência a quantificação pelo método das desidrogenases. Os compostos estudados com melhor atividade anti-proliferativa apresentaram IC50 da ordem de 2,5 – 2,9 x10-3 M. Estes valores foram observados em biguanidas cujos grupos substituintes possuíam cadeias hidrocarbonadas cíclicas, alifáticas ou aromáticas p-substituídas, na sua estrutura; Abstract: Synthesis of biguanides and evaluation of their biologic activity in tumor cell lines Biguanides are a group of compounds which have diverse biological activities. Recently, this family of compounds has been studied not only for its hypoglycemic activity, but also for its anti-proliferative activity. One purpose of this study was the synthesis of biguanides, with side chains with different structures and functional groups. The work led to the synthesis of several biguanides, with the isolation of four compounds. Another objective of this study was the evaluation of the anti-proliferative activity of biguanides, in the cell line MDST8. To this aim, it was initially developed a cell quantification method based on the ATPase activity, tested in MDST8, MCF7 and BRIN-BD11 cell lines, with the dehydrogenases method used as reference. The studied compounds with better anti-proliferative activity had IC50 in the range from 2.5 to 2.9 x10-3 M for biguanides whose substituent groups had cyclic hydrocarbon, aliphatic or p-substituted aromatic chains in their structure.