Diabetes is a metabolic disorder causing hyperglycemia, which is categorized into two types: type I (T1D) and type II (T2DM). The illness has no complete remedy, so lifelong medication is necessary.
T1D results from autoimmunity destructing β cells that secrete insulin in the pancreatic islets. Immunotherapy has been widely implemented for the prevention and management of this condition. Recent studies have suggested that human pancreatic islets' dual exposure to pro-inflammatory cytokines, IL-1β, and interferon-γ, can disturb the balance between pro-apoptotic and anti-apoptotic proteins, leading to pancreatitis.
T2DM is characterized by insulin resistance, in which the patient's pancreas may function normally, but several body tissues no longer respond appropriately to the effects of insulin. Previous research has shown that IL-6 and ciliary neurotrophic factor (CNTF) potentially increase insulin sensitivity in both mice and humans, presenting promising new therapies for managing T2DM. Additionally, FGF-21 displays effectiveness in treating cirrhosis, improving hepatic insulin sensitivity by reducing liver glucose production and increasing liver glycogen content, ultimately leading to enhancements in blood lipid levels and insulin resistance in individuals.
IGFs belong to a group of polypeptide growth factors. Among them, IGF-1 is a polypeptide protein substance similar in molecular structure to insulin. Additionally, it serves as a critical cytokine in differentiating, proliferating, and maturing various body tissues. When administered to patients with T1D alongside insulin, the combination effectively enhances glucose uptake and insulin sensitivity in peripheral tissues while preventing the risk of hyperinsulinemia. In the context of clinical practice for T2DM treatment with IGF-1, hyperglycemia can be lowered while circumventing hyperinsulinemia, thus potentially guarding against the appearance of macrovascular as well as microvascular complications.
Figure 1. Metabolic effects of IGF-1 and GH under pathological conditions. (Aguirre G A, et al., 2016)
GLP-1 promotes insulin gene transcription and insulin secretion, improves receptor sensitivity to insulin, and thereby reduces blood sugar levels. The latest agonist GLP-1RA developed for its receptor has become a hot drug for the treatment of T2DM.
FGF-21 is primarily synthesized by the liver and plays a pivotal role in regulating the body's blood sugar metabolism by enhancing insulin sensitivity, elevating glucose production, and increasing ketone body synthesis. The most recent studies have successfully generated a fusion protein of FGF-21 and GLP-1, which targets two receptors and significantly ameliorates blood sugar and lipid metabolism in obese and diabetic mice, exhibiting superior efficacy to single agonists.
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