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MECHANISMS IN ENDOCRINOLOGY: FXR signalling: a novel target in metabolic diseases.
内分泌学的机制: FXR信号: 代谢疾病的新靶点。
- 影响因子:5.04
- DOI:10.1530/EJE-20-1410
- 作者列表:"Sonne DP
- 发表时间:2021-05-01
Abstract
:During the last decades, it has become clear that the gastrointestinal tract plays a pivotal role in the regulation of glucose homeostasis. More than 40 hormones originate from the gastrointestinal tract and several of these impact glucose metabolism and appetite regulation. An astonishing example of the gut's integrative role in glucose metabolism originates from investigations into bile acid biology. From primary animal studies, it has become clear that bile acids should no longer be labelled as simple detergents necessary for lipid digestion and absorption but should also be recognised as metabolic regulators implicated in lipid, glucose and energy metabolism. The nuclear farnesoid X receptor (FXR) is a part of an exquisite bile acid-sensing system that among other things ensures the optimal size of the bile acid pool. In addition, intestinal and hepatic FXR also impact the regulation of several metabolic processes such as glucose and lipid metabolism. Accordingly, natural and synthetic FXR agonists and certain FXR-regulated factors (i.e. fibroblast growth factor 19 (FGF19)) are increasingly being evaluated as treatments for metabolic diseases such as type 2 diabetes and non-alcoholic fatty liver disease (and its inflammatory version, non-alcoholic steatohepatitis). Interestingly, decreased FXR activation also benefits glucose metabolism. This can be obtained by reducing bile acid absorption using bile acid sequestering agents (approved for the treatment of type 2 diabetes) or inhibitors of intestinal bile acid transporters,that is the apical sodium-dependent bile acid transporter (ASBT). This article discusses recent clinical trials that provide insights about the role of FXR-FGF19-targetted therapy for the treatment of metabolic diseases.
摘要
在过去的几十年中,已经清楚的是胃肠道在葡萄糖稳态的调节中起着关键作用。超过40种激素来源于胃肠道,其中几种影响葡萄糖代谢和食欲调节。肠道在葡萄糖代谢中的整合作用的一个惊人的例子源于对胆汁酸生物学的研究。从最初的动物研究中,已经清楚的是,胆汁酸不应再被标记为脂质消化和吸收所必需的简单去污剂,而还应被认为是涉及脂质、葡萄糖和能量代谢的代谢调节剂。核法尼醇X受体 (FXR) 是精致的胆汁酸传感系统的一部分,其中确保胆汁酸池的最佳大小。此外,肠和肝FXR也影响几种代谢过程如葡萄糖和脂质代谢的调节。因此,天然和合成的FXR激动剂和某些FXR调节因子 (即成纤维细胞生长因子19 (FGF19) 正越来越多地被评估为代谢疾病如2型糖尿病和非酒精性脂肪肝病 (及其炎性形式,非酒精性脂肪性肝炎) 的治疗。有趣的是,降低的FXR活化也有益于葡萄糖代谢。这可以通过使用胆汁酸螯合剂 (批准用于治疗2型糖尿病) 或肠胆汁酸转运蛋白抑制剂 (即顶端钠依赖性胆汁酸转运蛋白 (ASBT)) 减少胆汁酸吸收来获得。本文讨论了最近的临床试验,这些试验提供了关于FXR-FGF19-targetted疗法在治疗代谢疾病中的作用的见解。
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METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.