Integrated Physiology/Obesity
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INTEGRATED PHYSIOLOGY—INSULIN SECRETION INTEGRATED PHYSIOLOGY—LIVER IN VIVO CATEGORY Figure 1. 2473-PUB Application of Translational Pharmacokinetic and Pharmacody- namic Modeling in the Development of GPR40 Partial Agonists DANIEL A. TATOSIAN, OSKAR ALSKAER, MARIA E. TRUJILLO, GEORGE EIER- MANN, LENA E. FRIBERG, MARIA KJELLSON, KUMAR K. MURALIDHARAN, HUBERT JOSIEN, ADAM WEINGLASS, JERRY DI SALVO, XIAOYAN N. LI, MICHAEL MILLER, PAVAN VADDADY, PRAJAKTI KOTHARE, Kenilworth, NJ, Upp- sala, Sweden, Rahway, NJ, Boston, MA Partial GPR40 agonists have been clinically validated as a mechanism for glucose lowering in patients with type 2 diabetes. A prior GPR40 partial agonist TAK-875 by Takeda was discontinued in Phase 3 due to liver toxic- ity with unknown mechanism. Discovery efforts for identifying novel GPR40 partial agonists have since focused on compounds with low anticipated clinical dose as a mitigation strategy. Given the critical nature of human dose projection for this target, a translational pharmacokinetic and phar- macodynamic model was developed to enhance predictions of clinical dose- response for novel chemical matter. A semi-physiologic glucose and insulin model was developed based on a human model published by Jauslin et al. [J Clin Pharmacol 2007;47:1244– 55]. This compartmental model was allometrically scaled and applied to glu- cose and insulin data observed in man and in Goto-Kakizaki rats. Published and internal data from human trials and rodent experiments under fasted or Supported By: National Natural Science Foundation of China (81200630); Natu- oral glucose tolerance test conditions in single dose and chronic administra- ral Science Fund Committee of Zhejiang Province (LQ12H07001); Wenzhou Science tion were included in the analysis. A model-based in vitro-in vivo correla- and Technology Bureau (H20150001) tion relating potency from a cell-based inositol phosphatase 1 accumulation assay to in vivo response was established to enable predictions. The translational model adequately described data for 5 compounds eval- INTEGRATED PHYSIOLOGY—INSULIN SECRETION uated in preclinical experiments and was predictive of the published human IN VIVO dose-response relationship of TAK875. Simulations from the quantitative model were shown to be consistent with the observed dose-response glu- 2471-PUB cose data both in the fasted state and following meals in the completed GPR40 Knockout Rats Have Diminished Lipid-mediated Potentiation MK-8666 proof of concept study. This model was further used in making of Insulin Secretion quantitative predictions of the dose-response relationship for novel GPR40 TONYA L. MARTIN, JIANYING LIU, MATTHEW M. RANKIN, MEGHAN TOWERS, agonists in discovery phase, and has been used by the development team JENSON QI, LISA D. NORQUAY, ALESSANDRO POCAI, Spring House, PA as a basis for prioritization and decision making around proposed clinical Chronic activation of GPR40, a fatty acid sensing G-protein-coupled recep- development programs. tor, improves glycemic control in type 2 diabetic humans. We used zinc fi nger nuclease technology to generate GPR40 null rats in the 2474-PUB Sprague-Dawley genetic background with a 2 bp deletion resulting in a trun- WITHDRAWN cated GPR40 protein. GPR40 Knockout (GPR40 KO) rats and their wild type (WT) littermates were fed either high fat (HFD, Research Diets 12492, 60% kcals fat) or regular chow (LabDiets 5001, 13% kcals fat) for ten weeks. On regular chow, GPR40 KO rats showed fasting hyperglycemia when compared to WT rats (118 ± 4.5 vs. 94 ± 3.0 mg/dl, p < 0.05); there were no INTEGRATED PHYSIOLOGY—LIVER other differences observed between GPR40 KO and WT rats. HFD-GPR40 KO rats showed fasting hyperglycemia (121 ± 5.1 vs. 93 ± 2.5 2475-PUB mg/dl, p < 0.05) with decreased fasting insulin (471 ± 124.3 vs. 994 ± 105.2 Triple Therapy Utilizing Vitamin E, Milk Thistle, and Carnitine pg/ml, p < 0.05). HFD-WT rats were hyperinsulinemic compared to WT rats Improves ALT and the Metabolic Abnormalities Associated with on regular chow (1201 ± 166 pg/ml vs. 517 ± 80.4 pg/ml, p < 0.05). Insulin NAFLD levels in HF-GPR40 KO rats were similar to GPR40 KO rats on regular chow. JOHN POULOS, VALENTIN MILANOV, Fayetteville, NC After a glucose challenge, the glucose area under the curve (AUC) of HFD- Evidence of scientifi c data in peer reviewed journals indicates that anti- GPR40 KO rats was higher than, but not statistically different from, HFD-WT oxidant supplementation may improve abnormal liver chemistries, glucose rats (24411 ± 660 vs. 22224 ± 1237 mg/dl/120 min). However, the insulin AUC control, and hyperlipidemia, in patients with NAFLD. The primary objective was markedly decreased in the HFD-GPR40 KO rats (264,737 ± 25,702 vs. was to determine the effects of Vitamin E 200IU, Silymarin 750mg, L carni- 479,989 ± 40,157 pg/ml/120 min, p < 0.05). tine 1gm (VSC) on normalization of abnormalities in liver function testing in We examined pancreatic islets from the WT and KO rats. WT and KO islets patients with NAFLD and to determine possible improvements in blood glu- responded similarly to increased concentrations of glucose; however, con- cose, hemoglobin A1c, cholesterol, LDL, triglycerides and CRP. Patients with sistent with the in vivo data, when the islets were challenged with glucose NAFLD were treated with either VSC (n=15) or placebo (n=17) for a period and palmitate, the islets from the KO rats showed a diminished insulin secre- of 24 weeks. The following laboratory values were assessed AST, ALT, trig- tory response. lycerides, HDL, LDL, insulin levels, glucose and CRP. Eleven out of 15 (70%) Taken together, these data demonstrate that GPR40 is required for the patients in the VSC group had normalization of ALT whereas 9 of 17 patients Integrated maintenance of fasting glycemia and the compensatory response of the (54%) had normalization of ALT in the placebo group (p=0.1). Patients treated β-cell to lipid-induced hyperinsulinemia. with VSC had a 3% reduction in serum glucose levels after 24 weeks of Physiology/Obesity treatment, whereas patients on placebo had a 6% increase in serum glu- PUBLISHED ONLY 2472-PUB cose levels. A 17% increase in serum insulin levels was noted in the placebo WITHDRAWN group, while a 18% reduction in insulin was seen in the VSC group. Serum triglycerides were reduced by 12% at week 24 in the VSC treated subjects whereas a 18% increase in serum triglycerides were seen in the placebo group. A trend in the reduction of serum cholesterol, HDL, LDL and CRP was seen in the VSC treated patients in comparison to the placebo treated group. In this 24 week study patients treated with VSC had normalization of ALT and signifi cant reductions in serum glucose, insulin and triglycerides in com- parison to the placebo group. Also noted in this study were reductions in AST, cholesterol, HDL and LDL and CRP levels. The ability of this compound ADA-Supported Research For author disclosure information, see page A696. A617 INTEGRATEDCATEGORY PHYSIOLOGY—LIVER in reducing markers of liver infl ammation, glucose, insulin, and triglycerides 2480-PUB indicates that VSC could play an important role in the treatment of nonalco- Dietary Iron Restriction Prevents the Transition of Fatty Liver to Ste- holic fatty liver disease, diabetes and cardiovascular disease. atohepatitis in Mice Fed a High Fat/High Carbohydrate Diet LIPIKA SALAYE, IELIZAVETA BYCHKOVA, DONALD A. MCCLAIN, Winston-Salem, 2476-PUB NC, Cleveland, OH Pathogenesis of Prediabetes in Asian Indians High iron is associated with increased risk for nonalcoholic steatohepati- SONA VEETTIL, ANANDA BASU, JOHN PORT, RITA BASU, Rochester, MN tis (NASH), although iron has not been implicated causally in its pathogen- The pathophysiology of prediabetes (PD) has not been well explored in esis. We examined progression of NASH in mice fed a model “fast food” Asian Indians (AI) residing in the U.S. The study was conducted to evaluate diet supplemented with different levels of iron (4, 35, 500, or 2000 ppm). glucose metabolism and its association with hepatic fat in AI. 10 controls Mice on the 4 ppm iron diet did not become anemic, and the fold-increase with normal fasting glucose/normal glucose tolerance (NFG/NGT) (7M, age in hepatic iron seen at the highest iron was within the normal human range. 35 ± 13 yr, FPG 5.1 ± 0.2 mM, 2-hr glucose 5.7 ± 0.4 mM, BMI 24.0 ± 3.4 kg/m2, All mice developed similar steatosis. Mice on the 500 and 2000 ppm iron diets developed elevations in serum alanine transaminase (ALT) 3 and 6 mos LBM 43.4 ± 9.2 kg, HbA1c 34.6 ± 2.5 mmol/mol) and 10 subjects with PD (per current ADA guidelines) (4M, 43.4 ± 12.3 yr, FPG 6.3 ± 1.0 mM, 2-hr glucose after initiation of the diet (380±32 IU/L at 6 mo) compared to mice on normal 2 chow (121±40 IU/L, p<0.01). Mice on the 4 ppm diet did not exhibit elevations 9.3 ± 2.1 mM, BMI 25.2 ± 3.2 kg/m , LBM 40.5 ± 6.8 kg, HbA1c 40.0 ± 3.5 2 of ALT (70±15 IU/L at 6 mos). Mice on the 35 pp diet had a delay in the time mmol/mol) were studied using a [6, 6- H2 glucose] labeled 75g oral glucose tolerance test (OGTT). The percentage liver fat fraction (% LFF), and total course of elevation, with elevations of ALT at 6 mos (318±19 IU/L), but not fatty acid (total FA) were measured using magnetic resonance spectros- 3 mos (102±22 IU/L). Only mice on the higher iron diets showed up regula- copy (MRS) with an LC model. Plasma iAUC 0-240 min glucose was signifi - tion of collagen type 2, a marker of liver injury in NASH.