glp-1靶点的新药临床试验最新进展和结果

酪氨酸磷酸酶PTP1B已被公认为治疗II型糖尿病药物的理想靶标蛋白.通过重组表达制备PTP1B蛋白及其蛋白质晶体,并尝试将其与768种小分子片段进行以结构为基础的筛选,得到了数个与PTP1B结合的小分子片段及其化学结构.在此基础上利用计算机辅助药物设计方法设计与优化出一种新型PTP1B抑制剂,并经13步反应合成了该目标分子.体外药理活性和毒性的初步评价的结果表明,其对体外重组人源PTP1B的酪氨酸磷酸酶活性半数抑制浓度IC50值达到（3.4±1.2）μmol/L,优于阳性对照;在Hep G2细胞胰岛素抵抗模型中,该化合物能有效改善胰岛素抵抗细胞对葡萄糖的利用能力,其改善效果与阳性药匹格列酮相当.初步的斑马鱼毒性检测表明,目标该化合物在浓度为500μmol/L时未对幼鱼产生明显毒性.新化合物的发现为新型PTP1B抑制剂的后续开发开辟了新基础。

BACKGROUND Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. METHODS The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. RESULTS The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79). CONCLUSIONS A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent.