Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist
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- Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist
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Tirzepatide (LY3298176) is a dual GIP and GLP-1 receptor agonist under development for the treatment of type 2 diabetes mellitus (T2DM), obesity, and nonalcoholic steatohepatitis. Early phase trials in T2DM indicate that tirzepatide improves clinical outcomes beyond those achieved by a selective GLP-1 receptor agonist. Therefore, we hypothesized that the integrated potency and signaling properties of tirzepatide provide a unique pharmacological profile tailored for improving broad metabolic control. Here, we establish methodology for calculating occupancy of each receptor for clinically efficacious doses of the drug. This analysis reveals a greater degree of engagement of tirzepatide for the GIP receptor than the GLP-1 receptor, corroborating an imbalanced mechanism of action. Pharmacologically, signaling studies demonstrate that tirzepatide mimics the actions of native GIP at the GIP receptor but shows bias at the GLP-1 receptor to favor cAMP generation over beta-arrestin recruitment, coincident with a weaker ability to drive GLP-1 receptor internalization compared with GLP-1. Experiments in primary islets reveal beta-arrestin1 limits the insulin response to GLP-1, but not GIP or tirzepatide, suggesting that the biased agonism of tirzepatide enhances insulin secretion. Imbalance toward GIP receptor, combined with distinct signaling properties at the GLP-1 receptor, together may account for the promising efficacy of this investigational agent.
Original language | English |
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Article number | 140532 |
Journal | JCI insight |
Volume | 5 |
Issue number | 17 |
Number of pages | 16 |
ISSN | 2379-3708 |
DOIs | |
Publication status | Published - 2020 |
- GLUCAGON-LIKE PEPTIDE-1, DEPENDENT INSULINOTROPIC POLYPEPTIDE, SERUM-PROTEIN BINDING, IN-VITRO, DULAGLUTIDE, AFFINITY, PHARMACOLOGY, SEMAGLUTIDE, ACTIVATION, INHIBITORS
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