Effects of Tirzepatide, a Dual GIP and GLP-1 RA, on Lipid and Metabolite Profiles in Subjects With Type 2 Diabetes.

CONTEXT: Tirzepatide substantially reduced hemoglobin A1c (HbA1c) and body weight in subjects with type 2 diabetes (T2D) compared with the glucagon-like peptide 1 receptor agonist dulaglutide. Improved glycemic control was associated with lower circulating triglycerides and lipoprotein markers and improved markers of beta-cell function and insulin resistance (IR), effects only partially attributable to weight loss. OBJECTIVE: Assess plasma metabolome changes mediated by tirzepatide. DESIGN: Phase 2b trial participants were randomly assigned to receive weekly subcutaneous tirzepatide, dulaglutide, or placebo for 26 weeks. Post hoc exploratory metabolomics and lipidomics analyses were performed. SETTING: Post hoc analysis. PARTICIPANTS: 259 subjects with T2D. INTERVENTION(S): Tirzepatide (1, 5, 10, 15 mg), dulaglutide (1.5 mg), or placebo. MAIN OUTCOME MEASURE(S): Changes in metabolite levels in response to tirzepatide were assessed against baseline levels, dulaglutide, and placebo using multiplicity correction. RESULTS: At 26 weeks, a higher dose tirzepatide modulated a cluster of metabolites and lipids associated with IR, obesity, and future T2D risk. Branched-chain amino acids, direct catabolic products glutamate, 3-hydroxyisobutyrate, branched-chain ketoacids, and indirect byproducts such as 2-hydroxybutyrate decreased compared to baseline and placebo. Changes were significantly larger with tirzepatide compared with dulaglutide and directly proportional to reductions of HbA1c, homeostatic model assessment 2-IR indices, and proinsulin levels. Proportional to metabolite changes, triglycerides and diglycerides were lowered significantly compared to baseline, dulaglutide, and placebo, with a bias toward shorter and highly saturated species. CONCLUSIONS: Tirzepatide reduces body weight and improves glycemic control and uniquely modulates metabolites associated with T2D risk and metabolic dysregulation in a direction consistent with improved metabolic health.

Sphingolipid changes do not underlie fatty acid-evoked GLUT4 insulin resistance nor inflammation signals in muscle cells.

Ceramides contribute to obesity-linked insulin resistance and inflammation in vivo, but whether this is a cell-autonomous phenomenon is debated, particularly in muscle, which dictates whole-body glucose uptake. We comprehensively analyzed lipid species produced in response to fatty acids and examined the consequence to insulin resistance and pro-inflammatory pathways. L6 myotubes were incubated with BSA-adsorbed palmitate or palmitoleate in the presence of myriocin, fenretinide, or fumonisin B1. Lipid species were determined by lipidomic analysis. Insulin sensitivity was scored by Akt phosphorylation and glucose transporter 4 (GLUT4) translocation, while pro-inflammatory indices were estimated by IκBα degradation and cytokine expression. Palmitate, but not palmitoleate, had mild effects on Akt phosphorylation but significantly inhibited insulin-stimulated GLUT4 translocation and increased expression of pro-inflammatory cytokines Il6 and Ccl2 Ceramides, hexosylceramides, and sphingosine-1-phosphate significantly heightened by palmitate correlated negatively with insulin sensitivity and positively with pro-inflammatory indices. Inhibition of sphingolipid pathways led to marked changes in cellular lipids, but did not prevent palmitate-induced impairment of insulin-stimulated GLUT4 translocation, suggesting that palmitate-induced accumulation of deleterious lipids and insulin resistance are correlated but independent events in myotubes. We propose that muscle cell-endogenous ceramide production does not evoke insulin resistance and that deleterious effects of ceramides in vivo may arise through ancillary cell communication.

Identification of 4-Aminopyrazolopyrimidine Metabolite That May Contribute to the Hypolipidemic Effects of LY2584702 in Long Evans Diet-Induced Obese Rats.

LY2584702 is an inhibitor of p70 S6 kinase-1 previously developed for the treatment of cancer. In two phase 1 trials in oncology patients, significant reductions of total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglyceride were observed. In the current study, we sought to understand the potential mechanism of action of this compound in regulating lipid metabolism. In Long Evans diet-induced obese (DIO) rats, oral administration of LY2584702 for 3-4 weeks led to robust reduction of LDL-C up to 60%. An unexpected finding of liver triglyceride (TG) increase implicated a metabolite of LY2584702, 4-aminopyrazolo[3,4-day]pyrimidine (4-APP), in modulation of lipid metabolism in these rats. We showed that low-dose 4-APP, when administered orally for 3-4 weeks to Long Evans DIO rats, produced lipoprotein profile changes that were strikingly similar to LY2584702. Kinetic studies suggested that both LY2584702 and 4-APP had no effect on chylomicron-TG secretion and only exerted a modest effect on hepatic very low-density lipoprotein (VLDL)-TG secretion. In human hepatoma HepG2 cells, 4-APP, but not LY2584702, increased LDL uptake. We hypothesize that generation of the 4-APP metabolite may contribute to the efficacy of LY2584702 in lowering LDL-C in rats and potentially in humans as well. This mechanism of LDL-C lowering may include inhibition of VLDL production and increase in LDL clearance.

Mixed transition metal-lanthanide complexes at high oxidation states: heteronuclear CeIVMnIV clusters.

The syntheses of the first mixed-metal CeIVMnIV complexes are reported. [CeMn2O3(O2CMe)(NO3)4(H2O)2(bpy)2](NO3) (1; bpy=2,2'-bipyridine) was obtained from the reaction of Mn(NO3)2.xH2O and bpy with (NH4)2Ce(NO3)6 in a 1:1:2 molar ratio in 25% aqueous acetic acid. The complexes [CeMn6O9(O2CR)9(X)(H2O)2]y+ (R=Me, X=NO3-, y=0 (2); R=Me, X=MeOH, y=+1 (3); R=Et, X=NO3-, y=0 (7)) were obtained from reactions involving a [Mn(O2CR)2].4H2O/CeIV ratio of approximately 1:1.5 in concentrated aqueous carboxylic acid. A related reaction in less-concentrated aqueous acetic acid and in the presence of L (where L=2-hydroxy-6-methylpyridine (mhpH), 2-pyrrolidinone (pyroH), or pyridine (py)) gave [Ce3Mn2O6(O2CMe)6(NO3)2(L)a(H2O)b] (L=mhpH, a=4, b=0 (4); L=pyroH, a=2, b=3 (5)) and {{(pyH)3[Ce3Mn2O6(O2CMe)7.5(NO3)3].(HO2CMe)0.5.(H2O)2}2(NO3)}n (6), respectively. Solid-state magnetic susceptibility (chiM) data for compounds 1, 4, and 5 were fit to the theoretical chiMT versus T expression for a MnIV2 complex derived using the isotropic Heisenberg spin Hamiltonian (H=-2Js1s 2) and the Van Vleck equation. The obtained fit parameters were (in the format J, g) 1, -45.7(3) cm(-1), 1.95(5); 4, -0.40(10) cm(-1), 2.0(1); and 5, -0.34(10) cm(-1), 2.0(1), where J is the exchange interaction constant between the two MnIV ions. The data for compound 3 were fit by a matrix diagonalization method that gave J1=-5.8 cm(-1), J2=-0.63 cm(-1), J3 approximately 0, and g=2.0(1), where J1 and J2 are the exchange interactions for the [MnIV2O2(Omicron2CMe)] and [MnIV2O(Omicron2CMe)2] units, respectively, and J3 for a uniform next-nearest-neighbor interaction. Theoretical estimates of the exchange constants in compounds 1 and 3 obtained with the ZILSH method were in excellent and good agreement, respectively, with the values obtained from fits of the magnetization data. The difference for 3 is assigned to the presence of the Ce4+ ion, and atomic bond indices obtained from the ZILSH calculations were used to rationalize the values of the various exchange constants based on metal-ligand bond strengths.

Synthesis, structure, and properties of low-spin manganese(III)-poly(pyrazolyl)borate complexes.

The manganese(III)-bis[poly(pyrazolyl)borate] complexes, Mn(pzb)2SbF6, where pzb- = tetrakis(pyrazolyl)borate (pzTp) (1), hydrotris(pyrazolyl)borate (Tp) (2), or hydrotris(3,5-dimethylpyrazolyl)borate (Tp*) (3), have been synthesized by oxidation of the corresponding Mn(pzb)2 compounds with NOSbF6. The Mn(III) complexes are low-spin in solution and the solid state (microeff = 2.9-3.8 microB). X-ray crystallography confirms their uncommon low-spin character. The close conformity of mean Mn-N distances of 1.974(4), 1.984(5), and 1.996(4) A in 1, 2, and 3, respectively, indicates absence of the characteristic Jahn-Teller distortion of a high-spin d4 center. N-Mn-N bite angles of slightly less than 90 degrees within the facially coordinated pzb- ligands produce a small trigonal distortion and effective D3d symmetry in 1 and 2. These angles increase to 90.0(4)degrees in 3, yielding an almost perfectly octahedral disposition of N donors in Mn(Tp*)2+. Examination of structural data from 23 metal-bis(pzb) complexes reveals systematic changes within the metal-(pyrazolyl)borate framework as the ligand is changed from pzTp to Tp to Tp*. These deformations consist of significant increases in M-N-N, N-B-N, and N-N-B angles and a minimal increase in Mn-N distance as a consequence of the steric demands of the 3-methyl groups. Less effective overlap of pyrazole lone pairs with metal atom orbitals resulting from the M-N-N angular displacement is suggested to contribute to the lower ligand field strength of Tp* complexes. Mn(pzb)2+ complexes undergo electrochemical reduction and oxidation in CH3CN. The electrochemical rate constant (ks,h) for reduction of t2g4 Mn(pzb)2+ to t2g3eg2 Mn(pzb)2 (a coupled electron-transfer and spin-crossover reaction) is 1-2 orders of magnitude smaller than that for oxidation of t2g4 Mn(pzb)2+ to t2g3 Mn(pzb)22+. ks,h values decrease as Tp* > pzTp > Tp for the Mn(pzb)2+/0 electrode reactions, which contrasts with the behavior of the comparable Fe(pzb)2+/0 and Co(pzb)2+/0 couples.