Glucagon-like peptide-1 (GLP-1) is an incretin derived from the transcription product of the proglucagon gene. The major source of GLP-1 in the body is the intestinal L cell that secretes GLP-1 as a gut hormone. The biologically active forms of GLP-1 are: GLP-1-(7-37) and GLP-1-(7-36)NH2. Those peptides result from selective cleavage of the proglucagon molecule.
GLP-1 secretion by ileal L cells is dependent on the presence of nutrients in the lumen of the small intestine. The secretagogues (agents that cause or stimulate secretion) of this hormone include major nutrients like carbohydrate, protein and lipid. Once in the circulation, GLP-1 has a half-life of less than 2 minutes, due to rapid degradation by the enzyme dipeptidyl peptidase-4. It is a potent antihyperglycemic hormone, inducing glucose-dependent stimulation of insulin secretion while suppressing glucagon secretion. Such glucose-dependent action is particularly attractive because, when the plasma glucose concentration is in the normal fasting range, GLP-1 no longer stimulates insulin to cause hypoglycemia. GLP-1 appears to restore the glucose sensitivity of pancreatic β-cells, with the mechanism possibly involving the increased expression of GLUT2 and glucokinase. GLP-1 is also known to inhibit pancreatic β-cell apoptosis and stimulate the proliferation and differentiation of insulin-secreting β-cells. In addition, GLP-1 inhibits gastric secretion and motility. This delays and protracts carbohydrate absorption and contributes to a satiating effect.
GLP-1 possesses several physiological properties that make it (and its analogs) a subject of intensive investigation as a potential treatment of diabetes mellitus. The known physiological functions of GLP-1 include:
- increases insulin secretion from the pancreas in a glucose-dependent manner.
- decreases glucagon secretion from the pancreas by engagement of a specific G protein-coupled receptor.
- increases insulin-sensitivity in both alpha cells and beta cells
- increases beta cells mass and insulin gene expression, post-translational processing and incretion.
- inhibits acid secretion and gastric emptying in the stomach.
- decreases food intake by increasing satiety in brain.
- promotes insulin sensitivity.
As evidence of the physiological role of GLP-1 in post-prandial insulin secretion, it has been shown that an oral dose of glucose triggers a much higher peak in plasma insulin concentration compared to an intravenous dose.
Obese patients undergoing gastric bypass showed marked metabolic adaptations, resulting in frequent diabetes remission 1 year later. When the confounding of calorie restriction is factored out, β-cell function improves rapidly, very possibly under the influence of enhanced GLP-1 responsiveness.
Outside of its function as an insulin secretagogue, GLP-1 seems also to play a role in bone physiology. Researchers at Universities of Angers and Ulster evidenced a massive reduction in bone strength in GLP-1 receptor knockout mice mainly due to a poor bone quality.
- Glucagon-like peptide 1 receptor
- Glucagon-like peptide-2
- Type 2 diabetes
- GLP-1 analogs : exenatide, liraglutide, dulaglutide
- Dipeptidyl peptidase-4
- Sitagliptin ( a DPP4 inhibitor)
- Glucose-dependent insulinotropic peptide
- "Diabetes and Intestinal Incretin Hormones: A New Therapeutic Paradigm" at medscape.com (slide 36)
- Toft-Nielsen MB, Madsbad S, Holst JJ (August 2001). "Determinants of the effectiveness of glucagon-like peptide-1 in type 2 diabetes". The Journal of Clinical Endocrinology and Metabolism 86 (8): 3853–60. doi:10.1210/jcem.86.8.7743. PMID 11502823.
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- Presswala L, Shubrook J (April 2015). "What to do after basal insulin: 3 Tx strategies for type 2 diabetes". The Journal of family practice 64 (4): 214–20. PMID 25973447.
- Nannipieri M, Baldi S, Mari A et al. (November 2013). "Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones". The Journal of Clinical Endocrinology and Metabolism 98 (11): 4391–9. doi:10.1210/jc.2013-2538. PMID 24057293.
- Mabilleau G, Mieczkowska A, Irwin N, Flatt PR, Chappard D (October 2013). "Optimal bone mechanical and material properties require a functional glucagon-like peptide-1 receptor". The Journal of Endocrinology 219 (1): 59–68. doi:10.1530/JOE-13-0146. PMID 23911987.
- Banting and Best Diabetes Centre at UT glp1
- Glucagon-Like Peptide 1 at the US National Library of Medicine Medical Subject Headings (MeSH)
American diabetes association:link-http://diabetes.diabetesjournals.org/content/56/1/8.full