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Analysis of the efficacy of SGLT2 inhibitors using semi-mechanistic model.

Demin O, Yakovleva T, Kolobkov D, Demin O - Front Pharmacol (2014)

Bottom Line: The model shows that concentration levels of tofogliflozin, ipragliflozin, and empagliflozin are higher than levels of other inhibitors following administration of marketed SGLT2 inhibitors at labeled doses and non-marketed SGLT2 inhibitors at maximal doses (approved for phase 2/3 studies).All the compounds exhibited almost 100% inhibition of SGLT2.Based on the results of our model, two explanations for the observed low efficacy of SGLT2 inhibitors were supported: (1) the site of action of SGLT2 inhibitors is not in the lumen of the kidney's proximal tubules, but elsewhere (e.g., the kidneys proximal tubule cells); and (2) there are other transporters that could facilitate glucose reabsorption under the conditions of SGLT2 inhibition (e.g., other transporters of SGLT family).

View Article: PubMed Central - PubMed

Affiliation: Laboratory Alpha, Institute for Systems Biology Moscow Moscow, Russia.

ABSTRACT
The Renal sodium-dependent glucose co-transporter 2 (SGLT2) is one of the most promising targets for the treatment of type 2 diabetes. Two SGLT2 inhibitors, dapagliflozin, and canagliflozin, have already been approved for use in USA and Europe; several additional compounds are also being developed for this purpose. Based on the in vitro IC50 values and plasma concentration of dapagliflozin measured in clinical trials, the marketed dosage of the drug was expected to almost completely inhibit SGLT2 function and reduce glucose reabsorption by 90%. However, the administration of dapagliflozin resulted in only 30-50% inhibition of reabsorption. This study was aimed at investigating the mechanism underlying the discrepancy between the expected and observed levels of glucose reabsorption. To this end, systems pharmacology models were developed to analyze the time profile of dapagliflozin, canagliflozin, ipragliflozin, empagliflozin, and tofogliflozin in the plasma and urine; their filtration and active secretion from the blood to the renal proximal tubules; reverse reabsorption; urinary excretion; and their inhibitory effect on SGLT2. The model shows that concentration levels of tofogliflozin, ipragliflozin, and empagliflozin are higher than levels of other inhibitors following administration of marketed SGLT2 inhibitors at labeled doses and non-marketed SGLT2 inhibitors at maximal doses (approved for phase 2/3 studies). All the compounds exhibited almost 100% inhibition of SGLT2. Based on the results of our model, two explanations for the observed low efficacy of SGLT2 inhibitors were supported: (1) the site of action of SGLT2 inhibitors is not in the lumen of the kidney's proximal tubules, but elsewhere (e.g., the kidneys proximal tubule cells); and (2) there are other transporters that could facilitate glucose reabsorption under the conditions of SGLT2 inhibition (e.g., other transporters of SGLT family).

No MeSH data available.


Related in: MedlinePlus

Comparison of simulated average inhibition of glucose reabsorption mediated by SGLT2 and clinically measured glucose reabsorption inhibition levels during treatment with empagliflozin. Comparison of the average inhibition of glucose reabsorption mediated by SGLT2 (simulated in the model) and levels of glucose reabsorption inhibition (measured in experiment) on the 1st day after multiple administrations of different doses of empagliflozin (Heise et al., 2013a). Model simulations are presented with 95% confidence bands.
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Figure 10: Comparison of simulated average inhibition of glucose reabsorption mediated by SGLT2 and clinically measured glucose reabsorption inhibition levels during treatment with empagliflozin. Comparison of the average inhibition of glucose reabsorption mediated by SGLT2 (simulated in the model) and levels of glucose reabsorption inhibition (measured in experiment) on the 1st day after multiple administrations of different doses of empagliflozin (Heise et al., 2013a). Model simulations are presented with 95% confidence bands.

Mentions: We simulated the average level of inhibition of glucose reabsorption mediated by SGLT2 and compared our findings with experimentally measured levels of glucose reabsorption inhibition following treatment with compounds (Figures 9, 10, Supplementary Figures 21–23). In model simulations, the average level of inhibition of glucose reabsorption mediated by SGLT2 was higher than the level of total glucose reabsorption inhibition, and almost equal to 100%, following treatment with all experimental doses of SGLT2 inhibitors (Figures 9, 10, Supplementary Figures 21–23).


Analysis of the efficacy of SGLT2 inhibitors using semi-mechanistic model.

Demin O, Yakovleva T, Kolobkov D, Demin O - Front Pharmacol (2014)

Comparison of simulated average inhibition of glucose reabsorption mediated by SGLT2 and clinically measured glucose reabsorption inhibition levels during treatment with empagliflozin. Comparison of the average inhibition of glucose reabsorption mediated by SGLT2 (simulated in the model) and levels of glucose reabsorption inhibition (measured in experiment) on the 1st day after multiple administrations of different doses of empagliflozin (Heise et al., 2013a). Model simulations are presented with 95% confidence bands.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195280&req=5

Figure 10: Comparison of simulated average inhibition of glucose reabsorption mediated by SGLT2 and clinically measured glucose reabsorption inhibition levels during treatment with empagliflozin. Comparison of the average inhibition of glucose reabsorption mediated by SGLT2 (simulated in the model) and levels of glucose reabsorption inhibition (measured in experiment) on the 1st day after multiple administrations of different doses of empagliflozin (Heise et al., 2013a). Model simulations are presented with 95% confidence bands.
Mentions: We simulated the average level of inhibition of glucose reabsorption mediated by SGLT2 and compared our findings with experimentally measured levels of glucose reabsorption inhibition following treatment with compounds (Figures 9, 10, Supplementary Figures 21–23). In model simulations, the average level of inhibition of glucose reabsorption mediated by SGLT2 was higher than the level of total glucose reabsorption inhibition, and almost equal to 100%, following treatment with all experimental doses of SGLT2 inhibitors (Figures 9, 10, Supplementary Figures 21–23).

Bottom Line: The model shows that concentration levels of tofogliflozin, ipragliflozin, and empagliflozin are higher than levels of other inhibitors following administration of marketed SGLT2 inhibitors at labeled doses and non-marketed SGLT2 inhibitors at maximal doses (approved for phase 2/3 studies).All the compounds exhibited almost 100% inhibition of SGLT2.Based on the results of our model, two explanations for the observed low efficacy of SGLT2 inhibitors were supported: (1) the site of action of SGLT2 inhibitors is not in the lumen of the kidney's proximal tubules, but elsewhere (e.g., the kidneys proximal tubule cells); and (2) there are other transporters that could facilitate glucose reabsorption under the conditions of SGLT2 inhibition (e.g., other transporters of SGLT family).

View Article: PubMed Central - PubMed

Affiliation: Laboratory Alpha, Institute for Systems Biology Moscow Moscow, Russia.

ABSTRACT
The Renal sodium-dependent glucose co-transporter 2 (SGLT2) is one of the most promising targets for the treatment of type 2 diabetes. Two SGLT2 inhibitors, dapagliflozin, and canagliflozin, have already been approved for use in USA and Europe; several additional compounds are also being developed for this purpose. Based on the in vitro IC50 values and plasma concentration of dapagliflozin measured in clinical trials, the marketed dosage of the drug was expected to almost completely inhibit SGLT2 function and reduce glucose reabsorption by 90%. However, the administration of dapagliflozin resulted in only 30-50% inhibition of reabsorption. This study was aimed at investigating the mechanism underlying the discrepancy between the expected and observed levels of glucose reabsorption. To this end, systems pharmacology models were developed to analyze the time profile of dapagliflozin, canagliflozin, ipragliflozin, empagliflozin, and tofogliflozin in the plasma and urine; their filtration and active secretion from the blood to the renal proximal tubules; reverse reabsorption; urinary excretion; and their inhibitory effect on SGLT2. The model shows that concentration levels of tofogliflozin, ipragliflozin, and empagliflozin are higher than levels of other inhibitors following administration of marketed SGLT2 inhibitors at labeled doses and non-marketed SGLT2 inhibitors at maximal doses (approved for phase 2/3 studies). All the compounds exhibited almost 100% inhibition of SGLT2. Based on the results of our model, two explanations for the observed low efficacy of SGLT2 inhibitors were supported: (1) the site of action of SGLT2 inhibitors is not in the lumen of the kidney's proximal tubules, but elsewhere (e.g., the kidneys proximal tubule cells); and (2) there are other transporters that could facilitate glucose reabsorption under the conditions of SGLT2 inhibition (e.g., other transporters of SGLT family).

No MeSH data available.


Related in: MedlinePlus