GLP-2 has been shown to exhibit promising therapeutic potential in experimental models of intestinal atrophy and injury including:
TPN-induced mucosal atrophy
Prevention of parenteral nutrition-induced gut hypoplasia by coinfusion of glucagon-like peptide-2. Am J Physiol. 1997;273 :G559-63 Intravenous GLP-2 reverses the TPN-associated mucosal villus hypoplasia in the small bowelMaintaining gut integrity during parenteral nutrition of tumor-bearing rats: effects of glucagon-like peptide 2. Nutr Cancer. 2000;37(2):215-22 GLP-2 infusion reverses mucosal atrophy in the small bowel without effects on tumor growth in tumor-bearing ratsShort bowel syndrome following major intestinal resection
GLP-2 augments the adaptive response to massive intestinal resection in rat. Am J Physiol. 1998 Nov;275(5 Pt 1):G911-21 GLP-2 improves nutrient absorption and augments intestinal adaptation in rats following MSBR. Consistent with a role for endogenous GLP-2 in intestinal adaptation, the levels of circulating GLP-2 are rapidly and significantly elevated in the rat following MSBR. See Time-dependent intestinal adaptation and GLP-2 alterations after small bowel resection in rats. Am J Physiol Gastrointest Liver Physiol. 2001 Sep;281(3):G779-85. The increase in endogenous levels of GLP-2 after major small bowel resection appears to be an important component of intestinal adaptation as rats administered GLP-2 antisera exhibited diminished histological features of intestinal adaptation in the remnant ileum as shown in Glucagon-like Peptide 2 is an endogenous mediator of postresection intestinal adaptation. JPEN J Parenter Enteral Nutr. 2005 Mar-Apr;29(2):97-101
The timing of optimal GLP-2 administration was assessed in mice following ileo-cecal resection. Groups of mice were treated with GLP-2 immediately after ileo-cecal resection, or commencing 5 weeks after surgery. Only mice receiving early GLP-2 therapy exhibited therapeutic benefit as measured by augmentation of intestinal progenitors, increased cell proliferation and crypt fission, and more rapid attainment of increased mucosal circumference as outlined in Early but not late administration of glucagon-like peptide-2 following ileo-cecal resection augments putative intestinal stem cell expansion Am J Physiol Gastrointest Liver Physiol 2009;296 G643-G650
Experimental colitis in mice
Human [Gly2]GLP-2 reduces the severity of colonic injury in a murine model of experimental colitis Am J Physiol 1999 Jan;276(1 Pt 1):G79-91 GLP-2 markedly attenuates weight loss and reduces multiple histological parameters of intestinal injury in the colon of mice with DS colitis as also described in Glucagon-like peptide-2 and common therapeutics in a murine model of ulcerative colitis. J Pharmacol Exp Ther. 2003 Jul;306(1):347-54. Similarly, GLP-2 does not require IL-10 for its anti-inflammatory and therapeutic actions as administration of GLP-2 (50 microg/kg/sc. injection) treatment for 5 days to IL-10-/- mice produced significant amelioration of disease activity, in association with an increase in intestinal epithelial cell SOCS-3 expression and reduced STAT-3 signaling as outlined in Interleukin-10 independent anti-inflammatory actions of glucagon-like peptide 2. Am J Physiol Gastrointest Liver Physiol. 2008 Oct 9. GLP-2 also reduces the severity of colitis in rats either following injection of TNBS, or after oral administration of DS, actions which appear to require VIP, as described in Enteric neural pathways mediate the anti-inflammatory actions of glucagon-like peptide 2. Am J Physiol Gastrointest Liver Physiol. 2007 Jul;293(1):G211-21
Non-steroidal anti-inflammatory drug-induced enteritis in mice and rats
Administration of GLP-2 markedly decreased NSAID-induced
intestinal in mice, as shown below
Glucagon-like peptide 2 decreases mortality and reduces the severity of indomethacin-induced murine enteritis Am J Physiol 1999 Nov;277(5 Pt 1):E937-47 GLP-2, administered in a variety of regimens, reduces mortality and improves gross and microscopic indices of intestinal injury in mice with NSAID-induced enteritis
GLP-2 administration in experimental vascular ischemia
Evidence for the protective effects of GLP-2 in the setting of experimental intestinal injury is described in Glucagonlike peptide-2 analogue enhances intestinal mucosal mass after ischemia and reperfusion J Pediatr Surg. 2000 Feb;35(2):357-9. This study shows that GLP-2 promotes mucosal repair and significantly reduces mortality in rats following experimental SMA occlusion. Similarly, GLP-2 was administered prior to ischemia-reperfusion for 3 days, or prior to and following I/R, in rats. The authors concluded that treatment with GLP-2 attenuates intestinal I/R injury, reduces bacterial translocation, inhibits the release of oxygen free radicals and ET-1, and inhibitd the production of proinflammatory cytokines Protective effects of glucagon-like peptide 2 on intestinal ischemia-reperfusion rats Microsurgery. 2008 Mar 27;28(4):285-290. [Epub ahead of print]
GLP-2 and Immune-mediated IBD in rats
Treatment of inflammatory bowel disease in a rodent model with the intestinal growth factor glucagon-like peptide-2 J Pediatr Surg 2000 Jun;35(6):847-51 Administration of GLP-2 as a 14 day intravenous infusion at 50 microg/kg/d significantly reduced gross and histological intestinal mucosal damage and reduced the levels of the cytokines TNF-alpha and IFN-gamma in rats with antigen induced enteritis.
Increased levels of GLP-2 likely mediate small bowel villus
hyperplasia in experimental diabetes
Treatment of rats with insulin reverses the villus hyperplasia (left panel compared to right) and reduces circulating levels of GLP-2 See Intestinal growth is associated with elevated levels of glucagon-like peptide 2 in diabetic rats. Am J Physiol 1997 273: E815-20
GLP-2 effects in premature pigs
GLP-2 administration enhanced DNA synthesis, increased villus height, reduced apoptosis and reduced proteolysis in the developing pig gut. See GLP-2 stimulates intestinal growth in premature TPN-fed pigs by suppressing proteolysis and apoptosis AJP Vol. 279, Issue 6, G1249-G1256, December 2000
GLP-2 and cancer
Does GLP-2 exert its intestinotrophic actions in the setting of neoplasia? Treatment of tumor-bearing rats with TPN alone, versus TPN plus co-administered GLP-2 demonstrated that the trophic effects of GLP-2 on the small intestinal mucosa were maintained in tumor-bearing rats. In contrast, no significant effects of GLP-2 were noted in the colon. GLP-2 did not reduce tumor-bearing immunosuppression, and GLP-2 had no effect on tumor growth, whereas bacterial translocation was modestly reduced in GLP-2-treated animals. See Maintaining gut integrity during parenteral nutrition of tumor-bearing rats: effects of glucagon-like peptide 2. Nutr Cancer. 2000;37(2):215-22
In contrast, studies in mice administered the cancer inducing methylating carcinogen 1,2-dimethylhydrazine (DMH) demonstrated that concomitant GLP-2 administration for 10 or 30 days increased the number of colonic polyps, although no effect of GLP-2 treatment on survival was detected, See Glucagon-like peptide 2 (GLP-2) accelerates the growth of colonic neoplasms in mice. Gut. 2004 Aug;53 (8): 1145-50. A subsequent study demonstrated that twice daily administration of 1.5 ug [Gly2]-GLP-2 for 4 weeks to mice previously treated with azoxymethane resulted in an increased number of aberrant crypt foci and two GLP-2-treated animals developed colonic adenocrcinomas Carcinogenic effects of exogenous and endogenous glucagon-like peptide-2 in azoxymethane-treated mice. Endocrinology. 2009 Sep;150(9):4033-43. Epub 2009 Jun 4.
GLP-2 and chemotherapy
GLP-2 administration prevents chemotherapy-induced apoptosis. How does GLP-2 receptor activation in the gut endocrine cell reduce apoptosis in the
gastrointestinal epithelium, leading to increased survival in experimental
chemotherapy- induced mucositis? Review the data in Glucagon-like
Peptide (GLP)-2 Reduces Chemotherapy-associated Mortality and Enhances
Cell Survival in Cells Expressing a Transfected GLP-2 Receptor Cancer Res 2001 61: 687-693
A similar correlation between increased levels of GLP-2 and protection from chemotherapy-induced enteritis has been demonstrated in mice treated with 5-FU and either GLP-2 alone or both metformin and Val-Pyr, which enhances the levels of circulating GLP-2. See The combination of metformin and a dipeptidyl peptidase IV inhibitor prevents 5-fluorouracil-induced reduction of small intestine weight. Eur J Pharmacol. 2004 Mar 19;488(1-3):213-8
GLP-2 in experimental burn injury
GLP-2 infusion in burned rats prevented loss of gut protein and enhanced immune function. Glucagon-like peptide-2 stimulates gut mucosal growth and immune response in burned rats. J Burn Care Rehabil. 2001 Mar-Apr; 22(2):136-43.
GLP-2 in acute necrotizing pancreatitis
The effects of a GLP-2 analog, ALX-0600, have been examined in the setting of experimental necrotizing pancreatitis induced in Sprague-Dawley rats. Treatment with ALX-0600 for 3 days significantly reduced intestinal permeability, with a trend to reduction of bacterial translocation in viscera and mesenteric lymph nodes. See The effect of glucagon-like peptide 2 on intestinal permeability and bacterial translocation in acute necrotizing pancreatitis. Am J Surg. 2001 Jun;181(6):571-5.
GLP-2 in acute radiation-induced injury
The Therapeutic Actions of GLP-2 in Human Subjects
GLP-2 exerts potent trophic and anti-apoptotic effects in the GI tract of rodents and enhances nutrient absorption in mice and rats following small bowel resection. Does GLP-2 exert the same effects in human patients with short bowel syndrome? Review the data in the first human study "GLP-2 Improves Nutrient Absorption and Nutritional Status in Short-Bowel Patients With No Colon" in the March 2001 issue of Gastroenterology, and the accompanying Editorial.
Similar results were obtained in a 21 day pilot study of Teduglutide, a degradation-resistant GLP-2 anaolog, in 16 human subjects with short bowel syndrome, with and without a colon in continuity. Teduglutide improved energy absorption, in association with expansion of mucosal crypt plus villus height in the small bowel, as outlined in Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut. 2005 Sep;54(9):1224-31
Analysis of bone density in eight short bowel patients treated with synthetic human GLP-2, 400 ug sc twice daily for 5 weeks demonstrated significant increases in spinal bone mineral density in 7/8 patients, with an increase in ionized calcium detected in 5/8 patients. The mechanism for these findings remains unclear, but may be due in part to increased calcium absorption. See Short-term administration of glucagon-like peptide-2. Effects on bone mineral density and markers of bone turnover in short-bowel patients with no colon. Scand J Gastroenterol. 2002 Apr;37(4):392-8.
Longer follow up in a small number of patients treated with native GLP-2 reported modest but significant sustained effects on energy absorption, and a significant reduction of fecal wet weight by ~1 kg/day, enabling patients to maintain their fluid and electrolyte status with reduced oral intake, with a modest improvement in kidney function Short bowel patients treated for two years with glucagon-like Peptide 2: effects on intestinal morphology and absorption, renal function, bone and body composition, and muscle function. Gastroenterol Res Pract. 2009:616054. Epub 2009 Aug 20.
GLP-2 (Teduglutide) is currently being developed by NPS Pharmaceuticals through its Canadian subsidiary NPS Allelix Corp as a potential therapeutic agent for human subjects with intestinal diseases characterized by insufficient repair of intestinal mucosa and/or compromised nutrient absorption