Insulin, a hormone and life-saving therapy against diabetes, has just turned 100, in 2021. In this hundred years, full of satisfaction, with millions of lives saved and improved, the refinement of treatments with insulin and the search for new therapies went on, with several successful results.
Today a group of the Salk Institute, a research institute in San Diego, California, has identified a new path – literally a new “pathway”, that is, an alternative physiological path – associated with type 2 diabetes. This path is linked to the possibility of lower blood glucose and thus to keep the disease under control. The results, for now initial because obtained in research on animals and in test tubes, and not yet on humans, are published in the journal Cell Metabolism.
An alternative route against hyperglycemia
The researchers studied the role of a hormone called Fgf1, already known to be involved in controlling blood glucose (blood sugar). Just like insulin, this new hormone also inhibits a metabolic process called lipolysis, which is responsible for raising blood sugar. However, there is something new: Fgf1 performs this action in a completely different way than insulin. It does this by activating a series of new biological processes, an alternative “physiological path” to the one on which current treatments act.
In fact, insulin performs its action using an enzyme called Pde3b, while this hormone uses the molecular pathway called Pde4. The findings, which are in a preliminary stage, could open up new research options for treatments focused on glucose reduction and insulin resistance. The authors are already at work trying to modify the Fgf1 hormone or to intervene on the processes in the new route.
“The research is interesting and promising,” he comments Andrea Giaccari, diabetologist at the Agostino Gemelli Irccs University Polyclinic Foundation, not involved in the work, “because he focuses on the mechanism of action of Fgf1, discovering that it works on an alternative path to that of insulin”. While the treatments currently available for insulin resistance and type 2 diabetes are based on a single known molecular pathway, the expert continues.
“In fact – clarifies the diabetologist – they actually increase or make the insulin more effective, helping a gear that works little or badly. In this new case, however, the aim is to act a little more at the root of the problem. the need for insulin needed to keep blood sugar under control “.
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However, the novelty, which will have to be investigated and confirmed, only concerns type 2 diabetes. power over the lack or absence of insulin production typical of type 1 diabetes “.
Even in the face of this clarification, the study remains relevant. “If the trials confirm the data”, specifies the diabetologist, “following the new molecular pathway could be useful, in the future, for those patients with diabetes 2 and with very marked insulin resistance, who do not respond to the drugs mentioned above and require necessarily the administration of insulin “, more demanding therapy. In practice, the new path could identify a shortcut, for some people, and allow them to bypass obstacles that still exist.
When your blood sugar continues to rise
The present and the future
“The work is still in an early stage”, Giaccari remarks, “and it will take years to expand the data and have a result that can be translated into clinical practice”. In short, it takes patience to understand if this new path will actually prove effective. But already today, in addition to insulin, we have treatments that can support it or in some cases supplant it. These, based on the same “path” as insulin, can in some cases also be very valid. “We are talking about metformin”, underlines the diabetologist, “of the class of drugs called Glp-1 receptor agonists, one of which recently also available orally, and of the glyflozines (or Sglt-2 inhibitors)”.
In short, we are moving more and more in the direction of effective therapies, easier and with fewer side effects. On this journey, having alternative and new tools could be useful.