胰腺的胰島具有重要的生理功能，表現在系列的荷爾蒙，特別是能夠控制血糖穩態的胰島素的合成和分泌。胰島素的功能受到各種分子信號及環境的調節。在過去的十年裡，腎素血管緊張素系統(RAS)被發現除了調節血壓和體液穩態之外還具有局部性的生理功能。根據我們最近的發現，胰島存在自有的腎素血管緊張素系統並且可能在胰島生理作用和糖尿病方面發揮新穎的作用。同時，越來越多的研究發現一些與臨床相闊的調節因子在胰島的功能和糖尿病中起著關鍵的作用。這些調節因子促進胰島素分泌並且可以調節胰島細胞的生長和凋亡。其中一些調節因子顯示出極大的研究價值。胰高血糖素樣肽-1(GLP-1)能通過它在胰島上的受體改善胰島的功能和血糖的控制;另一方面， 維生素D 也可以通過它在胰島B細胞上的受體來起到調節胰島素分泌及控制糖尿病的作用。像胰島局部RAS一樣， GLP-1 和維生素D 都可以通過它們在同一個靶器官--胰島細胞上的受體來發揮它們的功能。因此，不難想象這三種調節因子之前具有潛在的聯系並且直接或間接地影響胰島功能。此研究可以分為三部分以闡述這三種調節因子在胰島上的新穎作用(1) GLP-l 和RAS 在胰島功能上的潛在協同作用; (2)維生素D 對於胰島RAS 表達的調節作用及對膜島功能的影響；(3) 維生素D 缺乏下的胰島RAS 表達以及胰島功能的改變。 / 在第一部分的研究裡，我們檢測了阻斷血管緊張素一型受體(纈沙坦)和增強GLP-l 作用(DPPIV 抑制劑LAF237) 的復合效應對二型糖尿病小鼠(db/db) 血糖控制和胰島功能方面的影響。我們比較了接受單一給藥和聯合給藥的db/db 小鼠的胰島功能。所有的藥物處理都改善了db/db 小鼠的血糖穩態，而聯合給藥組在增加胰島B細胞面積，減少細胞凋亡，促進增殖以及降低膜島氧化應激和膜島纖維化方面體現出復合效應。另外，短期的聯合給藥顯著促進分離出來的胰島細胞的胰島素分泌。這些結果顯示了血管緊張素型受體阻斷劑和DPPIV 抑制劑在改善胰島的結構與功能以及治療二型糖尿病方面具有復合效應。 / 據研究，維生素D 是種具有抗糖尿病和高血壓作用的荷爾蒙，而不適合的RAS活性能夠減少胰島功能和糖耐量。維生素D 對腎臟腎素的直接抑制作用表明維生素D 可能可以調節胰島得局部RAS 活性進而調節胰島的生理作用。因此第二部分的實驗旨在研究維生素D 是否能夠抑制分離培養的胰島中非正常表達的胰島局部RAS組分並且改善胰島且細胞功能。維生素D 受體存在於胰島且細胞的核與質中，計量依賴性地調節受體對活性維他命D-骨化三醇的反應。骨化三醇的刺激可以通過增加維生素D24羥化黣激發胰島局部維他命D 系統的反饋機制。在分離的胰島中，長期處於高糖的環境，胰島局部RAS 的異常表達可以一定濃度的骨化三醇治療和預防。然而，骨化三醇的送科治療效果，並沒有在生理正常糖濃度的情況下被發現。另外，在高糖環境下，骨化三醇增加胰島素前體合成以及葡萄糖刺激的服島素分泌。這些結果顯示骨化三醇能夠調節以及保護高糖環境引起的異常胰島RAS 組分表達並通過增加胰島素的合成與分泌來改善胰島的功能，為在高血糖和糖尿病情況下的維生素D 與胰島功能關系提供了新的機制。 / 循環中的維生素D 水平與血糖濃度以及糖尿病的患病風險成反比。第二部分的實驗結果現實了維生素D 具有潛在的調節胰島RAS 進而調節胰島功能的作用。因此，在第三部分的實驗裡，我們假設不充足的維生素D 水平可能引起異常的胰島RAS 表達進而引起胰島功能障薇。為了這個目的，我們使用了維生素D 受體缺失的基因敲除小鼠和維生素D 缺乏小鼠來檢測糖代謝，膜島形態以及局部RAS 組分的表達。結果顯示，在缺乏維生素D 以及正常的維生素D 作用的情況下，胰島局部RAS 組分異常表達。而這個維生素D 導致的RAS 異常表達的作用可能發生在高血糖現象之前，從而導致了胰島功能障礙，異常的糖代謝以及減弱的胰島且細胞本身的胰島素作用。這些結果為在生理情況下，維生素D 可以通過調節胰島局部RAS 的表達進而調節胰島功能提供了有力的支持。 / 總括來說，胰島局部RAS 在持續高糖環境下的胰島功能中有著關鍵的作用。GLP-l 和維生素D 都與胰島RAS 具有潛在的生物相關性並可以影響RAS 的表達，進而調節胰島功能和自細胞體積。我們的實驗數據顯示了這三種調節系統共同作用並調節目突島細胞功能以及血糖穩態，進一步提議了它們在二型糖尿病治療中的價值。 / Pancreatic islets perfonn critical biological activities by means of synthesizing and releasing islet peptide honnones, notably insulin that controls our glucose homeostasis. The insulin secretory function is, in turn, governed by various conditions and signaling molecules. In the past decade, it is recognized that the renin-angiotensin system (RAS) has local function rather than the maintenance of blood pressure and fluid homeostasis. With our recent recognition of an islet RAS, it is believed that it has novel roles in islet physiology and diabetes. Meanwhile, more and more clinically relevant regulators that have pivotal roles in islet function and diabetes have been well investigated; such regulators have positive action on insulin secretion, B-cell replication and cell apoptosis/proliferation balance. Of great interest in this context is the glucagon-like peptide I (GLP-I) that improves islet function and glycemic control via its islet specific receptors located on the islets. On the other hand,vitamin D also regulates islet insulin secretion and diabetes via its mediation of receptors on islet B-cells. Like islet RAS, GLPI and vitamin D exert their biological effects via mediation of respective receptors located on the common target, i.e. the islet beta-cells. As such, it is plausible to propose that all these three regulators have potential interactions so as to affect islet functions in a direct or an indirect manner. Accordingly, the primary objective of this study is to examine the potential roles oflocal RAS, GLP-I and vitamin D system in pancreatic islet function. The present study is thus divided into three main parts addressing the issues of these three novel regulators in islet function: (1) the potential synergism of GLP-I and RAS in islet function; (2) the modulatory effects of vitamin D on islet RAS expression and function; (3) The altered islet RAS and islet function under a hypovitaminosis D condition. / In the first part of our study, we examined the combined effect of blocking islet A Tl receptor (ATl receptor blocker: valsartan) and enhancing GLP-l actions (DPP IV inhibitor: LAF237) on islet function and glycemic control in a mouse model with type 2 diabetes, db/db mice. We compared the islet function in db/db mice with either valsartan or LAF237 mono treatment or combined treatment. Consistently, all these treatments improved glucose homeostasis in db/db mice while combined treatment resulted in a significant increase in islet B-cell area by decreasing cell apoptosis and increasing proliferation, together with marked decreases of islet oxidative stress and fibrosis. In addition, a short-term effect on stimulating insulin secretion was also observed in isolated islets with combined treatment. These results indicate that the combination treatments with ATl receptor blocker and DPP IV inhibitor has beneficial additive effects on islet structure and function in type 2 diabetes, compared with their monotherapeutic treatments. / It is reported that vitamin D is a hormone with anti-diabetic and anti-hypertension effects in human while inappropriate RAS activity has been known to reduce islet function and glucose tolerance. The direct suppressive effect of vitamin D on renal renin activity indicates vitamin D may acts as a regulator in RAS activity thus modulate islet physiology. In the second part of our study, it was aimed to study whether vitamin D vitamin D downregulation of abnormal islet RAS activity improves B-cell function using an isolated pancreatic islet model. VDR was localized in islet B-cell nuclei and cytoplasm, mediated responses to active form of vitamin D calcitriol in a dose-dependent manner. This islet local vitamin D system may have its own feedback system as a marked increase ofCYP24 transcription was triggered by calcitriol stimulation. In isolated islets exposed to prolonged high glucose environment, abnormal expressed islet RAS components could be reversed or protected by calcitriol at a specific concentration. However, the inhibition effect of calcitriol on islet RAS were not observed at physiological glucose concentrations. In additon, calcitriol increased islet proinsulin synthesis and insulin secretion with hyperglycemia. These results indicated that calcitriol modulate or protect the abnormal isolated islet RAS component expression against hyperglycemia and improve islet function via increasing insulin synthesis and secretion, which might provide an alternative mechanism by which vitamin D availability enhances islet function in hyperglycemia or diabetes. / The circulating vitamin D level is inversely related to blood glucose level and risks of diabetes. Results in the second part of experiments suggested the potential RAS modulatory effect of vitamin D in isolated islets Therefore, in the third part of our study, we hypothesize that the insufficient vitamin D levels may lead to the inappropriate regulation of islet RAS expression and thus result in islet dysfunction. To achieve this, we examined the potential islet RAS-mediated effect of vitamin D on islet function by accessmg glucose homeostasis, islet histomorphology, and local RAS expression and function by means of using a vitamin D receptor knockout and diet-induced vitamin D deficiency mouse models. Results showed that the islet RAS components were abnormally expressed when lacking a sufficient vitamin D level and normal vitamin D action. These observed effects of insufficient vitamin D might occur prior to onset of hyperglycemia thus modulating islet RAS expression, which in turn lead to islet failure and dysfunctional glucose homeostasis, together with decreased insulin actions in islet B-cells. These results provide supports for the view that vitamin D physiologically exerts modulatory effects on islet function by downregulating islet RAS expression and function. / In summary, islet local RAS may have a central role in islet function under prolonged hyperglycemic stress. GLP-l and vitamin D have biological interactions with the islet RAS by downregulation of its expression and function, thereby affecting islet cell function and cell mass. Our data indicate that all three regulators work together in the regulation of pancreatic islet B-cell functions and glucose homeostasis, further suggestive of their potential values in the treatment of type 2 diabetes. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Cheng, Qianni. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves [205]-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract --- p.i / 摘要 --- p.v / Acknowledgements --- p.viii / List of Publications --- p.x / Table of Contents --- p.xii / List of Abbreviations --- p.xvi / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1 --- Endocrine Pancreas --- p.2 / Chapter 1.1.1 --- The structure and composition of endocrine pancreas --- p.3 / Chapter 1.1.2 --- Functions of endocrine pancreas --- p.4 / Chapter 1.1.3 --- Insulin structure and insulin receptors --- p.8 / Chapter 1.1.4 --- Mechanisms of insulin secretion --- p.11 / Chapter 1.1.5 --- Mechanisms of insulin actions --- p.18 / Chapter 1.1.6 --- Disorders of the endocrine pancreas --- p.22 / Chapter 1.2 --- Diabetes mellitus --- p.23 / Chapter 1.2.1 --- Type 1 diabetes mellitus (TlDM) --- p.24 / Chapter 1.2.2 --- Type 2 diabetes mellitus (T2DM) --- p.26 / Chapter 1.2.3 --- Other types of diabetes mellitus --- p.29 / Chapter 1.2.4 --- Islet dysfunction and T2DM --- p.30 / Chapter 1.3 --- Renin-angiotensin system (RAS) --- p.33 / Chapter 1.3.1 --- Components ofRAS --- p.33 / Chapter 1.3.2 --- Tissue local RAS --- p.42 / Chapter 1.3.3 --- Pancreatic local RAS --- p.43 / Chapter 1.4 --- Glucagon like peptide-l (GLP-l) and pancreatic islet function --- p.54 / Chapter 1.4.1 --- Gastrointestinal incretin honnones --- p.54 / Chapter 1.4.2 --- GLP-l and pancreatic islet function --- p.56 / Chapter 1.4.3 --- Incretin based therapies for T2DM --- p.59 / Chapter 1.4.4 --- GLP-lIRAS axis and pancreatic islet function --- p.62 / Chapter 1.5 --- Vitamin D and pancreatic islet function --- p.64 / Chapter 1.5.1 --- Vitamin D synthesis and metabolism --- p.65 / Chapter 1.5.2 --- Vitamin D physiological functions and pancreatic islets --- p.67 / Chapter 1.5.3 --- Vitamin D and diabetes mellitus --- p.68 / Chapter 1.5.4 --- Vitamin D and RAS --- p.70 / Chapter 1.6 --- Objectives --- p.71 / Chapter Chapter 2 --- Materials and Methods --- p.73 / Chapter 2.1 --- Experimental animal models --- p.74 / Chapter 2.1.1 --- Animal model ofT2DM --- p.74 / Chapter 2.1.2 --- Animal model for pancreatic islet isolation --- p.75 / Chapter 2.1.3 --- Vitamin D receptor knockout mice (VDRKO mice) --- p.75 / Chapter 2.1.4 --- Animal model for vitamin D deficiency --- p.76 / Chapter 2.2 --- Pancreatic islet isolation and culture --- p.76 / Chapter 2.2.1 --- Mice pancreatic islet and single B-cell isolation --- p.77 / Chapter 2.2.2 --- Primary culture of isolated pancreatic islets: --- p.78 / Chapter 2.3 --- Physiological assay for pancreatic islet function --- p.78 / Chapter 2.3.1 --- Measurement of blood glucose and glucose tolerance test --- p.78 / Chapter 2.3.2 --- Measurement of glucose-induced insulin secretion --- p.79 / Chapter 2.3.3 --- Measurement of (pro )insulin biosynthesis --- p.80 / Chapter 2.4 --- Detection ofmRNA expression --- p.80 / Chapter 2.4.1 --- Design of primers --- p.81 / Chapter 2.4.2 --- mRNA extraction and cDNA synthesis --- p.82 / Chapter 2.4.3 --- Detection of mRN A expression by conventional peR --- p.83 / Chapter 2.4.4 --- SYBR Green real-time peR --- p.83 / Chapter 2.4.5 --- Real-time peR analysis using the comparative eT method --- p.84 / Chapter 2.5 --- Detection of protein expression --- p.84 / Chapter 2.5.1 --- Western blot analysis --- p.84 / Chapter 2.5.2 --- Immunostaining assessment --- p.85 / Chapter 2.6 --- In situ detection of oxidative stress, proliferation and apoptosis --- p.88 / Chapter 2.6.1 --- Detection of islet reactive oxygen species --- p.88 / Chapter 2.6.2 --- Detection of cell proliferation --- p.89 / Chapter 2.6.3 --- Measurement of cell apoptosis --- p.90 / Chapter 2.7 --- Statistical data analysis --- p.90 / Chapter Chapter 3 --- Combination of DPP-IV Inhibitor LAF237 with ATl Receptor Antagonist Valsartan Enhances Pancreatic Islet Morphology and Function in a Mouse Model of Type 2 Diabetes (This work has been published in J Pharmacal Exp Ther, 327: PI-9) --- p.91 / Chapter 3.1 --- Abstract --- p.92 / Chapter 3.2 --- Introduction --- p.94 / Chapter 3.3 --- Materials and Methods --- p.96 / Chapter 3.4 --- Results --- p.103 / Chapter 3.4.1 --- Effects of acute treatment with GLP-I and valsartan on insulin secretion in isolated islets --- p.103 / Chapter 3.4.2 --- Effects of LAF237 and valsartan on pancreatic --- p.105 / Chapter 3.4.3 --- Effects of LAF237 and valsartan on --- p.107 / Chapter 3.4.4 --- Effects ofLAF237 and valsartan on islet apoptosis --- p.109 / Chapter 3.4.5 --- Effects of LAF237 and valsartan on islet fibrosis --- p.110 / Chapter 3.4.6 --- Effects of LAF237 and valsartan on pancreatic islet superoxide and nitrotyrosine expression --- p.113 / Chapter 3.4.7 --- Effects of LAF237 and valsartan on bood glucose concentration and glucose tolerance in db/db diabetic mice --- p.116 / Chapter 3.5 --- Discussion --- p.119 / Chapter Chapter 4 --- The Role of Calcitriol in Modulating the Expression and Function of Islet Renin-Angiotensin System in Isolated Mouse Pancreatic Islets --- p.124 / Chapter 4.1 --- Abstract --- p.125 / Chapter 4.2 --- Introduction --- p.127 / Chapter 4.3 --- Materials and Methods --- p.130 / Chapter 4.4 --- Results --- p.135 / Chapter 4.4.1 --- The expression of islet VDR under different glucose conditions and the effects of calcitriol --- p.135 / Chapter 4.4.2 --- The effect of calcitriol on high glucose-modulated islet RAS component expression --- p.140 / Chapter 4.4.3 --- The protective effect of calcitriol against high glucose on islet RAS component expression --- p.144 / Chapter 4.4.4 --- The effect of calcitriol on (pro )insulin biosynthesis and insulin release in isolated islets --- p.148 / Chapter 4.5 --- Discussion --- p.151 / Chapter Chapter 5 --- Altered Islet Local Renin-Angiotensin System and Islet Function in Mice with Hypovitaminosis D --- p.158 / Chapter 5.1 --- Abstract --- p.159 / Chapter 5.2 --- Introduction --- p.160 / Chapter 5.3 --- Materials and methods --- p.163 / Chapter 5.4 --- Results --- p.168 / Chapter 5.4.1 --- Glucose homeostasis and islet morphology in VDR KO mice --- p.168 / Chapter 5.4.2 --- Expression of vitamin D receptor and major RAS components in the pancreatic islets of WT and VDR KO mice --- p.170 / Chapter 5.4.3 --- Vitamin D deficiency in mice on a vitamin D deficient diet --- p.172 / Chapter 5.4.4 --- Altered glucose homeostasis in vitamin D deficient mice --- p.174 / Chapter 5.4.5 --- Islet histomorphology in vitamin D deficient mice --- p.176 / Chapter 5.4.6 --- Regulation of islet RAS components expression in vitamin D deficient mice --- p.179 / Chapter 5.4.7 --- Transcriptional regulation of islet insulin receptor and its substrates in vitamin D deficient mice --- p.181 / Chapter 5.4.8 --- Effect of calcitriol treatment on glucose tolerance in vitamin D deficient mice --- p.183 / Chapter 5.5 --- Discussion --- p.185 / Chapter Chapter 6 --- General Discussion --- p.191 / Chapter 6.1 --- Combination effects of blocking islet RAS components and enhancing incretin activity on improving islet function in type 2 diabetes --- p.193 / Chapter 6.2 --- Potential modulatory effect of vitamin D on islet RAS expression and action --- p.196 / Chapter 6.3 --- The role of vitamin D in modulating islet RAS in glucose homeostasis and islet function --- p.199 / Chapter 6.4 --- The significance ofRAS, GLP-l and vitamin D in the management of T2DM --- p.201 / Chapter 6.5 --- Conclusion --- p.202 / Chapter 6.6 --- Future studies --- p.202 / Chapter Chapter 7 --- Bibliography --- p.205

Introdução: A doença cardiovascular prematura é uma das maiores causas de morbi-mortalidade no lúpus eritematoso sistêmico (LES) e parece estar relacionada à maior prevalência de fatores de risco clássicos e não clássicos. A resistência à insulina (RI) é um importante fator de risco para doenças cardiovasculares (DCV), podendo ter papel no risco cardiovascular aumentado no LES. Objetivo: Avaliar a sensibilidade à insulina de pacientes com LES em resposta ao teste oral de tolerância à refeição (MTT - Meal tolerance test), controlando por potenciais variáveis intervenientes, a saber, nível de atividade física, composição corporal e consumo alimentar. Metodologia: Pacientes com LES (LES; n=33) recrutadas no ambulatório de Reumatologia do HC-FMUSP e voluntárias saudáveis (CTRL; n = 16), pareadas por idade, gênero e índice de massa corporal foram selecionadas. As participantes foram submetidas ao MTT para determinação de estimativas da sensibilidade à insulina e de função das células beta, nível de atividade física (acelerometria), composição corporal (DXA), consumo alimentar (recordatórios alimentares), concentração de adipocinas e citocinas inflamatórias, atividade da doença e uso de medicamentos. Resultados: LES e CTRL apresentaram glicemia de jejum e em resposta ao MTT similares. Em contrapartida, LES apresentou maior insulinemia de jejum, HOMA RI, razão insulina/glicose de jejum e em resposta ao MTT, glucagonemia de jejum e em resposta ao MTT (p < 0,05) e tendência ao menor Índice de sensibilidade à inulina Matsuda (p = 0,06) e à maior insulinemia em resposta ao MTT (p=0,09) quando comparado ao CTRL. Em relação às estimativas da função das células beta, a razão pró-insulina/insulina de jejum e em resposta ao MTT foram similares entre os grupos, embora o grupo LES tenha apresentado maior índice insulinogênico (p=0,02). Conclusão: O grupo LES apresentou maior RI e hiperglucagonemia apesar de tolerância normal à glicose e função preservada das células beta quando comparado ao grupo controle. Esses resultados sugerem que os pacientes LES possuem maior risco de desenvolver DCV quando comparados a sujeitos saudáveis com composição corporal, ingestão alimentar e nível de atividade física similares, o que reforça a necessidade de estratégias para melhorar a sensibilidade à insulina, potencialmente prevenindo ou retardando o surgimento de DCV no LES / Background: Premature cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in systemic lupus erythematosus (SLE) and may be associated with classic and non-classic risk factors. Insulin resistance (IR) is an independent risk factor for CVD and could play a fundamental role in the substantially increased CVD risk in SLE. Objective: To assess insulin sensitivity in a cohort of patients with systemic lupus erythematosus (SLE) fasting and in response to a meal tolerance test (MTT), controlling by potential intervening components, such as physical activity level, body composition and food intake. Methods: SLE patients (LES; n=33) recruited in the HC-FMUSP ambulatory of rheumatology and 16 age- and BMI-matched healthy women (CTRL) were selected. The participants underwent a mixed meal test for assess insulin sensitivity and beta-cell function. Further measurements included physical activity level (assessed by accelerometry), body composition (assessed by DXA), food intake (assessed by a 3-day food record), inflammatory cytokines and adipokines concentrations, disease activity and drug intake. Results: SLE and CTRL showed similar fasting glucose and glucose response to the MTT. In contrast, SLE showed higher fasting insulin levels, HOMA IR, fasting insulin-to-glucose ratio, insulin-to-glucose ratio response to the MTT, fasting glucagon levels, glucagon response to the MTT (p < 0.05), and a tendency towards a lower Matsuda index of whole-body insulin sensitivity (p = 0.06) and a higher insulin response to the MTT (p = 0.09) when compared with CTRL. With respect to the beta-cell function estimates, fasting proinsulin-to-insulin ratio and proinsulin-to-insulin ratio response to the MTT were similar between groups, although SLE showed a higher insulinogenic index (p = 0.02). Conclusion: SLE group showed increased IR and hyperglucagonemia despite normal glucose tolerance and preserved beta-cell function when compared with healthy controls. These results suggest that SLE patients are at higher risk of developing CVD, when compared with healthy subjects with similar body composition, food intake and physical activity level, which reinforces the need of strategies capable of ameliorating insulin sensitivity, thus, potentially preventing or delaying the onset of CVD in SLE

Dados recentes do nosso laboratório sugerem que a enzima dipeptidil peptidase IV (DPPIV), uma serino-protease que pode ser encontrada ancorada na membrana celular de diversos tipos celulares ou na forma solúvel no plasma, possui um papel importante na fisiopatologia da insuficiência cardíaca (IC). Mais especificamente, demonstramos que a atividade da DPPIV circulante está associada com piores desfechos cardiovasculares em modelo experimental e pacientes com IC. Ademais, observamos que a inibição crônica da DPPIV atenua o desenvolvimento e/ou a progressão da IC em ratos submetidos à injúria do miocárdio. Entretanto, não é sabido se a inibição desta peptidase é capaz de reverter a disfunção cardiorrenal em ratos com IC estabelecida. Assim, este trabalho teve como objetivo testar a hipótese que a inibição da DPPIV exerce efeitos terapêuticos em ratos com IC. Para tal, ratos com IC foram tratados diariamente com o inibidor da DPPIV Vildagliptina (80 ou 120 mg/kg/dia) ou veículo (HF) durante quatro semanas. Ratos Sham não-tratados foram utilizados como controle. Análises ecocardiográficas demonstraram que ratos HF exibiram área fracional (FAC) menor e tempo de relaxamento isovolumétrico (TRIV) maior que ratos Sham. Por sua vez, o tratamento com a dose maior de Vildagliptina foi capaz de aumentar a FAC e diminuir o TRIV. Esta melhora funcional foi acompanhada por melhoras estruturais, visto que a inibição da DPPIV foi capaz de reduzir a hipertrofia cardíaca e a deposição de colágeno intersticial no miocárdio remanescente de ratos tratados com Vildagliptina em comparação aos ratos HF. Adicionalmente, ratos com IC exibiram maior teor de água nos pulmões, menor excreção urinária de sódio, menor fluxo urinário e menor ritmo de filtração glomerular em comparação ao grupo Sham. Por sua vez, o manuseio renal de sal e água foi completamente restaurado pelo tratamento crônico com 120 mg/kg/dia Vildagliptina. A normalização da função renal induzida pela inibição crônica da DPPIV foi associada com um aumento da expressão do receptor do peptídeo-1 semelhante ao glucagon (GLP-1) e maior ativação da proteína cinase A em córtex renal, isto é, da via de sinalização deflagrada pela ligação GLP-1/GLP-1R. Além disso, os níveis pós-prandiais do GLP-1, principal substrato da DPPIV que exerce ações insulinotrópicas, cardio e renoprotetoras, estavam mais baixos em ratos HF que em ratos Sham. Esta diminuição dos níveis circulantes de GLP-1 (ativo e total) em ratos HF foi acompanhada de intolerância à glicose bem como de maiores níveis plasmáticos de insulina. A inibição da DPPIV com Vildagliptina melhorou a biodisponibilidade e a secreção de GLP-1 após carga oral de glicose. Em conjunto, estes resultados sugerem que a inibição da DPPIV melhora a função cardiorrenal e metabólica de ratos com IC. Além disso, a secreção e a biodisponibilidade do GLP-1 encontram-se prejudicadas em ratos com IC e o tratamento com Vildagliptina é capaz de restaurar a sinalização mediada por este peptídeo. Assim, os inibidores da DPPIV podem ser eficazes não apenas para a prevenção, mas também para o tratamento da insuficiência cardíaca em ratos / Recent data from our laboratory suggest that the enzyme dipeptidyl peptidase IV (DPPIV), a serine protease that can be found anchored in the cell membrane of different cell types or in the soluble form in plasma, plays an important role in the pathophysiology of heart failure (HF). More specifically, we have demonstrated that the activity of circulating DPPIV is associated with poorer cardiovascular outcomes in an experimental model and patients with HF. In addition, we have found that chronic inhibition of DPPIV attenuates the development and/or progression of HF in rats with myocardial injury. However, it is unknown whether the inhibition of this peptidase is able to reverse the cardiorenal dysfunction in rats with established HF. Therefore, this study aimed to test the hypothesis that inhibition of DPPIV exerts therapeutic effects in rats with HF. To this end, HF rats were treated daily with the DPPIV inhibitor vildagliptin (80 or 120 mg/kg/day) or vehicle (HF) for four weeks. Untreated Sham rats were used as controls. Echocardiographic analysis demonstrated that HF rats exhibit lower fractional area change (FAC) and higher isovolumetric relaxation time (IVRT) than Sham rats. On the other hand, treatment with the highest dose of vildagliptin was able to increase FAC and decrease IVRT. These functional improvements were accompanied by structural improvements, since inhibition of DPPIV was also able to reduce cardiac hypertrophy and interstitial collagen deposition in the remaining myocardium of rats treated with vildagliptin rats compared to HF. In addition, HF rats exhibited higher water content in the lungs, lower urinary sodium excretion, lower urinary flow and lower glomerular filtration rate compared to the Sham group. In turn, the renal handling of salt and water was completely restored by chronic treatment with vildagliptin 120 mg/kg/day. Normalization of the renal function induced by chronic inhibition of DPPIV was associated with an increase in the expression of the glucagon like peptide-1 receptor (GLP-1R) and enhanced protein kinase A activation in the renal cortex, the signaling pathway triggered by bind between GLP-1/GLP-1R. In addition, the postprandial levels of GLP-1, the main substrate of DPPIV that exerts insulinotropic, cardio and renoprotective actions, were lower in HF rats than in Sham. This decrease in circulating levels of GLP-1 (active and total) in HF rats was accompanied by impaired glucose tolerance and higher plasma insulin levels. The inhibition of the DPPIV with vildagliptin improved the bioavailability and secretion after an oral glucose load. Taken together, these results suggest that the inhibition of DPPIV ameliorates the cardiorenal and metabolic function of rats with HF. Furthermore, bioavailability and secretion of GLP-1 are impaired in HF rats and vildagliptin is able to restore the signaling mediated by this peptide. Therefore, DPPIV inhibitors can be effective not only in preventing but also for the treatment of HF in rats

No description available.

Diese Arbeit beinhaltet Untersuchungen zu den unterschiedlichen Isoformen des Leptinrezeptors und dessen Regulation in primären humanen Hepatozyten. Leptin und der Leptinrezeptor nehmen in der Physiologie des menschlichen Energiehaushaltes eine wesentliche Funktion ein und sind an der Pathogenese der Adipositas mit Folgeerkrankungen wie der Entwicklung einer Fettleber beteiligt. Es wird erstmalig geprüft inwieweit das Modellsystem primärer humaner Hepatozyten für Analysen der Leptinrezeptor-Expression und der Abspaltung von löslichem Leptinrezeptor geeignet ist. Weiterhin werden untersucht, welchen Einfluss endokrine Regulatoren wie Dexamethason, Leptin und Glucagon auf die isoformspezifischen Rezeptormengen in primären Hepatozyten haben und wie der Rezeptor unter Apoptose reguliert ist, welche durch die lipotoxischen Effekte der freien Fettsäure Palmitat und den Apoptoseinduktor Staurosporin induziert wird. Hierdurch können Rückschlüsse auf eine möglicherweise veränderte Wirksamkeit des Leptins in der Leber gezogen werden.

No tratamento do diabetes mellitus tipo 2, busca-se a otimização do controle glicêmico para evitar as complicações da doença. Quando a combinação mais utilizada (sulfoniluréia e biguanida) falha em manter o controle glicêmico, um terceiro agente é associado, podendo ser a insulina ou outro hipoglicemiante oral. O objetivo deste estudo foi comparar os efeitos da sitagliptina (droga inibidora da enzima dipeptidil-peptidase-4) com os da insulina NPH ao deitar, como terceira droga no tratamento do diabetes mellitus tipo 2, em pacientes inadequadamente controlados com glibenclamida e metformina. Trinta e cinco pacientes, com dados clínicos, demográficos e laboratoriais semelhantes, foram randomizados para receber sitagliptina (grupo Sitagliptina, n= 18) ou insulina NPH ao deitar (grupo Insulina, n= 17) e reavaliados após 24 semanas. Amostras sanguíneas foram coletadas para dosagens de hemoglobina glicada (HbA1c), colesterol total e frações, ácido úrico, transaminases, proteína C reativa (PCR) e grelina em jejum. No teste de tolerância à dieta de 500 calorias, foram determinadas as concentrações de glicose, triglicérides, ácidos graxos livres (AGL), peptídeo glucagon-símile tipo 1 ativo (GLP-1a), glucagon, peptídeo C, pró-insulina e insulina. Monitorização ambulatorial da pressão arterial e ecocardiografia com Doppler tecidual também foram realizados. Decorridas 24 semanas, ambos os tratamentos promoveram reduções semelhantes das concentrações de HbA1c. A insulina NPH ao deitar foi superior à sitagliptina, ao promover redução da glicemia de jejum e das concentrações de triglicérides após a refeição. Diminuição das concentrações de glucagon pós-prandiais e aumento das concentrações de GLP-1 ativo de jejum e após a refeição foram observados somente no grupo Sitagliptina. Concentrações de peptídeo C não se alteraram após o tratamento com sitagliptina, porém diminuíram após a terapia com insulina. Os dois tratamentos reduziram as concentrações de pró-insulina pós-prandiais e de grelina de jejum. Nenhum deles alterou as concentrações de PCR, colesterol, ácido úrico e enzimas hepáticas, exceto a de fosfatase alcalina, que diminuiu em ambos os grupos. Peso, índice de massa corpórea, relação cintura/quadril e pressões arteriais sistólicas e diastólicas permaneceram inalterados. Avaliação cardíaca, realizada em 29 pacientes, mostrou disfunção diastólica do ventrículo esquerdo (DDVE), sinal pré-clínico da cardiomiopatia diabética, em 53 % e 64 % dos pacientes que foram incluídos nos grupos Sitagliptina e Insulina, respectivamente. Melhora da função diastólica de VE foi observada em 40,0% (6/15) dos pacientes do grupo Sitagliptina e em 7,0% (1/14) dos pacientes do grupo Insulina (p=0,049). Esta melhora da função cardíaca pareceu não depender do controle glicêmico, da PA e do status inflamatório. Concluindo, ambos os tratamentos foram efetivos, promovendo redução semelhante da HbA1c. Ambas as drogas parecem melhorar a função das células b, observada pela diminuição das concentrações de pró-insulina. A insulina NPH ao deitar foi mais efetiva na redução da glicemia de jejum e das concentrações de triglicérides após a refeição. Entretanto, melhora na função diastólica de VE foi superior no grupo Sitagliptina. Assim, o inibidor da DPP-4 parece ser uma droga promissora para a prevenção da cardiomiopatia diabética / The main goal of the treatment of type 2 diabetes mellitus is to achieve normal glucose levels in order to prevent diabetic complications. When two oral agents (sulfonylurea plus biguanide) fail to maintain target-level control, a third oral agent must be added or insulin must be started. The aim of this study was to compare sitagliptin, a dipeptidyl-peptidase-4 enzyme inhibitor, with bedtime NPH insulin as a third-line agent in type 2 diabetes mellitus patients inadequately controlled with metformin plus glyburide combined therapy. Thirty-five patients with similar clinical, demographic and basal laboratory characteristics were randomized to receive sitagliptin (Sitagliptin group, n=18) or bedtime NPH insulin (Insulin group, n=17) and reassessed after 24 weeks. Fasting blood samples were collected for determinations of glycated hemoglobin (HbA1c), total- LDL- and HDL-cholesterol, uric acid, liver enzymes, C-reactive protein and ghrelin levels. Determinations of blood glucose, triglycerides, free fatty acids, active glucagon-like peptide 1 (GLP-1), glucagon, C-peptide, pro-insulin and insulin levels was made during the meal tolerance test. Ambulatory blood pressure monitoring and tissue Doppler echocardiography were also performed. After 24 weeks, both treatments resulted in similar HbA1c levels. Bedtime NPH insulin was superior to sitagliptin in reducing fasting plasma glucose and postprandial triglyceride levels. Decreased postprandial glucagon and increased active GLP-1 levels were only observed in the Sitagliptin group. C-peptide levels did not change after treatment with sitagliptin, but decreased following insulin therapy. Both treatments reduced postprandial pro-insulin and fasting ghrelin levels. Neither treatment changed C-reactive protein, cholesterol, uric acid or liver enzymes, except alkaline phosphatase, which decreased in both. Weight, body mass index, waist-hip ratio and systolic and diastolic blood pressures remained unchanged. Cardiac evaluation was performed in 29 patients and showed basal left ventricular diastolic dysfunction, the pre-clinical signal of diabetic cardiomyopathy, in 53% and in 64% of patients in the Sitagliptin and Insulin group, respectively. Left ventricular diastolic function improved in 40% (6/15) of patients receiving sitagliptin and in 7% (1/14) of patients receiving bedtime NPH insulin (p= 0.049). This improvement did not seem to be influenced by glycemic control, blood pressure or inflammatory status. In conclusion, both treatments were effective in reducing HbA1c and seemed to similarly improve b-cell function, as shown by reduced pro-insulin levels. Bedtime NPH insulin was more effective in reducing fasting plasma glucose and postprandial triglyceride levels. However, improvement in left ventricular diastolic function was higher in the Sitagliptin group. Therefore, sitagliptin seems to be a promising drug for the prevention of diabetic cardiomyopathy

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-06-02T12:58:47Z No. of bitstreams: 2 Dissertação - Marina Monteiro Celestino - 2016.pdf: 3038939 bytes, checksum: f658681fb77c19cdbec1ee83ee51b443 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-06-02T14:50:30Z (GMT) No. of bitstreams: 2 Dissertação - Marina Monteiro Celestino - 2016.pdf: 3038939 bytes, checksum: f658681fb77c19cdbec1ee83ee51b443 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-06-02T14:50:30Z (GMT). No. of bitstreams: 2 Dissertação - Marina Monteiro Celestino - 2016.pdf: 3038939 bytes, checksum: f658681fb77c19cdbec1ee83ee51b443 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2016-02-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Overweight and obesity are associated with excessive food intake, due to changes in the productions of gastrointestinal hormones productions. Objectives: To evaluated the effect of a herbal extract derived from native species of South America on food intake, acylated ghrelin concentrations and peptide similar to glucagon 1. Material and methods: A randomized, blind, placebo-controlled, crossover design methodology, with intervention in two days with an interval (washout) seven days, consisted of 20 overweight women. Three capsules a mix of herbal medicines were administered, containing 112 mg of yerba mate, guarana 95 mg and 36 mg of damiana, or three placebo capsules containing 100 mg of lactose. The herbal extract was administered 15 minutes before a standardized breakfast (494.50 kcal, carbohydrates 52.67%, 12.91% protein and 34.5% lipid) and a standard lunch (632.05 kcal, 61, 67% carbohydrates, 16.97% protein and 21.44% lipid) for all patients. Food not eaten by the participants was weighed to evaluated food intake. Blood samples were collected at baseline and on days 45, 60, 90, 150, 210 minutes after breakfast in the morning and lunch for determination of plasma glucose concentrations, acylated ghrelin and peptide similar to glucagon 1. To compare the differences of the mean energy food intake and macronutrient was performed paired t-test, for the behavior of hormones was performed ANOVA and was calculated area under the curve and to determine the differences between the areas was performed Student's t test. Results: In the supplemented group, there was significant reduction in energy intake at lunch and macronutrients in both meals (p <0.05). The acylated ghrelin concentrations were lower after breakfast (p <0.05) and glucagon-like peptide 1 were higher (p <0.05) after breakfast in the supplemented group. Conclusion: Supplementation with herbal mix reduced energy intake and macronutrients by the modulating hormones glucagon-like 1 and acylated ghrelin in overweight and obesity women. / O excesso de peso se relaciona com a ingestão alimentar excessiva, decorrente de alterações nas produções de hormônios gastrointestinais. Objetivos: Avaliar o efeito de um extrato de ervas oriundos de espécies nativas da América do Sul sobre a ingestão alimentar, as concentrações de grelina acilada e peptídeo semelhante ao glucagon 1. Material e métodos: Ensaio clínico randomizado cego, crossover com intervenção em dois dias, com intervalo (washout) de sete dias, composto por 20 mulheres adultas com excesso de peso. Foram administradas três cápsulas de um extrato de ervas, contendo 112 mg de erva-mate, 95 mg de guaraná e 36 mg de damiana, ou três cápsulas de placebo, contendo 100 mg de lactose. O extrato de ervas foi administrado 15 minutos antes de um desjejum padronizado (494,50 kcal, 52,67% carboidratos, 12,91% proteínas e 34,5% lipídios) e de um almoço padronizado (632,05 kcal, 61,67% carboidratos, 16,97% proteínas e 21,44% lipídios) para todas pacientes. Os alimentos não ingeridos pelos participantes foram pesados para avaliar a ingestão alimentar. Foram coletadas amostras de sangue no início do estudo e nos tempos de 45, 60, 90, 150, 210 minutos após o café-da-manhã e almoço para determinação das concentrações plasmáticas de glicose, grelina acilada e peptídeo semelhante ao glucagon 1. Para comparar as diferenças das médias da ingestão alimentar energética e de macronutrientes foi realizado o teste t pareado, para o comportamento dos hormônios foi realizado ANOVA e foi calculado a área abaixo da curva e para determinar as diferenças entre as áreas foi realizado teste T de Student. Resultados: No grupo suplementado, foi observada redução significativa da ingestão energética no almoço e de macronutrientes em ambas as refeições (p < 0,05). As concentrações de grelina acilada foram menores após o almoço (p <0,05) e de peptídeo semelhante ao glucagon 1 foram maiores (p < 0,05) após o desjejum no grupo suplementado. Conclusão: A administração do extrato de ervas reduziu a ingestão calórica e de macronutrientes sugerindo que possa ter ocorrido por meio da modulação da ação dos hormônios peptídeo semelhante ao glucagon 1 e grelina acilada em mulheres com sobrepeso e obesidade.

Novos agentes terapêuticos que preservem as células <font face=\"Symbol\">&#946 do pâncreas e o controle do peso são importantes para o diabetes melittus tipo 2 (DM-2), constituindo uma importante área de investimento farmacêutico. Com o objetivo de contribuir com a toxinologia comparada de venenos de répteis e com a eventual descoberta de novos agentes insulinotrópicos, o presente estudo realizou a prospecção de compostos hipoglicemiantes análogos à exendina-4 (isolada de lagartos Heloderma) ou inibidores da dipeptidil-peptidase IV (DPP-IV) no veneno da serpente Bothrops jararaca. A espectrometria de massas identificou uma K49 Fosfolipase A2 inédita neste veneno. Inibidores da DPP-IV não foram encontrados. Porém, a existência de frações polipeptídicas deste veneno sem similares estruturais descritos, sem efeito na pressão arterial média, imunologicamente similares à exendina-4 e com efeito hipoglicemiante e provável capacidade de ligação ao receptor do peptídeo glucagon-símile tipo 1, caracterizaram, pela primeira vez, a ação de veneno de serpente sobre o metaboloma. / New therapeutic agents that protect pancreatic <font face=\"Symbol\">&#946 cells and regulate body mass are important to diabetes mellitus type 2 (DM-2). The search for these agents is one of the main objectives of investments made by pharmaceutical industries. To contribute to the comparative toxinology studies of reptile venoms and to reveal new insulinotropic agents, the present investigation searched for hypoglycemiant compounds such as exendin-4 analogues (isolated from Heloderma lizards) or dipeptidyl-peptidase IV (DPP-IV) inhibitors in the venom of the snake Bothrops jararaca. The mass spectrometry analysis identified a novel K-49 Phospholipase A2 in this venom. DPP-IV inhibitors were not found. However, the existence of polypeptide fractions from this venom without structural similarity with reported compounds, without effect on mean arterial blood pressure and with immunological similarity with exendin-4 and probable ability to bind to glucagon-like peptide type 1 receptor, led to the first characterization of snake venom activity on metaboloma.

Introdução: A sitagliptina, inibidor da dipeptidil-peptidase IV, impede a degradação do GLP-1 (peptídeo-1 semelhante ao glucagon), um dos principais hormônios incretínicos. A dieta interfere na secreção de GLP-1, no entanto, a interação das drogas que aumentam o GLP-1 e os macronutrientes da dieta é pouco estudada. Objetivo e Métodos: Determinar o efeito da sitagliptina, na secreção de GLP-1, glucagon, insulina, peptídeo-C, ácidos graxos livres e na glicemia após três dietas, isocalóricas, de diferentes composições nutricionais em pacientes diabéticos tipo 2, recém-diagnosticados, virgens de tratamento, quando comparado a uso de placebo. Dezesseis indivíduos nessas condições foram submetidos a dietas hiperglicídica, hiperprotêica e hiperlipídica, isocalóricas entre si. Dosaram-se nos tempos 0, 30, 60, 120 e 180 minutos os parâmetros: glicose, insulina, peptídeo C, GLP-1, glucagon e AGL. Foi calculada média de área sob a curva e cálculo da área incremental, além de análise de variância para medidas repetidas. Resultados: Durante o teste de dieta hiperglicídica a glicemia foi maior em todos os tempos quando comparado aos testes com PTN e LPD independentemente do uso de sitagliptina (p<0,05). Sitagliptina diminuiu a glicemia em todos os tempos, quando comparado ao uso de placebo (p<0,05). Durante a dieta CHO, a secreção de glucagon foi menor que nas dietas LPD e PTN (p<0,05). Já a concentração de insulina foi maior com a dieta CHO em relação à dieta LPD (p<0,05). A concentração de insulina e peptídeo C foi maior em todos os tempos na dieta CHO (p<0,05). A concentração de GLP-1 foi significativamente maior durante o teste hiperlipídico em relação à dieta CHO. Durante a dieta LPD, a medida de GLP-1 foi maior em todos os tempos. A dieta CHO apresentou medida de GLP-1 menor em todos os tempos do que as outras dietas (p<0,05). A medida de GLP-1 no tempo foi maior (até 120\') com o uso de sitagliptina do que com o uso do placebo, apesar de não estatisticamente significativa. Os níveis de AGL no tempo foram maiores com o uso do placebo do que com o uso da sitagliptina, apesar de não estatisticamente significativo. Conclusão: Houve diminuição da glicemia em todos os tempos com sitagliptina, independentemente da dieta testada. Houve diminuição do efeito da sitagliptina durante o uso da dieta hiperglicídica / Background: Sitagliptin, a dipeptidil-peptidase IV inhibitor, prevents the degradation of GLP-1 (glucagon-like peptide 1), one of the incretin hormones. It is well-known that diet interferes in the GLP-1 secretion; however, the interaction between drugs that stimulates the release of GLP-1 and the macronutrients from diet is hardly studied. Objective and Methods: To demonstrate the effect of sitagliptin on glycemia, and on the secretion of GLP-1, glucagon, insulin, C-peptide, and free fatty acids after three isocaloric diets with different nutritional compositions, in drug-naïve patients, newly diagnosed with type 2 diabetes, when compared to the use of placebo. Sixteen individuals were subjected to a high-carbohydrate diet, a high-protein diet, and a high-fat diet, all of which with similar caloric values. At 0, 30, 60, 120 and180 minutes after the diet, glucose, insulin, C-peptide, GLP-1, glucagon, and AGL were measured. The mean area under the curve, the incremental area, and the variance for repeated measures were calculated. Results: During high-carbohydrate diet, glycemia was higher for all time points, when compared to the PTN and LPD diets, independently of sitagliptin (p<0,05). Sitagliptin reduced glycemia during three diets when compared to placebo (p<0,05). During CHO diet, secretion of glucagon was smaller than it was during the LDP and PTN diets (p<0,05). On the other hand, insulin concentration was higher than during the LPD diet (p<0,05). Concentrations of insulin and C-peptide were higher for all the time points during the CHO diet (p<0,05). GLP-1 concentration was significantly higher during the high-fat diet than during the high-carbohydrate diet. During the LPD diet, the quantity of the GLP-1 was larger for all time points. The CHO diet presented lower GLP-1 level, for all the time points, than the other diets (p<0,05). The GLP-1 level (up to 120min) with the use of sitagliptin was higher with LPD and PTN diet than it was with the CHO diet. The AGL levels for all time points were higher with placebo than with sitagliptin, although not statistically significant. Conclusion: There was a reduction in glycemia with sitagliptin, independently of the diet tested, for all time points. There was a reduction in sitagliptin effect during the use of the high-carbohydrate diet

[pt] O agonista do receptor do peptídeo semelhante ao glucagon 1 (GLP-1), melhora o controle glicêmico, reduz o apetite e o peso corporal, sendo usado para o tratamento de diabetes tipo 2 (DM2). Também se mostrou associado a alterações nas respostas cerebrais, relacionadas a estímulos alimentares. Entretanto, seus efeitos na conectividade funcional intrínseca do cérebro não são conhecidos. Com objetivo de melhor entender o papel do GLP-1 na conectividade intrínseca do cérebro em pacientes DM2, dados de ressonância magnética funcional (RMf) de redes do estado de repouso relevantes para o comportamento alimentar foram analisados em dois estudos. Em ambos, todas as imagens foram adquiridas após um jejum noturno (8-12 horas). O estudo 1 teve como meta investigar o efeito agudo do bloqueio de GLP-1 na conectividade funcional. Foram adquiridas imagens de RMf durante o estado de repouso, em dois dias separados, de 20 pacientes DM2 sem complicações e 20 controles saudáveis, primeiro sob infusão de solução salina e, posteriormente, sob a infusão de antagonista do receptor de GLP-1. Já o estudo 2 teve como objetivo investigar, em pacientes DM2, se haveria diferenças na conectividade intrínseca, quando comparados os tratamentos com agonista do GLP1 liraglutida e com insulina glargina. Os mesmos pacientes DM2, participantes do estudo 1, foram tratados, em ordem aleatória, por 12 semanas com liraglutida e por 12 semanas com insulina glargina. Os dados de RMf em estado de repouso foram coletados antes do início do tratamento, após 10 dias e após 12 semanas. As análises de neuroimagem foram corrigidas para múltiplas comparações com o Family-wise error, as correlações foram feitas com coeficiente de correlação de Pearson. Os resultados do estudo 1 mostraram que, durante a infusão da solução salina, pacientes DM2 apresentaram maior conectividade comparados a controles na ínsula esquerda e opérculo, relacionada à maior perda de peso, mediada pelo agonista de GLP-1 após 10 dias e 12 semanas. Além disso, a conectividade foi maior em pacientes DM2 versus controles no polo frontal, córtex frontal medial, no giro cingulado anterior e no giro paracingulado, a qual se correlacionou com menor perda de peso, mediada por agonista de GLP-1, após 10 dias (todos P(FWE) menor que 0,05). Não houve efeito da infusão do antagonista do receptor de GLP-1 ou do tratamento com agonista de GLP-1, na conectividade (todos P(FWE) maior que 0,05). Em conclusão, a conectividade basal em estado de repouso mostrou estar relacionada à mudança de peso, mediada pelo agonista do GLP-1, com maior conectividade frontal correlacionando com menos perda de peso durante o tratamento com agonista do GLP-1, enquanto maior conectividade na ínsula esquerda, correlacionou com maior perda de peso, mediada pelo GLP-1, indicando relação entre a conectividade intrínseca dessas redes e o efeito de perda de peso do tratamento com GLP-1. / [en] The glucagon-like peptide 1 (GLP-1) receptor agonist is used for the treatment of type 2 diabetes (DM2) as it improves glycemic control, reduces appetite and body weight. It is also related to altered brain responses to food stimuli, but its effects on intrinsic brain connectivity are unknown. With the goal of better understanding GLP-1 s role in the intrinsic brain connectivity of DM2 patients, functional resonance imaging (fMRI) data of resting-state networks relevant for eating behavior was analyzed in two studies. In both, all images were acquired after an overnight fast (8-12 hours). Study 1 aimed to investigate the acute effect of GLP1 blockade on functional connectivity. On two separate days, fMRI data was acquired from 20 DM2 patients and 20 healthy controls, first under saline infusion and thereafter under GLP-1 antagonist infusion. Study 2 aimed to investigate, in DM2 patients, if there were any between treatment differences in intrinsic connectivity when comparing GLP-1 receptor agonist liraglutide with insulin glargine. The same DM2 participants in study 1 were thus treated in random order for 12 weeks with liraglutide and insulin glargine, fMRI data was collected at the start of treatment, after 10 days and after 12 weeks. Study 1 results showed that, during saline infusion, DM2 patients had greater connectivity compared to controls in the left insula and operculum, which related to greater GLP-1 mediated weightloss after 10 days and 12 weeks. Also, connectivity was greater in DM2 patients versus controls in the frontal pole, frontal medial cortex, anterior cingulate and paracingulate giry, which related to less GLP-1 mediated weight-loss after 10 days (all P(FWE) less than 0.05). There was no effect on connectivity for GLP-1 antagonist, and no long-term differences between treatments (all P(FWE) less than 0.05). In conclusion, baseline resting-state connectivity was shown to be related to GLP-1 mediated weightchange, with greater frontal connectivity relating to less weight loss during GLP-1 treatment, while higher left insula connectivity correlated to greater weight loss during GLP-1 treatment, indicating a relationship between baseline intrinsic connectivity in these regions and weight loss during GLP-1 treatment.