GLP-1 - , .198,205,206 GLP-1 .207,208,209 GLP-1 .176,210,211 PYY, CCK, , .212,213 The pathophysiological mechanism of GLP-1 in metabolic diseases GLP-1 plays a crucial role in the pathophysiology of metabolic diseases, particularly in T2DM and obesity.213,214,215 Role of GLP-1 in T2DM GLP-1 significantly influences the functionality of pancreatic -cells and -cells, contributing to its therapeutic effect on T2DM.132,216,217 As a vital incretin hormone, GLP-1 enhances glucose-dependent insulin secretion.3 It also promotes proliferation and reduces apoptosis of pancreatic -cells, thereby maintaining their quality and functionality.130,218 At the molecular level, GLP-1 activates the cAMP response element-binding protein (CREB) via its receptor (GLP-1R), a transcription factor crucial for expressing the insulin gene.3,130,219 GLP-1 also activates PKA and EPAC through a cAMP-dependent pathway.1,220 PKA, a key enzyme, phosphorylates various target proteins, affecting their activity and function, which in turn promotes insulin synthesis and secretion.178,180 The PI3K/Akt signaling pathway, activated by GLP-1, plays a vital role in maintaining pancreatic -cell survival and promoting their proliferation.221,222 Activation of Akt stimulates -cell proliferation, reduces apoptosis, and enhances insulin secretion by regulating downstream effector molecules like Forkhead box protein O1 (FoxO1) and the glucose transporter type 2 (GLUT2).223,224 GLP-1 also inhibits glucagon release from -cells, which is beneficial for reducing blood glucose levels since glucagon promotes hepatic gluconeogenesis.131,225 GLP-1s action on -cells regulates glucagon release.131 The direct impact of GLP-1 on these cells slows the secretion of glucagon, essential for maintaining glucose stability, especially postprandially.131,226 When GLP-1 binds to its receptor on -cells, it activates intracellular cAMP production.227 In -cells, increased cAMP affects glucagon synthesis and release.228 PKA, activated by cAMP, can regulate the activity of K-ATP channels in -cells.228,229 The opening of these channels is controlled by the intracellular ATP/ADP ratio.229 Specifically, PKA modifies the open state of K-ATP channels through phosphorylation, affecting the cell membranes potential and intracellular calcium ion concentration.230,231 By modulating the activity of K-ATP channels, GLP-1 indirectly controls the calcium signaling in -cells, thereby influencing glucagon secretion.232,233 GLP-1 inhibits the release of glucagon from -cells through multiple mechanisms
This is particularly important for patients with diabetes, as they may require specific nutrients, such as vitamin A, vitamin C, and zinc, for maintaining healthy vision
10.1016/j.arr.2003.05.001 113 SeleitI.BakryO
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