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ForumsPublic SquareGLP-1 receptor expression in cardiac tissue — 6 month update

GLP-1 receptor expression in cardiac tissue — 6 month update

amy_econ_NJ Thu, Mar 21, 2024 at 11:21 PM 26 replies 2,238 viewsPage 1 of 6
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amy_econ_NJ
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Mar 21, 2024 at 11:21 PM#1

Posting this because the summary going around does not say what the paper says, and the difference matters for how people here are using it.

The mechanism is more central than most summaries suggest. Receptor agonism in the arcuate nucleus activates POMC neurons and inhibits AgRP/NPY signalling, and the downstream MC4R pathway is the same one disrupted in monogenic obesity — convergent genetic evidence that the target is the right one. Peripherally there is glucose-dependent insulin secretion, glucagon suppression and delayed gastric emptying, but the gastric component largely adapts over months while the central effect persists, which is why the durable effect is appetite rather than fullness.

Where I think it is weakest: the follow-up is short relative to how long people actually take these drugs, so durability is an assumption here rather than a finding.

What would genuinely help is knowing which effects tachyphylax and which persist, because the answer explains why tolerability improves while the appetite effect keeps working. I would rather have one careful answer than five confident ones.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
25 3Dr.SportsMedIN, amy_econ_NJ, bbq_ray_KC and 22 others
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PharmD_Rodriguez
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Mar 21, 2024 at 11:37 PM#2
amy_econ_NJ said:
The mechanism is more central than most summaries suggest.

Amycretin (AMY/GLP-1 dual agonist) emerging data relevant to the pharmacology: Phase 1 showed -13.1% body weight at only 12 weeks, the fastest trajectory ever seen for an anti-obesity agent[1].

Amylin receptor agonism enhances satiety signaling through the area postrema and reduces glucagon secretion. Combined with GLP-1R agonism, this dual mechanism may produce even greater efficacy than current agents.

Early-stage data — interpret with caution. But the trajectory is extraordinary.

References:
[1] Novo Nordisk investor presentation, September 2023.
Last edited: Mar 22, 2024 at 4:37 AM
26 4TinaHashiRN, robert_kc, dan_philly and 23 others
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Dr.CardioMD
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Mar 21, 2024 at 11:53 PM#3
amy_econ_NJ said:
The mechanism is more central than most summaries suggest.

Pushing back on amy_econ_NJ here. The pharmacokinetics explain nearly every practical question asked here. Albumin binding above 99% slows clearance enough to make weekly dosing possible; a terminal half-life near a week means four to five weeks to steady state and therefore a four-week titration interval; subcutaneous bioavailability around 89% means injection site barely matters. Those three facts answer most timing questions before they are asked.

27 5tony_orlando, Dr.NephBHM_UK, kim_atl_prep and 24 others
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JenPlateau
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Mar 22, 2024 at 12:09 AM#4
Dr.CardioMD said:
The pharmacokinetics explain nearly every practical question asked here.

PK/PD modeling for the pharmacology: understanding the pharmacokinetics helps optimize dosing. Semaglutide:

  • Tmax: 24-72 hours post-injection
  • T½: ~168 hours (7 days) — enables weekly dosing
  • Steady state: reached at 4-5 weeks
  • Bioavailability (SubQ): ~89%
  • Volume of distribution: ~12.5L (primarily plasma)

The albumin binding (>99%) is the key pharmacological innovation — creating a sustained-release effect from a single injection. Previous GLP-1 agonists (exenatide) required BID dosing due to rapid clearance.

Last edited: Mar 22, 2024 at 6:09 AM
28 6FitDadDave, RunnerRach, TrialNerd_Beth and 25 others
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tony_orlando
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Mar 22, 2024 at 1:33 AM#5
PharmD_Rodriguez said:
Amycretin (AMY/GLP-1 dual agonist) emerging data relevant to the pharmacology: Phase 1 showed -13.1% body weight at only 12 weeks, the fastest…

Mine went the same way, slower. Nothing to add that would improve it.

Last edited: Mar 22, 2024 at 2:33 AM
29 7KetoKyle, CanadaChris, ZaraB_AL and 26 others
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