Document Detail


Mechanism and management of AKT inhibitor-induced hyperglycemia.
MedLine Citation:
PMID:  19118049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Insulin-like growth factor-I receptor and phosphoinositide 3-kinase/AKT/mammalian target of rapamycin pathways are among the most active areas of drug discovery in cancer research. However, due to their integral roles in insulin signaling, inhibitors targeting these pathways often lead to hyperglycemia and hyperinsulinemia. We investigated the mechanism of hyperglycemia induced by GSK690693, a pan-AKT kinase inhibitor in clinical development, as well as methods to ameliorate these side effects. EXPERIMENTAL DESIGN: The effect of GSK690693 on blood glucose, insulin, and glucagon levels was characterized in mice. We then evaluated the effects of commonly prescribed antidiabetic agents on GSK690693-induced hyperglycemia. The mechanism of blood glucose increase was evaluated using fasting and tracer uptake studies and by measuring liver glycogen levels. Finally, approaches to manage AKT inhibitor-induced hyperglycemia were designed using fasting and low carbohydrate diet. RESULTS: We report that treatment with antidiabetic agents does not significantly affect GSK690693-induced hyperglycemia in rodents. However, administration of GSK690693 in mice significantly reduces liver glycogen (approximately 90%), suggesting that GSK690693 may inhibit glycogen synthesis and/or activate glycogenolysis. Consistent with this observation, fasting before drug administration reduces baseline liver glycogen levels and attenuates hyperglycemia. Further, GSK690693 also inhibits peripheral glucose uptake and introduction of a low-carbohydrate (7%) or 0% carbohydrate diet after GSK690693 administration effectively reduces diet-induced hyperglycemia in mice. CONCLUSIONS: The mechanism of GSK690693-induced hyperglycemia is related to peripheral insulin resistance, increased gluconeogenesis, and/or hepatic glycogenolysis. A combination of fasting and low carbohydrate diet can reduce the magnitude of hyperglycemia induced by an AKT inhibitor.
Authors:
Ming-Chih Crouthamel; Jason A Kahana; Susan Korenchuk; Shu-Yun Zhang; Gobalakrishnan Sundaresan; Derek J Eberwein; Kathleen K Brown; Rakesh Kumar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cancer research : an official journal of the American Association for Cancer Research     Volume:  15     ISSN:  1078-0432     ISO Abbreviation:  Clin. Cancer Res.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-01     Completed Date:  2009-05-07     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9502500     Medline TA:  Clin Cancer Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  217-25     Citation Subset:  IM    
Affiliation:
Oncology Biology, GlaxoSmithKline, Collegeville, Pennsylvania 19426, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Diet, Carbohydrate-Restricted
Fasting
Female
Hyperglycemia / chemically induced*,  prevention & control
Liver Glycogen / metabolism
Male
Mice
Mice, SCID
Oxadiazoles / pharmacology*
Proto-Oncogene Proteins c-akt / antagonists & inhibitors*,  metabolism
Rats
Rats, Sprague-Dawley
Chemical
Reg. No./Substance:
0/GSK690693; 0/Liver Glycogen; 0/Oxadiazoles; EC 2.7.11.1/Proto-Oncogene Proteins c-akt

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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