Daniel J. Drucker, Jeffrey M. Friedman, Joel F. Habener, Jens Juul Holst and Svetlana Mojsov, pioneering scientists in the development of new medications that help control diabetes and obesity, have been recognized with the Princess of Asturias Award for Scientific Research and Technique 2024.
The minutes, read this Wednesday in Oviedo by the president of the jury, the physicist Pedro Miguel Echenique Landiríbar, highlighted that the research of the award-winning scientists has established the endocrine bases of diabetes and obesity“prominent pathologies that are a global public health problem with no effective treatment to date.”
The research of these five world leaders in the field of endocrinology have allowed the development of new antidiabetic drugs that have also proven to be effective against obesity, cardiovascular disease and, as has been recently confirmed, also kidney pathologies.
The award of the award is part of the progress made in recent years in the treatment of type 2 diabetes with the development of drugs that use the active ingredient semaglutidewhich plays a counterbalancing role for insulin in blood sugar balance.
The leading scientific journals Nature and Science They had already recognized the merits of these drugs and their discoverers. The first recognized Svetlana Mojsovwho decades ago played a crucial role in the discovery of the hormone GLP-1 and whose contributions had gone unnoticed.
Holsta researcher at the University of Copenhagen and one of the leading experts in the field of diabetes, discovered that insulin levels spiked and sugar levels decreased in patients undergoing intestinal surgery and related these changes to hormones such as glucagon (GLP-1)which is produced in the pancreas and on which the new generation of drugs that have become bestsellers against obesity, such as Ozempic and Wegovy.
Parallel, Habener and Druckeron the one hand, and biochemistry MojsovOn the other hand, they discovered new types of gut hormones related to weight control, GLP-1 and GLP-2, which have served as the basis for the development of new medications for obesity. Drucker, Habener, Holst and Mojsov share the recognition of having initiated and developed this research since the seventies of the last century.
Friedman (Orlando, 1954), an expert in molecular genetics and researcher at the Rockefeller University in New York, has also focused his work on the mechanisms that regulate body weight and how leptin hormone helps reduce it by reducing food intake and increasing energy expenditure.
“This research has led to the development of treatments that are now available and that are improving the quality of life of hundreds of millions of people around the world. These works are having an enormous clinical and social impact, since they have allowed for the first time the development of effective drugs to combat diabetes and obesity. In addition, they make it possible to mitigate associated pathologies such as cardiovascular diseases,” the ruling highlights.
The jury was made up of Jesús del Álamo, Alberto Aparici Benages, Juan Luis Arsuaga Ferreras, Juan Ignacio Cirac Sasturáin, Avelino Corma Canós, Elena García Armada, Bernardo Hernández González, Jerónimo López Martínez, Amador Menéndez Velázquez, Ginés Morata Pérez, Peregrina Quintela Estévez, Inés Rodríguez Hidalgo, María Teresa Telleria Jorge, María Paz Zorzano Mier, chaired by Pedro Miguel Echenique Landiríbar and Cristina Garmendia Mendizábal as secretary.
How the active ingredient of semaglutide works
Semaglutide is a GLP-1 glucanoid peptide (GLP-1 receptor) agonist medication. medicines that help control glucose (blood sugar) levels in people who have type 2 diabetes.
The physiological hormone glucagon-like peptide-1 (GLP-1) tells the pancreas to make more insulin, which moves sugar from the blood into the cells to produce energy. GLP-1 plays, in addition to glucose regulation, various functions in appetite, nutrient absorption and the cardiovascular system.
The effects on glucose and appetite are specifically mediated by GLP-1 receptors present in the pancreas and brain, on which the semaglutide mimicking the action of the hormone, reducing blood glucose by stimulating insulin secretion and decreasing glucagon secretion produced by the pancreas when the blood glucose level rises.
This “sugar lowering” mechanism also produces a slight delayed gastric emptyingwhich sends the brain the sensation of “being full”: during hypoglycemia, semaglutide decreases insulin secretion and does not affect glucagon secretion, reduces body weight and fat mass by reducing caloric intake, which It implies a general reduction in appetite and decreases the desire for fatty foods, all of which leads to weight loss.
From diabetes II to weight loss
Science chose GLP-1 drugs as the most important scientific advance of the year 2023: “the best-selling weight loss drugs promise a wide range of health benefits,” such as lower risk of heart failure and risk of heart attack and stroke,” which constitutes the most convincing evidence to date that these drugs have important benefits that go beyond weight loss itself“.
But like almost all medications, “These bestsellers have side effects and unknowns“, indicated Science. Among the first, possible intestinal problems or pancreatitis, the potential need to take them indefinitely and the concern of doctors for people who are not obese or overweight, but use them to lose weight quickly.
It has been almost two decades (since 2005) that the family of GLP-1 analogues -glucagon-like peptide-1 agonists- are used for the treatment of patients with type 2 diabetes who also have obesity (BMI>30kg/m2). “Over the years, several molecules that belong to this family have been used (exenatide, liraglutide, dulaglutide, semaglutide).
Since its potential in reducing body weight was proven, a new line of clinical studies to evaluate the role of these drugs in obesity without diabetes associated, given its effects on the brain to control appetite and the digestive tract (they cause the stomach to empty more slowly), among other effects at the level of peripheral organs (such as the liver, kidney and heart).
Currently, the GLP-1 analogues approved for the treatment of obesity, both in adults and adolescents over 12 years of age, are the liraglutide and the semaglutide. Without a doubt that the semaglutide (Wegovy) It is by far more powerful, with body weight loss of approximately 15% of total weight, a historical percentage that had never been achieved with medications, except with bariatric surgery.
These molecules not only have an effect on weight, but have shown cardiovascular protective effect (SELECT study) and renal (FLOW study), as well as at the level of fatty liverwhich are one of the most important complications of obesity.
But we also have to learn to handle these new powerful medications, both for weight loss and other consequences, since it seems that after several years of treatment, By withdrawing GLP-1 analogues, much of the lost weight is recovered, but not all, suggesting that these drugs could have the potential to rebalance biology.
Science predicted that it is possible that this year the discovery of the year prize will be awarded to GPL-2 intestinal peptide analogue drugs and not only to the GLP-1 analogues that, despite being now the most powerful, They will be outnumbered by combinations of dual, triple, gastrointestinal hormone agonists, etc., with numerous clinical trials underway.