The affiliated Ruijin Hospital revealed intestinal flora is a key factordetermining the efficacy of Acarbose, a hypoglycemic agent, for the first time

On November 27, Nature Communications, a subsidiary of Nature, published a study co-authored by the AcademicianNingGuang of the affiliated Ruijin Hospital and Huada Institute of Bioscience and Biomedical Research, which showed and reveals the reasonthat with the same treatment with acarbose for diabetes, patients with B intestinal flora responsed significantly better, especially in reducing weight, lipid-lowering and improving insulin resistance. The good news is that in the Chinese population, there is a higher percentage of population with B intestinal flora in the intestine.

Acarbose, a α-glucosidase inhibitor in thesmall intestinal, has long been widely used in the treatment of diabetic patients. Doctors found in clinical trials, compared with the traditional sulfonylureas, acarbose not onlycouldcontrol blood sugar but could lose weight and decreased blood lipidsin some patients with diabetes. What led to the results of different effects?

Ning Guang‘s team first conducted a controlled study of 106 patients with newly diagnosed type 2 diabetes who had not yet received medical treatment, in which patients were randomly assigned to acarbose and glipizide groups. After three months of treatment, the researchers found that acarbose does have more benefit than glipizide in improving the patient’s weight, insulin resistance, and lipid profile.

On this basis, the researchers classified the intestinal commensal flora of patients with newly diagnosed type 2 diabetes before treatment, and got two broad categories of different types: Type B and Type P.

Gu Yanyun, Associate Researcher in Department of Metabolism, Ruijin Hospital, took it for an example that “As we divided the human blood type into ABO type, the intestinal flora also could have intestinal type: rich in Bacillus enteric type (B intestinal type) and Prunella-rich intestinal type (P intestinal type). ”They found that people with intestinal type B showed more metabolic benefit after receiving acarbose treatment, such as weight loss, lipid-lowering and improving insulin resistance.

These results are all suggestive to researchers that the gut flora seems to play a crucial role in helping acarbose to work. Is that really true?

Researchers further use high-throughput sequencing combined with bioinformatics analysis, hoping to reveal the intestinal flora involved in the intrinsic efficacy of drugs. The study found that type B bacteria in the body with more bifidobacteria, lactic acid bacteria and other probiotics that help digestion, and P-type bacteria lack thebacteria to help bodydigest. Researchers believed this may be one of the reasons that acarbose “benefits greatly from this type of population.”

“For the first time, we looked at the drug response and found differences in the efficacy of acarbose between different gut types.” Ningguang, a member of the Chinese Academy of Engineering, said that in previous normal foreign macro-genomes, there were similar taxonomic studies in the study, but no association was found with human disease or metabolic abnormalities.

Professor Wang Weiqing of Department of Endocrinologyin Ruijin Hospital,explained that acarbose was likely to change the intestinal microbial metabolism of bile acids, affecting the host bile acid signal pathway, which was outside its glucose-lowering metabolic benefit.

This is the first time that the international community has established a study on the relationship between the efficacy of hypoglycemic agents and the characteristics of intestinal commensal flora, which not only explores the mystery of the mechanism of acarbose, a common hypoglycemic agent, but provides a new ideafor the future design of new diabetes drugstargeting at intestinal commensal bacteria bile acid metabolism, which means that it is possible to design tailored treatment for patients according to gut microbiota. The study‘s communicationauthors are Professor Wang Weijin from Ruijin Hospital, Academicians NingGuang and Prof. Karsten Kristiansen from Huada Life Science Research Institute.