7 Written Questions

1. free fatty acids (FFAs) and eicosanoids. When activated, the receptor migrates to the DNA, activating transcription of a number of specific genes.
2. Improved glucose tolerance. This indicates that CD26 contributes to blood glucose regulation by controlling the activity of GLP1 as well as additional substrates. Rem: GLP1 is insulinotropic.
3. contraindicated in patients with kidney and liver diseases or alcoholism. It is also contraindicated in patients with lactic acidosis.
4. CD26 (T cell antigen) and the membrane bound enzyme dipeptidyl peptidase-4 (DPP4).
5. Includes repaglinide (Prandin, Novo-Norm). Works in a similar manner to the sulfonylureas by closing the KATP channels in beta cell membrane, depolarizing the beta cells and opening the calcium channels. The resulting calcium influx induces insulin secretion. Repaglinide's cyclic regions allow it to bind to SUR receptors. Complications similar to the sulfonylureas.
6. Improved glucose tolerance in wild type diabetic mice, but NOT in CD26 negative mice.
7. 
   Januvia (sitagliptin) and vildagliptin. Have been shown to increase insulin response from pancreas due to their ability to inactivate dipeptidyl peptidase-4 (DPP-4) an enzyme which inactivates GLP-1 and other secretagogues.

6 Multiple Choice Questions

1. DPP4 Inhibitor. Increases the plasma concentration of active glucagon like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GDIP). These two hormones then simulate the secretion of insulin in a glucose-dependent manner and inhibit glucagon secretion, thus reducing circulating glucose levels.
   1. Megalitinides
   2. Liraglutide
   3. Januvia (sitagliptin)
   4. Thiazolidinediones
2. Bind to peroxisome proliferator-activated receptors (PPARs), a group of receptor molecules inside the cell nucleus, especially to PPAR-gamma. The PPARs have both a ligand binding domain (LBD) which binds the drug or other ligands and the DNA binding domain (DBD), needed for activation of transcription.
   1. How do Thiazolidinediones act?
   2. Liraglutide
   3. Megalitinides
   4. Thiazolidinediones
3. Metformin (dimethylbiguanide). For Type 2 DM. Decreases hepatic glucose production (both glycogenolysis and gluconeogenesis) and improves response to insulin (increased sensitivity) in those who lose weight. Promotes weight loss and decreases lipid levels.
   1. Biguanides
   2. Exenatide
   3. Liraglutide
   4. Megalitinides
4. Endogenous expression on donor tissue cells negatively regulates homing and grafting. By inhibition or deletion of CD26, it's possible to greatly increase the efficiency of transplantation.
   1. Discuss the effect of CD26 expression on donor tissue rejection?
   2. How do Thiazolidinediones act?
   3. What is the effect of CD26 on blood glucose regulation?
   4. What are some examples of DPP4 Inhibitors and what do they do?
5. aka Exendin-4 or Byetta. Treats Type 2 DM. Mimics effect of GLP-1. Improves the initial rapid release of endogenous insulin, suppression of glucagon release, regulation of gastric emptying, and reduced appetite; all of these events lower blood glucose. Self-regulating in that it lowers blood sugar when levels are elevated but does not continue to lower blood sugar when levels return to normal, unlike with sulfonylureas or insulin.
   1. Biguanides
   2. Acarboose
   3. Liraglutide
   4. Exenatide
6. aka "glitazones." Pioglitazone (Actos) and rosaglitizone (Avandia). Improve sensitivity to insulin, especially in skeletal muscle, and suppress hepatic glucose output. Avandia has been withdrawn from use due to evidence that it increases rates of acute myocardial infarction (AMI).
   1. Biguanides
   2. How do Thiazolidinediones act?
   3. Megalitinides
   4. Thiazolidinediones

6 True/False Questions

1. What effect will a lack of a functioning CD26 gene have on fasting glucose levels and glucose levels after a glucose challenge? → contributes to blood glucose regulation by controlling the activity of GLP1 as well as additional substrates.

   True        False

2. What is the effect of CD26 on blood glucose regulation? → contributes to blood glucose regulation by controlling the activity of GLP1 as well as additional substrates.

   True        False

3. Describe DPP4 enzymatically . Where are high levels of it found? → CD26 (T cell antigen) and the membrane bound enzyme dipeptidyl peptidase-4 (DPP4).

   True        False

4. Liraglutide → aka Exendin-4 or Byetta. Treats Type 2 DM. Mimics effect of GLP-1. Improves the initial rapid release of endogenous insulin, suppression of glucagon release, regulation of gastric emptying, and reduced appetite; all of these events lower blood glucose. Self-regulating in that it lowers blood sugar when levels are elevated but does not continue to lower blood sugar when levels return to normal, unlike with sulfonylureas or insulin.

   True        False

5. Acarboose → An α-glucosidase inhibitor that competitively inhibits hydrolysis of oligo- to monosaccharides. This delays carbohydrate digestion in the small intestine and subsequent absorption, resulting in less postprandial elevation of blood glucose levels. Because its mechanism of action differs from that of other oral hypoglycemics, it can be used in combination therapy with other oral agents.

   True        False

6. What does DPP4 do? What are some examples of hormones that DPP4 aids in regulating? → Inactivates GLP-1 and other secretagogues. Insulinotropic GLP-1 and glucose-dependent insulinotropic polypeptide (GDIP).

   True        False