The fiftieth anniversary of hypoglycaemic sulphonamides. How did the mother compound work?

Abstract

Probably over 20 million patients world-wide suffering from Type 2 (non-insulin-dependent) diabetes mellitus are treated with hypoglycaemic sulphonylureas. In fact, all antidiabetic drugs currently used with the aim of stimulating insulin release belong to this family.Soon after the discovery of insulin, Abel and Geiling [1] showed that the hormone contains large amounts of sulphur which is essential for its biological action. These observations prompted several studies on the possible effects of sulphur itself on glucose homeostasis. Oral and parenteral administration of colloidal sulphur caused a small decrease in blood glucose levels in normal rabbits and humans [2-4] and slightly lowered glycaemia and glucosuria in certain diabetic patients [4,5]. The mechanisms of action of sulphur have not been clearly identified.The first report that a synthetic sulphur-containing compound may lower blood glucose probably dates from 1930 [6]. Ruiz and collaborators observed that oral or intravenous administration of 4-or 5-methyl, 2-thiolimidazole ( Fig. 1) to normal fasting rabbits was followed by a slight decrease of glycaemia, but the mechanism involved was not elucidated [6].careful study of the mechanisms underlying this hypoglycaemia [11][12][13].He demonstrated that, whatever the route of administration, 2254 RP decreased blood glucose levels in normal dogs. This hypoglycaemic effect was unaffected by vagotomy, persisted in partially pancreatectomized animals, but disappeared when the pancreatectomy was complete. The degree of hypoglycaemia was dependent on the sulphonamide concentration in plasma, but low doses were sufficient to cause a marked fall in blood glucose when they were injected directly into the pancreatic artery [11][12][13].These observations led Loubati~res to propose that the hypoglycaemic property of 2254 RP was due to its ability to stimulate insulin release through a direct action on Beta cells. Further support for this interpretation was obtained in cross-circulation experiments. When the pancreaticoduodenal vein of a normal donor dog was anastomosed to the jugular vein of a receiver dog made diabetic by alloxan, injection of the drug to the donor was followed by a decrease in blood glucose levels in the receiver [12]. The hypoglycaemic effects of 2254 RP and of a related corn-

Pathways in Beta-Cell Stimulus-Secretion Coupling as Targets for Therapeutic Insulin Secretagogues

“…In 1955, in Berlin, Franke and Fuchs reported that another antibacterial sulfonamide, carbutamide, also caused hypoglycemia. The drug was rapidly used to treat diabetic patients who did not require insulin, and was followed 1 year later by tolbutamide (3). The discovery of hypoglycemic sulfonylureas was thus serendipitous.…”

Oral Antidiabetic Agents

“…Sulfonylureas were developed as structural variants of sulfonamides after the latter were reported to cause hypoglycemia [49] . Early sulfonylureas such as carbutamide, tolbutamide, acetohexamide, tolazamide and chlorpropamide are often referred to as " fi rst generation. "…”

A Cdk5 Inhibitor Enhances the Induction of Insulin Secretion by Exendin-4 Both in Vitro and in Vivo

“…One therapeutic approach for type 2 diabetes has been to use pharmacological reagents that increase endogenous insulin secretion, such as sulfonylurea and GLP-1 analogues [3,4]. Sulfonylurea induces insulin secretion by blocking ATP-sensitive K + channels.…”

“…The rise in cytosolic [Ca 2+ ] i triggers insulin exocytosis [6,7]. However, sulfonylurea has the shortcoming of inducing insulin secretion independently of the circulating glucose concentration, and this increases the risk of the incidence of hypoglycemic episodes [3].…”