Dorzagliatin, a Glucokinase Activator, Repairs Defective Islet Function in High-Fat Diet-Induced Diabetic Mice

The DREAM study showed long-term benefits for glucose control in newly diagnosed type 2 diabetes (T2D) patients even after withdrawal of dorzagliatin treatment, a newly approved glucokinase activator for T2D treatment, who were considered to be in the remission for diabetes. The purpose of the current study is to examine the mechanisms of dorzagliatin-induced diabetes remission by evaluating the changes in islet function over time after a period of administering dorzagliatin in high-fat diet (HFD) induced obesity and diabetes mouse models. Diabetes mice were generated after 7 months of HFD, then received dorzagliatin or vehicle controls via oral gavage once a day for 19 days (8 days of 30 mg/Kg and 11 days of 15 mg/Kg). After drug withdrawal, one group of mice remained in HFD and another group changed to a normal diet. Islets were then isolated at different time points after drug withdrawal, and the serum and liver were collected for evaluation. The glucose ramp-stimulated insulin secretion (GSIS) was evaluated in islet perifusion. Gene expression was measured by qPCR in islets and by RNA-seq in the liver. Compared to normal mouse islets, HFD-induced diabetic islets in vehicle groups have impaired GSIS with about 40% reduction in maximum insulin secretion. In contrast, GSIS was fully recovered to the levels of normal islets in 10, 18 and 38 days after dorzagliatin withdrawal, but returned to defective GSIS levels after 45 days of drug discontinuation. In addition, islet GSIS can be fully recovered after 80 days of diet change. In conclusion, the defective GSIS in HFD-induced diabetes mouse islets is reversible and can be fully restored by dorzagliatin even after a long period of drug withdrawal while still remaining in HFD. The mechanisms are likely due to increased glucokinase gene expression caused by a short treatment of dorzagliatin. Diet change alone can recover islet function but requires weight reduction and a longer duration. Disclosure D. Han: Employee; Nanjing AscendRare Pharmaceutical Technology. S. Meng: Employee; Nanjing AscendRare Pharmaceutical Technology. X. Zhou: Employee; Nanjing AscendRare Pharmaceutical Technology. R. Li: Employee; Nanjing AscendRare Pharmaceutical Technology. C. Li: Employee; Hua Medicine, Nanjing AscendRare Pharmaceutical Technology.