incretin comes up often in conversation and rarely with the context attached. Here we lay out the basics in order, then work through the practical considerations.
Last reviewed on 2025-09-21. Where a claim depends on a specific study, the study is described rather than over-claimed.
GLP-1 receptors are expressed on pancreatic beta cells, in the gut, and in several brain regions. Receptor activation raises cyclic AMP, enhances glucose-dependent insulin secretion, and suppresses glucagon release when blood glucose is high. Effects on gastric emptying and on hypothalamic appetite circuits reduce energy intake. Because insulin release remains glucose-dependent, the risk of hypoglycemia is low when the drug is used alone. The precise contribution of each pathway to body weight change in humans remains an area of active investigation.
Clinical studies of semaglutide generally measure glycated hemoglobin, fasting plasma glucose, body weight, and composite cardiovascular endpoints. The SUSTAIN program enrolled adults with type 2 diabetes, while the STEP program focused on obesity without diabetes. Administration follows a stepwise escalation schedule designed to limit gastrointestinal effects during the first weeks. Reported outcomes include mean percentage weight change, the proportion of participants reaching defined weight-loss thresholds, and rates of nausea, vomiting, and diarrhea. Long-term data on durability after treatment stops are still limited and remain a topic of ongoing research.
Semaglutide is a synthetic peptide analog of human glucagon-like peptide-1, developed by Novo Nordisk and first approved in 2017 for type 2 diabetes. It belongs to the incretin mimetic class, a group of agents that reproduce the glucose-dependent actions of endogenous GLP-1. The molecule was engineered to resist degradation by dipeptidyl peptidase-4 and to bind serum albumin, extending its half-life from minutes to roughly one week. Approval for chronic weight management followed in 2021, based on large cardiovascular and obesity outcome trials.
The company that developed the compound filed it as a long-acting analogue, and it gained first approval in 2017 for type 2 diabetes. Later authorisations from several regulators extended the indication to chronic weight management, and the World Health Organization added the glucagon-like peptide-1 receptor agonist drug class to its model list of essential medicines in 2023. Production uses solid-phase peptide synthesis followed by side-chain conjugation and chromatographic purification. Supply constraints and cost differences across regions are well documented. Literature on long-term outcomes continues to grow, with many trials reporting surrogate endpoints rather than hard clinical endpoints.
Semaglutide is a synthetic peptide of thirty-one amino acids that shares roughly ninety-four percent sequence identity with human glucagon-like peptide-1. Two substitutions resist enzymatic cleavage by dipeptidyl peptidase-4, and a fatty diacid side chain attached through a linker promotes binding to serum albumin. That albumin binding slows renal clearance and extends the circulating half-life from minutes to approximately one week. The structural changes are well established in the published literature. Whether the same modifications affect receptor signalling bias in ways that matter clinically remains an open question.
| Property | Value | Notes |
|---|---|---|
| Molecular formula | C187H291N45O59 | Peptide backbone with a C18 fatty diacid side chain |
| Molecular weight | Approximately 4113 Da | Consistent with a 31-residue peptide plus linker |
| Appearance | White to off-white powder | Lyophilized solid; hygroscopic if left open |
| Solubility class | Sparingly soluble to soluble in water | Varies with pH and ionic strength |
| Typical analytical method | Reversed-phase HPLC with UV detection | Often paired with mass spectrometry for identity |
=== 28 November === The Russian army was actively pushing on both sides of Bakhmut, in Donetsk Oblast. The Russians were trying to encircle the town but were making very slow progress, according to observers.
== Generation of endocrine progenitor cells from pancreatic islets == Similar to generation of Cancer Stem Cells, EMT was demonstrated to generate endocrine progenitor cells from human pancreatic islets. Initially, the human islet-derived progenitor cells (hIPCs) were proposed to be better precursors since β-cell progeny in these hIPCs inherit epigenetic marks that define an active insulin promoter region. However, later, another set of experiments suggested that labelled β-cells de-differentiate to a mesenchymal-like phenotype in vitro, but fail to proliferate; thus initiating a debate in 2007. Since these studies in human islets lacked lineage-tracing analysis, these findings from irreversibly tagged beta cells in mice were extrapolated to human islets. Thus, using a dual lentiviral and genetic lineage tracing system to label β-cells, it was convincingly demonstrated that adult human islet β-cells undergo EMT and proliferate in vitro. Also, these findings were confirmed in human fetal pancreatic insulin-producing cells, and the mesenchymal cells derived from pancreatic islets can undergo the reverse of EMT – MET – to generate islet-like cell aggregates. Thus, the concept of generating progenitors from insulin-producing cells by EMT or generation of Cancer Stem Cells during EMT in cancer may have potential for replacement therapy in diabetes, and call for drugs targeting inhibition of EMT in cancer.
Dedifferentiation () is a transient process by which cells become less specialized and return to an earlier cell state within the same lineage. This suggests an increase in cell potency, meaning that, following dedifferentiation, a cell may possess the ability to re-differentiate into more cell types than it did before dedifferentiation. This is in contrast to differentiation, where differences in gene expression, morphology, or physiology arise in a cell, making its function increasingly specialized. The loss of specialization observed in dedifferentiation can be noted through changes in gene expression, physiology, function within the organism, proliferative activity, or morphology. While it can be induced in a laboratory setting through processes like direct reprogramming and the production of induced pluripotent stem cells, endogenous dedifferentiation processes also exist as a component of wound healing mechanisms.
This hypothesis was opposed by French palaeontologist Marcellin Boule, who authored several publications starting in 1908 describing the French Neanderthal specimen La Chapelle-aux-Saints 1 ("The Old Man") as a slouching, ape-like creature distantly related to modern man. Boule's ideas would define discussions of Neanderthals for some time. Boule suggested two different lineages existed in Ice Age Europe: a more evolved one descending from the British Piltdown Man (a hoax) to the French Grimaldi Man (a Cro-Magnon) which would culminate with modern Europeans; and a less evolved dead-end lineage leading from the German Heidelberg Man to Neanderthal Man. As the focus of human origins shifted from Europe to East Asia ("Out of Asia" hypothesis) by the 1930s and 40s with discoveries such as Java Man and Peking Man (as well as the marginalisation of Piltdown Man), the question of a "Neanderthal phase" in human evolution once again became a topic of discussion. The definition of "Neanderthal" expanded to include several anatomically variable specimens around the Old World. In the contextual debate between monogenism and polycentrism, some specimens were described as "progressive" Neanderthals which would evolve into some local subspecies of H. sapiens (polycentricism), while the "classic" Neanderthals of the Western European Würm glaciation would not. In the 1970s, with the formulation of cladistics and the consequent refinement of the anatomical definitions of species, this "global morphological pattern" fell apart.
=== Branches === Ginkgo branches grow in length by growth of shoots with regularly spaced leaves, as seen on most trees. From the axils of these leaves, "spur shoots" (also known as short shoots) develop on second-year growth. Short shoots have short internodes (they may grow only one to two centimeters in several years) and their leaves are usually unlobed. They are short and knobby, and are arranged regularly on the branches except on first-year growth. Because of the short internodes, leaves appear to be clustered at the tips of short shoots, and reproductive structures are formed only on them (seeds and leaves are visible on short shoots). In ginkgos, as in other plants that possess them, short shoots allow the formation of new leaves in the older parts of the crown. After a number of years, a short shoot may change into a long (ordinary) shoot, or vice versa.
Sources: en.wikipedia.org
==== Home dialysis ==== UK clinical guidelines recommend offering people a choice regarding where they get their dialysis. Research in the UK found that receiving dialysis at home can lead to better quality of life and is less costly than receiving dialysis in hospital. However, many people in the UK prefer to receive dialysis in hospital: In 2022, only 1 in 6 chose receiving it at home. There are various reasons why people do not choose home dialysis. Among these are preferring hospitals as a way of getting regular social contact, being concerned about necessary changes to their homes and their family members becoming carers. Other reasons include a lack of motivation, doubting abilities for self-managed treatment, and not having suitable housing or support at home. Hospital dialysis is also often presented as the norm by healthcare professionals. Encouraging people to have dialysis at home could reduce the impact of dialysis on people's social and professional lives. Some ways to help are offering peer support from other people on home dialysis, better education materials, and professionals being more familiar with home dialysis and its impact. Choosing home dialysis is more likely at kidney centers which have better organisational culture, leadership and attitude.
British rule ended on 30 November 1967, when the People's Republic of Southern Yemen gained independence, and in line with other formerly British Arab territories in the Middle East, it did not join the Commonwealth of Nations.
The exact mechanism of action by which pennyroyal induces menses and abortions in humans is still unknown. Studies using animal models speculate the source of liver toxicity is due to one of the many constituents the plant contains: pulegone, a monoterpene. Pulegone is metabolized by cytochrome P450 (CYP 1A2 and 2E1) and converted to several toxins. Both in vitro and in vivo studies have found the pulegone metabolite menthofuran to be an inhibitor of CYP2A6, accounting for a significant degree of pennyroyal's hepatotoxicity. The exact pathway by which pulegone is converted to menthofuran is unknown, but one study strongly suggested it included allylic oxidation of a methyl group (from CYP450), intramolecular cyclization to form a hemiketal, and subsequent dehydration to form the furan. Pthofuran may deplete glutathione levels, leaving hepatocytes vulnerable to free radical damage.
== Structure == Thermolysin has a molecular weight of 34,600 Da. Its overall structure consists of two roughly spherical domains with a deep cleft running across the middle of the molecule separating the two domains. The secondary structure of each domain is quite different, the N-terminal domain consists of mostly beta pleated sheet, while the C-terminal domain is mostly alpha helical in structure. These two domains are connected by a central alpha helix, spanning amino acids 137–151. In contrast to many proteins that undergo conformational changes upon heating and denaturation, thermolysin does not undergo any major conformational changes until at least 70 °C. The thermal stability of members of the TLP family is measured in terms of a T50 temperature. At this temperature incubation for 30 minutes reduces the enzymes activity by half. Thermolysin has a T50 value of 86.9 °C, making it the most thermo stable member of the TLP family. Studies on the contribution of calcium to thermolysin stability have shown that upon thermal inactivation a single calcium ion is released from the molecule. Preventing this calcium from originally binding to the molecule by mutation of its binding site, reduced thermolysin stability by 7 °C. However, while calcium binding makes a significant contribution to stabilising thermolysin, more crucial to stability is a small cluster of N-terminal domain amino acids located at the proteins surface. In particular a phenylalanine (F) at amino acid position 63 and a proline (P) at amino acid position 69 contribute significantly to thermolysin stability.
Sources: en.wikipedia.org
== Clinical signs == The clinical manifestations of FPLV are variable based on the dose of the virus, the age of the cat, potential breed predispositions, and prior immunity from maternal antibodies, previous exposure, or vaccination. Most infections are subclinical, as evidenced by the high seroprevalence of anti-FPV antibodies among some populations of unvaccinated, healthy cats. The cats that become clinically ill are usually less than one year old, but older cats are also at risk. There is high mortality in clinically affected kittens, and sudden death can occur. Clinical signs usually develop in 4–6 days after exposure, but can show in 2–14 days. The virus infects and destroys actively dividing cells in bone marrow, lymphoid tissues, intestinal epithelium, and—in very young animals—in the cerebellum and retina. The virus primarily attacks the lining of the gastrointestinal tract, causing internal ulceration and, ultimately, total sloughing of the intestinal epithelium. Primary signs include:
An example of such an enantiomer is the sedative thalidomide, which was sold in a number of countries around the world from 1957 until 1961. It was withdrawn from the market when it was found to cause birth defects. One enantiomer caused the desirable sedative effects, while the other, unavoidably present in equal quantities, caused birth defects. The herbicide mecoprop is a racemic mixture, with the (R)-(+)-enantiomer ("Mecoprop-P", "Duplosan KV") possessing the herbicidal activity. Another example is the antidepressant drugs escitalopram and citalopram. Citalopram is a racemate [1:1 mixture of (S)-citalopram and (R)-citalopram]; escitalopram [(S)-citalopram] is a pure enantiomer. The dosages for escitalopram are typically 1/2 of those for citalopram. Here, (S)-citalopram is called a chiral switch of Citalopram.
Dein described Wenger as the most important manager in the club's history: "Arsène's a miracle worker. He's revolutionised the club. He's turned players into world-class players. Since he has been here, we have seen football from another planet". Former Watford manager Graham Taylor said of Wenger in 2002: "I believe his biggest contribution to football is getting across the idea that players have to prepare right and look after themselves". Wenger's loyalty towards financial fair play and handling of Arsenal's debt since their stadium move has earnt him praise, not least from American baseball general manager Billy Beane, who in particular lauded his transfer strategy. A survey in 2007 found Wenger was the only Premier League manager to have made a profit on transfers, and between 2004 and 2009, he made an average profit of £4.4 million per season on transfers, far more than any other club.
Sources: en.wikipedia.org
It is given either as a once-weekly subcutaneous injection or as an oral tablet taken once daily. The two forms use different absorption strategies, so they are not interchangeable on a milligram-for-milligram basis.
Structural modifications, including a fatty acid side chain and non-natural amino acid substitutions, slow enzymatic breakdown and promote albumin binding. These changes support once-weekly dosing rather than twice-daily administration.
The pathways involving insulin, glucagon, gastric emptying, and appetite signaling are well described. How much each pathway contributes to weight reduction in a given person is not fully established.
It is a glucagon-like peptide-1 receptor agonist, often grouped with the incretin mimetics. Its backbone is modified from the human hormone to resist enzymatic degradation and to bind albumin. These two features distinguish it from the native peptide.