The role and application prospect of exenatide in the treatment of PCOS

Exenatide (Ex) is a glucagon like peptide 1 (GLP-1) analog, which is mainly used to improve the patients with type II diabetes who have poor blood glucose control and need to lose weight. It is a new target drug for the treatment of diabetes in recent years. Ex has many functions such as improving the function of islet mouth cells, promoting the secretion of glucose dependent insulin, significantly reducing postprandial blood glucose, inhibiting glucagon secretion and weight loss. In view of the fact that patients with polycystic ovary syndrome (Pcos) are often accompanied by insulin resistance, and may be associated with impaired GLP-1 secretion function, at present, scholars began to explore the application of Exenatide impurities in the treatment of PcOS.

Polycystic ovary syndrome (PcOs) is an endocrine and metabolic disorder with multiple causes and heterogeneous clinical manifestations, which is common in adolescent and reproductive women. It is reported that among women of childbearing age, the incidence rate of PCoS is about 5%~10%, and among women with anovulatory infertility, the incidence rate is about 75%, which is one of the main causes of infertility. In addition, the risk of cardiovascular disease, type II diabetes and metabolic syndrome in PCOS patients is significantly increased. Insulin resistance (IR) and obesity are important characteristics of PCOS.

According to statistics, about 67% of PCOS patients are obese or overweight. Research shows that even a 5% drop in body mass index (BMI) can significantly improve IR and help patients recover their regular menstrual cycle and ovulation. It can also improve the therapeutic effect of infertility in PCOS patients. During the treatment process, reducing body weight and improving IR is one of the important therapeutic goals. However, the existing drug treatment is not effective. Although exercise and diet are very effective in weight control, it is not a long-term choice for most people. People try to find some new PCOS intervention methods.

GLP-1 is a kind of incretin, which is secreted by intestinal L cells under the stimulation of food, and then stimulates islet J3 cells to secrete insulin, and inhibits glucagon secretion, thus exerting its hypoglycemic effect. More importantly, some studies have shown that GLP-1 can directly act on pancreatic islet p cells, reduce their apoptosis, promote their proliferation, and thus protect the number of cells. In addition, GLP-1 has the effect of reducing appetite, which can further reduce the cell load

At present, GLP-1 analogues and receptor agonists have begun to try to be used in the treatment of PCOS, which has a number of physiological effects, such as significantly reducing postprandial blood glucose, reducing body weight, protecting pancreatic islet B cells, restoring regular menstrual cycle and ovulation. In particular, it has a special function to protect pancreatic islet cells, which other hypoglycemic drugs do not have.

As a synthetic GLP-1 analog, Exenatide can permanently improve the function of pancreatic islet cells, and the existing research shows that patients have good tolerance to Exenatide, so EX has a good prospect in the application of PCOS treatment, can improve the clinical and biochemical symptoms of PCOS patients from multiple ways, and provide new treatment strategies for PCoS patients, especially obese or fmoc-osu overweight patients. However, its disadvantage is that at present, Exenatide injection is administered by subcutaneous injection, which is a short-term preparation. It needs to be administered twice a day, and the price is relatively high, which brings great economic burden to patients, and will affect the compliance of patients to a certain extent, affecting their wide application. Therefore, it is necessary to develop new dosage forms and long-acting preparations of EX, and improve and innovate drug delivery routes.