A vitamin B12 conjugate of exendin-4 improves glucose tolerance without associated nausea or hypophagia in rodents

Elizabeth G. Mietlicki-Baase, Claudia G. Liberini, Jayme L. Workinger, Ron L. Bonaccorso, Tito Borner, David J. Reiner, Kieran Koch-Laskowski, Lauren E. McGrath, Rinzin Lhamo, Lauren M. Stein, Bart C. De Jonghe, George G. Holz, Christian L. Roth, Robert P. Doyle, Matthew R. Hayes

Research output: Contribution to journalArticle

12 Scopus citations


Aims: While pharmacological glucagon-like peptide-1 receptor (GLP-1R) agonists are FDA-approved for treating type 2 diabetes mellitus (T2DM) and obesity, a major side effect is nausea/malaise. We recently developed a conjugate of vitamin B12 (B12) bound to the GLP-1R agonist exendin-4 (Ex4), which displays enhanced proteolytic stability and retention of GLP-1R agonism. Here, we evaluate whether the conjugate (B12-Ex4) can improve glucose tolerance without producing anorexia and malaise. Materials and methods: We evaluated the effects of systemic B12-Ex4 and unconjugated Ex4 on food intake and body weight change, oral glucose tolerance and nausea/malaise in male rats, and on intraperitoneal glucose tolerance in mice. To evaluate whether differences in the profile of effects of B12-Ex4 vs unconjugated Ex4 are the result of altered CNS penetrance, rats received systemic injections of fluorescein-Ex4 (Flex), Cy5-B12 or Cy5-B12-Ex4 and brain penetrance was evaluated using confocal microscopy. Uptake of systemically administered Cy5-B12-Ex4 in insulin-containing pancreatic beta cells was also examined. Results: B12-Ex4 conjugate improves glucose tolerance, but does not elicit the malaise and anorexia produced by unconjugated Ex4. While Flex robustly penetrates into the brain (dorsal vagal complex, paraventricular hypothalamus), Cy5-B12 and Cy5-B12-Ex4 fluorescence were not observed centrally, supporting an absence of CNS penetrance, in line with observed reduction in CNS-associated Ex4 side effects. Cy5-B12-Ex4 colocalizes with insulin in the pancreas, suggesting direct pancreatic action as a potential mechanism underlying the hypoglycaemic effects of B12-Ex4. Conclusion: These novel findings highlight the potential clinical utility of B12-Ex4 conjugates as possible future T2DM therapeutics with reduced incidence of adverse effects.

Original languageEnglish (US)
Pages (from-to)1223-1234
Number of pages12
JournalDiabetes, Obesity and Metabolism
Issue number5
StatePublished - May 2018


  • antidiabetic drug
  • appetite control
  • drug development
  • exenatide

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Mietlicki-Baase, E. G., Liberini, C. G., Workinger, J. L., Bonaccorso, R. L., Borner, T., Reiner, D. J., Koch-Laskowski, K., McGrath, L. E., Lhamo, R., Stein, L. M., De Jonghe, B. C., Holz, G. G., Roth, C. L., Doyle, R. P., & Hayes, M. R. (2018). A vitamin B12 conjugate of exendin-4 improves glucose tolerance without associated nausea or hypophagia in rodents. Diabetes, Obesity and Metabolism, 20(5), 1223-1234. https://doi.org/10.1111/dom.13222