Tag: NOVEL

  • Pancragen

    Synthetic tetrapeptide bioregulator of pancreatic endocrine and exocrine cell differentiation and function

    A synthetic tetrapeptide (Lys-Glu-Asp-Trp) developed at the Saint Petersburg Institute of Bioregulation and Gerontology as a tissue-specific epigenetic modulator of pancreatic cell differentiation, glucose homeostasis, and beta cell functional recovery in aging and type 2 diabetes mellitus.

    Abstract

    Pancragen (Lys-Glu-Asp-Trp-NH2; KEDW) is a synthetic tetrapeptide bioregulator developed by Vladimir Khavinson and colleagues at the Saint Petersburg Institute of Bioregulation and Gerontology (Russia) as a tissue-specific modulator of pancreatic endocrine and exocrine cell differentiation and function. The compound belongs to the Khavinson class of ultrashort (two to four amino acid) bioregulatory peptides, a pharmacological category defined by the hypothesis that short peptides penetrate cell nuclei, bind complementary DNA sequences in promoter regions through electrostatic and hydrogen-bond interactions, and modulate gene expression in a tissue-specific manner without engaging classical cell-surface receptors. Pancragen was derived from fractionation of bovine pancreatic tissue extracts; the tetrapeptide Lys-Glu-Asp-Trp was identified as the minimal active sequence responsible for the pancreotrophic activity of the parent extract preparation Suprefort. The compound has a molecular formula of C26H36N6O9 (free acid form) and a molecular weight of 576.60 g/mol. Physical-chemical characterization by ultraviolet-visible absorption spectroscopy, circular dichroism, and molecular modeling has demonstrated that the KEDW tetrapeptide binds double-stranded DNA in the major groove at sequences containing the ACCT motif, which is found in promoter regions of genes responsible for pancreatic cell differentiation and function [1]. The principal downstream molecular consequence of this interaction is upregulation of transcription factors that govern pancreatic endocrine cell fate, including PDX1 (the earliest marker of pancreatic progenitor cells and the master regulator of beta cell identity), NGN3, PAX6, PAX4, FOXA2, NKX2-2, and NKX6.1 [2, 3]. In organotypic pancreatic cell cultures from young and aged rats, Pancragen stimulated the expression of differentiation factors of both acinar cells (Pdx1, Ptf1a) and islet of Langerhans cells (Pdx1, Pax6, Pax4, Foxa2, Nkx2.2), with the inducing effect more pronounced in aged cultures, consistent with a geroprotective mechanism [3]. Preclinical pharmacology in streptozotocin-induced diabetic rats demonstrated that oral Pancragen produced a pronounced hypoglycemic effect during the treatment period and that intramuscular administration normalized the adhesion properties of mesenteric capillary endothelium without modifying capillary permeability, suggesting homeostatic and endothelioprotective activity in early diabetes [4]. In a study of biological activity using immunoenzyme and high-performance liquid chromatography methods, the tetrapeptide modulated metabolic parameters characterizing apoptosis, including caspase-3 activity, in pancreatic beta cells and hepatocytes from streptozotocin-treated animals [5]. Primate studies in aged female rhesus monkeys demonstrated that a 10-day intramuscular course of Pancragen at 50 micrograms per day markedly increased the glucose disappearance rate, decreased basal insulin and C-peptide levels, and normalized glucose, insulin, and C-peptide dynamics during intravenous glucose tolerance testing, with partial persistence of these effects for three weeks after cessation of treatment [6, 7]. A comparative study in the same primate model demonstrated that Pancragen normalized insulin and C-peptide levels (suggesting recovery of disturbed glucose tolerance) while glimepiride produced a stronger but delayed blood-glucose-lowering effect without substantially affecting insulin secretion, indicating mechanistically distinct activity [7]. In a clinical study of 33 elderly patients with type 2 diabetes mellitus, Pancragen administered against a background of constant-dose glibenclamide significantly decreased fasting plasma glucose and glucose concentrations at two hours during oral glucose tolerance testing, reduced plasma insulin levels, and decreased the HOMA insulin resistance index; an additional glucose-lowering effect persisted for two weeks after cessation of Pancragen in 60 percent of patients who continued glibenclamide at unchanged doses [8]. Organotypic tissue culture studies confirmed that Pancragen at concentrations as low as 0.05 ng/mL stimulated tissue growth in pancreatic explants from both young and aged rats, with the stimulating effect tissue-specific (no effect on non-pancreatic tissue explants at the same concentration) [9]. The compound has not been approved by the United States Food and Drug Administration, the European Medicines Agency, or any major Western regulatory authority. It is marketed in Russia as a dietary supplement (Pancragen capsules) and is available internationally as a research-grade peptide from multiple suppliers. Formal toxicology studies meeting International Council for Harmonisation or FDA regulatory standards have not been published. The existing safety data, derived exclusively from the Khavinson research network, report no significant adverse events in preclinical or clinical studies at the doses and durations studied. This monograph reviews the chemistry, synthesis, and structural class of Pancragen; the epigenetic and transcriptional mechanism of action; the available pharmacokinetic considerations for ultrashort peptides; the preclinical pharmacology in cell culture, rodent, and primate models; the clinical evidence base in type 2 diabetes; sourcing and quality verification; reconstitution and handling; stack interactions; adverse events and safety signals; and a comparative assessment of five alternative pancreatic bioregulatory or beta cell-active compounds against Pancragen on five competency standards.

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  • Pentadeca Arginate (PDA)

    Arginate salt analog of BPC-157

    A research-grade arginate salt formulation of the pentadecapeptide BPC-157 sequence, formulated for improved aqueous stability and shelf life relative to acetate-salt parent.

    Abstract

    Pentadeca Arginate (PDA; the pentadecapeptide Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val formulated as the arginate salt; the underlying peptide is identical to BPC-157, CAS 137525-51-0; molecular formula C62H98N16O22 free peptide; molecular weight 1419.55 free peptide; the arginate salt adds counterions and is formulated for improved stability) is a research-grade alternative formulation of the BPC-157 pentadecapeptide that has emerged in research-grade peptide vendor catalogs in 2023 to 2024 as a stabilized analog. The pharmacological argument is that the arginate counterion improves aqueous solubility and extends shelf life of the lyophilized solid relative to acetate-salt BPC-157, which is the standard formulation; the underlying peptide sequence and pharmacology are identical, and any differences between PDA and BPC-157 in vivo are attributable to formulation rather than to a different molecule. The published preclinical record on the BPC-157 sequence is summarized in the Kodiac BPC-157 monograph (KDC-MN-002): tendon and ligament healing, vascular reorganization, gastrointestinal mucosal protection, dopaminergic system modulation, broad rodent injury-recovery activity, with the limitation that the literature is dominated by the originating Sikiric group at the University of Zagreb. PDA has no independent published preclinical record beyond the parent BPC-157 work; vendor literature emphasizes formulation stability claims rather than novel pharmacology. Investigators should not assume that PDA differs pharmacologically from BPC-157 acetate; the choice between formulations should be made on stability and handling considerations. Reconstitution and dosing follow BPC-157: bacteriostatic water for injection, refrigerated storage of reconstituted solution, parenteral administration at 250 to 500 mcg per dose. The compound is research-grade and not approved by any regulatory authority for human or veterinary use.

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  • Crystagen

    Synthetic immunomodulatory tripeptide bioregulator of thymic origin with epigenetic gene-regulatory and cytoprotective activity

    A synthetic tripeptide (L-Glu-L-Asp-L-Pro; EDP) derived from structural analysis of the thymic polypeptide complex Thymalin, developed at the Saint Petersburg Institute of Bioregulation and Gerontology as an ultrashort peptide bioregulator with immunomodulatory, cytoprotective, and epigenetic chromatin-regulatory activity targeting thymic epithelial cells, T-lymphocyte subpopulations, and heat-shock protein gene expression.

    Abstract

    Crystagen (L-glutamyl-L-aspartyl-L-proline; EDP tripeptide; molecular formula C14H21N3O8; molecular weight 359.33 g/mol) is a synthetic tripeptide bioregulator developed by Vladimir Khavinson and colleagues at the Saint Petersburg Institute of Bioregulation and Gerontology as one of the principal short-peptide bioactive components of Thymalin, a bovine thymus polypeptide extract approved in the Soviet Union and Russian Federation since 1982 for clinical immunocorrection [1, 2]. The compound belongs to the Khavinson class of ultrashort (two to seven residue) peptide bioregulators, a family of synthetic sequences modeled on tissue-specific peptide fragments isolated from organ extracts by acid-pepsin hydrolysis and ultrafiltration, and is designated as the thymic immune system bioregulator within this peptide family. Crystagen shares the Glu-Asp dipeptide core with the bronchial bioregulator Chonluten (Glu-Asp-Gly) and the cortical bioregulator Cortagen (Ala-Glu-Asp-Pro), differing from these compounds by the third-position proline residue and the absence of the N-terminal alanine extension, respectively; the single amino acid substitution at the third position determines tissue specificity within the Khavinson classification [3, 4]. In the Khavinson laboratory internal code system, the compound is designated T-36 [5]. The principal molecular mechanism of Crystagen, characterized through molecular modeling, cell culture, and organotypic tissue studies, is epigenetic regulation of gene expression through direct interaction of the tripeptide with double-stranded DNA in gene promoter regions and with histone proteins (H1, H2B, H3, H4), producing chromatin decondensation and reactivation of age-repressed transcriptional programs in immune cells [6, 7, 8]. The immunomodulatory activity, characterized in thymic cell cultures, splenic organotypic cultures, and in the THP-1 monocyte/macrophage cell line, includes stimulation of T-lymphocyte differentiation with increased CD3+ and CD4+ cell populations, normalization of the CD4+/CD8+ ratio, activation of B-cell immunity in the spleen, suppression of thymocyte apoptosis through p53 downregulation and Ki-67 upregulation, enhancement of normal lymphocyte proliferation with concurrent inhibition of K-562 tumor cell proliferation, and modulation of cytokine expression including interleukin-6 normalization [9, 10, 11, 12]. The cytoprotective profile includes a pronounced upregulation of heat-shock protein gene HSPA1A (encoding HSP-70), with expression increasing approximately 2.2-fold relative to baseline in a study of highly trained female artistic gymnasts receiving Crystagen in combination with other peptide bioregulators, an effect accompanied by reduced incidence of acute respiratory infections during epidemic conditions [13, 14]. In a clinical observational study of elderly patients, oral Crystagen administration normalized immunogram parameters in 82 percent of treated individuals compared to 56 percent in the control group [15]. The geroprotective context for Crystagen derives from the parent compound Thymalin, which in a 266-patient, 6-to-8-year prospective clinical study conducted at the Saint Petersburg Institute of Bioregulation and Gerontology and the Institute of Gerontology of the Ukrainian Academy of Medical Sciences produced a 2.0-to-2.1-fold reduction in mortality rate relative to control, and a 4.1-fold mortality reduction when combined with the pineal peptide Epithalamin [16]. No formal pharmacokinetic studies have been published for Crystagen as the isolated synthetic EDP tripeptide. As a linear tripeptide with unprotected termini, the compound is expected to undergo rapid proteolytic degradation by aminopeptidases and carboxypeptidases in plasma and gastrointestinal fluid; however, molecular modeling studies have demonstrated that ultrashort peptides including EDP are substrates of the proton-coupled oligopeptide transporter (POT) family carriers PEPT1 and PEPT2, supporting intestinal absorption and cellular uptake through active transport mechanisms [17, 18]. The compound is not approved by the United States Food and Drug Administration, the European Medicines Agency, or any major Western regulatory authority. It is not registered as a pharmaceutical product outside the Russian Federation. Crystagen is commercially available in Russia as a dietary supplement in capsule and sublingual formulations and is supplied internationally as a research-grade lyophilized peptide by multiple peptide synthesis vendors at greater than 95 percent purity by high-performance liquid chromatography. This monograph reviews the chemistry, synthesis, and structural characterization of Crystagen; the discovery and development history within the Khavinson bioregulatory peptide program; the molecular pharmacology including peptide-DNA binding, histone interaction, and gene expression modulation; the pharmacokinetic considerations for ultrashort peptides; the preclinical pharmacology across immune, inflammatory, and aging cell models; the clinical evidence base (observational); sourcing and quality verification; reconstitution and handling; stack interactions and combinations; adverse events and safety signal; and a comparative assessment of five immunomodulatory peptide candidates (Thymogen, Vilon, Thymosin alpha-1, Thymulin, Epithalon) against Crystagen on five competency standards.

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  • Tesofensine

    Triple monoamine reuptake inhibitor (DA, NE, 5-HT)

    A triple reuptake inhibitor originally developed for Alzheimer’s and Parkinson’s disease and repurposed for obesity, advanced through Phase 2 with substantial body weight reduction relative to placebo.

    Abstract

    Tesofensine (NS2330; CAS 195875-84-4; molecular formula C17H23Cl2N; molecular weight 312.28) is a triple monoamine reuptake inhibitor developed by NeuroSearch in the 1990s as a candidate for Alzheimer’s disease and Parkinson’s disease (where dopamine reuptake inhibition was hypothesized to provide motor symptom relief without the on-off fluctuations of L-DOPA). The compound failed to demonstrate efficacy in the original Alzheimer’s and Parkinson’s indications; weight loss observed as an adverse event in the central nervous system trials motivated repurposing for obesity, with Phase 2 data published in 2008 showing approximately 10 percent body weight reduction at 24 weeks at the 0.5 mg dose, substantially greater than the comparator orlistat and meaningfully greater than the GLP-1 agonist liraglutide at typical doses. Mechanism is competitive inhibition at the dopamine, norepinephrine, and serotonin transporters with similar affinity at all three sites; the integrated effect is monoamine elevation in mesolimbic, prefrontal, and hypothalamic targets that suppresses appetite and increases energy expenditure. The compound was advanced through Phase 3 by NeuroSearch and partner Saniona for obesity but Phase 3 enrollment was paused multiple times owing to safety signals (modest blood pressure elevation, dry mouth, insomnia, mood changes) and the program has progressed slowly relative to the more recent GLP-1 class. Saniona has continued development for hypothalamic obesity (Prader-Willi syndrome and acquired hypothalamic obesity from craniopharyngioma surgery), with the rationale that the central monoamine elevation may compensate for hypothalamic dysfunction in these niche populations. The compound is not approved in any jurisdiction. Plasma half-life is approximately 9 days, suitable for once-daily oral administration with steady-state achieved over 4 weeks.

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  • Pemvidutide

    Balanced dual glucagon-like peptide-1 (GLP-1) and glucagon receptor agonist peptide with glycolipid half-life extension

    A 29-amino-acid unimolecular peptide engineered for equipotent GLP-1 and glucagon receptor co-agonism, conjugated to a proprietary glycolipid moiety for weekly subcutaneous dosing, under clinical development for metabolic dysfunction-associated steatohepatitis, obesity, and alcohol use disorder.

    Abstract

    Pemvidutide (ALT-801; CAS 2538014-94-5; UNII A35F525WBG; molecular formula C182H275N39O54; molecular weight 3873.42 g/mol) is a synthetic 29-amino-acid peptide that functions as a balanced (1:1) dual agonist of the glucagon-like peptide-1 receptor (GLP-1R) and the glucagon receptor (GCGR), developed by Altimmune, Inc. (Gaithersburg, Maryland) for the treatment of metabolic dysfunction-associated steatohepatitis (MASH), obesity, alcohol use disorder (AUD), and alcohol-associated liver disease (ALD). The compound incorporates sequence elements derived from both GLP-1 and glucagon and is conjugated to an 18-carbon diacid alkyl chain through a proprietary glycosidic linkage (designated EuPort), which provides near-quantitative but transient binding to serum albumin and extends the plasma half-life to a duration consistent with once-weekly subcutaneous administration without dose titration [1, 2]. The dual receptor mechanism differentiates pemvidutide from selective GLP-1 receptor agonists such as semaglutide and liraglutide: GLP-1R activation suppresses appetite through hypothalamic and brainstem satiety circuits, delays gastric emptying, and improves glycemic control, while GCGR activation directly stimulates hepatic fatty acid beta-oxidation, suppresses de novo lipogenesis, and increases energy expenditure through thermogenic pathways, producing a composite antisteatotic and weight-reducing pharmacology that is mechanistically suited to liver-predominant metabolic disease [3, 4, 5]. In the translational AMLN diet-induced obese mouse model of NASH, pemvidutide at 10 nmol/kg subcutaneous produced approximately 25 percent body weight reduction, significant reductions in liver triglycerides, galectin-3, collagen type 1 alpha 1, and NAFLD Activity Score, with efficacy exceeding that of semaglutide and elafibranor at equimolar doses on composite histological endpoints [6]. Clinical development has advanced through Phase 1 studies (NCT04561245, 100 subjects), Phase 1b/2a studies in MASLD (NCT05006885, 95 subjects; NCT05292911, 64 subjects), the Phase 2 MOMENTUM obesity trial (391 subjects, 48 weeks), and the Phase 2b IMPACT trial in biopsy-confirmed MASH (NCT05989711, 212 subjects) [1, 7, 8, 9, 10]. In the Phase 1b/2a MASLD study (Harrison et al. 2025), 12 weeks of pemvidutide at 1.8 mg weekly produced a 68.5 percent relative reduction in liver fat content by MRI-proton density fat fraction versus 4.4 percent for placebo (p < 0.001), with 55.6 percent of treated subjects achieving liver fat normalization to 5 percent or below [8]. Extension to 24 weeks produced 75.2 percent liver fat reduction at 1.8 mg and 6.2 percent body weight reduction versus placebo [7]. In the MOMENTUM trial, pemvidutide at 2.4 mg weekly for 48 weeks produced mean weight loss of 15.6 percent versus 2.2 percent on placebo, with body composition analysis demonstrating 78.1 percent of weight loss attributable to fat mass and 21.9 percent to lean mass [9, 10]. In the Phase 2b IMPACT trial (Noureddin et al. 2025) in 212 patients with biopsy-confirmed MASH and fibrosis stages F2 or F3, pemvidutide met the primary endpoint of MASH resolution without fibrosis worsening: 59.1 percent at 1.2 mg and 52.1 percent at 1.8 mg versus 19.1 percent for placebo (p < 0.0001 for both comparisons) [11]. Topline 48-week data demonstrated continued antifibrotic activity with statistically significant improvements in Enhanced Liver Fibrosis score and liver stiffness measurement versus placebo [12]. The United States Food and Drug Administration has granted Breakthrough Therapy Designation for pemvidutide in MASH (January 2026) and Fast Track designations for both MASH and AUD [13, 14]. Phase 3 registrational programs for MASH and the VELOCITY Phase 3 program for obesity are in planning as of May 2026. Safety across completed trials has been favorable; adverse events are predominantly gastrointestinal (nausea, diarrhea, decreased appetite), mild to moderate in severity, and concentrated in the first 16 weeks of treatment. No imbalances in cardiac events, arrhythmias, or clinically meaningful heart rate increases have been observed. This monograph reviews the compound identification, structural pharmacology, mechanism of action, pharmacokinetics, preclinical and clinical evidence base, sourcing and quality verification, reconstitution and handling, stack interactions, adverse events, and a comparative assessment of five alternative agents (survodutide, semaglutide, tirzepatide, cotadutide, resmetirom) against pemvidutide on five competency standards.

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  • SLU-PP-332

    Pan-ERR (estrogen-related receptor) agonist exercise mimetic

    A small-molecule pan-agonist of the three estrogen-related receptor isoforms (ERRฮฑ, ERRฮฒ, ERRฮณ), studied as an exercise mimetic for activation of mitochondrial biogenesis and oxidative metabolism.

    Abstract

    SLU-PP-332 (CAS 2226909-79-9; molecular formula C25H26N2O5S; molecular weight 466.55) is a small-molecule pan-agonist of the estrogen-related receptor (ERR) family of orphan nuclear receptors developed at the Saint Louis University School of Medicine by Thomas Burris and colleagues. The ERR family comprises three isoforms (ERRalpha, ERRbeta, ERRgamma) that share substantial sequence homology with the estrogen receptor but bind distinct ligands and target distinct gene programs; the principal ERR-regulated gene programs include mitochondrial biogenesis, fatty acid oxidation, oxidative phosphorylation, and skeletal muscle oxidative fiber phenotype. ERR activity is induced by exercise and is one of the principal transcriptional drivers of the exercise-induced metabolic adaptation phenotype, alongside PGC-1alpha (which is itself an ERR coactivator). SLU-PP-332 was characterized as an inverse partial agonist or full agonist depending on the assay, with similar potency at all three ERR isoforms (EC50 in the low-nanomolar to mid-nanomolar range). Reported in vivo effects in rodent models include increased exercise endurance (treadmill running time approximately doubled in mice receiving the compound at 50 mg/kg subcutaneous daily for several weeks without exercise training), elevation of mitochondrial gene expression in skeletal muscle, reduction of body fat mass on high-fat diet, and protection against age-related muscle dysfunction. The pharmacological profile has motivated interest in the compound as an exercise mimetic for metabolic and aging indications. The compound is research-grade and not approved by any regulatory authority; clinical development through partner companies has been announced but no Phase 1 readouts have been published as of the most recent monograph revision. Reconstitution requires DMSO or co-solvent owing to limited aqueous solubility; storage of solid material at refrigerated or frozen conditions.

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  • Humanin

    24-residue mitochondrial-derived peptide (MDP)

    A 24-amino-acid peptide encoded within the 16S rRNA of the mitochondrial genome, identified as a neuroprotective and metabolic factor with broad anti-apoptotic activity.

    Abstract

    Humanin (Met-Ala-Pro-Arg-Gly-Phe-Ser-Cys-Leu-Leu-Leu-Leu-Thr-Ser-Glu-Ile-Asp-Leu-Pro-Val-Lys-Arg-Arg-Ala; molecular weight 2687.27 free peptide; CAS 330936-69-1) is a 24-residue peptide encoded within the 16S ribosomal RNA gene of the mitochondrial genome, identified by Yuichi Hashimoto and colleagues at Keio University in 2001 in a screen for anti-apoptotic factors that protected against amyloid-beta-induced neuronal death. Humanin is the founding member of the mitochondrial-derived peptide (MDP) family, a class of peptides encoded within mitochondrial DNA and translated from short open reading frames in mitochondrial RNAs; other family members include MOTS-c (KDC-MN-008), the SHLP family (small humanin-like peptides 1 through 6), and gau (gene antisense ubiquitous). The pharmacological signature of humanin includes anti-apoptotic activity through binding the BAX and BIM Bcl-2 family pro-apoptotic proteins, suppression of caspase activation, neuroprotection against amyloid-beta, prion peptide, and ALS-associated SOD1 toxicity in rodent and cell culture models, modulation of metabolic phenotypes (improved insulin sensitivity in rodent obesity models), and cytoprotection in models of myocardial ischemia and chemotherapy-induced toxicity. Receptors include the heterotrimeric ciliary neurotrophic factor (CNTF) receptor complex (CNTFR-WSX-1-gp130), the formyl peptide receptor 2 (FPR2), and direct cytoplasmic protein-protein interactions with BAX/BIM. The S14G analog of humanin (HNG; gly substituted for ser at position 14) is approximately 1000-fold more potent in neuroprotection assays and is the principal research-grade analog used in pharmacology studies. The compound is research-grade with no regulatory approval; clinical development has been limited despite the strong preclinical signal, attributed in part to the narrow therapeutic window for neurodegenerative disease drugs and the sparse human pharmacokinetic characterization.

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  • GDF-11

    TGF-beta superfamily growth differentiation factor

    A growth differentiation factor in the TGF-beta superfamily originally implicated in parabiosis-mediated rejuvenation and subsequently a focus of contested replication studies in cardiac and skeletal muscle aging.

    Abstract

    GDF-11 (growth differentiation factor 11; bone morphogenetic protein 11, BMP-11; CAS 268544-12-9; mature peptide molecular weight approximately 12.5 kDa as a homodimer) is a member of the transforming growth factor beta (TGF-beta) superfamily, closely related to myostatin (GDF-8) with which it shares approximately 90 percent amino acid identity in the mature C-terminal domain. The compound came to prominence in 2013 when a heterochronic parabiosis study by Amy Wagers and Richard Lee at the Harvard Stem Cell Institute identified GDF-11 as a putative young-blood-borne rejuvenation factor that reversed age-related cardiac hypertrophy when administered to old mice. Subsequent studies extended the proposed rejuvenation activity to skeletal muscle and the central nervous system. The original GDF-11 papers triggered substantial follow-up research and substantial contested replication: independent groups (notably the Glass laboratory at Eli Lilly and the Wagers laboratory’s own subsequent work) reported that the original immunoassays did not adequately distinguish GDF-11 from myostatin, that circulating GDF-11 levels do not in fact decline with age, and that recombinant GDF-11 administered to old mice produces muscle wasting at high doses (consistent with the myostatin-like activity expected from the structural homology) rather than rejuvenation. The contested literature has not produced consensus; some groups continue to report modest pro-cardiac and pro-cognitive effects of GDF-11 at carefully titrated doses, while others find no effect or harmful effects. Mechanism is canonical TGF-beta superfamily signaling through ActRIIA/B receptors and downstream SMAD2/3 transcription factor activation; GDF-11 and myostatin share the same receptor and signaling pathway, distinguishing them principally through tissue-specific expression patterns and post-translational propeptide regulation. The compound is research-grade with no regulatory approval and no active clinical development. Investigators studying GDF-11 should be aware of the contested replication literature and the importance of distinguishing GDF-11 from myostatin in immunoassays.

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  • Glepaglutide

    Long-acting glucagon-like peptide-2 (GLP-2) receptor agonist peptide analog

    A 39-amino-acid synthetic peptide analog of human glucagon-like peptide-2 engineered by Zealand Pharma with nine amino acid substitutions and a C-terminal hexalysine tail to enable depot formation, extended half-life, and ready-to-use liquid formulation for subcutaneous administration in short bowel syndrome.

    Abstract

    Glepaglutide (ZP1848) is a long-acting, synthetic peptide analog of human glucagon-like peptide-2 (GLP-2) developed by Zealand Pharma A/S (Soeborg, Denmark) for the treatment of short bowel syndrome (SBS) with intestinal failure in patients dependent on parenteral support. The compound comprises 39 amino acids and differs from native human GLP-2(1-33) by the incorporation of nine amino acid substitutions at positions 2, 3, 5, 8, 10, 11, 16, 24, and 28, together with a C-terminal amidated hexalysine tail ([Lys]6-NH2) derived from Zealand Pharma’s proprietary Structure Inducing Probe (SIP) technology. The substitutions confer resistance to dipeptidyl peptidase-4 (DPP-4) degradation, improved physicochemical stability enabling a ready-to-use aqueous liquid formulation, and formation of a subcutaneous depot from which the parent compound and its active C-terminally truncated metabolites (M1, 35 amino acids; M2, 34 amino acids) are slowly released into systemic circulation. The resulting effective half-life of approximately 50 to 124 hours in humans permits twice-weekly or once-weekly subcutaneous dosing, a substantial advance over the daily injection requirement of teduglutide (Gattex), the first-in-class approved GLP-2 analog. Glepaglutide binds and activates the GLP-2 receptor (GLP-2R), a class B G-protein-coupled receptor expressed on intestinal subepithelial myofibroblasts, enteroendocrine cells, and enteric neurons. Receptor activation triggers downstream release of intestinal growth mediators including insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF), and keratinocyte growth factor, resulting in crypt cell proliferation, villus elongation, inhibition of enterocyte apoptosis, enhanced intestinal barrier function, increased mesenteric blood flow, and suppression of gastric acid hypersecretion and accelerated gastrointestinal motility. The net physiological effect is increased intestinal absorptive capacity for fluid, electrolytes, and macronutrients in patients with anatomically shortened bowel. Clinical development has progressed through Phase 1 healthy volunteer pharmacokinetic studies, a Phase 2 randomized crossover trial in 18 SBS patients published in The Lancet Gastroenterology and Hepatology (Naimi et al., 2019) demonstrating dose-dependent improvements in intestinal wet weight absorption and plasma citrulline, and the pivotal Phase 3 EASE-SBS 1 trial (NCT03690206), a multinational, double-blind, placebo-controlled study in 106 patients that met its primary endpoint of significant reduction in weekly parenteral support volume at 24 weeks (mean change minus 5.13 versus minus 2.85 liters per week for glepaglutide twice weekly versus placebo; P equals 0.0039). The compound received orphan drug designation from both the United States Food and Drug Administration and the European Medicines Agency. Zealand Pharma submitted a New Drug Application to the FDA in late 2023; in December 2024, the FDA issued a Complete Response Letter citing insufficient evidence to confirm efficacy and safety at the proposed marketed dose and recommending an additional confirmatory trial. A Marketing Authorization Application was submitted to the European Medicines Agency in June 2025, and Zealand Pharma plans an additional Phase 3 trial to support regulatory resubmission in the United States. The safety profile is consistent with the known GLP-2 class effects. The most frequent adverse events in clinical trials are injection site reactions, stoma complications (primarily swelling or enlargement of the stoma nipple), gastrointestinal events (nausea, vomiting, abdominal pain), peripheral edema, fatigue, and headache. Anti-drug antibodies develop in a proportion of treated patients with a trend toward higher injection site reaction incidence in antibody-positive individuals, though no firm causal relationship has been established. The compound does not require reconstitution and is administered as a fixed-dose, ready-to-use subcutaneous injection via autoinjector, representing a practical advantage over lyophilized GLP-2 analogs requiring daily preparation. This monograph documents the chemistry, design rationale, and synthesis of glepaglutide; the GLP-2 receptor pharmacology and downstream intestinotrophic signaling; the comprehensive human pharmacokinetic profile including depot formation and metabolite characterization; the preclinical pharmacology in intestinal growth and inflammatory bowel disease models; the clinical evidence base from Phase 1 through Phase 3; sourcing and quality verification; reconstitution and handling; stack interaction considerations; adverse events and safety signals; and a comparative assessment of five GLP-2 receptor agonist candidates (teduglutide, apraglutide, dapiglutide, elsiglutide, and native GLP-2) against glepaglutide on five competency standards.

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  • Ladasten

    Adamantane-derived actoprotectant and atypical anxiolytic

    An N-substituted adamantyl bromophenylamine related to bromantane with longer plasma duration, registered in the Russian Federation as Ladasten for asthenic conditions.

    Abstract

    Ladasten (bromantane analog; N-(2-adamantyl)-N-(4-bromophenyl)amine derivative; INN bromantane in some sources but distinguished by the longer-acting Russian preparation; CAS for bromantane parent 40165-90-2) is an adamantane-class atypical psychostimulant and actoprotectant developed at the Russian Academy of Sciences and registered by the Russian Ministry of Health in the early 2000s for the treatment of asthenia and idiopathic chronic fatigue. Ladasten is closely related to bromantane and shares the dual immunomodulatory and dopaminergic profile of that parent compound, but Russian-language pharmacology reports describe a longer plasma half-life and a more pronounced antiasthenic effect at lower mass doses (50 to 100 mg daily versus 100 to 200 mg for bromantane). Mechanism is multifactorial and incompletely characterized in Western pharmacology: principal effects include induction of tyrosine hydroxylase and aromatic L-amino acid decarboxylase transcripts in mesolimbic dopaminergic neurons (driving sustained dopamine biosynthesis rather than release-mediated stimulation), modulation of GABA-A and serotonergic tone, and immunorestorative activity in stress models. The behavioral signature is anxiolysis without sedation combined with restoration of physical and cognitive performance under fatigue conditions, distinguishing the compound from classical psychostimulants and from benzodiazepine anxiolytics. Western clinical trial data are absent. Published Russian Phase 3 data describe efficacy in neurasthenia and post-infectious asthenia at 50 to 100 mg per day for 28 days. The compound is not approved by FDA, EMA, or any regulatory authority outside the Russian Federation and Eastern European member states; the published evidence base is dominated by a single research-clinical group, which is the principal limitation. Adverse event profile is benign at registered doses, with mild gastrointestinal upset and transient activation reported.

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