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Updated 2026-02-06. Numbers and descriptions here follow the published literature rather than marketing material.
Tirzepatide 是一种由 39 个氨基酸组成的合成肽，分子结构上以 GIP 序列为骨架并引入脂肪酸侧链修饰，使其能够同时与葡萄糖依赖性促胰岛素多肽（GIP）受体和胰高血糖素样肽-1（GLP-1）受体结合。这种双重激动特性使它在同类肽类药物中区别于选择性 GLP-1 受体激动剂。该分子最早由一家制药公司在 2010 年代报道，随后进入糖尿病与体重管理领域的临床研究。
在生理层面，GIP 与 GLP-1 均为肠道内分泌细胞分泌的肠促胰素，进食后参与胰岛素分泌调节与胃排空抑制。Tirzepatide 通过同时激活这两条信号通路，使胰岛素分泌的葡萄糖依赖性增强，并延缓冲胃排空、降低食欲信号。与单一 GLP-1 激动相比，双靶点作用在血糖控制和体重变化上的效应幅度更大，但具体贡献比例仍在研究之中。
脂肪酸侧链的存在使该肽与血浆白蛋白结合能力增强，从而延长循环半衰期，支持每周一次给药的用药间隔。白蛋白结合同时改变组织分布特征，减慢肾脏清除速度。该设计思路在多种长效肽类药物中被反复采用，属于既定的药代动力学策略。
At the receptor level, tirzepatide activates both the glucose-dependent insulinotropic polypeptide receptor and the glucagon-like peptide-1 receptor. Both belong to the class B family of G protein-coupled receptors and signal largely through cyclic AMP accumulation. The compound binds the two receptors with differing affinity, and the pattern of signaling at each site is described in the literature as biased rather than simply proportional to occupancy. Tissues carrying these receptors include pancreatic islets, adipose tissue, the central nervous system, and the gastrointestinal tract. The relative weight of each receptor population in producing metabolic effects continues to be studied.
Published work supports the view that engaging two incretin receptors produces changes in glucose handling and body weight larger than those seen with single-receptor activation. Why that difference arises is not fully settled. Open questions include how much of the observed weight effect depends on central versus peripheral signaling, and whether the two receptors form interacting complexes. Most reported findings come from controlled trials and animal models, and translation between species is imperfect. Further research is expected to refine these points over time.
| Property | Value | Notes |
|---|---|---|
| 分子类型 | 合成修饰肽 | 39 个氨基酸，含脂肪酸侧链 |
| 受体靶点 | GIP 与 GLP-1 受体 | 双重激动剂 |
| 分子量 | 约 4.8 kDa | 以游离肽计 |
| 外观 | 白色至类白色粉末 | 冻干形态常见 |
| 溶解性 | 可溶于水及水性缓冲液 | 溶解后宜低温保存 |
Clinical research programs have evaluated tirzepatide in adults with type 2 diabetes and in adults with obesity or excess weight. Trials generally reported reductions in glycated hemoglobin and body weight across treatment periods of several months. Since these studies enrolled defined populations under controlled conditions, the findings describe group averages rather than individual outcomes. Open questions include the durability of effects after treatment stops, variation among subgroups, and the long-term consequences of sustained dual receptor stimulation. Published trial summaries should be consulted for exact measurements rather than secondary accounts.
Tirzepatide is a synthetic peptide built from 39 amino acid residues. Its backbone derives from the native glucose-dependent insulinotropic polypeptide sequence, altered at several positions to resist enzymatic cleavage. A fatty diacid group attached through a linker extends plasma residence time by promoting reversible binding to serum albumin. The molecule carries a net negative charge near physiological pH and has a reported molecular weight close to 4813 daltons. These features separate it from shorter incretin analogs and account for its prolonged dosing interval.
The peptide backbone contains 39 amino acids and includes alpha-aminoisobutyric acid residues, which are not among the standard proteinogenic set. A C20 fatty diacid moiety is attached through a linker, allowing the compound to bind serum albumin and extend its circulation time. This albumin binding is the main reason the molecule supports once-weekly administration rather than more frequent dosing. The measured molecular mass is approximately 4,813 daltons, placing it firmly in the peptide rather than small-molecule class.
Tirzepatide is a synthetic peptide that activates both the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. This dual agonist profile distinguishes it from earlier incretin-based compounds that act on a single receptor. The molecule was engineered from the native GIP sequence and carries several non-natural residues that slow enzymatic breakdown. Researchers designed it to combine the insulinotropic effects of GIP signaling with the appetite and gastric-emptying effects associated with GLP-1 activation.
== Nasal drugs == The area of intranasal medication delivery provides a huge opportunity for research – both for specifically developed pharmaceutical drugs designed for intranasal treatment, as well as for investigating off-label uses of commonly available generic medications. Steroids, and a large number of inhalational anaesthetic agents are being used commonly. The recent developments in intranasal drug delivery systems are prodigious. Peptide drugs (hormone treatments) are also available as nasal sprays, in this case to avoid drug degradation after oral administration. The peptide analogue desmopressin is, for example, available for both nasal and oral administration, for the treatment of diabetes insipidus. The bioavailability of the commercial tablet is 0.1% while that of the nasal spray is 3-5% according to the SPC (Summary of Product Characteristics). Intranasal calcitonin, calcitonin-salmon, is used to treat hypercalcaemia arising out of malignancy, Paget's disease of bone, post menopausal and steroid induced osteoporosis, phantom limb pain and other metabolic bone abnormalities, available as Rockbone, Fortical and Miacalcin Nasal Spray. GnRH analogues like nafarelin and busurelin are used for the treatment of anovulatory infertility, hypogonadotropic hypogonadism, delayed puberty and cryptorchidism. Other potential drug candidates for nasal administration include anaesthetics, antihistamines (Azelastine), antiemetics (particularly metoclopramide and ondansetron) and sedatives that all benefit from a fast onset of effect.
== Constitutional status == Article 1 (1) of the Indian constitution says that India shall be a "Union of States", which is elaborated under Parts V (The Union) and VI (The States) of the constitution. Article 1 (3) says the territory of India comprises the territories of the states, the union territories and other territories that may be acquired. The concept of union territories was not in the original version of the constitution, but was added by the Constitution (Seventh Amendment) Act, 1956. Article 366(30) also defines union territory as any union territory specified in the First Schedule and includes any other territory comprised within the territory of India but not specified in that schedule. In the constitution wherever it refers to territories of India, it is applicable to the whole country including union territories. Where it refers to only India, it applies to all states only but not to union territories. Thus, citizenship (part II), fundamental rights (part III), Directive Principles of State Policy (part IV), Judiciary role, the Union Territories (part VIII), Article 245, etc. apply to union territories as it refers specifically to territories of India. The executive power of the Union (i.e. union of states only) rests with the president of India. The president of India is also the chief administrator of union territories as per Article 239. The union public service commission's role does not apply to all territories of India as it refers to India only in Part XIV.
==== Fuel cells ==== Appropriately perforated graphene (and hexagonal boron nitride hBN) can allow protons to pass through it, offering the potential for using graphene monolayers as a barrier that blocks hydrogen atoms but not protons/ionized hydrogen (hydrogen atoms with their electrons stripped off). They could even be used to extract hydrogen gas out of the atmosphere that could power electric generators with ambient air. The membranes are more effective at elevated temperatures and when covered with catalytic nanoparticles such as platinum. Graphene could solve a major problem for fuel cells: fuel crossover that reduces efficiency and durability. In methanol fuel cells, graphene used as a barrier layer in the membrane area, has reduced fuel cross over with negligible proton resistance, improving the performance. At room temperature, proton conductivity with monolayer hBN, outperforms graphene, with resistivity to proton flow of about 10 Ω cm2 and a low activation energy of about 0.3 electronvolts. At higher temperatures, graphene outperforms with resistivity estimated to fall below 10−3 Ω cm2 above 250 degrees Celsius. In another project, protons easily pass through slightly imperfect graphene membranes on fused silica in water. The membrane was exposed to cycles of high and low pH. Protons transferred reversibly from the aqueous phase through the graphene to the other side where they undergo acid–base chemistry with silica hydroxyl groups.
=== Signal transduction to the nucleus === PLCγ is a very important enzyme in the pathway as it generates second messenger molecules. It is activated by the tyrosine kinase Itk which is recruited to the cell membrane by binding to phosphatidylinositol (3,4,5)-trisphosphate (PIP3). PIP3 is produced by the action of phosphoinositide 3-kinase(PI-3K), which phosphorylates phosphatidylinositol 4,5-bisphosphate (PIP2) to produce PIP3. It is not known that PI-3K is activated by the T-cell receptor itself, but there is evidence that CD28, a co-stimulatory receptor providing the second signal, is able to activate PI-3K. The interaction between PLCγ, Itk and PI-3K could be the point in the pathway where the first and the second signal are integrated. Only if both signals are present, PLCγ is activated. Once PLCγ is activated by phosphorylation. It hydrolyses PIP2 into two secondary messenger molecules, namely the membrane-bound diacyl glycerol (DAG) and the soluble inositol 1,4,5-trisphosphate (IP3). These second messenger molecules amplify the TCR signal and distribute the prior localized activation to the entire cell and activate protein cascades that finally lead to the activation of transcription factors. Transcription factors involved in T-cell signaling pathway are the NFAT, NF-κB and AP1, a heterodimer of proteins Fos and Jun. All three transcription factors are needed to activate the transcription of interleukin-2 (IL2) gene.
Sources: en.wikipedia.org
doi: 10.1530/EJE-18-0608.) ERN / Endo ERN Existing networks or registries and biobanks (Adrenal (MTG1) / Existing networks) European Society of Endocrinology Clinical Practice Guideline on the management of Adrenal Incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors (ESE Clinical Practice Guideline on the management of Adrenal Incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors) European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma (BJS, Volume 104, Issue 4, March 2017, Pages 358–376) ENSAT registry-based randomized clinical trials for adrenocortical carcinoma (Eur J Endocrinol. 2021 Feb;184(2):R51-R59. doi: 10.1530/EJE-20-0800.)
Because severe cystic acne has the potential to cause permanent scarring over a short period, restrictions on its more immediate availability have proved contentious. In New Zealand, isotretinoin can be prescribed by any doctor but subsidized only when prescribed by a vocationally-registered general practitioner, dermatologist or nurse practitioner.
This is a shortened version of the second chapter of the ICD-9: Neoplasms. It covers ICD codes 140 to 239. The full chapter can be found on pages 101 to 144 of Volume 1, which contains all (sub)categories of the ICD-9. Volume 2 is an alphabetical index of Volume 1. Both volumes can be downloaded for free from the website of the World Health Organization. See here for a tabular overview of primary, secondary, in situ, and benign neoplasms.
=== Differential diagnosis === There are many causes of chest pain, which can originate from the heart, lungs, gastrointestinal tract, aorta, and other muscles, bones and nerves surrounding the chest. In addition to myocardial infarction, other causes include angina, insufficient blood supply (ischemia) to the heart muscles without evidence of cell death, gastroesophageal reflux disease; pulmonary embolism, tumors of the lungs, pneumonia, rib fracture, costochondritis, heart failure and other musculoskeletal injuries. Rarer severe differential diagnoses include aortic dissection, esophageal rupture, tension pneumothorax, and pericardial effusion causing cardiac tamponade. The chest pain in an MI may mimic heartburn. Causes of sudden-onset breathlessness generally involve the lungs or heart – including pulmonary edema, pneumonia, allergic reactions and asthma, and pulmonary embolus, acute respiratory distress syndrome and metabolic acidosis. There are many different causes of fatigue, and myocardial infarction is not a common cause.
The University of Wrocław (Polish: Uniwersytet Wrocławski, UWr; Latin: Universitas Wratislaviensis) is a public research university in Wrocław, Poland. It is the largest institution of higher learning in the Lower Silesian Voivodeship, with over 100,000 graduates since 1945, including some 1,900 researchers, among whom many have received the highest awards for their contributions to the development of scientific scholarship. The university was established in 1701 and reconstituted in its current form in 1945, as a direct successor to the previous German University of Breslau. Following the territorial changes of Poland's borders, academics primarily from the Jan Kazimierz University of Lwów restored the university building, which had been heavily damaged in the 1945 Battle of Breslau.
Sources: en.wikipedia.org
== Interactions == Prokinetic agents such as metoclopramide accelerate gastric emptying, shorten time (tmax) to paracetamol peak blood plasma concentration (Cmax), and increase Cmax. Medications slowing gastric emptying such as propantheline and morphine lengthen tmax and decrease Cmax. The interaction with morphine may result in patients failing to achieve the therapeutic concentration of paracetamol; the clinical significance of interactions with metoclopramide and propantheline is unclear. There have been suspicions that cytochrome inducers may enhance the toxic pathway of paracetamol metabolism to NAPQI (see Paracetamol#Pharmacokinetics). By and large, these suspicions have not been confirmed. Out of the inducers studied, the evidence of potentially increased liver toxicity in paracetamol overdose exists for phenobarbital, primidone, isoniazid, and possibly St John's wort. On the other hand, the anti-tuberculosis drug isoniazid cuts the formation of NAPQI by 70%. Ranitidine increased paracetamol area under the curve (AUC) 1.6-fold. AUC increases are also observed with nizatidine and cisapride. The effect is explained by these drugs inhibiting glucuronidation of paracetamol. Paracetamol raises plasma concentrations of ethinylestradiol by 22% by inhibiting its sulfation. Paracetamol increases INR during warfarin therapy and should be limited to no more than 2 g per week.
With the damage to the core columns, the buckling exterior columns could no longer support the buildings, causing them to collapse. Additionally, the report found the towers' stairwells were not properly reinforced to provide adequate emergency escape for people above the impact zones. NIST concluded that uncontrolled fires in 7 WTC caused floor beams and girders to heat and subsequently "caused a critical support column to fail, initiating a fire-induced progressive collapse that brought the building down."
== Structure == CDPSs don’t have a specific structure, given each one has its own specific function, but they still have common architectures, such as a Rossmann-fold domain. CDPSs are monomers that have been found to display a strong structural similarity to the catalytic domains of class Ic aminoacyl tRNA synthetases: both these families, CDPSs and class Ic aaRSs, have a Rossmann-fold domain and their structures can be superimposed showing many structural analogies. CDPSs characteristically feature a deep surface-accessible pocket bordered by the catalytic residues, which is where the catalysis of amide bond formation takes place. This structure is positioned similarly to the aminoacyl binding pocket in aaRSs, which leads to thinking that CDPSs evolved from class Ic aaRSs. CDPSs and aaRSs present substantial differences though, such as the absence of ATP-binding motifs in CDPSs, given that these use, unlike aaRSs, amino acids that have already been activated.
Lysine production for animal feed is a major global industry, reaching in 2009 almost 700,000 tons for a market value of over €1.22 billion. Lysine is an important additive to animal feed because it is a limiting amino acid when optimizing the growth of certain animals such as pigs and chickens for the production of meat. Lysine supplementation allows for the use of lower-cost plant protein (maize, for instance, rather than soy) while maintaining high growth rates, and limiting the pollution from nitrogen excretion. In turn, however, phosphate pollution is a major environmental cost when corn is used as feed for poultry and swine. Lysine is industrially produced by microbial fermentation, from a base mainly of sugar. Genetic engineering research is actively pursuing bacterial strains to improve the efficiency of production and allow lysine to be made from other substrates. The most common bacteria used is Corynebacterium glutamicum specially mutagenized or gene-engineered to produce lysine, but analogous strains of Escherichia coli are also employed.
In the United States, the Food and Drug Administration has categorized benzodiazepines into either category D or X, meaning the potential for harm to the unborn has been demonstrated. Exposure to benzodiazepines during pregnancy has been associated with a slightly increased (from 0.06 to 0.07%) risk of cleft palate in newborns, a controversial conclusion as some studies find no association between benzodiazepines and cleft palate. Their use by expectant mothers shortly before the delivery may result in a floppy infant syndrome. Newborns with this condition tend to have hypotonia, hypothermia, lethargy, and breathing and feeding difficulties. Cases of neonatal withdrawal syndrome have been described in infants chronically exposed to benzodiazepines in utero. This syndrome may be hard to recognize, as it starts several days after delivery, for example, as late as 21 days for chlordiazepoxide. The symptoms include tremors, hypertonia, hyperreflexia, hyperactivity, and vomiting and may last for up to three to six months. Tapering down the dose during pregnancy may lessen its severity. If used in pregnancy, those benzodiazepines with a better and longer safety record, such as diazepam or chlordiazepoxide, are recommended over potentially more harmful benzodiazepines, such as temazepam or triazolam. Using the lowest effective dose for the shortest period minimizes the risks to the unborn child.
Sources: en.wikipedia.org
它属于合成修饰肽，同时激动 GIP 与 GLP-1 两种肠促胰素受体。这类分子通常被称为双重肠促胰素受体激动剂，与选择性 GLP-1 激动剂在靶点范围上不同。
分子上的脂肪酸侧链使其与血浆白蛋白结合增强，显著延长循环半衰期。半衰期延长后，稳定血药浓度可在较长的给药间隔内维持，因此常见用法为每周一次。
同时激活两条肠促胰素通路可能在胰岛素分泌、胃排空和食欲调节上产生叠加效应。与单靶点相比，临床研究中观察到的血糖与体重变化幅度通常更明显，但各通路的具体贡献比例尚无定论。
It is a synthetic peptide and a dual agonist of two incretin receptors. It is not a small molecule, and it is not structurally related to the older single-receptor peptide agonists.