Everything below concerns incretin mimetic. We keep the language plain, cite what the science says, and separate well-supported claims from open questions.
Updated 2025-11-19. Numbers and descriptions here follow the published literature rather than marketing material.
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.
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 是一种经结构修饰的胰高血糖素样肽-1 类似物，其主链与内源性 GLP-1(7-36) 约有百分之九十四的序列一致性。第 8 位丙氨酸被 α-氨基异丁酸取代，使二肽基肽酶-4 无法识别原有切割位点。第 34 位赖氨酸换为精氨酸，进一步降低酶解速率。第 26 位赖氨酸经间隔基连接一条含十八个碳的二酸脂肪链，该侧链赋予分子与血浆白蛋白结合的能力。
该分子作为 GLP-1 受体的选择性激动剂发挥作用，受体属于 B 类 G 蛋白偶联受体家族，激活后经 Gs 通路提升细胞内环腺苷酸水平。在胰腺 β 细胞，信号促进葡萄糖依赖性的胰岛素释放，血糖偏低时该作用明显减弱。在胰岛 α 细胞，胰高血糖素分泌受到抑制。中枢神经系统与胃肠道同样存在受体表达，相应信号参与食欲调节以及胃排空速率的降低。
皮下注射后吸收相对缓慢，绝对生物利用度约为百分之八十九，血药浓度峰值通常出现在给药后一到三天。与白蛋白结合使清除减慢，终末半衰期约为一百六十五小时，接近一周。连续给药约四到五周后达到稳态暴露水平。表观分布容积约为每千克零点二五升，血浆蛋白结合率超过百分之九十九。代谢以蛋白水解切割和脂肪二酸侧链的 β-氧化为主，相关产物主要经尿液与粪便排出。
| 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 |
容器与密封系统同样参与稳定性表现。硅油涂层、胶塞材质与顶空氧含量可能改变聚集速率与氧化水平。分析结果因此需要在完整包装形式下评估，而不能仅凭原料药数据推断。法规文件通常要求同时提交批次数据与代表性容器中的稳定性趋势。
关于降解产物的免疫原性风险，文献中仍有讨论空间。体外聚集水平与临床免疫反应之间的定量关系尚未确立。多数公开研究只报告理化指标，缺少长期随访的对应数据。这一问题在生物类似物比对中尤其受到关注。
市售注射用制剂通常要求在二至八摄氏度冷藏保存，并避免光照与冻结。部分多剂量笔在首次使用后允许在不超过三十摄氏度的环境中存放有限周数，具体期限由辅料与防腐剂体系决定。反复冻融会促进肽链聚集并改变可见颗粒计数，因此应予避免。冻干粉末在干燥、避光、低温条件下更为稳定。溶液配制后宜使用低吸附容器，以减少肽类在塑料或玻璃表面的损失。
Activation of the GLP-1 receptor couples to Gs signalling and raises intracellular cyclic AMP in pancreatic beta cells. The resulting insulin release depends on prevailing glucose concentrations, so the effect is greater when glucose is elevated. Receptor engagement also suppresses glucagon secretion and slows gastric emptying, which flattens post-meal glucose excursions. In the central nervous system, signalling in hypothalamic and brainstem regions is associated with reduced appetite and lower energy intake. Studies continue to examine effects on cardiac, renal and hepatic endpoints; whether those benefits are independent of weight change remains an open question.
Clinical development of this compound followed earlier short-acting GLP-1 analogues that required frequent injection. Once-weekly subcutaneous formulations entered use after 2017, and an oral formulation using a permeation enhancer later became available. The oral version pairs the peptide with sodium N-(8-[2-hydroxybenzoyl] amino) caprylate, a carrier that improves uptake across the gastric epithelium. Interest has expanded from glycaemic control into weight management and metabolic liver disease. Regulatory status and approved indications differ between countries, and the product remains subject to ongoing safety monitoring.
==== Juan Alberto Kessel Linares and Viñas Alonso arrested ==== On July 4, 2025, agents from the State Security Unit issued summons to Acting Grand Mater Kessel Linares and Acting Grand Secretary Víctor Bravo Cabañas at the Picota Police Station, where they were again officially arrested by Lieutenant Colonel Kenia María Morales Larrea, but they were later released with warning notices. Filema Duarte called a special session of the High Chamber to occur on July 6. Many Cuban Freemasons considered this an illegal act, because they had voted him out of office, and believed that he did not have the authority to call sessions. After they were released, Kessel Linares and Bravo Cabañas both posted to Facebook that they were concerned about the intimidation tactics used by the government, and called for a peaceful demonstration on July 6.
===== Senior residency (Part II) ===== Duration: Varies depending on the specialty and institution. Objective: Advanced training with increased responsibilities, including research and teaching. Assessment: Completion of a dissertation and successful performance in the Part II Fellowship Examination.
== Selective antagonists == All of the centrally active opioid antagonists used widely in medicine are non-selective, either blocking multiple opioid receptors, or blocking the MOR but activating the KOR. However, for scientific research, selective antagonists are needed which can block one of the opioid receptors but without affecting the others. This has led to the development of antagonists which are highly selective to one of the four receptors:
A further derivative of rasagiline, ladostigil ([N-propargyl-(3R)-aminoindan-5-yl]-N-propylcarbamate), a dual MAO-B inhibitor and acetylcholinesterase inhibitor, was developed for treatment of Alzheimer's disease and other conditions but was ultimately never introduced for medical use.
Sources: en.wikipedia.org
While earlier centuries also saw significant developments, the 20th century was distinguished by the unprecedented pace and global scale of economic, technological, and cultural changes. Still, advancing technology and medicine have had a great impact even in the Global South. Large-scale industry and more centralized media made brutal dictatorships possible on an unprecedented scale in the middle of the century, leading to wars that were also unprecedented. However, the increased communications contributed to democratization. Technological developments included the development of airplanes and space exploration, nuclear technology, advancement in genetics, and the dawning of the Information Age. Major political developments included the Israeli–Palestinian conflict, two world wars, and the Cold War. It also saw the former British Empire lose most of its remaining political power over Commonwealth countries, most notably by the dividing of the British crown into several sovereignties by the Statute of Westminster, the patriation of constitutions by the Canada Act 1982, and the Australia Act 1986, as well as the independence of countries like India, Pakistan, South Africa, and Ireland.
=== Pharmacokinetics === After being ingested, clonidine is absorbed into the blood stream rapidly with an overall bioavailability around 70–80%. Peak concentrations in human plasma occur within 60–90 minutes for the "immediate release" (IR) version of the drug, which is shorter than the "extended release" (ER/XR) version. Clonidine is fairly lipid soluble with the logarithm of its partition coefficient (log P) equal to 1.6; to compare, the optimal log P to allow a drug that is active in the human central nervous system to penetrate the blood brain barrier is 2.0. Less than half of the absorbed portion of an orally administered dose will be metabolized by the liver into inactive metabolites, with roughly the other half being excreted unchanged by the kidneys. About one-fifth of an oral dose will not be absorbed, and is thus excreted in the feces. Work with liver microsomes shows in the liver clonidine is primarily metabolized by CYP2D6 (66%), CYP1A2 (10–20%), and CYP3A (0–20%) with negligible contributions from the less abundant enzymes CYP3A5, CYP1A1, and CYP3A4. 4-hydroxyclonidine, the main metabolite of clonidine, is also an α2A agonist but is non lipophilic and is not believed to contribute to the effects of clonidine since it does not cross the blood–brain barrier. Measurements of the half-life of clonidine vary widely, between 6 and 23 hours, with the half-life being greatly affected by and prolonged in the setting of poor kidney function. Variations in half-life may be partially attributable to CYP2D6 genetics.
== Selected publications == Books Identification and Application of Phenotypic and Molecular Markers for Abiotic Stress Tolerance in Soybean, Berhanu Amsalu Fenta, Belen Marquez Garcia, Christine H. Foyer, Karl J. Kunert, Magdeleen DuPlessis, Urte Schluter: 2011. INTECH Open Access Publisher: ISBN 978-953-307-721-5 A New Era in Plant Metabolism Research Reveals a Bright Future for Bio-fortification and Human Nutrition, Christine H Foyer, Dean Dellapenna, Dominique Van der Straeten: 2006 Plant Carbon-nitrogen Interactions from Rhizosphere to Plant, Caroline Bowsher, Christine H Foyer, Society for Experimental Biology: Oxford University Press: 2004. Molecular Physiology: Engineering Crops for Hostile Environments, Martin A Parry, Christine H Foyer, Brian Forde: Oxford University Press: 2000. ISBN Causes of Photooxidative Stress and Amelioration of Defense Systems in Plants, Christine H Foyer, Philip M Mullineaux: CRC Press: 1994. ISBN 978-0-8493-5443-4 Photosynthesis, Christine H Foyer, Kreiger Publishing Co.: 1991 ISBN 978-0-89464-506-8 Research articles Foyer, Christine H.; Halliwell, Barry (1976). "The presence of glutathione and glutathione reductase in chloroplasts: a proposed role in ascorbic acid metabolism". Planta. 133 (1): 21–25. doi:10.1007/BF00386001. PMID 24425174. S2CID 27896738.
The Kitchener reforms began in 1903 when Lord Kitchener of Khartoum, newly appointed Commander-in-Chief, India, completed the unification of the three former Presidency armies, and also the Punjab Frontier Force, the Hyderabad Contingent and other local forces, into one Indian Army. The principles underlying the reforms were that the defence of the North-West Frontier against foreign aggression was the army's primary role and that all units were to have training and experience in that role on that frontier. Furthermore, the army's organisation should be the same in peace as in war, and maintaining internal security was for the army a secondary role, in support of the Indian Imperial Police.
=== Secondary causes === There are causes for deficiency other than low dietary intake of vitamin A as retinol or carotenes. Adequate dietary protein and caloric energy are needed for a normal rate of synthesis of RBP, without which, retinol cannot be mobilized to leave the liver. Systemic infections can cause transient decreases in RBP synthesis even if protein-calorie malnutrition is absent. Chronic alcohol consumption reduces liver vitamin A storage. Non-alcoholic fatty liver disease (NAFLD), characterized by the accumulation of fat in the liver, is the hepatic manifestation of metabolic syndrome. Liver damage from NAFLD reduces liver storage capacity for retinol and reduces the ability to mobilize liver stores to maintain normal circulating concentration. Vitamin A appears to be involved in the pathogenesis of anemia by diverse biological mechanisms, such as the enhancement of growth and differentiation of erythrocyte progenitor cells, potentiation of immunity to infection, and mobilization of iron stores from tissues.
Sources: en.wikipedia.org
Each person carries 2 alleles of each of the 3 class-I genes, (HLA-A, HLA-B and HLA-C), and so can express six different types of MHC-I (see figure). In the class-II locus, each person inherits a pair of HLA-DP genes (DPA1 and DPB1, which encode α and β chains), a couple of genes HLA-DQ (DQA1 and DQB1, for α and β chains), one gene HLA-DRα (DRA1), and one or more genes HLA-DRβ (DRB1 and DRB3, -4 or -5). That means that one heterozygous individual can inherit six or eight functioning class-II alleles, three or more from each parent. The role of DQA2 or DQB2 is not verified. The DRB2, DRB6, DRB7, DRB8 and DRB9 are pseudogenes. The set of alleles that is present in each chromosome is called the MHC haplotype. In humans, each HLA allele is named with a number. For instance, for a given individual, his haplotype might be HLA-A2, HLA-B5, HLA-DR3, etc... Each heterozygous individual will have two MHC haplotypes, one each from the paternal and maternal chromosomes. The MHC genes are highly polymorphic; many different alleles exist in the different individuals inside a population. The polymorphism is so high, in a mixed population (nonendogamic), no two individuals have exactly the same set of MHC molecules, with the exception of identical twins. The polymorphic regions in each allele are located in the region for peptide contact. Of all the peptides that could be displayed by MHC, only a subset will bind strongly enough to any given HLA allele, so by carrying two alleles for each gene, each encoding specificity for unique antigens, a much larger set of peptides can be presented.
Circumduction is a conical movement of a body part, such as a ball and socket joint or the eye. Circumduction is a combination of flexion, extension, adduction and abduction. Circumduction may be performed at ball and socket joints, such as the hip and shoulder, as well as other parts of the body such as fingers, hands, feet, and head. For example, circumduction occurs when spinning the arm when performing a serve in tennis or bowling a cricket ball.
Blood is drawn into a test tube containing liquid sodium citrate, which acts as an anticoagulant by binding the calcium in a sample. The blood is mixed, then centrifuged to separate blood cells from plasma (as prothrombin time is most commonly measured using blood plasma). In newborns, a capillary whole blood specimen is used. A sample of the plasma is extracted from the test tube and placed into a measuring test tube (Note: for an accurate measurement, the ratio of blood to citrate needs to be fixed and should be labeled on the side of the measuring test tube by the manufacturing company; many laboratories will not perform the assay if the tube is underfilled and contains a relatively high concentration of citrate—the standardized dilution of 1 part anticoagulant to 9 parts whole blood is no longer valid). Next an excess of calcium (in a phospholipid suspension) is added to the test tube, thereby reversing the effects of citrate and enabling the blood to clot again. Finally, in order to activate the extrinsic / tissue factor clotting cascade pathway, tissue factor (also known as factor III) is added and the time the sample takes to clot is measured optically. Some laboratories use a mechanical measurement, which eliminates interferences from lipemic and icteric samples.
The Riksdag performs the normal functions of a legislature in a parliamentary democracy. It enacts laws, amends the constitution and appoints a government. In most parliamentary democracies, the head of state commissions a politician to form a government. Under the new Instrument of Government (one of the four fundamental laws of the Constitution) enacted in 1974, that task was removed from the monarch of Sweden and given to the speaker of the Riksdag. To make changes to the Constitution under the new Instrument of Government, amendments must be approved twice, in two successive electoral periods with a regular general election held in between. There are 15 parliamentary committees in the Riksdag.
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.
差别集中在三处：第 8 位残基被非天然氨基酸取代，第 34 位换成精氨酸，第 26 位增加一条脂肪酸侧链。前两处改动降低酶解速率，侧链则通过白蛋白结合延长循环时间。综合结果是半衰期从约两分钟延长到约一周。