dual agonist comes up often in conversation and rarely with the context attached. Here we lay out the basics in order, then work through the practical considerations.
Last reviewed on 2025-10-09. Where a claim depends on a specific study, the study is described rather than over-claimed.
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。
The compound first appeared in the scientific literature as an investigational agent for type 2 diabetes. Clinical development proceeded through phase 1, phase 2, and phase 3 programs that measured glycemic control as a primary endpoint while recording body weight as a secondary outcome. Regulatory approval in the United States followed in 2022 for glycemic control, and a separate indication for chronic weight management was added later. Subsequent trials have examined cardiovascular outcomes in adults with elevated cardiovascular risk. Debates continue over how much of the observed effect derives from each receptor arm.
Structural work on the molecule centers on a C20 fatty diacid moiety attached through a linker to the peptide backbone. This side chain promotes reversible binding to serum albumin, which slows renal clearance and supports a prolonged action profile. The peptide backbone incorporates aminoisobutyric acid substitutions that limit recognition by digestive enzymes. Together these modifications produce a molecule that is stable enough for subcutaneous delivery but still dependent on careful manufacturing control. Analytical characterization of the active pharmaceutical ingredient typically follows the conventions used for other synthetic peptides.
| 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 |
Tirzepatide is a synthetic linear peptide of 39 amino acids that acts as a dual agonist at the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. Its sequence derives from native GIP but incorporates non-natural residues and a C20 fatty diacid moiety linked to a lysine side chain. The lipophilic chain promotes albumin binding, which slows renal clearance and extends circulation time. The unmodified peptide has a molecular formula of C225H348N48O68 and a molecular mass near 4,813 daltons.
Receptor activation by tirzepatide raises intracellular cyclic AMP through Gs-coupled signalling at both targets. At the GLP-1 receptor the downstream effect includes glucose-dependent insulin release, suppressed glucagon secretion, delayed gastric emptying, and reduced appetite signalling in the hypothalamus. GIP receptor engagement adds insulinotropic activity and appears to influence lipid handling in adipose tissue. Because both receptors are stimulated at the same time, the pharmacological profile differs from that of selective GLP-1 receptor agonists, and the relative contribution of each arm remains an area of active investigation.
Clinical development proceeded through large phase 3 programmes in type 2 diabetes and in obesity or overweight with at least one weight-related comorbidity. Regulatory approvals followed in several jurisdictions for both indications. Weekly subcutaneous dosing reflects an elimination half-life of roughly five days. Open questions include the durability of metabolic effects after treatment stops, long-term cardiovascular and hepatic outcomes beyond completed trials, and whether the dual mechanism confers benefits independent of total receptor occupancy. Published literature continues to expand on these points. Substantial uncertainty remains about interindividual variability in response.
At the receptor level, the compound binds both GIP and GLP-1 receptors and triggers downstream signalling that raises cyclic AMP in target cells. GLP-1 receptor activation is associated with glucose-dependent insulin release, slower gastric emptying, and reduced appetite signalling. GIP receptor activation contributes effects that are less completely characterised, and how much each receptor adds to the overall clinical response is still an open question. The two pathways appear to interact in a complementary rather than a purely additive way.
An extended fatty diacid moiety promotes binding to serum albumin, which slows renal clearance and extends the circulating half-life to roughly five days. That property supports once-weekly administration and largely explains the dosing interval described in clinical reports. Published data come mainly from large randomised programmes that evaluated glycaemic control and body weight over periods of many months. Long-term outcomes beyond those trial windows, including what happens after treatment stops, remain an active area of investigation.
Tirzepatide is a synthetic peptide built from thirty-nine amino acids. Its sequence is derived from native glucose-dependent insulinotropic polypeptide, or GIP, with several non-natural residues and a fatty diacid side chain attached through a linker. The molecule behaves as a dual agonist at two incretin receptors, GIP and GLP-1, instead of targeting a single receptor. This dual engagement separates it from earlier single-receptor incretin compounds and underpins most of its reported pharmacological activity.
Heavy water reactors and some graphite moderated reactors can use natural uranium, but light water reactors must use low enriched uranium because of the higher neutron absorption of light water. Uranium enrichment removes some of the uranium-238 and increases the proportion of uranium-235. Highly enriched uranium (HEU), which contains an even greater proportion of uranium-235, is sometimes used in the reactors of nuclear submarines, research reactors and nuclear weapons.
== Uses == The only approved use of the thiazolidinediones is in diabetes mellitus type 2. According to a 2014 Cochrane systematic review of four randomized controlled trials, PPARγ-agonists may be effective in preventing further strokes in those who have already had a stroke or a transient ischemic attack (TIA) and may stabilize atherosclerotic plaques in the carotid arteries.
WSJ added Grist was still "scathing" about both pre-war and wartime actions taken by Georgia, but said that some of his remarks had been misinterpreted and quoted Grist saying, "I have never said there was no provocation by the South Ossetians." In an interview with The Wall Street Journal, Ryan Grist said that on 12 August he went to visit a friend in Tskhinvali, Lira Tskhovrebova. Tskhovrebova had connections with separatist authorities and Grist's meeting with two high-ranking South Ossetian officials was arranged by Grist's Ossetian friends. On the road back to Tbilisi, South Ossetian militia stopped Grist, who called the names of the South Ossetian officials "so they wouldn't shoot" him. It is noteworthy that during 6 August meeting between British ambassador to Georgia Denis Keefe and the South Ossetian leader Eduard Kokoity, Kokoity blasted the OSCE meanwhile praising OSCE's British officer Ryan Grist. In December 2008, an inquiry by the Associated Press found out that Lira Tskhovrebova was not an independent advocate. She was allegedly connected to South Ossetian KGB and Russian intelligence agency, the FSB. Matthew Bryza, Deputy Assistant Secretary of State of the United States, also expressed his doubts about Tskhovrebova.
=== Bone repair === Bone has a unique and well-documented natural healing process that normally is sufficient to repair fractures and other common injuries. Misaligned breaks due to severe trauma, as well as treatments like tumor resections of bone cancer, are prone to improper healing if left to the natural process alone. Scaffolds composed of natural and artificial components are seeded with mesenchymal stem cells and placed in the defect. Within four weeks of placing the scaffold, newly formed bone begins to integrate with the old bone and within 32 weeks, full union is achieved. Further studies are necessary to fully characterize the use of cell-based therapeutics for treatment of bone fractures. Stem cells have been used to treat degenerative bone diseases in dogs. The normally recommended treatment for dogs that have Legg–Calve–Perthes disease is to remove the head of the femur after the degeneration has progressed. Recently, mesenchymal stem cells have been injected directly in to the head of the femur, with success not only in bone regeneration, but also in pain reduction.
Sources: en.wikipedia.org
The High Court of England and Wales gives its approval to legal challenges against the Home Office by Braintree District Council in Essex and West Lindsey District Council in Lincolnshire over plans to use two former airbases in the areas, Wethersfield Airbase and RAF Scampton, to house asylum seekers. The former Manchester City footballer Benjamin Mendy is cleared of raping a woman and attempting to rape another, following a three-week trial at Chester Crown Court. Abbott Laboratories, producers of the FreeStyle Libre app, used by around 200,000 people with diabetes in the UK, temporarily withdraw the app from the App Store after technical problems with an update caused it to stop working on Apple devices in the UK. Just Stop Oil protesters interrupt the first night of the Proms at London's Royal Albert Hall. 15 July – The Local Government Association calls for disposable vapes to be banned in England and Wales by 2024, citing their environmental impact and their appeal to children. 17 July A report from the National Audit Office concludes that the UK government is likely to miss its 2019 target to build 40 new NHS hospitals by 2030. As train drivers begin a six-day overtime ban, their union, ASLEF, announces a further six day overtime ban from 31 July. 18 July The first British passports are issued featuring King Charles III. A BBC investigation into working conditions at McDonald's has collected together a number of allegations of sexual assault, harassment, bullying and racism.
1900: American botanist Anna Murray Vail became the first librarian of the New York Botanical Garden. A key supporter of the institution's establishment, she had earlier donated her entire collection of 3000 botanical specimens to the garden. 1900: Physicists Marie Skłodowska–Curie and Isabelle Stone attended the first International Congress of Physics in Paris, France. They were the only two women out of 836 participants. 1901: American Florence Bascom became the first female geologist to present a paper before the Geological Survey of Washington. 1901: Czech botanist and zoologist Marie Zdeňka Baborová-Čiháková became the first woman in the Czech Republic to receive a PhD. 1901: American astronomer Annie Jump Cannon published her first catalog of stellar spectra, which classified stars by temperature. This method was universally and permanently adopted by other astronomers. 1903: English microbiologist Grace Coleridge Frankland published her most notable work, Bacteria in Daily Life. She was also one of the nineteen female scientists who wrote the 1904 petition to the Chemical Society to request that they should create some female fellows of the society. 1903: Polish-born physicist and chemist Marie Skłodowska–Curie became the first woman to receive a Nobel Prize when she received the Nobel Prize in Physics along with her husband, Pierre Curie, "for their joint researches on the radiation phenomena discovered by Professor Henri Becquerel", and Henri Becquerel, "for his discovery of spontaneous radioactivity".
=== Pharmacodynamics === 4-HO-NiPT shows affinity for serotonin receptors, including for the serotonin 5-HT1D, 5-HT1E, 5-HT2A, 5-HT2B, 5-HT2C, 5-HT6, and 5-HT7 receptors (Ki = 229–2,461 nM). Conversely, it did not show affinity for the serotonin 5-HT1B or 5-HT5A receptors, whereas the serotonin 5-HT1A receptor was not reported. 4-HO-NiPT is a partial agonist of the serotonin 5-HT2A, 5-HT2B, and 5-HT2C receptors, with EC50Tooltip half-maximal effective concentration (EmaxTooltip maximal efficacy) values of 24 nM (88.4%), 188 nM (69.9%), and 963 nM (45.2%), respectively. It was also a weak agonist of other serotonin receptors, including the serotonin 5-HT1B, 5-HT1E, 5-HT1F, and 5-HT7A receptors (EC50 = 1,400–23,000 nM, Emax = 20.4–123%), but not of the 5-HT1A, 5-HT1D, 5-HT4, 5-HT5A, or 5-HT6 receptors. In contrast to norpsilocin, but similarly to psilocin and certain other N-monoalkyltryptamines like 4-HO-NET, 4-HO-NPT, 4-HO-NALT, and 4-HO-NBnT, the drug produces the head-twitch response, a behavioral proxy of psychedelic effects, in rodents. It showed 30-fold lower potency than psilocin in this action in mice, but produced about the same maximal response. Similarly to 4-HO-NiPT, other N-monoalkyltryptamines were also much less potent than psilocin, in the range of 10- to 26-fold less potent. In addition to the head-twitch response, 4-HO-NiPT produces hypothermia in rodents. 4-HO-NiPT is a known metabolite of 4-AcO-DiPT and presumably also of 4-HO-DiPT.
Sources: en.wikipedia.org
Faisal did treat Palestine differently in his presentation to the Peace Conference on 6 February 1919 saying "Palestine, for its universal character, [should be] left on one side for the mutual consideration of all parties concerned". The agreement was never implemented. In a subsequent letter written in English by Lawrence for Faisal's signature, he explained:
=== Spelling and etymology === Sulfur is derived from the Latin word sulpur, which was Hellenized to sulphur in the erroneous belief that the Latin word came from Greek. This spelling was later reinterpreted as representing an /f/ sound and resulted in the spelling sulfur, which appears in Latin toward the end of the Classical period. The Ancient Greek word for sulfur, θεῖον, theîon (from earlier θέειον, théeion), is the source of the international chemical prefix thio-. In 12th-century Anglo-French, it was sulfre. In the 14th century, the erroneously Hellenized Latin -ph- was restored in Middle English sulphre. By the 15th century, both full Latin spelling variants sulfur and sulphur became common in English. The parallel f~ph spellings continued in Britain until the 19th century, when the word was standardized as sulphur. In the U.S., Webster's Dictionary (1828) lists only sulphur, and sulfur only becomes the primary entry in 1961. Nonetheless, the form sulfur was widely adopted in the United States during the 19th century. Canada uses both spellings. The IUPAC adopted the spelling sulfur in 1990. UK institutions soon followed: the Royal Society of Chemistry in 1992; the British Standards Institute in 1993; the UK national school curriculum in 2000 (there was some controversy). It is now the more common spelling in British books. The World Health Organization has mandated sulfur since at least 1993. The 1989 edition of the Oxford English Dictionary gave sulphur as the headword, and listed sulfur as a U.S.
Approximately one month after the attacks, the United States led a broad coalition of international forces to overthrow the Taliban regime from Afghanistan for their harboring of al-Qaeda. Though Pakistani authorities were initially reluctant to align themselves with the U.S. against the Taliban, they permitted the coalition access to their military bases, and arrested and handed over to the U.S. more than 600 suspected al-Qaeda members. In 2011, the U.S. and NATO under President Obama initiated a drawdown of troops in Afghanistan finalized in 2016. During the presidencies of Donald Trump and Joe Biden in 2020 and 2021, the United States alongside its NATO allies withdrew all troops from Afghanistan, completing the withdrawal of all regular U.S. troops on August 30, 2021. The withdrawal marked the end of the 2001–2021 war in Afghanistan. Biden said that after nearly 20 years of war, it was clear that the U.S. military could not transform Afghanistan into a modern democracy.
=== Chemical and molecular properties === A neutral atom has the same number of electrons as protons. Thus different isotopes of a given element all have the same number of electrons and share a similar electronic structure. Because the chemical behaviour of an atom is largely determined by its electronic structure, different isotopes exhibit nearly identical chemical behaviour. The main exception to this is the kinetic isotope effect: due to their larger masses, heavier isotopes tend to react somewhat more slowly than lighter isotopes of the same element. This is most pronounced by far for protium (1H), deuterium (2H), and tritium (3H), because deuterium has twice the mass of protium and tritium has three times the mass of protium. These mass differences also affect the behavior of their respective chemical bonds, by changing the center of gravity (reduced mass) of the atomic systems. However, for heavier elements, the relative mass difference between isotopes is much less so that the mass-difference effects on chemistry are usually negligible. (Heavy elements also have relatively more neutrons than lighter elements, so the ratio of the nuclear mass to the collective electronic mass is slightly greater.) There is also an equilibrium isotope effect.
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 activates both the glucose-dependent insulinotropic polypeptide receptor and the glucagon-like peptide-1 receptor. This dual activity separates it from agents that act on only one of the two receptors. The relative contribution of each receptor to clinical effects remains an open area of study.