This is a working overview of 双受体激动, written for readers who want more than a one-paragraph summary but less than a textbook.
Reviewed 2025-12-26. Anything still debated is marked as such rather than presented as settled.
Tirzepatide is a synthetic peptide developed as a dual agonist at the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors. Its structure is built on a GIP-derived backbone with non-natural amino acid substitutions and a fatty diacid side chain that promotes albumin binding and slows clearance. That modification supports once-weekly subcutaneous dosing. Registrational trial programs reported reductions in body weight and glycated hemoglobin alongside the drug's glycemic effects.
Both receptors are class B G protein-coupled receptors that signal largely through Gs-mediated cyclic AMP production. Activation within pancreatic islets increases glucose-dependent insulin secretion and suppresses glucagon release when glucose is elevated. Outside the pancreas, signaling in the central nervous system and gut appears to influence appetite and gastric emptying. The relative contribution of each receptor to observed clinical effects remains under investigation, and the two pathways are not simply additive in practice.
Reported outcomes in large trials include dose-dependent weight reduction and improvements in glycemic markers over periods ranging from several months to more than a year. Whether the compound alters long-term cardiovascular or renal outcomes is being examined in dedicated outcome studies, so those questions remain open. Labeling describes gastrointestinal effects such as nausea and diarrhea, which tend to appear during dose escalation. Discontinuation rates and the durability of effects after treatment stops vary across study populations and are still debated.
Tirzepatide is a synthetic peptide that acts as a dual agonist at the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. The molecule contains 39 amino acids and features a C20 fatty diacid moiety attached via a linker, which promotes albumin binding and extends its circulating half-life. Its sequence incorporates non-natural amino acids and modifications that reduce susceptibility to degradation by dipeptidyl peptidase-4. This dual receptor activity distinguishes it from selective GLP-1 receptor agonists.
The GIP receptor is expressed in pancreatic islets, adipose tissue, and the central nervous system, while GLP-1 receptors are found in pancreatic islets, the gastrointestinal tract, and the brain. Activation of both receptors can enhance glucose-dependent insulin secretion and reduce glucagon release. The relative contribution of each receptor to the overall pharmacological effect remains an area of ongoing investigation. Preclinical studies suggest that GIP receptor agonism may modulate appetite and energy balance, but the precise mechanisms in humans are not fully established.
| Property | Value | Notes |
|---|---|---|
| Molecular class | Synthetic 39-residue peptide | GIP-derived backbone with non-natural residues |
| Molar mass | Approximately 4.8 kDa | Peptide chain plus linker and lipid modifications |
| Appearance | White to off-white powder | Typical of lyophilized research material |
| Solubility | Soluble in water and aqueous buffer | Practically insoluble in nonpolar solvents |
| Storage temperature | Typically −20 °C for dry powder | Solutions usually held at 2–8 °C short term |
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.
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。
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.
Pharmacologically, tirzepatide activates two distinct G protein-coupled receptors: the glucose-dependent insulinotropic polypeptide receptor and the glucagon-like peptide-1 receptor. Binding at each target triggers cyclic AMP accumulation and downstream signaling in pancreatic beta cells, adipose tissue and the central nervous system. Because the two pathways overlap only partially, the combined effect on insulin secretion, glucagon suppression and appetite signaling differs from that of selective single-receptor compounds. Affinity is not equal across the two targets, and the clinical meaning of that imbalance remains an area of active study.
=== Gaining strength === Liu Wenhui took advantage of the Sichuanese conflicts to gain power. In 1924, he gave financial support to Liu Xiang and Yang Sen in their campaign to oust Xiong Kewu's forces; in return, the two warlords allowed him to take control of a part of the defeated Xiong's army and territories. In October 1925, after Yang Sen's defeat in a military conflict, Liu again incorporated part of the losing party's armies and territories, expanding his influence to Meishan and Leshan. Chief Executive Duan Qirui also appointed him as the Assistant Military Affairs Commissioner for Sichuan. When his former commander Chen Hongfan was attacked by Yang Sen's forces, Liu offered him no help and even refused an appeal by Leng Yingdong to let Chen serve in his government. Instead, Liu absorbed Chen's remaining forces; Chen subsequently returned to Dayi County in disgrace and reportedly went mad. During the May Thirtieth Movement, students in Yibin staged a boycott of British goods and clashed with British merchants. Liu Wenhui's military police arrested the student leaders, sparking outrage, but Liu met with the students and made an anti-imperialist speech mentioning his connections to the patriot Jiang Baili. To prove that his prisoners were not being tortured, Liu let demonstrators observe that they were playing basketball in the prison courtyard. In the wake of the Northern Expedition and the First United Front, Liu began flirting with progressive ideas. Around 1926, Liu appointed Communist Party member Liu Yuan'an as one of his senior advisors.
inorganic reagents, such as strong acids and alkalis, or cytotoxic salts of heavy metals, for example zinc or silver organic compounds such as sanguinarine, salicylic acid, and certain medicines like imiquimod Irritant or corrosive fluids from plants, such as latex or resins from various species of Ficus, Euphorbia, Carica, or Taraxacum refrigerants, which kill the tissue by freezing; examples include liquid nitrogen, solid carbon dioxide, and its solution in ether Escharotics have long been used in medicine. In conventional modern practice some still are useful for topical treatment of growths such as warts. For lack of anything better in the past, escharotics once were more widely used, and for example, popular products included so-called black salves, with ingredients such as zinc chloride, plus sanguinarine in the form of bloodroot extract. These and others were traditional as topical treatments for localised skin cancers in herbal medicine. They combined unreliability in eradication of the cancer, with harmful effects such as scarring, serious injury, and disfigurement. Consequently escharotic salves now are strictly regulated in most western countries, and available on prescription only. Some prosecutions have been pursued over unlicensed sales of escharotic products such as Cansema.
=== Relative versus absolute measurement === Vacuum is measured in units of pressure, typically as a subtraction relative to ambient atmospheric pressure on Earth. But the amount of relative measurable vacuum varies with local conditions. On the surface of Venus, where ground-level atmospheric pressure is much higher than on Earth, much higher relative vacuum readings would be possible. On the surface of the Moon with almost no atmosphere, it would be extremely difficult to create a measurable vacuum relative to the local environment. Similarly, much higher than normal relative vacuum readings are possible deep in the Earth's ocean. A submarine maintaining an internal pressure of 1 atmosphere submerged to a depth of 10 atmospheres (98 metres; a 9.8-metre column of seawater has the equivalent weight of 1 atm) is effectively a vacuum chamber keeping out the crushing exterior water pressures, though the 1 atm inside the submarine would not normally be considered a vacuum. Therefore, to properly understand the following discussions of vacuum measurement, it is important that the reader assumes the relative measurements are being done on Earth at sea level, at exactly 1 atmosphere of ambient atmospheric pressure.
Sources: en.wikipedia.org
From the earliest crewed space flights to the first moon landing and the construction of the International Space Station (ISS), radiation protection has been a major concern. Spacesuits used for extravehicular activities are coated on the outside with aluminum, which largely protects against cosmic radiation. The largest international research project to determine the effective dose or effective dose equivalent was the Matryoshka experiment in 2010, named after the Russian Matryoshka dolls, because it uses a human-sized phantom that can be cut into slices. As part of Matroshka, an anthropomorphic phantom was exposed to the outside of the space station for the first time to simulate an astronaut performing an extravehicular activity (spacewalk) and determine their exposure to radiation.Microelectronics on satellites must also be protected from radiation.
Corticotropic cells, (corticotropes or corticotrophs) are basophilic cells in the anterior pituitary that produce pro-opiomelanocortin (POMC) which undergoes cleavage to adrenocorticotropin (ACTH), β-lipotropin (β-LPH), and melanocyte-stimulating hormone (MSH). These cells are stimulated by corticotropin releasing hormone (CRH) and make up 15–20% of the cells in the anterior pituitary. The release of ACTH from the corticotropic cells is controlled by CRH, which is formed in the cell bodies of parvocellular neurosecretory cells within the paraventricular nucleus of the hypothalamus and passes to the corticotropes in the anterior pituitary via the hypophyseal portal system. Adrenocorticotropin hormone stimulates the adrenal cortex to release glucocorticoids and plays an important role in the stress response.
==== Canada ==== In Canada, codeine is regulated under the Narcotic Control Regulations (NCR), which falls under the Controlled Drugs and Substances Act (CDSA). Regulations state the pharmacists may, without a prescription, sell low-dose codeine products (containing up to 8 mg of codeine per tablet or up to 20 mg per 30 ml in liquid preparation) if the preparation contains at least two additional medicinal ingredients other than a narcotic (S.36.1 NCR). In Canada tablets containing 8 mg of codeine combined with 15 mg of caffeine and 300 mg of acetaminophen are sold as T1s (Tylenol Number 1) without a prescription. A similar tablet called "A.C. & C." (which stands for Acetylsalicylic acid with Caffeine and Codeine) containing 325–375 mg of acetylsalicylic acid (Aspirin) instead of acetaminophen is also available without a prescription. Codeine combined with an antihistamine, and often caffeine, is sold under various trade names and is available without a prescription. These products are kept behind the counter and must be dispensed by a pharmacist who may limit quantities. Names of many codeine and dihydrocodeine products in Canada tend to follow the narcotic content number system (Tylenol With Codeine No. 1, 2, 3, 4 &c) mentioned below in the section on the United States; it came to be in its current form with the Pure Food and Drug Act of 1906. Controlled Drugs and Substances Act (S.C. 1996, c. 19) effective 28 July 2020. Codeine is now classified under Schedule 1, giving it a higher priority in the treatments of offenders of the law.
Sources: en.wikipedia.org
Plants and various other groups of photosynthetic eukaryotes collectively known as "algae" have unique organelles known as chloroplasts. Chloroplasts are thought to be descended from cyanobacteria that formed endosymbiotic relationships with ancient plant and algal ancestors. Chloroplasts and cyanobacteria contain the blue-green pigment chlorophyll a. Chlorophyll a (as well as its plant and green algal-specific cousin chlorophyll b) absorbs light in the blue-violet and orange/red parts of the spectrum while reflecting and transmitting the green light that we see as the characteristic colour of these organisms. The energy in the red and blue light that these pigments absorb is used by chloroplasts to make energy-rich carbon compounds from carbon dioxide and water by oxygenic photosynthesis, a process that generates molecular oxygen (O2) as a by-product. The light energy captured by chlorophyll a is initially in the form of electrons (and later a proton gradient) that is used to make molecules of ATP and NADPH which temporarily store and transport energy. Their energy is used in the light-independent reactions of the Calvin cycle by the enzyme rubisco to produce molecules of the 3-carbon sugar glyceraldehyde 3-phosphate (G3P). Glyceraldehyde 3-phosphate is the first product of photosynthesis and the raw material from which glucose and almost all other organic molecules of biological origin are synthesised. Some of the glucose is converted to starch which is stored in the chloroplast.
==== Use in males ==== In males, hCG injections are used to stimulate the Leydig cells to synthesize testosterone. The intratesticular testosterone is necessary for spermatogenesis from the sertoli cells. Typical medical uses for hCG in males include treating certain types of hypogonadism (either as monotherapy, or, more commonly, in combination with exogenous testosterone), as well as to either treat or prevent infertility, for example, during testosterone replacement therapy hCG is often used to restore or maintain fertility and prevent testicular atrophy.
=== Surgery === Surgical intervention is indicated in patients with symptomatic exposed bone with fistula formation and one or more of the following: exposed and necrotic bone extending beyond the alveolar bone resulting in pathological fracture; extra-oral fistula; oral antral communication or osteolysis extending from the inferior border of the mandible or the sinus floor. Surgical management involves necrotic bone resection, removal of loose sequestra of necrotic bone and reconstructive surgery. The objective of surgical management is to eliminate areas of exposed bone to prevent the risk of further inflammation and infection. The amount of surgical debridement required remains controversial.
Sources: en.wikipedia.org
It acts as an agonist at both the GIP and GLP-1 receptors, two related class B G protein-coupled receptors. This dual activity distinguishes it from single-receptor GLP-1 agonists. The clinical consequences of engaging both receptors are still being characterized.
It is given by subcutaneous injection, generally on a weekly schedule. Dosing usually begins low and increases in steps to limit gastrointestinal side effects. Formulated product is supplied as a ready-to-use pen or vial in most markets.
No. Receptor engagement is documented, but how central appetite circuits, gut signals, and insulinotropic effects combine is incompletely resolved. Investigators continue to separate GIP-driven from GLP-1-driven contributions in animal and human models.
It activates both GIP and GLP-1 receptors. This dual action differentiates it from selective GLP-1 agonists.