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The glucagon-like peptide 1 (GLP) receptor as a therapeutic target in Parkinson's disease: mechanisms of action
Open accessAbstract
Growing evidence suggests that agonists of the glucagon-like peptide 1 (GLP-1) receptor provide neuroprotection across a range of experimental models of Parkinson's disease (PD) and, recently, a small proof-of-concept, open-label human trial of exenatide in the treatment moderate severity PD appeared to show persistent improvements in motor and cognitive function. The underlying mechanisms of action remain unclear, but as evidence for the potential use of GLP-1 agonists in treating several neurodegenerative disease mounts, and with several clinical trials of GLP-1 analogues in PD and Alzheimer's disease (AD) currently underway, here we review the molecular mechanisms underlying the neuroprotective effects of GLP-1 analogues in the laboratory and their potential therapeutic utility with particular relevance to PD and PD dementia (PDD).
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“Glucagon-like peptide-1 (GLP-1) is an endogenous hormone secreted by ileal endocrine cells, which promotes insulin secretion in a hyperglycemic environment (Athauda and Foltynie 2016).”
From Therapeutic effect of GLP-1 engineered strain on mice model of Alzheimer’s disease and Parkinson’s disease (2020) · cites this paper as Athauda and Foltynie 2016
In the citing paper
“GLP-1 is an enterogenous hormone that promotes insulin secretion and reduces glucagon secretion to reduce blood glucose in a glucose concentration-dependent manner (Athauda and Foltynie 2016).”
From Therapeutic effect of GLP-1 engineered strain on mice model of Alzheimer’s disease and Parkinson’s disease (2020) · cites this paper as Athauda and Foltynie 2016
In the citing paper
“However, as GLP-1 is easily degraded, continuous intravenous drip or continuous subcutaneous injection is required to produce therapeutic effects, which limits its clinical usage.”
From Therapeutic effect of GLP-1 engineered strain on mice model of Alzheimer’s disease and Parkinson’s disease (2020) · cites this paper as Athauda and Foltynie 2016
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“23 Meanwhile, it is considered as a brain-targeting ligand, specifically binding to GLP-1R, which is abundantly expressed in the substantia nigra (especially on microglia) under PD pathological conditions.”
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“Glucagon-like peptide1 receptor (GLP-1R) is of particular interest due to its role in the treatment of type 2 diabetes mellitus (T2D) and appetite regulation [1].”
BackgroundInfluentialPharmacological interventions in human aging
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Obesity and Depression: Common Link and Possible Targets
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“neuroprotection.([14]) Interestingly, all of these mechanisms are also dysregulated in PD.”
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Exploring the potential impact of GLP-1 receptor agonists in cancer therapy
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“In rodent models of PD, GLP-1RAs have been shown to remediate striatal in fl ammation, reduce apoptosis, and improve motor and non-motor de fi cits [91].”
Status and future directions of clinical trials in Parkinson's disease
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“In addition to glucoregulation and satiation (Barrera et al, 2011; Cabou et al, 2008; Müller et al, 2019), the GLP-1 system plays a role in the behavioral and physiological response to stress (Ghosal et al, 2013; Herman, 2018; Holt et al, 2016), nausea/emesis (De Jonghe et al, 2016; Kanoski et al, 2012; Kinzig et al,…”
BackgroundAge-related change of GLP-1R expression in rats can be detected by [18F]AlF-NOTA-MAL-Cys39-exendin-4
Wang, L., Liu, Y., Xu, Y., Sheng, J., Pan, D., Wang, X., Yan, J., Yang, R., & Yang, M. (2018) · Brain Research · doi:10.1016/j.brainres.2018.08.022 · Cited by 14
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“Glp-1 provides clinical advantages in the treatment of moderate PD [38,39].”
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“21 Additionally, insulin resistance has attracted attention as a potential contributor to neurodegenerative processes.”
Mitigation of Hearing Damage After Repeated Blast Exposures in Animal Model of Chinchilla
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“With the discovery of the neurotrophic and neuroprotective function of GLP-1 receptor (R) in the central nervous system, the potential of GLP-1R agonists as a treatment strategy for neurological disorders was reported (Athauda and Foltynie 2016; Salcedo et al. 2012).”
BackgroundRecent Advances in Drug Repurposing for Parkinson’s Disease
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“This indicates that these receptors are crucial for the movement of synaptic signals among neurons [142, 143].”
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“The downstream process of their activation subsequently modulates “glycogen synthase kinase-3 beta (GSK3-β), NF-kB, and forkhead box protein O1 (FOXO1)”, which plays a crucial role in the pathological implications of PD (Athauda and Foltynie 2016).”
BackgroundTherapeutic potential of spinal GLP-1 receptor signaling
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The Intricate Interplay: Microbial Metabolites and the Gut‐Liver‐Brain Axis in Parkinson's Disease
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“33 34–36 Specifically, the MAPK/ERK pathway mediates cellular proliferation, differentiation, migratory dynamics, senescence, and apoptotic regulation.”
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“GLP1R is expressed at high levels in both microglia and astrocytes and its modulation exhibited neuroprotective effects in neurodegenerative disease conditions [97, 150].”
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“132 In obesity, the anorectic effect of GLP-1 seems to be reduced, since ob/ob mice show a reduction of GLP-1 receptors in the cortex and hippocampus.”
BackgroundInteractions between antidiabetes medications and heart–brain axis
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Therapeutic Opportunities for Intestinal Angioectasia‐ Targeting PPARγ and Oxidative Stress
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“Recent studies have shown that GLP-1 has the potential to induce PPARγ activity, partially explaining the anti-inflammatory effects of GLP-1 on endothelial cells.(37,38) SGLT-2 inhibitors, another class of antidiabetics, also showed decreased risk of intestinal bleeding (Tables S1 and S2).”
BackgroundHearing protection and damage mitigation in Chinchillas exposed to repeated low-intensity blasts
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A Research Update on Exendin-4 as a Novel Molecule Against Parkinson’s Disease
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Mitral cells and the glucagon‐like peptide 1 receptor: The sweet smell of success?
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“…microglial response and mitigate inflammation, is not completely clear yet, but it might involve the nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), important in the inflammatory gene expression regulation and upregulated in the pathogenesis of PD (Athauda & Foltynie, 2016).”
BackgroundElsiad, E. A., Aal, H. A. A. E., Salem, H. A., El-Yamany, M. F., & Rabie, M. A. (2025) · Toxics · doi:10.3390/toxics13070594 · Cited by 10
“This prevented the degradation of I κ B, thereby keeping NF-κ B sequestered in the cytoplasm [28].”
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Fire prevention in the Parkinson’s disease brain
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Athauda, D. S., Evans, J. R., Mahoney‐Sanchez, L., Virdi, G. S., Lopez-Garcia, P., Wernick, A. I., Wagen, A. Z., D’Sa, K., Lachica, J., Strohbuecker, S., et al. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.02.28.582460 · Cited by 7
Self-citationParkinson’s disease and brain insulin signaling: Mechanisms and potential role of GLP-1 mimetics
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“Recently, new studies showed that incretins influence several pathways in the brain, including neuroinflammation, mitochondrial function, cellular proliferation and apoptosis [15].”
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“Many studies have reported that GLP-1 and its analogues can improve various neurodegenerative diseases, including AD and Parkinson’s disease (Athauda and Foltynie, 2016; Athauda et al., 2017; Grieco et al., 2019).”
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“Dipeptidyl peptidase ‐ IV (DPP ‐ IV) cleaves peptides at the N ‐ terminal proline or alanine, but it can also act more slowly on serine, glycine, and valine [51, 56].”
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“The absence of a significant difference in motor function could be a result of GLP-1 agonists not directly modulating dopamine levels, but enhancing autophagy and clearance of aggregated proteins and suppressing inflammation and microglial activation (Athauda and Foltynie 2016).”
Tsai, W.-W., Lu, K.-H., Wu, J., Chuang, M., Chen, J., Lai, C.-C., Hung, K. C., & Hsieh, M. (2025) · Therapeutic Advances in Neurological Disorders · doi:10.1177/17562864251372747 · Cited by 8
GLP-1 Signalling as a Therapeutic Avenue in Parkinson’s Disease: A Comprehensive Review
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New insights into sodium phenylbutyrate as a pharmacotherapeutic option for neurological disorders
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“…blood–brain barrier and enter the brain to interact with its GLP-1R receptor that is expressed at the neuronal, glial, and microglial levels (Athauda & Foltynie, 2016; Qian et al., 2022).”
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“Both preclinical [83] and clinical [84] studies have also shown that GLP-1 agonists significantly reduce these pathological deposits in the brain, with similar results for GIP and dual GIP/ GLP-1 agonists [67, 68].”
Exercise Improves Spatial Learning and Memory Performance through the Central GLP-1 Receptors
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“The role of GLP-1 to inhibit apoptosis, neuronal growth, cell proliferation, and decreasing oxidative damage in the CNS has been recently revealed (Athauda and Foltynie [40]).”
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Nanocarriers to mediate the pathways from diabetes toward Parkinson's disease
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Potential association between obstructive lung diseases and cognitive decline
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Glucagon-like peptide-1 receptor agonists: What ophthalmologists need to know
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Challenges and unfulfilled promises in Parkinson's disease
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The potential role of CGRP in synuclein-associated neurodegenerative disorders
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“The therapeutic potential of the GLP1 analogues is mainly mediated through the involvement of PI3K/ERK/MAPK and PI3K/AKT-dependent pathways in terms of evading apoptosis toward cell survival (Athauda and Foltynie, 2016).”
Glucose Metabolism Disorders and Parkinson’s Disease: Coincidence or Indicator of Dysautonomia?
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Pathway-based network medicine identifies novel natural products for Alzheimer’s disease
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Neuroendocrine and metabolic impairments in patients with Parkinson’s disease
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Metadata
- Authors
- Athauda, D., & Foltynie, T.
- Affiliations
- National Hospital for Neurology and Neurosurgery (GB)
- Corresponding author
- Athauda, Dilan
- Venue
- Drug Discovery Today
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 21
- Issue
- 5
- Pages
- 802-818
- ISSN
- 1359-6446 (ISSN-L)
- OpenAlex
- W2270971263
- Cited by
- 383
- References
- 258
- Citations by year
- 2026: 38 · 2025: 51 · 2024: 53 · 2023: 31 · 2022: 46 · 2021: 34 · 2020: 42 · 2019: 32 · 2018: 29 · 2017: 19 · 2016: 8
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Drug Discovery Today (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Michael J. Fox Foundation, Brain Research Trust, Cure Parkinson's Trust, Parkinson's UK
- European Commission (FP7)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- GLP-1 receptor, GLP-1 receptor agonists, Parkinson's disease, neuroprotection, exenatide, Parkinson's disease dementia, Alzheimer's disease, mechanism of action, therapeutic target
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Alzheimer Disease, Animals, Humans, Insulin Resistance, Learning, Mitochondria, Parkinson Disease, Signal Transduction, Proto-Oncogene Proteins c-akt, Glucagon-Like Peptide 1, Neurogenesis
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