Exendin-4, a glucagon-like peptide 1 receptor agonist, protects cholangiocytes from apoptosis
Open accessAbstract
BACKGROUND AND AIMS: Progression of chronic cholestatic disorders towards ductopenia results from the dysregulation of cholangiocyte survival, with cell death by apoptosis prevailing over compensatory proliferation. Currently, no therapy is available to sustain cholangiocyte survival in the course of those disorders. It was recently shown that cholangiocytes express the glucagon-like peptide-1 receptor (GLP-1R); its activation results in enhanced proliferative reaction to cholestasis. The GLP-1R selective agonist exendin-4 sustains pancreatic beta cell proliferation and prevents cell death by apoptosis. Exendin-4 is now employed in humans as a novel therapy for diabetes. The aim of the present study was to verify whether exendin-4 is effective in preventing cholangiocyte apoptosis. METHODS: In vitro, tests were carried out to determine if exendin-4 is able to prevent apoptosis of cholangiocytes isolated from normal rats induced by glycochenodeoxycholic acid (GCDCA); in vivo, animals subjected to 1 week of bile duct ligation and to a single intraperitoneal injection of CCl(4) were treated with exendin-4 for 3 days. RESULTS: Exendin-4 prevented GCDCA-induced Bax mitochondrial translocation, cytochrome c release and an increase in caspase 3 activity. Phosphatidylinositol 3-kinase, but not cAMP/protein kinase A or Ca(2+)/calmodulin-dependent protein kinase inhibitors, neutralised the effects of exendin-4. In vivo, exendin-4 administration prevented the increase in TUNEL (terminal deoxynucleotidyl transferase-mediated triphosphate end-labelling)-positive cholangiocytes and the loss of bile ducts observed in bile duct-ligated rats treated with CCl(4). CONCLUSION: Exendin-4 prevents cholangiocyte apoptosis both in vitro and in vivo; such an effect is due to the ability of exendin-4 to counteract the activation of the mitochondrial pathway of apoptosis. These findings support the hypothesis that exendin-4 may be effective in slowing down the progression of cholangiopathies to ductopenia.
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Experimental investigations have demonstrated that cholangiocytes are sensitive to GLP-1 and respond with augmented proliferation, potentially increasing the risk of duct obstruction.
“Experimental investigations have demonstrated that cholangiocytes are sensitive to GLP-1 and respond with augmented proliferation, potentially increasing the risk of duct obstruction [47,48].”
From Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning (2025) · cites this paper as [48]
The Introduction (page unavailable) states that cholangiocytes express GLP-1R and that activation by GLP-1 or exendin-4 markedly increases cell growth in vitro and in vivo. The paper does not link that proliferation to a risk of duct obstruction; it instead discusses preserving bile ducts against loss. (LLM, conf=0.88)
Experimental — accuracy not yet measuredExendin-4 appears to stimulate cholangiocyte proliferation through the GLP-1 receptor, preventing cholangiocyte apoptosis in models of bile acid-induced damage and ductopenic cholangiopathies.
“exendin-4 appears to stimulate cholangiocyte proliferation through the GLP-1 receptor, hereby preventing cholangiocyte apoptosis in models of bile acid-induced damage and models of ductopenic cholangiopathies”
From Safety of Semaglutide (2021) · cites this paper as [95]
The Introduction says GLP-1R activation by exendin-4 increases cholangiocyte growth, and the Abstract Results report reduced apoptosis in bile acid-exposed cells and reduced cholangiocyte loss in BDL rats treated with CCl4. But the Abstract Summary/conclusion attributes the anti-apoptotic effect to counteracting the mitochondrial apoptosis pathway; it does not establish that increased proliferation prevents apoptosis. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredGLP-1 has cholangioprotective effects against apoptosis and attenuating the reactive cholangiocyte phenotype.
“Apart from its metabolic effects, GLP-1 has also cholangioprotective effects against apoptosis and attenuating the reactive cholangiocyte phenotype.196 197”
From Novel therapeutic targets for cholestatic and fatty liver disease (2022) · cites this paper as [196]
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- Authors
- Marzioni, M., Alpini, G., Saccomanno, S., Candelaresi, C., Venter, J., Rychlicki, C., Fava, G., Francis, H., Trozzi, L., & Benedetti, A.
- Affiliations
- Marche Polytechnic University (IT)
- Texas A&M Health Science Center (US)
- Texas A&M University System (US)
- Scott & White Memorial Hospital (US)
- Corresponding author
- Marzioni, M
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2008-10-01
- Volume
- 58
- Issue
- 7
- Pages
- 990-997
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC2695839
- OpenAlex
- W2123844577
- Cited by
- 73
- References
- 50
- Citations by year
- 2025: 2 · 2024: 10 · 2023: 1 · 2022: 6 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 2 · 2016: 5 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 8
- FWCI
- 3.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK062975, R01DK062975, DK076898, R01DK076898)
- Topics
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Cell death mechanisms and regulation
- Keywords
- exendin-4, GLP-1 receptor, cholangiocytes, apoptosis, ductopenia, cholestasis, bile duct ligation, carbon tetrachloride, mitochondrial apoptosis, Bax translocation, cytochrome c release, caspase-3, phosphatidylinositol 3-kinase, cholangiopathy
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Exenatide, Animals, Bile Ducts, Cell Survival, Cholestasis, Hypoglycemic Agents, Male, Peptides, Rats, Inbred F344, Venoms, Apoptosis, Receptors, Glucagon, Rats
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