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Glucagon‐like peptide‐1 (GLP‐1), a hormone released from enteroendocrine cells in the distal small and large intestines in response to nutrients and other stimuli, not only controls eating and insulin release, but is also involved in drinking control as well as renal and cardiovascular functions. Moreover, GLP‐1 functions as a central nervous system peptide transmitter, produced by preproglucagon (PPG) neurons in the hindbrain. Intestinal GLP‐1 inhibits eating by activating vagal sensory neurons directly, via GLP‐1 receptors (GLP‐1Rs), but presumably also indirectly, by triggering the release of serotonin from enterochromaffin cells. GLP‐1 enhances glucose‐dependent insulin release via a vago‐vagal reflex and by direct action on beta cells. Finally, intestinal GLP‐1 acts on the kidneys to modulate electrolyte and water movements, and on the heart, where it provides numerous benefits, including anti‐inflammatory, antiatherogenic, and vasodilatory effects, as well as protection against ischemia/reperfusion injury and arrhythmias. Hindbrain PPG neurons receive multiple inputs and project to many GLP‐1R‐expressing brain areas involved in reward, autonomic functions, and stress. PPG neuron‐derived GLP‐1 is involved in the termination of large meals and is implicated in the inhibition of water intake. This review details GLP‐1's roles in these interconnected systems, highlighting recent findings and unresolved issues, and integrating them to discuss the physiological and pathological relevance of endogenous GLP‐1 in coordinating these functions. As eating poses significant threats to metabolic, fluid, and immune homeostasis, the body needs mechanisms to mitigate these challenges while sustaining essential nutrient intake. Endogenous GLP‐1 plays a crucial role in this “ingestive homeostasis.”
Glucagon‐like peptide‐1 (GLP‐1), a hormone released from enteroendocrine cells in the distal small and large intestines in response to nutrients and other stimuli, not only controls eating and insulin release, but is also involved in drinking control as well as renal and cardiovascular functions. Moreover, GLP‐1 functions as a central nervous system peptide transmitter, produced by preproglucagon (PPG) neurons in the hindbrain. Intestinal GLP‐1 inhibits eating by activating vagal sensory neurons directly, via GLP‐1 receptors (GLP‐1Rs), but presumably also indirectly, by triggering the release of serotonin from enterochromaffin cells. GLP‐1 enhances glucose‐dependent insulin release via a vago‐vagal reflex and by direct action on beta cells. Finally, intestinal GLP‐1 acts on the kidneys to modulate electrolyte and water movements, and on the heart, where it provides numerous benefits, including anti‐inflammatory, antiatherogenic, and vasodilatory effects, as well as protection against ischemia/reperfusion injury and arrhythmias. Hindbrain PPG neurons receive multiple inputs and project to many GLP‐1R‐expressing brain areas involved in reward, autonomic functions, and stress. PPG neuron‐derived GLP‐1 is involved in the termination of large meals and is implicated in the inhibition of water intake. This review details GLP‐1's roles in these interconnected systems, highlighting recent findings and unresolved issues, and integrating them to discuss the physiological and pathological relevance of endogenous GLP‐1 in coordinating these functions. As eating poses significant threats to metabolic, fluid, and immune homeostasis, the body needs mechanisms to mitigate these challenges while sustaining essential nutrient intake. Endogenous GLP‐1 plays a crucial role in this “ingestive homeostasis.”
The glucagon-like peptide 1 receptor (GLP-1R) agonist semaglutide has revolutionized the treatment of obesity, with other gut hormone-based drugs lined up that show even greater weight-lowering ability in obese patients. Nevertheless, bariatric surgery remains the mainstay treatment for severe obesity and achieves unparalleled weight loss that generally stands the test of time. While their underlying mechanisms of action remain incompletely understood, it is clear that the common denominator between GLP-1R agonists and bariatric surgery is that they suppress food intake by targeting the brain. In this Review, we highlight recent preclinical studies using contemporary neuroscientific techniques that provide novel concepts in the neural control of food intake and body weight with reference to endogenous GLP-1, GLP-1R agonists, and bariatric surgery. We start in the periphery with vagal, intestinofugal, and spinal sensory nerves and then progress through the brainstem up to the hypothalamus and finish at non-canonical brain feeding centers such as the zona incerta and lateral septum. Further defining the commonalities and differences between GLP-1R agonists and bariatric surgery in terms of how they target the brain may not only help bridge the gap between pharmacological and surgical interventions for weight loss but also provide a neural basis for their combined use when each individually fails.
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