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Diabetes 54:2460-2470, 2005
© 2005 by the American Diabetes Association, Inc.

Therapeutic Roles of Peroxisome Proliferator–Activated Receptor Agonists

Bart Staels, and Jean-Charles Fruchart

Department of Atherosclerosis, INSERM (Institut National de la Santé et de la Recherche Médicale) Unit 545, Institut Pasteur and Université de Lille, Lille, France

Peroxisome proliferator–activated receptors (PPARs) play key roles in the regulation of energy homeostasis and inflammation, and agonists of PPAR{alpha} and -{gamma} are currently used therapeutically. Fibrates, first used in the 1970s for their lipid-modifying properties, were later shown to activate PPAR{alpha}. These agents lower plasma triglycerides and VLDL particles and increase HDL cholesterol, effects that are associated with cardiovascular benefit. Thiazolidinediones, acting via PPAR{gamma}, influence free fatty acid flux and thus reduce insulin resistance and blood glucose levels. PPAR{gamma} agonists are therefore used to treat type 2 diabetes. PPAR{alpha} and -{gamma} agonists also affect inflammation, vascular function, and vascular remodeling. As knowledge of the pleiotropic effects of these agents advances, further potential indications are being revealed, including roles in the management of cardiovascular disease (CVD) and the metabolic syndrome. Dual PPAR{alpha}/{gamma} agonists (currently in development) look set to combine the properties of thiazolidinediones and fibrates, and they hold considerable promise for improving the management of type 2 diabetes and providing an effective therapeutic option for treating the multifactorial components of CVD and the metabolic syndrome. The functions of a third PPAR isoform, PPAR{delta}, and its potential as a therapeutic target are currently under investigation.


Address correspondence and reprint requests to Prof. Bart Staels, Unité INSERM 545-Institut Pasteur, 1, rue du Professeur Calmette, 59019 Lille Cedex, France. E-mail: bart.staels{at}pasteur-lille.fr


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