The Effects of Peroxisome Proliferators Activated Receptor-Gamma (PPAR-γ) Agonists on Certain Biochemical and Inflammatory Markers in Metabolic Syndrome
Condition: Metabolic Syndrome
MeSH terms: Metabolic Syndrome; Syndrome
Study type: Interventional
Phase: Phase 4

Summary: 
      Metabolic syndrome, labeled as the world's latest epidemic, is the force behind the global
      epidemic of Type 2 Diabetes Mellitus and Cardio Vascular Diseases. This emerging epidemic is
      an important public health problem for South Asians in their homeland and worldwide.

      Pharmacological therapy is a critical step in the management of patients with metabolic
      syndrome. In general, treatment for metabolic syndrome, that targets all or most of the
      components of metabolic syndrome is either deficient or non-existent. The study presented
      here is the pioneering work in the management of metabolic syndrome, the emerging global
      epidemic.
    

Detailed description: 
      Our understanding of the metabolic syndrome has been improved by the discovery nuclear
      peroxisome proliferator-activated receptors (PPARs). PPAR-γ is a nuclear receptor that
      influences the expression of multiples gene involved in carbohydrate and lipid metabolism. At
      the crossroads of obesity, insulin resistance, and cardiovascular disease is the nuclear
      receptor PPAR-γ. At present, metabolic syndrome can be described as a 'PPAR-γ agonist
      resistance syndrome.' The modulation of PPAR-gamma activity is an interesting therapeutic
      approach to address multi-component metabolic syndrome and its consequent cardiovascular
      events.

      Recent studies have indicated that in addition to anti diabetic properties, PPAR-γ agonists
      (TZD)-Pioglitazone, provides protection against atherosclerotic cardiovascular disease.
      Further, the identification of ARBs-Telmisartan and Irbesartan, as capable of activating PPAR
      - γ, has provided a novel approach in treating hypertension, insulin resistance,
      hyperlipidemia, and inflammation.

      Emerging evidence suggests that PPAR-γ agonist: Thiazolidinediones (TZD)-Pioglitazone is an
      insulin sensitizer and modulator of metabolic syndrome, through its pleiotropic effects on
      vascular risk and have beneficial effects on systemic inflammatory markers. Despite the
      beneficial effects of full PPAR- agonists like the TZDs, recent evidence suggests that full
      PPAR- agonists are less than optimal agents in patients with metabolic syndrome. TZDs promote
      adipo-genesis and fluid retention, causing weight gain and precipitate congestive heart
      failure. The adverse effects of full PPAR- agonists like the TZDs have reinforced the need to
      identify additional therapies with insulin-sensitizing properties. The recent discovery that
      telmisartan, an angiotensin II type 1 receptor (AT1-R) blockers (ARBs), is uniquely capable
      of selective PPAR- -modulating activities, have the potential to treat both hemodynamic and
      biochemical features of insulin resistance and metabolic Syndrome.
    

Intervention name(s): Pioglitazone; Telmisartan
Intervention type(s): Drug; Drug
Intervention description(s): Tab. Pioglitazone-30 mg/day, oral, 24 weeks; Tab. Telmisartan- 40 mg/day, oral, 24 weeks
Intervention MeSH terms: Pioglitazone; Telmisartan
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Metabolic syndrome; inflammatory markers; Thiazolidinediones; Angiotensin receptor blockers