2.3.2.1. Food and Water Consumption and Body Weight
Figure 4A-4C shows the food and water consumption, as well as the body weight of the animals with T2D that were administered with compounds
3b and
4y in an equimolar ratio to PGZ (15 mg/kg) for 4 weeks. As can be seen in
Figure 4A, in the T2D +
3b and T2D +
4y groups, food consumption remained constant from the beginning of treatment (week 1) to the end of it (week 4). In the T2D and T2D + PGZ groups, food consumption was significantly higher in week 4 compared to the beginning of treatment (week 1). In
Figure 4B it can be observed that water consumption was significantly lower in the T2D +
3b group in week 4 compared to week 1, while in the T2D +
4y and T2D + PGZ groups water consumption remained constant and, in the T2D group, there was a significant decrease in week 4 compared to the start of treatment (week 1). In
Figure 4C, it can be observed that in the T2D +
3b group, the body weight of the animals increased significantly in week 4 with respect to week 1, and in the T2D +
4y group there was also an increase, although this was not significant with respect to time. In the Control and T2D + PGZ groups, the weight also increased significantly in week 4 with respect to the beginning of the treatment (week 1), while in the T2D group the weight remained constant. In this regard, it is well known that PGZ is capable of producing the differentiation of adipose tissue in animals with T2D through the activation of PPAR gamma, which was demonstrated in this study [63-Álvarez; 67-Alemán]. It is noteworthy that, although the weight of T2D animals administered compounds
3b and
4y increased during the treatment period (week 1-4), it was lower compared to that of the group administered PGZ, suggesting that both compounds do not induce adipogenesis compared to this drug.
On the other hand, despite the fact that T2D animals consumed food and water constantly and even in greater quantities (in the case of water) than the rest of the experimental groups (T2D + PGZ, T2D +
3b and T2D +
4y), their body weight did not change significantly (
Figure 4A-4C). These results are similar to the symptoms of T2D patients, which include weight loss despite polyphagia (increased food consumption), polydipsia (increased water consumption) and polyuria (increased urinary volume generation) [
63,
67]. STZ-induced diabetes is also characterized by weight loss, the decrease of which is due to the degradation of structural proteins such as those that form part of skeletal muscle (cachexia), since it is known that these contribute to weight gain [
74]. This was clearly demonstrated in this study, since although there was no significant decrease in the weight of animals with T2D, it was lower compared to that of animals in the Control group during the treatment period (week 1-4).
Following acute and subchronic administration of compounds
3b and
4y in equimolar ratio to PGZ (15 mg/kg), blood glucose concentration and HbA1c percentage were measured (
Figure 5A-5C).
Figure 5A shows that blood glucose levels in animals in the T2D +
3b group decreased significantly from 1 h to 4 h and in those in the T2D +
4y group from 2 h to 4 h, both cases with respect to the initial value (0 h). In animals in the TD2 + PGZ group, blood glucose concentration decreased significantly from 0.5 h to 4 h with respect to the start (0 h). In addition, the T2D +
4y and T2D + PGZ groups showed significant differences with the T2D group and the latter with the Control group. It is worth noting that in the T2D +
3b and T2D +
4y groups there was no decrease in blood glucose levels below that of the Control group, so these results suggest that, like PGZ, compounds
3b and
4y do not cause hypoglycemia in healthy subjects or in those with T2D below normal values [
63]. Regarding the subchronic administration of
3b and
4y,
Figure 5B shows that blood glucose concentration decreased significantly in both groups from week 1 until the end of treatment (week 4), as in the T2D + PGZ group. However, as can be seen in the graph, unlike the T2D +
3y and T2D +
4y groups, blood glucose values in the T2D + PGZ group did not reach normal levels (< 100 mg/dL) at week 4, which is consistent with what has been reported in previous studies [
63,
67,
75]. HbA1c is a sensitive marker used to detect early diabetes in high-risk individuals [
74].
Figure 5C shows that the percentage of HbA1c in the T2D +
3b, T2D +
4y, and T2D+PGZ groups decreased at week 4 from baseline (week 1). Furthermore, the percentage of HbA1c also decreased in the three aforementioned groups compared to the T2D group, but without reaching the values of the Control group at week 4 of treatment. In this regard, it has been shown that the percentage of HbA1c strongly correlates with fasting blood glucose concentration in patients with diabetes. Glycation of hemoglobin is irreversible during the 120 days of life of red blood cells in the body. The assessment of changes in blood glucose levels is cumulative over a period of 4 to 8 weeks [
76]. The percentage of HbA1c is stable, does not vary during the day and does not depend on recent changes in diet. Hemoglobin has free access to glucose, which passively diffuses through the red blood cell membrane. However, the glycation mechanism increases due to glycemic stress caused by the metabolic disturbance produced by the diabetic state [
76]. In the present study, a significant increase in HbA1c levels was observed in addition to hyperglycemia in rats with T2D compared to healthy control indicating their poor glycemic status, as previously reported [
74,
76]. However, this metabolic alteration decreased with the administration of compounds
3b and
4y, as well as with PGZ.
Regarding the lipid profile, it can be observed in
Table 7 that in animals with T2D administered with compounds
3b and
4y, the concentrations of triglycerides (TG), total cholesterol (T-Cho) and low-density lipoproteins (LDL-C) decreased with respect to the T2D group, while high-density lipoproteins (HDL-C) increased (week 4). It is worth mentioning that these results are comparable with those of the T2D + PGZ group, the effect of this drug on the lipid profile being well demonstrated in previous studies [
63,
67,
74,
75].
Oxidative stress may also play a central role in the pathogenesis of diabetic complications such as impaired glucose and lipid metabolism that promote hyperglycemia and dyslipidemia through overproduction of reactive oxygen species (ROS). These complications are associated with the development of atherosclerosis and cardiovascular diseases. Hyperglycemia is accompanied by elevated levels of TG, T-Cho, and LDL-C and decreased HDL-C levels in diabetic rats, in which the abnormally high serum lipid concentrations are mainly due to increased mobilization of free fatty acids from fat stores. Insulin activates the enzyme lipoprotein lipase (LPL) that hydrolyzes TG under normal conditions, however, it is not activated in the diabetic state due to insulin deficiency, resulting in hypertriglyceridemia. Circulating LDL-C is recaptured in the liver through specific receptors that clear the circulation. The increased serum LDL-C concentration in diabetic rats could be due to a defect in the LDL-C receptor, either through a failure in its production or function. ROS can stimulate the oxidation of LDL-C which can be taken up by scavenger receptors in macrophages leading to the formation of foam cells and atherosclerotic plaques. HDL-C is a cardioprotective lipid by reversing T-Cho transport, thus neutralizing the atherogenic effect of oxidized LDL-C, preventing coronary heart disease. The greater decrease in HDL-C could be due to the greater increase in LDL-C and VLDL-C since there is a reciprocal relationship between VLDL-C and HDL-C concentration. The decreased activity of the enzyme lecithin cholesterol acyltransferase (LCAT) could be responsible for the decreased activity of HDL-C [
74,
75]. In this study, animals with T2D administered compounds
3b and
4y showed an increase in HDL-C and a reduction in TG, T-Cho and LDL-C, so these results confirm that both compounds, like PGZ, can reduce the risk of cardiovascular diseases by restoring the unbalanced lipid profile.
In
Table 8 it can be observed that the administration of compounds
3b and
4y to animals with T2D did not produce a significant change in the serum concentrations of the enzymes alanine aminotransferase (ALT/GPT), aspartate aminotransferase (AST/GOT) and gamma-glutamyl transferase (GGT) with respect to the Control group.
These results are similar to those observed in the T2D + PGZ group, as well as with previous studies in which it has been shown that this drug does not produce an increase in the catalytic activity of liver enzymes in both rats and humans with T2D [
63,
75]. Furthermore, since these results correlate with those obtained in the in silico study, as well as with the macroscopic analysis performed after subchronic treatment with
3b and
4y, in which it was shown that both compounds do not cause tissue damage, particularly at the hepatic level (data not shown), it is suggested that they are safe and do not produce harmful effects on the liver. On the contrary, in animals administered with PGZ there was an increase in adipose tissue which is well known to be one of the adverse effects of TZDs [
63,
75].
In summary, compounds 3b and 4y administered to animals with T2D favor the decrease of blood glucose concentration and improve dyslipidemia, which could be explained based on a mechanism of action similar to that of PGZ that improves insulin sensitivity throughout the body, instead of stimulating its secretion from pancreatic beta cells. In addition, the attenuating effect on hyperlipidemia (although not significant) could result either from the inhibition of TG synthesis in the liver or from the increase in its clearance in the periphery by stimulating the LPL enzyme and/or the inhibition of intestinal absorption of dietary T-Cho.