dual agonist raises a handful of sensible questions. This page answers them in order, starting with the fundamentals and moving to applications.
This page was last updated on 2025-11-20 and is reviewed periodically as new material appears.
Clinical research programs have evaluated tirzepatide in adults with type 2 diabetes and in adults with obesity or excess weight. Trials generally reported reductions in glycated hemoglobin and body weight across treatment periods of several months. Since these studies enrolled defined populations under controlled conditions, the findings describe group averages rather than individual outcomes. Open questions include the durability of effects after treatment stops, variation among subgroups, and the long-term consequences of sustained dual receptor stimulation. Published trial summaries should be consulted for exact measurements rather than secondary accounts.
Tirzepatide is a synthetic peptide built from 39 amino acid residues. Its backbone derives from the native glucose-dependent insulinotropic polypeptide sequence, altered at several positions to resist enzymatic cleavage. A fatty diacid group attached through a linker extends plasma residence time by promoting reversible binding to serum albumin. The molecule carries a net negative charge near physiological pH and has a reported molecular weight close to 4813 daltons. These features separate it from shorter incretin analogs and account for its prolonged dosing interval.
该化合物的名称与结构由国际非专利名称体系统一维持，不同文献中出现的同义写法主要在拼写顺序或盐形式描述上不同。研究者通常通过受体结合实验、细胞内环磷酸腺苷积累测定以及动物模型来确认其双激动活性。相当一部分分子层面的细节——例如两条受体通路之间的信号交叉作用——尚处于开放问题状态。
当前公开资料把 tirzepatide 归为肠促胰素类受体双重激动剂。它并非激素天然变体，而是经过序列改造的工程化肽。其分子量、等电点与疏水性等基础参数已在药典和化学数据库中收录，可作为分析检测和质量研究的参照。
Tirzepatide 是一种由 39 个氨基酸组成的合成肽，分子结构上以 GIP 序列为骨架并引入脂肪酸侧链修饰，使其能够同时与葡萄糖依赖性促胰岛素多肽（GIP）受体和胰高血糖素样肽-1（GLP-1）受体结合。这种双重激动特性使它在同类肽类药物中区别于选择性 GLP-1 受体激动剂。该分子最早由一家制药公司在 2010 年代报道，随后进入糖尿病与体重管理领域的临床研究。
| Property | Value | Notes |
|---|---|---|
| Molecular formula | C225H348N48O68 | Includes the 39-residue backbone and the attached fatty diacid |
| Molecular weight | Approximately 4813 Da | Average mass; the monoisotopic value is slightly lower |
| Receptor targets | GIP receptor and GLP-1 receptor | Dual engagement defines the pharmacological class |
| Backbone length | 39 amino acids | Sequence modified from native glucose-dependent insulinotropic polypeptide |
| Albumin interaction | Reversible, mediated by the fatty diacid | Slows renal clearance and lengthens circulation time |
Clinical development proceeded through large phase 3 programmes in type 2 diabetes and in obesity or overweight with at least one weight-related comorbidity. Regulatory approvals followed in several jurisdictions for both indications. Weekly subcutaneous dosing reflects an elimination half-life of roughly five days. Open questions include the durability of metabolic effects after treatment stops, long-term cardiovascular and hepatic outcomes beyond completed trials, and whether the dual mechanism confers benefits independent of total receptor occupancy. Published literature continues to expand on these points. Substantial uncertainty remains about interindividual variability in response.
Tirzepatide is a synthetic linear peptide of 39 amino acids that acts as a dual agonist at the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. Its sequence derives from native GIP but incorporates non-natural residues and a C20 fatty diacid moiety linked to a lysine side chain. The lipophilic chain promotes albumin binding, which slows renal clearance and extends circulation time. The unmodified peptide has a molecular formula of C225H348N48O68 and a molecular mass near 4,813 daltons.
The GIP receptor is expressed in pancreatic islets, adipose tissue, and the central nervous system, while GLP-1 receptors are found in pancreatic islets, the gastrointestinal tract, and the brain. Activation of both receptors can enhance glucose-dependent insulin secretion and reduce glucagon release. The relative contribution of each receptor to the overall pharmacological effect remains an area of ongoing investigation. Preclinical studies suggest that GIP receptor agonism may modulate appetite and energy balance, but the precise mechanisms in humans are not fully established.
In clinical research, tirzepatide has been studied in randomized controlled trials for glycemic control and body weight reduction. These trials typically measure changes in hemoglobin A1c and body weight over periods of several months. The drug is administered by subcutaneous injection, and its pharmacokinetic profile supports once-weekly dosing. Post-marketing surveillance continues to evaluate long-term outcomes and rare adverse events.
Tirzepatide is a synthetic peptide developed as a dual agonist at the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors. Its structure is built on a GIP-derived backbone with non-natural amino acid substitutions and a fatty diacid side chain that promotes albumin binding and slows clearance. That modification supports once-weekly subcutaneous dosing. Registrational trial programs reported reductions in body weight and glycated hemoglobin alongside the drug's glycemic effects.
Both receptors are class B G protein-coupled receptors that signal largely through Gs-mediated cyclic AMP production. Activation within pancreatic islets increases glucose-dependent insulin secretion and suppresses glucagon release when glucose is elevated. Outside the pancreas, signaling in the central nervous system and gut appears to influence appetite and gastric emptying. The relative contribution of each receptor to observed clinical effects remains under investigation, and the two pathways are not simply additive in practice.
==== Other Risks ==== Post-operative bleeding is uncommon, but usually resolves without treatment. Infection is rare, but, when it does occur, it might progress to become an abscess requiring the surgical drainage of the pus, whilst the patient is under general anaesthesia. Adhesions, scars that obstruct the airways, can form a bridge across the nasal cavity, from the septum to the turbinates, and lead to difficulty breathing and may require surgical removal. Furthermore, in the course of the rhinoplasty, the surgeon might accidentally perforate the septum (septal perforation), which later can cause chronic nose bleeding, crusting of nasal fluids, difficult breathing, and whistling breathing. A turbinectomy may result in empty nose syndrome.
Rooty, the Great American Root Bear, originated as a prototype mascot in kids' meals in the US, but it was in Canada in 1974 that it gained further recognition, as a counter to the Ronald McDonald character of McDonald's and first appeared in the United States and in Asia shortly afterwards. However, the character's introduction was almost aborted when marketing received focus group research results that reported a poor reaction to him. In reaction, the marketing director, acting on instinct about the appeal of the character, ordered the researcher to return to Toronto with the cover story that he never presented the report. The researcher complied, and Rooty was presented to the franchisees as is. Rooty proved a popular marketing success. Rooty's adoption implied the phasing out of the Burger Family and the renaming of almost all of the burgers in the line outside of Canada. Throughout the 1970s, '80s, and '90s, Rooty was the face of A&W, both the bottled drinks and the restaurant chain, on television and print advertising. His presence all but disappeared in the late 1990s, but in 2011, under A Great American Brand's ownership, Rooty came out of retirement. He has since been featured in print ads, on A&W's website, as the voice of their official Twitter account, and in a variety of YouTube and Vine videos. A bronze statue of the bear was erected at the lobby of the current headquarters. In 2013, Rooty became the first mascot to have an official LinkedIn profile, which was quickly shut down as Rooty was not considered "real" by the authorities at Linkedin.
Bio Products Laboratory Limited (BPL) is a company involved in the manufacture of human blood plasma products, located in Elstree, Hertfordshire, England. It is run as a commercial business and supplies plasma derived products to the National Health Service in the UK as well as to markets in over 45 countries. BPL was a state owned organization and it was part of the U.K. National Health Service for most of its existence. On 1 September 2022, Permira and the Marcucci family acquired BPL and announced that their operations will be merged with another company acquired by the duo, Kedrion.
==== MeSH D13.695.827 – ribonucleotides ==== MeSH D13.695.827.068 – adenine nucleotides MeSH D13.695.827.068.124 – adenosine diphosphate MeSH D13.695.827.068.124.070 – adenosine diphosphate sugars MeSH D13.695.827.068.124.070.075 – adenosine diphosphate glucose MeSH D13.695.827.068.124.070.125 – adenosine diphosphate ribose MeSH D13.695.827.068.124.070.125.040 – o-acetyl-adp-ribose MeSH D13.695.827.068.124.070.125.195 – cyclic adp-ribose MeSH D13.695.827.068.180 – adenosine monophosphate MeSH D13.695.827.068.180.080 – adenosine phosphosulfate MeSH D13.695.827.068.236 – adenosine triphosphate MeSH D13.695.827.068.236.050 – adenylyl imidodiphosphate MeSH D13.695.827.068.236.250 – ethenoadenosine triphosphate MeSH D13.695.827.068.382 – coenzyme a MeSH D13.695.827.068.382.300 – acyl coenzyme a MeSH D13.695.827.068.382.300.020 – acetyl coenzyme a MeSH D13.695.827.068.382.300.500 – malonyl coenzyme a MeSH D13.695.827.068.382.300.700 – palmitoyl coenzyme a MeSH D13.695.827.068.395 – cyclic amp MeSH D13.695.827.068.395.225 – 8-bromo cyclic adenosine monophosphate MeSH D13.695.827.068.395.250 – bucladesine MeSH D13.695.827.068.506 – flavin-adenine dinucleotide MeSH D13.695.827.068.694 – nad MeSH D13.695.827.068.749 – nadp MeSH D13.695.827.068.850 – phosphoadenosine phosphosulfate MeSH D13.695.827.232 – cytosine nucleotides MeSH D13.695.827.232.115 – cyclic cmp MeSH D13.695.827.232.150 – cytidine diphosphate MeSH D13.695.827.232.150.180 – cytidine diphosphate choline MeSH D13.695.827.232.150.210 – cytidine diphosphate diglycerides MeSH D13.695.827.232.370 – cytidine monophosphate MeSH D13.695.827.232.370.250 – cytidine monophosphate n-acetylneuraminic acid MeSH D13.695.827.232.400 – cytidine triphosphate MeSH D13.695.827.349 – flavin mononucleotide MeSH D13.695.827.426 – guanine nucleotides MeSH D13.695.827.426.160 – cyclic gmp MeSH D13.695.827.426.160.325 – dibutyryl cyclic gmp MeSH D13.695.827.426.340 – guanosine diphosphate MeSH D13.695.827.426.340.350 – guanosine diphosphate sugars MeSH D13.695.827.426.340.350.400 – guanosine diphosphate fucose MeSH D13.695.827.426.340.350.500 – guanosine diphosphate mannose MeSH D13.695.827.426.440 – guanosine pentaphosphate MeSH D13.695.827.426.480 – guanosine tetraphosphate MeSH D13.695.827.426.504 – guanosine triphosphate MeSH D13.695.827.426.504.380 – guanosine 5'-o-(3-thiotriphosphate) MeSH D13.695.827.426.504.400 – guanylyl imidodiphosphate MeSH D13.695.827.426.525 – 5'-guanylic acid MeSH D13.695.827.426.700 – rna caps MeSH D13.695.827.426.700.710 – rna cap analogs MeSH D13.695.827.519 – inosine nucleotides MeSH D13.695.827.519.300 – cyclic imp MeSH D13.695.827.519.400 – inosine diphosphate MeSH D13.695.827.519.500 – inosine monophosphate MeSH D13.695.827.519.800 – inosine triphosphate MeSH D13.695.827.648 – nicotinamide mononucleotide MeSH D13.695.827.708 – nucleoside diphosphate sugars MeSH D13.695.827.708.070 – adenosine diphosphate sugars MeSH D13.695.827.708.070.075 – adenosine diphosphate glucose MeSH D13.695.827.708.070.125 – adenosine diphosphate ribose MeSH D13.695.827.708.070.125.040 – o-acetyl-adp-ribose MeSH D13.695.827.708.070.125.195 – cyclic adp-ribose MeSH D13.695.827.708.070.125.600 – poly adenosine diphosphate ribose MeSH D13.695.827.708.260 – cytidine diphosphate diglycerides MeSH D13.695.827.708.400 – guanosine diphosphate sugars MeSH D13.695.827.708.400.410 – guanosine diphosphate fucose MeSH D13.695.827.708.400.500 – guanosine diphosphate mannose MeSH D13.695.827.708.727 – uridine diphosphate sugars MeSH D13.695.827.708.727.100 – uridine diphosphate n-acetylgalactosamine MeSH D13.695.827.708.727.120 – uridine diphosphate n-acetylglucosamine MeSH D13.695.827.708.727.150 – uridine diphosphate n-acetylmuramic acid MeSH D13.695.827.708.727.300 – uridine diphosphate galactose MeSH D13.695.827.708.727.350 – uridine diphosphate glucose MeSH D13.695.827.708.727.375 – uridine diphosphate glucuronic acid MeSH D13.695.827.708.727.800 – uridine diphosphate xylose MeSH D13.695.827.919 – uracil nucleotides MeSH D13.695.827.919.600 – uridine diphosphate MeSH D13.695.827.919.600.677 – uridine diphosphate sugars MeSH D13.695.827.919.600.677.100 – uridine diphosphate n-acetylgalactosamine MeSH D13.695.827.919.600.677.120 – uridine diphosphate n-acetylglucosamine MeSH D13.695.827.919.600.677.150 – uridine diphosphate n-acetylmuramic acid MeSH D13.695.827.919.600.677.300 – uridine diphosphate galactose MeSH D13.695.827.919.600.677.350 – uridine diphosphate glucose MeSH D13.695.827.919.600.677.375 – uridine diphosphate glucuronic acid MeSH D13.695.827.919.600.677.800 – uridine diphosphate xylose MeSH D13.695.827.919.877 – uridine monophosphate MeSH D13.695.827.919.950 – uridine triphosphate
Sources: en.wikipedia.org
When newly opened, Viola flowers may be used to decorate salads or in stuffings for poultry or fish. Soufflés, cream, and similar desserts can be flavoured with essence of Viola flowers. The young leaves are edible raw or cooked as a mild-tasting leaf vegetable. The flowers and leaves of the cultivar 'Rebecca', one of the Violetta violets, have a distinct vanilla flavor with hints of wintergreen. The pungent perfume of some varieties of V. odorata adds inimitable sweetness to desserts, fruit salads, and teas while the mild pea flavor of V. tricolor combines equally well with sweet or savory foods, like grilled meats and steamed vegetables. The heart-shaped leaves of V. odorata provide a free source of greens throughout a long growing season, while the petals are used for fragrant flavoring in milk puddings and ice cream or in salads and as garnishes. A candied violet or crystallized violet is a flower, usually of Viola odorata, preserved by a coating of egg white and crystallised sugar. Alternatively, hot syrup is poured over the fresh flower (or the flower is immersed in the syrup) and stirred until the sugar recrystallizes and has dried. This method is still used for rose petals and was applied to orange flowers in the past (when almonds or orange peel are treated this way they are called pralines). Candied violets are still made commercially in Toulouse, France, where they are known as violettes de Toulouse. They are used as decorating cakes or trifles or included in aromatic desserts.
Traditional non-alcoholic beverage companies, like PepsiCo, Fuze Beverage, and The Coca-Cola Company. Major food companies, such as Nestlé, Altria, Kraft Foods, General Mills, and the Campbell Soup Company. Smaller-scaled private companies and specialized companies like POM Wonderful. Agricultural cooperatives, such as Ocean Spray and Sunsweet Growers.
Since this went too far for the Centre's national leadership, the negotiations were transferred to the national level, where Heinrich Brüning conferred with Gregor Strasser. During that period the anti-Nazi polemics ceased in order not to disturb the negotiations. Since the NSDAP was the larger party, the Centre was willing to accept a Nazi as Chancellor, provided he could gain the trust of the President, which at that time seemed quite a difficult task. The negotiations were bound for failure, since the aims of the two groups were largely incompatible. The Centre argued that the vote of July had "called Hitler not to dictatorship but to responsibility, to getting in line with law and constitution". They hoped to "build a strong government without touching the substance of the constitution", to create "clear responsibilities" and to "preclude anti-constitutional experiments". The Centre advocated a return to Brüning's "authoritarian democracy", which they considered up to the times and tested by experience, against Papen's "omnipotent state and independent leadership", while the Nazis would only accept a coalition that would serve their purpose of achieving total dominance. Not expecting a successful conclusion, Hitler used the Centre negotiations in order to put pressure on the Papen administration. The negotiations were also met with criticism from within the Centre Party. Some rejected them as "currying favour with the National Socialists" and giving credence to Hitler's strategy of legality.
Immersion in warm water or sour milk, followed by the application of snake-stones (also known as la Pierre Noire), which are believed to draw off the poison in much the way a sponge soaks up water. Application of a one-percent solution of potassium permanganate or chromic acid to the cut, exposed area. The latter substance is notably toxic and carcinogenic. Drinking abundant quantities of alcohol following the cauterization or disinfection of the wound area. Use of electroshock therapy in animal tests has shown this treatment to be useless and potentially dangerous. In extreme cases, in remote areas, all of these misguided attempts at treatment have resulted in injuries far worse than an otherwise mild to moderate snakebite. In worst-case scenarios, thoroughly constricting tourniquets have been applied to bitten limbs, completely shutting off blood flow to the area. By the time the person finally reached appropriate medical facilities, their limbs had to be amputated.
Their intention was to protect Raleigh from the destruction inflicted on other cities by Union troops. Graham and Swain departed to meet the advancing Federal forces on the morning of April 12, 1865, and were to return by that evening. The evening struck, but Graham and Swain had not returned due to train delays and their temporary capture by Sherman. Governor Vance left the evening after Graham and Sherman failed to return, leaving behind a letter giving Mayor William H. Harrison the authority to surrender. On the morning of April 13, Mayor Harrison among others went to the southern Wake County area to meet General Hugh Judson Kilpatrick and propose surrender. Kenneth Rayner, a long-time resident of Raleigh, delivered the proposal including a promise of no resistance. Kilpatrick agreed to accept the surrender and protect Raleigh from destruction. Kilpatrick's cavalry occupied Raleigh and removed the flagpole from the state capitol, replacing it with a United States Flag above the dome. Sherman arrived shortly after and established his headquarters in the governor's mansion. The city was spared significant destruction during the war. As Confederate cavalry retreated west, Union soldiers followed, leading to the Battle of Morrisville nearby. Due to the economic and social problems of the postwar period and Reconstruction, with a state economy still heavily dependent on agriculture, the city grew little over the next several decades. Shaw University, the South's first African American college, began classes in 1865 and was chartered in 1875.
Sources: en.wikipedia.org
=== Progress === To measure the results, the Government also set goals that corresponded to these research projects. The goals include: completion of the immunoprophylaxis strategy, such as HBV vaccine, to decrease the incidence of HCC by more than 10%; identification of molecular biomarkers, and the creation of molecular-typing diagnostic kits for the prediction of the therapeutic response; the development of regimens to treat HBV; the identification of biomarkers to predict the aggressiveness of severe hepatitis B and the development of a kit for early diagnosis of liver cirrhosis; the identification of markers (biological and genomic, and small molecules) for early diagnosis and to predict recurrence and metastasis, and the development of new drugs for HCC, to increase the rate of early diagnosis by more than 20% and 5-year survival by more than 5%. The fight against HBV and its related disorders is now thought of as a long-term one by the health authorities.
=== Prostate cancer === In males aged 55 years old and over finasteride decreases the risk of low-grade prostate cancer but may increase the risk of high-grade prostate cancer and has no effect on overall survival. A 2010 review found a 25% reduction in the risk of prostate cancer with 5α-reductase inhibitors. A follow-up study of the Medicare claims of participants in a 10-year Prostate Cancer Prevention Trial suggests the reduction in prostate cancer is maintained even after discontinuation of treatment. However, 5α-reductase inhibitors have been found to increase the risk of developing certain rare but aggressive forms of prostate cancer (27% risk increase), although not all studies have observed this. No impact of 5-α-reductase inhibitor on survival has been found in people with prostate cancer.
== Reception == Out Cold has an 8% approval rating on Rotten Tomatoes, a review aggregator, based on 49 reviews; the average rating is 2.9/10. The site's consensus reads: "A party movie that substitutes surfs for snow, Out Cold will leave viewers just that with its gross-out humor and sophomoric plot." Metacritic, which uses a weighted average, assigned the film a score of 22 out of 100, based on 15 critics, indicating "generally unfavorable" reviews. However, the movie holds an 84% fan approval rating on Rotten Tomatoes, compiled from over 25,000 audience ratings. The movie is considered a comedy cult classic among snowboarding enthusiasts and from its multiple broadcasts on Comedy Central.
=== Organic molecules in space === In 1974 Wickramasinghe first proposed the hypothesis that some dust in interstellar space was largely organic, and followed this up with other research confirming the hypothesis. Wickramasinghe also proposed and confirmed the existence of polymeric compounds based on the molecule formaldehyde (H2CO). Fred Hoyle and Wickramasinghe later proposed the identification of bicyclic aromatic compounds from an analysis of the ultraviolet extinction absorption at 2175A., thus demonstrating the existence of polycyclic aromatic hydrocarbon molecules in space.
Sources: en.wikipedia.org
It is a synthetic peptide that activates both the GIP and GLP-1 receptors, making it a dual agonist. Approved products are given by injection rather than by mouth. It is not a small molecule and does not belong to the older sulfonylurea or thiazolidinedione families.
Engaging two receptors recruits signaling pathways that only partly coincide. This can shift the magnitude of effects on insulin release, glucagon levels and appetite relative to selective agents. Whether the pairing delivers benefits beyond a simple sum of the two is still debated in the literature.
The proportional contribution of each receptor to observed clinical effects has not been fully separated. Long-term consequences of continuous dual stimulation are likewise unclear. Investigators continue to probe these points through laboratory and clinical work.
它属于合成修饰肽，同时激动 GIP 与 GLP-1 两种肠促胰素受体。这类分子通常被称为双重肠促胰素受体激动剂，与选择性 GLP-1 激动剂在靶点范围上不同。