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J Clin Invest. 2018 Dec 3;128(12):5280-5293. doi: 10.1172/JCI94307. Epub 2018 Oct 22.

A carnosine analog mitigates metabolic disorders of obesity by reducing carbonyl stress.

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Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa, USA.
Department of Pharmacology and Toxicology, East Carolina University, Greenville, North Carolina, USA.
Department of Pharmaceutical Sciences, University of Milan, Milan, Italy.
Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA.
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.
Flamma S.p.A., Chignolo d'Isola, Bergamo, Italy.


Sugar- and lipid-derived aldehydes are reactive carbonyl species (RCS) frequently used as surrogate markers of oxidative stress in obesity. A pathogenic role for RCS in metabolic diseases of obesity remains controversial, however, partly because of their highly diffuse and broad reactivity and the lack of specific RCS-scavenging therapies. Naturally occurring histidine dipeptides (e.g., anserine and carnosine) show RCS reactivity, but their therapeutic potential in humans is limited by serum carnosinases. Here, we present the rational design, characterization, and pharmacological evaluation of carnosinol, i.e., (2S)-2-(3-amino propanoylamino)-3-(1H-imidazol-5-yl)propanol, a derivative of carnosine with high oral bioavailability that is resistant to carnosinases. Carnosinol displayed a suitable ADMET (absorption, distribution, metabolism, excretion, and toxicity) profile and was determined to have the greatest potency and selectivity toward α,β-unsaturated aldehydes (e.g., 4-hydroxynonenal, HNE, ACR) among all others reported thus far. In rodent models of diet-induced obesity and metabolic syndrome, carnosinol dose-dependently attenuated HNE adduct formation in liver and skeletal muscle, while simultaneously mitigating inflammation, dyslipidemia, insulin resistance, and steatohepatitis. These improvements in metabolic parameters with carnosinol were not due to changes in energy expenditure, physical activity, adiposity, or body weight. Collectively, our findings illustrate a pathogenic role for RCS in obesity-related metabolic disorders and provide validation for a promising new class of carbonyl-scavenging therapeutic compounds rationally derived from carnosine.


Diabetes; Drug therapy; Endocrinology; Metabolism; Obesity

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