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▎ Hoʻolālā Tirzepatide
Puna: PubChem |
Kaʻina: Tyr-{Aib}-Glu-Gly-Thr-Phe-Thr-Ser-Asp-Tyr-Ser-Ile-{Aib}-Leu-Asp-Lys-Ile-Ala-Gln-{diacid-C20-gamm a-Glu-(AEEA)2-Lys}-Ala-Phe-Val-Gln-Trp-Leu-Ile-Ala-Gly-Gly-Pro-Ser-Ser-Gly-Ala-Pro-Pro-Pro-Ser-NH2 Ke Kumu Molekala: C 225H 348N 48O68 Kaumaha Molekala: 4813 g/mol Helu CAS: 2023788-19-2 PubChem CID: 163285897 Synonyms: Zepbound; Mounjaro |
▎ ʻImi ʻo Tirzepatide
He aha ke kumu noiʻi o Tirzepatide?
ʻO Tirzepatide kahi lāʻau polypeptide synthetic, a ʻo kona hoʻomohala ʻana mai ka ʻike hohonu o nā palena o nā agonists receptor GLP-1 i ka mālama ʻana i ka type 2 metabolism mellitus a me ka momona. ʻOiai ua hōʻike mua ka GLP-1 receptor agonists i ka hana maikaʻi loa i ka mālama ʻana i ka glucose o ke koko a me ke kaumaha o ke kaumaha, ua ʻike nā kānaka ʻepekema ʻoiai lākou e hoʻāla ai i ka mea hoʻokipa GLP-1, ua nāwaliwali kā lākou hopena hoʻāla i ka mea loaʻa GIP, kahi i kaupalena ʻia ai ka hopena therapeutic o nā lāʻau. No laila, ua kūpaʻa ka hui noiʻi a me ka hoʻomohala ʻana i ka hoʻomohala ʻana i kahi ʻano lāʻau lapaʻau hou e hiki ai ke hoʻāla i ka GIPR a me GLP-1R i ka manawa like, me ka manaʻolana e loaʻa i ka ʻoi aku ka piha o ka glucose koko a me ka hoʻokele kaumaha [1] .
I ka wā o ka noiʻi a me ka hoʻomohala ʻana o Tirzepatide, ua hana nā ʻepekema i ka nui o nā noiʻi kumu a me nā hoʻokolohua lapaʻau. ʻO ka mea mua, i ka pae noiʻi preclinical, ua loiloi nui ʻia nā hiʻohiʻona pharmacodynamic o Tirzepatide ma o nā hoʻokolohua holoholona, a ua hōʻoia ʻia kona hiki ke mālama i ka glucose koko a me ke kaumaha o ke kaumaha. Ua hōʻike nā hopena i hiki iā Tirzepatide ke hoʻemi nui i ke kiʻekiʻe o ka glucose koko i nā ʻano holoholona a hana maikaʻi hoʻi i ka hoʻokele kaumaha. Ua hoʻokumu kēia mau ʻike maikaʻi i kumu paʻa no nā hoʻokolohua lapaʻau ma hope.
Ma hope mai, ua komo ʻo Tirzepatide i ka pae hoʻokolohua lapaʻau, me ka hoʻāʻo ʻana o ka pae I, II, a me III. I ka hoʻāʻo ʻana o ka pae I, ua loiloi nui ʻia ka palekana, ka hoʻomanawanui, a me nā ʻano pharmacokinetic o ka lāʻau lapaʻau, a ua hōʻike ʻia nā hopena he palekana maikaʻi ʻo Tirzepatide a me ka hoʻomanawanui. Ua ʻimi hou ka hoʻāʻo ʻana o ka pae II i ka maikaʻi a me ka palekana o nā ʻano like ʻole o Tirzepatide i nā mea maʻi me ke ʻano 2 metabolism mellitus, a ua hoʻoholo mua i kona pae hopena kūpono. ʻO nā hoʻokolohua lapaʻau koʻikoʻi loa III, e like me ka SURPASS series of study, uhi i ka nui o nā maʻi me ka type 2 metabolism mellitus. Ua hōʻike ʻia nā hopena i ʻoi aku ka maikaʻi o Tirzepatide ma mua o nā agonists receptor GLP-1 i loaʻa, e like me semaglutide, i ka hōʻemi ʻana i ka glucose koko a me ke kaumaha. Hāʻawi kēia hopena holomua i ke kākoʻo hōʻike ikaika no ka noi kūʻai ʻana o Tirzepatide [1].
ʻO Tirzepatide kahi polypeptide i haku ʻia me 39 amino acids, kahi i hoʻololi ʻia ai nā amino acids i mea e hoʻomaikaʻi ai i kona kūpaʻa a me ka pono. ʻO kēia hoʻolālā hoʻolālā kūʻokoʻa e hiki ai iā Tirzepatide ke hoʻohui i nā hopena o nā hormones incretin ʻelua, GIP a me GLP-1, i loko o kahi mole hoʻokahi, a hoʻoulu i nā mea hoʻokipa hormone e pili ana i ka mana glucose koko ma o ka hana ʻelua o ka hana. ʻO ka kikoʻī, hiki i ka Tirzepatide ke hana ma ka pancreas a me ka ʻōnaehana nerve waena. Ma ka lima hoʻokahi, hoʻoikaika ia i ka huna ʻana o ka insulin a ke kāohi i ka hoʻokuʻu ʻana o ka glucagon, a laila e hoʻemi pono i ka glucose koko; ma ka ʻaoʻao ʻē aʻe, ma ka hoʻopaneʻe ʻana i ka hoʻokaʻawale ʻana o ka ʻōpū a me ka hoʻonui ʻana i ka satiety, hoʻemi ia i ka makemake a me ka ʻai ʻana i ka meaʻai, a pēlā e hoʻokō ai i ka hoʻokele kaumaha. Hāʻawi kēia ʻano hana ʻelua iā Tirzepatide i nā pono kūʻokoʻa i ka mālama ʻana i ke ʻano 2 metabolism mellitus a me ka momona, e hāʻawi ana i nā mea maʻi i kahi koho lapaʻau piha loa [1].
He aha ke ʻano o ka hana o Tirzepatide?
Hoʻohaʻahaʻa ʻo Tirzepatide i ka glucose koko ma o nā ʻano hana like ʻole, penei: Hoʻoulu ʻia o ka mea loaʻa GLP-1: Hoʻopaʻa ʻo Tirzepatide i ka mea loaʻa GLP-1 ma nā cell pancreatic β, e hoʻohālike ana i ka hopena o ka GLP-1 maoli. ʻO GLP-1 he hormone i hana ʻia i loko o ka ʻōpū a he mea koʻikoʻi ia no ka mālama ʻana i ka homeostasis glucose 2. Hiki iā ia ke hoʻoikaika i ka synthesis o ka insulin, ka huna ʻana o ka insulin, a me ka ʻike glucose, a hoʻemi i ka huna ʻana o ka glucagon e hoʻoikaika i ka māʻona a pale i ka makemake 2.
Hiki i kēia hana ke hoʻoikaika i ka huna ʻana o ka insulin. ʻO ka Insulin ka hormone hoʻohaʻahaʻa glucose koko nui i loko o ke kino, hiki ke hoʻonui i ka lawe ʻana a me ka hoʻohana ʻana i ka glucose e nā cell, a laila e hōʻemi i nā pae glucose koko. I nā poʻe maʻi me ke ʻano 2 metabolism mellitus, ʻaʻole lawa ka huna ʻana o ka insulin a i ʻole ua hoʻemi ʻia ka naʻau o nā cell i ka insulin, e alakaʻi ana i ka hoʻonui ʻana i ka glucose koko. Hoʻonui ʻo Tirzepatide i ka huna ʻana o ka insulin ma o ka hoʻāla ʻana i ka mea hoʻokipa GLP-1, e kōkua ana i ka hoʻomaikaʻi ʻana i ka mana glucose koko. I ka manawa like, hiki i ka hoʻoulu ʻana o ka mea hoʻokipa GLP-1 ke kāohi i ka hoʻokuʻu ʻana o ka glucagon. Hoʻoikaika pinepine ʻo Glucagon i ka glycogenolysis a me ka gluconeogenesis i ka mokuʻāina hoʻokē ʻai, e hoʻonui ana i ka hana glucose koko. Ma ka pale ʻana i ka hopena o ka glucagon, hoʻemi hou ʻo Tirzepatide i ke kumu o ka glucose koko, e kōkua ana i ka mālama ʻana i ka glucose koko [2] (Anonymous, 2023).
Hoʻoulu ʻia o ka mea loaʻa GIP: Hana ʻo Tirzepatide i ka mea loaʻa GIP i ka manawa like. Ma hope o ka hoʻoulu ʻana, hiki ke hoʻonui i ka naʻau a me ka huna ʻana o ka insulin. Loaʻa ka loaʻa ʻana o ka GIP i nā ʻiʻo e like me nā pancreatic β cell. Ma hope o ka hoʻoulu ʻana, ma o ka hana ʻana o ke ala hōʻailona intracellular, hoʻonui ʻia ka huna ʻana o ka insulin, a hoʻomaikaʻi ʻia ka pane ʻana o nā cell i ka insulin, a laila ʻoi aku ka maikaʻi o ka hoʻohaʻahaʻa ʻana i ke koko glucose 2. ʻO Tirzepatide ka mua o ka papa lua-glucagon-like peptide-1 a me ka glucose-dependent insulinotropic polypeptide (GIP) analog, i ʻae ʻia no ka mālama ʻana i nā mea maʻi me ke ʻano o ka jun metabolism2. ʻO Tirzepatide kahi hana kemika synthetic e pili ana i ke kaʻina GIP, i haku ʻia me kahi peptide 39-amino acid. Hoʻonui ia i ka huna ʻana o ka insulin, hoʻemi i ka hoʻokuʻu ʻana o ka glucagon ma ke ʻano pili i ka glucose, hoʻohaʻahaʻa i ka pae glucose koko hoʻokē ʻai a me ka postprandial, hoʻoikaika i ka māʻona, hoʻemi i ke kaumaha, a hoʻopaneʻe i ka hoʻokuʻu ʻana o ka ʻōpū.
ʻO kēia hopena agonist ʻelua ʻelua e ʻoi aku ka maikaʻi o Tirzepatide i ka hoʻolaha ʻana i ka huna ʻana o ka insulin a me ka pale ʻana i ka hoʻokuʻu ʻana o ka glucagon ma mua o ka GLP-1 receptor agonists [2].
Hoʻopaneʻe i ka hoʻokaʻawale ʻana o ka ʻōpū a me ka hoʻonui ʻana i ka māʻona: Hiki iā Tirzepatide ke hoʻopaneʻe i ka hoʻokuʻu ʻana o ka ʻōpū, hoʻolōʻihi i ka manawa noho o ka meaʻai i loko o ka ʻōpū, hoʻolohi i ka helu absorption o nā meaʻai, a pēlā e pale ai i ka piʻi nui o ka glucose koko postprandial. I nā haʻawina preclinical a me nā hoʻokolohua lapaʻau, ʻo ka hopena o Tirzepatide i ka hoʻokaʻawale ʻana o ka ʻōpū e like me ka GLP-1 receptor agonists. I nā ʻiole obese i hoʻokomo ʻia i ka meaʻai, ua like ke kiʻekiʻe o ka hoʻokaʻawale ʻana o ka ʻōpū e Tirzepatide me ka semaglutide, akā nalo kēia mau hopena inhibitory ma hope o 2 mau pule o ka mālama ʻana. I nā poʻe i komo me ka ʻole o ka type 2 metabolism mellitus, ʻo Tirzepatide i hoʻokahi pule i hoʻokahi pule (≥5 a me ≥4.5mg, kēlā me kēia) lohi i ka hoʻokaʻawale ʻana o ka ʻōpū ma hope o hoʻokahi maʻa. I nā poʻe komo olakino, ua hoʻemi ʻia kēia hopena ma hope o ka nui o nā dosis o Tirzepatide a i ʻole dulaglutide [3] .
I ka manawa like, hiki iā ia ke hana i ke kikowaena o ke kikowaena, hoʻonui i ka satiety, a hoʻemi i ka makemake a me ka ʻai ʻana i ka meaʻai. Ma ke kāohi ʻana i ka ʻai ʻana, kōkua ʻole ia i ka hoʻokele ʻana i nā pae glucose koko, kūpono loa no ka pilikia obesity i hele pinepine ʻia e nā poʻe maʻi me ke ʻano 2 metabolism mellitus, a kōkua i ka hoʻomaikaʻi ʻana i ka insulin a me ke kūlana metabolic holoʻokoʻa [2].
Hoʻomaikaʻi i ka ʻike insulin a me ka metabolism lipid: Ua ʻike ʻia ʻo Tirzepatide e hoʻonui i ke kiʻekiʻe o adiponectin, kahi adipocytokine e pili ana i ka ʻike insulin. ʻO ka piʻi ʻana o ke kiʻekiʻe o ka adiponectin e kōkua i ka hoʻomaikaʻi ʻana i ka naʻau o ka insulin, e hoʻonui ai i nā cell i ka insulin, a no laila ʻoi aku ka maikaʻi o ka lawe ʻana a me ka hoʻohana ʻana i ka glucose, e hōʻemi ana i ka glucose koko [2].
Eia kekahi, hiki i ka Tirzepatide ke hoʻomaikaʻi i ka lipid profile a loaʻa i kahi hopena pale i ke olakino cardiovascular. Ua hōʻike ʻia ʻo Tirzepatide e hiki ke hoʻomaikaʻi i ke kahe koko, e hoʻemi i ka lipoprotein haʻahaʻa haʻahaʻa (LDL) cholesterol a me nā triglycerides [4] .Kākoʻo hou kēia i kāna mau pono piha i ka hoʻokele glucose koko.
Ka noiʻi pili
ʻO ka maikaʻi o ka mālama kaumaha i nā maʻi me ka momona a me ke ʻano 2 metabolism mellitus:
Ua hōʻoia ka nui o nā haʻawina lāʻau lapaʻau i nā hopena hoʻemi koʻikoʻi: Ma kahi noiʻi i kapa ʻia ʻo 'SURMOUNT-2', ʻo kēia hoʻāʻo he pae 3, pālua-makapō, randomized, placebo-controlled hoʻokolokolo i mālama ʻia ma nā ʻāina ʻehiku. ʻO nā mākua (nā makahiki ≥18 makahiki) me ka helu helu kino kino (BMI) o 27 kg/m² a i ʻole ke kiʻekiʻe a me ka hemoglobin glycated (HbA₁c) o 7 - 10% i hāʻawi wale ʻia e loaʻa i hoʻokahi pule subcutaneous injection o Tirzepatide (10mg a i ʻole 15mg) a i ʻole placebo no 72 pule. Ua hōʻike nā hopena i ka pule 72, ʻo ka pākēneka o ka pohō kaumaha ma ka hui ʻo Tirzepatide 10mg a me 15mg he -12.8% a me -14.7%, ʻoiai ʻo ia i ka hui placebo he -3.2%. ʻO nā ʻokoʻa i manaʻo ʻia o ka lāʻau ʻo Tirzepatide 10mg a me 15mg i hoʻohālikelike ʻia me ka placebo he -9.6 pākēneka a me -11.6 pākēneka, ʻo ia mau mea ʻelua i helu nui (p~0.0001). Eia kekahi, ʻoi aku ka nui o nā poʻe maʻi i mālama ʻia me Tirzepatide i hiki i ka paepae o ka pohō kaumaha o 5% a ʻoi aku paha (79 - 83% vs 32%) [5] (Garvey WT, 2023). I loko o ka haʻawina 'SURMOUNT-2', ʻo ke kaupaona ʻana he 100.7 kg, ʻo ka BMI he 36.1 kg/m², a ʻo ka HbA₁c he 8.02%. Ma hope o 72 mau pule o ka mālama ʻana, ʻaʻole wale ʻo Tirzepatide i hoʻemi nui i ke kaumaha akā ua pāʻani pū kekahi i ka hana maikaʻi i ka hoʻokele glucose koko [5].
Hoʻonui ka hopena i ka neuropathy pili i ka metabolism:
Ua kuhikuhi kekahi mau noiʻi e hiki i ka glucagon-like peptide 1 receptor agonists (GLP1-RAs) ke hōʻemi i ka pilikia o ka dementia i nā maʻi me ke ʻano 2 metabolism mellitus ma o ka hoʻomaikaʻi ʻana i ka hoʻomanaʻo, ke aʻo ʻana, a me ka lanakila ʻana i ka hemahema o ka naʻau. Ma ke ʻano he ʻelua glucose-dependent insulin polypeptide receptor agonist (GIP-RA) / GLP-1RA, ua aʻo ʻia ʻo Tirzepatide no kāna mau hopena i nā māka o ka ulu ʻana o neuronal (CREB a me BDNF), apoptosis (BAX / Bcl2 ratio), ʻokoʻa (pAkt, MAP2, GAP43, a me AGBL4), a me ka insulin resistance (GLUT3 a me AGBL4), a me ka insulin resistance (GLUT3 a me AGBL1, GLUT4, , laina kelepona neuroblastoma (SHSY5Y). ʻO nā hualoaʻa no ka manawa mua i hoʻokūpaʻa i ke kuleana o Tirzepatide i ka hoʻouluʻana i ke ala pAkt / CREB / BDNF a me nā hōʻailona hōʻailona lalo, a me kona pono i ka neuroprotection. Ua hōʻike pū ʻia e hiki iā Tirzepatide ke pale aku i nā hopena e pili ana i ka hyperglycemia a me ka pale ʻana o ka insulin ma ka pae neuronal. No laila, hiki iā Tirzepatide ke hoʻomaikaʻi i ka neurodegeneration i hoʻokumu ʻia e ka hyperglycemia a lanakila i ka pale ʻana o ka insulinal neuronal, e hāʻawi ana i nā ʻike hou i ka hoʻomaikaʻi ʻana i ka neuropathy pili i ka metabolism [6] .
Ka holomua o ka noiʻi ʻana i ka mālama ʻana i ke ʻano 2 metabolism mellitus:
Ua hōʻike ʻia kekahi mau haʻawina ʻo Tirzepatide, he ʻano hou o ka lāʻau hypoglycemic, ua lilo ia i ʻelua GIP / GLP-1R agonist mua i ʻae ʻia no ka mālama ʻana i ka metabolism ma United States. Ua hōʻoia ʻia ka loaʻa ʻana o nā hopena hoʻohaʻahaʻa glucose koko a me nā hopena paona i nā hoʻokolohua lapaʻau nui nui, a aia nā hōʻike e loaʻa ai ka mana nui i ka pale cardiovascular. Eia kekahi, ua wehe ka manaʻo o nā peptides synthetic i nā mea i ʻike ʻole ʻia no Tirzepatide. Ke hoʻomau nei nā ho'āʻo (NCT04166773) a me nā hōʻike hōʻike e ʻike ʻia he lāʻau hoʻohiki maikaʻi ia ma nā kahua o ka maʻi ʻaʻai momona ʻole (NAFLD), renal a me neuroprotection, etc. [7].
Nā hopena lōʻihi o ka T irzepatide i ke olakino cardiovascular:
Hiki i ka Tirzepatide ke hōʻemi i ka pilikia o nā maʻi cardiovascular ma o ka hoʻoikaika ʻana i ke kaumaha o ke kaumaha. Ua nānā ʻia kahi haʻawina i ka hopena o Tirzepatide i ka momona a me nā hanana maʻi cardiovascular i nā poʻe ʻAmelika [8] . Ua ʻike ʻia i waena o nā poʻe ʻAmelika e kūpono i ka mālama ʻana iā Tirzepatide, ma hope o ka mālama ʻana me 15mg o Tirzepatide, ua manaʻo ʻia ʻo 70.6% a me 56.7% o nā pākeke i loaʻa ke kaumaha o ≥15% a me ka ≥15% o kēlā me kēia poʻe. ua emi iho e 58.8%. I ka poʻe me ka maʻi ʻole o ka maʻi cardiovascular, ua hoʻemi ʻia ka pilikia o 10 mau makahiki o nā maʻi cardiovascular mai 10.1% ma mua o ka mālama ʻana i 7.7% ma hope o ka mālama ʻana, e hōʻike ana i ka hōʻemi ʻana o ka pilikia o 2.4% a me ka hōʻemi o ka pilikia o 23.6%, ʻo ia hoʻi he 2 miliona mau hanana maʻi cardiovascular hiki ke pale ʻia i loko o 10 mau makahiki.
I ka hopena, ʻo Tirzepatide kahi moʻolelo ʻelua agonist o GIP a me GLP-1 receptors a he koʻikoʻi nui ia i ka mālama ʻana i ka type 2 metabolism mellitus a me ka momona. Hiki iā ia ke hoʻoikaika maikaʻi i ka huna ʻana o ka insulin, kaohi i ka huna ʻana o ka glucagon, hoʻoponopono pololei i ka glucose koko, hoʻemi i ka hopena o nā pilikia, hoʻomaikaʻi i ka hana o nā pancreatic β cell, a hoʻopaneʻe i ka holomua o ka metabolism. Loaʻa iā ia kahi hopena pale i ka ʻōnaehana cardiovascular. I ka mālama ʻana i ka momona, hiki iā ia ke hōʻemi pono i ka ʻai ʻana i ka meaʻai, hoʻemi i ka ʻai, hoʻonui i ka māʻona, kōkua i nā poʻe maʻi obese e hoʻemi i ke kaumaha, a hoʻemi i ka hopena o nā pilikia pili i ka momona. Hiki iā ia ke hoʻomaikaʻi i ka insulin resistance a me ka lipid metabolism. Eia kekahi, hōʻike ia i ka hiki ke mālama i nā maʻi e pili ana i ka metabolic abnormality e like me ka steatohepatitis non-alcoholic, sleep apnea syndrome, a me ka pau ʻole o ka naʻau, a hiki i ka manawa like ke hoʻomaikaʻi i nā hōʻailona metabolic he nui, e hāʻawi ana i kahi hoʻolālā lapaʻau piha. ʻO kāna ʻano hoʻokele injection hoʻokahi pule he maʻalahi ke hoʻohana a hiki ke hoʻomaikaʻi i ka mālama ʻana o nā maʻi. Ma ka mālama pono ʻana i ka glucose koko a me ke kaumaha a me ka hōʻemi ʻana i ka pilikia o nā pilikia, hiki ke hoʻomaikaʻi maikaʻi ʻia ke kūlana kino o nā maʻi, hiki ke hoʻonui ʻia ko lākou hiki ke hana i kēlā me kēia lā a me ka maikaʻi o ke ola, hiki ke hoʻonui ʻia ko lākou hilinaʻi i ka mālama ʻana i nā maʻi, hiki ke hoʻomaha ʻia ko lākou kaumaha noʻonoʻo, a hiki ke hoʻomaikaʻi ʻia ko lākou nohona pili.
No ka mea kakau
ʻO nā mea i ʻōlelo ʻia ma luna nei ua noiʻi ʻia, hoʻoponopono ʻia a hōʻuluʻulu ʻia e Cocer Peptides.
Mea kākau moʻolelo ʻepekema
ʻO Kauka William T. Garvey he kanaka naʻauao kaulana a me ka mea noiʻi i hui pū ʻia me nā ʻoihana hanohano he nui, ʻo ia hoʻi ke Kulanui o Alabama ma Birmingham, Aston University, a me ka Birmingham Veterans Affairs Medical Center. ʻO kona ʻano hoʻonaʻauao a me kāna ʻike ʻoihana e pili ana i nā ʻano aʻoaʻo ākea i loko o ka lāʻau lapaʻau a me ka ʻepekema. Ua hāʻawi nui ʻo Kauka Garvey i nā ʻano o ka endocrinology a me ka metabolism, ka meaʻai a me ka meaʻai, ka biochemistry a me ka biology mole, a me ka lāʻau lapaʻau maʻamau a me loko, me ka nānā pono ʻana i ka ʻōnaehana cardiovascular a me ka cardiology. Ua ʻike nui ʻia a hoʻohanohano ʻia kāna hana, ʻoiai ua kapa ʻia ʻo ia he Highly Cited Researcher ma ka Cross-Field category no 2023 a me 2024, e hōʻike ana i ka hopena nui a me ka mana o kāna noiʻi ʻana i ke kaiāulu ʻepekema ākea.
Hoʻonui ʻia ko Kauka Garvey makemake noiʻi a me ke akamai i nā ʻano like ʻole o nā maʻi metabolic a me kā lākou hoʻokele. Ua komo ikaika ʻo ia i ke aʻo ʻana i ka metabolism mellitus, ka momona, a me kā lākou mau pilikia pili, e manaʻo ana e wehe i nā hoʻolālā therapeutic novel a hoʻomaikaʻi i nā hopena maʻi. Hoʻopili ʻia kāna hana i ka noiʻi ʻepekema kumu, nā hoʻokolohua lapaʻau, a me nā noiʻi unuhi, e hoʻopaʻa ana i ka ʻokoʻa ma waena o nā ʻike noiʻi a me nā noi olakino honua maoli. Ma o kāna noiʻi nui, ua hāʻawi ʻo Kauka Garvey i ka ʻike hohonu ʻana i nā ʻano kumu o nā maʻi metabolic a ua kōkua i ke ʻano o nā alakaʻi alakaʻi a me nā protocol lapaʻau ma ke kahua o ka endocrinology a me ka metabolism. Ua helu ʻia ʻo Kauka William T. Garvey ma ka ʻōlelo kuhikuhi [5].
