NYU Langone Health researchers have developed a promising experimental compound that targets the underlying mechanisms of diabetic complications, offering a novel therapeutic approach that goes beyond traditional blood sugar management. The small molecule drug, called RAGE406R, demonstrated significant efficacy in reducing cell death, inflammation, and organ damage associated with both type 1 and type 2 diabetes in preclinical studies.
Breakthrough Mechanism of Action
The compound works by preventing the harmful interaction between two key proteins: RAGE (Receptor for Advanced Glycation End Products) and DIAPH1. This protein coupling enables the heart and kidney injury commonly seen in diabetes and impairs wound healing. RAGE406R competes for the binding site on RAGE that would otherwise be occupied by DIAPH1, which builds actin filaments forming part of the cell's structural skeleton.
"There are currently no treatments that address the root causes of diabetic complications, and our work shows that RAGE406R can—not by lowering the high blood sugar, but instead by blocking the intracellular action of RAGE," said co-senior study author Ann Marie Schmidt, MD, the Dr. Iven Young Professor of Endocrinology at NYU Grossman School of Medicine.
Targeting Advanced Glycation End Products
RAGE serves as a receptor for advanced glycation end products (AGEs), signaling molecules created when proteins or fats attach to sugars in people with diabetes. These AGEs accumulate in the blood of individuals with diabetes and obesity, as well as during normal aging. The research team demonstrated that when DIAPH1 attaches to the intracellular tail of RAGE, this complex increases the formation of actin structures that worsen diabetic complications.
Preclinical Efficacy Results
In testing using a chronic diabetes complications model focused on impaired wound healing in obese mice with type 2 diabetes, RAGE406R showed remarkable results. Topical treatment with the compound accelerated wound closure in both male and female diabetic mice. The mechanism involves the body's immune system, where RAGE406R reduced levels of CCL2, a key proinflammatory chemokine, which dampened inflammation in macrophages and promoted tissue healing.
Drug Development Journey
The compound represents the culmination of extensive screening efforts by Dr. Schmidt's team, who evaluated a library of more than 58,000 molecules to identify substances that could competitively inhibit RAGE-DIAPH1 signaling. Their previous lead candidate, RAGE229, failed safety testing due to potential DNA-altering properties that could create cancer risk. RAGE406R effectively eliminates these concerning structural elements while maintaining therapeutic efficacy.
Clinical Implications and Future Directions
The research, published as a cover story in Cell Chemical Biology, addresses a significant unmet medical need in diabetes care. Current treatments primarily focus on blood sugar control and work mainly against type 2 diabetes, leaving gaps in addressing the fundamental causes of diabetic complications.
"If confirmed by further testing in human trials, the compound could potentially fill gaps in treatment, including the fact that most current drugs work only against type 2 diabetes," Dr. Schmidt noted.
Co-senior study author Alexander Shekhtman, PhD, a professor in the Department of Chemistry at SUNY Albany, emphasized the broader therapeutic potential: "Our findings point to a promising new pathway for treating diabetes in the future. The current study results serve as a springboard for the development of therapies for both types of diabetes, and for designing markers that can measure how well the new treatment works in live animals."
The research involved collaboration between NYU Langone Health's Diabetes Research Program and SUNY Albany, with support from multiple U.S. Public Health Service grants. Several researchers are named on patent applications owned by NYU Langone Health covering this work, with intellectual property relationships managed according to institutional policies.
