Summary

Teduglutide is a 33-amino-acid analogue of glucagon-like peptide-2 (GLP-2), modified with a single glycine-to-alanine substitution at position 2 to confer resistance to DPP-4 degradation. Approved by the FDA and EMA in 2012 as Revestive/Gattex for the treatment of short bowel syndrome (SBS) with intestinal failure, teduglutide promotes intestinal mucosal growth and adaptation, reducing dependence on parenteral nutrition. It represents a landmark in peptide-based therapy for gastrointestinal disorders. This profile is for research and educational purposes only.

Mechanism

Teduglutide is an agonist of the GLP-2 receptor, a G-protein-coupled receptor expressed primarily on intestinal enteroendocrine cells, subepithelial myofibroblasts, and enteric neurons. Activation promotes: (1) intestinal crypt cell proliferation and villus growth, increasing absorptive surface area; (2) enhanced nutrient and fluid absorption; (3) decreased gastric emptying and intestinal motility, improving absorption time; (4) increased intestinal blood flow. The single amino acid substitution (Gly2→Ala) confers DPP-4 resistance, extending biological activity from minutes to hours.

Evidence base

Teduglutide has strong clinical evidence from the phase 3 STEPS trial (n=86), the STEPS-2 open-label extension (up to 30 months), and supporting animal and human biopsy studies. Efficacy in reducing parenteral nutrition dependence is well established. Long-term safety surveillance is ongoing regarding theoretical neoplasia risk.

Protocols

Teduglutide is a licensed prescription medicine. In clinical practice, it is administered at 0.05 mg/kg subcutaneously once daily. Patients undergo monitoring of fluid/electrolyte balance and periodic colonoscopy surveillance. These protocols are described for research reference only and do not constitute dosing advice.

Teduglutide is classified as a Prescription-Only Medicine (POM) in the United Kingdom. Revestive is licensed by the MHRA. Supply without a prescription is unlawful. As a specialist medicine for short bowel syndrome, it is prescribed by consultant gastroenterologists and nutrition support teams.

Vendor notes

Teduglutide is a licensed POM available only through registered pharmacies with a valid prescription, typically via specialist NHS centres. We do not list research-grade vendors for this compound. Researchers requiring teduglutide for in vitro or animal studies should source from established biochemical supply companies with appropriate COAs.

References

  1. Jeppesen PB, Pertkiewicz M, Messing B, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012;143(6):1473–1481.
  2. Schwartz LK, O'Keefe SJD, Fujioka K, et al. Long-term teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol. 2016;7(7):e180.
  3. Sigalet DL, Bawazir O, Martin GR, et al. Glucagon-like peptide-2 induces a specific pattern of adaptation in remnant intestine. Transplantation. 2007;83(7):938–943.
  4. Seidner DL, Schwartz LK, Winkler MF, et al. Increased intestinal absorption in the era of teduglutide and its impact on management. JPEN J Parenter Enteral Nutr. 2013;37(5):582–589.
  5. Compher C, Gilroy R, Pertkiewicz M, et al. Maintenance of parenteral nutrition volume reduction after teduglutide in adults with short bowel syndrome SBS-IF. JPEN J Parenter Enteral Nutr. 2016;40(5):695–703.