Gut health gamechanger: the specialist behind four new classes of medicines

In 1921, a small team of scientists at the University of Toronto discovered insulin and its ability to treat patients living with type 1 diabetes. The discovery has since saved countless lives across the world and is arguably one of the most valuable medical developments of the 20th century.

Now, 100 years later, the work of a senior scientist at the same Canadian university has not only helped revolutionise the treatment of type 2 diabetes, obesity and a range of intestinal disorders, but is also paving the way for the next generation of researchers.

Prof Daniel Drucker is a clinician-scientist and specialist in endocrinology – the study and treatment of hormone-related diseases – whose laboratory is based in the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto. Drucker has spent much of his career researching and detailing the molecular and physiological effects of peptides known as glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2). Found in the small and large intestines, GLP-1 belongs to a family of hormones known as incretins, which regulate blood glucose homeostasis (stability) and are released almost immediately after eating. As such, their overall function is to aid in digestion.

Through decades of research, Drucker and his colleagues have discovered a range of therapeutic applications for these peptides.

Scientists have now successfully exploited GLP-1 in the treatment of type 2 diabetes and obesity, with several GLP-1-like drugs, known as GLP-1 analogues, available on the market. These drugs can produce more insulin in the pancreas and reduce the amount of glucose produced in the liver when it is not required. They also slow the rate at which the stomach digests food and can even reduce appetite. GLP-1 analogues, as well as other medicines, such as dipeptidyl peptidase 4 (DPP-4) inhibitors which prevent the breakdown of GLP-1, have now been used to treat type 2 diabetes in more than 100 million people across the world. There is even evidence that GLP-1 has cardioprotective and neuroprotective effects and could be valuable in future treatment of neurodegenerative disorders such as Alzheimer’s.

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GLP-2 analogues stimulate intestinal growth and have been used to treat people with intestinal failure, often secondary to inflammatory bowel diseases. This condition, known as short bowel syndrome, arises when the small intestine is too short to absorb enough nutrients and fluids from food. People with short bowel syndrome are often reliant on intravenous nutrition, but GLP-2 treatments can offer a valuable alternative, reducing or eliminating the need for intravenous feeding.

Whereas many scientists hope they will be part of one major therapeutic advancement in their lifetime, Drucker has played a fundamental role in developing four different new classes of medicines for treating metabolic diseases. He describes it as “winning the lottery four different times”. The University of Toronto has been an important factor in this story too. Drucker, a professor at the university’s Temerty Faculty of Medicine, says that the university is a unique environment for carrying out science. It placed fifth in the world for clinical medicine in the 2020 US News & World Report rankings and, as the only university in Toronto with a medical school, “we have this tremendous breadth and strength across scientific disciplines”. He adds that when you work at a really good university “it is easy to find smart people to help you”, which he believes fosters collaborative research.

Drucker’s success is not due to a flash-in-the-pan discovery. It is the product of decades of careful, methodical research and collaborative work. At a time when many funding challenges face the scientific community, Drucker believes it is important to support the development of basic science. Funders often want to force breakthroughs in a short period of time, but the reality is that he and his team do “basic science with translational implications”.

This is why he has taken a keen interest in supporting the next generation of researchers and aims to not only offer a vibrant and healthy environment to work in, but to also provide his team with the skills and expert contacts needed to solve future problems. In this sense, Drucker sees his colleagues as family members and, like any parent, he feels it is “important to see the next generation bloom”. “I don’t think this is in any way a secret.” he says. “Having good teams working together is a great way to succeed in science.”

Earlier this year, Drucker received a 2021 Canada Gairdner International Award for his research into glucagon-like peptides. The Gairdner Foundation was established in 1957 to recognise fundamental research that impacts human health; about a quarter of its award recipients have later received Nobel prizes.

Dr Russell Moul holds a PhD in the history of colonial science and medicine and medical ethics