Genetic and preclinical evidence implicating chondroitin sulfate as a matritherapeutic target for the treatment of type 2 diabetes

Peptide-based treatments for type 2 diabetes (T2D) are often limited by variable patient responses, frequent discontinuation, and substantial costs. Emerging lines of evidence link the extracellular matrix (ECM) to the pathophysiology of T2D, highlighting a largely unexplored modality for managing this heterogenous disease. Chondroitin sulfate (CS), a major glycosaminoglycan in the ECM, has been suggested to improve cardiometabolic health in preclinical research. However, the human genetic and pharmacological basis for CS as an anti-diabetic target is largely unexplored. Here, we uncover novel and robust links between 12 CS-related genes and both glycemic traits and the risk of T2D in hu-mans. Complementing this, administration of CS leads to a profound lowering of blood glucose levels in severely diabetic mice and improves glucose tolerance and cardiac clearance of circulating glucose in diet-induced obese mice without causing hypoglyce-mia or other adverse effects. The improvement in glycemic control is accompanied by increased glucose-stimulated insulin secretion and enhanced insulin action, effects which seem to occur independent of the incretin system. The combination of human genetic evidence and appealing pharmacodynamic features highlights CS as a promising ECM-target for developing novel pharmacotherapies that complement current treatments for T2D.