Takeda G-protein-coupled receptor 5 and farnesoid X receptor agonists for diabetes treatment: a patent review and clinical advancements (2015-present)

INTRODUCTION: Takeda G-protein-coupled receptor 5 (TGR5) and farnesoid X receptor (FXR) are bile acid-activated receptors involved in glucose, lipid, and energy homeostasis, making them promising therapeutic targets for type 2 diabetes mellitus (T2DM) and metabolic liver diseases. AREAS COVERED: This review critically analyzes patents published between 2015 and 2025 retrieved from WIPO Patentscope, Espacenet, USPTO, and Google Patents using keyword- and IPC-based strategies. Major patented chemotypes include modified bile acids, benzoic acid-cholane hybrids, heteroaryl scaffolds, and sulfonylurea/sulfonamide derivatives. Several compounds demonstrated sub micromolar (µM) to nanomolar (nM) TGR5/FXR agonistic activity, while gut-restricted agonists showed enhanced GLP-1 secretion with reduced systemic adverse effects such as gallbladder filling and pruritus. Comparative patent analysis revealed a progressive transition from classical steroidal scaffolds toward tissue-selective and gut-restricted modulators designed to improve receptor selectivity, pharmacokinetics, and translational safety. EXPERT OPINION: Despite strong preclinical promise, the clinical translation of TGR5 and FXR agonists remains limited by mechanism-driven toxicities and inadequate long-term tolerability. Future progress will likely depend on tissue-selective, pathway-biased, and gut-restricted modulation rather than further increases in receptor potency.