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  "documentTitle": "Soleno Therapeutics (SLNO)",
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  "authorName": "Scorpion Capital",
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  "presentationDate": "2025-08-15 00:00:00",
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  "notes": "The seesaw diagram is a visual metaphor for the mechanism of action and its unintended side effects.",
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      "text": "However, chronic diazoxide therapy to lower insulin in PWS tips the scale to pharmacologically-driven insulin resistance, and prolonged mild/moderate hyperglycemia may cause irreversible type 2 diabetes (T2D).",
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      "text": "Seesaw diagram showing the shift from VHTG (High Insulin) to PWS (Low Insulin/Pharmacological Diabetes) via DCCR (Diazoxide) treatment.",
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      "text": "Vykat XR aka diazoxide choline mechanistically and inherently drives risk of hyperglycemia and type 2 diabetes. Diazoxide was approved in 1973 to treat hyperinsulinemia, a condition where the pancreas produces excess insulin. Diazoxide’s primary use case since then has been to inhibit insulin secretion to treat infant hyperinsulinism. Diazoxide is a potent opener of the KATP channels in pancreatic insulin-producing cells, reducing circulating insulin by >50%. Opening KATP channels allows K+ to leave the cell, making the inside of the cell more negative (hyperpolarization), decreasing Ca++ influx and a reduction in insulin release. Half a century of congenital hyperinsulinemia treatment demonstrate unequivocally that diazoxide’s primary and most sensitive action = ↓ insulin. Normalizing insulin in hyper-insulinemic patients restores metabolic homeostasis. However, chronic diazoxide therapy to lower insulin in PWS tips the scale to pharmacologically-driven insulin resistance, and prolonged mild/moderate hyperglycemia may cause irreversible type 2 diabetes (T2D).",
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