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Mizagliflozin is a potent, orally active, and selective inhibitor of sodium-glucose cotransporter 1 (SGLT1), with a Ki of 27 nM for human SGLT1 and over 300-fold selectivity versus SGLT2. It was developed as an antidiabetic agent to modify postprandial blood glucose excursions and as a potential treatment for chronic constipation. Mizagliflozin acts primarily in the small intestine due to its poor systemic absorption, inhibiting intestinal glucose transport via SGLT1, which leads to increased water content in stools and improved bowel movements. The drug reached Phase II clinical trials for chronic constipation but was not approved for medical use; development has since been discontinued for this indication. Mizagliflozin has also been investigated in other contexts such as vascular cognitive impairment through neural SGLT1 inhibition.
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