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Month-Long Diabetes Control Possible with New Injection

A new biopolymer-containing formulation may improve the delivery of glucose-control medication, extending the time a single injection stays effective. (Top two photos) A glucose-controlling drug (blue) is shown completely dissolving after 24 hours in the body

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A new biopolymer-containing formulation may improve the delivery of glucose-control medication, extending the time a single injection stays effective. (Top two photos) A glucose-controlling drug (blue) is shown completely dissolving after 24 hours in the body of a mouse. (Bottom two photos) A newly optimized version of a diabetes treatment forms a “depot” for controlled release that persists more than 24 hours. [Ashutosh Chilkoti/Duke University]

The daily or once-weekly insulin shot—necessary for the control of type 2 diabetes—could be replaced by a twice- or even once-a-month shot. A new, longer-lasting injectable formulation has been developed that combines a familiar diabetes-control molecule, glucagon-like peptide-1 (GLP1), with a heat-sensitive elastin-like polypeptide (ELP). Once a solution containing the GLP1–ELP combo passes through a standard needle and penetrates the skin, it reacts to body heat, forming a biodegradable gel-like “depot” that slowly releases the drug as it dissolves.

The novel drug-delivery mechanism was developed by scientists based at Duke University, who assert that it could be used to “enhance therapeutic outcomes by eliminating peak-and-valley pharmacokinetics and improving overall safety and tolerability.” The scientists, led by Ashutosh Chilkoti, Ph.D., chair of the department of biomedical engineering at Duke, suggest that their work could be “broadly applicable”; that is, it could improve the pharmacological performance of peptides and protein therapeutics besides GLP1.

Details of the work appeared June 5 in the journal Nature Biomedical Engineering, in an article entitled “One-Week Glucose Control via Zero-Order Release Kinetics from an Injectable Depot of Glucagon-Like Peptide-1 Fused to a Thermosensitive Biopolymer.” The “one week” indicated in the title refers to the drug depot’s performance in mice. Glucose control, the scientists found, was more durable in rhesus monkeys, and even longer glucose control, the scientists suggested, could be achieved in humans, since humans have slower metabolisms than mice or monkeys.

“A subcutaneous depot formed after a single injection of GLP1 recombinantly fused to a thermosensitive elastin-like polypeptide results in zero-order release kinetics and circulation times of up to 10 days in mice and 17 days in monkeys,” the authors of the article indicated. “The optimized pharmacokinetics lead to 10 days of glycaemic control in three different mouse models of diabetes, as well as the reduction of glycosylated haemoglobin levels and weight gain in ob/ob mice treated once weekly for 8 weeks.”

Many current treatments for type 2 diabetes use GLP1, a signaling molecule that causes the pancreas to release insulin to control blood sugar. However, this peptide has a short half-life and is cleared from the body quickly.

To make treatments last longer, researchers have previously fused GLP1 with synthetic microspheres and biomolecules like antibodies, making them active for 2 to 3 days in mice and up to a week in humans. Currently, the longest-acting glucose control treatment on the market, dulaglutide, requires a once-weekly injection, while standard insulin therapies often have to be injected twice or more every day. Despite improvements such as these, many treatments don't include a mechanism to control the rate of the peptide's release, and treatment effectiveness can plateau after prolonged use.

The Duke researchers persisted with their ongoing experiments, which focused on thermosensitive delivery biopolymers. By varying the design of their delivery biopolymers at the molecular level, they found a “sweet spot” that maximized the duration of the drug's delivery from a single injection, noted Dr. Chilkoti. “By doing so,” he continued, “we managed to triple the duration of this short-acting drug for type 2 diabetes, outperforming other competing designs.”

Building upon their previous work with the drug and delivery system, researchers in the Dr. Chilkoti’s laboratory optimized their solution to regulate glucose levels in mice for 10 days after a single injection, up from the previous standard of 2 to 3 days.

In further tests, the Duke team found that the optimized formulation improved glucose control in rhesus monkeys for more than 14 days after a single injection, while also releasing the drug at a constant rate for the duration of the trial.

“What's exciting about this work was our ability to demonstrate that the drug could last over 2 weeks in nonhuman primates,” remarked Kelli Luginbuhl, a Ph.D. student in Dr. Chilkoti’s laboratory and co-author of the study. “Because our metabolism is slower than monkeys and mice, the treatment should theoretically last even longer in humans, so our hope is that this will be the first biweekly or once-a-month formulation for people with type 2 diabetes.”

Despite a variety of treatment options, managing type 2 diabetes still poses a problem. Patients don't always reach their glycemic targets, and adherence to a treatment plan that relies on frequent, meal-specific dosing leaves room for human error. By limiting the number of injections a person will need to control their glucose levels, the researchers hope this new tool will improve treatment options for the disease.

The researchers now plan to study the immune response to repeated injections and test the material with other animal models. They are also considering additional applications for this controlled-release system, such as delivering pain medication.

Dr. Chilkoti also indicated that because the drug is synthesized inside Escherichia coli bacterial cultures instead of mammalian cells, it is cheaper and faster to produce, making it a potential target for use in developing countries once it's commercialized.

According to a report issued last year by Grand View Research, the global insulin market is expected to reach $53.04 billion by 2022. Grand View anticipates that the most lucrative segment will consist of long-acting analogs. The segment’s high growth rate, estimated at 15.0%/year, is accounted for by fast-selling products such as Lantus by Sanofi Aventis. Moreover, the addition of new products such as Novo Nordisk’s Tresiba ultra-long-acting analog is expected to further drive segment growth. Tresiba is administered subcutaneously once daily at any time of day. Even longer-lasting formulations, such as those contemplated by Dr. Chilkoti’s team, may contribute to yet more growth in the segment.

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03What roles does the system play?

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05A peptide identified in a fungus found in northern European pine forests possesses as much power as penicillin as well as vancomycin, according to an international team of researchers.

Reporting in the October 13 issue of Nature, a team from Denmark-based biotech company Novozymes, and researchers from Georgetown University Medical Center and the David Geffen School of Medicine at UCLA, say they have isolated "plectasin," the first defensin ever found in fungi. The research was performed at Novozymes laboratories in Denmark. Defensins are peptides, miniature protein molecules that are produced by a wide range of animals to protect themselves against infection. Humans have defensins in their white blood cells and in their skin, for example, but it is believed that this new fungal defensin, plectasin, is more potent and targets certain bacteria more specifically. Indeed, when plectasin was tested in the laboratory and in animals, it proved to be highly effective against the bacteria Streptococcus pneumoniae, and Streptococcus pyogenes, including strains that are now resistant to conventional antibiotics. These bacteria are responsible for such diseases as meningitis, community-acquired pneumonia, strep throat, life-threatening sepsis, and flesh destroying skin infections. The discovery of plectasin has implications for the development of defensins as a treatment against many common, and deadly, infections, and may initiate a new era of antibiotic discovery and development, said study co-author Michael Zasloff, M.D., Ph.D., Professor in the Departments of Surgery and Pediatrics at Georgetown University Medical Center. Zasloff says that the field of antibiotic development has not changed much since 1929 when Alexander Fleming realized that the fungal "bread mold" Penicillium, which had landed by chance in a Petri dish produced a substance that eliminated colonies of staphylococcal bacteria. "Most antibiotics used by humans are produced by fungi and certain soil bacteria," he said. "Using our existing tools of discovery, we have failed to uncover any new classes of antibiotics from these sources over the past decade. However, by utilizing a new genetic approach that allowed the team to discover plectasin, we now know that a whole class of antibiotics has been overlooked." "This finding (plectasin), and the existence of about 200,000 additional species of fungi, opens up a vast universe to explore for novel peptide antibiotics," said co-author Robert Lehrer, M.D., Distinguished Professor of Medicine at the David Geffen School of Medicine at UCLA. Plectasin, if proven safe and effective in humans, could be on the market by 2012, said Lehrer. Zasloff and Lehrer are known internationally as experts in antimicrobial peptides - the class of antibiotics that plectasin falls within - and in this study they collaborated with Novozymes, a Danish biotech company that led the research. Zasloff and Lehrer are the only two scientists from U.S. universities on the team of 20 researchers who co-authored the research paper. All life forms have to defend themselves against microbial invaders - bacteria, fungi, viruses - and to do this, they produce antimicrobial defensin peptides. In humans, defensins are made by specific white blood cells and immune cells that later engulf foreign invaders, and by the skin and mucous membranes, in order to kill microbes before they invade protective barriers. Researchers believe that fungi have a similar system of defense, especially since these plant-like organisms live off rotting matter, said Zasloff. "They must compete with other organisms, like bacteria and viruses, which also want to consume the same meal. In addition, they need to defend themselves from being eaten by the microbes which surround them." But he said no one had been able to find defensins in fungi using traditional research techniques, which involved growing fungi in liquid cultures and then testing the culture to see if it contained any antibiotic molecule. The research team instead used the latest genetic science to search for the defensins they thought fungi must have. Selecting the Pseudoplectania nigrella species of fungus may have been serendipitous, Lehrer said, but the Novozymes team used state-of-the-art biotechnology to intercept ,and interpret its genetic messages and exhibited tremendous skill in producing plectasin efficiently, economically, and in large amounts." "I started working on antimicrobial peptides over three decades ago, said Lehrer, and my laboratory first described human defensins in 1985. So, the discovery of plectasin makes me feel like a grandfather." Further examination revealed that this defensin, plectasin, resembles defensins found in spiders, scorpions, dragonflies and mussels - thus suggesting that the defensins found in insects, molluscs and fungi arose from a common ancestral gene, the researchers say. Based on this information, the scientists now believe that defensins appeared in living things more than a billion years ago. The investigators then turned to the National Center for Antimicrobials and Infection Control, the Danish equivalent of the U.S. Centers for Disease Control, to test plectasin in the laboratory for antimicrobial activity against a broad spectrum of bacteria. It showed potent activity against several species of Gram-positive bacteria, and was especially active against S. pneumoniae (the leading cause of pneumonia), including all known clinical strains and those that are now resistant to conventional antibiotics. "That is important because increasing bacterial resistance to conventional antibiotics threatens the future of many antibiotics in current use," Zasloff said. "In mouse studies, plectasin showed extremely low toxicity, and was as effective as vancomycin and penicillin in curing the animals of experimental peritonitis (inflammation of the lining of the abdominal cavity, which can be deadly) and pneumonia caused by S. pneumoniae, the researchers report. "Although the precise mechanism by which plectasin exerts its antimicrobial activity is still under investigation, it may work by a mechanism that is very different from traditional antibiotics, Zasloff said. "As a group, defensins exhibit activity against many types of bacteria, fungi, protozoa, and even viruses. It is entirely possible that fungal defensins will be discovered that could be developed against all of these human pathogens," Zasloff added.

Source: www.news-medical.net ↗
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Peptide Therapy Guide Editorial Team

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