1
|
Jensen VFH, Brinck PR, Nowak J, Thorup I, Sjögren I, Mølck AM. Evaluation of Cell Proliferation in Rat Mammary Glands Is Not Predictive of the Carcinogenic Potential of Insulin In Vivo. Int J Toxicol 2020; 39:560-576. [PMID: 32723118 DOI: 10.1177/1091581820941776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For nonclinical safety-assessment of insulin analogues in vivo, mitogenic effects are compared to that of human insulin. Besides histopathologic evaluation, this usually includes assessment of cell proliferation (CP) in mammary glands. Insulin analogue X10 is recommended as positive control, due to its known carcinogenic effect in rat mammary glands. Here, we discuss the mitogenic effect of insulin in vivo and use of X10 as positive control. We present results from 4 nonclinical rat studies evaluating effects of repeated dosing with insulin detemir (≤26 weeks) or degludec (52 weeks) in mammary glands. Studies included human insulin-dosed groups as comparators, CP, and histopathologic evaluation. One study included an X10-dosed group (26 weeks), another ≤3 weeks of dosing with X10 or human insulin evaluating effects of these comparators. Neither human insulin, insulin detemir, degludec, nor X10 induced mammary tumors or increased CP in the studies. The CP marker proliferating cell nuclear antigen varied within/between studies and was not correlated with the remaining markers or CP fluctuations during estrous cycle, whereas the other CP markers, Ki-67 and 5-bromo-2'-deoxyuridine (BrdU), correlated with estrous cycle changes and each other. In conclusion, we propose that the mitogenic effect of insulin in rat mammary glands is weak in vivo. Cell proliferation evaluation in nonclinical safety assessment studies is not predictive of the carcinogenic potential of insulin, thus, the value of including this end point is debatable. Moreover, X10 is not recommended as positive control, due to lack of proliferative effects. Typical CP markers vary greatly in quality, BrdU seemingly most reliable.
Collapse
Affiliation(s)
| | - Peter R Brinck
- Department of Safety Sciences & Imaging, 1450Novo Nordisk A/S, Maaloev, Denmark
| | - Jette Nowak
- Department of Safety Sciences & Imaging, 1450Novo Nordisk A/S, Maaloev, Denmark
| | - Inger Thorup
- Department of Safety Sciences & Imaging, 1450Novo Nordisk A/S, Maaloev, Denmark
| | - Ingrid Sjögren
- Department of Safety Sciences & Imaging, 1450Novo Nordisk A/S, Maaloev, Denmark
| | - Anne-Marie Mølck
- Department of Safety Sciences & Imaging, 1450Novo Nordisk A/S, Maaloev, Denmark
| |
Collapse
|
2
|
Abstract
Insulin is an important polypeptide hormone that regulates carbohydrate metabolism.
Collapse
Affiliation(s)
- Yixiao Shen
- Department of Food Science
- Shenyang Agricultural University
- Shenyang
- China
| | - Witoon Prinyawiwatkul
- School of Nutrition and Food Sciences
- Louisiana State University
- Agricultural Center
- Baton Rouge
- USA
| | - Zhimin Xu
- School of Nutrition and Food Sciences
- Louisiana State University
- Agricultural Center
- Baton Rouge
- USA
| |
Collapse
|
3
|
Borgquist S, Rosendahl AH, Czene K, Bhoo-Pathy N, Dorkhan M, Hall P, Brand JS. Long-term exposure to insulin and volumetric mammographic density: observational and genetic associations in the Karma study. Breast Cancer Res 2018; 20:93. [PMID: 30092829 PMCID: PMC6085687 DOI: 10.1186/s13058-018-1026-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/18/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Long-term insulin exposure has been implicated in breast cancer etiology, but epidemiological evidence remains inconclusive. The aims of this study were to investigate the association of insulin therapy with mammographic density (MD) as an intermediate phenotype for breast cancer and to assess associations with long-term elevated circulating insulin levels using a genetic score comprising 18 insulin-associated variants. METHODS We used data from the KARolinska MAmmography (Karma) project, a Swedish mammography screening cohort. Insulin-treated patients with type 1 (T1D, n = 122) and type 2 (T2D, n = 237) diabetes were identified through linkage with the Prescribed Drug Register and age-matched to 1771 women without diabetes. We assessed associations with treatment duration and insulin glargine use, and we further examined MD differences using non-insulin-treated T2D patients as an active comparator. MD was measured using a fully automated volumetric method, and analyses were adjusted for multiple potential confounders. Associations with the insulin genetic score were assessed in 9437 study participants without diabetes. RESULTS Compared with age-matched women without diabetes, insulin-treated T1D patients had greater percent dense (8.7% vs. 11.4%) and absolute dense volumes (59.7 vs. 64.7 cm3), and a smaller absolute nondense volume (615 vs. 491 cm3). Similar associations were observed for insulin-treated T2D, and estimates were not materially different in analyses comparing insulin-treated T2D patients with T2D patients receiving noninsulin glucose-lowering medication. In both T1D and T2D, the magnitude of the association with the absolute dense volume was highest for long-term insulin therapy (≥ 5 years) and the long-acting insulin analog glargine. No consistent evidence of differential associations by insulin treatment duration or type was found for percent dense and absolute nondense volumes. Genetically predicted insulin levels were positively associated with percent dense and absolute dense volumes, but not with the absolute nondense volume (percentage difference [95% CI] per 1-SD increase in insulin genetic score = 0.8 [0.0; 1.6], 0.9 [0.1; 1.8], and 0.1 [- 0.8; 0.9], respectively). CONCLUSIONS The consistency in direction of association for insulin treatment and the insulin genetic score with the absolute dense volume suggest a causal influence of long-term increased insulin exposure on mammographic dense breast tissue.
Collapse
Affiliation(s)
- Signe Borgquist
- Division of Oncology and Pathology, Clinical Sciences, Lund University, SE-221 85, Lund, Sweden. .,Clinical Trial Unit, Skåne University Hospital, Lund, Sweden.
| | - Ann H Rosendahl
- Division of Oncology and Pathology, Clinical Sciences, Lund University, SE-221 85, Lund, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Nirmala Bhoo-Pathy
- Julius Centre University of Malaya (JCUM), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mozhgan Dorkhan
- Global Medical Affairs, Novo Nordisk A/S, Søborg, Denmark.,Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
4
|
Aizen D, Pasmanik-Chor M, Sarfstein R, Laron Z, Bruchim I, Werner H. Genome-Wide Analyses Identify Filamin-A As a Novel Downstream Target for Insulin and IGF1 Action. Front Endocrinol (Lausanne) 2018; 9:105. [PMID: 29615978 PMCID: PMC5870203 DOI: 10.3389/fendo.2018.00105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/02/2018] [Indexed: 12/26/2022] Open
Abstract
Insulin analogs were developed to improve diabetes therapy. However, certain modifications introduced into the insulin molecule were shown to enhance their affinity to the insulin-like growth factor-1 receptor (IGF1R). Most tumors, including endometrial cancers, express high levels of IGF1R. The present study was aimed at identifying the entire set of genes that are differentially activated by insulin glargine or detemir, in comparison to insulin and IGF1, in Type 1 and Type 2 endometrial cancer cell lines (ECC-1 and USPC-1, respectively). Global gene expression analyses demonstrated a ligand-dependent upregulated expression of filamin-A (FLNA), a gene that encodes an actin filament cross-linking protein, in both endometrial cancer cell types. Silencing experiments linked to migration assays confirmed the role of FLNA in cell growth and motility. Our data suggest that the activation of distinct sets of genes by glargine may lead to stimulation of specific pathways or, alternatively, may provide additive effects, different from those classically induced by insulin. Given that metastases are probably the main factor contributing to tumor invasiveness, the identification of FLNA as a downstream target for insulin-like hormones may be of translational relevance in oncology. Clinical studies in endometrial cancer may add further relevant information regarding the possible differential actions of insulin analogs with respect to native insulin.
Collapse
Affiliation(s)
- Daniel Aizen
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Metsada Pasmanik-Chor
- Bioinformatics Unit, George Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Rive Sarfstein
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Laron
- Endocrine and Diabetes Research Unit, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Ilan Bruchim
- Gynecological Oncology Division, Hillel Yaffe Medical Center, Technion – Israel Institute of Technology, Hadera, Israel
| | - Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Yoran Institute for Human Genome Research, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Haim Werner,
| |
Collapse
|
5
|
Association between insulin therapy and risk of liver cancer among diabetics: a meta-analysis of epidemiological studies. Eur J Gastroenterol Hepatol 2018; 30:1-8. [PMID: 29064852 DOI: 10.1097/meg.0000000000001001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As the results of the association between insulin therapy and risk of liver cancer among diabetics have been inconsistent in epidemiological studies, we conducted a meta-analysis to quantify this issue. Data of relevant epidemiological studies were collected by searching articles in PubMed, Web of Science, and Embase till 29 June 2017. Random-effects models were employed to combine study-specific risks. Five cohort studies and nine case-control studies were included in our meta-analysis with 285 008 patients with diabetes mellitus and 4329 liver cancer cases. When we compared insulin-use group with noninsulin use group in patients with diabetes mellitus, we observed a statistically significant association between insulin therapy and liver cancer, with an overall relative risk of 1.90 (95% confidence interval: 1.44-2.50, I=76.1%). We did not find heterogeneity between subgroups stratified by study characteristics and adjusted confounders, except for subgroups related to 'follow-up years' of cohort studies. The combined estimate was robust across sensitivity analysis, and no publication bias was detected. Our results indicated that insulin therapy was associated with elevated incidence of liver cancer among diabetics. Given the high prevalence of diabetes, avoiding excess or unnecessary insulin use to control the blood glucose may offer a potential public health benefit in reducing liver cancer risk. Further studies are warranted to investigate the types, doses, and treatment duration of insulin use in large sample size or cohort of diabetic patients.
Collapse
|
6
|
Shafiei-Irannejad V, Samadi N, Salehi R, Yousefi B, Zarghami N. New insights into antidiabetic drugs: Possible applications in cancer treatment. Chem Biol Drug Des 2017; 90:1056-1066. [DOI: 10.1111/cbdd.13013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/27/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Vahid Shafiei-Irannejad
- Stem Cell Research Center; Tabriz University of Medical Sciences; Tabriz Iran
- Department of Clinical Biochemistry and Laboratory Medicine; Faculty of Medicine; Tabriz University of Medical Sciences; Tabriz Iran
| | - Nasser Samadi
- Department of Clinical Biochemistry and Laboratory Medicine; Faculty of Medicine; Tabriz University of Medical Sciences; Tabriz Iran
| | - Roya Salehi
- Department of Medical Nanotechnology; Faculty of Advanced Medical Sciences; Tabriz University of Medical Sciences; Tabriz Iran
| | - Bahman Yousefi
- Department of Clinical Biochemistry and Laboratory Medicine; Faculty of Medicine; Tabriz University of Medical Sciences; Tabriz Iran
| | - Nosratollah Zarghami
- Stem Cell Research Center; Tabriz University of Medical Sciences; Tabriz Iran
- Department of Clinical Biochemistry and Laboratory Medicine; Faculty of Medicine; Tabriz University of Medical Sciences; Tabriz Iran
- Department of Medical Biotechnology; Faculty of Advanced Medical Sciences; Tabriz University of Medical Sciences; Tabriz Iran
| |
Collapse
|
7
|
Schmid C, Ghirlanda C, Niessen M. Prevention of tumour cell apoptosis associated with sustained protein kinase B phosphorylation is more sensitive to regulation by insulin signalling than stimulation of proliferation and extracellular signal-regulated kinase. Mol Cell Biochem 2017; 432:41-54. [PMID: 28316059 PMCID: PMC5532423 DOI: 10.1007/s11010-017-2996-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/04/2017] [Indexed: 01/14/2023]
Abstract
Insulin controls blood glucose while insulin-like growth factor (IGF) 1 is an important growth factor. Interestingly, both hormones have overlapping bioactivities and can activate the same intracellular signal transduction cascades. Growth control (mainly by IGF1) and metabolic function (predominantly by insulin) are believed to depend on activation of extracellular signal-regulated kinases (ERKs) 1/2 and protein kinase B (Akt/PKB), respectively. Therefore, insulin analogues that are used to normalize blood glucose are tested for their ability to preferentially activate Akt/PKB but not ERK1/2 and mitogenesis. Growth hormone, IGF1, and hyperinsulinemia are associated with increased risk of growth progression of some cancer types. To test if continuous exposure to insulin can favour tumour growth, we studied insulin/IGF1-dependent activation of ERK1/2 and Akt/PKB by Western blotting, inhibition of apoptosis by ELISA, and induction of proliferation by [3H]-thymidine incorporation in Saos-2/B10 osteosarcoma cells. IGF1 and insulin both induced proliferation and prevented apoptosis effectively. Regulation of apoptosis was far more sensitive than regulation of proliferation. IGF1 and insulin activated PKB (Akt/PKB) rapidly and consistently maintained its phosphorylation. Activation of ERK1/2 was only observed in response to IGF1. Loss of p-Akt/PKB (but not of p-ERK1/2) was associated with increased apoptosis, and protection from apoptosis was lost when activation of Akt/PKB was inhibited. These findings in Saos-2/B10 cells were also replicated in the A549 cell line, originally derived from a human lung carcinoma. Therefore, IGF1 and insulin more likely (at lower concentrations) enhance tumour cell survival than proliferation, via activation and maintenance of phosphatidylinositol 3-kinase activity and p-Akt/PKB.
Collapse
Affiliation(s)
- Christoph Schmid
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Claudia Ghirlanda
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Markus Niessen
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Competence Centre for Systems Physiology and Metabolic Diseases, Swiss Federal Institute of Technology (ETH) Zurich, 8093, Zurich, Switzerland
| |
Collapse
|
8
|
Wu JW, Filion KB, Azoulay L, Doll MK, Suissa S. Effect of Long-Acting Insulin Analogs on the Risk of Cancer: A Systematic Review of Observational Studies. Diabetes Care 2016; 39:486-94. [PMID: 26740633 DOI: 10.2337/dc15-1816] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/10/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Observational studies examining the association between long-acting insulin analogs and cancer incidence have produced inconsistent results. We conducted a systematic review of these studies, focusing on their methodological strengths and weaknesses. RESEARCH DESIGN AND METHODS We systematically searched MEDLINE and EMBASE from 2000 to 2014 to identify all observational studies evaluating the relationship between the long-acting insulin analogs and the risk of any and site-specific cancers (breast, colorectal, prostate). We included cohort and case-control studies published in English on insulin glargine and detemir and any cancer incidence among patients with type 1 or 2 diabetes. The methodological assessment involved the inclusion of prevalent users, inclusion of lag periods, time-related biases, and duration of follow-up between insulin initiation and cancer incidence. RESULTS A total of 16 cohort and 3 case-control studies met our inclusion criteria. All studies evaluated insulin glargine, and four studies also examined insulin detemir. Follow-up ranged from 0.9 to 7.0 years. Thirteen of 15 studies reported no association between insulin glargine and detemir and any cancer. Four of 13 studies reported an increased risk of breast cancer with insulin glargine. In the quality assessment, 7 studies included prevalent users, 11 did not consider a lag period, 6 had time-related biases, and 16 had short (<5 years) follow-up. CONCLUSIONS The observational studies examining the risk of cancer associated with long-acting insulin analogs have important methodological shortcomings that limit the conclusions that can be drawn. Thus, uncertainty remains, particularly for breast cancer risk.
Collapse
Affiliation(s)
- Jennifer W Wu
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Margaret K Doll
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Samy Suissa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Baricevic I, Jones DR, Roberts DL, Lutzen A, Lundby A, Worm J, Hansen BF, Renehan AG. A framework for the in vitro evaluation of cancer-relevant molecular characteristics and mitogenic potency of insulin analogues. Carcinogenesis 2015; 36:1040-50. [PMID: 26026165 PMCID: PMC4552242 DOI: 10.1093/carcin/bgv071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/16/2015] [Indexed: 12/28/2022] Open
Abstract
Clinically prescribed insulin analogues are putatively linked with increased cancer risk. We developed a framework for the mandated regulatory in vitro evaluation of cancer-relevant bioassays for comparisons of insulin analogues, and showed that the cell-specific IGF-IR/IR ratio is crucial for interpretation. Epidemiological and laboratory studies raise the possibility of a link between clinically prescribed insulin analogues and increased cancer risk. Accordingly, there is a regulatory mandate for cancer-related pre-clinical safety evaluation during insulin analogue development, but currently, there is no standardized framework for such in vitro evaluation. We tested human insulin; the super-mitogenic insulin, X10 and insulin-like growth factor I, in four cancer cell lines with a range of insulin-like growth factor-I receptor (IGF-IR)/IR (insulin receptor) ratios (HCT 116, HT-29, COLO 205 and MCF7) and related these to IGF-IR and IR expression in 17 human adenocarcinomas. All cell types were IR-A isoform dominant. We determined IGF-IR/IR signalling pathway endpoints in dose- and time-varying experiments, and performed mitogenic dose–response equivalent assays to derive EC50 values, and correlated these with IGF-IR/IR ratios. We superimposed relative EC50 values onto data from the literature in a meta-analysis. The IGF-IR/IR ratios varied from <1 to 12 in the selected cell lines; similar pattern ranges were observed in human adenocarcinomas. The three ligands demonstrated differential IR/IGF-IR and Akt phosphorylation, which correlated with cell-specific IGF-IR/IR ratios. Mitogenic profiles of X10 mimicked those for insulin-like growth factor I (IGF-I) and correlated with IGF-IR/IR ratios. The meta-analysis, adding data from five additional studies, supported the hypothesis that ligand mitogenic potency, relative to human insulin, increases with increasing cell-specific IGF-IR/IR ratio. This study established a framework for the in vitro evaluation of cancer-relevant bioassays for comparisons of insulin analogues, and specifically consolidated earlier studies that determination of the cell-specific IGF-IR/IR ratio is crucial for the interpretation of ranking relative biological activities.
Collapse
Affiliation(s)
- Ivona Baricevic
- Faculty Institute of Cancer Sciences, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK, Inositide Laboratory, Cancer Research UK Manchester Institute, Paterson Building, Manchester M20 4BX, UK and Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - David R Jones
- Inositide Laboratory, Cancer Research UK Manchester Institute, Paterson Building, Manchester M20 4BX, UK and
| | - Darren L Roberts
- Faculty Institute of Cancer Sciences, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK, Inositide Laboratory, Cancer Research UK Manchester Institute, Paterson Building, Manchester M20 4BX, UK and Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - Anne Lutzen
- Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - Anders Lundby
- Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - Jesper Worm
- Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - Bo F Hansen
- Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - Andrew G Renehan
- Faculty Institute of Cancer Sciences, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK, Inositide Laboratory, Cancer Research UK Manchester Institute, Paterson Building, Manchester M20 4BX, UK and Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark
| |
Collapse
|
10
|
Aizen D, Sarfstein R, Bruchim I, Weinstein D, Laron Z, Werner H. Proliferative and signaling activities of insulin analogues in endometrial cancer cells. Mol Cell Endocrinol 2015; 406:27-39. [PMID: 25697343 DOI: 10.1016/j.mce.2015.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 01/15/2015] [Accepted: 02/12/2015] [Indexed: 12/29/2022]
Abstract
Insulin analogues have been developed to achieve further improvement in the therapy of diabetes. However, modifications introduced into the insulin molecule may enhance their affinity for the insulin-like growth factor-1 receptor (IGF1R). Hyperinsulinemia has been identified as a risk factor for endometrial cancer. We hypothesized that insulin analogues may elicit atypical proliferative and signaling activities in endometrial cancer cells. Our results demonstrate that glargine, but not detemir, stimulated cell proliferation, displayed an anti-apoptotic effect, and had a positive effect on cell cycle progression in endometrial cancer cell lines ECC-1 and USPC-1. In addition, we showed that glargine and detemir induced dual activation of the insulin receptor (INSR) and IGF1R in both cell types. Furthermore, we showed that glargine elicited signaling events that are markedly different from those induced by insulin. In conclusion, our data support the concept that, although insulin analogues were designed to display insulin-like metabolic effects, glargine and, possibly, additional analogues exhibit IGF1-like activities and, accordingly, may function as IGF1 analogues.
Collapse
Affiliation(s)
- Daniel Aizen
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Rive Sarfstein
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilan Bruchim
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Doron Weinstein
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Zvi Laron
- Endocrine and Diabetes Research Unit, Schneider Children's Medical Center, Petah Tikva 49292, Israel
| | - Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| |
Collapse
|
11
|
Makov M, Chodick G, Mohnike K, Otonkoski T, Huopio H, Banerjee I, Cave H, Polak M, Christesen HT, Hussain K, Deleon D, Stanley C, Cappa M, Ramos O, Zangen D, Laron Z. Congenital hyperinsulinism, neonatal diabetes and the risk of malignancies: an international collaborative study. Preliminary communication. Diabet Med 2015; 32:701-3. [PMID: 25494966 DOI: 10.1111/dme.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M Makov
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Rabin Campus, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Solomon Zemler R, Weingarten G, Sarfstein R, Laron Z, Werner H, Wertheimer E. Insulin analogues display atypical differentiative activities in skin keratinocytes. Arch Physiol Biochem 2015; 121:32-9. [PMID: 25897878 DOI: 10.3109/13813455.2014.1001856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We have previously shown that both insulin and IGF1 lead to increased proliferation of keratinocytes. However, whereas insulin supports keratinocytes differentiation, IGF1 inhibits this process. The aim of the present study was to examine the proliferative and differentiative effects of insulin analogues (glargine, detemir, lispro and aspart) in primary keratinocytes in comparison with insulin and IGF1. METHODS Primary keratinocytes cultures were produced from newborn BALB/c mice skin. Proliferation rates were assessed by [(3)H]-thymidine incorporation and XTT assays and differentiation was evaluated by Western blots analysis. Insulin receptor and IGF1 receptor phosphorylation was assessed by immunoprecipitation assays. RESULTS Treatment with glargine or detemir resulted in an insulin-like effect on the differentiation process whereas lispro and aspart treatment led to an IGF1-like effect. In addition, treatment of keratinocytes with aspart led to a rapid phosphorylation of the IGF1 receptor. CONCLUSIONS Our study provides evidence that insulin analogues elicit atypical actions in the skin.
Collapse
|
13
|
Sciacca L, Cassarino MF, Genua M, Vigneri P, Giovanna Pennisi M, Malandrino P, Squatrito S, Pezzino V, Vigneri R. Biological Effects of Insulin and Its Analogs on Cancer Cells With Different Insulin Family Receptor Expression. J Cell Physiol 2014; 229:1817-21. [DOI: 10.1002/jcp.24635] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/26/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Laura Sciacca
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Maria Francesca Cassarino
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Marco Genua
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Paolo Vigneri
- Division of Medical Oncology; Department of Clinical and Molecular Biomedicine; University of Catania; Catania Italy
| | - Maria Giovanna Pennisi
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Pasqualino Malandrino
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Sebastiano Squatrito
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Vincenzo Pezzino
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
| | - Riccardo Vigneri
- Division of Endocrinology; Department of Clinical and Molecular Biomedicine; University of Catania; Garibaldi-Nesima Hospital; Catania Italy
- Humanitas; Catania Oncology Centre; Catania Italy
| |
Collapse
|
14
|
Qiang G, Xue S, Yang JJ, Du G, Pang X, Li X, Goswami D, Griffin PR, Ortlund EA, Chan CB, Ye K. Identification of a small molecular insulin receptor agonist with potent antidiabetes activity. Diabetes 2014; 63:1394-409. [PMID: 24651808 PMCID: PMC3964510 DOI: 10.2337/db13-0334] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Insulin replacement therapy is a widely adopted treatment for all patients with type 1 diabetes and some with type 2 diabetes. However, injection of insulin has suffered from problems such as tissue irritation, abscesses, discomfort, and inconvenience. The use of orally bioactive insulin mimetics thus represents an ideal treatment alternative. Here we show that a chaetochromin derivative (4548-G05) acts as a new nonpeptidyl insulin mimetic. 4548-G05 selectively activates an insulin receptor (IR) but not insulin-like growth factor receptor-I or other receptor tyrosine kinases. Through binding to the extracellular domain of the IR, 4548-G05 induces activation of the receptor and initiates the downstream Akt and extracellular signal-related kinase pathways to trigger glucose uptake in C2C12 myotubes. Moreover, it displays a potent blood glucose-lowering effect when administrated orally in normal, type 1 diabetic, and type 2 diabetic mice models. Therefore, 4548-G05 may represent a novel pharmacological agent for antidiabetes drug development.
Collapse
Affiliation(s)
- Guifen Qiang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Shenghui Xue
- Departments of Chemistry and Biology, Center for Diagnostics and Therapeutics (CDT), Georgia State University, Atlanta, GA
| | - Jenny J. Yang
- Departments of Chemistry and Biology, Center for Diagnostics and Therapeutics (CDT), Georgia State University, Atlanta, GA
| | - Guanhua Du
- National Center for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaobin Pang
- National Center for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Institute of Pharmacy, Henan University, Kaifeng, China
| | - Xiaoting Li
- National Center for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Institute of Pharmacy, Henan University, Kaifeng, China
| | - Devrishi Goswami
- Department of Molecular Therapeutics, The Scripps Research Institute, Jupiter, FL
| | - Patrick R. Griffin
- Department of Molecular Therapeutics, The Scripps Research Institute, Jupiter, FL
| | - Eric A. Ortlund
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA
| | - Chi Bun Chan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Corresponding author: Chi Bun Chan, , or Keqiang Ye,
| | - Keqiang Ye
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Corresponding author: Chi Bun Chan, , or Keqiang Ye,
| |
Collapse
|
15
|
ter Braak B, Siezen CLE, Kannegieter N, Koedoot E, van de Water B, van der Laan JW. Classifying the adverse mitogenic mode of action of insulin analogues using a novel mechanism-based genetically engineered human breast cancer cell panel. Arch Toxicol 2014; 88:953-66. [PMID: 24464500 DOI: 10.1007/s00204-014-1201-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/15/2014] [Indexed: 12/29/2022]
Abstract
Insulin analogues are widely used in clinical practice. Modifications on the insulin molecular structure can affect the affinity and activation towards two closely related receptor tyrosine kinases: the insulin receptor (INSR) and the insulin-like growth factor 1 receptor (IGF1R). A switch towards higher IGF1R affinity is likely to emphasize mitogenesis rather than glucose metabolism. Relevant well-validated experimental tools to address the insulin analogue activation of either INSR or IGF1R are missing. We have established a panel of human MCF-7 breast cancer cell lines either ectopically expressing the INSR (A or B isoform) in conjunction with a stable knockdown of the IGF1R or ectopically expressing the IGF1R in conjunction with a stable knockdown of the INSR. In these cell lines, we systematically evaluated the INSR and IGF1R receptor activation and downstream mitogenic signalling of all major clinical relevant insulin analogues in comparison with insulin and IGF1R. While most insulin analogues primarily activated the INSR, the mitogenic activation pattern of glargine was highly similar to IGF1 and insulin AspB10, known to bind IGF1R and induce carcinogenesis. Yet, in a long-term proliferation assay, the proliferative effect of glargine was not much different from regular insulin or other insulin analogues. This was caused by the rapid enzymatic conversion into its two metabolic active metabolites M1 and M2, with reduced mitogenic signalling through the IGF1R. In summary, based on our new cell models, we identified a similar mitogenic potency of insulin glargine and AspB10. However, rapid enzymatic conversion of glargine precludes a sustained activation of the IGF1R signalling pathway.
Collapse
Affiliation(s)
- B ter Braak
- Division of Toxicology, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | | | | | | | | | | |
Collapse
|
16
|
Tennagels N, Welte S, Hofmann M, Brenk P, Schmidt R, Werner U. Differences in metabolic and mitogenic signallingof insulin glargine and AspB10 human insulin in rats [corrected]. Diabetologia 2013; 56:1826-34. [PMID: 23653049 PMCID: PMC3699703 DOI: 10.1007/s00125-013-2923-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/05/2013] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS In vitro, insulin glargine (A21Gly,B31Arg,B32Arg human insulin) has an insulin receptor (IR) profile similar to that of human insulin, but a slightly higher affinity for the IGF-1 receptor (IGF1R). AspB10 human insulin (AspB10), [corrected] the only insulin analogue with proven carcinogenic activity, has a greater affinity for IGF1R and IR, and a prolonged IR occupancy time. The pharmacological and signalling profile of therapeutic and suprapharmacological doses of glargine were analysed in different tissues of rats, and compared with human insulin and AspB10. METHODS Male Wistar rats were injected s.c. with human insulin or insulin analogue at doses of 1 to 200 U/kg, and the effects on blood glucose and the phosphorylation status of IR, IGF1R, Akt and extracellular signal-regulated protein kinase 1/2 in muscle, fat, liver and heart samples were investigated. RESULTS Glargine, AspB10 and human insulin lowered blood glucose, with the onset of action delayed with glargine. Glargine treatment resulted in phosphorylation levels of IR and Akt that were comparable with those achieved with human insulin, although delayed in time in some tissues. AspB10 treatment resulted in at least twofold higher phosphorylation levels and significantly longer duration of IR and Akt phosphorylation in most tissues. None of the insulin treatments resulted in detectable IGF1R phosphorylation in muscle or heart tissue, whereas intravenous injection of IGF-1 increased IGF1R phosphorylation. CONCLUSIONS/INTERPRETATION The IR signalling pattern of AspB10 in vivo is distinctly different from that of human insulin and insulin glargine, and might challenge the notion that activation of IGF1R plays a role in the observed carcinogenic effect of AspB10.
Collapse
Affiliation(s)
- N Tennagels
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany.
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
Basal insulin have been developed over the years. In recent times newer analogues have been added to the armanentarium for diabetes therapy. This review specifically reviews the current status of different basal insulins.
Collapse
Affiliation(s)
- S. V. Madhu
- Department of Medicine, Division of Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - M. Velmurugan
- Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| |
Collapse
|
18
|
Tennagels N, Werner U. The metabolic and mitogenic properties of basal insulin analogues. Arch Physiol Biochem 2013; 119:1-14. [PMID: 23373726 PMCID: PMC3581051 DOI: 10.3109/13813455.2012.754474] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/21/2012] [Accepted: 11/26/2012] [Indexed: 12/28/2022]
Abstract
CONTEXT Retrospective, observational studies have reported an association between diabetes treatment with insulin and a higher incidence of cancer. OBJECTIVE Overview the literature for in vitro and in vivo studies of the metabolic and mitogenic properties of basal insulin analogues and assess the implications for clinical use. METHODS Relevant studies were identified through PubMed and congress abstract database searches; data on metabolic and mitogenic signalling in relation to insulin treatment of diabetes are included in this review. RESULTS The balance of evidence shows that although some analogues have demonstrated mitogenic potency in some in vitro studies in cancer cell lines, these findings do not translate to the in vivo setting in animals or to the clinical setting in humans. CONCLUSIONS The current consensus is that there is no clinical or in vivo evidence to indicate that any commercially available insulin analogue has carcinogenic effects. Large-scale, prospective clinical and observational studies will further establish any potential link.
Collapse
Affiliation(s)
- Norbert Tennagels
- R&D Diabetes Division, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany.
| | | |
Collapse
|
19
|
Colatrella A, Visalli N, Abbruzzese S, Leotta S, Bongiovanni M, Napoli A. Comparison of Insulin Lispro Protamine Suspension with NPH Insulin in Pregnant Women with Type 2 and Gestational Diabetes Mellitus: Maternal and Perinatal Outcomes. Int J Endocrinol 2013; 2013:151975. [PMID: 23840206 PMCID: PMC3691907 DOI: 10.1155/2013/151975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/16/2013] [Indexed: 01/25/2023] Open
Abstract
Insulin therapy is still the gold standard in diabetic pregnancy. Insulin lispro protamine suspension is an available basal insulin analogue. Aim. To study pregnancy outcomes of women with type 2 and gestational diabetes mellitus when insulin lispro protamine suspension or human NPH insulin was added to medical nutrition therapy and/or short-acting insulin. Methods. In this retrospective study, for maternal outcome we recorded time and mode of delivery, hypertension, glycaemic control (fasting blood glucose and HbA1c), hypoglycemias, weight increase, and insulin need. For neonatal outcome birth weight and weight class, congenital malformations was recorded and main neonatal complications. Two-tail Student's t-test and chi-square test were performed when applicable; significant P < 0.05. Results. Eighty-nine pregnant women (25 with type 2 diabetes and 64 with gestational diabetes mellitus; 53 under insulin lispro protamine suspension and 36 under human NPH insulin) were recruited. Maternal and neonatal outcomes were quite similar between the two therapeutic approaches; however, insulin need was higher in NPH. At the end of pregnancy, eight women with gestational diabetes continued to use only basal insulin analogue. Conclusions. Pregnancy outcome in type 2 and gestational diabetes mellitus with insulin lispro protamine suspension was similar to that with NPH insulin, except for a lower insulin requirement.
Collapse
Affiliation(s)
- Antonietta Colatrella
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035–1039, 00189 Rome, Italy
| | - Natalia Visalli
- Unit of Dietology, Diabetology and Metabolic Diseases, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy
| | - Santina Abbruzzese
- Unit of Dietology, Diabetology and Metabolic Diseases, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy
| | - Sergio Leotta
- Unit of Dietology, Diabetology and Metabolic Diseases, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy
| | - Marzia Bongiovanni
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035–1039, 00189 Rome, Italy
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035–1039, 00189 Rome, Italy
- *Angela Napoli:
| |
Collapse
|
20
|
Hansen BF, Glendorf T, Hegelund AC, Lundby A, Lützen A, Slaaby R, Stidsen CE. Molecular characterisation of long-acting insulin analogues in comparison with human insulin, IGF-1 and insulin X10. PLoS One 2012; 7:e34274. [PMID: 22590494 PMCID: PMC3348127 DOI: 10.1371/journal.pone.0034274] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/26/2012] [Indexed: 12/29/2022] Open
Abstract
AIMS/HYPOTHESIS There is controversy with respect to molecular characteristics of insulin analogues. We report a series of experiments forming a comprehensive characterisation of the long acting insulin analogues, glargine and detemir, in comparison with human insulin, IGF-1, and the super-mitogenic insulin, X10. METHODS We measured binding of ligands to membrane-bound and solubilised receptors, receptor activation and mitogenicity in a number of cell types. RESULTS Detemir and glargine each displayed a balanced affinity for insulin receptor (IR) isoforms A and B. This was also true for X10, whereas IGF-1 had a higher affinity for IR-A than IR-B. X10 and glargine both exhibited a higher relative IGF-1R than IR binding affinity, whereas detemir displayed an IGF-1R:IR binding ratio of ≤ 1. Ligands with high relative IGF-1R affinity also had high affinity for IR/IGF-1R hybrid receptors. In general, the relative binding affinities of the analogues were reflected in their ability to phosphorylate the IR and IGF-1R. Detailed analysis revealed that X10, in contrast to the other ligands, seemed to evoke a preferential phosphorylation of juxtamembrane and kinase domain phosphorylation sites of the IR. Sustained phosphorylation was only observed from the IR after stimulation with X10, and after stimulation with IGF-1 from the IGF-1R. Both X10 and glargine showed an increased mitogenic potency compared to human insulin in cells expressing many IGF-1Rs, whereas only X10 showed increased mitogenicity in cells expressing many IRs. CONCLUSIONS Detailed analysis of receptor binding, activation and in vitro mitogenicity indicated no molecular safety concern with detemir.
Collapse
Affiliation(s)
- Bo F Hansen
- Diabetes Research Unit, Novo Nordisk A/S, Måløv, Denmark.
| | | | | | | | | | | | | |
Collapse
|
21
|
Yang XL, Chan JC. Diabetes, insulin and cancer risk. World J Diabetes 2012; 3:60-4. [PMID: 22532884 PMCID: PMC3334387 DOI: 10.4239/wjd.v3.i4.60] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 03/03/2012] [Accepted: 04/10/2012] [Indexed: 02/05/2023] Open
Abstract
There is a consensus that both type 1 and type 2 diabetes are associated with a spectrum of cancers but the underlying mechanisms are largely unknown. On the other hand, there are ongoing debates about the risk association of insulin use with cancer. We have briefly reviewed recent related research on exploration of risk factors for cancer and pharmacoepidemiological investigations into drug use in diabetes on the risk of cancer, as well as the current understanding of metabolic pathways implicated in intermediary metabolism and cellular growth. Based on the novel findings from the Hong Kong Diabetes Registry and consistent experimental evidence, we argue that use of insulin to control hyperglycemia is unlikely to contribute to increased cancer risk and that dysregulations in the AMP-activated protein kinase pathway due to reduced insulin action and insulin resistance, the insulin-like growth factor-1 (IGF-1)-cholesterol synthesis pathway and renin-angiotensin system, presumably due to reduced insulin secretion and hyperglycemia, may play causal roles in the increased risk of cancer in diabetes. Further exploration into the possible causal relationships between abnormalities of these pathways and the risk of cancer in diabetes is warranted.
Collapse
Affiliation(s)
- Xi-Lin Yang
- Xi-Lin Yang, Department of Epidemiology, Public Health College, Tianjin Medical University, Tianjin 300070, China
| | | |
Collapse
|
22
|
Blin P, Lassalle R, Dureau-Pournin C, Ambrosino B, Bernard MA, Abouelfath A, Gin H, Le Jeunne C, Pariente A, Droz C, Moore N. Insulin glargine and risk of cancer: a cohort study in the French National Healthcare Insurance Database. Diabetologia 2012; 55:644-53. [PMID: 22222504 PMCID: PMC3268990 DOI: 10.1007/s00125-011-2429-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 12/02/2011] [Indexed: 01/07/2023]
Abstract
AIMS/HYPOTHESIS Using the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is higher than in human insulin users. The investigation period was from 1 January 2003 to 30 June 2010. METHODS We used Cox proportional hazards time-dependent models that were stratified on propensity score quartiles for use of insulin glargine vs human insulin, and adjusted for insulin, biguanide and sulfonylurea possession rates to assess the risk of cancer or death in all or incident exclusive or predominant (≥ 80% use time) users of insulin glargine compared with equivalent human insulin users. RESULTS Only type 2 diabetic patients were studied. Exposure rates varied from 2,273 and 614 patient-years for incident exclusive users of insulin glargine or human insulin, respectively, to 3125 and 2341 patient-years for all patients predominantly using insulin glargine or human insulin, respectively. All-type cancer HRs with insulin glargine vs human insulin ranged from 0.59 (95% CI 0.28, 1.25) in incident exclusive users to 0.58 (95% CI 0.34, 1.01) in all predominant users. Cancer risk increased with exposure to insulin or sulfonylureas in these patients. Adjusted HRs for death or cancer associated with insulin glargine compared with human insulin ranged from 0.58 (95% CI 0.32, 1.06) to 0.56 (95% CI 0.36, 0.87). CONCLUSIONS/INTERPRETATION There was no excess risk of cancer in type 2 diabetic patients on insulin glargine alone compared with those on human insulin alone. The overall risk of death or cancer in patients on insulin glargine was about half that of patients on human insulin, thereby excluding a competitive risk bias.
Collapse
Affiliation(s)
- P. Blin
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
| | - R. Lassalle
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
| | - C. Dureau-Pournin
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
| | - B. Ambrosino
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
| | - M. A. Bernard
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
| | - A. Abouelfath
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
| | - H. Gin
- CHU de Bordeaux, Bordeaux, France
- Université Bordeaux Segalen, Bordeaux, France
| | | | - A. Pariente
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
- CHU de Bordeaux, Bordeaux, France
- Inserm U657, Bordeaux, France
| | - C. Droz
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
- Inserm U657, Bordeaux, France
| | - N. Moore
- Department of Pharmacology, Bat du Tondu, Case 40, Université de Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Inserm CIC-P0005, Bordeaux, France
- CHU de Bordeaux, Bordeaux, France
- Inserm U657, Bordeaux, France
| |
Collapse
|
23
|
Abstract
This article highlights selected milestones in insulin discovery and its continued development as a pivotal therapy for diabetes. The last 90 years have witnessed tremendous progress in insulin therapy, from the initial crude, yet life-saving, animal insulin extracts to novel human insulin analogues. Although the complete physiologic replacement of insulin is inherently difficult to achieve with open-loop subcutaneously administered insulin, the continued development of improved injectable insulin formulations with superior pharmacokinetics and pharmacodynamics will enhance glucose control, and represents important clinical advances in the treatment of both type 1 and type 2 diabetes.
Collapse
Affiliation(s)
- Carla A Borgoño
- Division of General Internal Medicine, Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada
| | | |
Collapse
|
24
|
Abstract
The introduction of the so-called 'designer' insulins, the insulin analogues, has offered new opportunities in the clinical management of diabetes. Two additional new entities are close to reaching clinical practice. Linjeta™ (formally called VIAject) is not an analogue but rather a different formulation of human insulin which may give it a more rapid onset of action, potentially even faster than the currently available rapid-acting insulin analogues. Degludec™, on the other hand, is an insulin analogue molecule with an ultra-long clinical profile derived from the soluble multi-hexamer formation, resulting in a continuous slow and stable release of insulin degludec monomers which may last longer than currently available long-acting analogues. As with any new type of drug, the safety of the 'designer' insulins has to be closely scrutinised. Last year the increased cancer risk in diabetes entered the spotlight and the potential role of insulin analogues led to controversial discussions. In spite of recent new in vitro and observational data no new conclusive evidence became available. The need for multiple well-conducted and appropriately designed prospective observational studies to follow up the effectiveness and safety of the new insulins and the new insulin treatment regimens remains. In this chapter it was our mission to chose articles published about "new insulins" over the last year that have the most important contribution for the on-going development of ultra-fast- and ultra-long-acting insulin analogs and preparations and their potential side-effects, particularly cancer. This has been done by means of PubMed searches as well as a review of abstracts of the recent large international diabetes meetings such as ADA, EASD and ISPAD.
Collapse
Affiliation(s)
- T Danne
- Diabetes-Zentrum für Kinder and Jugendliche, Kinderkrankenhaus auf der Bult, Hannover, Germany.
| | | |
Collapse
|
25
|
Suissa S, Azoulay L, Dell'Aniello S, Evans M, Vora J, Pollak M. Long-term effects of insulin glargine on the risk of breast cancer. Diabetologia 2011; 54:2254-62. [PMID: 21614572 DOI: 10.1007/s00125-011-2190-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS There have been growing concerns regarding the long-term effects of insulin glargine (A21Gly,B31Arg,B32Arg human insulin) on the risk of breast cancer. METHODS We used the UK's General Practice Research Database (GPRD) to identify a cohort of women aged 40 years or over with type 2 diabetes, treated with insulin during 2002-2006 and followed until the first breast cancer diagnosis or 31 December 2009. After the users of insulin glargine had been matched with users of other insulins on age, calendar time and duration of prior insulin use, the HR of breast cancer associated with insulin glargine use was estimated using a Cox proportional hazards model, adjusted for known risk factors for breast cancer. RESULTS The cohort comprised 15,227 women, including 4,579 glargine users and 10,648 users of other insulins, of which 246 developed breast cancer during up to 8 years follow-up (incidence rate 4.1 per 1,000 per year). Insulin glargine use was not associated with an increased risk of breast cancer during the first 5 years of use (HR 0.9; 95% CI 0.7-1.3). The risk tended to increase after 5 years (HR 1.8; 95% CI 0.8-4.0), and significantly so for the women who had been on insulin before starting glargine (HR 2.7; 95% CI 1.1-6.5). CONCLUSIONS/INTERPRETATION The risk of breast cancer in women with type 2 diabetes is not increased during the first 5 years of insulin glargine use. However, longer-term use may increase this risk, particularly in women with longstanding use of insulin before starting insulin glargine.
Collapse
Affiliation(s)
- S Suissa
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, QC, Canada H3T 1E2.
| | | | | | | | | | | |
Collapse
|
26
|
Gough SCL, Belda-Iniesta C, Poole C, Weber M, Russell-Jones D, Hansen BF, Mannucci E, Tuomilehto J. Insulin therapy in diabetes and cancer risk: current understanding and implications for future study: proceedings from a meeting of a European Insulin Safety Consensus Panel, convened and sponsored by Novo Nordisk, held Tuesday October 5, 2010 at The Radisson Edwardian Heathrow Hotel, Hayes, Middlesex, UK. Adv Ther 2011; 28 Suppl 5:1-18. [PMID: 21863297 DOI: 10.1007/s12325-011-0047-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Interest in the possibility of certain insulin treatments having the potential to modify cancer development and prognosis was reawakened in 2009, following publication of several epidemiological studies addressing this issue. This interest extends to how diabetes itself and cancer might be linked, and makes desirable an exchange of expert views and knowledge to enhance understanding in this subject among those treating diabetes and cancer, or those developing diabetes therapies. METHODS A European meeting was convened with participants invited based on known relevant interests in endocrinology, oncology, epidemiology, and insulin analog design and investigation. Experts in these fields were invited to present on relevant topics, with open discussions held after each presentation. RESULTS Concern over the potential mitogenic properties of certain insulin analogs has arisen from some (but not all) epidemiological studies, although confounding factors render interpretation controversial. Future epidemiological studies are likely to strengthen confidence in drawing conclusions. Meanwhile, pharmacological studies, and a consideration of cancer pathophysiology, implicate increased insulin-like growth factor-1 receptor affinity, and/or deranged insulin receptor interaction/signaling properties as possible a priori causes for concern with some insulin analogs. Again, interpretation of the body of pharmacological evidence is confounded by the array of test systems and methodologies used, and by studies frequently succumbing to methodological pitfalls. Reassuringly, most available insulin analogs do not differ in their receptor interaction response profile to human insulin, and for those that do there are reasons to question any potential clinical relevance. Nevertheless, it is desirable that new experimental models are devised that can better determine the likely clinical consequences of any variance in receptor response profile versus human insulin. CONCLUSION More data are required to increase our understanding of this issue. To facilitate and disseminate such understanding, close cooperation and communication between diabetologists, epidemiologists, oncologists, and insulin engineers will be essential.
Collapse
|
27
|
Enzmann HG, Weise M. Current european regulatory perspectives on insulin analogues. Diabetol Metab Syndr 2011; 3:14. [PMID: 21736748 PMCID: PMC3224552 DOI: 10.1186/1758-5996-3-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 07/07/2011] [Indexed: 12/28/2022] Open
Abstract
Insulin analogues are increasingly considered as an alternative to human insulin in the therapy of diabetes mellitus. Insulin analogues (IAs) are chemically different from human insulin and may have different pharmacokinetic or pharmacodynamic properties. The significance of the modifications of the insulin molecule for the safety profile of IAs must be considered. This review describes the regulatory procedure and the expectations for the scientific content of European marketing authorization applications for innovative IAs submitted to the European Medicines Agency. Particular consideration is given to a potential cancer hazard. Specific regulatory guidance on how to address a possible carcinogenic or tumor promoting effect of innovative IAs in non-clinical studies is available. After marketing authorization, the factual access of patients to the new product will be determined to great extent by health technology assessment bodies, reimbursement decisions and the price. Whereas the marketing authorization is a European decision, pricing and reimbursement are national or regional responsibilities. The assessment of benefit and risk by the European Medicines Agency is expected to influence future decisions on price and reimbursement on a national or regional level. Collaborations between regulatory agencies and health technology assessment bodies have been initiated on European and national level to facilitate the use of the European Medicines Agency's benefit risk assessment as basis on which to build the subsequent health technology assessment. The option for combined or joint scientific advice procedures with regulators and health technology assessment bodies on European level or on a national level in several European Member States may help applicants to optimize their development program and dossier preparation in regard of both European marketing authorization application and reimbursement decisions.
Collapse
Affiliation(s)
- Harald G Enzmann
- Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, D-53175 Bonn, Germany
| | - Martina Weise
- Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, D-53175 Bonn, Germany
| |
Collapse
|
28
|
Abstract
In recent years, the influence of the IGF system and insulin on cancer growth has been widely studied. Observational human studies have reported increased cancer mortality in those with obesity and type 2 diabetes, which may be attributable to hyperinsulinemia, elevated IGF-I, or potentially both factors. Conversely, those with low insulin, IGF-I and IGF-II levels appear to be relatively protected from cancer development. Initial attention focused on the role of IGF-I in tumor development. The results of these investigations allowed for the development of therapies targeting the IGF-I receptor signaling pathway. However, after in vitro and in vivo studies demonstrating that insulin may also play a significant and independent role in tumorigenesis, insulin is now receiving more attention in this regard. Some studies suggest that targeting insulin receptor signaling may be an important alternative or adjunct to targeting IGF-I receptor signaling. In this minireview, we discuss some of the recent in vitro, animal, and clinical studies that have elaborated our understanding of the influence of IGF and insulin on tumorigenesis. These studies have shed more light on the interaction between insulin and IGF signaling in cancer cells. They have made possible the development of novel targeted therapies and highlighted some of the potential future directions for research and therapeutics.
Collapse
Affiliation(s)
- Emily J Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, Box 1055, One Gustave L. Levy Place, New York, New York 10029, USA
| | | |
Collapse
|
29
|
Werner H, Chantelau EA. Differences in bioactivity between human insulin and insulin analogues approved for therapeutic use- compilation of reports from the past 20 years. Diabetol Metab Syndr 2011; 3:13. [PMID: 21714872 PMCID: PMC3160352 DOI: 10.1186/1758-5996-3-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 06/29/2011] [Indexed: 11/10/2022] Open
Abstract
In order to provide comprehensive information on the differences in bioactivity between human insulin and insulin analogues, published in vitro comparisons of human insulin and the rapid acting analogues insulin lispro (Humalog®), insulin aspart ( NovoRapid®), insulin glulisine (Apidra®), and the slow acting analogues insulin glargine (Lantus®), and insulin detemir (Levemir®) were gathered from the past 20 years (except for receptor binding studies). A total of 50 reports were retrieved, with great heterogeneity among study methodology. However, various differences in bioactivity compared to human insulin were obvious (e.g. differences in effects on metabolism, mitogenesis, apoptosis, intracellular signalling, thrombocyte function, protein degradation). Whether or not these differences have clinical bearings (and among which patient populations) remains to be determined.
Collapse
Affiliation(s)
- Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ernst A Chantelau
- Formerly Heinrich-Heine-University of Düsseldorf/Germany, Holthorster Weg 16, 28717 Bremen, Germany
| |
Collapse
|
30
|
Werner H, Weinstein D, Yehezkel E, Laron Z. Controversies in the use of insulin analogues. Expert Opin Biol Ther 2011; 11:199-209. [PMID: 21219237 DOI: 10.1517/14712598.2011.540233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In recent years, insulin analogues have been developed in order to improve the pharmacological parameters of insulin and to better mimic endogenous insulin output. Given that some of the modifications introduced into insulin analogues are located in a domain involved in a potential interaction with the insulin-like growth factor-I receptor (IGF-IR), it has been postulated that certain analogues may display IGF-I-like activities. AREAS COVERED We review the recent literature investigating the risk of malignant neoplasms and mortality in diabetic patients treated either with human insulin or with one of three insulin analogues (lispro, aspart, and glargine). We examine how critical analyses are consistent with the notion that the use of insulin glargine is associated with a possible increased risk of tumors in humans. EXPERT OPINION The introduction of insulin analogues has had a major impact in diabetes care. However, the benefit of some of these new insulins for the patient has yet to be demonstrated. Furthermore, research is needed to clarify whether insulin glargine is more strongly associated with cancer risk compared with other insulins.
Collapse
Affiliation(s)
- Haim Werner
- Tel Aviv University, Sackler School of Medicine, Department of Human Molecular Genetics and Biochemistry, Tel Aviv 69978, Israel.
| | | | | | | |
Collapse
|