Is there a future in glucose-sensitive, responsive insulin delivery systems?

Recent Insights into Glucose-Responsive Concanavalin A-Based Smart Hydrogels for Controlled Insulin Delivery

Many efforts are continuously undertaken to develop glucose-sensitive biomaterials able of controlling glucose levels in the body and self-regulating insulin delivery. Hydrogels that swell or shrink as a function of the environmental free glucose content are suitable systems for monitoring blood glucose, delivering insulin doses adapted to the glucose concentration. In this context, the development of sensors based on reversible binding to glucose molecules represents a continuous challenge. Concanavalin A (Con A) is a bioactive protein isolated from sword bean plants (Canavalia ensiformis) and contains four sugar-binding sites. The high affinity for reversibly and specifically binding glucose and mannose makes Con A as a suitable natural receptor for the development of smart glucose-responsive materials. During the last few years, Con A was used to develop smart materials, such as hydrogels, microgels, nanoparticles and films, for producing glucose biosensors or drug delivery devices. This review is focused on Con A-based materials suitable in the diagnosis and therapeutics of diabetes. A brief outlook on glucose-derived theranostics of cancer is also presented.

Recent advances in glucose-oxidase-based nanocomposites for diabetes diagnosis and treatment

Glucose oxidase (GOx) has attracted a lot of attention in the field of diabetes diagnosis and treatment in recent years owing to its inherent biocompatibility and glucose-specific catalysis. GOx can effectively catalyze the oxidation of glucose in the blood to hydrogen peroxide (H2O2) and glucuronic acid and can be used as a sensitive element in biosensors to detect blood glucose concentrations. Nanomaterials based on the immobilization of GOx can significantly improve the performance of glucose sensors through, for example, reduced electron tunneling distance. Moreover, various insulin-loaded nanomaterials (e.g., metal-organic backbones, and mesoporous silica nanoparticles) have been developed for the control of blood glucose concentrations based on GOx catalytic chemistry. These nano-delivery carriers are capable of releasing insulin in response to GOx-mediated changes in the microenvironment, allowing for a rapid return of the blood microenvironment to a normal state. Therefore, glucose biosensors and insulin delivery vehicles immobilized with GOx are important tools for the diagnosis and treatment of diabetes. This paper reviews the characteristics of various GOx-based nanomaterials developed for glucose biosensing and insulin-responsive release as well as research progress, and also highlights the current challenges and opportunities facing this field.

Recent Advances in Glucose Responsive Insulin Delivery Systems: Novel Hydrogels and Future Applications

Over the past several decades, there have been major advancements in the field of glucose sensing and insulin delivery for the treatment of type I diabetes mellitus. The introduction of closed-loop insulin delivery systems that deliver insulin in response to specific levels of glucose in the blood has shifted significantly the research in this field. These systems consist of encapsulated glucose-sensitive components such as glucose oxidase or phenylboronic acid in hydrogels, microgels or nanoparticles. Since our previous evaluation of these systems in a contribution in 2004, new systems have been developed. Important improvements in key issues, such as consistent insulin delivery over an extended period of time have been addressed. In this contribution, we discuss recent advancements over the last 5 years and present persisting issues in these technologies that must be overcome in order for these systems to be applicable in patients.

A forskolin-conjugated insulin analog targeting endogenous glucose-transporter for glucose-responsive insulin delivery

Insulin administration for the management of diabetes is accompanied by hypoglycemia, which is expected to be mitigated by glucose-responsive smart insulin that has self-regulation ability in response to blood glucose level (BGL) fluctuation. Here, we have prepared a new insulin analog by modifying insulin with forskolin (designated as insulin-F), a glucose-transporter (Glut) inhibitor. In vitro, insulin-F is capable of binding to Glut on erythrocyte ghosts, which can be inhibited by glucose and cytochalasin B. Upon subcutaneous injection in type 1 diabetic mice, insulin-F maintains BGLs below 200 mg mL-1 for up to 10 h, and achieves 20 h with two sequential injections. Moreover, insulin-F also binds to endogenous Gluts. Upon a glucose challenge, the elevated level of glucose competitively replaces and liberates insulin-F that binds to Glut, rapidly restoring BGLs to the normal range.

Glucose-responsive insulin by molecular and physical design

The concept of a glucose-responsive insulin (GRI) has been a recent objective of diabetes technology. The idea behind the GRI is to create a therapeutic that modulates its potency, concentration or dosing relative to a patient's dynamic glucose concentration, thereby approximating aspects of a normally functioning pancreas. From the perspective of the medicinal chemist, the GRI is also important as a generalized model of a potentially new generation of therapeutics that adjust potency in response to a critical therapeutic marker. The aim of this Perspective is to highlight emerging concepts, including mathematical modelling and the molecular engineering of insulin itself and its potency, towards a viable GRI. We briefly outline some of the most important recent progress toward this goal and also provide a forward-looking viewpoint, which asks if there are new approaches that could spur innovation in this area as well as to encourage synthetic chemists and chemical engineers to address the challenges and promises offered by this therapeutic approach.

Boronic Acid as Glucose-Sensitive Agent Regulates Drug Delivery for Diabetes Treatment

In recent years, glucose-sensitive drug delivery systems have attracted considerable attention in the treatment of diabetes. These systems can regulate payload release by the changes of blood glucose levels continuously and automatically with potential application in self-regulated drug delivery. Boronic acid (BA), especially phenylboronic acid (PBA), as glucose-sensitive agent has been the focus of research in the design of glucose-sensitive platforms. This article reviews the previous attempts at the developments of PBA-based glucose-sensitive drug delivery systems regarding the PBA-functionalized materials and glucose-triggered drug delivery. The obstacles and potential developments of glucose-sensitive drug delivery systems based on PBA for diabetes treatment in the future are also described. The PBA-functionalized platforms that regulate drug delivery induced by glucose are expected to contribute significantly to the design and development of advanced intelligent self-regulated drug delivery systems for treatment of diabetes.

Controlled Drug Delivery: Historical perspective for the next generation

The modern day drug delivery technology is only 60years old. During this period numerous drug delivery systems have been developed. The first generation (1950-1980) has been very productive in developing many oral and transdermal controlled release formulations for clinical applications. On the other hand, the second generation (1980-2010) has not been as successful in generating clinical products. This is in large part due to the nature of the problems to overcome. The first generation of drug delivery technologies dealt with physicochemical problems, while the second struggled with biological barriers. Controlled drug delivery systems can be made with controllable physicochemical properties, but they cannot overcome the biological barriers. The third generation (from 2010) drug delivery systems need to overcome both physicochemical and biological barriers. The physicochemical problems stem from poor water solubility of drugs, large molecular weight of peptide and protein drugs, and difficulty of controlling drug release kinetics. The biological barriers to overcome include distribution of drug delivery systems by the body rather than by formulation properties, limiting delivery to a specific target in the body. In addition, the body's reaction to formulations limits their functions in vivo. The prosperous future of drug delivery systems depends on whether new delivery systems can overcome limits set by human physiology, and the development process can be accelerated with new ways of thinking.

Bio-responsive polymer hydrogels homeostatically regulate blood coagulation

Bio-responsive polymer architectures can empower medical therapies by engaging molecular feedback-response mechanisms resembling the homeostatic adaptation of living tissues to varying environmental constraints. Here we show that a blood coagulation-responsive hydrogel system can deliver heparin in amounts triggered by the environmental levels of thrombin, the key enzyme of the coagulation cascade, which—in turn—becomes inactivated due to released heparin. The bio-responsive hydrogel quantitatively quenches blood coagulation over several hours in the presence of pro-coagulant stimuli and during repeated incubation with fresh, non-anticoagulated blood. These features enable the introduced material to provide sustainable, autoregulated anticoagulation, addressing a key challenge of many medical therapies. Beyond that, the explored concept may facilitate the development of materials that allow the effective and controlled application of drugs and biomolecules.

Implementing biomolecular recognition mechanisms in synthetic materials may enable a wealth of biomedical and related applications. Here Maitz et al. present a bio-responsive hydrogel that releases the anticoagulant heparin in amounts proportional to the environmental levels of the procoagulatory protein thrombin.

From Drug Dosage Forms to Intelligent Drug-delivery Systems: a Change of Paradigm

The design of new drug-delivery systems (DDSs) able to regulate the moment and the rate at which the release should take place, and even to target the drug to specific tissues and cell compartments, has opened novel perspectives to improve the efficacy and safety of the therapeutic treatments. Ideally, the drug should only have access to its site of action and the release should follow the evolution of the disease or of certain biorhythms. The advances in the DDSs field are possible because of a better knowledge of the physiological functions and barriers to the drug access to the action site, but also due to the possibility of having “active” excipients that provide novel features. The joint work in a wide range of disciplines, comprising materials science, biomedical engineering and pharmaceutical technology, prompts the design and development of materials (lipids, polymers, hybrids) that can act as sensors of physiological parameters or external variables, and as actuators able to trigger or tune the release process. Such smart excipients lead to an advanced generation of DDSs designed as intelligent or stimuli-responsive. This chapter provides an overview of how the progress in DDSs is intimately linked to the evolution of the excipients, understood as a specific category of biomaterials. The phase transitions, the stimuli that can trigger them and the mechanisms behind the performance of the intelligent DDSs are analyzed as a whole, to serve as an introduction to the topics that are comprehensively discussed in the subsequent chapters of the book. A look to the future is also provided.

pH- and redox-responsive polysaccharide-based microcapsules with autofluorescence for biomedical applications

Autofluorescent microcapsules were assembled by covalent cross-linking of polysaccharide alginate dialdehyde (ADA) derivative and cystamine dihydrochloride (CM) through a layer-by-layer (LBL) technique. The formulated Schiff base and disulfide bonds render capsules with pH- and redox-responsive properties for pinpointed intracellular delivery based on the physiological difference between intracellular and extracellular environments. This simple and versatile method could be extended to other polysaccharide derivatives for the fabrication of autofluorescent nano- and micromaterials with dual stimuli response for biomedical applications.

AP@home: a novel European approach to bring the artificial pancreas home

The development of an artificial pancreas (AP) made huge strides from 2006 to 2008 and a large number of activities are going on in this area of research. Until now, most AP systems under development were tested only under highly controlled conditions. The aim of our project, funded by the European Union, is to develop an AP system to such a level that it can be studied under daily life conditions at the home of patients with diabetes (hence AP@home). Based on a subcutaneous-subcutaneous closed-loop strategy (i.e., glucose sensing and insulin infusion in the subcutaneous tissue), two different approaches will be taken to achieve this aim: a two-port AP system and a single-port AP system. The two-port AP system will use off-the-shelf-components for the glucose sensor and insulin pump in combination with closed-loop algorithms generated in Europe. As to the single-port AP system, two different innovative single-port systems will be developed; in this case, continuous glucose monitoring and insulin infusion will take place via a single catheter. The first clinical trials with the two-port AP system under controlled clinical conditions have started and good progress has been made in the development of the single-port AP systems. We believe that our consortium of 12 European partners, which builds on existing achievements and close cooperation between academic centers and industry, can contribute substantially to the development of an AP system that can be used by patients in daily life.

Supramolecular interactions in chemomechanical polymers

Molecular recognition is the basis for the operation of most biological functions; outside of nature, it has also been developed to a high degree of sophistication within the framework of supramolecular chemistry. More recently, selective noncovalent interactions, which constitute molecular recognition, are being used in intelligent new materials that transform chemical signals into actions, such as the release of drugs. The presence of supramolecular binding sites allows chemomechanical polymers to operate as sensors and actuators within a single unit without the need for any additional devices such as transducers or power supplies. A polymer can be designed so that a particular chemical substance, most often in aqueous surroundings, will trigger either a large expansion or a large contraction, depending on the mechanism. The translation of binding energy into mechanical motion can, with a suitable arrangement of the materials in tubes or on flexible films, be harnessed for unidirectional drives, flow control, the liberation of drugs, or the uptake of toxic compounds, among other applications. Miniaturization of the polymer particles allows one to enhance both the sensitivity and speed of the response, which is of particular importance in sensing. The basis for the selective response to external effector compounds, such as metal ions, amino acids, peptides, or nucleotides, is their noncovalent interaction with complementary functions covalently bound to the polymer network. With suitable polymers, selectivity between structural isomers, and even between enantiomers, as triggers can be achieved. As with supramolecular complexes in solution, the underlying interactions in polymers comprise a variety of noncovalent binding mechanisms, which are not easy to distinguish and quantify, and more so with polymers that are not monodisperse. In this Account, we present systematic comparisons of different polymers and effector classes that allow, for the first time, the characterization of these contributions in chemomechanical polymers: they comprise ion pairing, metal coordination, stacking, cation-pi, dispersive, and hydrophobic forces. In contrast, hydrogen bonding has a major role primarily in the hydrogel network structure itself. The fully reversible polymer volume changes are essentially determined by water uptake or release. In gels derived from boronic acid, glucose can serve as a cross-linking effector in promoting contractions via strong, reversible covalent bond formation in a highly distinctive manner. Cooperativity between two different effector compounds is more frequently seen with such polymers than in solution: it leads to logical AND gates by different motions of the particles, with a direct communication link to the outside world. For example, with a polymer that bears several recognition sites, triggering peptides induce motion only if Zn(2+) or Cu(2+) ions are simultaneously present. The molecular recognition mechanisms that cause volume changes in polymers share similarities with extensively studied supramolecular systems in solution, but there are also remarkable differences. In this Account, we bring the knowledge learned from solution studies to bear on our systematic analysis of polymeric systems in an effort to promote the effective harnessing of the forces involved in chemomechanical polymers and the smart materials that can be created with them.

Recent progress in analytical instrumentation for glycemic control in diabetic and critically ill patients

Implementing strict glycemic control can reduce the risk of serious complications in both diabetic and critically ill patients. For this reason, many different analytical, mainly electrochemical and optical sensor approaches for glucose measurements have been developed. Self-monitoring of blood glucose (SMBG) has been recognised as being an indispensable tool for intensive diabetes therapy. Recent progress in analytical instrumentation, allowing submicroliter samples of blood, alternative site testing, reduced test time, autocalibration, and improved precision, is comprehensively described in this review. Continuous blood glucose monitoring techniques and insulin infusion strategies, developmental steps towards the realization of the dream of an artificial pancreas under closed loop control, are presented. Progress in glucose sensing and glycemic control for both patient groups is discussed by assessing recent published literature (up to 2006). The state-of-the-art and trends in analytical techniques (either episodic, intermittent or continuous, minimal-invasive, or noninvasive) detailed in this review will provide researchers, health professionals and the diabetic community with a comprehensive overview of the potential of next-generation instrumentation suited to either short- and long-term implantation or ex vivo measurement in combination with appropriate body interfaces such as microdialysis catheters.

Release mechanisms for polyelectrolyte capsules

Polyelectrolyte capsules have recently been introduced as new microscopic vehicles which could have high potential in the biomedical field. In this critical review we give an introduction to the layer-by-layer (LbL) technique which is used to fabricate these polyelectrolyte capsules as well as to the different triggers that have been exploited to obtain drug release from these capsules. Furthermore, other types of triggered delivery systems are compared and critically discussed with regard to their clinical relevance. (171 references.).

Microfabricated drug delivery devices

We review newest developments in the design and fabrication of drug delivery devices based on micropatterned structures. Electronic devices have now reached a stage of dimensions comparable to those of biological macromolecules. This raises exciting possibilities for combining microelectronics and biotechnology to develop new technologies with unprecedented power and versatility. While molecular electronics use the unique self-assembly, switching and dynamic capabilities of molecules to miniaturize electronic devices, nanoscale biosystems use the power of microelectronics to design ultrafast/ultrasmall biocompatible devices, including implants, that can revolutionize the field of bioengineering. Thus, in recent years we have seen an explosion in the field of novel microfabricated and nanofabricated devices for drug delivery. Such devices seek to develop a platform of well controlled functions in the micro- or nano-level. They include nanoparticulate systems, recognitive molecular systems, biosensing devices, and microfabricated and microelectronic devices.