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Sarangi M, Padhi S, Rath G. Non-Invasive Delivery of Insulin for Breaching Hindrances against Diabetes. Crit Rev Ther Drug Carrier Syst 2024; 41:1-64. [PMID: 38608132 DOI: 10.1615/critrevtherdrugcarriersyst.2023048197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Insulin is recognized as a crucial weapon in managing diabetes. Subcutaneous (s.c.) injections are the traditional approach for insulin administration, which usually have many limitations. Numerous alternative (non-invasive) slants through different routes have been explored by the researchers for making needle-free delivery of insulin for attaining its augmented absorption as well as bioavailability. The current review delineating numerous pros and cons of several novel approaches of non-invasive insulin delivery by overcoming many of their hurdles. Primary information on the topic was gathered by searching scholarly articles from PubMed added with extraction of data from auxiliary manuscripts. Many approaches (discussed in the article) are meant for the delivery of a safe, effective, stable, and patient friendly administration of insulin via buccal, oral, inhalational, transdermal, intranasal, ocular, vaginal and rectal routes. Few of them have proven their clinical efficacy for maintaining the glycemic levels, whereas others are under the investigational pipe line. The developed products are comprising of many advanced micro/nano composite technologies and few of them might be entering into the market in near future, thereby garnishing the hopes of millions of diabetics who are under the network of s.c. insulin injections.
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Affiliation(s)
| | - Sasmita Padhi
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Malhaur Railway Station Road, Gomti Nagar, Lucknow, Uttar Pradesh, Pin-201313, India
| | - Goutam Rath
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Siksha 'O' Anusandhan University, Bhubaneswar-751030, Odisha, India
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2
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Rawat U, Choudhary A, Mittal P, Verma A. The hidden obstacles to intranasal insulin delivery: A narrative review. J Diabetol 2023. [DOI: 10.4103/jod.jod_108_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
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Nemati M, Fathi-Azarbayjani A, Al-Salami H, Roshani Asl E, Rasmi Y. Bile acid-based advanced drug delivery systems, bilosomes and micelles as novel carriers for therapeutics. Cell Biochem Funct 2022; 40:623-635. [PMID: 35830577 DOI: 10.1002/cbf.3732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 12/17/2022]
Abstract
Diabetes mellitus affects almost half a billion patients worldwide and results from either destruction of β-cells responsible for insulin secretion or increased tissue resistance to insulin stimulation and the reduction of glycemic control. Novel drug delivery systems can improve treatment efficacy in diabetic patients. The low aqueous solubility of most oral antidiabetic drugs decreases drug bioavailability; therefore, there is a demand for the use of novel methods to overcome this issue. The application of bile acids mixed micelles and bilosomes can provide an enhancement in drug efficacy. Bile acids are amphiphilic steroidal molecules that contain a saturated tetracyclic hydrocarbon cyclopentanoperhydrophenanthrene ring, and consist of three 6-membered rings and a 5-membered ring, a short aliphatic side chain, and a tough steroid nucleus. This review offers a comprehensive and informative data focusing on the great potential of bile acid, their salts, and their derivatives for the development of new antidiabetic drug delivery system.
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Affiliation(s)
- Mohadeseh Nemati
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Anahita Fathi-Azarbayjani
- Experimental and Applied Pharmaceutical Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Hani Al-Salami
- Biotechnology and Drug Development Research Laboratory, Curtin Medical School, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Elmira Roshani Asl
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rasmi
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
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Baloch SG, Shaikh H, Shah S, Memon S, Memon AA. Synthesis of an insulin intercalated graphene oxide nanogel composite: evaluation of its release profile and stability for oral delivery of insulin. Nanoscale Adv 2022; 4:2303-2312. [PMID: 36133704 PMCID: PMC9417858 DOI: 10.1039/d1na00887k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 06/16/2023]
Abstract
Diabetes mellitus (DM) is a disorder of glucose regulation produced due to insufficient availability of insulin. Generally, insulin is given to diabetes patients via subcutaneous injection which is a painful method to deliver this drug. In this work we have made an attempt to develop an oral drug delivery system that can efficiently deliver insulin to the small intestine. An insulin intercalated GO based nanogel composite (In@GO NgC) was fabricated for oral delivery of insulin. The in vitro release of insulin from In@GO NgC was studied in artificial gastric (pH 1.2) and intestinal (pH 7.5) fluids. The In@GO NgC produced better release in artificial intestinal fluid as compared to gastric fluid. The enzymatic degradation of released insulin was also examined and the results revealed that even after 6 h of incubation, the gel remained stable and the un-degraded insulin seemed to be sufficient for the physiological processes. The efficacy of In@GO NgC was also confirmed by comparing its release profile with non-intercalated GO NgC and nanogel (Ng) without GO. The prepared nanogels were thoroughly characterized using FTIR, SEM, EDS, DSC and DLS. The better release profile and enzymatic stability of In@GO NgC suggests that it can be utilized for oral drug delivery of insulin.
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Affiliation(s)
- Shabana Gul Baloch
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Huma Shaikh
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Shahnila Shah
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Shahabuddin Memon
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Ayaz Ali Memon
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
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Deguchi S, Ogata F, Isaka T, Otake H, Nakazawa Y, Kawasaki N, Nagai N. Prevention of Postprandial Hyperglycemia by Ophthalmic Nanoparticles Based on Protamine Zinc Insulin in the Rabbit. Pharmaceutics 2021; 13:pharmaceutics13030375. [PMID: 33809008 PMCID: PMC8000746 DOI: 10.3390/pharmaceutics13030375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Postprandial hyperglycemia, a so-called blood glucose spike, is associated with enhanced risks of diabetes mellitus (DM) and its complications. In this study, we attempted to design nanoparticles (NPs) of protamine zinc insulin (PZI) by the bead mill method, and prepare ophthalmic formulations based on the PZI-NPs with (nPZI/P) or without polyacrylic acid (nPZI). In addition, we investigated whether the instillation of the newly developed nPZI and nPZI/P can prevent postprandial hyperglycemia in a rabbit model involving the oral glucose tolerance test (OGTT). The particle size of PZI was decreased by the bead mill to a range for both nPZI and nPZI/P of 80-550 nm with no observable aggregation for 6 d. Neither nPZI nor nPZI/P caused any noticeable corneal toxicity. The plasma INS levels in rabbits instilled with nPZI were significantly higher than in rabbits instilled with INS suspensions (commercially available formulations, CA-INS), and the plasma INS levels were further enhanced with the amount of polyacrylic acid in the nPZI/P. In addition, the rapid rise in plasma glucose levels in OGTT-treated rabbits was prevented by a single instillation of nPZI/P, which was significantly more effective at attenuating postprandial hyperglycemia (blood glucose spike) in comparison with nPZI. In conclusion, we designed nPZI/P, and show that a single instillation before OGTT attenuates the rapid enhancement of plasma glucose levels. These findings suggest a better management strategy for the postprandial blood glucose spike, which is an important target of DM therapy.
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Affiliation(s)
- Saori Deguchi
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan; (S.D.); (F.O.); (T.I.); (H.O.); (N.K.)
| | - Fumihiko Ogata
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan; (S.D.); (F.O.); (T.I.); (H.O.); (N.K.)
| | - Takumi Isaka
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan; (S.D.); (F.O.); (T.I.); (H.O.); (N.K.)
| | - Hiroko Otake
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan; (S.D.); (F.O.); (T.I.); (H.O.); (N.K.)
| | - Yosuke Nakazawa
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan;
| | - Naohito Kawasaki
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan; (S.D.); (F.O.); (T.I.); (H.O.); (N.K.)
| | - Noriaki Nagai
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan; (S.D.); (F.O.); (T.I.); (H.O.); (N.K.)
- Correspondence: ; Tel.: +81-6-4307-3638
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Ahad A, Raish M, Bin Jardan YA, Al-Mohizea AM, Al-Jenoobi FI. Delivery of Insulin via Skin Route for the Management of Diabetes Mellitus: Approaches for Breaching the Obstacles. Pharmaceutics 2021; 13:pharmaceutics13010100. [PMID: 33466845 PMCID: PMC7830404 DOI: 10.3390/pharmaceutics13010100] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022] Open
Abstract
Insulin is used for the treatment of diabetes mellitus, which is characterized by hyperglycemia. Subcutaneous injections are the standard mode of delivery for insulin therapy; however, this procedure is very often invasive, which hinders patient compliance, particularly for individuals requiring insulin doses four times a day. Furthermore, cases have been reported of sudden hypoglycemia occurrences following multidose insulin injections. Such an invasive and intensive approach motivates the quest for alternative, more user-friendly insulin administration approaches. For example, transdermal delivery has numerous advantages, such as prolonged drug release, low variability in the drug plasma level, and improved patient compliance. In this paper, the authors summarize different approaches used in transdermal insulin delivery, including microneedles, chemical permeation enhancers, sonophoresis, patches, electroporation, iontophoresis, vesicular formulations, microemulsions, nanoparticles, and microdermabrasion. Transdermal systems for insulin delivery are still being widely researched. The conclusions presented in this paper are extracted from the literature, notably, that the transdermal route could effectively and reliably deliver insulin into the circulatory system. Consistent progress in this area will ensure that some of the aforementioned transdermal insulin delivery systems will be introduced in clinical practice and commercially available in the near future.
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Yazdi JR, Tafaghodi M, Sadri K, Mashreghi M, Nikpoor AR, Nikoofal-Sahlabadi S, Chamani J, Vakili R, Moosavian SA, Jaafari MR. Folate targeted PEGylated liposomes for the oral delivery of insulin: In vitro and in vivo studies. Colloids Surf B Biointerfaces 2020; 194:111203. [DOI: 10.1016/j.colsurfb.2020.111203] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 02/03/2023]
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Muhammad K, Khan T, Nisar-ur-rehman, Khan Z, Subhan F. Knowledge and attitude regarding insulin self-administration among diabetic patients: a cross-sectional study in a teaching hospital of Khyber-Pakhtunkhwa, Pakistan. Drugs Ther Perspect 2020; 36:266-272. [DOI: 10.1007/s40267-020-00719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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A. Mumuni M, E. Calister U, Aminu N, C. Franklin K, Musiliu Oluseun A, Usman M, Abdulmumuni B, Y. James O, C. Ofokansi K, A. Anthony A, C. Ibezim E, Díaz Díaz D. Mucin-Grafted Polyethylene Glycol Microparticles Enable Oral Insulin Delivery for Improving Diabetic Treatment. Applied Sciences 2020; 10:2649. [DOI: 10.3390/app10082649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this study, different ratios of mucin-grafted polyethylene-glycol-based microparticles were prepared and evaluated both in vitro and in vivo as carriers for the oral delivery of insulin. Characterization measurements showed that the insulin-loaded microparticles display irregular porosity and shape. The encapsulation efficiency and loading capacity of insulin were >82% and 18%, respectively. The release of insulin varied between 68% and 92% depending on the microparticle formulation. In particular, orally administered insulin-loaded microparticles resulted in a significant fall of blood glucose levels, as compared to insulin solution. Subcutaneous administration showed a faster, albeit not sustained, glucose fall within a short time as compared to the polymeric microparticle-based formulations. These results indicate the possible oral delivery of insulin using this combination of polymers.
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Agazzi ML, Herrera SE, Cortez ML, Marmisollé WA, Tagliazucchi M, Azzaroni O. Insulin Delivery from Glucose‐Responsive, Self‐Assembled, Polyamine Nanoparticles: Smart “Sense‐and‐Treat” Nanocarriers Made Easy. Chemistry 2020; 26:2456-2463. [DOI: 10.1002/chem.201905075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Maximiliano L. Agazzi
- Instituto de Investigaciones Fisicoquímicas Teóricas y, Aplicadas Facultad de Ciencias ExactasUniversidad Nacional de La, Plata-CONICET Sucursal 4, Casilla de Correo 16 1900 La Plata Argentina
| | - Santiago E. Herrera
- Instituto de Investigaciones Fisicoquímicas Teóricas y, Aplicadas Facultad de Ciencias ExactasUniversidad Nacional de La, Plata-CONICET Sucursal 4, Casilla de Correo 16 1900 La Plata Argentina
| | - M. Lorena Cortez
- Instituto de Investigaciones Fisicoquímicas Teóricas y, Aplicadas Facultad de Ciencias ExactasUniversidad Nacional de La, Plata-CONICET Sucursal 4, Casilla de Correo 16 1900 La Plata Argentina
| | - Waldemar A. Marmisollé
- Instituto de Investigaciones Fisicoquímicas Teóricas y, Aplicadas Facultad de Ciencias ExactasUniversidad Nacional de La, Plata-CONICET Sucursal 4, Casilla de Correo 16 1900 La Plata Argentina
| | - Mario Tagliazucchi
- Departamento de Química Inorgánica, Analítica y Química FísicaINQUIMAE-CONICETFacultad de Ciencias Exactas y NaturalesCiudad Universitaria Pabellón 2 Buenos Aires C1428EHA Argentina
| | - Omar Azzaroni
- Instituto de Investigaciones Fisicoquímicas Teóricas y, Aplicadas Facultad de Ciencias ExactasUniversidad Nacional de La, Plata-CONICET Sucursal 4, Casilla de Correo 16 1900 La Plata Argentina
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Baghban Taraghdari Z, Imani R, Mohabatpour F. A Review on Bioengineering Approaches to Insulin Delivery: A Pharmaceutical and Engineering Perspective. Macromol Biosci 2019; 19:e1800458. [DOI: 10.1002/mabi.201800458] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Zahra Baghban Taraghdari
- Z. Baghban Taraghdari, Dr. R. Imani, F. MohabatpourDepartment of Biomedical EngineeringAmirkabir University of Technology Tehran 15875/4413 Iran
| | - Rana Imani
- Z. Baghban Taraghdari, Dr. R. Imani, F. MohabatpourDepartment of Biomedical EngineeringAmirkabir University of Technology Tehran 15875/4413 Iran
| | - Fatemeh Mohabatpour
- Z. Baghban Taraghdari, Dr. R. Imani, F. MohabatpourDepartment of Biomedical EngineeringAmirkabir University of Technology Tehran 15875/4413 Iran
- Division of Biomedical EngineeringUniversity of Saskatchewan Saskatoon S7N5A9 Canada
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Lim ZW, Ping Y, Miserez A. Glucose-Responsive Peptide Coacervates with High Encapsulation Efficiency for Controlled Release of Insulin. Bioconjug Chem 2018; 29:2176-2180. [DOI: 10.1021/acs.bioconjchem.8b00369] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zhi Wei Lim
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
| | - Yuan Ping
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
| | - Ali Miserez
- Centre for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Drive, 637553 Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551 Singapore
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Yatoo MI, Dimri U, Gopalakrishnan A, Saxena A, Wani SA, Dhama K. In vitro and in vivo immunomodulatory potential of Pedicularis longiflora and Allium carolinianum in alloxan-induced diabetes in rats. Biomed Pharmacother 2018; 97:375-384. [DOI: 10.1016/j.biopha.2017.10.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/12/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022] Open
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P.V. J, Nair SV, Kamalasanan K. Current trend in drug delivery considerations for subcutaneous insulin depots to treat diabetes. Colloids Surf B Biointerfaces 2017; 153:123-131. [DOI: 10.1016/j.colsurfb.2017.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/01/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
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Abstract
Because of uncomfortable, painful and even deleterious effects of daily injection of insulin, extensive efforts are being made worldwide for developing noninvasive drug delivery systems, especially via the oral route. In this study, we synthesized hydroxyethyl methacrylate (HEMA) nanogel via emulsion polymerization method. The morphology and stability of the nanogel were characterized by scanning electronic microscope and dynamic light scattering. In vivo results showed the soft HEMA nanogel had longer half-live in the body circulation and exhibited almost negligible uptake by the macrophage cells as compared with blank cells. For the FITC-dextran tracking for intestinal penetration, the results indicated that the FITC-dextran in the soft nanogel penetrated faster from the inner side of the abdominal segment, which explained why the soft HEMA nanogel could promote intestinal absorption of encapsulated insulin. In vivo delivery of insulin encapsulated in the soft HEMA nanogel sustained blood glucose control for 12 h, and the overall bioavailability of administrated insulin was much higher than free insulin. Our results showed that the insulin-loaded HEMA nanogel was able to efficiently control blood glucose as a delivery system, suggesting the HEMA nanogel using emulsion polymerization could be an alternative carrier for oral insulin delivery.
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Affiliation(s)
- Xiaomei Wang
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
| | - Dan Cheng
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
| | - Linglin Liu
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
| | - Xuejun Li
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
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Liu HY, Chen CC, Lin YY, Chen YJ, Liu BH, Wong SC, Wu CY, Chang YT, Chou HE, Ding ST. Chitosan-assisted differentiation of porcine adipose tissue-derived stem cells into glucose-responsive insulin-secreting clusters. PLoS One 2017; 12:e0172922. [PMID: 28253305 DOI: 10.1371/journal.pone.0172922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/11/2017] [Indexed: 12/25/2022] Open
Abstract
The unique advantage of easy access and abundance make the adipose-derived stem cells (ADSCs) a promising system of multipotent cells for transplantation and regenerative medicine. Among the available sources, porcine ADSCs (pADSCs) deserve especial attention due to the close resemblance of human and porcine physiology, as well as for the upcoming availability of humanized porcine models. Here, we report on the isolation and conversion of pADSCs into glucose-responsive insulin-secreting cells. We used the stromal-vascular fraction of the dorsal subcutaneous adipose from 9-day-old male piglets to isolate pADSCs, and subjected the cells to an induction scheme for differentiation on chitosan-coated plates. This one-step procedure promoted differentiation of pADSCs into pancreatic islet-like clusters (PILC) that are characterized by the expression of a repertoire of pancreatic proteins, including pancreatic and duodenal homeobox (Pdx-1), insulin gene enhancer protein (ISL-1) and insulin. Upon glucose challenge, these PILC secreted high amounts of insulin in a dose-dependent manner. Our data also suggest that chitosan plays roles not only to enhance the differentiation potential of pADSCs, but also to increase the glucose responsiveness of PILCs. Our novel approach is, therefore, of great potential for transplantation-based amelioration of type 1 diabetes.
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Barua S, Kim H, Jo K, Seo CW, Park TJ, Lee KB, Yun G, Oh K, Lee J. Drug delivery techniques for buccal route: formulation strategies and recent advances in dosage form design. Journal of Pharmaceutical Investigation 2016; 46:593-613. [DOI: 10.1007/s40005-016-0281-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present an example of human factors research using our data to examine psychological factors associated with technology use. Device/technology uptake and use has increased over the years and at present day is a common clinical practice. There are mixed results in terms of health and psychosocial outcomes, with specific subgroups doing better than others with technology. Our data demonstrated that patients have moderately elevated diabetes distress across differing types of technology used, from low-tech to high-tech options, possibly meaning that technology does not add or take away distress. In addition, users on multiple daily injections compared to all other technology groups have less positive attitudes about technology. Finally, we discuss implications for clinical practice and future research.
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Affiliation(s)
- Diana Naranjo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
| | - Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
| | - Korey K Hood
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA Department of Pediatrics, Stanford University School of Medicine, CA, USA
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Lu J, Ji W, Zhao M, Wang M, Yan W, Chen M, Ren S, Yuan B, Wang B, Chen L. Protamine zinc insulin combined with sodium selenite improves glycometabolism in the diabetic KKAy mice. Sci Rep 2016; 6:26563. [PMID: 27212152 DOI: 10.1038/srep26563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/05/2016] [Indexed: 12/22/2022] Open
Abstract
Long-term, high dosage protamine zinc insulin (PZI) treatments produce adverse reactions. The trace element selenium (Se) is a candidate for the prevention of diabetes due to anti-oxidative stress activity and the regulation of glycometabolism. In this study, we aimed to investigate the anti-diabetic effects of a combination of PZI and Se on type 2 diabetes. Diabetic KKAy mice were randomized into the following groups: model group and groups that were subcutaneously injected with PZI, Se, high or low dose PZI + Se for 6 weeks. PZI combined with Se decreased the body weight and fasting blood glucose levels. Moreover, this treatment also improved insulin tolerance, as determined by the reduced values from the oral glucose tolerance test and insulin tolerance test, and increased insulin levels and insulin sensitivity index. PZI combined with Se ameliorated skeletal muscle and β-cell damage and the impaired mitochondrial morphology. Oxidative stress was also reduced. Furthermore, PZI combined with Se upregulated phosphatidylinositol 3-kinase (PI3K) and downregulated protein tyrosine phosphatase 1B (PTP1B). Importantly, the low dosage combination produced effects similar to PZI alone. In conclusion, PZI combined with Se improved glycometabolism and ameliorated the tissue and mitochondrial damage, which might be associated with the PI3K and PTP1B pathways.
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Abstract
Many patients with advanced type 2 diabetes mellitus (T2DM) and all patients with T1DM require insulin to keep blood glucose levels in the target range. The most common route of insulin administration is subcutaneous insulin injections. There are many ways to deliver insulin subcutaneously such as vials and syringes, insulin pens, and insulin pumps. Though subcutaneous insulin delivery is the standard route of insulin administration, it is associated with injection pain, needle phobia, lipodystrophy, noncompliance and peripheral hyperinsulinemia. Therefore, the need exists for delivering insulin in a minimally invasive or noninvasive and in most physiological way. Inhaled insulin was the first approved noninvasive and alternative way to deliver insulin, but it has been withdrawn from the market. Technologies are being explored to make the noninvasive delivery of insulin possible. Some of the routes of insulin administration that are under investigation are oral, buccal, nasal, peritoneal and transdermal. This review article focuses on the past, present and future of various insulin delivery techniques. This article has focused on different possible routes of insulin administration with its advantages and limitation and possible scope for the new drug development.
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Affiliation(s)
- Rima B Shah
- Department of Pharmacology, GMERS Medial College, Gandhinagar, Gujarat, India
| | - Manhar Patel
- Brain Research and Intervention Center, University of Illinois, Chicago, USA
| | - David M Maahs
- Barbara Davis Center for Diabetes, University of Colorado, Denver, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado, Denver, USA
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Chou HS, Larsson M, Hsiao MH, Chen YC, Röding M, Nydén M, Liu DM. Injectable insulin-lysozyme-loaded nanogels with enzymatically-controlled degradation and release for basal insulin treatment: In vitro characterization and in vivo observation. J Control Release 2016; 224:33-42. [DOI: 10.1016/j.jconrel.2015.12.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022]
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Olczyk P, Komosinska-Vassev K, Ramos P, Mencner Ł, Olczyk K, Pilawa B. Interactions of short-acting, intermediate-acting and pre-mixed human insulins with free radicals--Comparative EPR examination. Int J Pharm 2015; 490:9-15. [PMID: 25975232 DOI: 10.1016/j.ijpharm.2015.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
Electron paramagnetic resonance (EPR) spectroscopy was used to examine insulins interactions with free radicals. Human recombinant DNA insulins of three groups were studied: short-acting insulin (Insuman Rapid); intermediate-acting insulins (Humulin N, Insuman Basal), and pre-mixed insulins (Humulin M3, Gensulin M50, Gensulin M40, Gensulin M30). The aim of an X-band (9.3GHz) study was comparative analysis of antioxidative properties of the three groups of human insulins. DPPH was used as a stable free radical model. Amplitudes of EPR lines of DPPH as the paramagnetic free radical reference, and DPPH interacting with the individual tested insulins were compared. For all the examined insulins kinetics of their interactions with free radicals up to 60 min were obtained. The strongest interactions with free radicals were observed for the short-acting insulin - Insuman Rapid. The lowest interactions with free radicals were characteristic for intermediate-acting insulin - Insuman Basal. The pre-mixed insulins i.e. Humulin M3 and Gensulin M50 revealed the fastest interactions with free radicals. The short acting, intermediate acting and premixed insulins have been found to be effective agents in reducing free radical formation in vitro and should be further considered as potential useful tools in attenuation of oxidative stress in diabetic patients.
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Affiliation(s)
- Paweł Olczyk
- Department of Community Pharmacy, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-200 Sosnowiec, Poland.
| | - Katarzyna Komosinska-Vassev
- Department of Clinical Chemistry and Laboratory Diagnostics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jedności 8, 41-200 Sosnowiec, Poland.
| | - Paweł Ramos
- Department of Biophysics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jedności 8, 41-200 Sosnowiec, Poland.
| | - Łukasz Mencner
- Department of Clinical Chemistry and Laboratory Diagnostics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jedności 8, 41-200 Sosnowiec, Poland.
| | - Krystyna Olczyk
- Department of Clinical Chemistry and Laboratory Diagnostics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jedności 8, 41-200 Sosnowiec, Poland.
| | - Barbara Pilawa
- Department of Biophysics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jedności 8, 41-200 Sosnowiec, Poland.
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Bilbao D, Luciani L, Johannesson B, Piszczek A, Rosenthal N. Insulin-like growth factor-1 stimulates regulatory T cells and suppresses autoimmune disease. EMBO Mol Med 2015; 6:1423-35. [PMID: 25339185 PMCID: PMC4237469 DOI: 10.15252/emmm.201303376] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The recent precipitous rise in autoimmune diseases is placing an increasing clinical and economic burden on health systems worldwide. Current therapies are only moderately efficacious, often coupled with adverse side effects. Here, we show that recombinant human insulin-like growth factor-1 (rhIGF-1) stimulates proliferation of both human and mouse regulatory T (Treg) cells in vitro and when delivered systemically via continuous minipump, it halts autoimmune disease progression in mouse models of type 1 diabetes (STZ and NOD) and multiple sclerosis (EAE) in vivo. rhIGF-1 administration increased Treg cells in affected tissues, maintaining their suppressive properties. Genetically, ablation of the IGF-1 receptor specifically on Treg cell populations abrogated the beneficial effects of rhIGF-1 administration on the progression of multiple sclerotic symptoms in the EAE model, establishing a direct effect of IGF-1 on Treg cell proliferation. These results establish systemically delivered rhIGF-1 as a specific, effective stimulator of Treg cell action, underscoring the clinical feasibility of manipulating natural tolerance mechanisms to suppress autoimmune disease.
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Affiliation(s)
- Daniel Bilbao
- Mouse Biology Unit, European Molecular Biology Laboratory (EMBL), Monterotondo, Italy
| | - Luisa Luciani
- Mouse Biology Unit, European Molecular Biology Laboratory (EMBL), Monterotondo, Italy
| | - Bjarki Johannesson
- Mouse Biology Unit, European Molecular Biology Laboratory (EMBL), Monterotondo, Italy
| | - Agnieszka Piszczek
- Mouse Biology Unit, European Molecular Biology Laboratory (EMBL), Monterotondo, Italy
| | - Nadia Rosenthal
- Mouse Biology Unit, European Molecular Biology Laboratory (EMBL), Monterotondo, Italy National Heart and Lung Institute, Imperial College, London, UK Australian Regenerative Medicine Institute/EMBL Australia, Monash University, Clayton, Vic., Australia
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Zisser H, Dassau E, Lee JJ, Harvey RA, Bevier W, Doyle FJ. Clinical results of an automated artificial pancreas using technosphere inhaled insulin to mimic first-phase insulin secretion. J Diabetes Sci Technol 2015; 9:564-72. [PMID: 25901023 PMCID: PMC4604530 DOI: 10.1177/1932296815582061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether or not adding a fixed preprandial dose of inhaled insulin to a fully automated closed loop artificial pancreas would improve the postprandial glucose control without adding an increased risk of hypoglycemia. RESEARCH DESIGN AND METHODS Nine subjects with T1DM were recruited for the study. The patients were on closed-loop control for 24 hours starting around 4:30 pm. Mixed meals (~50 g CHO) were given at 6:30 pm and 7:00 am the following day. For the treatment group each meal was preceded by the inhalation of one 10 U dose of Technosphere Insulin (TI). Subcutaneous insulin delivery was controlled by a zone model predictive control algorithm (zone-MPC). At 11:00 am, the patient exercised for 30 ± 5 minutes at 50% of predicted heart rate reserve. RESULTS The use of TI resulted in increasing the median percentage time in range (70-180 mg/dl, BG) during the 5-hour postprandial period by 21.6% (81.6% and 60% in the with/without TI cases, respectively, P = .06) and reducing the median postprandial glucose peak by 33 mg/dl (172 mg/dl and 205 mg/dl in the with and without TI cases, respectively, P = .004). The median percentage time in range 80-140 mg/dl during the entire study period was 67.5% as compared to percentage time in range without the use of TI of 55.2% (P = .03). CONCLUSIONS Adding preprandial TI (See video supplement) to an automated closed-loop AP system resulted in superior postprandial control as demonstrated by lower postprandial glucose exposure without addition hypoglycemia.
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Affiliation(s)
- Howard Zisser
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Eyal Dassau
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Justin J Lee
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Rebecca A Harvey
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Wendy Bevier
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Francis J Doyle
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, USA
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Krichten C, Kapustin J, Ghabranious M, Mewborn A. V-Go Insulin Delivery Device: A New Tool for Primary Care Settings. J Nurse Pract 2015; 11:341-346. [DOI: 10.1016/j.nurpra.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McQueen RB, Ellis SL, Maahs DM, Anderson HD, Nair KV, Libby AM, Campbell JD. Association between glycated hemoglobin and health utility for Type 1 diabetes. Patient 2014; 7:197-205. [PMID: 24458545 DOI: 10.1007/s40271-014-0045-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cost-effectiveness models for diabetes link glycated hemoglobin (HbA1c) to diabetes-related complications. Independent of diabetes-related complications, there is little known on the association between HbA1c and health utility scores. This link can alter the cost effectiveness of interventions designed to improve HbA1c. The cross-sectional relationship between HbA1c and health utility scores in adult type 1 diabetes patients was estimated after adjusting for diabetes-related complications. METHODS The EuroQoL-5 dimension (EQ-5D) questionnaire and an ad hoc survey requesting demographic information and adherence to glucose monitoring therapies was administered to adult type 1 diabetes patients during a clinic visit and combined with clinical medical record data. Health utility scores were derived using the US time-tradeoff valuation of the EQ-5D. Linear regression was used to estimate the relationship between HbA1c and utility, adjusting for treatments, demographics, and diabetes-related complications. RESULTS Among 176 patients, mean (standard deviation [SD]) age was 38 (12.2) years, duration of disease was 22 (12.1) years, and number of chronic conditions other than type 1 diabetes was 2.7 (2.0). Unadjusted mean (SD) utility was 0.94 (0.09) for those with HbA1c levels <7 % (n = 54), 0.89 (0.15) for those with HbA1c ≥ 7 % (n = 122), and 0.91 (0.14) for all patients. After adjustment, a 1 % absolute increase in HbA1c was associated with a disutility of -0.03 (95 % confidence interval [CI] -0.049, -0.006). CONCLUSIONS Findings suggest that, after adjusting for diabetes-related complications, higher HbA1c levels are associated with a significant health disutility. Pending additional data from longitudinal studies, these findings could be used in cost-effectiveness evaluations of type 1 diabetes interventions that impact HbA1c.
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Affiliation(s)
- R Brett McQueen
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA,
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Smirnova E, Safenkova I, Stein-Margolina V, Shubin V, Gurvits B. Can aggregation of insulin govern its fate in the intestine? Implications for oral delivery of the drug. Int J Pharm 2014; 471:65-8. [DOI: 10.1016/j.ijpharm.2014.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
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Abstract
PURPOSE Despite many advances in diabetes care over the last century, some elements of insulin therapy remain inadequate for optimal care of the patient with diabetes. There is a need for improved pharmacokinetics and pharmacodynamics of rapid-acting insulin analogues to mimic physiologic insulin secretion. In addition, a major barrier to successful insulin therapy has been patient resistance. Alternative routes of insulin administration, including inhaled insulin, have been under investigation for several years. This review discusses the rationale for pulmonary delivery of insulin, compares previous inhaled insulin products, reviews the literature on the safety and efficacy of a current inhaled insulin formulation under investigation, and compares this product with other prandial insulin products. METHODS English-language studies and reviews of inhaled insulin were searched in MEDLINE, the ClinicalTrials.gov registry (through May 2014), and the US Food and Drug Administration Website. FINDINGS Inhaled insulin has several favorable characteristics due to pulmonary anatomy/physiology and the lack of injections. Pharmacokinetic and pharmacodynamic studies have shown a time-action profile suitable for prandial insulin use. Inhaled insulin seems to be safe and effective compared with other prandial insulin products and may be preferable to subcutaneous rapid-acting insulin analogues in terms of time-action profiles and rates of hypoglycemia. Small decreases in forced expiratory volume in 1 second (FEV1) have been shown with inhaled insulin, although this finding is not progressive over time and reverses with cessation of the medication. IMPLICATIONS Although several inhaled insulin products have been under investigation, only one (Exubera(®) [Nektar Therapeutics, San Carlos, California/Pfizer Inc, New York, New York]) was approved by the US Food and Drug Administration, and it was pulled from the market after only a short period of time. Technosphere(®) insulin (MannKind Corporation, Valencia, California) is currently the only inhaled insulin that remains under investigation. A review of the past and present literature on inhaled insulin is pertinent in understanding the current status of inhaled insulin and its risks and benefits. The current literature suggests that inhaled insulin could be a valuable option for prandial insulin administration, with a favorable risk to benefit ratio in some patients.
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Affiliation(s)
| | - Steven Edelman
- University of California, San Diego, San Diego, California
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Siekmeier R, Hofmann T, Scheuch G, Pokorski M. Aerosolized GLP-1 for treatment of diabetes mellitus and irritable bowel syndrome. Adv Exp Med Biol 2014; 849:23-38. [PMID: 25427821 DOI: 10.1007/5584_2014_94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Diabetes is a global burden and the prevalence of the disease, in particular diabetes mellitus type 2 is rapidly increasing worldwide. After introduction of insulin into clinical therapy about 90 years ago a major number of pharmaceuticals has been developed for treatment of diabetes mellitus type 2. One of these, the incretin glucagon-like peptide 1 (GLP-1), like insulin, needs subcutaneous administration causing inconvenience to patients. However, administration of GLP-1 plays also a role for treatment of irritable bowel syndrome (IBS). To improve patient convenience inhaled insulin (Exubera(®)) was developed and approved but failed market acceptance some years ago. Recently, another inhalative insulin (Afrezza(®)) received market approval and GLP-1 may serve as another candidate drug for inhalative administration. This review analyzes the current literature investigating alternative administration of GLP-1 and GLP-1 analogs focusing on inhalation. Several formulations for inhalative administration of GLP-1 and analogs were investigated in animal studies, whereas there are only few clinical data. However, feasibility of GLP-1 inhalation has been shown and should be further investigated as such type of drug administration may serve for improvement of therapy in patients with diabetes mellitus or irritable bowel syndrome.
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Affiliation(s)
- Rüdiger Siekmeier
- Drug Regulatory Affairs, Pharmaceutical Institute, Bonn University, An der Immenburg 4, 53121, Bonn, Germany,
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Zarogoulidis P, Petridis D, Ritzoulis C, Li Q, Huang H, Ning Y, Darwiche K, Freitag L, Zarogoulidis K. Further experimentation of inhaled; LANTUS, ACTRAPID and HUMULIN with todays' production systems. Int J Pharm 2013; 458:39-47. [PMID: 24140545 DOI: 10.1016/j.ijpharm.2013.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several aerosol production systems have been used for aerosol insulin production. However; since the first studies several new models of jet-nebulizers and ultrasound nebulizers have been introduced in the market. MATERIALS AND METHODS Three different models of jet-nebulizers (different brands, same properties) and three different ultrasound nebulizers (different brands, same properties). Six residual cups (2 small ≤ 6 ml and 3 large ≤ 8 ml) were used for the jet-nebulizers. The ultrasound nebulizers were used with their facemasks or with their inlets which were included in the purchase package. RESULTS Ultrasound nebulizers; LANTUS produces by far the lowest mean droplets (2.44) half the size of the other two drugs (4.43=4.97). GIMA nebulizer is the most efficient producing one third of the droplet size of SHIMED and one second of EASYNEB (2.06<3.15<6.62). Finally, the 4 ml loading concentration is more suitable for supporting the production of smaller droplets (3.65<4.24). Drugs and nebulizers act interactively yielding very large droplets when ACTRAPID and HUMULIN are administered in joint with SHIMED nebulizer (9.59=7.72). Jet-nebulizers; HUMULIN again is the least preferred insulin since it hardly reaches the low but equal performance of others at the loading level of 6 ml. Residual cups E and B produce uniquely lower mean droplets at loading level 6. CONCLUSIONS Ultrasound nebulizers; the best suggested combination should be LANTUS insulin, GIMA nebulizer administered at loading dose of 4 ml jet-nebulizers. A global review can give the best combination: the lowest mean droplets are produced when the drugs LANTUS (mostly) and ACTRAPID are administered, applying the SUNMIST nebulizer in concert with residual cup B at loading levels of 6 ml.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany.
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