Abstract
Insulin was discovered by Banting and Best in 1921 (Bliss 1982). Soon afterwards manufacturing processes were developed to extract the insulin from porcine and bovine pancreas. From 1921 to 1980, efforts were directed at increasing the purity of the insulin and providing different formulations for altering time action for improved glucose control (Brange 1987a, b; Galloway 1988). Purification was improved by optimizing extraction and processing conditions and by implementing chromatographic processes (size exclusion, ion exchange, and reversed-phase (Kroeff et al. 1989)) to reduce the levels of both general protein impurities and insulin-related proteins such as proinsulin and insulin polymers. Formulation development focused on improving chemical stability by moving from acidic to neutral formulations and by modifying the time-action profile through the uses of various levels of zinc and protamine. The evolution of recombinant DNA technology led to the widespread availability of human insulin, which has eliminated issues with sourcing constraints while providing the patient with a natural exogenous source of insulin. Combining the improved purification methodologies and recombinant DNA (rDNA) technology, manufacturers of insulin are now able to provide the purest human insulin ever made available, >98 %. Further advances in rDNA technology, coupled with a detailed understanding of the molecular properties of insulin and knowledge of its endogenous secretion profile, enabled the development of insulin analogs with improved pharmacology relative to existing human insulin products.
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Notes
- 1.
During the preparation of this book chapter, the structure of LY2605541 was disclosed at conference proceedings as insulin lispro PEGylated at LysB28 with a 20kDa PEG (Hansen et al. 2012).
References
Anderson JH Jr, Brunelle RL, Keohane P, Koivisto VA, Trautmann ME, Vignati L, DiMarchi R (1997) Mealtime treatment with insulin analog improves postprandial hyperglycemia and hypoglycemia in patients with non-insulin-dependent diabetes mellitus. Multicenter Insulin Lispro Study Group. Arch Intern Med 157:1249–1255
Baker EN, Blundell TL, Cutfield JF, Cutfield SM, Dodson EJ, Dodson GG, Hodgkin DM, Hubbard RE, Isaacs NW, Reynolds CD, Sakabe K, Sakabe N, Vijayan NM (1988) The structure of 2Zn pig insulin crystals at 1.5Å resolution. Philos Trans R Soc Lond B Biol Sci 319:369–456
Balschmidt P (1996) AspB28 Insulin crystals. US Patent 5,547,930
Bell DS, Clements RS Jr, Perentesis G, Roddam R, Wagenknecht L (1991) Dosage accuracy of self-mixed vs premixed insulin. Arch Intern Med 151:2265–2269
Binder C (1969) Absorption of injected insulin. A clinical-pharmacologic study. Acta Pharmacol Toxicol (Copenh) 27(Suppl 2):1–84
Binder C, Lauritzen T, Faber O, Pramming S (1984) Insulin pharmacokinetics. Diabetes Care 7:188–199
Birkeland KI, Home PD, Wendisch U, Ratner RE, Johansen T, Endahl LA, Lyby K, Jendle JH, Roberts AP, DeVries JH, Meneghini LF (2011) Insulin degludec in type 1 diabetes: a randomized controlled trial of a new-generation ultra-long-acting insulin compared with insulin glargine. Diabetes Care 34:661–665
Bliss M (1982) Who discovered insulin. In: The discovery of insulin. McClelland and Stewart Limited, Toronto, pp 189–211
Boldo A, Comi RJ (2012) Clinical experience with U500 insulin: risks and benefits. Endocr Pract 18:56–61
Brackenridge B (1994) Diabetes medicines: insulin. In: Brackenridge B (ed) Managing your diabetes. Eli Lilly and Company, Indianapolis, pp 36–50
Brader ML, Dunn MF (1991) Insulin hexamers: new conformations and applications. Trends Biochem Sci 16:341–345
Brange J (1987a) Insulin preparations. In: Galenics of insulin. Springer, Berlin, pp 17–39
Brange J (1987b) Production of bovine and porcine insulin. In: Galenics of insulin, Springer, Berlin, pp 1–5
Brange J (1987c) Insulin preparations. In: Galenics of insulin. Springer, Berlin, pp 58–60
Brange J, Langkjaer L (1992) Chemical stability of insulin. 3. Influence of excipients, formulation, and pH. Acta Pharm Nord 4:149–158
Brange J, Ribel U, Hansen JF, Dodson G, Hansen MT, Havelund S, Melberg SG, Norris F, Norris K, Snel L et al (1988) Monomeric insulins obtained by protein engineering and their medical implications. Nature 333:679–682
Brange J, Owens DR, Kang S, Vølund A (1990) Monomeric insulins and their experimental and clinical applications. Diabetes Care 13:923–954
Brange J, Havelund S, Hougaard P (1992a) Chemical stability of insulin. 2. Formation of higher molecular weight transformation products during storage of pharmaceutical preparations. Pharm Res 9:727–734
Brange J, Langkjaer L, Havelund S, Vølund A (1992b) Chemical stability of insulin. 1. Hydrolytic degradation during storage of pharmaceutical preparations. Pharm Res 9:715–726
Brems DN, Alter LA, Beckage MJ, Chance RE, DiMarchi RD, Green LK, Long HB, Pekar AH, Shields JE, Frank BH (1992) Altering the association properties of insulin by amino acid replacement. Protein Eng 6:527–533
Brennan TV, Clarke S (1994) Deamidation and isoasparate formation in model synthetic peptides. In: Aswad DW (ed) Deamidation and isoaspartate formation in peptides and proteins. CRC Press, Boca Raton, pp 65–90
Cefalu WT (2004) Concept, strategies, and feasibility of noninvasive insulin delivery. Diabetes Care 27:239–246
Cernea S, Kidron M, Wohlgelernter J, Modi P, Raz I (2004) Comparison of pharmacokinetic and pharmacodynamic properties of single-dose oral insulin spray and subcutaneous insulin injection in healthy subjects using the euglycemic clamp technique. Clin Ther 26:2084–2091
Chacra AR, Kipnes M, Ilag LL, Sarwat S, Giaconia J, Chan J (2010) Comparison of insulin lispro protamine suspension and insulin detemir in basal-bolus therapy in patients with type 1 diabetes. Diabet Med 27:563–569
Charman SA, McLennan DN, Edwards GA, Porter CJH (2001) Lymphatic absorption is a significant contributor to the subcutaneous bioavailability of insulin in a sheep model. Pharm Res 18:1620–1626
Charvet R, Soula G, Mora G, Soula O, Soula R (2010) Fast-acting insulin formulations, US Patent Application 2010249020A
Ciszak E, Beals JM, Frank BH, Baker JC, Carter ND, Smith GD (1995) Role of the C-terminal B-chain residues in insulin assembly: the structure of hexameric LysB28ProB29-human insulin. Structure 3:615–622
Dailey G, Rosenstock J, Moses RG, Ways K (2004) Insulin glulisine provides improved glycemic control in patients with type 2 diabetes. Diabetes Care 27:2363–2368
Darrington RT, Anderson BD (1995) Effects of insulin concentration and self-association on the partitioning of its A-21 cyclic anhydride intermediate to desamido insulin and covalent dimer. Pharm Res 12:1077–1084
Davis SN, Thompson CJ, Brown MD, Home PD, Alberti KG (1991) A comparison of the pharmacokinetics and metabolic effects of human regular and NPH mixtures. Diabetes Res Clin Pract 13:107–117
De la Peña A, Riddle M, Morrow LA, Jiang HH, Linnebjerg H, Scott A, Win KM, Hompesch M, Mace KF, Jacobson JG, Jackson JA (2011) Pharmacokinetics and pharmacodynamics of high-dose human regular U-500 insulin versus human regular U-100 insulin in healthy obese subjects. Diabetes Care 34:2496–2501
Deckert T (1980) Intermediate-acting insulin preparations: NPH and lente. Diabetes Care 3:623–626
DeFelippis MR, Bakaysa DL, Bell MA, Heady MA, Li S, Pye S, Youngman KM, Radziuk J, Frank BH (1998) Preparation and characterization of a cocrystalline suspension of [LysB28, ProB29]-human insulin analogue. J Pharm Sci 87:170–176
DeFelippis MR, Bell MA, Heyob JA, Storms SM (2006) In vitro stability of insulin lispro in continuous subcutaneous insulin infusion. Diabetes Technol Ther 8:358–368
Derewenda U, Derewenda Z, Dodson EJ, Dodson GG, Reynolds CD, Smith GD, Sparks C, Swenson D (1989) Phenol stabilizes more helix in a new symmetrical zinc insulin hexamer. Nature 338:594–596
Dodd SW, Havel HA, Kovach PM, Lakshminarayan C, Redmon MP, Sargeant CM, Sullivan GR, Beals JM (1995) Reversible adsorption of soluble hexameric insulin onto the surface of insulin crystals cocrystallized with protamine: an electrostatic interaction. Pharm Res 12:60–68
Dreyer M, Prager R, Robinson A, Busch K, Ellis G, Souhami E, Van Leendert R (2005) Efficacy and safety of insulin glulisine in patients with type 1 diabetes. Horm Metab Res 37:702–707
Eljamal M, Patton JS, Foster LC, Platz RM (2003) Powdered Pharmaceutical Formulation Having Improved Dispersibility, US Patent 6,582,729
Fogelfeld L, Dharmalingam M, Robling K, Jones C, Swanson D, Jacober SJ (2010) A randomized, treat-to-target trial comparing insulin lispro protamine suspension and insulin detemir in insulin-naive patients with type 2 diabetes. Diabet Med 27:181–188
Galloway JA (1988) Chemistry and clinical use of insulin. In: Galloway JA, Potvin JH, Shuman CR (eds) Diabetes mellitus, 9th edn. Lilly Research Laboratories, Indianapolis, pp 105–133
Galloway JA, Chance RE (1994) Improving insulin therapy: achievements and challenges. Horm Metab Res 26:591–598
Galloway JA, Spradlin CT, Nelson RL, Wentworth SM, Davidson JA, Swarner JL (1981) Factors influencing the absorption, serum insulin concentration, and blood glucose responses after injections of regular insulin and various insulin mixtures. Diabetes Care 4:366–376
Galloway JA, Spradlin CT, Jackson RL, Otto DC, Bechtel LD (1982) Mixtures of intermediate-acting insulin (NPH and Lente) with regular insulin: an update. In: Skyler JS (ed) Insulin update: 1982. Exerpta Medica, Princeton, pp 111–119
Garg SK, Kelly WC (2009) Insulin delivery via lungs-is it still possible? Diabetes Technol Ther 11 (Suppl 2):S1–S3
Gibney MA, Arce CH, Byron KJ, Hirsch LJ (2010) Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin 26:1519–1530
Goldman J, Carpenter FH (1974) Zinc binding, circular dichroism, and equilibrium sedimentation studies on insulin (bovine) and several of its derivatives. Biochemistry 13:4566–4574
Hagedorn HC, Jensen BN, Krarup NB, Wodstrup I (1936) Protamine insulinate. JAMA 106:177–180
Hamaguchi T, Hashimoto Y, Miyata T, Kishikawa H, Yano T, Fukushima H, Shichiri M (1990) Effect of mixing short and intermediate NPH insulin or Zn insulin suspension acting human insulin on plasma free insulin levels and action profiles. J Jpn Diabetes Soc 33:223–229
Havelund S, Plum A, Ribel U, Jonassen I, Vølund A, Markussen J, Kurtzhals P (2004) The mechanism of protraction of insulin detemir, a long-acting, acylated analog of human insulin. Pharm Res 21:1498–1504
Heinemann L (2012) New ways of insulin delivery. Int J Clin Pract 66(Suppl 175):35–39
Heinemann L, Weyer C, Rave K, Stiefelhagen O, Rauhaus M, Heise T (1997) Comparison of the time-action profiles of U40- and U100-regular human insulin and the rapid-acting insulin analogue B28 Asp. Exp Clin Endocrinol Diabetes 105:140–144
Heinemann L, Sinha K, Weyer C, Loftager M, Hirschberger S, Heise T (1999) Time-action profile of the soluble, fatty acid acylated, long-acting insulin analogue NN304. Diabet Med 16:332–338
Heinemann L, Pfützner A, Heise T (2001) Alternative routes of administration as an approach to improve insulin therapy: update on dermal, oral, nasal and pulmonary insulin delivery. Curr Pharm Des 7:1327–1351
Heinemann L, Nosek L, Flacke F, Albus K, Krasner A, Pichotta P, Heise T, Steiner S (2012) U-100, pH-neutral formulation of VIAject®: faster onset of action than insulin lispro in patients with type 1 diabetes. Diabetes Obes Metab 14:222–227
Heise T, Weyer C, Serwas A, Heinrichs S, Osinga J, Roach P, Woodworth J, Gudat W, Heinemann L (1998) Time-action profiles of novel premixed preparations of insulin lispro and NPL insulin. Diabetes Care 21:800–803
Heise T, Nosek L, Rønn BB, Endahl L, Heinemann L, Kapitza C, Draeger E (2004) Lower within-subject variability of insulin detemir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes. Diabetes 53:1614–1620
Hermansen K, Madsbad S, Perrild H, Kristensen A, Axelsen M (2001) Comparison of the soluble basal insulin analog insulin detemir with NPH insulin: a randomized open crossover trial in type 1 diabetic subjects on basal-bolus therapy. Diabetes Care 24:296–301
Hoffmann JA, Chance RE, Johnson MG (1990) Purification and analysis of the major components of chum salmon protamine contained in insulin formulations using high-performance liquid chromatography. Protein Expr Purif 1:127–133
Holleman F, Schmitt H, Rottiers R, Rees A, Symanowski S, Anderson JH (1997) Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. The Benelux-UK Insulin Lispro Study Group. Diabetes Care 20:1827–1832
Home PD (2012) The pharmacokinetics and pharmacodynamics of rapid-acting insulin analogues and their clinical consequences. Diabetes Obes Metab 14:780–788
Hompesch M, Ocheltree SM, Wondmagegnehu ET, Morrow LA, Kollmeier AP, Campaigne BN, Jacober SJ (2009) Pharmacokinetics and pharmacodynamics of insulin lispro protamine suspension compared with insulin glargine and insulin detemir in type 2 diabetes. Curr Med Res Opin 25:2679–2687
Howey DC, Bowsher RR, Brunelle RL, Woodworth JR (1994) [Lys(B28), Pro(B29)]-human insulin: a rapidly-absorbed analogue of human insulin. Diabetes 43:396–402
Jansen R, Dzwolak W, Winter R (2005) Amyloidogenic self-assembly of insulin aggregates probed by high resolution atomic force microscopy. Biophys J 88:1344–1353
Janssen MM, Casteleijn S, Devillé W, Popp-Snijders C, Roach P, Heine RJ (1997) Nighttime insulin kinetics and glycemic control in type 1 diabetic patients following administration of an intermediate-acting lispro preparation. Diabetes Care 20:1870–1873
Kaarsholm NC, Havelund S, Hougaard P (1990) Ionization behavior of native and mutant insulins: pK perturbation of B13-Glu in aggregated species. Arch Biochem Biophys 283:496–502
Krayenbuhl C, Rosenberg T (1946) Crystalline protamine insulin. Rep Steno Hosp (Kbh) 1:60–73
Kroeff EP, Owen RA, Campbell EL, Johnson RD, Marks HI (1989) Production scale purification of biosynthetic human insulin by reversed-phase high-performance liquid chromatography. J Chromatogr 461:45–61
Kurtz AB, Gray RS, Markanday S, Nabarro JD (1983) Circulating IgG antibody to protamine in patients treated with protamine-insulins. Diabetologia 25:322–324
Lane WS, Cochran EK, Jackson JA, Scism-Bacon JL, Corey IB, Hirsch IB, Skyler JS (2009) High-dose insulin therapy: is it time for U-500 insulin? Endocr Pract 15:71–79
Modi P, Mihic M, Lewin A (2002) The evolving role of oral insulin in the treatment of diabetes using a novel RapidMistSystem. Diabetes Metab Res Rev 18(Suppl 1):S38–S42
Muchmore DB, Vaughn DE (2010) Review of the mechanism of action and clinical efficacy of recombinant human hyaluronidase coadministration with current prandial insulin formulations. J Diabetes Sci Technol 4:419–428
Nell LJ, Thomas JW (1988) Frequency and specificity of protamine antibodies in diabetic and control subjects. Diabetes 37:172–176
Nielsen L, Khurana R, Coats A, Frokjaer S, Brange J, Vyas S, Uversky VN, Fink AL (2001) Effect of environmental factors on the kinetics of insulin fibril formation: elucidation of the molecular mechanism. Biochemistry 40:6036–6046
Ocheltree SM, Hompesch M, Wondmagegnehu ET, Morrow L, Win K, Jacober SJ (2010) Comparison of pharmacodynamic intrasubject variability of insulin lispro protamine suspension and insulin glargine in subjects with type 1 diabetes. Eur J Endocrinol 163:217–223
Patton JS, Bukar J, Nagarajan S (1999) Inhaled insulin. Adv Drug Deliv Rev 35:235–247
Patton JS, Bukar JG, Eldon MA (2004) Clinical pharmacokinetics and pharmacodynamics of inhaled insulin. Clin Pharmacokinet 43:781–801
Pekar AH, Frank BH (1972) Conformation of proinsulin. A comparison of insulin and proinsulin self-association at neutral pH. Biochemistry 11:4013–4016
Peyrot M, Rubin RR (2010) Effect of technosphere inhaled insulin on quality of life and treatment satisfaction. Diabetes Technol Ther 12:49–55
Pfutzner A, Mann AE, Steiner SS (2002) Technosphere/insulin–a new approach for effective delivery of human insulin via the pulmonary route. Diabetes Technol Ther 4:589–594
Porcellati F, Bolli GB, Fanelli CG (2011) Pharmacokinetics and pharmacodynamics of basal insulins. Diabetes Technol Ther 13(Suppl 1):S15–S24
Porter CJ, Charman SA (2000) Lymphatic transport of proteins after subcutaneous administration. J Pharm Sci 89:297–310
Richardson PC, Boss AH (2007) Technosphere insulin technology. Diabetes Technol Ther 9(Suppl 1):S65–S72
Robertson KE, Glazer NB, Campbell RK (2000) The latest developments in insulin injection devices. Diabetes Educ 26:135–152
Schade DS, Santiago JV, Skyler JS, Rizza RA (1983) Intensive insulin therapy. Medical Examination Publishing, Princeton, p 24
Segal AR, Brunner JE, Burch FT, Jackson JA (2010) Use of concentrated insulin human regular (U-500) for patients with diabetes. Am J Health Syst Pharm 67:1526–1535
Senstius J, Harboe E, Westermann H (2007a) In vitro stability of insulin aspart in simulated continuous subcutaneous insulin infusion using a MiniMed 508 pump. Diabetes Technol Ther 9:75–79
Senstius J, Poulsen C, Hvass A (2007b) Comparison of in vitro stability for insulin aspart and insulin glulisine during simulated use in infusion pumps. Diabetes Technol Ther 9:517–521
Sharrow SD, Glass LC, Dobbins MA (2012) 14-day in vitro chemical stability of insulin lispro in the MiniMed paradigm pump. Diabetes Technol Ther 14:264–270
Strojek K, Shi C, Carey MA, Jacober SJ (2010) Addition of insulin lispro protamine suspension or insulin glargine to oral type 2 diabetes regimens: a randomized trial. Diabetes Obes Metab 12:916–922
Supersaxo A, Hein WR, Steffen H (1990) Effect of molecular weight on the lymphatic absorption of water-soluble compounds following subcutaneous administration. Pharm Res 7:167–169
USP Monographs: Insulin (2013) USP36-NF31: 3911–3913
Vague P, Selam JL, Skeie S, De Leeuw I, Elte JW, Haahr H, Kristensen A, Draeger E (2003) Insulin detemir is associated with more predictable glycemic control and reduced risk of hypoglycemia than NPH insulin in patients with type 1 diabetes on a basal-bolus regimen with premeal insulin aspart. Diabetes Care 26:590–596
Waldhäusl W, Bratusch-Marrain P, Gasic S, Kom A, Nowotny P (1979) Insulin production rate following glucose ingestion estimated by splanchnic C-peptide output in normal man. Diabetologia 17:221–227
Weyer C, Heise T, Heinemann L (1997) Insulin aspart in a 30/70 premixed formulation. Pharmacodynamic properties of a rapid-acting insulin analog in stable mixture. Diabetes Care 20:1612–1614
White S, Bennett DB, Cheu S, Conley PW, Guzek DB, Gray S, Howard J, Malcolmson R, Parker JM, Roberts P, Sadrzadeh N, Schumacher JD, Seshadri S, Sluggett GW, Stevenson CL, Harper NJ (2005) EXUBERA: pharmaceutical development of a novel product for pulmonary delivery of insulin. Diabetes Technol Ther 7:896–906
Whittingham JL, Edwards DJ, Antson AA, Clarkson JM, Dodson GG (1998) Interactions of phenol and m-cresol in the insulin hexamer, and their effect on the association properties of B28 pro –> Asp insulin analogues. Biochemistry 37:11516–11523
Whittingham JL, Jonassen I, Havelund S, Roberts SM, Dodson EJ, Verma CS, Wilkinson AJ, Dodson GG (2004) Crystallographic and solution studies of N-lithocholyl insulin: a new generation of prolonged-acting human insulins. Biochemistry 43:5987–5995
Zerhouni E (2012) Sanofi. 32nd Cowen Annual Health Care Conference, Boston. http://en.sanofi.com/investors/events/other_events/2012/Presentation_2012-03-06_Cowen_Zerhouni.aspx. Accessed 2 Jul 2013
Ziesmer AE, Kelly KC, Guerra PA, George KG, Dunn KL (2012) U500 regular insulin use in insulin-resistant type 2 diabetic veteran patients. Endocr Pract 18:34–38
Zinman B, Fulcher G, Rao PV, Thomas N, Endahl LA, Johansen T, Lindh R, Lewin A, Rosenstock J, Pinget M, Mathieu C (2011) Insulin degludec, an ultra-long-acting basal insulin, once a day or three times a week versus insulin glargine once a day in patients with type 2 diabetes: a 16-week, randomised, open-label, phase 2 trial. Lancet 377:924–931
Recommended Reading
American Diabetes Association (2011) Practical insulin: a handbook for prescribing providers, 3rd edn. American Diabetes Association, New York
Bliss M (1982) The discovery of insulin. McClelland and Stewart Limited, Toronto
Brange J (1987) Galenics of insulin. Springer, Berlin
Burant C (ed) (2008) Medical management of type 2 diabetes, 6th edn. American Diabetes Association, New York
Cooper T, Ainsburg A (2010) Breakthrough: Elizabeth Hughes, the discovery of insulin, and the making of a medical miracle. St. Martin’s Press, New York
Galloway JA, Potvin JH, Shuman CR (1988) Diabetes mellitus, 9th edn. Lilly Research Laboratories, Indianapolis
Wolfsdorf JI (2009) Intensive diabetes management, 4th edn. American Diabetes Association, New York
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Beals, J.M., DeFelippis, M.R., Kovach, P.M., Jackson, J.A. (2013). Insulin. In: Crommelin, D., Sindelar, R., Meibohm, B. (eds) Pharmaceutical Biotechnology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6486-0_12
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