Abstract
One hundred years after its discovery, insulin remains the life-saving therapy for many patients with diabetes. It has been a 100-years-old success story thanks to the fact that insulin therapy has continuously integrated the knowledge developed over a century. In 1982, insulin becomes the first therapeutic protein to be produced using recombinant DNA technology. The first “mini” insulin pump and the first insulin pen become available in 1983 and 1985, respectively. In 1996, the first generation of insulin analogues were produced. In 1999, the first continuous glucose-monitoring device for reading interstitial glucose was approved by the FDA. In 2010s, the ultra-long action insulins were introduced. An equally exciting story developed in parallel. In 1966. Kelly et al. performed the first clinical pancreas transplant at the University of Minnesota, and now it is a well-established clinical option. First successful islet transplantations in humans were obtained in the late 1980s and 1990s. Their ability to consistently re-establish the endogenous insulin secretion was obtained in 2000s. More recently, the possibility to generate large numbers of functional human β cells from pluripotent stem cells was demonstrated, and the first clinical trial using stem cell-derived insulin producing cell was started in 2014. This year, the discovery of this life-saving hormone turns 100 years. This provides a unique opportunity not only to celebrate this extraordinary success story, but also to reflect on the limits of insulin therapy and renew the commitment of the scientific community to an insulin free world for our patients.
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Acknowledgements
The author is grateful to his research coworkers Dr. ssa Valeria Sordi, Dr.ssa Silvia pellegrini and Dr. Antonio Citro for their long-term collaboration and numerous discussions on the science and technology of stem cell and tissue engineering. The author is highly grateful to his research coworkers Dr.ssa Marina Scavini for help in the preparation of this review and for helpful discussions. This work was supported by SOStegno 70 Insieme ai ragazzi diabetici Associazione Onlus (Project “Beta is better”). The author is indebted to Paola Macchieraldo, Antonio Mincione, Elena Riva, Antonio Civita, Luca Casaura, Patrizia Pappini, Giorgio Mario Oldrati, Andrea Marchesi and Michele Mainardi for their support to the fundraising campaign “Un brutto t1po”.
Funding
This work was supported by SOStegno 70 Insieme ai ragazzi diabetici Associazione Onlus (Project “Beta is better”). The author is indebted to Paola Macchieraldo, Antonio Mincione, Elena Riva, Antonio Civita, Luca Casaura, Patrizia Pappini, Giorgio Mario Oldrati, Andrea Marchesi and Michele Mainardi for their support to the fundraising campaign “Un brutto t1po”.
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LP contributed to the conception of the work, wrote the manuscript, researched data and contributed to the discussion. Professor LP is the guarantor of this work and, as such, had full access to all the data presented in the study and takes responsibility for the integrity of data and the accuracy of data analysis. The author is highly grateful to his research coworkers Dr. ssa MS for help in the preparation of this review and for helpful discussions.
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The author has no conflict of interest to disclose in relation to the topic of this manuscript. The author declares that there are no relationships or activities that might bias, or be perceived to bias, his work.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1975, as revised in 2008.
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Informed consent was obtained from all patients for being included in the study.
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Piemonti, L. Felix dies natalis, insulin… ceterum autem censeo “beta is better”. Acta Diabetol 58, 1287–1306 (2021). https://doi.org/10.1007/s00592-021-01737-3
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DOI: https://doi.org/10.1007/s00592-021-01737-3