2023-05-30 16:14:30
Can diabetics do without insulin injections in the future? Researchers say yes. Two novel methods are in the pipeline.
One of the greatest difficulties in the treatment of Diabetes is the administration of insulin with a syringe and pen. Every prick is associated with pain and, especially in the case of new diabetics, also with anxiety, so that research into avoiding the needle is being pushed further and further. But will it be possible in the future to dispense with this invasive administration altogether? Can you give type 1 and type 2 diabetics hope if they ask about it in the pharmacy?
Insulin in tablet form?
And Insulin is a peptide hormone, it has not been possible to administer it orally because it is denatured and broken down in the stomach. But now scientists at RMIT University in Melbourne have a capsule developed, which might make oral administration of protein drugs possible in the future. The research team around Dr. Jamie Strachan developed a formulation in which the insulin, embedded in a cubic lipid phase, is administered to the patient using an enteric-coated capsule. Strachan explained to the press that the special encapsulation protects the drug inside so it can safely pass through the stomach and into the small intestine.
The newly developed capsule has a special coating designed not to break down in the low pH environment in the stomach before the higher pH in the stomach small intestine triggers the dissolution of the capsule. It involves integrating the insulin itself into a fatty nanomaterial in the capsule, which helps disguise the insulin so it can pass through the gut walls. This principle could be removed with the functioning of the Covid vaccines from Biontech and Moderna, where the mRNA is also packed in fats. This helps keep the drugs active and safe in the body during delivery.
Good absorption, delayed action
The team tested the new oral capsule with insulin in a preclinical study and published the results in the international journal Biomaterials Advances published. One of the lead researchers, Prof. Charlotte Conn, expressed told the press that the team is now conducting a series of preclinical tests on diabetic rats in order to start clinical trials as soon as possible. To stabilize the peptide hormone in the body, the capsule was designed so that its lipid bilayer was arranged in three dimensions over a minimal surface area, dividing space into two interpenetrating aqueous networks. This is not only a suitable solution for insulin, this new technology can also be used for the oral administration of other protein drugs. The construction of polar and non-polar components is also possible for the protection and stabilization of encapsulated proteins and other biomolecules.
The effect of oral insulin capsules has so far been evaluated with both fast-acting and slow-acting insulin. Conn highlighted the excellent absorption results for the slow-acting form, which was approximately 50% better than injectable administration for the same amount of insulin. Fast-acting insulin also had good absorption results, but the effect was naturally significantly delayed compared to injection. She therefore sees the capsules with their bicontinuous cubic phase primarily as a replacement for slow-acting insulin. The bioavailability of the insulin and the pharmacokinetics depended on the thickness of the enteric coating. Possibilities could even arise here to control the release rates. The insulin required 20-60 minutes for the approximately 160 μm thin-coated capsule and 75-140 minutes for the 500 μm thick-coated capsule to get into the blood.
Boost the body’s own insulin production
A completely different, pioneering idea for treating type 1 diabetes without insulin injections was presented at the international conference on innovative technologies and treatments for diabetes in Berlin presented. Intensive research is being carried out into the possibility of restarting the body’s own insulin production. That would mean a big plus in quality of life and a significant improvement in the continuous insulin supply of those affected, without blood sugar spikes and the associated complications. Genprex Inc., in collaboration with researchers from the University of Pittsburgh, presented an experimental gene therapy that has achieved good results in non-human primates.
Eight of the primates were treated artificially using Streptozotocin a so-called toxin-induced Diabetes mellitus brought about. Streptozotocin is a naturally occurring from Streptomyces achromogenes formed antibiotic that has a diabetogenic effect by largely destroying the beta cells of the pancreas. After waiting a month for the diabetes to actually manifest, the animals were given an intraductal infusion of special proteins coupled to adeno-associated viruses into the pancreas during open surgery.
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Pancreas/duodenum homeobox protein-1 (Pdx1) und V-maf musculoaponeurotic fibrosarcoma oncogene homolog A (mafA) sind The transcription factor, which trigger forced expression of other specific transcription factors. After this treatment, new beta-cell-like cells developed in the primate’s pancreas, which were able to Hyperglycemia and trigger insulin secretion to restore normoglycemia. After the treatment, a significantly reduced need for insulin, increased C-peptide levels and an improved Glukosetoleranz to be determined. In one of the test animals, it was even possible to achieve normoglycemia three months after the gene therapy. An immunohistochemical examination using insulin and glucagon staining also showed more insulin-positive cells compared to the untreated diabetic control.
Pharmacy refrigerators without insulin in the future?
The researchers can imagine that this gene therapy could later be used in humans without surgery, in order to create a long-term replacement for the lost pancreatic cells through the formation of new beta cells. The idea is to administer them using endoscopic retrograde cholangiopancreatography (ERCP). The hope is that they will also avoid attacks by the immune system and that insulin injections – or insulin capsules – can be dispensed with forever.
Even though it will be some time before both methods are actually ready for the market, they represent a promising treatment for both types of diabetes. So we can remain excited about what the future will bring – and who knows, maybe we can actually get rid of many pharmacy refrigerators for insulin in a few years?
Image source: Christian Iona, unsplash
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