|Locus:||Chr. 11 p15.5|
|Gene type:||Protein coding|
|Molecular Weight:||5808 (Da)|
|Structure:||Solution Structure of Human pro-Insulin Polypeptide|
|Protein type:||insulin family|
|Taxa expressing:||Homo sapiens; homologs: in metazoan taxa from invertebrates to mammals|
|Cell types:||pancreas: beta cells of the Islets of Langerhans|
|Subcellular localization:||extracellular fluids|
|Covalent modifications:||glycation, proteolytic cleavage|
|Pathway(s):||Insulin signaling pathway (KEGG); Type II diabetes mellitus (KEGG); Type I diabetes mellitus (KEGG); Maturity onset diabetes of the young (KEGG); Regulation of actin cytoskeleton (KEGG)|
|Antagonists:||glucagon, steroids, most stress hormomes|
|Diseases:||familial hyperproinsulinemia, Diabetes mellitus|
|Pharmaceuticals:||insulin (Humulin Novolin), insulin lispro (Humalog), insulin aspart (Novolog), insulin detemir (Levemir), insulin glargine (Lantus), etc|
Insulin is an anabolic (part of metabolism that builds larger molecules) polypeptide hormone and regulates carbohydrate metabolism in animals. It is produced in the pancreas in vertebrates, but also is required by invertebrates.
Apart from being the primary agent in carbohydrate homeostasis, insulin in vertebrates has effects on fat metabolism and it changes the liver's activity in storing or releasing glucose and in processing blood lipids. Insulin helps in the transporting of glucose into skeletal muscle and liver, stimulates skeletal muscle and liver to convert glucose to a storage form called glycogen, stimulates fat cells to synthesize fat, and acts on the hypothalamus to reduce appetite. The amount of insulin in circulation has extremely widespread effects throughout the body.
Unity in nature is seen in the fact that insulin's structure varies slightly between species of animals, and is particularly close among vertebrates. Insulin from animal sources differs somewhat in regulatory function strength (i.e., in carbohydrate metabolism) when used medically in humans because of those variations. Porcine (pig) insulin is especially close to the human version.
It is important for people to maintain blood glucose levels within a narrow range, despite intervals between meals or the occasional consumption of meals with substantial carbohydrates. This maintenance of balance can be compared to the Oriental philosophy of Yin and Yang, the two primal, opposing yet complementary forces found in all things in the universe, which are considered to have been separated from one unified whole. Similarly, there are two types of mutually opposing but complementary groups of metabolic hormones affecting blood glucose levels, the catabolic hormones (such as glucagon, growth hormone, and catecholamines), which increase blood glucose, and one anabolic hormone (insulin), which decreases blood glucose.
Insulin is used medically to treat some forms of diabetes mellitus in humans. Patients with type 1 diabetes mellitus depend on external insulin (most commonly injected subcutaneously) for their survival because of an absolute deficiency of the hormone. Patients with type 2 diabetes mellitus have insulin resistance or relatively low insulin production, or both; some type 2 diabetics eventually require insulin when other medications become insufficient in controlling blood glucose levels.
The word insulin comes from the Latin insula, meaning "island," as it is produced in mammals in the Islets of Langerhans in the pancreas.
Insulin is a polypeptide containing two chains of amino acids joined together by two disulfide bridges. Insulin is composed of 51 amino acid residues (constituents) in total and has a molecular weight of 5808 Da.
Within vertebrates, the similarity of insulins is very close. Bovine insulin differs from human in only three amino acid residues, and porcine insulin in one. Even insulin from some species of fish is similar enough to human to be effective in humans. The C-peptide of proinsulin (discussed later), however, is very divergent from species to species.
In mammals, insulin is synthesized in the pancreas within the beta cells (β-cells) of the islets of Langerhans. The pancreas is one of the few organs that has both an exocrine and an endocrine function. Exocrine glands are glands that secrete their products into ducts (duct glands). Endocrine glands are glands that secrete their product directly into the blood rather than through a duct. The endocrine portion of the pancreas consists of about 1 million islets of Langerhans (pancreatic islets), amounting to only 1-3 percent of the organ weight.
The islets are a compact collection of endocrine cells arranged in clusters and cords that are crisscrossed by a dense network of capillaries. The capillaries are lined by layers of endocrine cells in direct contact with them by either cytoplasmic processes or by direct apposition. The cells release their hormones, without ducts, directly into the capillaries. There are four main types of cells in the islets of Langerhans. The beta cells constitute 60–80 percent of all the cells.
In beta cells, insulin is synthesized from the proinsulin precursor molecule by the action of proteolytic enzymes, known as prohormone convertases (PC1 and PC2), as well as the exoprotease carboxypeptidase E. These modifications of proinsulin remove the center portion of the molecule, or C-peptide, from the C- and N- terminal ends of the proinsulin. The remaining polypeptides (51 amino acids in total), the B- and A- chains, are bound together by disulfide bonds. Confusingly, the primary sequence of proinsulin goes in the order "B-C-A," since B and A chains were identified on the basis of mass, and the C peptide was discovered after the others.
The actions of insulin on the global human metabolism level include:
The actions of insulin on cells include:
Despite long intervals between meals or the occasional consumption of meals with a substantial carbohydrate load (e.g., half a birthday cake or a bag of potato chips), human blood glucose levels normally remain within a narrow range. In most humans, this varies from about 70 mg/dl to perhaps 110 mg/dl (3.9 to 6.1 mmol/liter) except shortly after eating when the blood glucose level rises temporarily. This homeostatic effect is the result of many factors, of which hormone regulation is the most important.
It is usually a surprise to realize how little glucose is actually maintained in the blood, and body fluids. The control mechanism works on very small quantities. In a healthy adult male of 75 kg with a blood volume of 5 liters, a blood glucose level of 100 mg/dl or 5.5 mmol/l corresponds to about 5 g (1/5 ounce) of glucose in the blood and approximately 45 g (1½ ounces) in the total body water (which obviously includes more than merely blood and will be usually about 60% of the total body weight in men). A more familiar comparison may help—5 grams of glucose is about equivalent to a commercial sugar packet (as provided in many restaurants with coffee or tea).
There are two types of mutually antagonistic (or perhaps opposite but "complementary") metabolic hormones affecting blood glucose levels:
Mechanisms that restore satisfactory blood glucose levels after hypoglycemia must be quick, and effective, because of the immediate serious consequences of insufficient glucose (in the extreme, coma; less immediately dangerously, confusion or unsteadiness; among many other effects). This is because, at least in the short term, it is far more dangerous to have too little glucose in the blood than too much. In healthy individuals these mechanisms are indeed generally efficient, and symptomatic hypoglycemia is generally only found in diabetics using insulin or other pharmacologic treatment. Such hypoglycemic episodes vary greatly between persons and from time to time, both in severity and swiftness of onset. In severe cases, prompt medical assistance is essential, as damage (to brain and other tissues) and even death will result from sufficiently low blood glucose levels.
Beta cells in the islets of Langerhans are sensitive to variations in blood glucose levels through the following mechanism (see figure to the right):
This is the main mechanism for release of insulin and regulation of insulin synthesis. In addition, some insulin synthesis and release takes place generally at food intake, not just glucose or carbohydrate intake, and the beta cells are also somewhat influenced by the autonomic nervous system. The signalling mechanisms controlling this are not fully understood.
Other substances known that stimulate insulin release are acetylcholine, released from vagus nerve endings (parasympathetic nervous system); cholecystokinin, released by enteroendocrine cells of Intestinal mucosa; and glucose-dependent insulinotropic peptide (GIP). The first of these act similarly as glucose through phospholipase C, while the last acts through the mechanism of adenylate cyclase.
When the glucose level comes down to the usual physiologic value, insulin release from the beta cells slows or stops. If blood glucose levels drop lower than this, especially to dangerously low levels, release of hyperglycemic hormones (most prominently glucagon from Islet of Langerhans' alpha cells) forces release of glucose into the blood from cellular stores, primarily liver cell stores of glycogen. By increasing blood glucose, the hyperglycemic hormones correct life-threatening hypoglycemia. Release of insulin is strongly inhibited by the stress hormone norepinephrine (noradrenaline), which leads to increased blood glucose levels during stress.
There are special transporter proteins in cell membranes through which glucose from the blood can enter a cell. These transporters are, indirectly, under insulin control in certain body cell types (e.g., muscle cells). Low levels of circulating insulin, or its absence, will prevent glucose from entering those cells (eg, in untreated Type 1 diabetes). However, more commonly there is a decrease in the sensitivity of cells to insulin (e.g., the reduced insulin sensitivity characteristic of Type 2 diabetes), resulting in decreased glucose absorption. In either case, there is "cell starvation," weight loss, sometimes extreme. In a few cases, there is a defect in the release of insulin from the pancreas. Either way, the effect is, characteristically, the same: elevated blood glucose levels.
Activation of insulin receptors leads to internal cellular mechanisms, which directly affect glucose uptake by regulating the number and operation of protein molecules in the cell membrane which transport glucose into the cell. The genes that specify the proteins which make up the insulin receptor in cell membranes have been identified, as well as the structure of the interior, cell membrane section, and now, finally after more than a decade, the extra-membrane structure of receptor.
Two types of tissues are most strongly influenced by insulin, as far as the stimulation of glucose uptake is concerned: muscle cells (myocytes) and fat cells (adipocytes). The former are important because of their central role in movement, breathing, circulation, and so forth, and the latter because they accumulate excess food energy against future needs. Together, they account for about two-thirds of all cells in a typical human body.
Although other cells can use other fuels for a while (most prominently fatty acids), neurons depend on glucose as a source of energy in the non-starving human. They do not require insulin to absorb glucose, unlike muscle and adipose tissue, and they have very small internal stores of glycogen. Glycogen stored in liver cells (unlike glycogen stored in muscle cells) can be converted to glucose, and released into the blood, when glucose from digestion is low or absent, and the glycerol backbone in triglycerides can also be used to produce blood glucose.
Exhaustion of these sources can, either temporarily or on a sustained basis, if reducing blood glucose to a sufficiently low level, first and most dramatically manifest itself in impaired functioning of the central nervous system—dizziness, speech problems, even loss of consciousness, are not unknown. This is known as hypoglycemia or, in cases producing unconsciousness, "hypoglycemic coma" (formerly termed "insulin shock" from the most common causative agent). Endogenous causes of insulin excess (such as an insulinoma) are very rare, and the overwhelming majority of hypoglycemia cases are caused by human action (e.g., iatrogenic, caused by medicine) and are usually accidental. There have been a few reported cases of murder, attempted murder, or suicide using insulin overdoses, but most insulin shocks appear to be due to mismanagement of insulin (did not eat as much as anticipated, or exercised more than expected), or a mistake (e.g., 20 units of insulin instead of 2).
Possible causes of hypoglycemia include:
There are several conditions in which insulin disturbance is pathologic:
Insulin is required for all animal (including human) life. Its mechanism of action is almost identical in nematode worms (e.g., C. elegans), fish, and mammals, and it is a protein that has been highly conserved throughout evolution. In humans, insulin deprivation due to the removal or destruction of the pancreas leads to death in days or, at most, weeks. Insulin must be administered to patients who experience such a deprivation. Clinically, this condition is called diabetes mellitus type 1.
The initial sources of insulin for clinical use in humans were cattle, horse, pig, or fish pancreases. Insulin from these sources is effective in humans as it is nearly identical to human insulin (three amino acid difference in bovine insulin, one amino acid difference in porcine). Differences in suitability of beef, pork, or fish derived insulin for individual patients have been primarily due to low preparation purity resulting in allergic reactions to the presence of non-insulin substances. Though purity has improved steadily since the 1920s, less severe allergic reactions still occur. Insulin production from animal pancreases was widespread for decades, but very few patients today rely on insulin from animal sources.
Human insulin is now manufactured for widespread clinical use using genetic engineering techniques, which significantly reduces the presence of impurities. Eli Lilly marketed the first such insulin, Humulin, in 1982. Humulin was the first medication produced using modern genetic engineering techniques in which actual human DNA is inserted into a host cell (E. coli in this case). The host cells are then allowed to grow and reproduce normally, and due to the inserted human DNA, they produce actual human insulin.
Genentech developed the technique Lilly used to produce Humulin. Novo Nordisk has also developed a genetically engineered insulin independently. Most insulins used clinically today are produced this way, as they are less likely to produce an allergic reaction.
Since January 2006, all insulins distributed in the Unites States and some other countries are human insulins or their analogs. A special FDA importation process is required to obtain bovine or porcine derived insulin for use in the U.S., though there may be some remaining stocks of porcine insulin made by Lilly in 2005 or earlier.
Unlike many medicines, insulin cannot be taken orally. Like nearly all other proteins introduced into the gastrointestinal tract, it is reduced to fragments (even single amino acid components), whereupon all "insulin activity" is lost. There is research underway to develop methods of protecting insulin so that it can be taken orally, but none has yet reached clinical use. Instead insulin is usually taken as subcutaneous injections by single-use syringes with needles, an insulin pump, or by repeated-use insulin pens with needles.
There are several problems with insulin as a clinical treatment for diabetes:
There have been attempts to improve upon this mode of administering insulin, as many people find injection inconvenient, awkward, and generally painful.
Insulin pumps are a reasonable solution for some. Advantages to the patient are better control over background or "basal" insulin dose, bolus doses calculated to fractions of a unit, and calculators in the pump that help with dosing "bolus" infusions. The limitations are cost, the potential for hypoglycemic and hyperglycemic episodes, catheter problems, and no "closed loop" means of controlling insulin delivery based on current blood glucose levels.
As with injections, if too much insulin is delivered or the patient eats less than he or she dosed for, there will be hypoglycemia. On the other hand, if too little insulin is delivered, there will be hyperglycemia. Both can be life-threatening. In addition, indwelling catheters pose the risk of infection and ulceration. These risks can be minimized by keeping infusion sites clean. Insulin pumps require care and effort to use correctly. However, some diabetics are capable to keep their glucose in reasonable control only on a pump.
Researchers have produced a watch-like device that tests for blood glucose levels through the skin and administers corrective doses of insulin through pores in the skin. Both electricity and ultrasound have been found to make the skin temporarily porous. The insulin administration aspect remains experimental, but the blood glucose test aspect of "wrist appliances" is commercially available.
Another "improvement" would be a transplantation of the pancreas or beta cell to avoid periodic insulin administration. This would result in a self-regulating insulin source. Transplantation of an entire pancreas (as an individual organ) is difficult and uncommon. Generally, it is performed in conjunction with liver or kidney transplant. However, it is possible to do a transplantation of only the pancreatic beta cells. It has been highly experimental (for which read "prone to failure") for many years, but some researchers have developed techniques with a high initial success rate (about 90 percent in one group). Nearly half of those who got an islet cell transplant are insulin-free one year after the operation; by the end of the second year that number drops to about one in seven. Beta cell transplant may become practical in the near future. Additionally, some researchers have explored the possibility of transplanting genetically engineered non-beta cells to secrete insulin (Zhu et al. 2004). Clinically testable results are far from realization. Several other non-transplant methods of automatic insulin delivery are being developed in research labs, but none is close to clinical approval.
Inhalable insulin is under investigation, as are several other insulin administration techniques. The only inhalable insulin approved by the Food and Drug Administration is Exubera (FDA 2006). Inhaled insulin has similar efficacy to injected insulin, both in terms of controlling glucose levels and blood half-life. Currently, inhaled insulin is short acting and is typically taken before meals; an injection of long-acting insulin at night is often still required (NICE 2006). When patients were switched from injected to inhaled insulin, no significant difference was found in HbA1c levels over three months. Accurate dosing is still a problem, but patients showed no significant weight gain or pulmonary function over the length of the trial, when compared to the baseline (Cefalu et al. 2001). Following its commercial launch in 2005 in the United Kingdom, it has not (as of July 2006) been recommended by National Institute for Health and Clinical Excellence for routine use, except in cases where there is "proven injection phobia diagnosed by a psychiatrist or psychologist" (NICE 2006).
Pulsatile insulin is an additional method of administration of insulin to diabetics. In this method, insulin is pulsed into the patient, mimicking the physiological secretions of insulin by the pancreas.
The central problem for those requiring external insulin is picking the right dose of insulin and the right timing.
Physiological regulation of blood glucose, as in the non-diabetic, would be best. Increased blood glucose levels after a meal is a stimulus for prompt release of insulin from the pancreas. The increased insulin level causes glucose absorption and storage in cells, reducing glycogen to glucose conversion, reducing blood glucose levels, and so reducing insulin release. The result is that the blood glucose level rises somewhat after eating, and within an hour or so, returns to the normal "fasting" level. Even the best diabetic treatment with human insulin, however administered, falls short of normal glucose control in the non-diabetic.
Complicating matters is that the composition of the food eaten affects intestinal absorption rates. Glucose from some foods is absorbed more (or less) rapidly than the same amount of glucose in other foods. Fats and proteins cause delays in absorption of glucose from carbohydrate eaten at the same time. As well, exercise reduces the need for insulin even when all other factors remain the same, since working muscle has some ability to take up glucose without the help of insulin.
It is, in principle, impossible to know for certain how much insulin (and which type) is needed to "cover" a particular meal to achieve a reasonable blood glucose level within an hour or two after eating. Non-diabetics' beta cells routinely and automatically manage this by continual glucose level monitoring and insulin release. All such decisions by a diabetic must be based on experience and training (i.e., at the direction of a physician, PA, or in some places a specialist diabetic educator) and, further, specifically based on the individual experience of the patient. It is not straightforward and should never be done by habit or routine. With care it can be done quite successfully in practice.
For example, some diabetics require more insulin after drinking skim milk than they do after taking an equivalent amount of fat, protein, carbohydrate, and fluid in some other form. Their particular reaction to skimmed milk is different from other diabetics', but the same amount of whole milk is likely to cause a still different reaction even in that person. Whole milk contains considerable fat while skimmed milk has much less. It is a continual balancing act for all diabetics, especially for those taking insulin.
Insulin-dependent diabetics require a base level of insulin (basal insulin), as well as short-acting insulin to cover meals (bolus insulin). Maintaining the basal rate and the bolus rate is a continuous balancing act that insulin-dependent diabetics have to manage each day. This is normally achieved through regular blood tests, although there is work being done on continuous blood sugar testing equipment.
It is important to notice that diabetics generally need more insulin than the usual—not less—during physical stress like infections or surgeries.
Medical preparations of insulin (from the major suppliers—Eli Lilly and Novo Nordisk—or from any other) are never just "insulin in water." Clinical insulins are specially prepared mixtures of insulin plus other substances. These delay absorption of the insulin, adjust the pH of the solution to reduce reactions at the injection site, and so on.
Slight variations of the human insulin molecule are called insulin analogs. They have absorption and activity characteristics not possible with insulin proper. They are:
Choosing insulin type and dosage/timing should be done by an experienced medical professional working with the diabetic patient.
Allowing blood glucose levels to rise, though not to levels which cause acute hyperglycemic symptoms, is not a sensible choice. Several large, well designed, long term studies have conclusively shown that diabetic complications decrease markedly, linearly, and consistently as blood glucose levels approach "normal" patterns over long periods. In short, if a diabetic closely controls blood glucose levels (i.e., on average, both over days and weeks, and avoiding too high peaks after meals) the rate of diabetic complications goes down. If glucose levels are very closely controlled, that rate approaches "normal." The chronic diabetic complications include cerebrovascular accidents (CVA or stroke), heart attack, blindness (from proliferative diabetic retinopathy), other vascular damage, nerve damage from diabetic neuropathy, or kidney failure from diabetic nephropathy. These studies have demonstrated beyond doubt that, if it is possible for a patient, so-called intensive insulinotherapy is superior to conventional insulinotherapy. However, close control of blood glucose levels (as in intensive insulinotherapy) does require care and considerable effort, for hypoglycemia is dangerous and can be fatal.
A good measure of long term diabetic control (over approximately 90 days in most people) is the serum level of glycosylated hemoglobin (HbA1c). A shorter term integrated measure (over two weeks or so) is the so-called fructosamine level, which is a measure of similarly glyclosylated proteins (chiefly albumin) with a shorter half life in the blood. There is a commercial meter available which measures this level in the field.
The commonly used types of insulin are:
There are reports that some patients abuse insulin by injecting large doses that lead to hypoglycemic states. This is extremely dangerous. Severe acute or prolonged hypoglycemia can result in brain damage or death.
On July 23, 2004, news reports claimed that a former spouse of a prominent international track athlete said that, among other drugs, the ex-spouse had used insulin as a way of "energizing" the body. The intended implication would seem to be that insulin has effects similar to those alleged for some steroids. This is not so: 80 years of injected insulin use has given no reason to believe it could be in any respect a performance enhancer for non-diabetics. Improperly treated diabetics are, to be sure, more prone than others to exhaustion and tiredness, and in some cases, proper administration of insulin can relieve such symptoms. Insulin is not, chemically or clinically, a steroid, and its use in non-diabetics is dangerous and always an abuse outside of a well-equipped medical facility.
Game of Shadows, a book by reporters Mark Fainaru-Wada and Lance Williams, includes allegations that a prominent baseball player used insulin in the apparent belief that it would increase the effectiveness of the growth hormone he was (also alleged to be) taking. On top of this, non-prescribed insulin is a banned drug at the Olympics and other global competitions.
The use/abuse of exogenous insulin is widespread among the bodybuilding community. Both insulin, growth hormone (GH), and insulin-like growth factor 1 (IGF1) are self-administered by those looking to increase muscle mass beyond the scope offered by anabolic steroids alone. Their rationale is this: Since insulin and GH act synergistically to promote growth, and since IGF1 is the primary mediator of the musculoskeletal effects of growth hormone, the "stacking" of insulin, GH, and IGF1 should offer a synergistic growth effect on skeletal muscle. This theory has been borne out in recent years by the creation of top-level bodybuilders whose competition weight is in excess of 50lbs of muscle greater than the professionals of the past, yet with even lower levels of body fat. Indeed, the use of insulin, combined with GH and/or IGF1 has resulted in the development of such massively muscled physiques, that there has been a backlash among fans of the sport, with a professed disgust at the "freakish" appearance of top-level professionals.
Bodybuilders will inject up to 10 i.u. of quick-acting synthetic insulin following meals containing starchy carbohydrates and protein, but little fat, in an attempt to "force feed" nutrients necessary for growth into skeletal muscle, while preventing growth of adipocytes. This may be done up to 4 times each day, following meals, for a total usage of 40iu of synthetic insulin / day. However there have been reports of substantially heavier usage, among even 'recreational' bodybuilders.
The abuse of exogenous insulin carries with it an attendant risk of hypoglycemic coma and death. Long term risks include development of type II diabetes, and a lifetime dependency on synthetic insulin.
In 1869 Paul Langerhans, a medical student in Berlin, was studying the structure of the pancreas (a glandular organ found in vertebrates near the stomach and small intestine) under a microscope when he identified some previously un-noticed tissue clumps scattered throughout the bulk of the pancreas. The function of the "little heaps of cells," later known as the Islets of Langerhans, was unknown, but Edouard Laguesse later suggested that they might produce secretions that play a regulatory role in digestion. Paul Langerhans' son, Archibwai, also helped in exploring the function of this part.
In 1889, the Polish-German physician Oscar Minkowski, in collaboration with Joseph von Mehring, removed the pancreas from a healthy dog to test its assumed role in digestion. Several days after the dog's pancreas was removed, Minkowski's animal keeper noticed a swarm of flies feeding on the dog's urine. On testing the urine, they found that there was sugar in the dog's urine, establishing for the first time a relationship between the pancreas and diabetes.
In 1901, another major step was taken by Eugene Opie, when he clearly established the link between the Islets of Langerhans and diabetes: Diabetes mellitus … is caused by destruction of the islets of Langerhans and occurs only when these bodies are in part or wholly destroyed. Before his work, the link between the pancreas and diabetes was clear, but not the specific role of the islets.
Over the next two decades, several attempts were made to isolate whatever it was the islets produced as a potential treatment. In 1906, George Ludwig Zuelzer was partially successful treating dogs with pancreatic extract but was unable to continue his work. Between 1911 and 1912, E.L. Scott at the University of Chicago used aqueous pancreatic extracts and noted a slight diminution of glycosuria but was unable to convince his director of his work's value; it was shut down. Israel Kleiner demonstrated similar effects at Rockefeller University in 1919, but his work was interrupted by World War I and he did not return to it. Nicolae Paulescu, a professor of physiology at the University of Medicine and Pharmacy in Bucharest, published similar work in 1921 that had been carried out in France. Use of his techniques was patented in Romania, though no clinical use resulted (Murray 1971).
In October 1920, Frederick Banting was reading one of Minkowski's papers and concluded that it is the very digestive secretions that Minkowski had originally studied that were breaking down the islet secretion(s), thereby making it impossible to extract successfully. He jotted a note to himself Ligate pancreatic ducts of the dog. Keep dogs alive till acini degenerate leaving islets. Try to isolate internal secretion of these and relieve glycosurea.
The idea was that the pancreas's internal secretion, which supposedly regulates sugar in the bloodstream, might hold the key to the treatment of diabetes.
He traveled to Toronto to meet with J.J.R. Macleod, who was not entirely impressed with his idea—so many before him had tried and failed. Nevertheless, he supplied Banting with a lab at the University, an assistant (medical student Charles Best), and 10 dogs, then left on vacation during the summer of 1921. Their method was tying a ligature (string) around the pancreatic duct, and, when examined several weeks later, the pancreatic digestive cells had died and been absorbed by the immune system, leaving thousands of islets. They then isolated an extract from these islets, producing what they called isletin (what we now know as insulin), and tested this extract on the dogs. Banting and Best were then able to keep a pancreatectomized dog alive all summer because the extract lowered the level of sugar in the blood.
Macleod saw the value of the research on his return but demanded a re-run to prove the method actually worked. Several weeks later, it was clear the second run was also a success, and he helped publish their results privately in Toronto that November. However, they needed six weeks to extract the isletin, which forced considerable delays. Banting suggested that they try to use fetal calf pancreas, which had not yet developed digestive glands; he was relieved to find that this method worked well. With the supply problem solved, the next major effort was to purify the extract. In December 1921, Macleod invited the biochemist James Collip to help with this task, and, within a month, the team felt ready for a clinical test.
On January 11, 1922, Leonard Thompson, a 14-year-old diabetic who lay dying at the Toronto General Hospital, was given the first injection of insulin. However, the extract was so impure that Thompson suffered a severe allergic reaction, and further injections were canceled. Over the next 12 days, Collip worked day and night to improve the ox-pancreas extract, and a second dose injected on the 23rd. This was completely successful, not only in not having obvious side-effects, but in completely eliminating the glycosuria sign of diabetes. However, Banting and Best never worked well with Collip, regarding him as something of an interloper, and Collip left the project soon after.
Over the spring of 1922, Best managed to improve his techniques to the point where large quantities of insulin could be extracted on demand, but the preparation remained impure. The drug firm Eli Lilly and Company had offered assistance not long after the first publications in 1921, and they took Lilly up on the offer in April. In November, Lilly made a major breakthrough, and were able to produce large quantities of purer insulin. Insulin was offered for sale shortly thereafter.
The Nobel Prize committee in 1923 credited the practical extraction of insulin to a team at the University of Toronto and awarded the Nobel Prize to two men: Frederick Banting and John Macleod. They were awarded the Nobel Prize in Physiology or Medicine in 1923 for the discovery of insulin. Banting, insulted that Best was not mentioned, shared his prize with Best, and Macleod immediately shared his with Collip. The patent for insulin was sold to the University of Toronto for one dollar.
The exact sequence of amino acids comprising the insulin molecule, the so-called primary structure, was determined by British molecular biologist Frederick Sanger. It was the first protein to have its sequence be determined. He was awarded the 1958 Nobel Prize in Chemistry for this work.
In 1969, after decades of work, Dorothy Crowfoot Hodgkin determined the spatial conformation of the molecule, the so-called tertiary structure, by means of X-ray diffraction studies. She had been awarded a Nobel Prize in Chemistry in 1964 for the development of crystallography.
Rosalyn Sussman Yalow received the 1977 Nobel Prize in Medicine for the development of the radioimmunoassay for insulin.
All links retrieved March 3, 2018.
|Hormones and endocrine glands - edit|
Hypothalamus: GnRH - TRH - CRH - GHRH - somatostatin - dopamine | Posterior pituitary: vasopressin - oxytocin | Anterior pituitary: GH - ACTH - TSH - LH - FSH - prolactin - MSH - endorphins - lipotropin
Thyroid: T3 and T4 - calcitonin | Parathyroid: PTH | Adrenal medulla: epinephrine - norepinephrine | Adrenal cortex: aldosterone - cortisol - DHEA | Pancreas: glucagon- insulin - somatostatin | Ovary: estradiol - progesterone - inhibin - activin | Testis: testosterone - AMH - inhibin | Pineal gland: melatonin | Kidney: renin - EPO - calcitriol - prostaglandin | Heart atrium: ANP
Adipose tissue: leptin, adiponectin
Target-derived NGF, BDNF, NT-3
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