Basal insulin analogues have been designed to mimic endogenous insulin secretion for maintaining normoglycaemia. Current insulin therapy for type 2 diabetes (T2D) requires at least daily dosing for patients. However, such daily injections can have poor patient compliance. An insulin analogue with longer duration requiring less frequent administration could improve compliance and maintain better glycaemic control. To achieve extended insulin action pharmacology, a panel of recombinant native single chain (SC) insulin molecules, consisting of B chain to A chain-linker variants, were fused to an antibody fragment crystallizable region (Fc). Characterization of the single chain insulin-Fc (SC-Insulin-Fc) variants were conducted in insulin receptor (IR) and insulin-like growth factor 1 receptor (IGF1R) luminescence-linked reporter assays, and with primary rodent and human hepatocyte assays for phosphorylated AKT. SC-Insulin-Fc-1 and -2 retained potency at the human IR within 6-fold of human insulin, without specificity over IGF1R binding, and induced Akt phosphorylation within a range of endogenous insulin. SC-Insulin-Fc variants lowered blood glucose levels in DIO and db/db mice by more than 50% vs. vehicle controls (p<0.05) for 5 days following a single dose, significantly superior to a standard insulin bolus. Continuous glucose monitoring (CGM) telemetry to profile 24 h control of blood glucose in diabetic ZDF rats was also applied. CGM telemetry revealed enhanced basal and postprandial glucose control in both light and dark cycles (p<0.05 vs. vehicle) up to 10 days following a single administration (90 nmol/kg). Repeat dosing of SC-Insulin-Fc variants (10/30/60 nmol/kg, Q1W) over 5 weeks resulted in dose-dependent improvements of glycaemic control (p≤0.05 vs. vehicle) with a long term readout towards decreasing %HbA1c. This dramatic shift in time spent away from hyperglycaemia toward normoglycaemia suggests once-weekly insulin as a novel viable option to treat human T2D.
V.G. Howard: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. C.D. Church: Employee; Self; AstraZeneca, MedImmune. S. Oldham: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. D.C. Hornigold: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. J. Trevaskis: Employee; Self; Gilead Sciences, Inc., MedImmune. Stock/Shareholder; Self; AstraZeneca. D. Baker: Stock/Shareholder; Self; AstraZeneca. C.J. Rhodes: Employee; Self; AstraZeneca, MedImmune. A. Rossi: Employee; Self; MedImmune. J. Naylor: Employee; Self; MedImmune. Stock/Shareholder; Self; AstraZeneca. J. Dhillon: Employee; Self; MedImmune. A. Buchanan: Employee; Self; MedImmune. L. Liang: None.