Oral delivery of insulin using ligand-directed nanoparticles that do not compete with physiological ligands

项目摘要 传统上，管理2型糖尿病(T2D)的主要焦点是严格控制血糖 使用一种或多种口服药物。目前用于治疗T2D的药物范围从 增加胰岛素分泌或敏感性的药物，对那些降低肝脏的药物 糖异生或肠道碳水化合物吸收。较新的药物包括类胰高血糖素 抑制二肽基肽酶-IV分解内源性GLP-1的GLP-1类似物 (DPP-IV)和钠-葡萄糖共转运体-2(SGLT-2)抑制剂，它们可以阻断正常的葡萄糖重吸收。 肾脏。根据英国前瞻性糖尿病研究(UKPDS 33)，即使疗效 这些药物在预防T2D的微血管并发症(如视网膜病变、神经病变和肾病)方面有何作用 已经部分确定，它们在预防大血管并发症(例如冠心病)方面的作用 和中风)仍然难以捉摸。此外，同一项研究指出，50%的患者最初控制了 一种药物获得了耐受性，三年后需要添加第二种药物，到九年时 多年来，大约75%的患者需要多种治疗才能达到目标值。的确有 有重要证据表明，在一些T2D患者中，尽管服用了药物，但β细胞功能 持续下降，最终完全失败，留下这些患者唯一的选择胰岛素治疗。宁可 然而，临床和研究界正在认识到，作为最后的治疗手段， T2D患者早期开始胰岛素治疗将纠正所有潜在的致病机制 如增加β细胞的凋亡、糖毒性、脂毒性和炎症。早期胰岛素的主要缺点 注射T2D包括心血管疾病、体重增加和低血糖的风险，源于 剂量不规律或不正确，医生的日程安排中没有时间来管理胰岛素治疗，以及大多数 重要的是，患者不遵守医嘱。因此，成功的口服胰岛素是治疗的圣杯 其模拟自然分泌过程的固有易用性潜在地避免或最大限度地减少了许多 这些缺点，应该会大大减轻卫生保健专业人员管理T2D的负担。 然而，胃的不稳定和缺乏通过紧密堆积的上皮和覆盖的粘液的运输是 胰岛素在肠道的成功吸收面临巨大挑战。根据以前的发现所做的工作， 使用不与生理配体竞争的配体导向纳米粒口服胰岛素 与传统的纳米粒子相比，导致了更好的治疗结果。在这个项目中，技术是 通过研究进一步发展，微调纳米颗粒组成如何影响药物处置和 在通常经验的生理学和病理生理学的影响下的治疗结果 条件。通过这样做，该项目将建立1)最佳的非竞争性纳米颗粒化学，2)活性 在相关生理条件下给药；3)T2D中口服胰岛素的治疗窗。

Project Summary The primary focus of managing type 2 diabetes (T2D) has traditionally been the strict control of blood glucose using one or multiple orally administered medications. Drugs currently used to treat T2D range from pharmaceutical agents that increase insulin secretion or sensitivity, to those that decrease hepatic gluconeogenesis or intestinal carbohydrate absorption. Agents that are more recent include glucagon-like peptide-1 (GLP-1) analogues, which inhibit the breakdown of endogenous GLP-1 by dipeptidyl peptidase-IV (DPP-IV), and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, which block normal glucose reabsorption in the kidneys. According to the United Kingdom Prospective Diabetes Study (UKPDS 33), even though the efficacy of these drugs in preventing microvascular complications of T2D (e.g., retinopathy, neuropathy and nephropathy) has been partially established, their role in preventing macrovascular complications (e.g., coronary heart disease and stroke) remains elusive. Moreover, the same study points out that 50 percent of patients originally controlled with a single drug acquired tolerance and needed the addition of a second drug after three years, and by nine years, about 75 percent of patients needed multiple therapies to achieve the target HbA1c value. There is significant evidence that in some T2D patients, despite taking medications, the β-cell function undergoes continuous decline and eventually fails entirely, leaving these patients the only option of insulin therapy. Rather than being used as a treatment of last resort however, the clinical and research communities are recognizing that early initiation of insulin therapy in T2D patients will correct all of the underlying pathogenic mechanisms such as increased β-cell apoptosis, glucotoxicity, lipotoxicity, and inflammation. Major drawbacks of early insulin injections for T2D include risks of cardiovascular disease, weight gain and hypoglycemia, stemming from irregular or incorrect dosing, lack of time in the physician's schedule to manage insulin therapy, and most importantly, patient non-compliance. Successful oral delivery of insulin is therefore a therapeutic Holy Grail as its inherent ease of administration mimicking natural secretion process potentially obviates or minimizes many of the drawbacks, and should reduce much of the burden of managing T2D by health care professionals. However, gastric instability and lack of transport across tightly packed epithelium and overlying mucus are formidable challenges to successful intestinal absorption of insulin. The work enabled by previous findings, in which oral delivery of insulin using ligand-directed nanoparticles that do not compete with physiological ligands led to improved therapeutic outcomes compared to conventional nanoparticles. In this project, the technology is further developed by investigating, how fine-tuning the nanoparticle composition affect the drug disposition and therapeutic outcomes, under the influence of commonly experienced physiological and pathophysiology conditions. In doing so, the project will establish 1) optimal non-competitive nanoparticle chemistry, 2) active drug delivery under pertinent physiological conditions, and 3) the therapeutic window of oral insulin in T2D.