Amylin Agonists: A Novel Approach in the Treatment of Diabetes

  1. Ole Schmitz,
  2. Birgitte Brock and
  3. Jorgen Rungby
  1. From the Departments of Endocrinology and Diabetes, University Hospital of Aarhus; and the Department of Clinical Pharmacology, University of Aarhus, Aarhus, Denmark
  1. Address correspondence and reprint requests to Ole Schmitz, Department of Clinical Pharmacology, The Bartholin Building, University of Aarhus, DK 8000 Aarhus C, Denmark. E-mail: ole.schmitz{at}iekf.au.dk

Abstract

Amylin is a peptide hormone that is cosecreted with insulin from the pancreatic β-cell and is thus deficient in diabetic people. It inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent. Amylin replacement could therefore possibly improve glycemic control in some people with diabetes. However, human amylin exhibits physicochemical properties predisposing the peptide hormone to aggregate and form amyloid fibers, which may play a part in β-cell destruction in type 2 diabetes. This obviously makes it unsuitable for pharmacological use. A stable analog, pramlintide, which has actions and pharmacokinetic and pharmacodynamic properties similar to the native peptide, has been developed. The efficacy and safety of pramlintide administration has been tested in a vast number of clinical trials. Aproximately 5,000 insulin-treated patients have received pramlintide and ∼250 for ≥2 years. The aims of this review are to 1) briefly describe actions of amylin as demonstrated in animal and human models and 2) primarily review results from clinical trials with the amylin analog pramlintide.

Footnotes

  • This article is based on a presentation at a symposium. The symposium and the publication of this article were made possible by an unrestricted educational grant from Servier.

    • Accepted May 25, 2004.
    • Received May 2, 2004.
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