Molecule of the Month: Designer Insulins

A century ago, people with diabetes mellitus had no good options for treatment and the medical condition was invariably fatal. The discovery of insulin dramatically reversed this grim reality, and today, insulin therapy allows those with diabetes to manage their disease and thereby minimize the deleterious impact of elevated blood sugar levels, while living long and productive lives. The first preparations of insulin were extracted from livestock (cattle or pigs). Today, insulin is created by bioengineered bacteria that manufacture pure human insulin. The structure shown here, from PDB entry 1trz, was determined using the first recombinant human insulin, marketed as Humulin.

When recombinant human insulin is injected under the skin, it lowers blood sugar levels rapidly, but its effects wear off in a matter of a few hours. This approach to controlling blood sugar works well immediately after eating, but cells in our bodies also fuel themselves between meals by mobilizing glycogen stored in muscles and the liver. Under normal circumstances, the pancreas continually secretes low levels of insulin, to control blood sugar levels when we are fasting. Soon after recombinant human insulin was approved by the US Food and Drug Administration, scientists began trying to create another genetically modified form of insulin that acts over longer times, to help provide basal blood sugar control.

The trick to creating long-acting insulin was inspired by our knowledge of its structure. Insulin is stored in the pancreas as a hexameric complex, which then falls apart to form the active monomer when it is released into the blood stream and binds to insulin receptors, which are found on the surface of most cells in the human body. To make a long-acting molecule we need to slow the appearance of the active monomer. The first successful approach combines insulin with a fish protein, protamine, to create a heterogeneous complex that slowly dissolves in the blood. Researchers then designed new insulins that do a similar thing. They added two arginine amino acids, and later changed an asparagine to glycine, to change the chemical character of the insulin. The final result is glargine (Lantus ®) (PDB entry 4iyf), a long-acting insulin that is less soluble at the normal pH of the body, forming aggregates that slowly release the active monomer.

Long-acting insulins have also been created by attaching long hydrocarbon chains to the hormone. This modification brings together several hexamers, forming an aggregate of insulin hexamers that slowly dissolves in the blood. They also stabilize interactions with the blood protein serum albumin, which further extends the action of this designer insulin. The structure shown here is that of degludec (Tresiba ®) (PDB entry 4ajx). In this crystal form, one of the hydrocarbon chains bridges two hexamers, giving a hint for how these designer hormones might form higher order aggregates after they are injected under the skin.