Seguridad de los análogos de insulina: qué evaluar, cómo hacerlo y cómo interpretar los resultados / Safety of insulin analogues: What to evaluate, how to do it, and how to interpret the results

La utilización casi generalizada de análogos de insulina está basada no solo en la farmacocinética de estos preparados, mucho más cercana a la fisiología de la secreción de insulina en condiciones normales, sino, además, en su eficacia y seguridad. Se ha publicado una posible asociación entre el uso de un análogo lento de insulina (glargina) y la aparición de cáncer de mama, lo que ha condicionado una inquietud en la comunidad médica sobre la seguridad de estos análogos. Resumen Para explicar el mecanismo del aumento de la actividad tumoral de los análogos de insulina es que actúan a través de los receptores de insulina (IR) y del factor de crecimiento insulínico–1 (IGF-1R) estimulando el crecimiento celular e inhibiendo la apoptosis. En este sentido, existen dos mecanismos principales: el aumento del tiempo de unión de la insulina al IR y la activación aumentada del IGF-1R. Por tanto, para evaluar la seguridad de un análogo hay que descartar su disociación más lenta al IR así como un aumento de su afinidad por el IGF-1. Esto equivale a un índice de actividad mitogénica/metabólica menor a 1. Evaluar estos aspectos sólo es posible mediante el estudio de líneas celulares y la experimentación animal, modelos reduccionistas que no siempre son extrapolables al ser humano. Hasta el momento no existen datos para poner en duda la seguridad de los análogos de insulina en general, si bien la observación de un potencial riesgo de mitogenicidad con la administración de glargina basada en estudios observacionales y en algunos estudios in vitro ha causado cierta alarma en la comunidad médica. A la espera de datos que descarten o confirmen este riesgo, es fundamental poder evaluar los datos existentes de forma crítica con el objeto de proporcionar información objetiva (AU)

The widespread use of insulin analogues is based not only on the pharmacokinetics of these preparations, which is much closer to the physiology of insulin secretion under normal conditions, but also on their safety and effectiveness. The publication of a possible association between the use of a long-acting insulin analogue (glargine) and breast cancer has caused uneasiness among the medical community regarding the safety of these analogues. The mechanism of increased tumor activity of insulin analogues is explained by the fact that they act through insulin receptors (IR) and insulin-like growth factor-1 (IGF-1R), stimulating cell growth and inhibiting apoptosis. There are two major mechanisms: an increase in the binding time of insulin to IR and increased activation of IGF-1R. Therefore, to evaluate the safety of an analogue, the slower dissociation rate from its insulin receptor must be excluded, as well as the increased affinity for the IGF-1 receptor. This is equivalent to an index of mitogenic/metabolic activity of less than 1. These aspects can only be evaluated through study of cell lines and animal testing, which are reductionist models that cannot always be extrapolated to humans. To date, there are no data to question the safety of insulin analogues in general. However, the results of observational studies and some in vitro studies, suggesting a potential risk of mitogenicity with the administration of glargine, have caused some alarm among the medical community. Until now, there are no data to refute or confirm this risk and, therefore, evaluation of the existing data is crucial to obtain objective information (AU)

Old hormones of the insulin family as new developmental signals

La insulina fue identificada como una hormona anabólica pancreática,responsable de la homeostasis de la glucosa, y el Factor de Crecimiento similar ala Insulina tipo I (IGF-I) como el mediador de la acción de la Hormona deCrecimiento postnatalmente. Nuevas informaciones moleculares, farmacológicas yembriológicas han ampliado el concepto del papel fisiológico de estas hormonasy sus moléculas relacionadas, particularmente del precursor de la insulina, laproinsulina, en el desarrollo de vertebrados. Los estudios de nuestro laboratoriohan demostrado que la proinsulina está expresada y es funcional antes deque aparezca el páncreas. La expresión de proinsulina en los embriones de polloy ratón muestra regulación transcripcional y post-transcripcional muy fina, conla generación de transcritos específicos embrionarios que se traducen de formasdistintas. El producto de estos mRNAs se mantiene como proinsulina sinprocesar, que protege a las células de la apoptosis excesiva durante la neurulación.En contraste, el IGF-I está expresado más tarde que la proinsulina en el embriónde pollo y comienza en el sistema nervioso. En el embrión de ratón, la generaciónde células madre neurales en cultivo ha permitido estudiar el papel de estasmoléculas en la proliferación y diferenciación de precursores neurales. Laproinsulina y el IGF-I pueden cooperar con los mitógenos (EGF y FGF2) en elcontrol de la proliferación de células madre/precursores mientras que el IGF-I esun factor esencial para la diferenciación neural. Los ratones deficientes en IGF-Ipresentan alteración de la citoarquitectura del bulbo olfatorio con disminución delnúmero de neuronas mitrales y glía radial anormal. Este artículo da una visiónglobal del importante papel de las proteínas de la familia de la insulina en eldesarrollo

Insulin was first identified as an anabolic pancreatic hormone responsible forglucose homeostasis, and Insulin-like Growth Factor (IGF-I) as the mediator of theaction of Growth Hormone on postnatal growth. New molecular, pharmacologicaland embryological information has broadened the scope of the physiological rolesof these hormones and their related molecules, particularly the insulin precursorproinsulin, during vertebrate development. Studies in our laboratory havedemonstrated that proinsulin is expressed and functional before emergence of thepancreas. Proinsulin gene expression in the chick and mouse embryo shows finetranscriptional and postrancriptional regulation with generation of specificembryonic transcripts which are differentially translated. The protein productremains as unprocessed proinsulin that protects the cells from excessive apoptosisduring neurulation. In contrast, IGF-I is expressed later than proinsulin in thechick embryo and it starts in the nervous system. In the mouse embryo, generationof olfactory bulb stem cells in culture has allowed the study of these molecules’role in the proliferation and differentiation of neural precursors. Proinsulin andIGF-I can cooperate with mitogens (EGF and FGF2) in the control of stem/precursor cells proliferation and IGF-I is an essential factor for neuraldifferentiation. Mice deficient in IGF-I present a disruption of olfactory bulbcytoarchitecture, with decreased numbers of mitral cells and abnormal radial glia.This article gives thus an overview of the important role of insulin family proteinsin development

Mitogen induced activation, proliferation and surface antigen expression patterns in unmutated and hypermutated chronic lymphocytic leukemia cells.

OBJECTIVES: To determine whether the immunoglobulin V(H) gene mutational status has an effect on the activation, proliferation and surface antigen expression of chronic lymphocytic leukemia (CLL) cells when stimulated in vitro. METHODS: The proliferation and activation responses of CLL cells were studied in 22-immunoglobulin gene V(H) unmutated (UM-CLL) and 12 hypermutated (M-CLL) CLL cases in 4-day cultures. As the mitogen responses have been previously shown to be diverse in CLL, a case-specific strategy based on optimized mitogen combinations (OMCs) of interleukin-2 (IL-2), 12-O-tetradecanoylphorbol 13-acetate (TPA), Staphylococcus aureus Cowan 1 (SAC), and human recombinant tumor necrosis factor alpha (TNF) was applied in cell stimulation. The expression of 23 surface membrane antigens (CD5, CD11c, CD19, CD20, CD21, CD22, CD23, CD25, CD27, CD38, CD40, CD45, CD45RA, CD45RO, CD79b, CD80, CD95, CD124, CD126, CD130, FMC7, IgD, and IgM) was studied by flow cytometry at days 0 and 4. RESULTS: The proliferation and activation responses were similar in UM-CLL and M-CLL when OMCs contained IL-2, TPA or TNF. SAC induced faster proliferation in UM-CLL than in M-CLL. OMC stimulation induced preferential down-regulation of growth- promoting cell surface receptors CD5, CD21, and CD124 and preferential up-regulation of growth-inhibiting antigen CD80 in M-CLL. CONCLUSIONS: Difference in immunophenotypic evolution of UM-CLL and M-CLL can be demonstrated if appropriate matrix signals are provided. The pathways for CD5, CD21, CD124 (IL4R), and CD80 (B7-1) regulation should be further explored in relation with somatic hypermutation and outcome of CLL.

Synthesis of thiol-reactive lipopeptide adjuvants. Incorporation into liposomes and study of their mitogenic effect on mouse splenocytes.

Synthetic analogues of triacylated and diacylated lipopeptides derived from the N-terminal domain of respectively bacterial and mycoplasmal lipoproteins are highly potent immunoadjuvants when administered either in combination with protein antigens or covalently linked to small peptide epitopes. Because of their amphipathic properties, lipopeptides, such as S-[2,3-bis(palmitoyloxy)-(2RS)-propyl]-N-palmitoyl-(R)-cysteinyl-alanyl-glycine (Pam(3)CAG), can be conveniently incorporated into liposomes and serve as anchors for antigens that are linked to them. To design vaccination constructs based on synthetic peptides and liposomes as vectors. we have accordingly synthesized a series of lipopeptides that differ by the number (Pam(3)C vs Pam(2)C) and nature of the acyl chains (palmitoyl vs oleoyl) and by the presence at their C-terminus of thiol-reactive functions, such as maleimide or bromoacetyl. When incorporated into liposomes, these latter functionalized lipopeptides allow, in aqueous media, a well controlled chemoselective conjugation of HS-peptides to the surface of the vesicles. Using a BALB/c mice splenocyte proliferation assay ([(3)H]thymidine incorporation), we have measured the lymphocyte activation potency of the different lipopeptides. We found that, compared to their free (emulsified) forms, the liposomal lipopeptides were endowed with enhanced mitogenic activities; i.e., up to 2 orders of magnitude for Pam(3)CAG which was more potent than Pam(2)CAG. The impact of functionalization on the cellular activity of Pam(3)CAG was dependent on the thiol-reactive group introduced: whereas the bromoacetyl derivative retained its full activity, the presence of a maleimide group virtually abolished the lymphocyte activation of the lipopeptide. Finally, the substitution of saturated palmitoyl chains by unsaturated oleoyl chains was inhibitory. Thus, thiol-reactive Ol(3)CAG derivatives were the least active mitogens in our assay. Taken together, our findings are of importance for the further optimization of antigen-specific liposomal-based synthetic vaccines; the bromoacetyl derivative of Pam(3)CAG should be a promising lipopeptide derivative serving as an anchor for peptide epitopes while retaining its lymphocyte activation activity.

Exogenous myristoylated-G(i2)alpha subunits of GTP-binding proteins are mitogens following their internalization by astrocytes in culture.

Heterotrimeric GTP-binding proteins (G proteins) are involved in the coupling of a variety of cell surface receptors to different intracellular signalling pathways, some of which take part in the regulation of growth by affecting cell proliferation and/or differentiation. In cultured astrocytes, many receptors of neuropeptides and hormones are coupled to the heterotrimeric G(i) proteins which regulate the mitogen-activated protein kinase (MAPK/ERK) cascade through both the Galpha and Gbetagamma subunits. We have previously reported that functionally active recombinant myr-G(i2)alpha subunits added to such cultures are internalised and distributed within the plasma membrane and cytosol as well as in the nuclei of dividing astrocytes. Here we show that astrocytes proliferate dose-dependently in response to exogenous myr-G(i2)alpha subunits. Concentrations of 100 pM-30 nM myr-G(i2)alpha caused more than 2.5-fold increase of [3H]thymidine incorporation over basal levels. Other classes of myr-Galpha subunits, such as G(i3)alpha or G(o)alpha, induced a much lower proliferative effect. The addition of G(i1)alpha subunits to the cultures produced no change, indicating the selectivity of this effect. Even though myr-G(i2)alpha subunits are internalised by the cells regardless of their guanine nucleotide-bound state, much less [3H]thymidine incorporation was observed in the presence of GDPbetaS-myr-G(i2)alpha or GTPgammaS-myr-G(i2)alpha. Further, the fluorescent labelling was dissimilarly distributed, the signal being concentrated in the nucleus and perinuclear regions of the astrocytes. Selective disassembly of caveolae impaired both myr-G(i2)alpha internalisation and DNA induction. Together, these data reveal a proliferative effect of myr-G(i2)alpha subunits in astrocytes, and provide evidence for the incorporation of exogenous myr-G(i2)alpha subunits into the mitogen cascade activated by neurotransmitters or growth factors. The fact that Galpha proteins can enter cells is particularly interesting because options for delivering functional proteins into cells are limited. Thus, these proteins may have clinical applications for compensating deficits in the transduction mechanisms associated with several neurological diseases, or as a non-invasive membrane traversing carriers.

Fate of patulin in the presence of the yeast Saccharomyces cerevisiae.

Patulin is known to become analytically non-detectable during the production of cider from contaminated apple juice. The fate of [14C]-labelled patulin during the alcoholic fermentation of apple juice was studied. Three commercial cider strains of Saccharomyces cerevisiae degraded patulin during active fermentative growth, but not when growing aerobically. The products of patulin degradation were more polar than patulin itself and remained in the clarified fermented cider. Patulin did not appear to bind to yeast cells or apple juice sediment in these model experiments. HPLC analysis of patulin-spiked fermentations showed the appearance of two major metabolites, one of which corresponded by both TLC and HPLC to E-ascladiol prepared by the chemical reduction of patulin using sodium borohydride. Using a diode array detector, both metabolites had a lambda(max) = 271 nm, identical to that of ascladiol. The nmr spectrum of a crude preparation of these metabolites showed signals corresponding to those of the E-ascladiol prepared chemically and a weaker set of signals corresponding to those reported in the literature for Z-ascladiol.

The calcium response of human T lymphocytes is decreased in aging but increased in Alzheimer's dementia.

BACKGROUND: A significant increase in the [Ca2+]i response of single T lymphocytes to mitogenic stimulation with phytohemagglutinin is reported for 27 Alzheimer patients compared with 27 healthy gender- and age-matched control subjects, regardless of gender. METHODS: The [Ca2+]i signals of T lymphocytes were assessed using the Fura-2-AM method. RESULTS: In Alzheimer's disease (AD) the reaction pattern is similar to that seen in a group of 27 young healthy control subjects who exhibited a marked [Ca2+]i rise after stimulation. During normal aging the reaction pattern of T cells is significantly attenuated in comparison to that found in young subjects. In healthy control subjects differences in age-related changes in calcium homeostasis are highly significant among women, young women showing the most intense cell response. CONCLUSIONS: The elevation of [Ca2+]i appears to be a prerequisite for apoptosis, which is suggested to be involved in the neuronal death occurring in AD. An increased [Ca2+]i in AD is consistent with processes leading to neurodegeneration in AD.

Enhanced tumor imaging with pokeweed mitogen.

Traditional tumor imaging with biotracer techniques relies solely on the target specificity of the biomolecule. We hypothesize that specific imaging is possible by altering the rate of tissue clearance (both normal and aberrant) of any given radiotracer. Pokeweed mitogen (PWM) as a biomodulator, represents a class of molecules which regulate cellular differentiation and cell-cell interactions and, as part of these mechanisms alter tissue clearance rates (both normal and aberrant). Utilizing the B-16/C57BL/6 model, 7 days post-transplantation (which represents log phase growth of the tumor), 10 animals were imaged following an i.v. injection of 1-2 mCi 99mTc-PWM in order to visualize the tumors and determine the optimal imaging kinetics. A specific tumor image is achieved between 120 and 240 min post-injection. In addition, tumor imaging studies using a non-tumor-specific biomolecule were conducted by injecting 19 animals i.v. with 1-2 mCi of 99mTc-human serum albumin (HSA). Twelve of these animals were given 10 micrograms of PWM i.p. at various intervals prior to the 99mTc-HAS administration. Imaging and biodistribution studies were performed at various intervals up to 2 h post-99mTc-HSA injection. A 32-59% increase in the tumor-to-muscle ratio was observed in the PWM-treated animals relative to the non-treated controls. To further investigate the PWM-induced tissue clearance alteration hypothesis, tissue clearance studies using 99mTc-diethylenetriaminepentaacetic acid (DTPA) were conducted in non-tumor bearing ICR mice and the B-16/C57BL/6 tumor bearing animals. 99mTc-DTPA normal tissue clearance rates were significantly increased in the PWM treated animals relative to the non-treated controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Mitogen-activation of spleen cells in aged animals is potentiated by dietary restriction: a preliminary report.

Dietary restriction has been reported to be associated with increased life span and increased DNA repair capacity in both male and female rats and mice. We examined dietary restriction effects on immune system function and prolongation of life span in specific pathogen free rats and mice. In this preliminary report the authors show that dietary restriction is correlated with a dramatic increase in the lifespan of both male and female rats and mice in a pathogen free environment, and in the capacity of cultured splenocytes from those animals to initiate blastogenesis in response to antigenic stimulation.