Pramlintide

Pramlintide

Clinical data
Trade names	Symlin
AHFS/Drugs.com	monograph
MedlinePlus	a605031
Pregnancy category	US: C (Risk not ruled out)
Legal status	US: ℞-only
Routes of administration	Subcutaneous
Pharmacokinetic data
Bioavailability	30 to 40%
Protein binding	Approximately 60%
Metabolism	Renal
Biological half-life	Approximately 48 minutes
Identifiers
CAS Number	151126-32-8
ATC code	A10BX05
PubChem	CID 16132446
IUPHAR/BPS	7482
DrugBank	DB01278
UNII	D3FM8FA78T
KEGG	D05595
ChEMBL	CHEMBL1201669
Chemical data
Formula	C171H269N51O53S2
Molar mass	3951.41 g/mol
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Pramlintide (Symlin) is an injectable amylin analogue drug for diabetes (both type 1 and 2), developed by Amylin Pharmaceuticals (now a wholly owned subsidiary of AstraZeneca).^[1] Pramlintide is sold as an acetate salt.

Pharmacology

Pramlintide is an analogue of amylin, a small peptide hormone that is released into the bloodstream by the β-cells of the pancreas along with insulin after a meal.^[2] Like insulin, amylin is completely absent in individuals with Type I diabetes.^[3]

By augmenting endogenous amylin, pramlintide aids in the cellular absorption and regulation of blood glucose by slowing gastric emptying, promoting satiety via hypothalamic receptors (different receptors than for GLP-1), and inhibiting inappropriate secretion of glucagon, a catabolic hormone that opposes the effects of insulin and amylin. Pramlintide also has effects in raising the acute first-phase insulin response threshold following a meal.

Both a reduction in glycated hemoglobin and weight loss have been shown in insulin-treated patients with type 2 diabetes taking pramlintide as an adjunctive therapy.^[4]

Approval

Pramlintide has been approved by the FDA, for use by Type 1 and Type 2 Diabetics who use insulin.^[5] Pramlintide allows patients to use less insulin, lowers average blood sugar levels, and substantially reduces what otherwise would be a large unhealthy rise in blood sugar that occurs in diabetics right after eating. Apart from insulin analogs, pramlintide is the only drug approved by the FDA to lower blood sugar in type 1 diabetics since insulin in the early 1920s.

Design and structure

Since native human amylin is highly amyloidogenic and potentially toxic, the strategy for designing pramlintide was to substitute residues from rat amylin, which is not amyloidogenic (but would presumably retain clinical activity). Proline residues are known to be structure-breaking residues, so these were directly grafted into the human sequence.

Amino acid sequences:

Pramlintide	KCNTATCATQRLANFLVHSSNNFGPILPPTNVGSNTY-(NH2)
Amylin	KCNTATCATQRLANFLVHSSNNFGAILSSTNVGSNTY-(NH2)
Rat amylin	KCNTATCATQRLANFLVRSSNNLGPVLPPTNVGSNTY-(NH2)

Pramlintide as protein is (positively charged).

References

1. Taylor, Phil (19 December 2013). "AstraZeneca buys BMS out of diabetes alliance". Retrieved 16 June 2014.
2. Jones MC (2007). "Therapies for diabetes: pramlintide and exenatide" (pdf). American Family Physician 75 (12): 1831–5. PMID 17619527.
3. Edelman, Steve; Maier, Holly; Wilhelm, Ken (2008). "Pramlintide in the Treatment of Diabetes Mellitus". BioDrugs 22 (6): 375–386. doi:10.2165/0063030-200822060-00004. ISSN 1173-8804.
4. Hollander, Priscilla; Maggs, David G.; Ruggles, James A.; Fineman, Mark; Shen, Larry; Kolterman, Orville G.; Weyer, Christian (2004). "Effect of Pramlintide on Weight in Overweight and Obese Insulin-Treated Type 2 Diabetes Patients" (pdf). Obesity 12 (4): 661–668. doi:10.1038/oby.2004.76. ISSN 1930-7381.
5. Ryan GJ, Jobe LJ, Martin R (2005). "Pramlintide in the treatment of type 1 and type 2 diabetes mellitus". Clinical therapeutics 27 (10): 1500–12. doi:10.1016/j.clinthera.2005.10.009. PMID 16330288.

External links

• www.symlin.com - product website
• www.amylin.com - Symlin page on the Amylin Pharmaceuticals website