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Kesserwan S, Lewis BE, Mao L, Sharafieh R, Atwood T, Kreutzer DL, Klueh U. Inflammation at Site of Insulin Infusion Diminishes Glycemic Control. J Pharm Sci 2022; 111:1952-1961. [PMID: 34986358 PMCID: PMC9880961 DOI: 10.1016/j.xphs.2021.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 01/31/2023]
Abstract
The approximation of euglycemia is the most effective means of preventing diabetic complications, which is achieved through effective insulin delivery. Recent reports indicate that insulin phenolic preservatives, which are found in all commercial insulin formulations, are cytotoxic, pro-inflammatory and induce secondary fibrosis. Therefore, we hypothesize that these preservatives induce an inflammatory response at the site of insulin infusion leading to diminished glycemic control and adverse pharmacokinetic outcomes. Insulin degradation by inflammatory cell proteases was quantitated following protease treatment in vitro. A modified murine air pouch model was utilized to evaluate the relative inflammatory responses following infusions of saline, insulin preservatives, and insulin, utilizing the adjuvant irritant thioglycolate. Blood glucose levels were monitored in diabetic mice with and without air pouch irritation. A pharmacokinetic analysis evaluated insulin effectiveness for diabetic mice between these two conditions. Inflammatory cells are significantly present in insulin preservative-induced inflammation, which effects diminished blood glucose control by both insulin uptake and degradation. Insulin containing these preservatives resulted in similar degrees of inflammation as observed with the irritant thioglycolate. These studies imply that the preservative agents found in commercial insulin formulations induce an intense localized inflammatory reaction. This inflammatory reaction may be responsible for the premature failure of insulin infusion devices. Future studies directed at reducing this inflammatory reaction may prove to be an important step in extending the lifespan of insulin infusion devices.
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Affiliation(s)
- Shereen Kesserwan
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Brianne E. Lewis
- Department of Foundational Medical Studies, Oakland University, William Beaumont School of Medicine, Rochester, MI, USA
| | - Li Mao
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Roshanak Sharafieh
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Thomas Atwood
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Donald L. Kreutzer
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Ulrike Klueh
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA,Corresponding Author: Ulrike Klueh Ph.D., Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, , Phone: 313-577-1359
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Kesserwan S, Mulka A, Sharafieh R, Qiao Y, Wu R, Kreutzer DL, Klueh U. Advancing continuous subcutaneous insulin infusion in vivo: New insights into tissue challenges. J Biomed Mater Res A 2020; 109:1065-1079. [PMID: 32896081 DOI: 10.1002/jbm.a.37097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/13/2023]
Abstract
Continuous Subcutaneous Insulin Infusion (CSII) is superior to conventional insulin therapy as it improves glycemic control thus reducing the probability of diabetic complications. Notwithstanding CSII's benefits, insulin dependent diabetic patients rarely achieve optimal glucose control. Moreover, CSII is only FDA approved for 3 days and often fails prematurely for reasons that have not been fully elucidated. We hypothesize that phenolic compounds, such as m-cresol and phenol, which are present in all commercial insulin formulations are responsible for the tissue reaction occurring at the insulin infusion site. This hypothesis was examined with in vitro cell cultures and a mouse air-pouch model to determine cellular and tissue reactions following infusions with saline, phenolic compounds, (i.e., commercial diluent), and insulin. We demonstrated that diluent and insulin were cytotoxic to cells in culture at sub-clinical concentrations (e.g., >1:10 of commercial insulin). Air pouch studies demonstrated that infusion of either diluted insulin or diluent itself induced three to five-fold level of recruited leukocytes as compared to saline. At both 3- and 7-days post infusion, these were predominantly neutrophils and macrophages. We conclude that phenolic compounds in commercial insulin preparations are cell and tissue toxic, which contributes to the failure of effective insulin infusion therapy.
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Affiliation(s)
- Shereen Kesserwan
- Integrative Biosciences Center (IBio), Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Adam Mulka
- Integrative Biosciences Center (IBio), Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Roshanak Sharafieh
- Department of Surgery, UConn Health, School of Medicine, Farmington, Connecticut, USA
| | - Yi Qiao
- Department of Surgery, UConn Health, School of Medicine, Farmington, Connecticut, USA
| | - Rong Wu
- Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, Connecticut, USA
| | - Donald L Kreutzer
- Department of Surgery, UConn Health, School of Medicine, Farmington, Connecticut, USA
| | - Ulrike Klueh
- Integrative Biosciences Center (IBio), Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Surgery, UConn Health, School of Medicine, Farmington, Connecticut, USA
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