Insulin (/ˈɪn.sjʊ.lɪn/,[5][6] from Latininsula, 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (INS)gene. It is the main anabolichormone of the body.[7] It regulates the metabolism of carbohydrates, fats, and protein by promoting the absorption of glucose from the blood into cells of the liver, fat, and skeletal muscles.[8] In these tissues the absorbed glucose is converted into either glycogen, via glycogenesis, or fats (triglycerides), via lipogenesis; in the liver, glucose is converted into both.[8]Glucose production and secretion by the liver are strongly inhibited by high concentrations of insulin in the blood.[9] Circulating insulin also affects the synthesis of proteins in a wide variety of tissues. It is thus an anabolic hormone, promoting the conversion of small molecules in the blood into large molecules in the cells. Low insulin in the blood has the opposite effect, promoting widespread catabolism, especially of reserve body fat.
Beta cells are sensitive to blood sugar levels so that they secrete insulin into the blood in response to high level of glucose, and inhibit secretion of insulin when glucose levels are low.[10] Insulin production is also regulated by glucose: high glucose promotes insulin production while low glucose levels lead to lower production.[11] Insulin enhances glucose uptake and metabolism in the cells, thereby reducing blood sugar. Their neighboring alpha cells, by taking their cues from the beta cells,[10] secrete glucagon into the blood in the opposite manner: increased secretion when blood glucose is low, and decreased secretion when glucose concentrations are high. Glucagon increases blood glucose by stimulating glycogenolysis and gluconeogenesis in the liver.[8][10] The secretion of insulin and glucagon into the blood in response to the blood glucose concentration is the primary mechanism of glucose homeostasis.[10]
Decreased or absent insulin activity results in diabetes, a condition of high blood sugar level (hyperglycaemia). There are two types of the disease. In type 1 diabetes, the beta cells are destroyed by an autoimmune reaction so that insulin can no longer be synthesized or be secreted into the blood.[12] In type 2 diabetes, the destruction of beta cells is less pronounced than in type 1, and is not due to an autoimmune process. Instead, there is an accumulation of amyloid in the pancreatic islets, which likely disrupts their anatomy and physiology.[10] The pathogenesis of type 2 diabetes is not well understood but reduced population of islet beta-cells, reduced secretory function of islet beta-cells that survive, and peripheral tissue insulin resistance are known to be involved.[7] Type 2 diabetes is characterized by increased glucagon secretion which is unaffected by, and unresponsive to the concentration of blood glucose. But insulin is still secreted into the blood in response to the blood glucose.[10] As a result, glucose accumulates in the blood.
The human insulin protein is composed of 51 amino acids, and has a molecular mass of 5808 Da. It is a heterodimer of an A-chain and a B-chain, which are linked together by disulfide bonds. Insulin's structure varies slightly between species of animals. Insulin from non-human animal sources differs somewhat in effectiveness (in carbohydrate metabolism effects) from human insulin because of these variations. Porcine insulin is especially close to the human version, and was widely used to treat type 1 diabetics before human insulin could be produced in large quantities by recombinant DNA technologies.[13][14][15][16]
Insulin may have originated more than a billion years ago.[21] The molecular origins of insulin go at least as far back as the simplest unicellular eukaryotes.[22] Apart from animals, insulin-like proteins are also known to exist in fungi and protists.[21]
Insulin is produced by beta cells of the pancreatic islets in most vertebrates and by the Brockmann body in some teleost fish.[23]Cone snails: Conus geographus and Conus tulipa, venomous sea snails that hunt small fish, use modified forms of insulin in their venom cocktails. The insulin toxin, closer in structure to fishes' than to snails' native insulin, slows down the prey fishes by lowering their blood glucose levels.[24][25]
Production
Insulin is produced exclusively in the beta cells of the pancreatic islets in mammals, and the Brockmann body in some fish. Human insulin is produced from the INSgene, located on chromosome 11.[26] Rodents have two functional insulin genes; one is the homolog of most mammalian genes (Ins2), and the other is a retroposed copy that includes promoter sequence but that is missing an intron (Ins1).[27]Transcription of the insulin gene increases in response to elevated blood glucose.[28] This is primarily controlled by transcription factors that bind enhancer sequences in the ~400 base pairs before the gene's transcription start site.[26][28]
During a low-glucose state, PDX1 (pancreatic and duodenal homeobox protein 1) is located in the nuclear periphery as a result of interaction with HDAC1 and 2,[33] which results in downregulation of insulin secretion.[34] An increase in blood glucose levels causes phosphorylation of PDX1, which leads it to undergo nuclear translocation and bind the A3 element within the insulin promoter.[35] Upon translocation it interacts with coactivators HAT p300 and SETD7. PDX1 affects the histone modifications through acetylation and deacetylation as well as methylation. It is also said to suppress glucagon.[36]
NeuroD1, also known as β2, regulates insulin exocytosis in pancreatic β cells by directly inducing the expression of genes involved in exocytosis.[37] It is localized in the cytosol, but in response to high glucose it becomes glycosylated by OGT and/or phosphorylated by ERK, which causes translocation to the nucleus. In the nucleus β2 heterodimerizes with E47, binds to the E1 element of the insulin promoter and recruits co-activator p300 which acetylates β2. It is able to interact with other transcription factors as well in activation of the insulin gene.[37]
MafA is degraded by proteasomes upon low blood glucose levels. Increased levels of glucose make an unknown protein glycosylated. This protein works as a transcription factor for MafA in an unknown manner and MafA is transported out of the cell. MafA is then translocated back into the nucleus where it binds the C1 element of the insulin promoter.[38][39]
These transcription factors work synergistically and in a complex arrangement. Increased blood glucose can after a while destroy the binding capacities of these proteins, and therefore reduce the amount of insulin secreted, causing diabetes. The decreased binding activities can be mediated by glucose induced oxidative stress and antioxidants are said to prevent the decreased insulin secretion in glucotoxic pancreatic β cells. Stress signalling molecules and reactive oxygen species inhibits the insulin gene by interfering with the cofactors binding the transcription factors and the transcription factors itself.[40]
Insulin is synthesized as an inactive precursor molecule, a 110 amino acid-long protein called "preproinsulin". Preproinsulin is translated directly into the rough endoplasmic reticulum (RER), where its signal peptide is removed by signal peptidase to form "proinsulin".[26] As the proinsulin folds, opposite ends of the protein, called the "A-chain" and the "B-chain", are fused together with three disulfide bonds.[26] Folded proinsulin then transits through the Golgi apparatus and is packaged into specialized secretory vesicles.[26] In the granule, proinsulin is cleaved by proprotein convertase 1/3 and proprotein convertase 2, removing the middle part of the protein, called the "C-peptide".[26] Finally, carboxypeptidase E removes two pairs of amino acids from the protein's ends, resulting in active insulin – the insulin A- and B- chains, now connected with two disulfide bonds.[26]
The resulting mature insulin is packaged inside mature granules waiting for metabolic signals (such as leucine, arginine, glucose and mannose) and vagal nerve stimulation to be exocytosed from the cell into the circulation.[41]
Insulin and its related proteins have been shown to be produced inside the brain, and reduced levels of these proteins are linked to Alzheimer's disease.[42][43][44]
Insulin release is stimulated also by beta-2 receptor stimulation and inhibited by alpha-1 receptor stimulation. In addition, cortisol, glucagon and growth hormone antagonize the actions of insulin during times of stress. Insulin also inhibits fatty acid release by hormone-sensitive lipase in adipose tissue.[8]
Contrary to an initial belief that hormones would be generally small chemical molecules, as the first peptide hormone known of its structure, insulin was found to be quite large.[17] A single protein (monomer) of human insulin is composed of 51 amino acids, and has a molecular mass of 5808 Da. The molecular formula of human insulin is C257H383N65O77S6.[45] It is a combination of two peptide chains (dimer) named an A-chain and a B-chain, which are linked together by two disulfide bonds. The A-chain is composed of 21 amino acids, while the B-chain consists of 30 residues. The linking (interchain) disulfide bonds are formed at cysteine residues between the positions A7-B7 and A20-B19. There is an additional (intrachain) disulfide bond within the A-chain between cysteine residues at positions A6 and A11. The A-chain exhibits two α-helical regions at A1-A8 and A12-A19 which are antiparallel; while the B chain has a central α -helix (covering residues B9-B19) flanked by the disulfide bond on either sides and two β-sheets (covering B7-B10 and B20-B23).[17][46]
The amino acid sequence of insulin is strongly conserved and varies only slightly between species. Bovine insulin differs from human in only three amino acid residues, and porcine insulin in one. Even insulin from some species of fish is similar enough to human to be clinically effective in humans. Insulin in some invertebrates is quite similar in sequence to human insulin, and has similar physiological effects. The strong homology seen in the insulin sequence of diverse species suggests that it has been conserved across much of animal evolutionary history. The C-peptide of proinsulin, however, differs much more among species; it is also a hormone, but a secondary one.[46]
Insulin is produced and stored in the body as a hexamer (a unit of six insulin molecules), while the active form is the monomer. The hexamer is about 36000 Da in size. The six molecules are linked together as three dimeric units to form symmetrical molecule. An important feature is the presence of zinc atoms (Zn2+) on the axis of symmetry, which are surrounded by three water molecules and three histidine residues at position B10.[17][46]
The hexamer is an inactive form with long-term stability, which serves as a way to keep the highly reactive insulin protected, yet readily available. The hexamer-monomer conversion is one of the central aspects of insulin formulations for injection. The hexamer is far more stable than the monomer, which is desirable for practical reasons; however, the monomer is a much faster-reacting drug because diffusion rate is inversely related to particle size. A fast-reacting drug means insulin injections do not have to precede mealtimes by hours, which in turn gives people with diabetes more flexibility in their daily schedules.[47] Insulin can aggregate and form fibrillar interdigitated beta-sheets. This can cause injection amyloidosis, and prevents the storage of insulin for long periods.[48]
Beta cells in the islets of Langerhans release insulin in two phases. The first-phase release is rapidly triggered in response to increased blood glucose levels, and lasts about 10 minutes. The second phase is a sustained, slow release of newly formed vesicles triggered independently of sugar, peaking in 2 to 3 hours. The two phases of the insulin release suggest that insulin granules are present in diverse stated populations or "pools". During the first phase of insulin exocytosis, most of the granules predispose for exocytosis are released after the calcium internalization. This pool is known as Readily Releasable Pool (RRP). The RRP granules represent 0.3-0.7% of the total insulin-containing granule population, and they are found immediately adjacent to the plasma membrane. During the second phase of exocytosis, insulin granules require mobilization of granules to the plasma membrane and a previous preparation to undergo their release.[49] Thus, the second phase of insulin release is governed by the rate at which granules get ready for release. This pool is known as a Reserve Pool (RP). The RP is released slower than the RRP (RRP: 18 granules/min; RP: 6 granules/min).[50] Reduced first-phase insulin release may be the earliest detectable beta cell defect predicting onset of type 2 diabetes.[51] First-phase release and insulin sensitivity are independent predictors of diabetes.[52]
The description of first phase release is as follows:
Glucose enters the β-cells through the glucose transporters, GLUT 2. At low blood sugar levels little glucose enters the β-cells; at high blood glucose concentrations large quantities of glucose enter these cells.[53]
The glucose that enters the β-cell is phosphorylated to glucose-6-phosphate (G-6-P) by glucokinase (hexokinase IV) which is not inhibited by G-6-P in the way that the hexokinases in other tissues (hexokinase I – III) are affected by this product. This means that the intracellular G-6-P concentration remains proportional to the blood sugar concentration.[10][53]
Glucose-6-phosphate enters glycolytic pathway and then, via the pyruvate dehydrogenase reaction, into the Krebs cycle, where multiple, high-energy ATP molecules are produced by the oxidation of acetyl CoA (the Krebs cycle substrate), leading to a rise in the ATP:ADP ratio within the cell.[54]
An increased intracellular ATP:ADP ratio closes the ATP-sensitive SUR1/Kir6.2potassium channel (see sulfonylurea receptor). This prevents potassium ions (K+) from leaving the cell by facilitated diffusion, leading to a buildup of intracellular potassium ions. As a result, the inside of the cell becomes less negative with respect to the outside, leading to the depolarization of the cell surface membrane.
The cytosolic calcium ion concentration can also be increased by calcium release from intracellular stores via activation of ryanodine receptors.[55]
The calcium ion concentration in the cytosol of the beta cells can also, or additionally, be increased through the activation of phospholipase C resulting from the binding of an extracellular ligand (hormone or neurotransmitter) to a G protein-coupled membrane receptor. Phospholipase C cleaves the membrane phospholipid, phosphatidyl inositol 4,5-bisphosphate, into inositol 1,4,5-trisphosphate and diacylglycerol. Inositol 1,4,5-trisphosphate (IP3) then binds to receptor proteins in the plasma membrane of the endoplasmic reticulum (ER). This allows the release of Ca2+ ions from the ER via IP3-gated channels, which raises the cytosolic concentration of calcium ions independently of the effects of a high blood glucose concentration. Parasympathetic stimulation of the pancreatic islets operates via this pathway to increase insulin secretion into the blood.[56]
The significantly increased amount of calcium ions in the cells' cytoplasm causes the release into the blood of previously synthesized insulin, which has been stored in intracellular secretoryvesicles.
Release of insulin is strongly inhibited by norepinephrine (noradrenaline), which leads to increased blood glucose levels during stress. It appears that release of catecholamines by the sympathetic nervous system has conflicting influences on insulin release by beta cells, because insulin release is inhibited by α2-adrenergic receptors[58] and stimulated by β2-adrenergic receptors.[59] The net effect of norepinephrine from sympathetic nerves and epinephrine from adrenal glands on insulin release is inhibition due to dominance of the α-adrenergic receptors.[60]
When the glucose level comes down to the usual physiologic value, insulin release from the β-cells slows or stops. If the blood glucose level drops lower than this, especially to dangerously low levels, release of hyperglycemic hormones (most prominently glucagon from islet of Langerhans alpha cells) forces release of glucose into the blood from the liver glycogen stores, supplemented by gluconeogenesis if the glycogen stores become depleted. By increasing blood glucose, the hyperglycemic hormones prevent or correct life-threatening hypoglycemia.
Evidence of impaired first-phase insulin release can be seen in the glucose tolerance test, demonstrated by a substantially elevated blood glucose level at 30 minutes after the ingestion of a glucose load (75 or 100 g of glucose), followed by a slow drop over the next 100 minutes, to remain above 120 mg/100 mL after two hours after the start of the test. In a normal person the blood glucose level is corrected (and may even be slightly over-corrected) by the end of the test. An insulin spike is a 'first response' to blood glucose increase, this response is individual and dose specific although it was always previously assumed to be food type specific only.
Even during digestion, in general, one or two hours following a meal, insulin release from the pancreas is not continuous, but oscillates with a period of 3–6 minutes, changing from generating a blood insulin concentration more than about 800 pmol/l to less than 100 pmol/L (in rats).[61] This is thought to avoid downregulation of insulin receptors in target cells, and to assist the liver in extracting insulin from the blood.[61] This oscillation is important to consider when administering insulin-stimulating medication, since it is the oscillating blood concentration of insulin release, which should, ideally, be achieved, not a constant high concentration.[61] This may be achieved by delivering insulin rhythmically to the portal vein, by light activated delivery, or by islet cell transplantation to the liver.[61][62][63]
The blood insulin level can be measured in international units, such as μIU/mL or in molar concentration, such as pmol/L, where 1 μIU/mL equals 6.945 pmol/L.[64] A typical blood level between meals is 8–11 μIU/mL (57–79 pmol/L).[65]
Signal transduction
The effects of insulin are initiated by its binding to a receptor, the insulin receptor (IR), present in the cell membrane. The receptor molecule contains an α- and β subunits. Two molecules are joined to form what is known as a homodimer. Insulin binds to the α-subunits of the homodimer, which faces the extracellular side of the cells. The β subunits have tyrosine kinase enzyme activity which is triggered by the insulin binding. This activity provokes the autophosphorylation of the β subunits and subsequently the phosphorylation of proteins inside the cell known as insulin receptor substrates (IRS). The phosphorylation of the IRS activates a signal transduction cascade that leads to the activation of other kinases as well as transcription factors that mediate the intracellular effects of insulin.[66]
The cascade that leads to the insertion of GLUT4 glucose transporters into the cell membranes of muscle and fat cells, and to the synthesis of glycogen in liver and muscle tissue, as well as the conversion of glucose into triglycerides in liver, adipose, and lactating mammary gland tissue, operates via the activation, by IRS-1, of phosphoinositol 3 kinase (PI3K). This enzyme converts a phospholipid in the cell membrane by the name of phosphatidylinositol 4,5-bisphosphate (PIP2), into phosphatidylinositol 3,4,5-triphosphate (PIP3), which, in turn, activates protein kinase B (PKB). Activated PKB facilitates the fusion of GLUT4 containing endosomes with the cell membrane, resulting in an increase in GLUT4 transporters in the plasma membrane.[67] PKB also phosphorylates glycogen synthase kinase (GSK), thereby inactivating this enzyme.[68] This means that its substrate, glycogen synthase (GS), cannot be phosphorylated, and remains dephosphorylated, and therefore active. The active enzyme, glycogen synthase (GS), catalyzes the rate limiting step in the synthesis of glycogen from glucose. Similar dephosphorylations affect the enzymes controlling the rate of glycolysis leading to the synthesis of fats via malonyl-CoA in the tissues that can generate triglycerides, and also the enzymes that control the rate of gluconeogenesis in the liver. The overall effect of these final enzyme dephosphorylations is that, in the tissues that can carry out these reactions, glycogen and fat synthesis from glucose are stimulated, and glucose production by the liver through glycogenolysis and gluconeogenesis are inhibited.[69] The breakdown of triglycerides by adipose tissue into free fatty acids and glycerol is also inhibited.[69]
After the intracellular signal that resulted from the binding of insulin to its receptor has been produced, termination of signaling is then needed. As mentioned below in the section on degradation, endocytosis and degradation of the receptor bound to insulin is a main mechanism to end signaling.[41] In addition, the signaling pathway is also terminated by dephosphorylation of the tyrosine residues in the various signaling pathways by tyrosine phosphatases. Serine/Threonine kinases are also known to reduce the activity of insulin.
The actions of insulin (indirect and direct) on cells include:
Stimulates the uptake of glucose – Insulin decreases blood glucose concentration by inducing intake of glucose by the cells. This is possible because Insulin causes the insertion of the GLUT4 transporter in the cell membranes of muscle and fat tissues which allows glucose to enter the cell.[66]
Increased fat synthesis – insulin forces fat cells to take in blood glucose, which is converted into triglycerides; decrease of insulin causes the reverse.[71]
Increased esterification of fatty acids – forces adipose tissue to make neutral fats (i.e., triglycerides) from fatty acids; decrease of insulin causes the reverse.[71]
Decreased lipolysis in – forces reduction in conversion of fat cell lipid stores into blood fatty acids and glycerol; decrease of insulin causes the reverse.[71]
Induced glycogen synthesis – When glucose levels are high, insulin induces the formation of glycogen by the activation of the hexokinase enzyme, which adds a phosphate group in glucose, thus resulting in a molecule that cannot exit the cell. At the same time, insulin inhibits the enzyme glucose-6-phosphatase, which removes the phosphate group. These two enzymes are key for the formation of glycogen. Also, insulin activates the enzymes phosphofructokinase and glycogen synthase which are responsible for glycogen synthesis.[72]
Decreased gluconeogenesis and glycogenolysis – decreases production of glucose from noncarbohydrate substrates, primarily in the liver (the vast majority of endogenous insulin arriving at the liver never leaves the liver); decrease of insulin causes glucose production by the liver from assorted substrates.[71]
Decreased proteolysis – decreasing the breakdown of protein[71]
Decreased autophagy – decreased level of degradation of damaged organelles. Postprandial levels inhibit autophagy completely.[73]
Increased amino acid uptake – forces cells to absorb circulating amino acids; decrease of insulin inhibits absorption.[71]
Arterial muscle tone – forces arterial wall muscle to relax, increasing blood flow, especially in microarteries; decrease of insulin reduces flow by allowing these muscles to contract.[74]
Increased potassium uptake – forces cells synthesizing glycogen (a very spongy, "wet" substance, that increases the content of intracellular water, and its accompanying K+ ions)[75] to absorb potassium from the extracellular fluids; lack of insulin inhibits absorption. Insulin's increase in cellular potassium uptake lowers potassium levels in blood plasma. This possibly occurs via insulin-induced translocation of the Na+/K+-ATPase to the surface of skeletal muscle cells.[76][77]
In hepatocytes, insulin binding acutely leads to activation of protein phosphatase 2A (PP2A)[citation needed], which dephosphorylates the bifunctional enzyme fructose bisphosphatase-2 (PFKB1),[79] activating the phosphofructokinase-2 (PFK-2) active site. PFK-2 increases production of fructose 2,6-bisphosphate. Fructose 2,6-bisphosphate allosterically activates PFK-1, which favors glycolysis over gluconeogenesis. Increased glycolysis increases the formation of malonyl-CoA, a molecule that can be shunted into lipogenesis and that allosterically inhibits of carnitine palmitoyltransferase I (CPT1), a mitochondrial enzyme necessary for the translocation of fatty acids into the intermembrane space of the mitochondria for fatty acid metabolism.[80]
Insulin also influences other body functions, such as vascular compliance and cognition. Once insulin enters the human brain, it enhances learning and memory and benefits verbal memory in particular.[81] Enhancing brain insulin signaling by means of intranasal insulin administration also enhances the acute thermoregulatory and glucoregulatory response to food intake, suggesting that central nervous insulin contributes to the co-ordination of a wide variety of homeostatic or regulatory processes in the human body.[82] Insulin also has stimulatory effects on gonadotropin-releasing hormone from the hypothalamus, thus favoring fertility.[83]
Degradation
Once an insulin molecule has docked onto the receptor and effected its action, it may be released back into the extracellular environment, or it may be degraded by the cell. The two primary sites for insulin clearance are the liver and the kidney.[84] It is broken down by the enzyme, protein-disulfide reductase (glutathione),[85] which breaks the disulphide bonds between the A and B chains. The liver clears most insulin during first-pass transit, whereas the kidney clears most of the insulin in systemic circulation. Degradation normally involves endocytosis of the insulin-receptor complex, followed by the action of insulin-degrading enzyme. An insulin molecule produced endogenously by the beta cells is estimated to be degraded within about one hour after its initial release into circulation (insulin half-life ~ 4–6 minutes).[86][87]
Regulator of endocannabinoid metabolism
Insulin is a major regulator of endocannabinoid (EC) metabolism and insulin treatment has been shown to reduce intracellular ECs, the 2-arachidonoylglycerol (2-AG) and anandamide (AEA), which correspond with insulin-sensitive expression changes in enzymes of EC metabolism. In insulin-resistant adipocytes, patterns of insulin-induced enzyme expression is disturbed in a manner consistent with elevated EC synthesis and reduced EC degradation. Findings suggest that insulin-resistant adipocytes fail to regulate EC metabolism and decrease intracellular EC levels in response to insulin stimulation, whereby obese insulin-resistant individuals exhibit increased concentrations of ECs.[88][89] This dysregulation contributes to excessive visceral fat accumulation and reduced adiponectin release from abdominal adipose tissue, and further to the onset of several cardiometabolic risk factors that are associated with obesity and type 2 diabetes.[90]
Hypoglycemia, also known as "low blood sugar", is when blood sugar decreases to below normal levels.[91] This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures or death.[91] A feeling of hunger, sweating, shakiness and weakness may also be present.[91] Symptoms typically come on quickly.[91]
There are several conditions in which insulin disturbance is pathologic:
Diabetes – general term referring to all states characterized by hyperglycemia. It can be of the following types:[95]
Type 1 diabetes – autoimmune-mediated destruction of insulin-producing β-cells in the pancreas, resulting in absolute insulin deficiency
Type 2 diabetes – either inadequate insulin production by the β-cells or insulin resistance or both because of reasons not completely understood.
there is correlation with diet, with sedentary lifestyle, with obesity, with age and with metabolic syndrome. Causality has been demonstrated in multiple model organisms including mice and monkeys; importantly, non-obese people do get Type 2 diabetes due to diet, sedentary lifestyle and unknown risk factors, though this may not be a causal relationship.
it is likely that there is genetic susceptibility to develop Type 2 diabetes under certain environmental conditions
Other types of impaired glucose tolerance (see Diabetes)
Metabolic syndrome – a poorly understood condition first called syndrome X by Gerald Reaven. It is not clear whether the syndrome has a single, treatable cause, or is the result of body changes leading to type 2 diabetes. It is characterized by elevated blood pressure, dyslipidemia (disturbances in blood cholesterol forms and other blood lipids), and increased waist circumference (at least in populations in much of the developed world). The basic underlying cause may be the insulin resistance that precedes type 2 diabetes, which is a diminished capacity for insulin response in some tissues (e.g., muscle, fat). It is common for morbidities such as essential hypertension, obesity, type 2 diabetes, and cardiovascular disease (CVD) to develop.[97]
Biosynthetic human insulin (insulin human rDNA, INN) for clinical use is manufactured by recombinant DNA technology.[13] Biosynthetic human insulin has increased purity when compared with extractive animal insulin, enhanced purity reducing antibody formation. Researchers have succeeded in introducing the gene for human insulin into plants as another method of producing insulin ("biopharming") in safflower.[99] This technique is anticipated to reduce production costs.
Several analogs of human insulin are available. These insulin analogs are closely related to the human insulin structure, and were developed for specific aspects of glycemic control in terms of fast action (prandial insulins) and long action (basal insulins).[100] The first biosynthetic insulin analog was developed for clinical use at mealtime (prandial insulin), Humalog (insulin lispro),[101] it is more rapidly absorbed after subcutaneous injection than regular insulin, with an effect 15 minutes after injection. Other rapid-acting analogues are NovoRapid and Apidra, with similar profiles.[102] All are rapidly absorbed due to amino acid sequences that will reduce formation of dimers and hexamers (monomeric insulins are more rapidly absorbed). Fast acting insulins do not require the injection-to-meal interval previously recommended for human insulin and animal insulins. The other type is long acting insulin; the first of these was Lantus (insulin glargine). These have a steady effect for an extended period from 18 to 24 hours. Likewise, another protracted insulin analogue (Levemir) is based on a fatty acid acylation approach. A myristic acid molecule is attached to this analogue, which associates the insulin molecule to the abundant serum albumin, which in turn extends the effect and reduces the risk of hypoglycemia. Both protracted analogues need to be taken only once daily, and are used for type 1 diabetics as the basal insulin. A combination of a rapid acting and a protracted insulin is also available, making it more likely for patients to achieve an insulin profile that mimics that of the body's own insulin release.[103][104] Insulin is also used in many cell lines, such as CHO-s, HEK 293 or Sf9, for the manufacturing of monoclonal antibodies, virus vaccines, and gene therapy products.[105]
The Dispovan Single-Use Pen Needle by HMD[106] is India’s first insulin pen needle that makes self-administration easy. Featuring extra-thin walls and a multi-bevel tapered point, these pen needles prioritise patient comfort by minimising pain and ensuring seamless medication delivery. The product aims to provide affordable Pen Needles to the developing part of the country through its wide distribution channel. Additionally, the universal design of these needles guarantees compatibility with all insulin pens.
Unlike many medicines, insulin cannot be taken by mouth because, like nearly all other proteins introduced into the gastrointestinal tract, it is reduced to fragments, whereupon all activity is lost. There has been some research into ways to protect insulin from the digestive tract, so that it can be administered orally or sublingually.[107][108]
Insulin, and all other medications, are supplied free of charge to people with diabetes by the National Health Service in the countries of the United Kingdom.[110]
History of study
Discovery
In 1869, while studying the structure of the pancreas under a microscope, Paul Langerhans, a medical student in Berlin, identified some previously unnoticed tissue clumps scattered throughout the bulk of the pancreas.[111] The function of the "little heaps of cells", later known as the islets of Langerhans, initially remained unknown, but Édouard Laguesse later suggested they might produce secretions that play a regulatory role in digestion.[112] Paul Langerhans' son, Archibald, also helped to understand this regulatory role.
In 1889, the physician Oskar Minkowski, in collaboration with Joseph von Mering, removed the pancreas from a healthy dog to test its assumed role in digestion. On testing the urine, they found sugar, establishing for the first time a relationship between the pancreas and diabetes. In 1901, another major step was taken by the American physician and scientist Eugene Lindsay Opie, when he isolated the role of the pancreas to the islets of Langerhans: "Diabetes mellitus when the result of a lesion of the pancreas is caused by destruction of the islands of Langerhans and occurs only when these bodies are in part or wholly destroyed".[113][114][115]
Over the next two decades researchers made several attempts to isolate the islets' secretions. In 1906 George Ludwig Zuelzer achieved partial success in treating dogs with pancreatic extract, but he was unable to continue his work. Between 1911 and 1912, E.L. Scott at the University of Chicago tried aqueous pancreatic extracts and noted "a slight diminution of glycosuria", but was unable to convince his director of his work's value; it was shut down. Israel Kleiner demonstrated similar effects at Rockefeller University in 1915, but World War I interrupted his work and he did not return to it.[116]
In 1916, Nicolae Paulescu developed an aqueouspancreatic extract which, when injected into a diabetic dog, had a normalizing effect on blood sugar levels. He had to interrupt his experiments because of World War I, and in 1921 he wrote four papers about his work carried out in Bucharest and his tests on a diabetic dog. Later that year, he published "Research on the Role of the Pancreas in Food Assimilation".[117][118]
The name "insulin" was coined by Edward Albert Sharpey-Schafer in 1916 for a hypothetical molecule produced by pancreatic islets of Langerhans (Latin insula for islet or island) that controls glucose metabolism. Unbeknown to Sharpey-Schafer, Jean de Meyer had introduced the very similar word "insuline" in 1909 for the same molecule.[119][120]
Extraction and purification
In October 1920, Canadian Frederick Banting concluded that the digestive secretions that Minkowski had originally studied were breaking down the islet secretion, thereby making it impossible to extract successfully. A surgeon by training, Banting knew that blockages of the pancreatic duct would lead most of the pancreas to atrophy, while leaving the islets of Langerhans intact. He reasoned that a relatively pure extract could be made from the islets once most of the rest of the pancreas was gone. He jotted a note to himself: "Ligate pancreatic ducts of dog. Keep dogs alive till acini degenerate leaving Islets. Try to isolate the internal secretion of these + relieve glycosurea[sic]."[121][122]
In the spring of 1921, Banting traveled to Toronto to explain his idea to John Macleod, Professor of Physiology at the University of Toronto. Macleod was initially skeptical, since Banting had no background in research and was not familiar with the latest literature, but he agreed to provide lab space for Banting to test out his ideas. Macleod also arranged for two undergraduates to be Banting's lab assistants that summer, but Banting required only one lab assistant. Charles Best and Clark Noble flipped a coin; Best won the coin toss and took the first shift. This proved unfortunate for Noble, as Banting kept Best for the entire summer and eventually shared half his Nobel Prize money and credit for the discovery with Best.[123] On 30 July 1921, Banting and Best successfully isolated an extract ("isletin") from the islets of a duct-tied dog and injected it into a diabetic dog, finding that the extract reduced its blood sugar by 40% in 1 hour.[124][122]
Banting and Best presented their results to Macleod on his return to Toronto in the fall of 1921, but Macleod pointed out flaws with the experimental design, and suggested the experiments be repeated with more dogs and better equipment. He moved Banting and Best into a better laboratory and began paying Banting a salary from his research grants. Several weeks later, the second round of experiments was also a success, and Macleod helped publish their results privately in Toronto that November. Bottlenecked by the time-consuming task of duct-tying dogs and waiting several weeks to extract insulin, Banting hit upon the idea of extracting insulin from the fetal calf pancreas, which had not yet developed digestive glands. By December, they had also succeeded in extracting insulin from the adult cow pancreas. Macleod discontinued all other research in his laboratory to concentrate on the purification of insulin. He invited biochemist James Collip to help with this task, and the team felt ready for a clinical test within a month.[122]
On 11 January 1922, Leonard Thompson, a 14-year-old diabetic who lay dying at the Toronto General Hospital, was given the first injection of insulin.[125][126][127][128] However, the extract was so impure that Thompson had a severe allergic reaction, and further injections were cancelled. Over the next 12 days, Collip worked day and night to improve the ox-pancreas extract. A second dose was injected on 23 January, eliminating the glycosuria that was typical of diabetes without causing any obvious side-effects. The first American patient was Elizabeth Hughes, the daughter of U.S. Secretary of State Charles Evans Hughes.[129][130] The first patient treated in the U.S. was future woodcut artist James D. Havens;[131]John Ralston Williams imported insulin from Toronto to Rochester, New York, to treat Havens.[132]
Banting and Best never worked well with Collip, regarding him as something of an interloper,[citation needed] and Collip left the project soon after. Over the spring of 1922, Best managed to improve his techniques to the point where large quantities of insulin could be extracted on demand, but the preparation remained impure. The drug firm Eli Lilly and Company had offered assistance not long after the first publications in 1921, and they took Lilly up on the offer in April. In November, Lilly's head chemist, George B. Walden discovered isoelectric precipitation and was able to produce large quantities of highly refined insulin. Shortly thereafter, insulin was offered for sale to the general public.
Patent
Toward the end of January 1922, tensions mounted between the four "co-discoverers" of insulin and Collip briefly threatened to separately patent his purification process. John G. FitzGerald, director of the non-commercial public health institution Connaught Laboratories, therefore stepped in as peacemaker. The resulting agreement of 25 January 1922 established two key conditions: 1) that the collaborators would sign a contract agreeing not to take out a patent with a commercial pharmaceutical firm during an initial working period with Connaught; and 2) that no changes in research policy would be allowed unless first discussed among FitzGerald and the four collaborators.[133] It helped contain disagreement and tied the research to Connaught's public mandate.
Initially, Macleod and Banting were particularly reluctant to patent their process for insulin on grounds of medical ethics. However, concerns remained that a private third-party would hijack and monopolize the research (as Eli Lilly and Company had hinted[134]), and that safe distribution would be difficult to guarantee without capacity for quality control. To this end, Edward Calvin Kendall gave valuable advice. He had isolated thyroxin at the Mayo Clinic in 1914 and patented the process through an arrangement between himself, the brothers Mayo, and the University of Minnesota, transferring the patent to the public university.[135] On 12 April, Banting, Best, Collip, Macleod, and FitzGerald wrote jointly to the president of the University of Toronto to propose a similar arrangement with the aim of assigning a patent to the Board of Governors of the university.[136] The letter emphasized that:[137]
The patent would not be used for any other purpose than to prevent the taking out of a patent by other persons. When the details of the method of preparation are published anyone would be free to prepare the extract, but no one could secure a profitable monopoly.
The assignment to the University of Toronto Board of Governors was completed on 15 January 1923, for the token payment of $1.00.[138] The arrangement was congratulated in The World's Work in 1923 as "a step forward in medical ethics".[139] It has also received much media attention in the 2010s regarding the issue of healthcare and drug affordability.
Following further concern regarding Eli Lilly's attempts to separately patent parts of the manufacturing process, Connaught's Assistant Director and Head of the Insulin Division Robert Defries established a patent pooling policy which would require producers to freely share any improvements to the manufacturing process without compromising affordability.[140]
Richardson diagram of a porcine insulin hexamer. The sphere at the center is a stabilizing zinc atom, surrounded by coordinating histidine residues. This is the form in which insulin is stored in beta cells. PDB: 4INS.
Purified animal-sourced insulin was initially the only type of insulin available for experiments and diabetics. John Jacob Abel was the first to produce the crystallised form in 1926.[141] Evidence of the protein nature was first given by Michael Somogyi, Edward A. Doisy, and Philip A. Shaffer in 1924.[142] It was fully proven when Hans Jensen and Earl A. Evans Jr. isolated the amino acids phenylalanine and proline in 1935.[143]
Hans E. Weber discovered preproinsulin while working as a research fellow at the University of California Los Angeles in 1974. In 1973–1974, Weber learned the techniques of how to isolate, purify, and translate messenger RNA. To further investigate insulin, he obtained pancreatic tissues from a slaughterhouse in Los Angeles and then later from animal stock at UCLA. He isolated and purified total messenger RNA from pancreatic islet cells which was then translated in oocytes from Xenopus laevis and precipitated using anti-insulin antibodies. When total translated protein was run on an SDS-polyacrylamide gel electrophoresis and sucrose gradient, peaks corresponding to insulin and proinsulin were isolated. However, to the surprise of Weber a third peak was isolated corresponding to a molecule larger than proinsulin. After reproducing the experiment several times, he consistently noted this large peak prior to proinsulin that he determined must be a larger precursor molecule upstream of proinsulin. In May 1975, at the American Diabetes Association meeting in New York, Weber gave an oral presentation of his work[152] where he was the first to name this precursor molecule "preproinsulin". Following this oral presentation, Weber was invited to dinner to discuss his paper and findings by Donald Steiner, a researcher who contributed to the characterization of proinsulin. A year later in April 1976, this molecule was further characterized and sequenced by Steiner, referencing the work and discovery of Hans Weber.[153] Preproinsulin became an important molecule to study the process of transcription and translation.
The first genetically engineered, synthetic "human" insulin was produced using E. coli in 1978 by Arthur Riggs and Keiichi Itakura at the Beckman Research Institute of the City of Hope in collaboration with Herbert Boyer at Genentech.[14][15] Genentech, founded by Swanson, Boyer and Eli Lilly and Company, went on in 1982 to sell the first commercially available biosynthetic human insulin under the brand name Humulin.[15] The vast majority of insulin used worldwide is biosynthetic recombinant "human" insulin or its analogues.[16] Recently, another approach has been used by a pioneering group of Canadian researchers, using an easily grown safflower plant, for the production of much cheaper insulin.[154]
Recombinant insulin is produced either in yeast (usually Saccharomyces cerevisiae) or E. coli.[155] In yeast, insulin may be engineered as a single-chain protein with a KexII endoprotease (a yeast homolog of PCI/PCII) site that separates the insulin A chain from a C-terminally truncated insulin B chain. A chemically synthesized C-terminal tail is then grafted onto insulin by reverse proteolysis using the inexpensive protease trypsin; typically the lysine on the C-terminal tail is protected with a chemical protecting group to prevent proteolysis. The ease of modular synthesis and the relative safety of modifications in that region accounts for common insulin analogs with C-terminal modifications (e.g. lispro, aspart, glulisine). The Genentech synthesis and completely chemical synthesis such as that by Bruce Merrifield are not preferred because the efficiency of recombining the two insulin chains is low, primarily due to competition with the precipitation of insulin B chain.
Several Nobel Prizes also have an indirect connection with insulin. George Minot, co-recipient of the 1934 Nobel Prize for the development of the first effective treatment for pernicious anemia, had diabetes. William Castle observed that the 1921 discovery of insulin, arriving in time to keep Minot alive, was therefore also responsible for the discovery of a cure for pernicious anemia.[158]Dorothy Hodgkin was awarded a Nobel Prize in Chemistry in 1964 for the development of crystallography, the technique she used for deciphering the complete molecular structure of insulin in 1969.[151]
Controversy
The work published by Banting, Best, Collip and Macleod represented the preparation of purified insulin extract suitable for use on human patients.[159] Although Paulescu discovered the principles of the treatment, his saline extract could not be used on humans; he was not mentioned in the 1923 Nobel Prize. Ian Murray was particularly active in working to correct "the historical wrong" against Nicolae Paulescu. Murray was a professor of physiology at the Anderson College of Medicine in Glasgow, Scotland, the head of the department of Metabolic Diseases at a leading Glasgow hospital, vice-president of the British Association of Diabetes, and a founding member of the International Diabetes Federation. Murray wrote:
Insufficient recognition has been given to Paulescu, the distinguished Romanian scientist, who at the time when the Toronto team were commencing their research had already succeeded in extracting the antidiabetic hormone of the pancreas and proving its efficacy in reducing the hyperglycaemia in diabetic dogs.[160]
In a private communication, Arne Tiselius, former head of the Nobel Institute, expressed his personal opinion that Paulescu was equally worthy of the award in 1923.[161]
^American Society of Health-System Pharmacists (1 February 2009). "Insulin Injection [". PubMed Health. National Center for Biotechnology Information, U.S. National Library of Medicine. Retrieved 12 October 2012.
^Iwase H, Kobayashi M, Nakajima M, Takatori T (January 2001). "The ratio of insulin to C-peptide can be used to make a forensic diagnosis of exogenous insulin overdosage". Forensic Science International. 115 (1–2): 123–127. doi:10.1016/S0379-0738(00)00298-X. PMID11056282.
^Bergamini E, Cavallini G, Donati A, Gori Z (October 2007). "The role of autophagy in aging: its essential part in the anti-aging mechanism of caloric restriction". Annals of the New York Academy of Sciences. 1114 (1): 69–78. Bibcode:2007NYASA1114...69B. doi:10.1196/annals.1396.020. PMID17934054. S2CID21011988.
^Benziane B, Chibalin AV (September 2008). "Frontiers: skeletal muscle sodium pump regulation: a translocation paradigm". American Journal of Physiology. Endocrinology and Metabolism. 295 (3): E553–58. doi:10.1152/ajpendo.90261.2008. PMID18430962. S2CID10153197.
^Clausen T (September 2008). "Regulatory role of translocation of Na+-K+ pumps in skeletal muscle: hypothesis or reality?". American Journal of Physiology. Endocrinology and Metabolism. 295 (3): E727–28, author reply 729. doi:10.1152/ajpendo.90494.2008. PMID18775888. S2CID13410719.
^Gupta AK, Clark RV, Kirchner KA (January 1992). "Effects of insulin on renal sodium excretion". Hypertension. 19 (Suppl 1): I78–82. doi:10.1161/01.HYP.19.1_Suppl.I78. PMID1730458.
^ abcdef"Hypoglycemia". National Institute of Diabetes and Digestive and Kidney Diseases. October 2008. Archived from the original on 1 July 2015. Retrieved 28 June 2015.
^"Free prescriptions (England)". Diabetes UK. Retrieved 21 November 2022. If you use insulin or medicine to manage your diabetes, ... you don't pay for any item you're prescribed.
^Opie EL (1901). "Diabetes Mellitus Associated with Hyaline Degeneration of the islands of Langerhans of the Pancreas". Bulletin of the Johns Hopkins Hospital. 12 (125): 263–64. hdl:2027/coo.31924069247447.
^The American Institute of Nutrition (1967). "Proceedings of the Thirty-First Annual Meeting of the American Institute of Nutrition". Journal of Nutrition. 92 (4): 509. doi:10.1093/jn/92.4.507.
^de Leiva A, Brugués E, de Leiva-Pérez A (2011). "The discovery of insulin: Continued controversies after ninety years". Endocrinología y Nutrición (English Edition). 58 (9): 449–456. doi:10.1016/j.endoen.2011.10.001.
^Zuger A (4 October 2010). "Rediscovering the First Miracle Drug". The New York Times. Retrieved 6 October 2010. Elizabeth Hughes was a cheerful, pretty little girl, five feet tall, with straight brown hair and a consuming interest in birds. On Allen's diet her weight fell to 65 pounds, then 52 pounds, and then, after an episode of diarrhea that almost killed her in the spring of 1922, 45 pounds. By then she had survived three years, far longer than expected. And then her mother heard the news: Insulin had finally been isolated in Canada.
^Bliss M (2007). The discovery of insulin (25th anniversary ed.). Chicago: University of Chicago Press. p. 132. ISBN978-0-226-05899-3. OCLC74987867. The Lilly company would be delighted to work with Toronto, Clowes wrote, and hinted, perhaps intentionally, perhaps not, that Toronto could be bypassed: "I have thus far refrained from starting work in our laboratories on the field of this question as I was anxious to avoid in any way intruding on the field of yourself and your associates until you had published your results. I feel, however, that the matter is now one of such immediate importance that we should take up the experimental end of the question without delay, preferably cooperating with you and your associates..."
^Bliss M (2007). The discovery of insulin (25th anniversary ed.). Chicago: University of Chicago Press. pp. 131–133. ISBN978-0-226-05899-3. OCLC74987867.
^Katsoyannis PG, Fukuda K, Tometsko A, Suzuki K, Tilak M (1964). "Insulin Peptides. X. The Synthesis of the B-Chain of Insulin and Its Combination with Natural or Synthetis A-Chin to Generate Insulin Activity". Journal of the American Chemical Society. 86 (5): 930–32. doi:10.1021/ja01059a043.
^Kung YT, Du YC, Huang WT, Chen CC, Ke LT (November 1965). "Total synthesis of crystalline bovine insulin". Scientia Sinica. 14 (11): 1710–6. PMID5881570.
^Marglin A, Merrifield RB (November 1966). "The synthesis of bovine insulin by the solid phase method". Journal of the American Chemical Society. 88 (21): 5051–2. doi:10.1021/ja00973a068. PMID5978833.
^Tsou CL (2015). 对人工合成结晶牛胰岛素的回忆 [Memory on the research of synthesizing bovine insulin]. 生命科学 [Chinese Bulletin of Life Science] (in Simplified Chinese). 27 (6): 777–79.
^Drury MI (July 1972). "The golden jubile of insulin". Journal of the Irish Medical Association. 65 (14): 355–63. PMID4560502.
^Murray I (April 1971). "Paulesco and the isolation of insulin". Journal of the History of Medicine and Allied Sciences. 26 (2): 150–57. doi:10.1093/jhmas/XXVI.2.150. PMID4930788.
Further reading
Laws GM, Reaven A (1999). Insulin resistance : the metabolic syndrome X. Totowa, NJ: Humana Press. ISBN978-0-89603-588-1.
Kumar S, O'Rahilly S (14 January 2005). Insulin Resistance: Insulin Action and Its Disturbances in Disease. Chichester, England: Wiley. ISBN978-0-470-85008-4.
Draznin B, LeRoith D (September 1994). Molecular Biology of Diabetes: Autoimmunity and Genetics; Insulin Synthesis and Secretion. Totowa, New Jersey: Humana Press. ISBN978-0-89603-286-6.
McKeage K, Goa KL (2001). "Insulin glargine: a review of its therapeutic use as a long-acting agent for the management of type 1 and 2 diabetes mellitus". Drugs. 61 (11): 1599–624. doi:10.2165/00003495-200161110-00007. PMID11577797. S2CID46972328.
de Leiva A, Brugués E, de Leiva-Pérez A (November 2011). "[The discovery of insulin: continued controversies after ninety years]". Endocrinologia y Nutricion (in Spanish). 58 (9): 449–56. doi:10.1016/j.endonu.2011.10.001. PMID22036099.
1ai0: R6 HUMAN INSULIN HEXAMER (NON-SYMMETRIC), NMR, 10 STRUCTURES
1aiy: R6 HUMAN INSULIN HEXAMER (SYMMETRIC), NMR, 10 STRUCTURES
1aph: CONFORMATIONAL CHANGES IN CUBIC INSULIN CRYSTALS IN THE PH RANGE 7-11
1b17: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 5.00 COORDINATES)
1b18: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 5.53 COORDINATES)
1b19: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 5.80 COORDINATES)
1b2a: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 6.00 COORDINATES)
1b2b: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 6.16 COORDINATES)
1b2c: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 6.26 COORDINATES)
1b2d: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 6.35 COORDINATES)
1b2e: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 6.50 COORDINATES)
1b2f: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 6.98 COORDINATES)
1b2g: PH AFFECTS GLU B13 SWITCHING AND SULFATE BINDING IN CUBIC INSULIN CRYSTALS (PH 9.00 COORDINATES)
1b9e: HUMAN INSULIN MUTANT SERB9GLU
1ben: INSULIN COMPLEXED WITH 4-HYDROXYBENZAMIDE
1bph: CONFORMATIONAL CHANGES IN CUBIC INSULIN CRYSTALS IN THE PH RANGE 7-11
1cph: CONFORMATIONAL CHANGES IN CUBIC INSULIN CRYSTALS IN THE PH RANGE 7-11
1dph: CONFORMATIONAL CHANGES IN CUBIC INSULIN CRYSTALS IN THE PH RANGE 7-11
1ev3: Structure of the rhombohedral form of the M-cresol/insulin R6 hexamer
1ev6: Structure of the monoclinic form of the M-cresol/insulin R6 hexamer
1evr: The structure of the resorcinol/insulin R6 hexamer
1fu2: FIRST PROTEIN STRUCTURE DETERMINED FROM X-RAY POWDER DIFFRACTION DATA
1fub: FIRST PROTEIN STRUCTURE DETERMINED FROM X-RAY POWDER DIFFRACTION DATA
1g7a: 1.2 A structure of T3R3 human insulin at 100 K
1g7b: 1.3 A STRUCTURE OF T3R3 HUMAN INSULIN AT 100 K
1guj: INSULIN AT PH 2: STRUCTURAL ANALYSIS OF THE CONDITIONS PROMOTING INSULIN FIBRE FORMATION.
1hiq: PARADOXICAL STRUCTURE AND FUNCTION IN A MUTANT HUMAN INSULIN ASSOCIATED WITH DIABETES MELLITUS
1hit: RECEPTOR BINDING REDEFINED BY A STRUCTURAL SWITCH IN A MUTANT HUMAN INSULIN
1hls: NMR STRUCTURE OF THE HUMAN INSULIN-HIS(B16)
1htv: CRYSTAL STRUCTURE OF DESTRIPEPTIDE (B28-B30) INSULIN
1iza: ROLE OF B13 GLU IN INSULIN ASSEMBLY: THE HEXAMER STRUCTURE OF RECOMBINANT MUTANT (B13 GLU-> GLN) INSULIN
1izb: ROLE OF B13 GLU IN INSULIN ASSEMBLY: THE HEXAMER STRUCTURE OF RECOMBINANT MUTANT (B13 GLU-> GLN) INSULIN
1j73: Crystal structure of an unstable insulin analog with native activity.
1jca: Non-standard Design of Unstable Insulin Analogues with Enhanced Activity
1jco: Solution structure of the monomeric [Thr(B27)->Pro,Pro(B28)->Thr] insulin mutant (PT insulin)
1lph: LYS(B28)PRO(B29)-HUMAN INSULIN
1m5a: Crystal Structure of 2-Co(2+)-Insulin at 1.2A Resolution
1mhi: THREE-DIMENSIONAL SOLUTION STRUCTURE OF AN INSULIN DIMER. A STUDY OF THE B9(ASP) MUTANT OF HUMAN INSULIN USING NUCLEAR MAGNETIC RESONANCE DISTANCE GEOMETRY AND RESTRAINED MOLECULAR DYNAMICS
1mhj: SOLUTION STRUCTURE OF THE SUPERACTIVE MONOMERIC DES-[PHE(B25)] HUMAN INSULIN MUTANT. ELUCIDATION OF THE STRUCTURAL BASIS FOR THE MONOMERIZATION OF THE DES-[PHE(B25)] INSULIN AND THE DIMERIZATION OF NATIVE INSULIN
1mpj: X-RAY CRYSTALLOGRAPHIC STUDIES ON HEXAMERIC INSULINS IN THE PRESENCE OF HELIX-STABILIZING AGENTS, THIOCYANATE, METHYLPARABEN AND PHENOL
1mso: T6 Human Insulin at 1.0 A Resolution
1os3: Dehydrated T6 human insulin at 100 K
1os4: Dehydrated T6 human insulin at 295 K
1q4v: CRYSTAL STRUCTURE OF ALLO-ILEA2-INSULIN, AN INACTIVE CHIRAL ANALOGUE: IMPLICATIONS FOR THE MECHANISM OF RECEPTOR
1qiy: HUMAN INSULIN HEXAMERS WITH CHAIN B HIS MUTATED TO TYR COMPLEXED WITH PHENOL
1qiz: HUMAN INSULIN HEXAMERS WITH CHAIN B HIS MUTATED TO TYR COMPLEXED WITH RESORCINOL
1qj0: HUMAN INSULIN HEXAMERS WITH CHAIN B HIS MUTATED TO TYR
1rwe: Enhancing the activity of insulin at receptor edge: crystal structure and photo-cross-linking of A8 analogues
1sf1: NMR STRUCTURE OF HUMAN INSULIN under Amyloidogenic Condition, 15 STRUCTURES
1t0c: Solution Structure of Human Proinsulin C-Peptide
1trz: CRYSTALLOGRAPHIC EVIDENCE FOR DUAL COORDINATION AROUND ZINC IN THE T3R3 HUMAN INSULIN HEXAMER
1tyl: THE STRUCTURE OF A COMPLEX OF HEXAMERIC INSULIN AND 4'-HYDROXYACETANILIDE
1tym: THE STRUCTURE OF A COMPLEX OF HEXAMERIC INSULIN AND 4'-HYDROXYACETANILIDE
1uz9: CRYSTALLOGRAPHIC AND SOLUTION STUDIES OF N-LITHOCHOLYL INSULIN: A NEW GENERATION OF PROLONGED-ACTING INSULINS.
1w8p: STRUCTURAL PROPERTIES OF THE B25TYR-NME-B26PHE INSULIN MUTANT.
1wav: CRYSTAL STRUCTURE OF FORM B MONOCLINIC CRYSTAL OF INSULIN
1xda: STRUCTURE OF INSULIN
1xgl: HUMAN INSULIN DISULFIDE ISOMER, NMR, 10 STRUCTURES
1xw7: Diabetes-Associated Mutations in Human Insulin: Crystal Structure and Photo-Cross-Linking Studies of A-Chain Variant Insulin Wakayama
1zeg: STRUCTURE OF B28 ASP INSULIN IN COMPLEX WITH PHENOL
1zeh: STRUCTURE OF INSULIN
1zni: INSULIN
1znj: INSULIN, MONOCLINIC CRYSTAL FORM
2a3g: The structure of T6 bovine insulin
2aiy: R6 HUMAN INSULIN HEXAMER (SYMMETRIC), NMR, 20 STRUCTURES
2bn1: INSULIN AFTER A HIGH DOSE X-RAY BURN
2bn3: INSULIN BEFORE A HIGH DOSE X-RAY BURN
2c8q: INSULINE(1SEC) AND UV LASER EXCITED FLUORESCENCE
2c8r: INSULINE(60SEC) AND UV LASER EXCITED FLUORESCENCE
2g4m: Insulin collected at 2.0 A wavelength
2g54: Crystal structure of Zn-bound human insulin-degrading enzyme in complex with insulin B chain
2g56: crystal structure of human insulin-degrading enzyme in complex with insulin B chain
2hiu: NMR STRUCTURE OF HUMAN INSULIN IN 20% ACETIC ACID, ZINC-FREE, 10 STRUCTURES
2ins: THE STRUCTURE OF DES-PHE B1 BOVINE INSULIN
2omg: Structure of human insulin cocrystallized with protamine and urea
2omh: Structure of human insulin cocrystallized with ARG-12 peptide in presence of urea
2omi: Structure of human insulin cocrystallized with protamine
2tci: X-RAY CRYSTALLOGRAPHIC STUDIES ON HEXAMERIC INSULINS IN THE PRESENCE OF HELIX-STABILIZING AGENTS, THIOCYANATE, METHYLPARABEN AND PHENOL
3aiy: R6 HUMAN INSULIN HEXAMER (SYMMETRIC), NMR, REFINED AVERAGE STRUCTURE
3ins: STRUCTURE OF INSULIN. RESULTS OF JOINT NEUTRON AND X-RAY REFINEMENT
3mth: X-RAY CRYSTALLOGRAPHIC STUDIES ON HEXAMERIC INSULINS IN THE PRESENCE OF HELIX-STABILIZING AGENTS, THIOCYANATE, METHYLPARABEN AND PHENOL
4aiy: R6 HUMAN INSULIN HEXAMER (SYMMETRIC), NMR, 'GREEN' SUBSTRATE, AVERAGE STRUCTURE
4ins: THE STRUCTURE OF 2ZN PIG INSULIN CRYSTALS AT 1.5 ANGSTROMS RESOLUTION
5aiy: R6 HUMAN INSULIN HEXAMER (SYMMETRIC), NMR, 'RED' SUBSTRATE, AVERAGE STRUCTURE
6ins: X-RAY ANALYSIS OF THE SINGLE CHAIN /B29-A1$ PEPTIDE-LINKED INSULIN MOLECULE. A COMPLETELY INACTIVE ANALOGUE
7ins: STRUCTURE OF PORCINE INSULIN COCRYSTALLIZED WITH CLUPEINE Z
9ins: MONOVALENT CATION BINDING IN CUBIC INSULIN CRYSTALS
دكتور آلكمي (بالإنجليزية: Doctor Alchemy) معلومات شخصية الحياة العملية الجنس ذكر [لغات أخرى] المهنة عالم اجتماع تعديل مصدري - تعديل هذه المقالة يتيمة إذ تصل إليها مقالات أخرى قليلة جدًا. فضلًا، ساعد بإضافة وصلة إليها في مقالات متعلقة بها. (يوليو 2017) دكتور آلك
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Thai badminton player Badminton playerBusanan OngbamrungphanOngbamrungphan in June 2013Personal informationCountryThailandBorn22 March 1996 (1996-03-22) (age 27)Nonthaburi, ThailandHeight1.68 m (5 ft 6 in)HandednessRightWomen's singlesHighest ranking10 (1 November 2022[1])Current ranking18 (14 November 2023) Medal record Women's badminton Representing Thailand Sudirman Cup 2017 Gold Coast Mixed team 2019 Nanning Mixed team Uber Cup 2018 Bangkok...
Medium-security United States federal prison for male inmates in Atlanta, Georgia, USA United States Penitentiary, AtlantaLocationAtlanta, GeorgiaCoordinates33°42′40″N 84°22′7″W / 33.71111°N 84.36861°W / 33.71111; -84.36861StatusOperationalSecurity classLow-security (with minimum-security prison camp)Population1,903 (September 2023)Opened1902Managed byFederal Bureau of Prisons Federal Penitentiary Atlanta 1920 postcard The United States Penitentiary, Atlant...
1994 fighting video game This article is about the first game in the series. For the video game series, see Tekken. For other uses, see Tekken (disambiguation). 1994 video gameTekkenPlayStation cover artDeveloper(s)NamcoPublisher(s)ArcadeWW: NamcoPlayStationJP: NamcoNA: Namco HometekEU: Sony Computer Entertainment EuropeDirector(s)Seiichi IshiiProducer(s)Hajime NakataniDesigner(s)Seiichi IshiiProgrammer(s)Masanori YamadaComposer(s)Yoshie ArakawaYoshie TakayanagiShinji Hosoe (PS)Nobuyoshi Sano...
Dialect of North Levantine Arabic This article contains Levantine written in Arabic characters. Without proper rendering support, you may see احنا and احنا appearing as two different characters. If so, apply this custom style in your user settings: [lang=apc] { font-family: 'Segoe UI', Tahoma; } . Lebanese Arabicاللهجة اللبنانيةNative toLebanonNative speakers6.4 million (2020)[1]Language familyAfro-Asiatic SemiticCentral SemiticArabicLeva...
American soccer player (born 1995) Brianna Visalli Personal informationFull name Brianna Elizabeth Visalli[1]Date of birth (1995-04-17) April 17, 1995 (age 28)[2]Place of birth San Jose, California, United StatesHeight 5 ft 2 in (1.57 m)Position(s) MidfielderTeam informationCurrent team Aarhus GFYouth career CV Chilipeppers De Anza Force Valley Christian High SchoolCollege careerYears Team Apps (Gls)2014–2017 Pepperdine Waves[4] 83 (26)Senior care...
2003 single by Ai OtsukaMomo no HanabiraSingle by Ai Otsukafrom the album Love Punch ReleasedSeptember 10, 2003 CDOctober 1, 2003 CD+DVDRecorded2003GenrePopLength18:54 CDLabelAvex TraxAVCD-30525 (Japan, CD)AVCD-30528 (Japan, CD+DVD)Songwriter(s)Ai OtsukaAi Otsuka singles chronology Momo no Hanabira (2003) Sakuranbo (2003) Alternative coverThe CD and DVD Cover Momo no Hanabira (桃ノ花ビラ, Peach Flower Petals) is the debut single of Japanese singer Ai Otsuka, released on September 10, 200...
German armored military unit of WWII This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages) This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.Find sources: Panzer division Wehrmacht – news · newspapers · books · scholar ·...
First ROM cartridge–based video game console Fairchild Channel FChannel F and its two controllersAlso known asFairchild Video Entertainment SystemDeveloperGerald Jerry LawsonManufacturerFairchild Camera and InstrumentTypeHome video game consoleGenerationSecondRelease dateNA: November 1976JP: October 1977Lifespan1976 –1983Introductory priceUS$169.95 (equivalent to $870 in 2022)Discontinued1983Units soldc. 350,000 (as of 1979)[1]MediaROM cartridgeCPUFairchild F8Memory64 by...
Settlement in Shropshire, England This article is about the settlement in Shropshire. For the iron structure, see The Iron Bridge. For other uses, see Iron Bridge. Human settlement in EnglandIronbridgeIronbridge, seen from the Iron BridgeIronbridgeLocation within ShropshirePopulation2,582 (2011)[1]OS grid referenceSJ6724903350• London126 mi (203 km) SECivil parishThe GorgeUnitary authorityTelford and WrekinCeremonial countyShropshireRegio...
American politician Kel SeligerPresident pro tempore of the Texas SenateIn officeJanuary 10, 2017 – May 29, 2017Preceded byKevin EltifeSucceeded byRobert NicholsMember of the Texas Senatefrom the 31st districtIn officeMarch 2, 2004 – January 10, 2023Preceded byTeel BivinsSucceeded byKevin SparksMayor of AmarilloIn office1993–2001Preceded byKeith AdamsSucceeded byTrent Sisemore Personal detailsBornKelton Gray Seliger (1953-06-16) June 16, 1953 (age 70)Amarillo, Tex...
Schober Datos personalesNombre completo Mathias SchoberNacimiento Marl, Alemania Federal8 de abril de 1976 (47 años)Nacionalidad(es) Altura 1.91 metrosCarrera deportivaDeporte FútbolClub profesionalDebut deportivo 1994(Schalke 04)Posición Guardameta[editar datos en Wikidata] Mathias Schober (8 de abril de 1976) es un ex-futbolista alemán se desempeñaba como guardameta y su último club fue el Schalke 04, donde ha jugado gran parte de su carrera deportiva. Clubes Club ...
Ultimate Air Shuttle IATA ICAO Callsign UE UJC ULTIMATE Founded2009[1]HubsCincinnati Municipal Lunken AirportFleet size10HeadquartersCincinnati, OhioWebsite[1] A Ultimate Air Shuttle airplane at Purdue University Airport Ultimate Air Shuttle is an airline from the United States. It's main hub is at Cincinnati. It's first flight was in July 2009.[2] The airline is a shuttle because it flies many flights a day between the cities it goes to. Destinations Charlotte - Charlotte Dou...