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Pramlintide
	Golden line indicates disulfide bond
Clinical data
Trade names	Symlin
AHFS/Drugs.com	Monograph
MedlinePlus	a605031
Routes of; administration	Subcutaneous
ATC code	A10BX05 (WHO) ;
Legal status
Legal status	US: ℞-only;
Pharmacokinetic data
Bioavailability	30 to 40%
Protein binding	~60%
Metabolism	Renal
Elimination half-life	~48 minutes
Identifiers
CAS Number	151126-32-8 ;
PubChem CID	16132446;
IUPHAR/BPS	7482;
DrugBank	DB01278 ;
ChemSpider	44241191 ;
UNII	D3FM8FA78T;
KEGG	D05595 ;
ChEMBL	ChEMBL1201669 ;
Chemical and physical data
Formula	C171H267N51O53S2
Molar mass	3949.44 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES CC[C@H](C)[C@@H](C(=O)N[C@@H](CC(C)C)C(=O)N1CCC[C@H]1C(=O)N2CCC[C@H]2C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@@H](CC(=O)N)C(=O)N[C@@H](C(C)C)C(=O)NCC(=O)N[C@@H](CO)C(=O)N[C@@H](CC(=O)N)C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@@H](Cc3ccc(cc3)O)C(=O)N)NC(=O)[C@@H]4CCCN4C(=O)CNC(=O)[C@H](Cc5ccccc5)NC(=O)[C@H](CC(=O)N)NC(=O)[C@H](CC(=O)N)NC(=O)[C@H](CO)NC(=O)[C@H](CO)NC(=O)[C@H](Cc6cnc[nH]6)NC(=O)[C@H](C(C)C)NC(=O)[C@H](CC(C)C)NC(=O)[C@H](Cc7ccccc7)NC(=O)[C@H](CC(=O)N)NC(=O)[C@H](C)NC(=O)[C@H](CC(C)C)NC(=O)[C@H](CCCNC(=N)N)NC(=O)[C@H](CCC(=O)N)NC(=O)[C@H]([C@@H](C)O)NC(=O)[C@H](C)NC(=O)[C@@H]8CSSC[C@@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N8)[C@@H](C)O)C)[C@@H](C)O)CC(=O)N)NC(=O)[C@H](CCCCN)N;
	InChI InChI=1S/C171H267N51O53S2/c1-21-81(12)130(163(268)207-110(56-78(6)7)169(274)222-53-33-42-118(222)170(275)221-52-32-41-117(221)160(265)219-135(89(20)230)167(272)206-109(66-125(180)238)151(256)212-128(79(8)9)161(266)186-68-126(239)192-111(70-223)154(259)203-107(64-123(178)236)152(257)218-134(88(19)229)166(271)195-98(136(181)241)57-92-43-45-94(231)46-44-92)214-159(264)116-40-31-51-220(116)127(240)69-187-141(246)101(58-90-34-24-22-25-35-90)199-148(253)105(62-121(176)234)201-149(254)106(63-122(177)235)202-155(260)112(71-224)209-156(261)113(72-225)208-146(251)103(60-93-67-184-75-188-93)205-162(267)129(80(10)11)213-150(255)100(55-77(4)5)198-145(250)102(59-91-36-26-23-27-37-91)200-147(252)104(61-120(175)233)196-137(242)82(13)189-144(249)99(54-76(2)3)197-142(247)96(39-30-50-185-171(182)183)193-143(248)97(47-48-119(174)232)194-165(270)132(86(17)227)215-138(243)83(14)190-157(262)114-73-276-277-74-115(210-140(245)95(173)38-28-29-49-172)158(263)204-108(65-124(179)237)153(258)217-131(85(16)226)164(269)191-84(15)139(244)216-133(87(18)228)168(273)211-114/h22-27,34-37,43-46,67,75-89,95-118,128-135,223-231H,21,28-33,38-42,47-66,68-74,172-173H2,1-20H3,(H2,174,232)(H2,175,233)(H2,176,234)(H2,177,235)(H2,178,236)(H2,179,237)(H2,180,238)(H2,181,241)(H,184,188)(H,186,266)(H,187,246)(H,189,249)(H,190,262)(H,191,269)(H,192,239)(H,193,248)(H,194,270)(H,195,271)(H,196,242)(H,197,247)(H,198,250)(H,199,253)(H,200,252)(H,201,254)(H,202,260)(H,203,259)(H,204,263)(H,205,267)(H,206,272)(H,207,268)(H,208,251)(H,209,261)(H,210,245)(H,211,273)(H,212,256)(H,213,255)(H,214,264)(H,215,243)(H,216,244)(H,217,258)(H,218,257)(H,219,265)(H4,182,183,185)/t81-,82-,83-,84-,85+,86+,87+,88+,89+,95-,96-,97-,98-,99-,100-,101-,102-,103-,104-,105-,106-,107-,108-,109-,110-,111-,112-,113-,114-,115-,116-,117-,118-,128-,129-,130-,131-,132-,133-,134-,135-/m0/s1 ; Key:TZIRZGBAFTZREM-MKAGXXMWSA-N ;
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Pramlintide (trade name 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]

In synergy with endogenous amylin, pramlintide aids in the 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.^{[citation needed]}

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]

Research Applications

In the research field, pramlintide has been experimented with and used as a potential treatment drug. Pramlintide has demonstrated its ability to decrease amyloid beta plaques in Alzheimer's disease mouse models.^[5]

Approval

Pramlintide has been approved on 3/16/2005 by the FDA, for use by type 1 and type 2 diabetic patients who use insulin.^[6](subscription required) 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.^{[citation needed]}^[7]

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 less amyloidogenic^[8]^[9] but presumably retains clinical activity. Proline residues are known to be structure-breaking^{[clarification needed]} residues, so these were directly grafted into the human sequence. Despite its enhanced stability compared to human amylin, however, pramlintide is still able to organize into amyloid material.^[10]

Amino acid sequences:

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

Pramlintide is a positively charged protein.^{[citation needed]}

References

^ Taylor P (19 December 2013). "AstraZeneca buys BMS out of diabetes alliance". Retrieved 16 June 2014.
^ Jones MC (June 2007). "Therapies for diabetes: pramlintide and exenatide" (PDF). American Family Physician. 75 (12): 1831–1835. PMID 17619527.
^ Edelman S, Maier H, Wilhelm K (2008). "Pramlintide in the treatment of diabetes mellitus". BioDrugs. 22 (6): 375–386. doi:10.2165/0063030-200822060-00004. PMID 18998755. S2CID 34608423.
^ Hollander P, Maggs DG, Ruggles JA, Fineman M, Shen L, Kolterman OG, Weyer C (April 2004). "Effect of pramlintide on weight in overweight and obese insulin-treated type 2 diabetes patients". Obesity Research. 12 (4): 661–668. doi:10.1038/oby.2004.76. PMID 15090634.
^ Tao Q, Zhu H, Chen X, Stern RA, Kowall N, Au R, et al. (2018). "Pramlintide: The Effects of a Single Drug Injection on Blood Phosphatidylcholine Profile for Alzheimer's Disease". Journal of Alzheimer's Disease. 62 (2): 597–609. doi:10.3233/jad-170948. PMC 5956916. PMID 29480193.
^ Ryan GJ, Jobe LJ, Martin R (October 2005). "Pramlintide in the treatment of type 1 and type 2 diabetes mellitus". Clinical Therapeutics. 27 (10): 1500–1512. doi:10.1016/j.clinthera.2005.10.009. PMID 16330288.
^ "Dual-Hormone, Artificial Pancreas with Insulin and Pramlintide Significantly Improves Glucose Levels, Compared to Insulin-Only Artificial Pancreas". American Diabetes Association. Archived from the original on 2018-08-29. Retrieved 2018-08-28.
^ Palmieri LC, Melo-Ferreira B, Braga CA, Fontes GN, Mattos LJ, Lima LM (2013). "Stepwise oligomerization of murine amylin and assembly of amyloid fibrils". Biophysical Chemistry. 180–181: 135–144. doi:10.1016/j.bpc.2013.07.013. PMID 23974296.
^ Erthal LC, Marques AF, Almeida FC, Melo GL, Carvalho CM, Palmieri LC, et al. (November 2016). "Regulation of the assembly and amyloid aggregation of murine amylin by zinc". Biophysical Chemistry. 218: 58–70. doi:10.1016/j.bpc.2016.09.008. PMID 27693831.
^ da Silva DC, Fontes GN, Erthal LC, Lima LM (December 2016). "Amyloidogenesis of the amylin analogue pramlintide". Biophysical Chemistry. 219: 1–8. doi:10.1016/j.bpc.2016.09.007. PMID 27665170.