Stimulation of the glucagon-like peptide-1 (GLP1) receptor is a useful treatment strategy for type 2 diabetes due to pleiotropic effects, such as the regulation of islet hormones and the induction of satiety. However, the native ligand for the GLP1 receptor has a short half-life owing to enzymatic inactivation and rapid clearance. Here, we show that a subcutaneous depot formed after a single injection of GLP1 recombinantly fused to a thermosensitive elastin-like polypeptide results in zero-order release kinetics and circulation times of up to 10 days in mice and 17 days in monkeys. The optimized pharmacokinetics lead to 10 days of glycaemic control in three different mouse models of diabetes, as well as the reduction of glycosylated haemoglobin levels and weight gain in ob/ob mice treated once weekly for 8 weeks. Our results suggest that the optimized GLP1 formulation could enhance therapeutic outcomes by eliminating peak-and-valley pharmacokinetics and improving overall safety and tolerability. The design principles that we established should be broadly applicable for improving the pharmacological performance of other peptide and protein therapeutics.
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A.C. acknowledges the support of NIH through grant R01-DK091789. K.M.L. acknowledges the support of the NSF through a Graduate Research Fellowship. We thank D. Drucker for providing BHK cells for assaying in vitro activity, G. A. Johnson and Duke’s Center for In Vivo Microscopy for use of their U-SPECT-II/CT imaging equipment, and M. R. Zalutsky for allowing us to use his laboratory and equipment to conduct radiolabelling experiments. K.L. thanks C. Gilroy for productive discussions on in vitro and in vivo experiments. The authors all sincerely thank K. Gerken, who provided pathology expertise and helped to analyse and interpret injection site histology, as well as the Duke Research Immunohistology Shared Resource Lab who processed the skin samples. Finally, we would like to thank J. Jowett, D. Sendecki and C. Woods of PhaseBio Pharmaceuticals, who helped to express and purify fusion protein for the non-human primate experiment.
A.C. is a scientific advisor and is on the board of directors for PhaseBio Pharmaceuticals, which has licensed the ELP technology for drug delivery applications from Duke University.
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Luginbuhl, K., Schaal, J., Umstead, B. et al. One-week glucose control via zero-order release kinetics from an injectable depot of glucagon-like peptide-1 fused to a thermosensitive biopolymer. Nat Biomed Eng 1, 0078 (2017). https://doi.org/10.1038/s41551-017-0078
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