Design of Insulin Variants for Improved Treatment of Diabetes - Peptide and Protein Design for Biopharmaceutical Applications - page 273

furthermore be accompanied by chronic treatment with immunosuppres-
sive drugs - not a good trade for insulin.
Transplantation of animal pancreas to humans is used in a Mexican
clinic [179], but animal organs will likely never be accepted in Europe or
the USA [180].
Other future scenarios could include diabetes treatment via engineered
insulin-secreting cells [181] or transformation of stem cells to b-cells [182].
However, for type 1 diabetes, the autoimmune destruction of b-cells would
also have to be overcome. For type 2 diabetes, low insulin sensitivity in the
peripheral tissue is more of a problem than lack of b-cells, so cell therapy
may not be viable for type 2.
Notably, the numerous principles invented for insulin delivery mod-
ulation could be better exploited as general tools for peptide drug engi-
neering. Peptide activity prolongation by subcutaneous precipitation via
modulation of the peptide pI point should be a generally applicable
principle, but this method does not seem to have been exploited outside
of insulin drugs. On the other hand, prolongation of peptide bioactivity
by fatty acid acylation has been successfully adopted to other peptides,
such as GLP-1 in the form of Liraglutide, among others [183,184].
Only time will tell where insulin and general peptide and protein
engineering will take us. Stay tuned.
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