Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Trivella, 56124 Pisa, Italy.
Section of Metabolic Diseases and Diabetes, Azienda Ospedaliero-Universitaria Pisana, Via Trivella, 56124 Pisa, Italy.
Metabolism. 2022 Feb;127:154941. doi: 10.1016/j.metabol.2021.154941. Epub 2021 Nov 25.
The discovery of insulin in 1921 - due to the efforts of the Canadian research team based in Toronto - has been a landmark achievement in the history of medicine. Lives of people with diabetes were changed forever, considering that in the pre-insulin era this was a deadly condition. Insulin, right after its discovery, became the first hormone to be purified for human use, the first to be unraveled in its amino acid sequence and to be synthetized by DNA-recombinant technique, the first to be modified in its amino acid sequence to modify its duration of action. As such the discovery of insulin represents a pivotal point in medical history. Since the early days of its production, insulin has been improved in its pharmacokinetic and pharmacodynamic properties in the attempt to faithfully reproduce diurnal physiologic plasma insulin fluctuations. The evolution of insulin molecule has been paralleled by evolution in the way the hormone is administered. Once-weekly insulins will be available soon, and glucose-responsive "smart" insulins start showing their potential in early clinical studies. The first century of insulin as therapy was marked by relentless search for better formulations, a search that has not stopped yet. New technologies may have, indeed, the potential to provide further improvement of safety and efficacy of insulin therapy and, therefore, contribute to improvement of the quality of life of people with diabetes.
1921 年，加拿大研究团队在多伦多发现胰岛素，这是医学史上的一个里程碑式成就。在胰岛素发现之前，糖尿病是一种致命的疾病，而这一发现彻底改变了糖尿病患者的生活。胰岛素是第一个被纯化用于人体的激素，第一个被揭示其氨基酸序列并通过 DNA 重组技术合成，第一个被修饰其氨基酸序列以改变其作用持续时间的激素。因此，胰岛素的发现代表了医学史上的一个关键点。自胰岛素开始生产以来，人们一直致力于改善其药代动力学和药效学特性，以忠实再现生理性昼夜血浆胰岛素波动。胰岛素分子的进化伴随着激素给药方式的进化。不久将有每周一次的胰岛素可供使用，葡萄糖反应性“智能”胰岛素在早期临床研究中开始显示出其潜力。胰岛素作为治疗手段的第一个世纪的特点是不断寻求更好的配方，这种探索尚未停止。新技术确实有可能进一步提高胰岛素治疗的安全性和疗效，从而提高糖尿病患者的生活质量。
