Insulin-XTEN® Exhibits a Size-Dependent Alteration in Tissue Action in Rats
Authors: CHRISTE MICHAEL E. , KONKOL DEBRA , FRIEDRICH JESSICA , JACOBS JULIE , HAWKINS ERIC , MOYERS JULIE , ZHANG CHEN , KAHL STEVEN D. , BAKER HANA E. , COX AMY L. , HANSEN RYAN J. , SPERRY ANDREA , DODSON MICHAEL M. , SCHELLENBERGER VOLKER , BRUCE BALDWIN D. , BEALS JOHN M. , KORYTKO ANDREW 
Published: June 2018

To optimize the action of exogenously administered insulin, we employed XTEN® technology to create insulins with variably sized XTEN amino acid polymers. Recombinant fusions of XTEN polymers linked to insulin lispro with an A21G mutation were prepared in various amino acid lengths. Insulin-XTEN molecules demonstrated 15-fold lower potency in binding and receptor phosphorylation than insulin lispro but did not differ from each other. These insulin-XTEN molecules were equally effective in lowering blood glucose at a 100nmol/kg dose in diabetic Sprague-Dawley rats. Furthermore, the larger insulin-XTEN molecules had a longer duration of glucose lowering. Insulin-XTENs were compared to insulin lispro in rat euglycemic clamp studies, using insulin doses that would elicit steady plasma insulin concentrations and equivalent increases in glucose infusion rate. Insulin-mediated suppression of endogenous glucose production was not significantly different among any of the administered insulins. However, plasma free fatty acids and soleus muscle glucose uptake were significantly decreased in an XTEN size-dependent manner when compared to insulin lispro. Additional studies demonstrated equal hepatic pAkt accumulation in rats treated with insulin lispro or any of the insulin-XTENs, but revealed a significant XTEN size-dependent reduction in skeletal muscle pAkt in rats administered insulin-XTENs compared to insulin lispro. These data suggest a possible XTEN size-dependent regulation of insulin action and that the differing sizes of the XTEN polymer may convey preferential tissue action.
In conclusion, XTEN technology may permit “tuning” of the glucodynamic effects of the insulin, leading to an enhanced time extension and improved hepatic and peripheral pharmacodynamic action that could more closely mimic the action of endogenously secreted insulin into the portal circulation.

Disclosure
M.E. Christe: Employee; Self; Eli Lilly and Company. D. Konkol: None. J. Friedrich: None. J. Jacobs: None. E. Hawkins: Employee; Self; Eli Lilly and Company. J. Moyers: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. C. Zhang: Employee; Self; Eli Lilly and Company. S.D. Kahl: Employee; Self; Eli Lilly and Company. H.E. Baker: None. A.L. Cox: None. R.J. Hansen: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. A. Sperry: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. M. Michael: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Employee; Spouse/Partner; Eli Lilly and Company. Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. V. Schellenberger: None. D. Baldwin: None. J.M. Beals: Employee; Self; Eli Lilly and Company. A. Korytko: None.