Hypoglycemia, a decrease in blood sugar levels, is a common occurrence for the 30 million Americans with diabetes. In severe hypoglycemia, the individual is at risk for diabetic coma and even death. Although these events can be managed using a glucagon emergency kit, current kits require a multi-step procedure in which lyophilized glucagon is reconstituted and administered as an injection. Emergency kits are associated with a high rate of user error and frequently go unused. Additionally, kits are often not available when needed, as diabetic individuals find them cumbersome and rely on emergency room visits to treat severe hypoglycemia. The misuse and underutilization of glucagon emergency kits can be traced to the limited solubility and stability of glucagon. Glucagon is supplied as a powder in the kits because it is unstable in solution, rapidly forming amyloid fibrils. Additionally, glucagon has limited solubility at neutral pH and is solubilized in acidic pH in the kits. Monon Bioventures is developing glucagon derivatives with enhanced stability and solubility to provide a more versatile and user-friendly product. Monon BioventuresÂ’ approach involves using reversible phosphorylation of glucagon to prevent the formation of amyloid fibrils, thus creating a solution-stable glucagon derivative, known as phospho-glucagon. Preliminary efforts have identified phospho-glucagons with improved solubility and stability and have shown increases in blood glucose comparable to native glucagon (in rats). These data support the continued development of lead phospho-glucagons through a Fast-Track program that is geared toward generating target product profiles (TPPs) for intranasal and self-injectable intramuscular phospho- glucagon formulations. This overall goal will be met through the execution of the following aims: Phase I Specific Aims are: 1) To execute formulation studies and structural modifications of lead phospho-glucagons to improve oxidative stability. 2) To develop and validate analytical methods for phospho-glucagon in plasma. The measures of success to advance to Phase II are 1) identification of at least two candidate phospho-glucagons formulated in solution at a neutral pH that have desired stability (<10% oxidation at 30oC for 3 months, no detectable fibrillation), solubility (>1 mg/mL), and functionality (increases blood glucose at rate and extent similar to native glucagon); and 2) a validated bioanalytical method with a limit of detection of 50 ng/mL or less. Phase II Specific Aims are: 1) To determine long-term stability of lead phospho-glucagon formulations. To assess the PK/pharmacodynamic (PD) properties of phospho-glucagon formulations. 3) To generate preliminary safety and immunogenicity profiles of the lead phospho-glucagon formulations. The measure of success for Phase II is to complete key pharmacological and safety assessments to construct the TPP.
Public Health Relevance Statement: PROJECT NARRATIVE Severe hypoglycemia, which involves a large drop in blood sugar that can result in diabetic coma and even death, is a significant risk for the 30.0 million Americans living with diabetes. These episodes can be successfully treated with timely and proper administration of glucagon by a third party using an emergency kit; however, this treatment is often underutilized or inadequately used due to a complex administration protocol that results from solubility and stability limitations of glucagon. Monon Bioventures seeks to develop a solution-stable phospho- glucagon prodrug, that would enable intramuscular and intranasal delivery of a rescue dose of glucagon. Novel solutions of phospho-glucagon will allow for emergency glucagon delivery regimens significantly more user friendly than kits that are either currently marketed or under development by competitors. Availability of such kits will increase utilization and proper administration of this life-saving intervention for severe hypoglycemia.
NIH Spending Category: Diabetes
Project Terms: Address; Adverse event; American; amyloid fibril formation; Amyloid Fibrils; analytical method; Antibodies; Antibody Response; Artificial Pancreas; Biological Assay; Blood Glucose; Cessation of life; Charge; Cleaved cell; commercialization; Complex; cost; Data; Detection; Development; Diabetes Mellitus; diabetic; Diabetic Coma; Dose; Drops; Drug Kinetics; Effectiveness; Emergency department visit; Emergency Situation; Ensure; Enzymes; Event; experience; Formulation; Freeze Drying; Glucagon; Goals; Histologic; Hypoglycemia; immunogenicity; improved; in vivo; Individual; Inflammation; Injectable; Injections; inorganic phosphate; Intervention; Intramuscular; Kinetics; Lead; Life; Measures; Methionine; Methods; Modification; neutralizing antibody; novel; oxidation; Patient-Focused Outcomes; Peptides; Pharmaceutical Preparations; Pharmacodynamics; Pharmacology; Phase; Phosphoric Monoester Hydrolases; Phosphorylation; Plasma; Powder dose form; prevent; Procedures; Prodrugs; programs; Property; Protocols documentation; Rattus; reconstitution; Regimen; Risk; Safety; safety assessment; Savings; Site; Solubility; Structure; success; Temperature; Therapeutic; Time; user-friendly
