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Biomedical subjects

M Fineman

Publications and source records attributed to M Fineman.

7 recordsLinked to original sources
PubMed2004

Amylin replacement with pramlintide as an adjunct to insulin therapy improves long-term glycaemic and weight control in Type 1 diabetes mellitus: a 1-year, randomized controlled trial.

AIMS: The autoimmune-mediated destruction of pancreatic beta-cells in Type 1 diabetes mellitus renders patients deficient in two glucoregulatory peptide hormones, insulin and amylin. With insulin replacement alone, most patients do not achieve glycaemic goals. We aimed to determine the long-term efficacy and safety of adjunctive therapy with pramlintide, a synthetic human amylin analogue, in patients with Type 1 diabetes. METHODS: In a double-blind, placebo-controlled, parallel-group, multicentre study, 651 patients with Type 1 diabetes (age 41 +/- 13 years, HbA(1c) 8.9 +/- 1.0%, mean +/- sd) were randomized to mealtime injections of placebo or varying doses of pramlintide, in addition to their insulin therapy, for 52 weeks. RESULTS: Addition of pramlintide [60 microg three times daily (TID) or four times daily (QID)] to insulin led to significant reductions in HbA(1c) from baseline to Week 52 of 0.29% (P < 0.011) and 0.34% (P < 0.001), respectively, compared with a 0.04% reduction in placebo group. Three times the proportion of pramlintide- than placebo-treated patients achieved an HbA(1c) of < 7%. The greater reduction in HbA(1c) with pramlintide was achieved without an increase in concomitant insulin use and was accompanied by a significant reduction in body weight from baseline to Week 52 of 0.4 kg in the 60 microg TID (P < 0.027) or QID (P < 0.040) pramlintide treatment groups, compared with a 0.8-kg gain in body weight in the placebo group. The most common adverse event in pramlintide-treated patients was transient, mild-to-moderate nausea. CONCLUSIONS: These results show that mealtime amylin replacement with pramlintide, as an adjunct to insulin therapy, improves long-term glycaemic and weight control in patients with Type 1 diabetes.

Adult↗
PubMed2003

Addition of pramlintide to insulin therapy lowers HbA1c in conjunction with weight loss in patients with type 2 diabetes approaching glycaemic targets.

AIM: Two long-term, randomized, double-blind, placebo-controlled clinical trials in insulin-using patients with type 2 diabetes, spanning a wide range of baseline glycaemic control, have shown that the addition of pramlintide, an analogue of the beta-cell hormone amylin, to pre-existing insulin regimens results in reductions in HbA1c that are accompanied by weight loss. METHODS: To assess whether this profile of pramlintide is observed in patients approaching, but not yet reaching, glycaemic targets, we conducted a pooled post hoc analysis of the two trials, including all patients with an entry HbA1c between 7.0 and 8.5%. Within this subset of patients, 80 were treated with placebo + insulin [baseline HbA1c 8.0 +/- 0.3%, weight 87.3 +/- 19.3 kg (mean +/- s.d.)] and 86 with pramlintide (120 micro g bid) + insulin [HbA1c 8.0 +/- 0.4%, weight 92.5 +/- 20.4 kg (mean +/- s.d.)]. Endpoints included changes from baseline to Week 26 in HbA1c, body weight, and the event rate of severe hypoglycaemia. RESULTS: Adjunctive therapy with pramlintide resulted in significant reductions in both HbA1c and body weight from baseline to Week 26 (-0.43% and -2.0 kg differences from placebo, respectively, both p < 0.001). These changes were achieved without a concomitant increase in the overall rate of severe hypoglycaemic events (0.13 pramlintide vs. 0.19 placebo, events/patient year of exposure). CONCLUSIONS: The data from this post hoc analysis indicate that the addition of pramlintide to insulin therapy may help patients with type 2 diabetes who are approaching, but not yet reaching, glycaemic targets to achieve further reductions in HbA1c without concomitant weight gain and increased risk of severe hypoglycaemia.

Aged↗
PubMed2002

The human amylin analog, pramlintide, reduces postprandial hyperglucagonemia in patients with type 2 diabetes mellitus.

AIMS: Amylin is a second beta-cell hormone that is normally co-secreted with insulin in response to meals; it complements the effects of insulin in postprandial glucose control, in part by suppressing glucagon secretion. In patients with type 2 diabetes, mealtime administration of the human amylin analog pramlintide markedly improves postprandial glucose excursions. The aim of this study was to examine whether pramlintide reduces the postprandial hyperglucagonemia that is often seen in this patient population. METHODS: Utilizing a single-blind, placebo-controlled crossover design, 24 patients with type 2 diabetes, 12 insulin-treated and 12 non-insulin-treated, underwent a standardized mixed meal test on 2 occasions during which they received, in randomized order, a five-hour intravenous infusion of placebo or pramlintide (100 microg/h). RESULTS: During the placebo infusion, plasma glucose and plasma glucagon concentrations increased substantially after the meal. During the pramlintide infusion, postprandial plasma glucose and plasma glucagon responses were significantly (p < 0.05, all) reduced following ingestion of the same meal, both in the insulin-treated and non-insulin-treated subgroups. CONCLUSION: Supplementation of mealtime amylin with pramlintide reduces postprandial hyperglucagonemia in patients with type 2 diabetes, a mechanism that likely contributes to pramlintide's postprandial glucose-lowering effect.

Adult↗
PubMed2000

High-frequency oscillations in circulating amylin concentrations in healthy humans.

Amylin is stored in the pancreatic beta-cell granules and cosecreted with insulin in response to nutrient stimuli. To gain further insight into control of hormonal release in beta-cell physiology, we examined whether amylin, like insulin, circulates in a high-frequency oscillatory pattern, and if it does, to compare the secretory patterns of the two hormones. Eight overnight-fasted healthy individuals were studied during intravenous glucose infusion (2.0 mg. kg(-1). min(-1)). Blood was collected every minute for 90 min and analyzed in triplicate for amylin, total amylin immunoreactivity (TAI), and insulin. Mean plasma concentrations of amylin (nonglycosylated), TAI (nonglycosylated plus glycosylated), insulin, and glucose were 2.77 +/- 1.21 pmol/l, 7.60 +/- 1.73 pmol/l, 50.4 +/- 17.5 pmol/l, and 5.9 +/- 0.3 mmol/l, respectively. The 90-min time series of amylin, TAI, and insulin were analyzed for periodicity (by spectral analysis, autocorrelation analysis, and deconvolution analysis) and regularity [by approximate entropy (ApEn)]. Significant spectral density peaks were demonstrated by a random shuffling technique in 7 (out of 7), 8 (out of 8), and 8 (out of 8) time series, respectively, whereas autocorrelation analysis revealed significant pulsatility in 5 (out of 7), 7 (out of 8), and 5 (out of 8), respectively. The dominant periodicity of oscillations determined by spectral analysis was 4.6 +/- 0.3, 4.6 +/- 0.4, and 6. 5 +/- 1.1 min/pulse, respectively (amylin vs. insulin, P = 0.017, TAI vs. insulin, P = 0.018). By deconvolution analysis, amylin and insulin periodicities were, respectively, 6.3 +/- 1.0 and 5.5 +/- 0. 6 min. By application of the regularity statistic, ApEn, 6 (out of 7), 7 (out of 8), and 6 (out of 8), respectively, were found to be significantly different from random. In conclusion, like several other hormones, circulating amylin concentrations exhibit oscillations in the secretory patterns for nonglycosylated as well as glycosylated forms. Whether the high-frequency pulsatile release of amylin is disturbed in diabetes is not known.

Adult↗
PubMed1992

Induction of acute hyperglycemia, hyperlactemia and hypocalcemia in fed and fasted BALB/c mice by intravenous amylin injection.

Amylin has been reported to influence carbohydrate metabolism in rats, dogs and cats. We report here that intravenous injection of 50 micrograms amylin (640 nmol/kg) induced hyperglycemia, hyperlactemia, and hypocalcemia in both fed and 5-hour fasted mice. Peak glucose and lactate increments occurred within 15 minutes of treatment, followed by a slower decline of plasma calcium levels. To determine dose-response characteristics of these effects, fasted animals were given amylin doses ranging from 0.005 micrograms to 500 micrograms (64 pmol/kg to 6.4 mumol/kg). Median effective doses (ED50) for the hyperglycemic, hyperlactemic, and hypocalcemic effects were 155, 16.9 and 190 nmol/kg, respectively, with maximum increases of 6.27 mM for glucose, 1.85 mM for lactate and maximum decrease of 0.37 mM for calcium. The estimated half-life (t1/2) of exogenous amylin in the circulation was 5.0 minutes in fasted mice. These results indicate that amylin is bioactive in mice. The kinetic data predict that biologically effective doses of exogenous amylin result in plasma concentrations comparable to pathophysiological concentrations of endogenous hormone previously reported.

Amyloid↗
PubMedDate not supplied

Kinetics of the dissociation of indium-(p-substituted-benzyl)ethylenediaminetetraacetic acid hapten analogues from the monoclonal anti-hapten antibody CHA255.

Half-lives were measured for the dissociation of a series of 20 indium-benzyl-EDTA derivatives from a monoclonal antibody that binds to them. Most haptens gave expected monoexponential dissociation curves with half-lives ranging from approximately 8 to approximately 100 min at 22 +/- 1 degree C. Precise (+/- approximately 2.5%) determinations were made using centrifugal ultrafiltration to separate free from bound hapten. A strong pH dependence of the dissociation half-life was found for the two haptens studied. Activation enthalpies were identical (23 +/- 1 kcal/mol) for the dissociation of four haptens, suggesting that, in contrast to individual rate constants, this parameter is insensitive to hapten modification. The dissociation half-lives provided evidence for the location of a positive charge in the binding site, but gave no clear indication of the role of hydrophobic interactions or of steric requirements in hapten binding. While variations in ionic strength had no effect on the dissociation rate, lowering surface tension with dioxane increased the rate somewhat. Three hapten-antibody complexes showed biexponential dissociation rates. It is postulated that this results from distinct conformations of the complex dissociating at different rates. The dissociation rate constant was found to be an extremely sensitive indicator of the hapten-antibody interaction that can be measured very precisely.

Albumins↗