Needleless delivery of insulin. Inhale the insulin rich formulation.

1. RECENT ADVANCES IN PHARMACOTHERAPY
OF DIABETES- PULMONAY DELIVERY
OF INSULIN
PREPARED BY:
HARSHIT JOSHI

2. List of contents
1. Introduction
2. Intrapulmonary insulin
3. Fate of pulmonary insulin
4. Systems for pulmonary
delivery of insulin
5. Drawbacks
6. Conclusion

3. INTRODUCTION
Initial attempts delivered the insulin hormone intramuscularly,
intravenously, and eventually subcutaneously. Other routes of
administration of the drug were explored. These included oral, rectal,
sublingual, buccal, transdermal, vaginal, intramuscular, intrapulmonary,
and intranasal delivery systems.
The purpose of these latter studies was to determine a noninjectable
method to deliver insulin to patients with type 1 and 2 diabetes that
would effectively lower blood sugar, and allow patients a simpler, less
invasive, and more direct control oftheir underlying disease process.

4. In January 2006 the United States Food and Drug
Administration approved Exubera (Pfizer Pharmaceuticals,
New York, NY) as the first pulmonary inhaled insulin. In
actuality attempts to explore various methods to deliver insulin
using intrapulmonary delivery had occurred since 1925.

5. INTRAPULMONARY INSULIN
The lung has been considered a route for systemic delivery of many
therapeutic proteins and peptides.
This system includes two major anatomical parts. The first includes the
upper airways, oral cavity, trachea, bronchi, and all upper airways distal
to the bronchioles. The second includes the lower airways, conducting
airways including respiratory bronchioles, alveolar ducts, and alveolar
sacs.
The lung offers a large surface area for drug absorption. The very thin
alveolar epithelium permits rapid drug absorption. The alveoli can be
targeted for effective drug absorption by drug delivery by aerosol with a
mass medium aerodynamic particle diameter <5 mm.

6. Pulmonary absorption is through two routes: transcytosis and
paracellular transport.
Absorption involves several factors: particle size and velocity,
active ingredient molecule size and weight, physiochemical
characteristics of the substance (lipophilic, hygroscopic, electric
charge), smoking and possible bronchopulmonary disorders
(asthma and COPD), presence of surfactant, bile salts, fatty acids
and chelating agents.

7. The inhaled route has limits: the tolerance threshold applicable to
inhalation of insoluble particles, and pharmacological limits of the
nebulised form (real administrable dose/minimum effective dose ratio).

8. FATE OF PULMONARY INSULIN
Inhaled insulin is absorbed more rapidly, or at least as quickly as
subcutaneous insulin.
The hypoglycaemic effect is more rapid with inhaled insulin and the
maximal metabolic effect is at least equal to that of injectable insulin..
There are less episodes of hypoglycaemia with inhaled insulin.
The bioavailability of inhaled insulin is low, between 9 and 22%
depending on the system.
Pharmacokinetic intra-individual variability is between 15 and 30%,
identical to the values with subcutaneous insulin.
Insulin resistance increases with ageing.

9. SYSTEMS FOR PULMONARY DELIVERY OF INSULIN
The formulation used is:
Either insulin in dry power form:
•Exubera Device,
•TechnosphereTM Insulin,
•Spiros Device,
Or insulin adsorbed on porous particles:
•AirTM Pulmonary Drug System Device
Or insulin in nebulised liquid form:
•AERx® (iIDMS)
•AerodoseTM Inhaler
•Kos Device

10. Exubera Device (Nektar Therapeutics Inc., San Carlos, CA, Aventis,
Bridgewater, NJ, Pfizer, NY, USA)
It is a dry powder containing recombinant
human insulin presented in blisters to be
inserted in an inhaler. As for all powder forms,
there are problems with hygroscopicity and
intra- and interindividual variability related to
the inhalation technique.
However, the mannitol is used as an excipient
and the design of the inhalator minimises their
impact. It does not use gas for propulsion or
require electrical energy.

11. TechnosphereTM Insulin (Pharmaceutical Discovery Corporation
MannKind Biopharmaceuticals, NY, USA)
This is insulin formulated as a crystalline
powder with an aerodynamic diameter of
3μm, in capsules presented in three
strengths corresponding to the equivalent
of 2, 4 and 8 IU of injectable insulin. The
aerosol, composed of insulin particles
loaded onto diketopiperazine molecules,
is produced using an inhaler triggered
when the patient inhales.

12. AirTM Pulmonary drug system device (Advanced Inhalation Research,
Alkermes, MA, and Eli Lilly, Indianapolis, USA)
The Air system uses porous particles with a
geometric diameter between 5 and 30μm. As
the particles are very low in density
(<0.03g/cm3), their aerodynamic diameter,
proportional to the square root of their
density, is small at 1 to 5μm. The porous
nature of the particles, by minimising the
tendency to particle aggregation, facilitates
their dispersion and enables better
absorption

13. DRAWBACKS
Insulin is a peptide with anabolic, proinflammatory and
immunoreactive properties that contribute to the multiplication of
alveolar epithelial cells, block apoptosis, and cause capillary
vasodilation.
The pulmonary lesions observed associate thickening of the basal
lamina, intraseptal nodular fibrosis and emphysema-like features.
 it is expensive than conventional sources of insulin.

14. CONCLUSION
Inhaled insulin, whose profile of action is comparable to rapid-acting
subcutaneous insulin, could be proposed for preprandial administration
in both types of diabetes in replacement of or in addition to oral
hypoglycaemic agents or injections of insulin, to improve control of
blood glucose levels.
To date, it is an interesting and innovative dosage form for its design,
easy administration, and efficacy, but potentially expensive compared
with the conventional injectable form.

15. Thank
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