Dear Henry:
I do owe you one more discussion about the "replacement" and "add on"s. Pramlintide is a modified version of hormone amylin, and is a replacement treatment for amylin deficiency in diabetic patients. Rezulin is a modified version of prostaglandin, but it is an "add on" treatment for diabetic patients. The difference here is not whether they are modified or not, it is what is missing in patients compared to normal people.
Normal people do have their amylin secreted all the time, and patients do not have it anymore. However, normal people do not have their PPAR gamma activated all the time (the receptor for Rezulin), and Rezulin "add on" that activation.
For metabolism diseases like diabetes, the best treatment is "replacement" or "restoration" because the "add on" treatments sometimes add on something more than intended (liver problem for example). Unfortunately, in type II patients, what is missing is still not known, the decreased sensitivity to insulin is only a function on the surface (it is the phenotype, the genotype is unknown). What is missing maybe very complicated. That is why the response to Rezulin varies among the same type II patients grooup. At the meantime, I believe that pramlintide would only work in type II patients who do not have enough amylin to start with. Of course, all type I patients have amylin deficiency.
My prediction is most type I patients will use amylin replacement. Many of type II patients will use amylin replacement on top of one form or the other of drugs like Rezulin. Rezulin will be wildly used even with its liver problems, but patients will watch out for it.
I hope I answered your questions.
Good luck with LGND
D.Right |
