Type 1 diabetes is a disease that prevents the body from producing insulin, the hormone responsible for regulating blood sugar levels. Without insulin, the body cannot properly use glucose, leading to toxic blood sugar levels and potentially fatal consequences. Today, people with diabetes can live normal lives thanks to insulin injections, but a century ago, the situation was vastly different.
In the early 20th century, the only way to manage diabetes was through an extremely restrictive diet low in carbohydrates and calories, which often left patients on the brink of starvation. The life expectancy of a person with type 1 diabetes was barely five years. However, a groundbreaking discovery in 1921 would change the fate of millions of people forever: insulin.
The Discovery of Insulin
Canadian physician Frederick Banting, along with his assistant Charles Best and under the supervision of Professor John Macleod at the University of Toronto, began researching the relationship between the pancreas and diabetes. They discovered that the key was insulin, a hormone produced by the beta cells of the pancreas, and set out to extract and administer it to diabetic patients.
In their initial experiments, they extracted insulin from healthy dogs and injected it into diabetic dogs, successfully lowering their blood sugar levels. Later, with the help of biochemist James Bertram Collip, they refined the process of insulin extraction and purification from the pancreases of cows and pigs. Finally, in January 1922, they injected insulin into Leonard Thompson, a 14-year-old boy with severe diabetes. The treatment was a success, reducing his glucose levels and extending his life by 13 more years.
This discovery not only marked a milestone in medicine but also enabled the industrial production of insulin by the pharmaceutical company Eli Lilly, making it the first biopharmaceutical in history. In 1923, Banting and Macleod were awarded the Nobel Prize in Medicine for their discovery, sharing the recognition with Best and Collip.
The Recombinant Insulin Revolution
Although insulin extracted from animals saved countless lives, it had limitations. Around 5% of patients developed allergic reactions, and the growing demand for insulin meant that production depended on millions of cow and pig pancreases each year—an expensive and unsustainable process.
In the 1970s, advances in recombinant DNA technology led to the idea of producing human insulin in genetically modified bacteria. Molecular biologist Herbert Boyer, along with Arthur Riggs and Keiichi Itakura from the City of Hope National Medical Center, set out to synthesize the insulin gene artificially and transfer it to Escherichia coli, a bacterium that could be easily cultured in large quantities.
The process was not straightforward, as the sequence of the insulin gene was unknown at the time. The scientists took an innovative approach: they chemically synthesized the DNA sequence based on the protein structure of insulin, which had been discovered in 1955 by British biologist Fred Sanger. They then introduced this gene into E. coli, which began producing human insulin in the laboratory.
In 1979, Genentech, the company founded by Boyer and Robert Swanson, successfully produced insulin in bacteria for the first time. Eli Lilly later took over large-scale production, and in 1982, the FDA approved recombinant insulin under the name Humulin, making it the first biotechnological drug in history. This new insulin eliminated allergy issues and supply limitations, revolutionizing diabetes treatment.
The success of Humulin marked a turning point in medicine, paving the way for the development of other biopharmaceuticals. It also laid the foundation for the production of therapeutic proteins through genetic engineering, a field that has grown exponentially over the past few decades and continues to save millions of lives worldwide.
Current Innovations and Challenges
Since the introduction of recombinant insulin, science has continued to refine this treatment. Rapid-acting insulins have been developed, which are absorbed more quickly into the bloodstream, as well as long-acting insulins that maintain stable glucose levels for 24 hours. Additionally, technological advancements have led to the creation of insulin pumps and continuous glucose monitoring systems that enhance patients’ quality of life.
However, despite these advancements, access to insulin remains a global issue. In countries like the United States, insulin prices have skyrocketed. In the U.S., for example, the price per vial has surged from just a few dollars in the 1990s to over $300 today. This has led many patients to seek alternatives, such as buying insulin on the black market, traveling to countries with regulated prices, or even rationing doses—decisions that can have fatal consequences.
The issue lies in the fact that major pharmaceutical companies have maintained control over insulin through continuous modifications and new patents, preventing the production of more affordable generic versions. In contrast, in countries with public healthcare systems and stricter regulations, such as Spain, insulin remains affordable and accessible to all patients who need it.
Conclusion
The discovery and production of insulin marked a turning point in medicine. What began as a crude extraction process from animal pancreases has evolved into a high-quality biotechnological product, allowing millions of people with diabetes to live long and healthy lives. However, even today, access to this essential treatment remains a challenge in some parts of the world, reminding us of the importance of advocating for a fair and equitable healthcare system.
If Frederick Banting were alive today, he would undoubtedly be outraged to see how his discovery—one he considered a gift to humanity—has become a product with exorbitant prices that put the lives of those who depend on it at risk.
About 53Biologics:
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