SAT-260 Selective Nonpeptide Somatostatin Subtype 5 (sst5) Agonists Suppress Induced Insulin Secretion in Pancreatic Islets from both Rats and Healthy Human Donors

Hyperinsulinemia is a heterogeneous condition in which dangerously low blood sugar levels are caused by improperly regulated insulin secretion from pancreatic ß-cells. The most severe form of hyperinsulinemia arises from congenital hyperinsulinism (CHI), a set of genetic disorders in which the underlying pathology is driven by mutations in key genes that regulate insulin secretion. CHI is the most common cause of persistent hypoglycemia in newborns and infants, and prompt recognition and treatment are vital to prevent coma, long-term neurological complications, and even death. The neuropeptide somatostatin is an important modulator of hormonal signaling from the pancreas mediated by different somatostatin receptor (sst) subtypes. Glucagon secretion from α-cells is inhibited through sst2 receptor activation and insulin secretion from β-cells is inhibited through sst2, sst3, and sst5. The injectable peptide drugs octreotide and lanreotide are primarily agonists at sst2 and are often prescribed for these patients in an attempt to reduce insulin secretion, but their efficacy is limited, and they carry the risk of impairing glucagon secretion, an important defense mechanism against hypoglycemia. We hypothesize that an orally available selective sst5 agonist may be a useful new approach to managing hyperinsulinemia. We launched an iterative medicinal chemistry program that led to the discovery of selective sst5 agonists, with multiple nonpeptide series possessing EC(50)s < 1 nM in cell-based assays of receptor activation (these compounds also routinely possess similar potencies for the rat sst5 receptor). We have shown that these sst5 agonists potently suppress insulin and raise plasma glucose in multiple glycemic studies in rats. To explore the mechanism of selective sst agonism and its translation from rat studies to humans, we undertook a series of studies using pancreatic islets isolated from human donors and from naïve Sprague Dawley rats. Selective sst5 agonists were compared to selective sst2 and selective sst3 agonists as well as somatostatin peptides for their capacity to suppress insulin and/or glucagon from islets under various conditions including increasing glucose concentrations and the presence of a sulfonylurea (the increased insulin secretion mimics many CHI patients). In both human and rat islets, we found that selective sst5 agonists potently suppressed insulin secretion more effectively than selective sst2 or sst3 agonists, while having little effect on glucagon secretion, demonstrating their potential efficacy in the human condition. These studies support our program to identify and develop potent nonpeptide selective sst5 agonists with pharmaceutical and safety characteristics suitable for evaluation in human clinical trials.