Effect of sirolimus on insulin dynamics in horses

Abstract Background Sirolimus, a mechanistic target of rapamycin inhibitor, suppresses insulin production in other species and has therapeutic potential for hyperinsulinemia in horses. Hypothesis/Objective Determine the pharmacokinetics (PKs) of sirolimus and evaluate its effect on insulin dynamics in healthy and insulin dysregulation (ID) horses. Animals Eight Standardbred geldings. Methods A PK study was performed followed by a placebo‐controlled, randomized, crossover study. Blood sirolimus concentrations were measured by liquid chromatography‐mass‐spectrometry. PK indices were estimated by fitting a 2‐compartment model using nonlinear least squares regression. An oral glucose test (OGT) was conducted before and 4, 24, 72, and 144 hours after administration of sirolimus or placebo. Effects of time, treatment and animal on blood glucose and insulin concentrations were analyzed using mixed‐effects linear regression. Sirolimus was then administered to 4 horses with dexamethasone‐induced ID and an OGT was performed at baseline, after ID induction and after 7 days of treatment. Results Median (range) maximum sirolimus concentration was 277.0 (247.5‐316.06) ng/mL at 5 (5‐10) min and half‐life was 3552 (3248‐4767) min. Mean (range) oral bioavailability was 9.5 (6.8‐12.4)%. Sirolimus had a significant effect on insulin concentration 24 hours after a single dose: median (interquartile range) insulin at 60 min (5.0 [3.7‐7.0] μIU/mL) was 37 (−5 to 54)% less than placebo (8.7 [5.8‐13.7] μIU/mL, P = .03); and at 120 min (10.2 [8.4‐12.2] μIU/mL) was 28 (−15 to 53)% less than placebo (14.9 [8.4‐24.8] μIU/mL, P = .02). There was minimal effect on glucose concentration. Insulin responses decreased toward baseline in ID horses after 7 days of treatment. Conclusion and Clinical Importance Sirolimus decreased the insulinemic response to glucose and warrants further investigation.