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An insulin-Fc fusion is a recombinant fusion protein platform designed to extend the half-life of insulin, enabling once-weekly administration for the treatment of diabetes mellitus. These molecules typically consist of a single-chain or two-chain insulin variant fused to the fragment crystallizable (Fc) region of an immunoglobulin (such as IgG2 or IgG1) via a peptide linker. The Fc domain allows the fusion protein to bind to the neonatal Fc receptor (FcRn), leveraging the IgG recycling pathway to prolong circulation and reduce clearance. Key candidates developed under this architecture include Eli Lilly's insulin efsitora alfa (LY3209590), which is approved for type 2 diabetes, and Akston Biosciences' AKS-440. Additionally, inactive variants like AKS-107 are being explored as antigen-specific immunotherapies to target and delete insulin-reactive B cells for the prevention of type 1 diabetes.
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