Amylin

Where it comes from

Made in

Beta cells, in the same granules as insulin, about one amylin for every hundred insulins

Sent out by

With insulin, after meals

Acts on

• Brainstem (area postrema)
• Stomach
• Pancreatic alpha cells

What it does

• Slows the emptying of the stomach
• Suppresses glucagon after a meal
• Brings on fullness through the brainstem

In medicine

• Pramlintide, an analogue that does not clump, has been approved since 2005 as an add-on to mealtime insulin ²
• Human amylin clumps into amyloid fibrils that fill the islets in type 2 diabetes and are toxic to beta cells ¹
• Absent in type 1 diabetes, as insulin is

Beyond the body’s own use

• Cagrilintide, a weekly amylin analogue, took off up to 10.8% of body weight on its own against 3.0% on placebo in a 906-person phase 2 trial ³
• Paired with semaglutide as CagriSema it reached 20.4% against 3.0% on placebo at 68 weeks in a 3,417-person phase 3 trial ⁴ and is under regulatory review; the amylin agonists are the next class after GLP-1 in the obesity pipelines
• Pramlintide is not a weight-loss medicine on its own: given with insulin it takes off a few kilograms, and its approved use is mealtime glucose control ²
• The amyloid question runs the other way: whether the fibrils can be stopped from forming at all, which no medicine yet does ¹