Last Monday evening, my husband and I attended the annual Research Update through my local JDRF Chapter. The reason I’m so belated in updating this blog is that I kept misplacing my notes! But I found them and now sit back while I share some of what Dr. Richard Insel, VP of Research for JDRF, had to tell us!
Dr. Insel opened with a general “state of the union” for diabetes research, saying that a lot of “amazing changes in research” have happened in the last 10 years. While he emphasized the JDRF was now on a path to look at prevention, treatment and the cure, he reiterated that to JDRF, curing diabetes means “getting rid of it completely” but that JDRF wanted folks “healthy enough to benefit from that cure.” Couldn’t have said it better myself.
Dr. Insel explained that JDRF was committed to getting more research out of the laboratory and into the clinical setting with actual, real live people. Mice aren’t enough.
“Until you test in humans, you don’t know what you have. [Animal models] aren’t predictive enough,” he said.
What does JDRF see as a cure?
“Perfect glucose control without having to do anything in management,” Dr. Insel said. “A biological cure.”
Islet Cell Replacement / Regeneration
There are two main ways to do this:
1) Implanting or replacing new islets, encapsulated or using a physical barrier
2) Regrow new islets and tame the immune process that causes diabetes so they won’t be destroyed
So far, diabetes has been “cured” more or less via islet cell transplants. But it’s not a long-term feasible option because there are only 100-150 pancreases available each year, plus the immunosuppressant drugs are so strong that it can’t be used on children and it’s not ethical to use it on anyone who isn’t in dire need of a transplant, such as someone with severe hypoglycemia unawareness or other complication (such as someone receiving a kidney transplant as well).
Dr. Insel shared news out of New Zealand that Living Cell Technologies is making progress on using encapsulation technology to protect islet cell transplanted into the body. They may seek approval in New Zealand as early as 2016. JDRF has created an encapsulation consortium of researchers working to perfect encapsulation technology, and they have just completed initial human safety studies.
ViaCyte is another company that has made strides in encapsulation technology. They use immature islets that mature into mature islets in the body, turning into glucose responsive, insulin secreting islet cells. It’s taken 8-10 years to develop the technology, but it looks like they will be going into clinical trials for the technology next year.
Another interesting avenue of research is in pregnant women. Researchers have found that women, even those with type 1 diabetes, spontaneously generate islet cells during pregnancy which are not attacked by the immune system. Researchers are now focused on the question of “How does this occur?” and “Can we make a drug that mimics this?” In fact, after 50 years with diabetes, some people still have beta cell function. Some beta cells were even attempting to divide and multiply, but the immune system squashed every attempt. There is also work being done to see if there are drug like molecules that can expand beta cell numbers while also keeping them from dying.
Dr. Insel also shared that in animal models, alpha cells — glucagon producing cells — can turn into beta cells when genetically deleting beta cells. The alpha cells spontaneously become beta cells and they are protected from the immune system, so there is also research into whether or not a drug could flip our alpha cells and turn them into beta cells.
Protection from the Immune System
For a long time, folks have blamed the pancreas for just “up and quitting” on us — but that isn’t so! It’s actually the thymus gland, or the immune system controller, that causes the beta cells to die. The pancreas is really just a victim of friendly fire. There are bad immune cells, called T-cells, that we need to take out in order to stop the immune process from continuing again and again.
But what causes the T-cells to go haywire. They really don’t know, but Dr. Insel explains that it’s definitely a combination of genetics and environmental factors. In fact, 1 in 30 children in Finland will have diabetes by 15, while 1 in 400 children in the US will have diabetes by 18. Wow!
Preventing Diabetes — A Possible Stepping Stone
Although most of us with diabetes don’t really think much about preventing diabetes (hello, we already have it!), it turns out that a vaccine or other preventative step could also help us in the event we are able to replace islet cells.
There are several avenues that JDRF and researchers are working on, and I’ll touch on a couple:
1) Vaccines: researchers are looking into potential viruses that trigger diabetes. If they could find a virus associated with diabetes, such as the enterovirus, then a vaccine could be created. But this only works if a virus really plays a primary role in diabetes, otherwise it’s a waste of time. But they won’t really know until they investigate more instances of diabetes around the world.
2) Microbiota: microbiota has been linked to other gastrointestinal issues and diseases (like Crohn’s) but I haven’t heard much in the way of diabetes. However, it’s possible that there is an imbalance of healthy microbiota (a fancy term for good bacteria in our gut) and that is leaving us open for autoimmune issues. Allergies and asthma are also going up, so it’s possible all of this is connected.
In addition to finding a cure, JDRF is also focused on the payer side of the equation. Dr. Insel shared that JDRF was instrumental in getting CGMs covered by insurance companies, which gave commercial incentive for medical device companies to work on second and third generation devices. JDRF has to go beyond the discovery, Dr. Insel explained, and make sure drugs and devices are affordable. Dr. Insel also shared quite a bit about the continuous glucose monitor, but most of the information was repeats from previous conferences and lectures, so I will leave you to explore Google for more info on that.
Dr. Insel concluded saying, “We have to relieve the burden of this disease.” While the research into a cure is very exciting and something I’ve always supported wholeheartedly, it’s also important to realize that a cure won’t mean much to those of us funding it if we’re not here to see it because of complications. At nearly 28, I’m a third through my life expectancy, but I’ve already lived with diabetes for almost 20 years.
It’s very exciting to see all the possibilities that lay ahead of us, and that there are so many people working on diabetes. I’ve always been a big believer that you don’t want to put all your eggs in one basket, especially with something as mysterious and complex as diabetes.