Roadmap to the Cure

Catchy title, ay?  This is what they chose to dub the set of cutting-edge diabetes research presentations at last month’s NYC Diabetes Research Institute (DRI) meeting.

If you like to keep up on the latest and greatest advancements, this is certainly some stuff you should know about.  Of particular interest:

* Preserving Beta Cells - Jay Skyler, NIH Study Chairman and past ADA President

Remember, it’s the so-called “regulatory t-cells” that keep the autoreactive (self-attacking) cells in check in a body without autoimmune disease. For those of us whose t-cells have gone wild, intervention strategies are aimed at knocking them out.

Numerous studies are now under way, including attempts to preserve beta cell function with immunosuppressive drugs in those who are newly diagnosed. Researchers have also tested a vaccine… “however, the studies had mixed results. Some patients maintained insulin function, while others did not.”

* Islet Cell Transplantation - Jonathan Lakey, director of the Clinical Islet Laboratory in Edmonton, Canada (birthplace of the Edmonton Protocol)

In the last five years, over 60 institutions have performed more than 850 transplants worldwide (!), but this includes patients who’ve received multiple infusions. The procedure has been performed primarily on those with “brittle type 1 diabetes,” i.e. unable to control their glucose levels despite continued management, suffer “unstable hypoglycemia” and also already show complications.

Eligibility requires some very stringent screening: the Edmonton team received more than 1,800 patient requests, but only 6% were eligible for participation. Note that you’re automatically disqualified at this time if your BG control is already adequate, if you’ve suffered kidney damage, or if your body weight is too high.

Anyway, of the 59 transplants conducted in 36 patients in Lakey’s study, the overall rate of insulin independence post-transplant was 82%.  That sounds kinda promising, no?

* Tissue Engineering - Cherie Stabler, grad student at Emory University School of Medicine

Dr. Stabler helps design biological substances for implantation into the body — specifically, capsules that can be used to transplant and graft new cells (like the one I reported on in June).  Researchers are working on three ways to do this:

- Macroencapsulation, which takes all of the isolated islets and combines them in a single device that is implanted subcutaneously (under the skin). Not ideal, apparently.

- Microencapsulation, which refers to encapsulating a single islet in a gel capsule, which “can partially protect the islets from the host’s immune system, and allow for the diffusion of nutrients since the membrane of the capsule is porous, or semi-permeable.”  Better.    

- Nanoencapsulation, whereby a thin layer of coating is applied to the surface of the islet, minimizing the adverse effects of a thicker membrane. Apparently works well in the liver.

Real-world success of all of this is TBD, hinging on REJECTION issues (whether the body will accept the “invaders,” that is).

* Stem Cell Research - Juan Dominguez-Bendala, director of Stem Cell Development at the DRI in Miami

Sounds like researchers are trying just about everything here to get stem cells to develop into usable insulin-producing cells — while avoiding the need for immuno-suppression drugs in the patients who’ll eventually get them. But the obstacles are many, calling for some ingenious safety procedures:

“In the process of obtaining islets, you get other cells, too… and if that happens, you may develop tumors called teratomas. This can occur even if only one cell escapes.

“The DRI team is combating this potential risk by developing ‘suicide genes.’  If a cell is developing into a beta cell, then the suicide gene is specifically removed, and the cell is allowed to develop and mature. However, if a cell is going down the wrong path, or if they keep proliferating, these genes are activated and they die off.”

Ooh, too much information??  Have I told you more than you wanted to know?  Sorry, can’t help myself.  I’m fascinated with research.  Rock on, scientists!  We’re cheering for you to live up to those arresting presentation titles like “Roadmap to the Cure.”