PERSONA
Recent breakthroughs in Diabetes research
NEWSCOPE
RESEARCH
ISSUES
WELL-BEING
TRENDS
THEME
By Sahana Shankar
W
hile the jury is still out on whether diabetes is one disease or a spectrum of metabolic disorders, clinicians mostly encounter cases classified as Type I (where the body’s immune cells attack the pancreatic insulin-producing cells) and Type II (where the pancreatic cells fail to recognize and utilize insulin). Thanks to multi-national collaborative efforts we now have fairly good knowledge of how either of these types’ manifests, their symptoms and some methods of management. However, it is imperative that we find a more permanent solution to cure the disease. While Type II is dubbed as a lifestyle disease which can be monitored, managed and reversed in some cases with specific diet, exercise and minimal medication, it is the Type I which is seen in children and younger people, although with a prevalence lower than Type II. It causes severe disruption and affects the patients’ quality of life due to their dependence on insulin injections and risk of hypoglycemia, making a cure much needed to help these patients reclaim their lives. The scientific community across the world contributed immensely to our understanding of the etiology of the disorder in the 60s and 70s. The 80s and 90s were instrumental in the identification of insulin, glucagon and the recombinant production of insulin for sub-cutaneous administration. Recent research has focused mainly on understanding the way pancreas can be remodeled to improve insulin production and/or its utilization. It has also improved monitoring and management of diabetes with the use of non-invasive and wearable technology. Listed below are some of the recent advances in diabetes research. Smart insulin- the major drawback of Type I is the dependence on regular external doses of insulin. While technology has made it more and more manageable 22
Volume 4 | Issue 1 | January-March 2019
with insulin pens, it results in the patient’s life to be largely centered around their medication. In 2015, researchers at the University of North Carolina devised a glucose-monitoring, insulin-delivery system using nanotechnology and biomedical engineering. The smart insulin patch consists of an array of tiny needles which can be used anywhere on the body to detect glucose levels and release insulin accordingly. The technology is currently undergoing revision and preclinical testing. Islet transplant- recovering healthy pancreas from cadavers and transplanting islet cells into the liver of the patient is an experimental procedure in practice since 2008 to assist with Type I. However, the success rate of this intervention is low due to rejection by the patient’s immune system and dependence on immunesuppressants which increase the risk of infection. It also does not completely reverse patient’s insulin-dependence and requires regular low doses of insulin. A variation of this therapy at the University of Miami in 2017 was a successful transplant of pancreatic islet cells into the stomach lining of the patient which resulted in her complete remission from Type I and independence from constant insulin injections. Stem cell therapy- With the evolution of cell biology techniques, we now have the ability to program immature cells to develop into a specific lineage of cells. Viacyte, a California based biomedical engineered a direct delivery device in April 2017, which when placed under the skin delivers stem cells into the bloodstream. These stem cells are programmed to home into the pancreas and develop into mature insulin-producing cells to replace those eliminated by the immune system. While this device is still in its nascent stages of trial, it would be a life-saver for patients with highly variable glucose levels and severe risk of hypoglycemia. Immature beta cells- another variation
of the stem cell therapy may be derived from our ability to now image the pancreatic tissue at unprecedented resolution. Scientists from the University of California, Davis identified an immature population of beta cells which can produce insulin but, unlike mature beta cells, are unaffected by the presence of glucose in the blood since they do not have glucose receptors. This discovery could lead to a deeper understanding of how beta cells function, and these immature cells can be manipulated to produce more insulin to keep the glucose levels in check. In February 2018, researchers at the University of Miami identified the exact anatomical location of pancreatic stem cells which can be stimulated to be glucose-responsive insulin-producing cells. Subsequently, University of California, San Francisco reported that beta cells can be ‘trained’ to adapt to deficiency in oxygen and nutrients due to exposure before and during the transplantation, ideally ensuring an endless supply of insulin-producing beta cells. IgM immunotherapy- the antibody IgM has been used as a diagnostic marker for Type I since early 2000s. A team of researchers at the University of Virginia have found a new role for IgM as a vaccine against Type I autoimmunity. Injecting human IgM into diabetic mice resulted in reduction of autoimmune reactivity, restoration of the balance of cells in the pancreas and reversal of Type I. Methyldopa- this is a classic case of serendipity in science. Methyldopa is a clinically approved drug to treat hypertension. Scientists at the University of Colorado and University of Florida screened all FDA-approved small molecules to check if any of them could prevent the autoimmune pathway of Type I from getting activated and Methyldopa was a successful candidate. After successful experiments on mice and a pilot clinical study, the drug can be developed as a vaccine to prevent Type I in those at risk.
