The Cure: So many “breakthroughs” why so little progress?

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

 

It seems that every other day we hear of some sort of breakthrough in relation to diabetes. Some are promising results from reputable institutions, others, like cinnamon and okra juice are the same sort of snake oil that charlatans have been peddling for centuries.  So many “breakthroughs” but why so little progress?

Snake oil aside, there are a few different areas being researched that hold promise if not for a cure at least for normalisation of blood sugars in type 1 diabetes.  I have attended 2 different talks about “the cure” in the last six months and interestingly, they drew different conclusions about where the cure was most likely to come from.  As best as I can tell there are 4 broad areas that offer promise of real improvement but there are still significant hurdles to overcome before we can throw away our glucometers and needles.  Five years? N’ah I think we’ll be lucky to see any of these  even trialled on a significant basis in humans in 15 years.

Transplants

I actually know somebody who is no longer diabetic after receiving a kidney and pancreas transplant, her last hba1c was 4.5.  The problem is that she suffers from complications of the anti rejection drugs required to stop her body rejecting the “foreign” organs .  For most people anti rejection drugs pose bigger problems than being insulin-dependent, which is why it is only those type 1s who need to receive a kidney will undergo a pancreas transplant as well.  Even if these problems could be overcome (and it doesn’t look likely in the foreseable future) the biggest problem is a shortage of donated organs.  With over 100,000 type 1 diabetics in Australia, only approximately 10 pancreases become available from transplantation each year.  Even if the rate of organ donation increased dramatically, there still wouldn’t be enough suitable pancreases to cure everyone.

The problem is similar with islet transplants-a shortage of donors (very few useful islet cells can even be harvested from a pancreas).  There is hope that islet cells can be encapsulated by a material that will allow insulin to be excreted but won’t let your immune system “in” to kill them off, as happened to make you type 1 in the first place.  So far, they have tried encapsulating the cells in seaweed  and some researchers are trying to bioengineer coatings.  Even if these coatings could be perfected, it still doesn’t solve the problem of shortage of donated cells.

Stem Cells and Xenotransplantation

To overcome the shortage of human organs for donation, researchers are looking at two main areas. One is the possibility of being able to grow new islet cells from stem cells. I believe this has been done with limited success in mice-but we all know curing a mouse of diabetes doesn’t mean that can be transplanted into a cure for people-sadly.

Another, potentially unlimited source of islet cells for transplantation could come from other species.  Pigs are a likely candidate for this as their insulin is very similar to ours-many of us old time diabetics will remember being kept alive by pig or beef insulin-that was all that was available until the mid-80s. Limitation of trialling this is the potential for animal viruses to mutate and infect humans.  A company have bred pigs that are virus free especially for xenotransplantation and I think that there may have been some trials but so far nobody has been cured-of course.

The benefit of being able to “manufacture” islet cells via stem cells or use pig islet cells is that supply would be virtually unlimited.  Even if the cells suffered destruction over time (as is the case with most islet cell transplants at the moment, after a few years most recipients require insulin again)-if they could be topped up regularly-even every few months-to keep sugars “normal” this would be a far superior treatment to those currently available.

These ‘cures’ sound good in theory but so far they are a long way from reality. To the best of my knowledge no human being has been able to produce insulin for even a day from xenotransplanted or manufactured islet cells.  There is, in my opinon, a long way to go and it’ll take a lot more than 10 years to get there for either of these to be a viable option.

Smart Insulin

I haven’t heard a lot about this one but the idea is intuitively very appealing. You’d take a shot, maybe once a week BUT here’s the kicker-the insulin would only work in the presence of high blood sugar, so it would only work when it needed to work. This would be brilliant. Time Magazine published a very upbeat article on this last year, “Nanoparticles can now control blood sugar levels in Diabetics for Days at a Time”  You have to read the fine print to realise the “diabetics” were mice!   Still IF this could be made to work and it’s a complicated process of building an insulin cocktail that will “bond’ with elevated sugar levels, then it really would be an end to the highs and lows and all the consequent problems of diabetes.

Realistically, I can’t see this being even trialled in humans for many years.

Artificial Pancreas

Artificial pancreasInterestingly, the presentation/s at WDC were very positive about this technology. So positive in fact that Kate’s cynicism was put on hold but a talk I went to by a Professor from Westmead Children’s Hospital was much more downbeat about the viability of the artificial pancreas.   My view is somewhat mixed. I agree, that based on current technology, the closed loop is too big and bulky for everyday use BUT it’d be ok to use while you slept and, particularly for children, the ability to have perfect sugars for 7-10 hours of the day would be a big improvement, not to mention reducing the stress of parents and carers and doing away with the fear of the relatively rare but devastating “dead-in-bed” syndrome.

Given that we now have insulin pumps and CGMs and increasingly sophisticated algorithms for insulin dosage calculation, I think it makes sense that this technology will continue to be refined and may eventually be sophisticated and unobtrusive enough to be called an artificial pancreas.  I suspect that this technology will be expensive and like insulin pumps, will only be available to those who are by world standards, extremely wealthy.  Still glucometers used to be prohibitively expensive for everyone in the first two-thirds of the twentieth century but thanks to improved technology and market forces (the economies of scale from massive demand) they are relatively affordable in much of the world.

This isn’t the whole story on potential cures or on the impediments to turning ideas into reality. What do you think? Know of any projects in the pipeline or of problems/shortcomings in cure research.?  What about the claim that there are too many vested commercial interests to “allow” a cure for diabetes?   Is it a shortage of  Knowledge? Science? Money? Are promising cures “shut down” and how?  Let us know in the comments.

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