Health
Type 2 Diabetes, Type 1 Diabetes, Gestational Diabetes
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Type 1 diabetes is an autoimmune disorder that usually appears in childhood or early adulthood. It’s caused when the body’s immune system attacks and destroys the insulin-producing beta cells. Without insulin, the level of blood glucose climbs too high, which is known as hyperglycemia.
People who have type 1 diabetes must take injections to replace the insulin their body doesn’t make, as well as monitor and control their blood glucose level on a daily basis.
“At present, there is nothing that a patient can do to prevent type 1 diabetes,” says Joshua Miller, MD, medical director of diabetes care at Stony Brook Medicine in New York, who also manages a personal diagnosis of type 1 diabetes. There’s no cure for type 1 diabetes.
Nonetheless, there have been developments in donor cell transplantation, as well as artificial pancreas technology, that have shown some promise in the quest for helping these people achieve remission.
To understand some of these developments, it’s important to know what the pancreas’s islet cells (also known as islets of Langerhans) do. They make hormones that help the body break down glucose and use it for energy, including the beta cells that make insulin and allow your body to use or store glucose.
Islet Cell Transplantation
A growing field of treatment involves the transplantation of islet cells into a recipient with type 1 diabetes, in the hope that they will begin secreting the hormones that allow the independent regulation of blood sugar.
Among the most established of this type of procedure is pancreatic islet allotransplantation, in which the mature beta cells of a deceased donor are purified, processed, and transferred into a recipient.
The islet cells begin to secrete insulin soon after transplantation, but insulin injections are usually needed until the donated cells are fully functional. After that, the recipient may need less insulin or may not need to take it at all.
Yet the same autoimmune response that attacked the recipient’s original islet cells can strike the donated ones. Additionally, as with most organ donations, the recipient must take immunosuppressive drugs to stop the body from rejecting the transplanted islet cells. These drugs come with significant side effects and can raise one’s risk of developing cancer and bacterial or viral infections.
Dr. Miller’s perspective is that despite limited successes, such procedures are “very expensive, fraught with complications and risk, and not at all ready for prime time in terms of widespread application.”
He is more optimistic about the potential for transplant procedures that use innovative, protective methods to tackle the problem of donor cell rejection. “What transplant scientists are working on is how to package beta cells in the body so that they remain viable in someone who receives them,” he explains.
For instance, Sernova is conducting a human clinical trial in the United States for a pouch that encapsulates donor islet cells to protect them; it is implanted under the skin, where it incorporates itself into the recipient’s living tissue and supports vein and tissue growth.
People with type 1 diabetes who have hypoglycemia unawareness (a potentially life-threatening condition in which they are unaware of the signs that their blood sugar has dropped too low)
have been recruited to participate in the Sernova trial. This trial will include immunosuppressive therapy.
The company Vertex has similar therapies in development, including a pouch that uses implantable technology to protect and support transplanted pancreatic progenitor cells that are derived from embryonic stem cells. After the pouch is implanted into the recipient, the cells mature into islet cells that secrete insulin and regulate blood sugar levels.
Preliminary data for one patient showed that this therapy helped reduce A1C levels by 0.5 percent, giving researchers hope that this therapy improves blood glucose control. But larger studies are needed to be sure.
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