Recent breakthroughs
in Diabetes research
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
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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 pre-
clinical 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 immune-
suppressants 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.