Posts tagged ‘type 1 diabetes’
A strict diet and insulin shots can’t always control type 1 diabetes. What people with the immune disorder really need are insulin-producing cells of their own – currently only available through a still-experimental procedure known as islet cell transplantation.
A new clinical trial at City of Hope will make that possible for some patients, with physicians in the newly launched Diabetes & Metabolism Research Institute at City of Hope now providing this transplantation to suitable candidates. The trial, they say, could be the first step in a multipronged effort to permanently cure type 1 diabetes.
The new phase I/II trial is open to adults with type 1 diabetes who have had the disease for more than five years and who experience frequent episodes of hypoglycemia or hypoglycemia unawareness, in which blood sugar drops precipitously without corresponding symptoms. Diabetic patients who have hypoglycemic unawareness are at risk of injuries and accidents, because the drop in their blood sugar can go undetected until they suddenly lose consciousness.
“We are one of only a few islet cell transplant programs in the country,” said Fouad Kandeel, M.D., Ph.D., chair of the Department of Clinical Diabetes, Endocrinology & Metabolism at City of Hope, who is leading the islet cell transplantation trial. “This trial, in addition to providing a much needed potential cure for patients with severe type 1 diabetes, will also be vital in opening the door to other major studies to address the medical needs of these patients.”
The goal of the trial is to further evaluate the effectiveness of transplantation as a treatment and possible cure for type 1 diabetes. Researchers also hope to gain a better understanding of the mechanisms of islet cell rejection if it occurs.
Henry Ford said it well: “Working together is success.” For biomedical researchers, this is especially true. The challenges they face often require expertise from multiple fields to find answers and solutions.
Scientists seeking cures for type 1 diabetes in particular must overcome biological, medical and technological barriers that make the disease particularly difficult to address. A breakthrough grant from The Leona M. and Harry B. Helmsley Charitable Trust will help.
Joyce Niland, Ph.D., the Edward and Estelle Alexander Chair in Information Sciences, is principal investigator on the three-year, $228,000 grant — the first obtained from the Helmsley Charitable Trust by a City of Hope investigator. It will support and encourage the attendance of diabetes researchers at annual Human Islet Cell Research Network (HIRN) conferences.
The HIRN was recently launched by the National Institute of Diabetes and Digestive and Kidney Diseases to understand how human beta cells — the cells in the pancreas that produce insulin — are lost in people with type 1 diabetes. Chief among the network’s objectives is to find innovative strategies to protect or replace functional beta cells in those living with the disease.
The network focuses on research that will lead to a greater understanding of the early stages of the type 1 diabetes disease process in humans. The grant from the trust will help make it easier for members to learn, collaborate and advance their work by providing opportunities for exchange of scientific ideas, fostering collaborations, generating additional joint projects and supporting junior investigators who may not otherwise be able to attend.
Diabetes affects nearly every organ in the body. In type 1 diabetes (previously called juvenile onset, or insulin-dependent, diabetes), its cause, and potentially its cure, can be found in the pancreas — home to islet cells which produce insulin, the hormone that enables the body to process sugar.
In people with type 1 diabetes — a lifelong condition — the body’s immune system attacks and kills the islet cells. Patients must inject themselves with insulin to control their blood sugar (known as glucose). Transplantation of healthy insulin-producing islet cells is the first step on the path to freedom from this constant struggle.
A leader in the field
Fouad Kandeel, M.D., Ph.D, chair of the Department of Clinical Diabetes, Endocrinology & Metabolism, was instrumental in launching City of Hope’s Islet Cell Transplantation Program. Since leading the first transplantation in 2004, he has pursued the safest and most effective methods of transplantation — using islet cells from donors — a far simpler procedure than transplantation of an entire pancreas.
As Kandeel works to perfect the protocols, or rules, for islet cell transplantation, he’s also working with other researchers and clinicians at City of Hope to create a comprehensive — potentially conclusive — approach to curing diabetes. » Continue Reading
City of Hope has a longstanding commitment to combating diabetes, a leading national and global health threat. Already, it’s scored some successes, from research that led to the development of synthetic human insulin – still used by millions of patients – to potentially lifesaving islet cell transplants.
Diabetes researchers here continue to push forward in the fields of epigenetics, immunology, developmental biology, translational medicine, obesity, nutrition and metabolism. A pioneer in translational research for diabetes, City of Hope serves as the West Coast’s leading center for islet cell therapy, and is a leader in epigenetics and molecular research. Its diabetes program is built on a rich history that started with its founder, Rachmiel Levine, M.D. He was the first scientist to describe the role of insulin in regulating glucose entry into the cell. That work led to an understanding of what’s now known as “insulin resistance,” the hallmark of type 2 diabetes.
Diabetes comes in two basic types. Type 1 diabetes is usually diagnosed in children and young adults. In this disease, the body attacks its own pancreatic islet cells, which produce insulin, a hormone needed to convert sugar, starches and other food into energy the body needs. In type 2 diabetes, the body doesn’t use insulin properly, leading to blood sugar levels that are higher than normal – also called hyperglycemia. At first, the pancreas produces extra insulin to compensate, but over time it isn’t able to keep up and can’t maintain normal glucose levels.
Researchers are working hard to make needles a thing of the past for people with type 1 diabetes. Islet transplantation is proving to be a powerful and promising way to do that, but the supply of islets is extremely limited. Teresa Ku, Ph.D., is working to find more islets, and a five-year, $1.9 million grant from the National Institutes of Health will help her do that.
Islets are groups of cells in the pancreas that produce insulin, the hormone that enables the body to process sugar. In people with type 1 diabetes, islets cells are damaged or destroyed. These patients must inject themselves with insulin to control their blood sugar levels.
By transplanting patients with healthy islets from donors, researchers hope to restore their ability to produce insulin in the body and eliminate the need for injections.
Unfortunately, donated islets are in very short supply. Current methods require at least two pancreases per patient to get enough islets for a successful transplant. So scientists such as Ku, an associate professor in the Division of Developmental & Translational Diabetes and Endocrine Research, are looking for ways to grow these insulin-producing cells in the laboratory to make large batches for later transplant.
Researchers already have used embryonic stem cells to make insulin-producing cells that can be transplanted, but those cells have been shown to carry a risk of cancer. Scientists believe that they can avoid the cancer risk by using stem cells from adult pancreases. » Continue Reading
Nearly 350 million people worldwide are coping with diabetes, and the disease is expected to be the seventh-leading cause of death by 2030. Aware of these grim statistics, researchers at City of Hope are committed to halting the global epidemic.
On the frontiers of epigenetic engineering
Art Riggs, Ph.D., chair of the Department of Diabetes and Metabolic Diseases Research, is focused on the possibilities within the field of epigenetics. A concept pioneered by Riggs, epigenetics refers to stable changes in gene expression, some of which can be passed on to future generations — but are not written into our genetic code.
Riggs is currently studying epigenetic engineering, the process of making epigenetic changes in stem or progenitor cells to impact how those cells differentiate, grow and mature. Riggs is collaborating with researchers throughout City of Hope’s Diabetes Research Center to find ways to use epigenetic engineering to increase the supply of beta cells for islet transplantation, and to improve regulatory T cells to reverse autoimmunity. » Continue Reading
City of Hope endocrinologist Raynald Samoa, M.D., has seen a lot of people struggle with their weight. His roots are in the South Pacific, a region that has eight of the 10 countries with the highest prevalence of obesity in the world, according to Forbes.com.
Now, as a physician, Samoa is committed to fighting obesity and its associated diseases, including diabetes. Here he offers insight into how certain lifestyle changes can make a dramatic difference in the lives of people with diabetes, whether young or old.
What is an endocrinologist, and who should see one?
An endocrinologist is a specialist who deals with hormonal issues and who is specifically trained to help patients with diabetes, thyroid disorders (including thyroid cancer), osteoporosis and many other hormonally based diseases.
Why is the prevalence of diabetes rising in the United States, particularly among children?
Type 2 diabetes prevalence is rising in the U.S., and many have associated the increase with the rise in obesity. Although the relationship between diabetes and obesity is not a direct one, they do share common causes, such as a high caloric intake and not enough exercise. As processed food has made food more accessible in the U.S., it has also made it easier to increase our caloric intake.
What can one do to prevent diabetes?
To prevent diabetes, one must understand the different types of diabetes:
- Type 1 diabetes is caused by a destruction of the cells in the pancreas that secrete insulin, the main hormone that helps control blood sugar. The destruction of these insulin-producing cells are caused by one’s own immune system. Although many preventive studies are being conducted, there has not been any consensus regarding the prevention of type 1 diabetes. There are some experts who propose that early feeding of cereal to infants may be a contributing factor.
- Type 2 diabetes is associated with weight gain. In type 2 diabetes, the body still secretes insulin but can’t use it effectively. If one can still secrete enough insulin, then blood sugars can still be controlled. But when one’s pancreas can’t secrete enough insulin, then blood sugars start to rise. Several landmark studies show that modifying one’s lifestyle via eating healthier and regular exercise is the best way to prevent type 2 diabetes. A medication called Metformin was also shown to prevent diabetes (but not as well as lifestyle modification) in high-risk patients.
It all starts with education. If people take simple steps like eating better and exercising, and make them a part of their routine for a lifetime, many can deter type 2 diabetes. They just need to know how. And in addition to our research, education is part of how City of Hope can help.
How is diabetes treated? Are there any new emerging therapies or techniques?
The mainstay for treatment of type 1 diabetes is to replace insulin. This can be done through injections either with a syringe, pen or an insulin pump. Newer studies are looking at the utility of transplanting pancreatic cells into patients with diabetes as a form of treatment, and currently is being studied for patients with low blood-sugar awareness. Type 2 diabetes treatment revolves around making one more sensitive to the effects of insulin and giving more insulin to control blood sugars.
Both types of diabetes require a multidisciplinary team. Treatment plans should include dietary education and follow-up, glucometer use to check blood sugars, identification and treatment of low blood sugars, and medication assessment. With type 2 diabetes, oral medications have been used to both improve insulin resistance and/or provide more insulin to control blood sugars.
Why did you choose this specialty?
I chose this specialty because I am strongly interested in the hormonal pathways that cause these diseases. The epidemic of diabetes that is sweeping across our country motivates me to take the best of science to help patients find the best way for them to live healthier.
Read more about options and approaches for treating diabetes in our Division of Molecular Diabetes Research section.
The Islets of Langerhans may sound like an exclusive tropical retreat, but they’re closer to home than you might think. These islets are found in the pancreas and hold precious treasures for researchers bent on finding cures for diabetes.
Commonly referred to as islets, they’re clusters of cells in the pancreas, containing 1,000 to 3,000 cells each – resembling small islands in the pancreatic tissue. The average healthy, adult pancreas contains about 1 million islets, and they make up about 3 to 4 percent of the organ. As treatments for diabetes advance, these cells are becoming a focus of procedures lauded as potential keys to curing the disease.
The islets are named after Paul Langerhans, a German physician who discovered in them 1869. They include four major types of cells working together to regulate blood sugar, which is why they’re an important factor in diabetes.
The most plentiful are the insulin-producing beta cells and the glucagon-producing alpha cells. In diabetes, the immune system attacks the beta cells, destroying them. Diabetic patients cannot produce insulin, the hormone which lowers blood glucose levels. » Continue Reading
H. Teresa Ku, Ph.D., believes adult pancreatic stem cells could hold the key to making a type 1 diabetes cure more widely available.
First, she has to prove they exist.
Transplantation of insulin-producing islet cells into the pancreas is one promising method for treating type 1 diabetes patients, particularly those with very advanced disease that can no longer be sufficiently managed with insulin shots.
But, of the 200,000 patients who fit this description, only 1 percent will be able to receive a transplant. The procedure requires two donor pancreases to gather enough healthy islet cells, and the precious organs are in short supply – with only 1,000 a year available for islet cell transplantation.
“I would argue this is a critical need,” said Ku, associate professor in the Department of Diabetes and Metabolic Diseases Research at City of Hope. “As we go through the numbers, 99 percent of those patients who are in need cannot have that beneficial transplantation.”