Posts tagged ‘type 1 diabetes’


Made in City of Hope: A comprehensive approach to curing diabetes

November 28, 2014 | by

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.

Fouad Kandeel, M.D., Ph.D.

Fouad Kandeel was instrumental in launching City of Hope’s Islet Cell Transplantation Program. 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.

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


7 diabetes facts for World Diabetes Day

November 10, 2014 | by

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 blood sugar test

For World Diabetes Day, City of Hope shares some of the diabetes facts that drive the institution to keep looking for better treatments and a cure for this growing national and global health threat.

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.

To mark World Diabetes Day on Nov. 14, consider these diabetes facts. They drive our researchers year-round to keep looking for cures: » Continue Reading


Diabetes’ lasting harm, or ‘metabolic memory,’ may be linked to genes

May 12, 2014 | by

A landmark clinical trial in the mid-1980s changed the way type 1 diabetes is treated, but it also led to some lingering questions about the persistent effects of the disease. Now, researchers led by City of Hope’s Rama Natarajan, Ph.D., director of the Division of Molecular Diabetes Research, may have found some answers.

Natarajan Rama

Rama Natarajan, director of the Division of Molecular Diabetes Research, has discovered some clues to the “metabolic memory” experienced by diabetes patients.

So-called “metabolic memory” has puzzled scientists for decades. The condition refers to the enduring harmful effects of high blood sugar on the cardiovascular system. Researchers first uncovered the phenomenon during a long-running diabetes clinical trial that compared the effects of standard control of blood sugar versus intensive control.

Standard control involved one to two insulin injections per day and normal monitoring by a physician. Intensive control used three to four insulin injections and rigorous medical supervision aimed at keeping blood sugar as close to normal as possible. The study showed that intensive therapy significantly reduced the risk of many diabetes complications, such as kidney and eye disease, compared to standard therapy. The results were so clear it led researchers to propose that the intensive therapy be made the new standard of care.

Scientists were surprised by another result, however. Patients who started with standard diabetes therapy but switched to intensive therapy still had significantly higher risk of kidney, eye and cardiovascular diseases later in life. In other words, moving patients from standard to intensive therapy did not reverse or halt the harm done by high blood sugar levels. The body “remembered” the sugar’s effects, and damage to heart and blood vessel tissues continued to build over the years.

Natarajan and her team at City of Hope, along with collaborators from other institutions, found strong evidence that epigenetic modifications could be the culprit. These chemical changes, which occur within chromosomes, can hinder or boost the activity of genes. » Continue Reading


Diabetes researcher’s hunt for islet cells gets $1.9 million NIH boost

May 2, 2014 | by

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.

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.

Teresa Ku received a five-year, $1.9 million grant from the National Institutes of Health to produce more islet cells to treat type 1 diabetes.

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


Diabetes research: From epigenetics to islet cell transplants

January 5, 2014 | by

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.

Islet cells produce insulin

Researchers at City of Hope are working on multiple fronts to make islet transplantation a viable option for patients.

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


Meet our doctors: Endocrinologist Raynald Samoa on diabetes

October 12, 2013 | by

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.

Dr. Raynald Samoa says eating better and exercising can deter type 2 diabetes.

Raynald Samoa, a City of Hope endocrinologist, says eating better and exercising can reduce the risk of type 2 diabetes.

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.


Treasure islets: Pancreatic cells hold promise for diabetes

July 12, 2013 | by

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.

The Islets of Langerhans are clusters of cells in the pancreas, which include insulin-producing cells. In patients with type 1 diabetes, the immune system attacks and kills these cells.

The Islets of Langerhans are clusters of cells in the pancreas, which include insulin-producing cells. In patients with type 1 diabetes, the immune system attacks and kills these cells. (Photo credit: Ivan Todorov)

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


Diabetes researcher’s quest: Find adult pancreatic stem cells

May 24, 2013 | by

H. Teresa Ku, Ph.D., believes adult pancreatic stem cells could hold the key to making a type 1 diabetes cure more widely available.

    In type 1 diabetes, insulin-producing islet cells in the pancreas are killed by the immune system. Researchers hope to use stem cells to cultivate islet cells for transplantation.

In type 1 diabetes, insulin-producing islet cells in the pancreas are killed by the immune system. Researchers hope to use stem cells to cultivate islet cells for transplantation. (Credit: Ivan Todorov)

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.”

» Continue Reading


Diabetes and islet cells: The quest for a permanent cure

March 6, 2013 | by

Not all diabetes researchers are obsessed with islet cells – just many of them. And for good reason. Diabetes destroys the islet cells that produce insulin, a hormone necessary to regulate blood sugar.

Pancreas, highlighted

In diabetes, the body destroys insulin-producing cells in the pancreas, highlighted here. Researchers hope to replace those cells.

Researchers at the Diabetes Research Center at City of Hope, one of the most influential diabetes research programs in the world, are working on impressive array of approaches to diabetes treatment and cure, as detailed in a previous story.  But the work on islet cells is impressive for its variety as well.

Here are some of the recent developments connected to islet cells.

Devising better treatment options for type 1 diabetes patients

Director of the Division of Molecular Diabetes Research, Fouad Kandeel, M.D., Ph.D., is an international leader in the research effort to realize islet cell transplantation as a cure for people with type 1 diabetes, completely freeing them of the need for daily insulin injections.

In addition to perfecting clinical transplantation protocols, he has developed imaging methods that enable physicians to assess the health of islets after transplantation by visualizing them within the body in real-time. The ability to closely monitor the activity of transplanted islets will help improve efforts to prolong islet survival and function. » Continue Reading


Diabetes researcher’s goal: Make insulin-producing cells in lab

January 29, 2013 | by

As people diagnosed with type 1 diabetes know all too well, their disease is caused by their own immune system’s destruction of insulin-producing cells in the pancreas. Treatments exist, but there is no long-term  cure.

Pancreas, highlighted

In diabetes, the body destroys insulin-producing cells in the pancreas, highlighted here.

Insulin can stabilize blood sugar levels, but dosage is sometimes difficult to determine and manage, resulting in hypoglycemia. Over time, poor management of blood sugar levels can lead to kidney failure, cardiovascular disease and stroke.

Because nothing is as good as one’s own cells, some City of Hope investigators have been focused on finding a way to replace pancreatic cells destroyed by the disease. One method is through islet cell transplantation.

In this approach, pancreatic islets, which contain the insulin-producing cells, are transplanted from deceased donors to  patients with diabetes.  City of Hope investigators have conducted phase I clinical trials in this area and have been able to help patients decrease their use of insulin or become insulin independent for at least one year.

Still, this is a costly approach. It takes two donor pancreases to provide enough islet cells to conduct the procedure. Further, pancreases are in short supply. As a result, only 1 percent of those patients who would be eligible for islet cell transplantation are able to benefit from it. Thus, it is urgent that scientists be able to find other sources of insulin-producing cells. » Continue Reading