Wednesday, June 23, 2010

Steps toward the cure

There are so many different directions that the research towards the cure is heading.  I'm going to try to summarize some of the ones that I think are the most promising.  I will consider this a kind of time capsule that I can look back at in the years to come and see which one(s) were most successful.

The first is the artificial pancreas.  This one is probably going to be the first to come to the general population.  The JDRF is working hard to get this to fruition.  It involves an insulin pump and a continuous glucose monitor that are electronically connected.  The monitor will tell the pump how much insulin to deliver.  I am least excited about this one because it is electronic technology.  It will never be in the same real time as our bodies.

Islet cell transplantation is what I am experiencing.  Its not considered the cure because it requires immunosuppression and is not permanent.  As I have said many times before though, it sure seems close to the cure.  I don't need insulin, the side effects of the immunosuppressants (which I have had the experience of 3 regimens now) are easier tolerated than those of insulin.  They can make you uncomfortable, but not debilitated.  This research will serve as a major stepping stone for what is to come.  Here is a good summary of the field, and the CITR on the sidebar has the current information.  Here is a list of some past, present, and future clinical trials.

Building on this research is the encapsulation of islet cells.  This will eliminate the need for immunosuppression.  The capsules will allow the glucose and insulin to pass through, but not the antibodies that are trying to destroy it.  This sounds great, but it will probably be awhile before it becomes available because of difficulties in keeping the capsules viable.

A possible solution to some of these challenges is the Cell Pouch that has just been developed.  This is a pouch of islet cells that is implanted under the skin.  Its about the size of a credit card and has the same properties as the encapsulated islets, so no immunosuppression would be necessary.  The nice thing about this is that it can be replaced when the islets are no longer viable.  The worry that I have about how long this will last would not be an issue here.  The patient would just go in for another pouch.  The JDRF has not endorsed this yet.  I'm not sure if they question its claims, or if they are still deciding.

Another huge problem is the availability of islet cells.  A transplant like mine requires a cadaver pancreas.  There are not enough of these to cover even a small percentage of diabetics who need them.  So, to address this issue, xenotransplantation is being pursued.  In the US, the Spring Point Project at the U. of Minnesota will be the first to try this.  Pig islets can provide a continuous supply of islet cells.  This will serve to relieve many diabetics of their health problems and will also enhance the research of islet cell transplantation in general because of all of the data collected from so many more patients.  If islet transplantation is a stepping stone of the cure, pig islets will be the catalyst that gets us there faster.

A combination of some of these strategies that is taking place outside the US is happening at Living Cell Techologies in New Zealand.  They are transplanting encapsulated pig islet cells.  They have been having success with this and are continuing to try different approaches of this to see what works best.  They were able to get the xenotransplantation approved before we could here.  I have been following them for awhile and am very excited by what they are doing.

Another front of the research towards the cure is regeneration of islet cells.  This would not involve any surgery or new cells.  The goal is to get your body to remake its own islet cells.  The potential problem with this would be in how to keep your immune system from destroying these cells again.

One of the more promising fields is that of stem cell therapy.  There are two kinds of stem cells, embryonic and adult.  The embryonic stem cells are very controversial and the research is way behind because of the restraints imposed by the Bush administration.  Adult stem cells are derived from existing tissues and can be from your own tissue or from a donor.  This research is moving more swiftly because there are no moral restraints.  For the latest on Adult stem cell research, my fellow diabetes cure enthusiast and friend, Sandra, has the most update information as well as her own personal experience with her son.

Now I'll commit myself to how I think this will all play out.  It will be a process that involves all of these approaches.  I think that pig islets will be used for several, maybe many years.  The encapsulation and pouch systems will allow for multiple transplants as necessary.  The regeneration will help the Type 2 diabetics who still have some islet cells to regenerate.  Then islets will be generated using stem cells.  They will be from donors or pigs and will be encapsulated or in a pouch, but plentiful and able to be applied as necessary.  The final cure will be derived from all of this and will involve stem cells of the patient.  Islet cells will be made either within the patient's body or in a test tube and inserted into the pancreas.  The immunosuppression problem will be solved so that they are safe there. The cells will last forever, or might require boosters which again will be of a noninvasive procedure.

Whatever the future holds, I still maintain that everything that involves new islet cells and a biological cure is a long journey away from using insulin, and a short step away from the cure.

Thursday, June 3, 2010

Thoughts on the Cure

I enjoyed the group blog week that I participated in last month.  I had no idea that there were so many people writing about their experiences with diabetes. It was interesting reading and there are several that I will be following more closely.  Of course, the topic that interested me the most was the last day's in which we all wrote about how life would be after the cure.

There was a variety of responses ranging from no hope to plans to celebrate.  I started looking at them at random and then became so interested that I decided to read them all.  Then I decided to start taking some notes and consolidating the responses. Over 80 people responded.  These are the most common phrases:

Plans for a celebration 16
It would feel like a dream 10
It will not happen in my lifetime 7
I would appreciate the freedoms I would have 7
I believe it will happen 6
I would be so thankful 5
I have hope that it will happen 5
I will just live with having diabetes 5
There are parts of being diabetic that I would miss 5
I would enjoy not having these worries 5
If only it would happen 4
I would be so relieved 4
I can't even imagine a cure 3
I don't know 2
I would love to feel normal
I would love to be able to think of something else 
I would jump at the chance
It hurts to wish for it
And my favorite from Typical type 1 from a mouse's perspective.

My perspective is so different now.  Before my transplant, I couldn't even let my mind go all of the way there.  It seemed like too much and too impossible of a wish.  I guess I would have related to "It hurts to wish for it" the most.  Even during the screening process for the clinical trial, it felt like such a long shot.  Something that only happens to other people.  Thats why I applied to four sites, to increase my odds.

Now I feel that this is almost like a dream.  I have so many new freedoms.  I am so thankful to those who have made this possible....... and on and on through most of the other phrases above.  Even including the one about missing parts of being diabetic.  It's an eerie feeling to be living my old dreams and those of so many others.  I have very mixed emotions about it.  I feel very lucky and even a little guilty because its something that I can't share.  My identity is somewhat in limbo.  Its hard to decide which is the real me; the diabetic me or the no longer diabetic me.  Reading all of these thoughts that were written by people that I really respect  makes me feel so strongly that a cure has to be available to everyone.  And soon.

My next project is to organize some of the articles I've been reading and saving pertaining to the cure.  There are some really exciting projects happening now. They all seem to be so promising.   One of the things I like about working on this blog is thinking about how I will look back on some of these things that I have written in the years to come.  This post will arouse some feelings I know.  And it will be interesting to see if I was right about which research front will be the first to arrive.

I'm still feeling really good.  My blood sugars have stabilized.  They aren't as good as when I was on the Cellcept, but they're ok.  If they stay where they are, I'll be very happy.  My fastings range from about 80-120 and my post-prandials range from about 100-180.  Dr. Bellin increased my Rapamune from 5 to 6mg/day.  That seems to be helping, although I'm not really sure why.