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.

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