There is no knowing how soon scientists will find a cure for Type 1 diabetes, but the illness is one of several autoimmune disorders occupying the workweeks of hundreds of scientists. They are busy investigating the human immune system to discover why a person’s antibodies attack healthy cells in the body.
“It’s hard to predict which autoimmune disorder will be the first one” for which a cure or preventive method is perfected, said Jeffrey Bluestone, a University of Chicago scientist and director of the recently launched $144 million Collaborative Network for Clinical Research on Immune Tolerance.
The ambitious multicenter research project is aimed at pooling the resources of scientists and what they know about immune systems gone awry. It is scheduled on a seven-year timeline. More than 50 million Americans are affected by autoimmune diseases such as Type 1 diabetes, multiple sclerosis, lupus and rheumatoid arthritis.
Just last year, Yale University researchers confirmed Type 1 diabetes is an autoimmune disorder by identifying a certain protein that stimulates the autoimmune or self-destructing response. The protein, known as GAD, is the target of cytotoxic T cells that are the destroyer mechanisms. Researchers say the findings might help develop a diabetes vaccine or help more accurately screen people at the highest risk.
“Autoimmune diseases are multiple disorders whether you are talking about Type 1 diabetes, rheumatoid arthritis or multiple sclerosis,” said Bluestone. “You want to catch a condition like diabetes early on, before a person is fully diabetic when the pancreas still has some function.”
One new major clinical research trial aims at just that time frame. The Diabetes Prevention Trial, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, identifies family members of diabetics who are considered at risk for developing Type 1 diabetes themselves, then treats them with low doses of insulin or oral insulin-like capsules.
“We have much better methods for determining who is at risk,” said Dr. Mary Ann Emanuele, an endocrinologist at Loyola University Medical Center in Maywood. “It is an exciting prospect to prevent diabetes before it can do the most serious damage.”
Another promising area of research for a cure involves islet cells in the pancreas. These cells (also known as beta cells) produce insulin. Scientists and doctors are beginning to transplant beta cell capsules into diabetic patients to see if transferring such tissue to a diabetic’s pancreas can help revive insulin production.
The process figures to be as slow as it is careful. The body’s natural reaction is to attack the transplanted cells, so researchers are looking at ways to best implant the beta cells so they will remain functional in the new pancreas. For example, two challenges are exactly where to put the beta cell capsules (near the liver seems optimal so far) and how big to make the capsules’ pores (which are microscopic) so beta cells get out but killer cells don’t get in.
Transplanting the whole pancreas is a highly invasive procedure and not a feasible solution unless a diabetic experiences kidney failure and will be having kidney transplantation anyway.
“Patients hear about the islet cell therapy and get excited,” said Emanuele. “We have to tell them the technology is still years away.”
But that doesn’t mean experts such as Bluestone or Emanuele are pessimistic. Bluestone, for one, said vaccinations are entirely possible in the future (no guess on the number of years) and he is clearly enthused about immune tolerance, which focuses on selectively disabling the immune system so it doesn’t attack healthy cells.
“Fifty years ago people were getting cow thyroid shots for hypothyroidism, which is an underactive thyroid,” said Emanuele. “Today, people with hypothyroidism take a single pill (typically a synthetic form of thyroid) to control their symptoms. Who’s to say we won’t be shaking our heads at somebody having to take daily insulin shots in 20 years?”
