Embryonic Stem Cells Make Insulin

[My_Dana]

Check this out -

"Doctors may be one step closer to using stem cells to cure diabetes, according to a new study by researchers at the stem cell engineering company Novacell, Inc. in San Diego who report that they managed to convert human embryonic stem cells into insulin-producing cells."

http://abcnews.go.com/Health/DiabetesResource/story?id=4318544&page=1

[WestinsMom]

If we could get all the scientist to work together... Lots of promising research out there.

[Pavlos]

Three cheers to them :)

[brokenheart]

Check this out -

"Doctors may be one step closer to using stem cells to cure diabetes, according to a new study by researchers at the stem cell engineering company Novacell, Inc. in San Diego who report that they managed to convert human embryonic stem cells into insulin-producing cells."

http://abcnews.go.com/Health/DiabetesResource/story?id=4318544&page=1

But, the problem is that a T1D patient's immune system keeps killing islet cells. In other words, somehow the immune system has to be fixed. Am I right? Please correct me if I am wrong.

[Ali]

This is what I understand also. So the possible solutions (that I have read about) are immune suppressant drugs, encapsulated cells like the New Zealand Co. is working on, or a rich enough supply of cells that you could just restock people once a year with new cells to replace the ones lost during the past year. Ali


But, the problem is that a T1D patient's immune system keeps killing islet cells. In other words, somehow the immune system has to be fixed. Am I right? Please correct me if I am wrong.

[My_Dana]

You are correct.
This has been my quest.
There are many ways to make insulin producing cells.
Stem cells are probably the most promising.

However as you mentioned, we need to find the cause to stop the destruction process.
Some protein, enzyme, virus...is still at large triggering the antibodies to attack.

That is why I get frustrated when most studies constantly want to look at genes. Yes, genes are obviously involved.
BUT, we hear time and time and again that around 10% of T1s' are genetic and 90% are not. So what is causing the 90%!

Find that and now you can fix it.

[brokenheart]

This is what I understand also. So the possible solutions (that I have read about) are immune suppressant drugs, encapsulated cells like the New Zealand Co. is working on, or a rich enough supply of cells that you could just restock people once a year with new cells to replace the ones lost during the past year. Ali

Immune suppressant drugs? I don't think anything that involves suppressing the immune system is a solution.

If I have to suppress my immune system, I would rather stay with insulin shots/pump.

[CDoyle1013]

Well, actually immune system modification is the study of Dr. Faustman that a previous thread addresses. Also, Dr. Burt from Northwestern University went to Brazil for a study (with some teens - see that happen in the USA) of newly diagnosed Type 1's...Blood was withdrawn from the subjects, cleaned and treated. The subjects' immune systems were reduced to nothing...using chemo I believe. The cleaned blood was re-introduced into the patients' respective bodies and they have been "cured" of their diabetes. The study is monitoring how long they can remain diabetes free

[brokenheart]

Well, actually immune system modification is the study of Dr. Faustman that a previous thread addresses. Also, Dr. Burt from Northwestern University went to Brazil for a study (with some teens - see that happen in the USA) of newly diagnosed Type 1's...Blood was withdrawn from the subjects, cleaned and treated. The subjects' immune systems were reduced to nothing...using chemo I believe. The cleaned blood was re-introduced into the patients' respective bodies and they have been "cured" of their diabetes. The study is monitoring how long they can remain diabetes free

That's absolutely interesting. I went to Dr. Faustman's web, but could not find the article. Do you mind sharing the article? Thanks.

[CDoyle1013]

This particular research was not part of Faustman's research. It was headed by Northwestern University MD, Dr. Burt. Google: Brazil, Dr. Burt, stem cells..the following is the Associated Press article

updated 5:43 p.m. MT, Tues., April. 10, 2007
Thirteen young diabetics in Brazil have ditched their insulin shots and need no other medication thanks to a risky, but promising treatment with their own stem cells — apparently the first time such a feat has been accomplished.

Though too early to call it a cure, the procedure has enabled the young people, who have type 1 diabetes, to live insulin-free so far, some as long as three years. The treatment involves stem cell transplants from the patients’ own blood.

“It’s the first time in the history of type 1 diabetes where people have gone with no treatment whatsoever ... no medications at all, with normal blood sugars,” said study co-author Dr. Richard Burt of Northwestern University’s medical school in Chicago.

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While the procedure can be potentially life-threatening, none of the 15 patients in the study died or suffered lasting side effects. But it didn’t work for two of them.

Larger, more rigorous studies are needed to determine if stem cell transplants could become standard treatment for people with the disease once called juvenile diabetes. It is less common than type 2 diabetes, which is associated with obesity.

The hazards of stem cell transplantation also raise questions about whether the study should have included children. One patient was as young as 14.

Dr. Lainie Ross, a medical ethicist at the University of Chicago, said the researchers should have studied adults first before exposing young teens to the potential harms of stem cell transplant, which include infertility and late-onset cancers.

In addition, Ross said that the study should have had a comparison group to make sure the treatment was indeed better than standard diabetes care.

Ethical questions
Burt, who wrote the study protocol, said the research was done in Brazil because U.S. doctors were not interested in the approach. The study was approved by ethics committees in Brazil, he said, adding that he personally believes it was appropriate to do the research in children as well as adults, as long as the Brazilian ethics panels approved.

Burt and other diabetes experts called the results an important step forward.

“It’s the threshold of a very promising time for the field,” said Dr. Jay Skyler of the Diabetes Research Institute at the University of Miami.

Skyler wrote an editorial in the Journal of the American Medical Association, which published the study, saying the results are likely to stimulate research that may lead to methods of preventing or reversing type 1 diabetes. Test yourself

Diabetes: How much do you know?


“These are exciting results. They look impressive,” said Dr. Gordon Weir of Joslin Diabetes Center in Boston.

Still, Weir cautioned that more studies are needed to make sure the treatment works and is safe. “It’s really too early to suggest to people that this is a cure,” he said.

The patients involved were ages 14 to 31 and newly diagnosed with type 1 diabetes. An estimated 12 million to 24 million people worldwide — including 1 to 2 million in the United States — have this form of diabetes, which is typically diagnosed in children or young adults. An autoimmune disease, it occurs when the body attacks insulin-producing cells in the pancreas.

Insulin is needed to regulate blood sugar levels, which when too high, can lead to heart disease, blindness, nerve problems and kidney damage.

Burt said the stem cell transplant is designed to stop the body’s immune attack on the pancreas.

A study published last year described a different kind of experimental transplant, using pancreas cells from donated cadavers, that enabled a few diabetics to give up insulin shots. But that requires lifelong use of anti-rejection medicine, which isn’t needed by the Brazil patients since the stem cells were their own.

The 15 diabetics were treated at a bone marrow center at the University of Sao Paulo.

All were newly diagnosed, before their insulin-producing cells had been destroyed.

Timing key
That timing is key, Burt said. “If you wait too long,” he said, “you’ve exceeded the body’s ability to repair itself.”

The procedure involves stimulating the body to produce new stem cells and harvesting them from the patient’s blood. Next comes several days of high-dose chemotherapy, which virtually shuts down the patient’s immune system and stops destruction of the few remaining insulin-producing cells in the body. This requires hospitalization and potent drugs to fend off infection. The harvested stem cells, when injected back into the body, build a new healthier immune system that does not attack the insulin-producing cells.

Patients were hospitalized for about three weeks. Many had side effects including nausea, vomiting and hair loss. One developed pneumonia, the only severe complication.


Click for related content
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Read the JAMA report on the procedure



Doctors changed the drug regimen after the treatment failed in the first patient, who ended up needing more insulin than before the study. Another patient also relapsed.

The remaining 13 “live a normal life without taking insulin,” said study co-author Dr. Julio Voltarelli of the University of Sao Paulo. “They all went back to their lives.”

The patients enrolled in the study at different times so the length of time they’ve been insulin-free also differs.

Burt has had some success using the same procedure in 170 patients with other autoimmune diseases, including lupus and multiple sclerosis; one patient with an autoimmune form of blindness can now see, Burt said.

“The body has tremendous potential to repair,” he said.

The study was partly funded by the Brazilian Ministry of Health, Genzyme Corp. and a maker of blood sugar monitoring products.

FACT FILE Diabetes

[Ellen]

Full text of teh JAMA article is here

http://jama.ama-assn.org/cgi/reprint/297/14/1568

It's been a long time since I read this article but I recall the news reports greatly exaggerated the claims. I don't think this toxic immunosuppression is anything I would allow to be done to my otherwise healthy child with new onset diabetes. Maybe we should write to Dr. Voltarelli and ask the status of the patients today.

[CDoyle1013]

Ellen, most parents with whom I have discussed this research agree with you as do I...why would one want their child to undergo such a horrendous treatment with all the risks...but the trial does make us look at information regarding the immune system and how the body can correct itself. I remember when even JDRF rebuked Diane Faustman and funded research in an attempt to disprove her (which ended up the other way around!). I am just so glad that there are so many smart people that are seemingly in a race amongst themselves (researchers can be very competitive people) to find that elusive cure. (Remember the guy in Florida that mutated tobacco and then lettuce leaves to "cure" diabetes and restore a beta cell like fuction in the intestinal tract - I wonder how his trials are going). My nephew (a prior recipient of JDRF research funds) thinks a "cure" is out about a decade...15 years at most. I believe that he leans towards counting on hESC for that cure. (Thanks for the download...I love dissecting the microbiological terms...usually takes me about a month to translate into somewhat of an understanding of the article - the body is one miraculous system)

[brokenheart]

OK, but it says that this treatment is life-threatening. Would love to see improvement.

[buggle]

Does anyone have close contact with the Faustman lab? They are fairly far into Phase I trails now. I know they must have some indication if the treatment is showing an increase of TNF (tumor necrotic factor, which attacks the rogue T-cells) in diabetics.

Here's the latest newsletter about the project:

http://www.faustmanlab.org/News/FaustmannSpring2008Newsltr.pdf

My husband and I have given a lot of thought as to whether we'd enroll our son in her trials if they open up to children (currently only 18 and over). This treatment uses the TB vaccine. It's been used for 80 years all over the world, but not at the doses and number of times that will likely be required for diabetes treatment.

One thing I like about her approach is that she didn't immediately run and sell the idea to the pharm and biotech companies. They could easily use another drug that isn't cheap and generic to make the price exorbitant if this treatment works. If this does show promise, it will be available to kids all over the world and will be cost effective, even in poor countries.

The work of the Toronto group on Substance P looks interesting. But, they immediately patented everything to do with it and it's now all owned by a company. sigh... Many years ago, I purchased Substance P for some research and it was incredibly cheap. So, I'd think that this research would potentially be useful to people everywhere. But, profit always rears its ugly head. It's easy to make a slight alteration to a molecule, so you can retain the biological activity and then introduce a new drug and patent it and raise the price to outlandish levels. When you think about public money funding all of the initial research... it's disillusioning.

The thing that worries the most about diabetes research is what a huge business and money-making market our current treatment is. I'm sure the corporations don't want to give that market up. Is anyone else as skeptical as I am about this? It makes me worry that if a cure is found, it will be stalled and stalled.

[CDoyle1013]

I, too, am skeptical to a point...I start thinking about all of the "cures" for many diseases in the past and how far humans have come in negating disease. The issue that still drives me nuts is the egos between researchers and their facilities and donors. JDRF's refusal to fund Faustman was a decision fronted by 2 of her research equals. Then JDRF goes out to fund three studies to try to DISPROVE HER (which resulted in support of her conclusions - in opposite of what JDRF tried to do) drives me nuts. I mean, I cannot turn my back on raising funds to cure diabetes but sometimes I wonder about JDRF and whether they want to stay banded as a nonprofit...Do they really want to go out of business. That is how cynical I get.

[Ellen]

Full text of teh JAMA article is here

http://jama.ama-assn.org/cgi/reprint/297/14/1568

It's been a long time since I read this article but I recall the news reports greatly exaggerated the claims. I don't think this toxic immunosuppression is anything I would allow to be done to my otherwise healthy child with new onset diabetes. Maybe we should write to Dr. Voltarelli and ask the status of the patients today.

I wrote to Dr. Voltarelli about the status. Here is his reply on 4/7/2008:

All our patients were transplanted<6 wks from diagnosis. All 18 pts w/o previous ketoacidosis stopped insulin use, 6 resumed insulin use, 12 are insulin free so far. We'll update our results in the literature when we have a longer followup. Regards, Julio Voltarelli, MD.