Diabetes: Scientific Research for Type I Diabetes (cont.)
Moderator: Will this new protocol be replicated elsewhere so more people can participate (again referring to the transplant)?
Dr. Furlanetto: Initially, the studies were done in Edmonton, Alberta, Canada, and eight patients were transplanted. All eight became insulin independent, which was very exciting. The study will now be extended to include 32 patients in the US and Europe in the next 12 to 18 months. Hopefully, many more will then be included.
Moderator: How many pancreases does it take to do this transplant?
Dr. Furlanetto: Currently as it is done at Edmonton, they took islets isolated from two pancreases to cure each patient. One of the first things that researchers will do will be to try to improve on this and cure patients with a single pancreas. This, of course, would double the number of patients who could be treated and essentially halve the cost of therapy.
Moderator: What are some of the biggest challenges you face when researching a cure for Type I diabetes?
Dr. Furlanetto: From a JDF (Juvenile Diabetes Foundation) perspective, one of our major goals has been to recruit more researchers into the field. More researchers will mean more original ideas and more interest in the problems. We think that new advances depend on having new ideas.
Moderator: How does one go about becoming a participant in one of the trials go on or coming up?
Dr. Furlanetto: The trials that are sponsored by JDF funded researchers are posted on the JDF web site. This web site also has links to other sites where other government and industry research is posted. Patients can read the study design, determine if they're eligible for the studies, and phone numbers to contact the researchers are included. However, people interested in participating in research studies should be aware that this is clinical research, and no guarantees are made. They should familiarize themselves with the rights of patients enrolling in studies, and the obligations of the researchers performing them. Only when they've had all of their questions answered should they volunteer to participate. Patient safety is really our utmost concern. The web site address www.jdf.org .
girlsarefun_WebMD: How long before the islet transplant would become reality to the general population (considering current status, cost/reimbursements, etc.)?
Dr. Furlanetto: It is not a matter of cost as much as it is availability of islets and perfecting the techniques themselves. The Edmonton study is only a first step and we would expect that within the next few years, great advances will be made in improving it. It will become safer, we'll learn better about the drugs we're using, and hopefully, we can use fewer pancreases. Right now, the real limiting factor may turn out to be the number of pancreases available. About 30,000 are donated per year, which barely keeps up with the number of new patients. To cure 1 million patients, would take a lot of pancreases. JDF is supporting research aimed at developing beta cells in the laboratory. Hopefully, this could provide an inexhaustible supply of beta cells, but it's a long way off.
Moderator: Is there a push for more Pancreases donors? Or what is the likelihood of creating a pancreases?
Dr. Furlanetto: There are a number of studies which suggest that we can get beta cells to increase in number in cell culture, that is, in a laboratory. There is also research aimed at developing new beta cells using a variety of techniques. The past year, there have been a few reports which have shown success with mouse beta cells, and now people are turning their attention to doing similar studies with human beta cells. The question of pancreas donors is really a question of organ donation in general. A number of organizations are trying to increase awareness of the need for organ donation to cure diabetes, but also kidney disease, liver disease, heart disease, and many other illnesses. Efforts are important, but in the case of diabetes, I doubt that we will ever be able to get enough pancreases to truly cure everyone.
Moderator: Is there a preventative diabetes vaccine being worked on?
Dr. Furlanetto: YES. This has become an area of interest in the last few years. There are two studies underway, one in the US and one in Europe, to try to prevent diabetes from occurring in people who are at risk for developing the disease. The results are not available for either study, so we can't say if it is working yet. The JDF has also initiated a large program to develop new vaccines for preventing Type I diabetes. We've been joined by the Australian Medical Research Council, and we expect the National Institutes of Health to also support this. We really believe that prevention of Type I diabetes is possible, and will be the most cost effective method of treating Type I diabetes.
cddcgd_WebMD: Have pancreas transplants from animals been done?
Dr. Furlanetto: Animal pancreas and islet transplants have not been done in humans. There has been considerable research aimed at trying to perfect this technique using animal models. The JDF supports a large effort aimed at determining if animal islets can be transplanted into humans. The species of choice is pigs. Their metabolism is very much like humans, and their islets respond to similar blood sugars and nutrients. However, the barrier to transplanting between species is even greater than that within a species, so it has proved quite difficult. Nonetheless, pig islets are readily available, and if they could be transplanted, there probably would not be a supply problem limiting therapy.