As of yet, we don't have a simple one-time fix on hand, because being diagnosed with type 1 diabetes means a lifetime ofinsulin injections.
Each breakthrough promising a cure for diabetes has encountered significant hurdles, making it not viable for most people. 9 million people around the world have this condition, and researchers in the US have improved upon one type of transplant-based treatment.
The immune system is a tightly controlled defense mechanism that ensures the wellbeing of individuals in an environment full of infections, according to one of the researchers.
When the immune system misidentifies the cells in the pancreas as infections, type 1 diabetes develops.
The immune cells of the body destroy the islets of the cells that produceinsulin, which are grouped into clusters.
An islet cell transplant, or a transplant of an entire pancreas, are helpful treatments. People who receive transplants need to take immunosuppressive drugs for the rest of their lives to make sure the rogue immune cells don't destroy the new tissue as well.
The team writes in their new paper that transplant recipients must be immune suppressed for the rest of their lives with agents that are toxic to the recipient and may induce peripheralinsulin resistance.
The application of islet transplantation as a cure for type 1 diabetes will be made easier by the development of tolerogenic regimens that do not need immunosuppression.
In a study using cynomolgus monkeys, the team had great success by combining islets with a microgel containing a proteins involved in cell death.
A type of apoptosis occurs when a molecule called FasL interacts with another molecule called Fas on rogue immune cells, and it causes them to die.
Our team pioneered a technology that enabled the production of a novel form of FasL and its presentation on transplanted islet cells or microgels to prevent being rejected by rogue cells.
Following islet cell transplantation, rogue cells mobilize to the graft for destruction but are eliminated by FasL, engaging Fas on their surface.
There are other changes from a traditional transplant. The researchers formed a pouch in the omentum, a large flat layer of fat tissue just below the stomach, instead of using the typical clinical route.
The omentum is a non-vital organ, which should make it easier to remove.
The omentum is a safer location for transplants to treat diabetes and may be particularly suited for stem-cell-derived beta cells and bio- engineered cells.
Four of the monkeys received the microgels, while three others did not. Rapamycin was given to the monkeys for three months after the transplant surgery.
After this, the drugs were stopped and the monkeys that had received the FasL treatment all maintained their glycemic control for the entire study period.
The experiment had to be cut short due to COVID-19 but compared to the controls, this is a great result.
The strategy to create a local immune-privileged environment allowed islets to survive without long-term immunosuppression and achieved robust blood sugar control in all nonhuman primates during a six-month study period, says Lei.
We believe that our approach allows the transplants to survive and control diabetes for much longer than six months without anti-rejection drugs because surgical removal of the transplant tissue at the end of the study resulted in all animals promptly returning to a diabetic state.
There is still a long way to go before a type 1 diabetes patient can expect to receive something.
Despite being very similar, monkeys are not humans. The omentum in monkeys is thinner than in humans, so the results could be different.
We need more research to find out.
Nevertheless, this is an impressive result, and members of the team have filed a patient and started a new company to bring their findings to clinical trials.
The research has been published.
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