June 30, 2001
Research: Cure
Question from New York, New York, USA:
The June 19, 2001 New York Times described research done on diabetic mice by Dr. Denise Faustman of Harvard Medical School, in which a drug called CFA was used to destroy the autoimmune cells that were responsible for the diabetes, with the result that the islet cells resumed making insulin. Our 13 year old son was diagnosed with type 1 diabetes about two months ago, and is presently in a honeymoon period (which we understand that we must assume that this will not continue indefinitely), so, at first, we were heartened by this research although we recognize that sometimes results obtained in animals cannot be replicated in humans), but now we have started to wonder about the following
If, after his honeymoon period ends and our son will have no islet cells left that are capable of making insulin, would this mean that, even if a treatment of the kind suggested by Dr. Faustman’s research were later to become available for humans, our son would then still have no islet cells left that could resume making insulin?
If the answer to this question is “yes,” would this suggest that it might be a good idea to remove some of our son’s islet cells by a biopsy performed while he still has some such cells left, and then to preserve them (by freezing or otherwise) so that they would be available if such a treatment ever became available? Otherwise, it would seem as though the only recourse would be to transplant islet cells from others, with all the problems of rejection and infection that such a course would entail. Obviously, this is a question of some urgency, because if we should be thinking about such a biopsy, the time may be quite short.
Answer:
There have been many studies showing that CFA or Froin’s Adjuvant can prevent the onset of diabetes in the NOD mouse. BCG which is a similar non-specific lymphocyte stimulant has also been used in humans to prolong the honeymoon period in type 1A (autoimmune) diabetes, and, like other attempts to do this, did not succeed.
With present technology, it would not be possible to remove enough islet cells by biopsy for an attempt at transplantation. Even if you could preserve them until all other islet cells were destroyed, the evidence is that reintroduction of these cells would again trigger a continuation of the autoimmune response.
Progress has been made with islet cell transplants, but the disadvantages remains that it requires two or more donors and sustained immunosuppression. It may be though that the technique of using specially encapsulated porcine islet cells may soon be made to work in a larger series.
DOB
Additional comments from Dr. Stuart Brink:
Great questions. Nobody knows the answers, unfortunately. Dr Faustman and her team have done great research but, as you suggest, results need to be replicated in other animals far before anyone will attempt similar projects in humans — and always we do such projects in adults before kids. There are many teams working on similar projects in the US and around the world so hopefully the research funding through ADA, JDRF and the NIH among other funding sources will continue.
SB
