July 27, 2003
Research: Cure
Question from Portland, Oregon, USA:
I’ve read a lot about a new therapy option some people say can cure type 1 diabetes all together. The therapy includes shielding the cells that produce insulin off in such a way that the immune system can’t attack them, but the insulin produced in the cells is let through. That may be nice but I really don’t think this works for everyone with the condition, especially in cases (such as mine) where the immune system attacks the insulin itself, and not the cells producing it. Shielding the cells off would only be a therapy/cure for people who’s immune system attacks the actual cells. Am I correct? (After all, it’s irrelevant in my case if the insulin is allowed to ‘pass’, my immune system will attack it anyway, regardless of if the cells are shielded off) Am I right? I just need a confirmation.
I really want to know this as people keep on talking about ‘cure’ (I’m suspicious about that anyway), but that question keeps on popping up in my head and no one can answer it.
Answer:
You are talking very theoretical immunological research. Most people think that the major autoimmune attack is against the beta cell itself. While there are antibodies made against insulin, this is not likely the major pathophysiologic dilemma but supposedly only a secondary phenomenon. Therefore, if the body could be protected against attacking the proteins (islet cell antibodies, GAD 65 antibody, for example) of the beta cell itself, then the autoimmune attack would be halted.
A key trick would be identifying such potential attacks early enough to allow such treatment. By the time most people show up with high sugars, they have lost more than 80% of their beta cell capacity, so it is already very late. However, to prevent repeat attacks on beta cells would allow transplantation to occur whole pancreas, partial pancreas and beta cells — without immunosuppression and the side effects of immunosuppression, but the research is still research.
SB
