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May 17, 2002

Research: Cure

Question from Raleigh, North Carolina, USA:

When will results be released on the first phase of human trials involving INGAP? I would think they would at least have some initial results as to the success of the treatment. The fact that Procter and Gamble was willing to invest 30 million dollars in GMP companies would seem to say that the treatment has promising potential. What is your view on this new treatment? How does the progression of different drugs, treatments, and transplants towards a cure compare to progression to curative therapy such as implantable insulin pumps with continual sensors, artificial pancreases, or islet sheets? Just curious as to a professional's opinion on the status of the race to find a cure, a vaccine, or some type of curative therapy.

Answer:

To reply to your question fully is well beyond the scope of an e-mail, and, in any case, the answer rather depends on what kind of diabetes you are talking about.

At the present time if you have insufficiently controlled type 1A (autoimmune) diabetes, the Canadians have recently shown that islet cell transplantation can be very successful. The trouble though is that it took an average of two donors to achieve insulin independence, and there has to be a lifetime commitment to immunosuppressive drugs.

INGAP, (Islet Neogenesis Associated Protein) has certainly been shown to promote islet cell development from pancreatic duct tissue, but I have not so far seen the results of any clinical trials in man. Even supposing that the peptide could be synthesised at reasonable cost in type IA diabetes, there would still be the problem of the autoimmune response to overcome.

My own belief is that, in the relatively near future, it will be possible to develop surrogate insulin producing cells either from stem cells or by genetic engineering to overcome the donor problem, and there is already good evidence from other autoimmune conditions in man that lifetime tolerance can be induced permanently by a very brief autoimmune manipulation.

All this rather takes attention from the much more common type 2 diabetes, and here my prediction is that because of the relative convenience and success of diet, exercise and oral hypoglycemic agents, there will be a reluctance to promote any of the above possibilities until they become more surely developed and much less costly.

DOB