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Diabetes Treatments Entering New Phase

Latest research aims at helping body heal itself

TUESDAY, Jan. 22, 2002 (HealthDayNews) -- The secret to curing Type I diabetes might be hidden within the body itself.

That idea is fueling some of the most important research on this chronic illness, which attacks and destroys the insulin-producing islet cells of the pancreas.

In series of research projects around the world, doctors and scientists are finding new ways to help the body regenerate damaged or even dead islet cells, thus restoring insulin production to almost normal levels. Insulin is a hormone that breaks down sugar in our bodies.

"A leading theory right now is that islet cells can be regenerated, whether that be via transplant, or through drugs designed to encourage new cell growth," says Dr. Loren Wissner-Greene, an endocrinologist at New York University Medical Center who specializes in the treatment of diabetes.

Type I diabetes tends to occur early in life, which is why it is sometimes called juvenile diabetes. Complications of the disease can include serious kidney and heart damage, as well as blindness. Type I diabetics account for 5 percent to 10 percent of the 16 million Americans who have diabetes. The current treatment involves injections of a laboratory version of insulin into the bloodstream up to eight times a day.

Soon, however, treatments may help the body to once again make its own supply of insulin.

Virginia researchers and Canadian scientists have developed INGAP -- short for Islets Neogenesis Associated Protein-Peptide. This gene tells proteins in the body to manufacture insulin-producing cells. In animals, the gene increases insulin levels and decreases glucose levels. A human trial is now underway, and subjects are still needed for that.

The gene "doesn't just treat symptoms; it goes to the root of diabetes by helping the body to overcome its insulin deficiency by producing what it needs on its own," says Wissner-Greene.

Another approach takes the concept even further, working to stop the initial destruction of the insulin-producing cells.

Discovered by a group of Israeli scientists who reported their findings only two months ago, this new treatment involves a protein known as DiaPep227. It helps trigger the body's alarm system, so it stops destroying the much-needed islet cells of the pancreas.

"What many people don't realize is that diabetes is an autoimmune disorder where the body turns on itself -- in this case, the pancreas -- and begins producing antibodies programmed to destroy what [are] otherwise healthy tissues and cells," says Dr. Kevan Herold, an endocrinologist at the Naomi Berrie Diabetes Center at Columbia Presbyterian Medical Center in New York City.

The new Israeli drug, says Herold, goes right to the source by telling the body to stop the cell destruction.

If started early enough, it may stop the progression of diabetes or even prevent it from occurring, says Herold, who is researching another form of immunotherapy for the disease.

The new drug he is testing is known by the complicated term huOKT3y (Ala-Ala). It is, he says, a modified version of a medication already used by kidney transplant patients to help stop rejection of their new organ. Herold believes it can help reverse newly diagnosed Type I diabetes. His study is ongoing.

"When administered within the first six weeks, results are very promising," he says.

For Wissner-Greene, both these new drugs may hold the most promise when used with other treatments.

"At some point, the best treatment of all may turn out to be a combination of the medications to stop the destruction of cells, and INGAP to help regenerate the growth of new cells," says Wissner-Greene.

If that one-two punch works, then it could play an important role in still another major development -- islet cell transplantation.

In this treatment, doctors remove islet cells from a donor pancreas and implant them into the liver of a diabetes patient, where they produce insulin. Because insulin is made by the pancreas and delivered to the liver, the location is proving to be a good site for the new cells.

"It is one of the most promising therapies being looked at today, and it could become a reality for many patients in the not-too-distant future," says Herold, who is developing a transplant program at Columbia Presbyterian.

The one caveat: To keep the body from rejecting the new cells, powerful immunosuppressants must be taken for life, and those drugs can have some powerful consequences of their own, not the least of which is increased susceptibility to disease.

However, a group of Canadian researchers are trying to wean patients off anti-rejection drugs slowly. In preliminary findings last year, the scientists reported promising results with islet cell transplantation. Herold says his research may eventually dovetail with that work.

While all these advances offer hope, Wissner-Greene is most excited about a treatment that's much closer to fruition -- inhaled insulin.

"This is a real breakthrough for diabetics, since it completely does away with insulin shots and may allow for better control of the disease," says Wissner-Greene.

Using a device much like that used by asthma patients, the diabetes patient inhales the insulin into the lungs, where tiny vessels move it directly into the bloodstream.

Experts predict inhaled insulin could probably be on the market, for use by adults, before the end of this year.

What To Do

For more information on diabetes, visit The American Diabetes Center.

For the latest research on Type I diabetes, visit The National Institute of Diabetes and Digestive and Kidney Diseases.

For the latest clinical trials on diabetes treatments, go here.

SOURCES: Interviews with Loren Wissner-Greene, M.D., endocrinologist and diabetes specialist, New York University Medical Center, New York City; Kevan Herold, M.D., endocrinologist, Naomi Berrie Diabetes Center, Columbia Presbyterian Medical Center, New York City
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