At the American Diabetes Association (ADA) 2016 Scientific Sessions, there was an exciting discussion on how doctors and scientists may be able to genetically engineer the beta cells in a pig’s pancreas and implant them into humans so that people with diabetes, who are no longer able to produce insulin, will produce insulin again. There was a second similar discussion on gene – editing donor stem cells to do the same thing.
This is not new news! There have been 1000 surgeries in the last 10 years where cells have been implanted into someone with type 1 diabetes and they have left the hospital 3 days later with no diabetes, according to Gordon C Weir, MD, professor of medicine at Harvard Medical School, and co-head of the Joslin Diabetes Centers. In these surgeries, cells from donor cadavers have been used. However it is the shortage of these cells that is preventing a greater number of people benefiting from this amazing surgery according to Dr Weir.
We are all aware that people can reject a transplanted organ or tissue. Dr David Cooper, MD, PhD, (Thomas E Starzl Transplantation Institute, Pittsburgh, Pennsylvania) explained that donor pigs can be genetically engineered to be protected from the human immune response, with a requirement for only minimal immunosuppression after the transplant. In terms of safety he believes pig pancreatic cells would actually be less likely than human islets to transmit viruses or other infectious agents because the animals can either be raised in biosecure housing or the cells themselves could be tested as they develop in the laboratory. The approach has been successful so far in monkey models of type 1 diabetes (Int J Surg. 2015;23:261-266). Currently Dr Cooper is actively pursuing sponsorship / funding to begin clinical trials in humans so we will try to not get too excited and will watch this space.
Dr Chad Cowan’s PhD, (Harvard Stem Cell Institute, Boston, Massachusetts) has already developed a method for generating hundreds of millions of insulin-producing pancreatic cells from human pluripotent stem cells. He hopes these cells will become “universal-donor” cells and usable for all types of transplantations in humans, not just pancreas cells. He believes he can remove the components from the cells that cause the organ/tissue to be rejected by humans. He does this by editing the gene. Gene-editing is similar to what takes place during pregnancy to keep the foetus from becoming rejected by the mother’s body and similar to cancer, where the cancer cells learns to evade our immune system and thrive.
Dr Weir cautioned that “It’s important not to make promises we can’t keep, but the field has tremendous momentum. In the end, it’s hard to imagine there won’t be a biological solution”. He added “The stuff that’s happening is dramatically different from where it was 5 years ago.”
Diabetes Ireland will watch this space with interest and keep you updated with any developments.
Meanwhile, closer to home, Diabetes Ireland supports research led by Professor Peter Jones, (Kings College London) who is developing new techniques using nano-technology to provide very thin porous coatings (built up from layers of only one cell thick) around the beta cells before transplantation. This layer protects cells but allows nutrients, glucose and insulin to flow in and out of the cell freely. Nano-encapsulated cells are significantly smaller than gel-coated cells and can be placed in a vein where they will be more effective. This is in comparison to normal practice where the gel-coated cells were placed in the abdominal cavity resulting in a lower proportion surviving and producing insulin.
If you are interested in donating to the Kings College project, you can donate on our website.