Yes, immunity is the big problem. You probably need to replenish the islets either way. Also, I don't think doctors would be content giving someone that isn't suppressed this without loads of research.
More groundbreaking research funded by the NIH. It's sad to think about how much the US is going to lose with the arbitrary slashing and burning and purging.
So it's a trade-off between increased risk of cancer[0] and the consequences of type 1 diabetes? Doesn't sound like a fun trade-off but I don't know anything.
I don't think that's how Type I Diabetes works. People get Type I Diabetes because their immune system attacked their own insulin producing cells in the first place. It's an autoimmune disease. So if you replenish those cells, they'll just get attacked again.
If you take rapamycin or a rapalog as an anti-rejection drug, your risk of cancer is lower - not higher - because it's not actually an immune suppressant so much as a drug that prevents hyperimmunity. [1] Other immune suppressants work differently but it's not a blanket true statement that taking anti-rejection drugs will increase your risk of cancer. Depends what you take.
You can read the section in [1] titled "Cancer prevention in humans."
> Starting from 2004, numerous studies demonstrated that rapamycin and everolimus reduced the incidence of various cancers in organ transplant patients.
[edit] In fact in addition to its use as an anti-rejection medication, rapamycin is used as chemotherapy to treat certain forms of cancer.
Type 1 diabetic here: you're right, it's a bad tradeoff. We already can do pancreas transplants for T1D, but the reason it's very uncommon is that immunosuppressants are a very bad tradeoff. Insulin treatment is preferred in the vast majority of cases.
Stuff like this will never be a breakthrough until it doesn't need immunosuppressants. The best advancements in diabetes treatment will most likely continue to be on closed loop artificial pancreas systems.
Insulin-specific immunotherapies are currently under development. We will soon be able to restore tolerance to insulin, and other pancreatic antigens such as GAD-65, without the need for broad immunosupressants. Ideally, this should stop β cell destruction and conversion to T1D from auto-antibody positive status, as well as facilitate islet transplants with minimal side effects for those that are already T1D patients.
> To prevent islet rejection, immune-suppressing drugs are given over the long term.
This makes it a non starter. Immunosuppressants are generally considered a worse quality of life than insulin treatment. That's why pancreas transplants are generally only done for type 1 diabetics if they are already on immunosuppressants.
I'm hopeful that someday we'll have a good system for "caging" cells to prevent an immune response (in either direction) while also permitting the visitors to sustain themselves with blood nutrients and regulate hormones or clean waste.
Sort of like the role of the blood-brain barrier, or maybe a placenta.
Yes! I think there was some work being done with a islet transplant like that. I'm not sure of the details though - it's probably a long way off, if it works.
Yep. The hard, if not kear impossible part will be just resetting the one part of the immune system attacking the islets without turning off or resetting the immune system.
The promising part here is that someday it will be possible to take stem cells from a patient and specialize them to islet cells. Similar to what they’re doing here with vascular cells. It’s far too expensive at the moment, but ultimately the process will be improved and refined, and the costs will come down. At least that’s my hope for a cure.
Easiest method may be to nuke the immune system and put a new one in place. As the immune system consists of several parts it may be sufficient to just replace one of them.
The author claimed no competing interests, yet his research is used for the patents. We'll see how it plays out in the real world after all the stardust settles.
Awesome. Hopefully when this is perfected they'll be enough pancreases to cure everyone. My pancreas is ear marked for my sibling should I become an eligible donor.
And not just mice, but mice engineered with “T1D like” conditions. Human testing too early is certainly undesirable but these studies with mice, while necessary and important, are nothing newsworthy for the general public (but good for fundraising for follow up work).
She was on immunosuppressants, so how long the new beta cells would last without those is still an open question. Other similar, ongoing trials are showing promising results.
Not if it requires immune suppressants. They can already transplant whole pancreases. They rarely do because the resulting lifetime of immune suppression is worse than the quite effective insulin injections.
Any research could pay big benefits eventually but this is far from "great news". It's a step forward along a path that is actually well behind the others.
I think you and I have a different approach to science.
I see research as not entirely linear and think that multiple paths should be funded. Most paths won't be "the definitive answer" but add capability, or definitively rule out an approach, that can be used in other scenarios. TheFineArticle shows a different path to the others and they made a great step on it - that seems like money well spent to me.
What I get from reading your post is that it's some kind of race and only the one currently winning should be lauded. I'm not sure if that is what you intend to communicate though.
If you pair this with genetically engineered hypoimmune islet cells to avoid needing to suppress immune system you could have a viable cure. https://ir.sana.com/news-releases/news-release-details/sana-...
Yes, immunity is the big problem. You probably need to replenish the islets either way. Also, I don't think doctors would be content giving someone that isn't suppressed this without loads of research.
More groundbreaking research funded by the NIH. It's sad to think about how much the US is going to lose with the arbitrary slashing and burning and purging.
Don't worry they'll take credit for saving this
So it's a trade-off between increased risk of cancer[0] and the consequences of type 1 diabetes? Doesn't sound like a fun trade-off but I don't know anything.
[0] https://www.cancer.gov/about-cancer/causes-prevention/risk/i...
There was a recent "breakthrough" involving the same, except with patient's own stem cells, & not just in mice.
https://stemcellres.biomedcentral.com/articles/10.1186/s1328...
That would mitigate the cancer risk, since immunosuppression would not be required?
> patient's own stem cells
> immunosuppression would not be required
I don't think that's how Type I Diabetes works. People get Type I Diabetes because their immune system attacked their own insulin producing cells in the first place. It's an autoimmune disease. So if you replenish those cells, they'll just get attacked again.
If you take rapamycin or a rapalog as an anti-rejection drug, your risk of cancer is lower - not higher - because it's not actually an immune suppressant so much as a drug that prevents hyperimmunity. [1] Other immune suppressants work differently but it's not a blanket true statement that taking anti-rejection drugs will increase your risk of cancer. Depends what you take.
You can read the section in [1] titled "Cancer prevention in humans."
> Starting from 2004, numerous studies demonstrated that rapamycin and everolimus reduced the incidence of various cancers in organ transplant patients.
[edit] In fact in addition to its use as an anti-rejection medication, rapamycin is used as chemotherapy to treat certain forms of cancer.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC10103596/
Type 1 diabetic here: you're right, it's a bad tradeoff. We already can do pancreas transplants for T1D, but the reason it's very uncommon is that immunosuppressants are a very bad tradeoff. Insulin treatment is preferred in the vast majority of cases.
Stuff like this will never be a breakthrough until it doesn't need immunosuppressants. The best advancements in diabetes treatment will most likely continue to be on closed loop artificial pancreas systems.
Insulin-specific immunotherapies are currently under development. We will soon be able to restore tolerance to insulin, and other pancreatic antigens such as GAD-65, without the need for broad immunosupressants. Ideally, this should stop β cell destruction and conversion to T1D from auto-antibody positive status, as well as facilitate islet transplants with minimal side effects for those that are already T1D patients.
I'm sorry for your plight and I genuinely hope there will be a much more tenable solution in the near future.
> To prevent islet rejection, immune-suppressing drugs are given over the long term.
This makes it a non starter. Immunosuppressants are generally considered a worse quality of life than insulin treatment. That's why pancreas transplants are generally only done for type 1 diabetics if they are already on immunosuppressants.
Lots of biotech companies are working on immunosuppressant-free islet-equivalent transplantation.
Two examples off the top of my head: Sana recently announced islet cell transplantation without immunosuppression (press release: https://ir.sana.com/news-releases/news-release-details/sana-... ) and Vertex (ongoing trial: https://www.breakthrought1d.org/news-and-updates/vertex-laun... ).
I'm hopeful that someday we'll have a good system for "caging" cells to prevent an immune response (in either direction) while also permitting the visitors to sustain themselves with blood nutrients and regulate hormones or clean waste.
Sort of like the role of the blood-brain barrier, or maybe a placenta.
Yes! I think there was some work being done with a islet transplant like that. I'm not sure of the details though - it's probably a long way off, if it works.
Yep. The hard, if not kear impossible part will be just resetting the one part of the immune system attacking the islets without turning off or resetting the immune system.
The promising part here is that someday it will be possible to take stem cells from a patient and specialize them to islet cells. Similar to what they’re doing here with vascular cells. It’s far too expensive at the moment, but ultimately the process will be improved and refined, and the costs will come down. At least that’s my hope for a cure.
Easiest method may be to nuke the immune system and put a new one in place. As the immune system consists of several parts it may be sufficient to just replace one of them.
Note this is for the current common approach, not the new approach.
[flagged]
The author claimed no competing interests, yet his research is used for the patents. We'll see how it plays out in the real world after all the stardust settles.
Awesome. Hopefully when this is perfected they'll be enough pancreases to cure everyone. My pancreas is ear marked for my sibling should I become an eligible donor.
...IN MICE
And not just mice, but mice engineered with “T1D like” conditions. Human testing too early is certainly undesirable but these studies with mice, while necessary and important, are nothing newsworthy for the general public (but good for fundraising for follow up work).
Indeed, I would appreciate if the title were updated to reflect that the subjects were mice, not humans. It’s a bit misleading.
Late last year a woman's T1D was put into remission using beta cells derived from her own stem cells: https://www.nature.com/articles/s41591-024-03394-9
She was on immunosuppressants, so how long the new beta cells would last without those is still an open question. Other similar, ongoing trials are showing promising results.
Yeah! How amazing is that! Reversing type 1 diabetes anywhere is amazing.
A way to go until it becomes an option for humans. And then way more to go until it becomes a preferred option.
But this is great news.
Not if it requires immune suppressants. They can already transplant whole pancreases. They rarely do because the resulting lifetime of immune suppression is worse than the quite effective insulin injections.
Any research could pay big benefits eventually but this is far from "great news". It's a step forward along a path that is actually well behind the others.
I think you and I have a different approach to science.
I see research as not entirely linear and think that multiple paths should be funded. Most paths won't be "the definitive answer" but add capability, or definitively rule out an approach, that can be used in other scenarios. TheFineArticle shows a different path to the others and they made a great step on it - that seems like money well spent to me.
What I get from reading your post is that it's some kind of race and only the one currently winning should be lauded. I'm not sure if that is what you intend to communicate though.
Rapamycin increases lifespan of mice more than any other known compound.