Seattle on Cutting Edge of Research to Find a Cure for Type 1 Diabetes
By Wenda Reed
Every morning Jonathan Zosel, Elizabeth Zosel’s 6-year-old brother, takes a pill. He doesn’t know if it’s oral insulin or a placebo. If it’s oral insulin, it may delay – or even prevent – the onset of Type 1 diabetes in a little boy who tested positive for three out of four antibodies and who has a high probability of developing the disease.
Jonathan is part of a multi-year Type 1 Diabetes TrialNet Oral Insulin Study, composed of people who have relatives with Type 1 diabetes and have certain antibodies in their blood. Every six months, he has his blood glucose tested, a process that used to hurt a lot, he says, (holding his hands wide apart to show the degree of pain). Now he holds his fingers close together to show only a little pain, and revels in his reward for enduring the blood test – “money, money, money, money!”
Diabetes TrialNet is an international consortium of endocrinologists, immunologists and researchers funded by the National Institutes of Health, the American Diabetes Association, the Juvenile Diabetes Research Foundation (JDRF) and others. The Benaroya Research Institute (BRI) at Virginia Mason in Seattle is the clinical center for the Northwestern United States, and Dr. Carla Greenbaum, resident endocrinologist and researcher, is on the board that decides which trials to bring forward.
“We have found 300 therapies that will cure diabetes in animals,” she says. “Which ones will be safe for humans?”
Greenbaum explains that there is a gap – sometimes of several years – between the time the antibodies begin killing the beta cells in the pancreas that produce insulin and the “tipping point” when 80 percent of the cells have been killed and the body no longer produces enough insulin to break down blood sugars. At that point, people are diagnosed with full-blown Type 1 diabetes.
“The question is, can we stop the immune system from killing off the cells before it becomes the disease?” she asks. It is possible that insulin, taken orally and absorbed through the gut, may be let through to the pancreas and may “tell the immune system to shut down the destructive tendencies,” she says.
The research institute, one of the three primary Type 1 research facilities in the nation, is conducting other studies through various organizations.
Even after diabetes is diagnosed, most people have a couple of years before all of their insulin-producing cells have been inexorably killed off, Greenbaum says. Two trials test new drugs to prevent the further destruction of the cells in people recently diagnosed. Other trials involve compounds which may interfere with the antibodies’ attacks of cells at different points in the process.
A third category of trials involves people 18 and older, up to four years after diagnosis, who still have some insulin-producing cells left. Various therapies are testing drugs approved for other conditions to see if they work against Type 1 diabetes. Simply restoring the insulin-producing cells would not help, Greenbaum explains, because the immune system would attack the new cells. A promise on the horizon is the development of an artificial pancreas, furthered by the launch of the JDRF Artificial Pancreas Project in late 2005. An artificial pancreas would combine a glucose sensor with an insulin delivery device to automatically provide the right amount of insulin at the right time, as a healthy pancreas does in people without diabetes. Yale researchers have successfully tested an artificial pancreas on a small group of teens. Meanwhile, BRI is recruiting Washington residents to help with its efforts to find a cure. BRI would like to screen 200,000 people for the TrialNet Natural History Study and for the Type 1 Diabetes Genetics Consortium, making blood samples available to researchers around the world. Scientists especially need samples from African-American and Mexican-American people with and without diabetes or a family history of the disease. Participants will be paid a small amount.
For the specific trials, BRI is looking for people with Type 1 diabetes, including those newly diagnosed, as well as relatives of people with Type 1 diabetes (parents, siblings, children, aunts, uncles and cousins). For more information on all studies, call the Benaroya Research Institute at 1-800-888-4187 or visit diabetes@BenaroyaResearch.org. For more information on the Type 1 Diabetes TrialNet Oral Insulin Study, visit www.diabetestrialnet.org or contact the additional local screening sites at Children’s Hospital and Regional Medical Center (Corinne Shubin at 206-987-4441, Corinne.shubin@seattlechildrens.org) or Woodinville Pediatrics (Susan McCormick at 425-483-5437, susanlhmccormick@comcast.net.)
