The Cure for Type 1 Diabetes

Living with type 1 diabetes has never been easy. Aside from what people usually think about like having to count carbs, inject myself with insulin, and constantly monitor my blood sugar, it also has other, less acknowledged side effects. Having type 1 diabetes means countless questions from strangers as well as trying not to feel discouraged or angry when people say over and over, "can you eat that?" "you don't look diabetic," and "have you tried eating more cinnamon, I'm sure it'll cure you." This last one in particular is frustrating because cinnamon obviously isn't a cure, and no matter how far science has come, there never seemed to be a one in sight, but now, all of that may be changing. 

Firstly, type 1 diabetes (or T1D) isn't caused by eating too much sugar as common misconceptions may lead you to believe. Though the exact cause of T1D is unknown, the most common hypothesis is that it is caused by an autoimmune reaction in which beta cells in the pancreas, responsible for the production of insulin, are destroyed. Since insulin is responsible for regulating the glucose levels in a person's blood, without it, their blood sugar will go too high or too low. This can result in immediate side effects such as nausea, dehydration, and dizziness, and long-term side effects such as nerve damage, heart and blood vessel disease, blindness, and even death. 

Comparison of the production of insulin by a healthy and a T1D pancreas 

Thanks to modern medicine and treatment plans, T1D is no longer a life-threatening diagnosis and can be controlled by monitoring the patient's blood sugar and using regular insulin injections.  This type of treatment, however, is time-consuming, expensive, and doesn't work for everyone. Because of this, scientists have been working for years to discover a cure, and thanks to new advances that no longer seems like a fantasy.

In 2014 a huge breakthrough was made in the diabetes world: two research groups found a method for "growing large volumes of well-developed human beta cells from stem cells." This breakthrough allows researchers to study different aspects of beta cells that they were previously unable to determine such as how they are produced and how to prevent their destruction. This also enables researchers to reimplant the beta cells into patients with diabetes. There are currently three main companies working towards a cure, each company has many ongoing trials so I will just talk about a few of them.

Lab-grown, insulin-producing beta cells

The first company is Vertex, a global biotechnology company that purchased Semma Therapeutics in 2019. With the companies combined research, there is more hope to find a cure. Vertex is currently testing two methods. The first is implanting insulin-producing islet cells (groups of cells found in the pancreas which include beta cells) into the liver. This method would involve immunosuppressant therapy similar to what patients undergo before any other organ transplant. Preliminary testing of this method in diabetic animals has shown that it is sufficient to control blood sugar levels. Vertex's other method is testing is the use of a cell device (sometimes called a pouch) which would protect the lab-grown beta cells from the individual's immune response, allowing them to perform their normal function. The advantage of this method is that it would not require the immunosuppression needed for the simple transplant. Before being absorbed into Vertex in 2019, Semma announced "pre-clinical proof of concept" for both of these methods. This means that when tested on non-human primates and pigs there was not only positive c-peptide release (a sign of insulin secretion) but also an ability to control glucose levels. 

Difference between a normal and T1D pancreatic islet 

The second major company is ViaCyte, a regenerative medicine company. ViaCyte also found a way to produce lab-grown beta cells in 2014. Similar to Vertex's pouch method, ViaCyte is actively researching a potential cure using an encapsulation device they call PEC-Encap. For PEC-Encap there is a pouch-like membrane that contains the lab-grown beta cells. This membrane would protect the cells from the body's immune reaction but would allow the necessary proteins and nutrients to travel along the cells inside the pouch as well as through the blood vessels on the outside of the pouch. Clinical trials have already shown that the PEC-01 pancreatic progenitor cells (the beta cells ViaCyte was able to grow and use in trials) can develop into insulin-responsive, glucose-secreting beta cells when transplanted into the body 

Diagram of the PEC-Encap product currently being tested by ViaCyte

The last company is Sernova Corp, another regenerative medicine company focused on developing therapeutic treatment via regeneration for chronic illnesses. Sernova Corp is developing what they call Sernova's Cell Pouch System. The Cell Pouch is very similar to Vertex's pouch plan and also includes surrounding the therapeutic beta cells in a "scalable medical device." This device will be able to protect the insulin cells and secrete the necessary proteins and factors missing from the body, effectively replacing the non-functioning pancreas. Something particularly cool about this device is that it isn't limited to curing diabetes. Since any therapeutic cells can be transplanted into the pouch, it could work for any disease caused by missing proteins or hormones in the bloodstream. The Cell Pouch System combined with therapeutic beta cells has been proven to work in animals during trials, effectively maintaining the animal's glucose levels. Through trials, Sernova Corp has also determined that the pouches do in fact create a suitable space for the islet cells in humans.

Cell pouch implantation and therapeutic cells delivery process

Overall, though these advances may seem small, they are incredible. In my eight years of having diabetes, I never considered a cure to be a real possibility. Now, however, thanks to the numerous companies and ongoing trials to find a cure it seems like I might have a future where I don't have to think about giving myself insulin, and to me, that's pretty amazing.