Resetting the immune system
New treatment could spur production of insulin in Type 1 diabetes
By Morgan Sherburne
Combining two different medications could help patients with Type 1 diabetes at least partially regain the ability to produce their own insulin.
Michael Haller, M.D., a pediatric endocrinologist, likens his approach to treating Type 1 diabetes to a game of cops and robbers. First, he ferrets out problematic cells of the immune system that could be behind a patient’s inability to produce insulin and wipes them out with a medication called Thymoglobulin, a drug initially developed for use in organ transplantation. Then he uses a medication called Neulasta, a drug designed to improve the lives of people with certain forms of cancer, to stimulate the production of new and potentially beneficial immune cells.
Haller presented the results of the study at the annual meeting of the American Diabetes Association in June.
“The treatment is almost like trying to hit the reset button on the immune system,” Haller said. “We’re trying to wipe out the bad cells and stimulate the good cells at the same time.”
Haller treated 17 adult Type 1 diabetes patients for two weeks with the cocktail therapy and then followed them for a year. Another eight patients were given a placebo. By the end of the year, the patients treated with the cocktail had increased their ability to produce insulin. This indicates that the Thymoglobulin was successful in killing the bad immune system cells, and the Neulasta was successful in stimulating new, healthy immune cells. The researchers also say the patients’ ability to produce insulin indicates they had an increase in beta cells, the cells responsible for producing insulin in the pancreas.
According to conventional diabetes wisdom, within just a few months of the onset of Type 1 diabetes, there are very few of the insulin-producing beta cells left in the pancreas, said Mark Atkinson, Ph.D., a co-investigator in this study and member of the department of pathology, immunology and laboratory medicine. That the treatment seemed to stimulate insulin production in people with established Type 1 diabetes made the researchers “cautiously optimistic,” Atkinson said.
“The results that Dr. Haller saw in his first study are profound,” Atkinson said.
Haller says he hopes the approach will help patients manage their disease more easily.
“If we can confirm the results in a larger effort, the study could potentially be paradigm-shifting for our field in that it documents we should really be looking at combination therapies in treating Type 1 diabetes,” Haller said. “Our ultimate goal is to prevent and cure this disease, but we have to crawl before we walk, and walk before we run. This study is an important step forward in our efforts to make life easier for patients with Type 1 diabetes.”