Twists and turns ahead for diabetes research - Blog report
But this is just one part of the problem!
If we can generate beta cells and generate alpha cells, how can we get them to stick together again as they reaggregate into islet-like structures?
What is the most efficacious extracellular matrix to facilitate this?
Safety, efficacy, robustness and cost-effectiveness are the watchwords and there is a lot of debate over what is the best matric to use.
From there we move onto the upscaling of this process and the clinical translation aspects. Dr Jon Odorico from Madison, Wisconsin outlines the four broad risks in this translation process – teratoma formation, oncogenicity, immunogenicity and infection. It is important to characterise the starting cell line or lines and the cell product in order to measure and minimise teratoma and oncogenic risk with the goal not just to show that there is no risk but to know all of the risk factors to begin with.
And, of course, there is a lot of pre-clinical testing of such cells that needs to be done before safety issues can be addressed and elucidated.
There are a number of biochemical assays like glucose-stimulated insulin secretion and oxygen consumption rates that are being used as markers of graft function. The site of transplant also needs to be defined but, as is reported by the islet transplantation group from Lille in France, their clinical programme uses around 2.7 grafts per recipient hammering home the point that there are insufficient islets available from donor sources to ensure that everyone who is eligible for an islet transplant can receive one.
The day ends with two very different presentations from two very big names – Professors Bart Roep and Patrik Rorsman – talking about curing diabetes without the need for beta cell replacement and how the beta cell releases insulin in healthy subjects and in those with type 2 diabetes.
And, although these seem out of kilter with the rest of the talks today, they actually dovetail beautifully and stimulate an enormous amount of questions and discussions.
The question you may be asking is why
Because throughout the day, it has been repeated several times that stem cells may not be the answer on their own. This is going to need the input from immunologists and cell biologists, from surgeons and diabetologists and from clinicians and basic scientists.
As the delegates drift off into the snowy, Austrian evening at the end of this first day, these discussions are continuing and, perhaps even new collaborations forming to help bring all of this research into relevant, safe and well tolerated clinical practice.
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