The Holy Grail in Type 1 diabetes is the development of a treatment (or even range of treatments) that will obviate the need for insulin administration by either injection or infusion. To achieve this goal, researchers aim to produce cells with the ability to synthesise insulin and then inject or implant these to provide the insulin that the patient’s own pancreas is unable to produce. While this is an attractive concept, success so far has been limited, largely because the demands on such a bioengineered system are substantial. * Actual human B-cells from cadaver donor pancreases have been used and are currently the subject of research in Canada and the UK. Present harvesting techniques are relatively inefficient and two to three donor pancreases are required to collect enough islets of Langerhans to render one patient independent of exogenous insulin. Potent immunosuppressive cocktails are also required to prevent rejection. The shortage of donor organs and the side effects of the immunosuppression mean that this option is only ever going to be available for a tiny minority of diabetic patients. * Efforts have been made to encourage whole islets, or B-cells alone, to grow in vitro, potentially providing limitless supplies of insulin producing cells. So far progress has been slow and limited. * Molecular biology techniques have been used to cause non-B-cells to synthesise insulin. This has been achieved, with varying degrees of success, in a number of cell lines. These cell lines, however, lack the ability to measure ambient plasma glucose and therefore the ability to match insulin synthesis and secretion to the prevailing blood glucose. Uncontrolled insulin release would be unlikely to lead to acceptable glycaemic control and could produce potentially severe hypoglycaemia. * The hexokinase gene, responsible for glucose measurement by B-cells, has been expressed in other cell lines. There remains, however, the substantial challenge of not only expressing the hexokinase gene and insulin gene in the same cell line but of establishing the, as yet poorly understood, intracellular signalling systems which link glucose sensing to insulin secretion. This ultimate ‘bio-engineered Bcell’ is some way off at present. * An alternative solution is the use of stem cells, which could perhaps be grown in vitro and then persuaded to differentiate as B-cells. This is an attractive option but is, at present, many years away from reality. * Whatever techniques eventually succeed in producing artificial B-cells, it is highly unlikely that a single ‘dose’ of such cells will provide a complete cure for Type 1 diabetes. The paracrine and other interactions which take place within the islet of Langerhans appear to be important for B-cell longevity and function and these interactions will be absent where artificial B-cells are being used in isolation. In addition, Type 1 diabetes is an auto-immune disease with cell-mediated immunity turned against the patient’s own B-cells. Any treatment which involves cells similar to real human B-cells risks re-igniting the immune processes which led to the original disease; the use of immunosuppressive therapies to prevent this would carry the substantial long-term risks of such therapies. In summary, much research effort is presently directed at the quest for a bioengineered solution to Type 1 diabetes and progress is being made. The recent report in *The Scotsman* is of another small, and not entirely novel, step along a very long road. At present we have the means, using insulin therapies, to achieve good glycaemic control in the great majority of people with Type 1 diabetes who receive adequate education and support. Until innovative therapies are much further advanced, care for people with diabetes should concentrate on maximising the efficacy of existing proven interventions rather than holding out the prospect of miracles to come. 2006-12-01T15:31:58Z None declared. 20 2003-06-16T00:00:00Z 2006-06-16T00:00:00Z reports-of-a-single-injection-cure-for-diabetes-are-premature 2003-06-16T00:00:00Z

How close are we to developing a single injection cure for diabetes? Dr Ken Paterson responds to a media article which could have raised false expectations and provides an overview in developments in diabetes research.

2009-03-23T11:25:29Z