This story was originally published on June 3, 2019.
WKSU asked listeners for ideas for what to explore in the next episode of our Exploradio science series.
We had some great suggestions. When the ideas were put to a vote, the top choice was –
“Is enough being done to find a cure for type-1 diabetes?”
In this week’s Exploradio, we try to find the answer.
Around 1.25 million Americans have type-1, or insulin dependent diabetes.
Rich Janus is one of them.
He takes a glass vial out of the fridge at his home near Cleveland. “This is the Humalog that I take right before I eat,” Janus said. He’s been injecting it three or four times a day for 45 years.
It isn't cheap.
Humalog insulin earned drug maker Eli Lily $3 billion last year.
Worldwide around $280 billion is spent managing diabetes and its complications.
Janus wonders if all of this money has been a disincentive for drug makers and the medical industry to find a cure for type-1 diabetes.
“If I weren’t so cynical, I’d be really cynical,” he said.
This cynicism led Janus, as a WKSU listener, to ask, “How much is spent to cure the disease vs treat the disease?”
To answer the question, we followed the science.
Our first stop is the Cleveland Clinic.
Turning stem cells into beta cells
Diabetes researcher Jan Jensen once worked in the pharmaceutical industry.
He shares some cynicism about drug makers’ interest in a cure. “It’s quite lucrative to actually provide therapies for diabetic patients," Jensen said. "So I think over the years there hasn’t been as much pickup to provide curative therapies for the disease.”
But Rich Janus and I are here to find out if he has an idea of what a cure could look like.
For Jensen it begins with induced pluripotent stem cells. These stem cells can be turned into any kind of cell once you know the combination of chemical signals that triggers the transformation.
Jensen is working on ways to automate the process of turning stem cells into beta cells, the insulin producing cells in the pancreas that diabetes destroys.
He has started a company to industrialize the process, located in the clinic's business incubator.
Jensen’s company, Trailhead Biosystems, uses robots to automate experiments in hopes of someday mass producing the derived beta cells.
Like many startups, he’s starved for capital.
“We have a system for which we can generate enormous amounts of information, and therefore capital does become a limiting factor because we know how to do it, we just have to do the science.”
A shift in funding priorities
The idea of using stem cell derived beta cells is one of several promising paths to a cure, although major challenges remain in how to get the cells safely back into the body.
Several companies are working on techniques to implant them and keep them safe from the body's immune system.
Philip Shaw is keeping an eye on those projects and all diabetes research. He’s general manager of the watchdog group the Juvenile Diabetes Cure Alliance.
He’s concerned that the world’s leading funding organization, the Juvenile Diabetes Research Foundation, or JDRF, has lost its focus on finding a cure.
“If you go back 10 years," says Shaw, "about 65 percent of all the income the JDRF would get in a given year was going to research grants. As of the past five years, that number’s floated around the high 30’s,” a nearly fifty percent drop over the past decade.
Sanjoy Dutta, associate vice president of research at the JDRF, defends the group’s spending, “We have never shied away from investing in cures, ever, ever.”
But he acknowledges JDRF's mission includes increased funding for life enhancing therapies and education.
He also strongly disputes the idea that "big pharma" is not interested in curing diabetes.
“We are heavily invested with the pharma companies in finding cures," says Dutta, emphasizing more than one cure will be needed for the range of people wih type 1 diabetes.
It turns out, he says, that diabetes is much more complicated than anyone thought.
“We’re now discovering type-1 diabetes is probably six or seven different sub-types of diseases,” Dutta said.
And still, no one knows what causes it.
“I used to say [diabetes] is a mistake of the immune system, and now I think it’s a mistake of the beta cells,” Roep said.
He’s working on a therapy that reprograms misbehaving beta cells in the pancreases of newly diagnosed people, while simultaneously training their immune systems to leave them alone.
“So the word cure is actually on the horizon now,” he said.
The fact is, research takes time, no matter how much money is thrown at it, and spending on diabetes therapies has improved people’s lives.
And all this leaves listener Rich Janus feeling… slightly less cynical.
“It’s not going to happen during my lifetime," Janus said. "I’m realistic about that, and I’ll keep giving myself shots.”