IT MIGHT be possible to block the development of insulin-dependent diabetes in children, sparing them from a lifetime of injections and the many health complications the disease causes. Hopes have been raised by a drug that halts the onset of diabetes in mice.
Around 3 in every 1000 people worldwide suffer from insulin-dependent diabetes, caused by the immune system attacking the insulin-producing islet cells in the pancreas. Sufferers need daily insulin injections. In sub-Saharan Africa, many children with the disease die. A handful of people have been cured by islet-cell transplants based on the 鈥淓dmonton protocol鈥�, but this means a lifetime of taking immunosuppressant drugs.
What triggers the autoimmune attack is unknown, but six years ago Yousef Al-Abed鈥檚 team at North Shore-Long Island Jewish Research Institute in Manhasset, New York, suggested that a protein called macrophage inhibitory factor, or MIF, might play a key role in the chain of events that leads to the death of islet cells. Now the team has found a drug that binds to MIF and blocks this chain, Al-Abed told a meeting of the American Chemical Society in California this week.
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He has tested the drug, called ISO-1, on around 200 mice. Some were given chemicals which induce diabetes, while others had been genetically engineered to develop the disease. In the chemical group, all the animals injected with ISO-1 for 10 days in a row remained diabetes-free. Of the genetically susceptible mice, 90 per cent remained healthy. There were no signs of any adverse reactions to ISO-1. All the untreated animals, however, developed the disease.
Al-Abed hopes a pill can be developed to give to children who are likely to develop insulin-dependent diabetes. He envisages identifying those at risk, and giving them the drug when diabetes is imminent. Antibodies to islet cells can often be detected years before the onset of disease, and several gene variants are known to increase the risk.
But predicting who is at risk is challenging, cautions Eba Hathout, director of a children鈥檚 diabetes centre at Loma Linda University in California. Some may be missed and others treated unnecessarily, she says. And the fastest growing group of insulin-dependent diabetics are under 5 and have no antibodies to herald the disease. Prevention strategies are not as promising as current efforts to find a cure, she thinks.
But Helen Vlassara, a diabetes expert who works with Al-Abed, thinks the drug has potential as a very early intervention for those who have the disease. Rescuing some of the islet cells, she says, may be enough.