‘This is where the horizon is’: Diabetes research closer than ever to a possible cure

As the world prepares to celebrate the 100th anniversary of the discovery of insulin next year, researchers at the University of Alberta are hard at work on what they hope will become the next big diabetes breakthrough.

The project is led by James Shapiro, professor of surgery in the Faculty of Medicine & Dentistry and Canada Research Chair in Transplantation Surgery and Regenerative Medicine, in collaboration with Greg Korbutt, Patrick MacDonald, Colin Anderson, Jean Buteau and Andrew Pepper from the U of A and Timothy J. Kieffer from the University of British Columbia. Together, the team aims to transform blood cells from Type 1 diabetes patients into insulin-producing cells, which can then be transplanted back into the patient. 

If successful, the technique would bypass the need for anti-rejection drugs and possibly keep patients from needing lifelong insulin injections to survive. 

Removing this need for anti-rejection drugs—a critical component of current islet transplantation therapies that substantially increases the risk of cancer and life-threatening infections—would be a major step forward, Shapiro said.

“We would like to be able to treat patients, including children, without the need of anti-rejection drugs. If we are successful enough, that will be as close to a cure for diabetes as I think we're ever going to see, and I am very excited about this.”

The project to develop a next-generation diabetes therapy recently received a $400,000 grant from the Stem Cell Network.

The technique used in the project is based on a protocol from the winner of the 2012 Nobel Prize in Physiology or Medicine, Shinya Yamanaka. He discovered how to reprogram skin cells, through the use of hormones and other growth factors, into inducible pluripotent stem cells (iPSC), which could then be induced to become any type of cell desired, such as heart cells beating in a dish. 

Shapiro and his team have adapted this technique with the overarching goal of finding a cure for diabetes. They collect blood samples from patients and treat the cells with a cocktail of hormones and other growth factors to “turn them back in time” and induce them to become insulin-producing cells. When these cells have been transplanted into mice with Type 1 diabetes, early results have proven promising. 

“I like to think about it as alchemy, where you are turning dust into gold,” said Shapiro. 

Shapiro, who in 2019 changed his lab’s focus to pursue the new approach, said the work has been shaped and guided by his previous work on the Edmonton Protocol—a breakthrough procedure that transplants islet cells harvested from donated pancreases to Type 1 diabetes patients, temporarily freeing them from the need for insulin injections—and his current collaborations with pharmaceutical company ViaCyte. 

Although it’s hard to define a time when the therapy will be available, Shapiro and his collaborators hope to move toward clinical trials in the next few years.

“Clearly there is a long way to go and a lot of research that we have to do between these initial stages of the experiments in mice to be able to treat first a handful of patients, and ultimately people with diabetes across the world,” said Shapiro.

Even if the technique is successful, Shapiro noted much more work will be needed in the fields of robotic engineering, artificial intelligence and stem-cell science to improve the process and make it less labour-intensive. In the future, he envisions a mass production of iPSC and patient-personalized medicine to cure diabetes.

“This is the future, this is where the horizon is, this is where the sun is rising,” said Shapiro. “I am confident that we, the industry and mankind will find a way to pay for this and justify the cost of these treatments because it will be so much better than insulin. It will prevent all the complications of diabetes and lead to a far better quality of life.”