Treatments for diabetes have come a long way since the days when the only recourse was a starvation diet, and the Faculty of Medicine & Dentistry has been at the forefront of these advances, audience members heard at the fall Centennial Lectures on Sept. 25.
Two members of the faculty showcased their latest diabetes research in the lab and clinical setting.
More than 225 people packed the Allard Family Lecture Theatre in the Katz Centre for the public lecture series hosted by the faculty to commemorate its upcoming centennial in 2013. Dean Douglas Miller noted how impressed he was with the Alberta Diabetes Institute for its research discovery and knowledge translation.
"I think you'll find their work eye-opening or islet-opening," he quipped as he introduced the speakers - Peter Senior, medical director of the Clinical Islet Transplant Program and an associate professor in the Department of Medicine, and Patrick MacDonald, an associate professor in the Department of Pharmacology and a Canada Research Chair.
Prior to the discovery of insulin in the early 1920s, diabetics were given a life expectancy of just six weeks to six months after diagnosis, Senior said. Now people can live full lives with the disease, he said, pointing out U of A biochemist James Collip was central to the insulin discovery although his name isn't as widely known.
Today, local medical research in diabetes is on the world map thanks to the Edmonton protocol, a procedure developed here. A team in the faculty demonstrated islets from donated pancreases could be transplanted into patients with Type 1 diabetes. The impressive results from seven patients who received the first transplants were published in the prestigious peer-reviewed journal, The New England Journal of Medicine, in 2000. The seven patients in the study required anywhere from one to three transplants and a year later they all remained free of having to take insulin injections.
As of late September 2012, 175 diabetics have received islet transplants here - many of them getting more than one transplant. In total, 370 islet transplants have been performed in Edmonton since the procedure was introduced - an average of about 30 a year. So far this year, 45 transplants have been done and at this rate 67 transplants could be done by year's end.
Much of the diabetes research happening today at the U of A is focused on beta cells, which make insulin. These cells are either destroyed or not working properly in people with diabetes, explained Senior. In many cases, before diabetes develops, beta cells are trying to compensate for insulin issues by working extra hard. But working extra hard is a difficult level to maintain and eventually leads to Type 2 diabetes.
All the action is in the pancreas, says Senior. And this is where MacDonald has focused his lab research. MacDonald's work is zeroing in on pancreatic islets, which can malfunction and impair the secretion of insulin.
"Islets can be important sites of treatment and intervention of diabetes," he explained. "There are some key questions that we researchers here in Edmonton are coming close to being able to address. Can we restore insulin secretion when it becomes dysfunctional? What underlies impaired secretion? Can we regenerate islets after they've been lost? And can we protect those islets in the first place before they are destroyed?"
He said a great deal of research has been done with animal models, but the work needed to transition to the study of human islets.
MacDonald wanted to know what happens to human islets as they age and when the patient has a disease like diabetes. He worked with the FoMD's world-renowned diabetes researcher Ray Rajotte to set up a program where islets are isolated and studied. The team received pancreases from a variety of donors - young and old, lean and obese, those with diabetes and those without the disease.
"We want to find out if we can replace or regenerate islets. Can we trick the pancreas to start making beta cells and islets? We want to translate what we are doing in our lab to the clinic, to bring actual benefit to people," says MacDonald.
Senior noted the work being done in MacDonald's lab is key and that "lessons learned from the lab will help us move closer towards a cure that so far has proved very elusive."