Lessons from Exeter

Published on: 1 July 2014

nPOD's first Insulitis working group meeting took place in Exeter in November 2013.

Important new insights, which have challenged the accepted view about the insulin-secreting (beta) cells of people with Type 1 Diabetes, have been uncovered through research undertaken at the University of Exeter Medical School.

Researchers have revealed that some patients with Type 1 Diabetes still have the cells responsible for the storage and release of insulin long after they develop the illness. This discovery means researchers may be able to answer key questions about insulin production which will improve the effectiveness of treatment and may help to prevent people developing the disease, in future.

Professor Noel Morgan and Dr Sarah Richardson have been studying the processes which cause beta-cell destruction in pancreas samples whilst Dr Richard Oram has examined the insulin levels in patients with Type 1 Diabetes. When brought together, these two approaches provide strong evidence that some beta cells may survive for long periods and release insulin into the blood of patients with Type 1 Diabetes. Investigation into the causes of Type 1 Diabetes requires researchers to study the pancreas and, despite the illness being very common, few such are samples available. Professor Morgan and Dr Richardson have access to the world’s largest collection, including many from donors who died shortly after diagnosis. This enables them to perform detailed studies of how the condition progresses.

Examining the numbers of beta cells in pancreatic tissue samples and comparing the results with the research of Dr Oram, was soon to reveal a surprising secret - as he explained: “The medical assumption has been that all insulin producing beta cells die off, but this isn’t totally true; in the vast majority of cases, people still have a small number of beta cells left – and there are some rare people who have quite a lot of beta cells left and we just don’t know why. If we can answer this, it might help us stop the beta cells dying in the first place."

Dr Oram added: “Noel, Sarah and I are studying the same topic from different perspectives; if they can see beta cells under the microscope in the tissue samples and I can show that patients are still making insulin, it proves that what they see and what we measure are real.”

The benefits of the collaborative research, both locally and internationally, were echoed by Dr Richardson. She said: “We’ve really pushed the idea of working with other groups to confirm our findings in these rare samples. This gives us confidence in the new results and allows us to make much faster progress than would otherwise be possible.”

Their success led to invitations to the three researchers to speak at the JDRF Network for Pancreatic Organ Donors with Diabetes (nPOD) conference. This meeting was attended by leading experts from across the world and included a session entitled ‘Lessons from Exeter’. This title stems from a workshop, held in Exeter in 2013, on the topic of insulitis – an inflammation of the pancreas causing destruction of the beta cells.

Dr Richardson explained: “The two day insulitis conference brought together experts who have studied the immune cells that infiltrate the pancreas. They came from all over the world to review what has been learned about Type 1 Diabetes from these pancreas samples.”

It is hoped that this ground breaking research will ultimately lead to changes in the diagnosis and treatment of patients with Type 1 Diabetes. Professor Morgan said: “We haven’t solved things by any means but we’ve provided a lot of important hints. We’re still at an early stage, but the research has a lot of potential impact. We are contributing to a better understanding of the illness which could lead to more targeted treatments.”

Related links

» Diabetes Genes
» Persistent Virus Infection in Diabetes Network (PEVNET)
» JDRF nPOD
» Research, Innovation, Learning and Development building (RILD)

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