The scientific community has been in a heated debate about xenotransplants (transplanting pig islets into humans). Although the procedures are showing to be effective - is the insulin secretion entirely pig? Some experts surmise that after the transplants, diabetic patients are actually able to produce some insulin on their own, after all.

The latest press release from Tissera, Inc (an Israeli-based company) made a statement that raises my hopes. It was, "By the fourth month after transplantation, the insulin dose needed to maintain near-normal blood sugar levels decreased by more than 90% in comparison with the insulin dose needed before transplantation, meaning that endogenous insulin production was predominantly responsible for blood sugar control."

The question of the origin of endogenous insulin was addressed by measurement of blood C-peptide. C-peptide splits from insulin and indicates the level of insulin secretion from the patient. C-peptide levels were measured both at baseline and in response to a sugar load, which brings about a rise in blood C-peptide. The measured C-peptide was shown to be predominantly of pig origin. So herein lies my question: is predominantly more than 50%? A type 1 diabetic has undetectable levels of C-peptide. Period. After the xenotransplant the C-peptide level is all of a sudden detectable? Could these islet transplants assist in regenerating the diabetics' own islets?

Just like a referee to normalize play throughout the game - DiaKine Therapeutics is developing ways to normalize the body's immune system.

The new drugs modulate cytokines, part of the body's immune system, which mistakenly attack normal organs and tissue and cause diseases such as: diabetes, multiple sclerosis and inflammatory bowel disease. Research by Dr. Nadler and his collaborators published in 2006 showed that controlling certain cytokines can arrest the progression of, or reverse, type 1 diabetes in an animal model.

The company's first product, IsletLifeLSF Media 1 is designed to improve the viability and insulin producing capabilities of harvested islet cells prior to transplant. This would potentially improve the success rate of the procedure. Additional therapeutics under development by DiaKine include: adjunct therapy to islet cell transplants, halting the progression of type 1 diabetes in newly diagnosed adults, treatment and prevention of Latent Autoimmune Diabetes of Adults (LADA), treatment and prevention of insulin requiring type 2 diabetic, treatment and prevention of diabetes complications.

It all sounds like good stuff in the works. Keep an eye on the progress and press releases of DiaKine, as well as their research partner - the Diabetes Research Institute. A lot is happening these days. What else have you seen or heard about in the autoimmune arena?

Chat live with Dr. Pugliese, an expert on the immunology and genetics of diabetes at The Diabetes Research Institute. His work has been focused on preventing the autoimmune attack that leads to diabetes. This research is very important for future prevention strategies, as well as stopping autoimmune destruction of transplanted islets.

Dr. Pugliese's has studied the role of the thymus gland in the immune system and he describes it as the "school for the immune system". All immune cells are forced to pass through the thymus gland where they are exposed to the antigens present throughout the body. Immune cells that bind to these normal antigens are destroyed, thereby preventing the later destruction of healthy cells. If no binding occurs, then the cell is deemed to be friendly to host tissue and is released to become part of the immune system. The insulin producing cells of the body - islets -- are not the only body cells that release insulin. Dr. Pugliese's research has shown that there are other cells that release tiny amounts of insulin, but not in response to blood glucose. These cells present insulin to the visiting immune cells in the thymus, and any immune cell that binds is killed. It is believed that a low insulin output in these decoy cells in people who develop diabetes may be the reason that immune cells are allowed to live that will later track insulin back to its source and destroy healthy islets. In people who have the genetic markers that protect against diabetes, these cells secrete more insulin than they do in people with genes that pre-dispose them to diabetes. The more insulin in the thymus, the more likely that insulin-specific autoreactive lymphocytes will be killed, with fewer chances of developing diabetes.

Confused yet? Yeah, me too - but my confusion feeds my insatiable curiosity. That is precisely why I will be joining the rescheduled chat with Dr. Pugliese. Please, be there on March 15th at 9pm Eastern Standard Time on Diabetes Talkfest. Make it a date: you, me, Dr. P and the most informed people in the diabetes community. Once again, thanks to Gina and Jon for Linking Diabetics Coast to Coast!

The Spring Point Project is a nonprofit organization created to increase the availability of islet tissue for diabetes care by cultivating medical-grade pigs for islet xenotransplantation.

Dr. Bernhard Hering is the scientific director of the Diabetes Institute for Immunology & Transplantation at the University of Minnesota. He believes the shortage of human donor organs greatly limits the applicability of islet transplants. Of course he does. In 2004, President Bush directed the Diabetes Research Work Group, created by Congress, to develop a comprehensive plan for diabetes research. One of the outgrowths has been the establishment of the NIH (National Institute of Health) Clinical Islet Transplant Consortium. Spring Point Project's consultant Dr. Bernhard Hering, M.D., is one of only five researchers worldwide appointed to serve on it. Hold the cornmeal, Wilbur. Who else has a seat in the NIH panel?These medical-grade pig islets require immunosuppression drugs to sustain the life of the islets without another autoimmune attack taking place. A statement from the faq page on The Spring Point Project site states, "Pig islet graft survival was made possible with a novel immunosuppressive protocol." Okay. Minor detail but very important when you weigh your options.

The Spring Point Project says human trials are slated to begin in 2008. Funny-- that is the same time Massachusetts General Hospital's human trials for Dr. Denise Faustman's proposed cure for type 1 diabetes is set to begin. Dr. Faustman's cure does not require any immunosuppression drugs. In my book - any cure that requires a continuum of drugs is not a cure, at all.

There's a fascinating story in Canada's Globe and Mail about the controversial use of xenotransplantation as a method of treating Type 1 diabetes. Xenotransplantation involves transplanting animal cells into human bodies. The surgeon in question here is the Mexican transplant surgeon Raphael Valdes, who claims to treat diabetes by transferring pancreas cells from piglets into his diabetic patients. Eww. What a nasty thought.

Even aside from the gross-out factor of this procedure, critics of Valdes believe his treatment does not work. In fact, the International Xenotransplantation Society has called for an end to his clinical trials saying that, despite the claims made by Valdes, there isn't enough independent proof that the treatment works. For now, the surgery is unavailable while the Mexico City hospital at which Valdes works and the National Committee for Bioethics review his techniques and ethics.

Nevertheless, Valdes has his supporters. The Globe and Mail article profiles a couple of Canadian Type 1 diabetics who have had the procedure done and who are happy with the results. It's an article that's well worth checking out.