A new drug halts the progression of Type I diabetes, researchers writing in the New England Journal of Medicine report today. Affecting nearly a million people in the U.S. alone, Type I, or juvenile, diabetes occurs when the bodys own immune system attacks the insulin-producing islet cells in the pancreas, preventing the formation of insulin--the protein that controls glucose levels--and thus hindering the regulation of sugar in the blood. Most diabetics must continually suffer painful insulin injections to control their blood sugar levels. But clinical trial results show that patients taking the new drug, called hOKT3g1(ala-ala), continued to make their own insulin and did not need externally created protein. By destroying the immune cells responsible for preventing insulin production, this treatment has allowed diabetics to live shot-free for at least a year without any serious side effects.
Kevan C. Herold of Columbia University and his colleagues administered hOKT3g1(ala-ala) to 12 newly diagnosed diabetics between the ages of seven and 27. After a year, nine of these patients exhibited little, if any, reduction in insulin production and still did not require external insulin injections. Ten of the 12 diabetics who did not receive the drug, on the other hand, showed a significant decrease in their ability to make the glucose regulating protein.
The advantages of controlling diabetes metabolically--through continued insulin production instead of injection--are great. "People with diabetes who make some insulin have a much easier time in controlling their disease than those who do not," Herold comments. In addition, fewer complications of the disease, such as vascular, eye and kidney problems, occur in patients whose bodies can still assemble the vital protein. Although other experimental immune-suppressive drugs have generated dangerous side effects (kidney disease, increased infection risk, and certain types of cancer, among them), hOKT3g1(ala-ala) is almost risk-free: because the drug acts selectively on T cells--the immune cells that halt insulin production--and needs to be ingested for only two weeks, patients experienced no serious side effects.
Further testing of the drug in more people and for periods longer than a year is planned, but researchers are optimistic. "The remarkable results reported in this study provide enormous hope for finding a cure for people with Type I diabetes," remarks Robert Goldstein of the Juvenile Diabetes Research Foundation. "For the first time it has been shown that progression of the destructive autoimmune response can be stopped with few side effects and islet function preserved."