India faces a diabetes burden of untold magnitude in the coming year. There is a drastic need for new means of treatment. Fortunately, hope may be on the horizon.
Disease prevalence in India
According to the International Diabetes Federation (IDF) there are currently 72,946,400 adults living with diabetes in India. This equates to nearly a tenth of India’s 829,491,000 adult-strong population.
India’s elevated number of diabetics compared to other nations can be explained in part by the fact that Indians suffer a genetic predisposition to diabetes. A number of genes have been uncovered which could play a role in both type 1 and type 2 diabetes, as these genes are often involved with insulin regulation. Coupled with the increasing prevalence of unhealthy lifestyles that contribute to diabetes risk, the number of those suffering from the condition in India is surging.
MS is far more rare in India than diabetes, though numbers have been rising in recent years, potentially due to a higher capacity to diagnose the disease. Estimates by the Multiple Sclerosis International Federation (MSIF) “Atlas of MS” 2013 claim a prevalence rate of five to twenty per 100,000, though this is said to be an underestimate. Many individuals with the condition may go undiagnosed due to the lack of prevalence of practicing neurologists in many rural areas, leaving gaps in the diagnosis system.
Due to the sheer volume of diabetes patients in India, as well as the increasing incidence of MS, any new therapies in development could offer untold numbers of people a new lease on life.
The new therapy
Diabetes and MS are both autoimmune conditions. This means that a dysfunction within the patient’s immune system has caused it to attack the body’s own cells. In diabetes, cells within the pancreas are damaged, resulting in lowered production or sensitivity to insulin. In MS, myelin sheaths surrounding nerve cells are depleted by the immune system, causing dysfunctional signaling in the brain and spinal cord.
The common feature of both is an improper function within the immune system. Current treatments target the damaging immune cells, but also have a side effect of causing damage to healthy, protective immune cells.
The team at the University of Utah set out to create a means of addressing the condition without damaging healthy immune cells. “We are really taking treatment for autoimmune disease in a new direction,” said Mingnan Chen, an assistant professor at the University of Utah. “This is the first time anyone has looked at the programmed cell death protein (PD-1) cells as a target to develop therapeutics for autoimmune disease.”
In a healthy individual, the PD-1-expressing cells, including immune cells (B and T lymphocytes), contain a mechanism that acts like a checkpoint that prevents the immune system from attacking itself. In those with an autoimmune disorder, this checkpoint is bypassed, leaving the immune cells in a constantly operating state that can cause damage to the host’s own cells.
The therapy involved an engineered protein molecule to deplete the malfunctioning PD-1-expressing cells from the body.
The study, published in Nature Biomedical Engineering, tested the treatment in a mouse model that mimics type 1 diabetes. They found the treatment delayed the onset of diabetes symptoms in mice to 29 weeks old compared to nineteen weeks old for control-treated mice. While this does not indicate a cure, it does represent the first steps towards stalling the disease.
The treatment was also applied to an MS model mouse. In this case the outcome was even more positive than with diabetes. The treatment halted the progression of paralysis in the six mice in this model, in addition, the mice regained the ability to walk. The team monitored the mice for 25 days after treatment and found the paralysis did not return.
The potential treatment is in its initial phases, though shows promising potential. Currently the treatment is limited as the antibodies used are specific to the mouse models used. “If we can generate the human version of therapeutics,” said Chen, “I think we could make a huge impact in treating autoimmune disease.”