This. I’m stupefied that they would include someone in immunosuppressants in such a study. It’s pointless since requiring them in a “cure” makes it largely worse than the disease (when well controlled).
Hi type 1 here. Since our errant immunity is localized on the insulin producing beta cells being on immune supressants would still be better than being insulin deoendent. Type 1 diabetes is a wild condition, when my blood sugar drops, subsections of my brain switch off. Low sugars are very emotionally bleak. There is a whole set of post traumatic stressors as part of this. 35 years ago I could just walk into a pharmacy and buy insulin without a prescription, maybe the pharmacist might as a couple of questions to at least try and be sure I need it, and that insulin was maybe $30 cash with no insurance and that was enough for a month. So everything might be $70 for an entire month w 5 blood sugar tests per day. Now a months supplies is in the hundreds of dollars. This stuff doesn't involve much more to manufacture, just layers of beauracy and markups. So yes having to take a cheap pill or two every day with the worst case being a revertion to being insulin dependent is worthwhile. Now side effects of the immune drugs might maybe be worse, but I doubt that. And this is a pilot to get FDA approval to test genetically modified beta cells that a type 1 wont destroy. Thanks for any understanding and compassion you can bring to this discussion.
My wife has a closed-loop system here in Germany, that is a small pod she changes every 3 days with the insulin loaded into and a wireless monitoring device in the arm that syncs to the phone. She is way into 95% or more in range and she lives a normal life. I think immunodepressants would not be the solution for her.
> Since our errant immunity is localized on the insulin producing beta cells being on immune supressants would still be better than being insulin deoendent
As a Type 1 diabetic, I'm not sure I would agree. Surely immune suppressants would suppress our whole immune system not just the faulty bit which opens us up to all sorts of problems. I don't think that is someone I would like to risk just to avoid taking insulin. Mind you I have to confess my attitude might be affected by the fact that I don't have to pay for insulin.
My youngest was diagnosed with type 1 diabetes at 14 and it has been a tremendous emotional and physical burden on her. It's so encouraging to see research in this area and the faintest glimmer of a hope for a hope that she'll find relief.
is it possible for a type 1 diabetic to not know and live their life fully untreated? By this I don't mean every type 1 diabetic, what I'm asking is whether it's possible for someone to be like this, due to their specific health circumstances.
My in-law (brother) got what is called diabetes type "1.5", or LADA (latent autoimmune diabetes in adults), at the ripe age of 40.
It is like type 1, but much, much slower progressing - hence why it shows up at adult age, compared to childhood. Unlike type 2, you can't keep it under control by lifestyle changes. My in-law is a physically fit person with a good diet, and has been his whole life.
In any case, after the onset of symptoms, he had to get treatment. No treatment leads to further organ damage, which eventually leads to death.
Possibly caused by a virus. A person can develop type 1 diabetes from the effects of a virus like measles and other viruses. I don't think many people are aware of that.
Autoimmune conditions can stem from viral infections, yes. But most of the time type-1 diabetics have a very weak phenotype of the disease, that is to say, the patient has pancreatic antibodies (specifically beta-cell antibodies) and produces them very, very slowly.
According to this source, half of all "new cases" (whatever that means) occurs in adults: https://diabetesjournals.org/care/article/44/11/2449/138477/...
My partner is a rare example of this. A little over 2 years ago at the age of 37 she was diagnosed as diabetic and put on metformin. The doctor thought it was LADA, or Type 1.5. The then the doctor kinda.... forgot about her? Historically he's been a terrible primary care doctor, just shoves pills and has no discussions so I wasn't super surprised. I'd been asking her to switch doctors for 3 years at that point due to some bad pill prescriptions that sent her suicidal. She was on metformin for 18 months with no meetings with her doctor beyond switching from an instant release to an extended release due to stomach pain. She got really irritated at me for suggesting that she be touching base with her doctor and progressing the care along, so I just dropped the topic and helped with carb counting, meal planning, and paid for a personal trainer.
About 6 months ago she suddenly started dropping weight. Extreme exhaustion (winded after going up a flight of stairs), dropped 30 pounds in two months, she was starting to get skeletal. Still not being active with her healthcare, but when she went under 110lbs for the first time since she was 14, she finally found the motivation she needed to get proactive and quickly found a better team of doctors who diagnosed her with Type 1 and put her on Insulin immediately.
Today we're putting her 2nd Omnipod on her for insulin delivery. She should get a closed loop system soon, I guess the iPhone support for her Omnipod+Dexcom combo is still going through FDA approval. Her new team says she's lucky to be alive at all. They've been going through her extensive medical history, pointing at occasions when she was hospitalized during her menses and saying "here you were going through diabetic ketoacidosis, that's why you were vomiting constantly", "every evening you're going critically low, that's why family thought you were a closet alcoholic", and "on average during the day your blood glucose is far, far too high, that's why you drink and piss gallons of water per day but are never sated".
So... I guess yes you can get lucky and survive, but with symptoms strong enough that it _should_ be caught.
> Because the woman was already receiving immunosuppressants for a previous liver transplant,
This makes sense - this was the first trial, so doing this on a person already on immunosuppressants minimizes risk while still validating the basics of if it works at all in the first place.
I believe it’s already reasonably common to give a person Type 1 diabetes a pancreas transplant if they have another transplant and will therefore be taking immunosuppressants anyway.
It’s true that you wouldn’t do this unless they were already needed, say, a liver transplant.
Amazing! Hopefully the effects are sustained over the long term and can be replicated.
The potential of the stem cell space is incredible. Another interesting development is patients "cured" of HIV following stem cell transplants to treat leukaemia - which has no direct clinical implications given the significant risk of stem cell transplant but does inspire hope for the future [1].
I’m surprised more people didn’t try that route earlier. Step one in stem cell transplant for leukemia it to kill all existing immune cells. HIV hides in immune cells.
I think too many HIV patients were too compromised by opportunistic infections to ever be healthy enough for stem cell transplants
Nowadays many hiv positive individuals are in better than average health. And a fluke for the ones diagnosed with AIDS they enjoy a slightly longer than average lufe expectancy. This is part a survivor bias, where only the fittest of tgat cohort survived. It is also due to their being eledgable for medicaid with double the income of anyone else.
TFA claims the stem cells were administered into the abdominal muscles, which may reduce the "significant risk of stem cell transplant" compared to direct injection into the liver.
The point of stem cell treatments is to replace cells that are no longer there doing their job. It's not too relevant for the replaced cells to be in the same spot, as long as they exist and produce insulin, you are good to go.
You could argue for the location having physiological implications, for instance: it's convenient for the liver to be right after the intestines (connected through the portal vein), like this, it metabolizes large amounts of whatever is absorbed intestinally at once, before it reaches systemic circulation.
This may hold true for the pancreas as well. It uses duodenal glucose concentrations to know exactly how much insulin to release, which may not be representative of the rest body's glucose concentrations.
Practically speaking, it is far safer to inject stem cells in the abdomen where you have room for erscqror and can do surgery on without much trouble vs the pancreas, if anything goes wrong there, you could easily kill a patient.
Stem cells are pretty good at moving around. If they don't want to stay in the pancreas, you won't be able to make them, and if they want to go to the pancreas, they will find their way there even if transplanted in a less invasive way.
This is a fascinating development, especially for type 1 diabetes, where autoimmunity is such a challenge. Using the patient’s own reprogrammed cells to avoid immune rejection is promising.
I've been waiting for stem cell therapy to regrow my recessed gums. Every option for taking care of my recessed gums seem horrible and my gums are so far gone. Wish I'd have developed better habits for taking care of them when I was younger but oh well.
That's always easier said than done, isn't it? I'm sure many of us wish they had taken better care of their bodies when they were younger, but sometimes life gets in the way, long term impacts are unclear, and we overestimate our ability to "fix it later".
It's also important to not underestimate just how powerful lifestyle changes can be even in the face of (a lot of our potential) dire outcomes. Not sure about gums here specifically.
Reversing a condition once you have it is an order of magnitude more difficult to fix than to prevent, but if you're in luck and able to do so, every day now has the potential for taking a step in the right direction.
My favorite example of this is post-menopausal women regaining bone density, muscle mass, balance, mood etc. to rival women half their age in a matter of a few weeks (weight training). The same can be said for pre-diabetes, early T2, high blood pressure, addictions... the list goes on.
With regards to OP, I hope you find some relief somehow! I still have some baby teeth with very short roots; the second I get inflamed gums my pain level approaches levels were I can't function properly. What is the symptoms of receded gums?
> It's also important to not underestimate just how powerful lifestyle changes can be
Agreed, what's that phrase, "The best time to start was 20 years ago, the second best time is now"?
But it's also important to be a little kind to yourself, don't be too harsh on yourself for the things you didn't do or could have done differently. You can't go back in time.
From your own mouth or from cadavers? Cadavers sounds freaky to me, from my own mouth seems like I'm just robbing Peter to pay Paul, but maybe it's worth it.
It was from the roof of my own mouth. Except for a bit of bleeding I had no complications whatsoever as it's just connective tissue that's taken. It regrows quite fast.
Out of curiosity, what habits would you adopt? Flossing? Or is there something else doctors recommend? A cursory search seems to bring up rather regular dental hygiene.
I had all the habits, I just wasn't prioritizing them if I was tired or sleeping late due to school/work/stuff. I probably should have prioritized set times to do them each day irregardless of what I was doing. Plus, I didn't take seriously the habit to brush for several minutes instead of several seconds.
Not the OP, but on top of cleaning the gaps between teeth well, I started going to dental hygienist four times a year and the expense seems to be worth it.
Nowadays my gums just don't bleed ever, period, even when the hygienist is scrapping away calculus.
That's awesome! My sister got diabetes Type 1 few years ago and was loosing hope. That's a very great news for her and all the people that have to lived with it and who we told there was no cure when they got it.
I have wondered for awhile what just injecting [fresh] placental/umbilical cord tissue into people with various autoimmune issues may result in, as apparently it has powerful immune system regulators in it; I've not looked for related research yet though.
Interesting that the stem reprogramming technique was invented 20 years ago. I wonder if all who contributed to this over the years will get their due rewards. I feel they won’t, which makes me sad. Amazing results and huge potential for diabetes but also other conditions.
The fact this worked on Type 1, which is an autoimmune disorder, is very interesting/surprising as a layman.
The patient was on immunosuppressants.
This. I’m stupefied that they would include someone in immunosuppressants in such a study. It’s pointless since requiring them in a “cure” makes it largely worse than the disease (when well controlled).
Hi type 1 here. Since our errant immunity is localized on the insulin producing beta cells being on immune supressants would still be better than being insulin deoendent. Type 1 diabetes is a wild condition, when my blood sugar drops, subsections of my brain switch off. Low sugars are very emotionally bleak. There is a whole set of post traumatic stressors as part of this. 35 years ago I could just walk into a pharmacy and buy insulin without a prescription, maybe the pharmacist might as a couple of questions to at least try and be sure I need it, and that insulin was maybe $30 cash with no insurance and that was enough for a month. So everything might be $70 for an entire month w 5 blood sugar tests per day. Now a months supplies is in the hundreds of dollars. This stuff doesn't involve much more to manufacture, just layers of beauracy and markups. So yes having to take a cheap pill or two every day with the worst case being a revertion to being insulin dependent is worthwhile. Now side effects of the immune drugs might maybe be worse, but I doubt that. And this is a pilot to get FDA approval to test genetically modified beta cells that a type 1 wont destroy. Thanks for any understanding and compassion you can bring to this discussion.
My wife has a closed-loop system here in Germany, that is a small pod she changes every 3 days with the insulin loaded into and a wireless monitoring device in the arm that syncs to the phone. She is way into 95% or more in range and she lives a normal life. I think immunodepressants would not be the solution for her.
Similar story for my partner in the USA.
What is the range that she is keeping?
70-180.
> Since our errant immunity is localized on the insulin producing beta cells being on immune supressants would still be better than being insulin deoendent
As a Type 1 diabetic, I'm not sure I would agree. Surely immune suppressants would suppress our whole immune system not just the faulty bit which opens us up to all sorts of problems. I don't think that is someone I would like to risk just to avoid taking insulin. Mind you I have to confess my attitude might be affected by the fact that I don't have to pay for insulin.
My youngest was diagnosed with type 1 diabetes at 14 and it has been a tremendous emotional and physical burden on her. It's so encouraging to see research in this area and the faintest glimmer of a hope for a hope that she'll find relief.
is it possible for a type 1 diabetic to not know and live their life fully untreated? By this I don't mean every type 1 diabetic, what I'm asking is whether it's possible for someone to be like this, due to their specific health circumstances.
My in-law (brother) got what is called diabetes type "1.5", or LADA (latent autoimmune diabetes in adults), at the ripe age of 40.
It is like type 1, but much, much slower progressing - hence why it shows up at adult age, compared to childhood. Unlike type 2, you can't keep it under control by lifestyle changes. My in-law is a physically fit person with a good diet, and has been his whole life.
In any case, after the onset of symptoms, he had to get treatment. No treatment leads to further organ damage, which eventually leads to death.
Possibly caused by a virus. A person can develop type 1 diabetes from the effects of a virus like measles and other viruses. I don't think many people are aware of that.
Autoimmune conditions can stem from viral infections, yes. But most of the time type-1 diabetics have a very weak phenotype of the disease, that is to say, the patient has pancreatic antibodies (specifically beta-cell antibodies) and produces them very, very slowly. According to this source, half of all "new cases" (whatever that means) occurs in adults: https://diabetesjournals.org/care/article/44/11/2449/138477/...
I'm not quite sure how exactly to interpret your question, but untreated type 1 diabetes usually kills you within five years of diagnosis.
i'm asking about what may happen when the illness isn't, in your words, usual
It's not possible. Type 1 diabetes stops the production of insulin, which is generally required for survival.
My partner is a rare example of this. A little over 2 years ago at the age of 37 she was diagnosed as diabetic and put on metformin. The doctor thought it was LADA, or Type 1.5. The then the doctor kinda.... forgot about her? Historically he's been a terrible primary care doctor, just shoves pills and has no discussions so I wasn't super surprised. I'd been asking her to switch doctors for 3 years at that point due to some bad pill prescriptions that sent her suicidal. She was on metformin for 18 months with no meetings with her doctor beyond switching from an instant release to an extended release due to stomach pain. She got really irritated at me for suggesting that she be touching base with her doctor and progressing the care along, so I just dropped the topic and helped with carb counting, meal planning, and paid for a personal trainer.
About 6 months ago she suddenly started dropping weight. Extreme exhaustion (winded after going up a flight of stairs), dropped 30 pounds in two months, she was starting to get skeletal. Still not being active with her healthcare, but when she went under 110lbs for the first time since she was 14, she finally found the motivation she needed to get proactive and quickly found a better team of doctors who diagnosed her with Type 1 and put her on Insulin immediately.
Today we're putting her 2nd Omnipod on her for insulin delivery. She should get a closed loop system soon, I guess the iPhone support for her Omnipod+Dexcom combo is still going through FDA approval. Her new team says she's lucky to be alive at all. They've been going through her extensive medical history, pointing at occasions when she was hospitalized during her menses and saying "here you were going through diabetic ketoacidosis, that's why you were vomiting constantly", "every evening you're going critically low, that's why family thought you were a closet alcoholic", and "on average during the day your blood glucose is far, far too high, that's why you drink and piss gallons of water per day but are never sated".
So... I guess yes you can get lucky and survive, but with symptoms strong enough that it _should_ be caught.
Yep weight is a basic vital statistic. Everyone should weigh themselves at least once a week.
From the article:
> Because the woman was already receiving immunosuppressants for a previous liver transplant,
This makes sense - this was the first trial, so doing this on a person already on immunosuppressants minimizes risk while still validating the basics of if it works at all in the first place.
I believe it’s already reasonably common to give a person Type 1 diabetes a pancreas transplant if they have another transplant and will therefore be taking immunosuppressants anyway.
It’s true that you wouldn’t do this unless they were already needed, say, a liver transplant.
Amazing! Hopefully the effects are sustained over the long term and can be replicated.
The potential of the stem cell space is incredible. Another interesting development is patients "cured" of HIV following stem cell transplants to treat leukaemia - which has no direct clinical implications given the significant risk of stem cell transplant but does inspire hope for the future [1].
Edit: Source: https://www.who.int/news/item/25-07-2024-a-seventh-case-of-h...
I’m surprised more people didn’t try that route earlier. Step one in stem cell transplant for leukemia it to kill all existing immune cells. HIV hides in immune cells.
I think too many HIV patients were too compromised by opportunistic infections to ever be healthy enough for stem cell transplants
Nowadays many hiv positive individuals are in better than average health. And a fluke for the ones diagnosed with AIDS they enjoy a slightly longer than average lufe expectancy. This is part a survivor bias, where only the fittest of tgat cohort survived. It is also due to their being eledgable for medicaid with double the income of anyone else.
TFA claims the stem cells were administered into the abdominal muscles, which may reduce the "significant risk of stem cell transplant" compared to direct injection into the liver.
I'm curious why they don't transplant into the pancreas?
The point of stem cell treatments is to replace cells that are no longer there doing their job. It's not too relevant for the replaced cells to be in the same spot, as long as they exist and produce insulin, you are good to go.
You could argue for the location having physiological implications, for instance: it's convenient for the liver to be right after the intestines (connected through the portal vein), like this, it metabolizes large amounts of whatever is absorbed intestinally at once, before it reaches systemic circulation. This may hold true for the pancreas as well. It uses duodenal glucose concentrations to know exactly how much insulin to release, which may not be representative of the rest body's glucose concentrations. Practically speaking, it is far safer to inject stem cells in the abdomen where you have room for erscqror and can do surgery on without much trouble vs the pancreas, if anything goes wrong there, you could easily kill a patient.
It seems from the article that it's harder to monitor, so by injecting in the abdomen they can monitor them using MRI and remove them if needed.
Stem cells are pretty good at moving around. If they don't want to stay in the pancreas, you won't be able to make them, and if they want to go to the pancreas, they will find their way there even if transplanted in a less invasive way.
How do stem cells move?
This is a fascinating development, especially for type 1 diabetes, where autoimmunity is such a challenge. Using the patient’s own reprogrammed cells to avoid immune rejection is promising.
I've been waiting for stem cell therapy to regrow my recessed gums. Every option for taking care of my recessed gums seem horrible and my gums are so far gone. Wish I'd have developed better habits for taking care of them when I was younger but oh well.
> Wish I'd have developed better habits
That's always easier said than done, isn't it? I'm sure many of us wish they had taken better care of their bodies when they were younger, but sometimes life gets in the way, long term impacts are unclear, and we overestimate our ability to "fix it later".
It's also important to not underestimate just how powerful lifestyle changes can be even in the face of (a lot of our potential) dire outcomes. Not sure about gums here specifically.
Reversing a condition once you have it is an order of magnitude more difficult to fix than to prevent, but if you're in luck and able to do so, every day now has the potential for taking a step in the right direction.
My favorite example of this is post-menopausal women regaining bone density, muscle mass, balance, mood etc. to rival women half their age in a matter of a few weeks (weight training). The same can be said for pre-diabetes, early T2, high blood pressure, addictions... the list goes on.
With regards to OP, I hope you find some relief somehow! I still have some baby teeth with very short roots; the second I get inflamed gums my pain level approaches levels were I can't function properly. What is the symptoms of receded gums?
> It's also important to not underestimate just how powerful lifestyle changes can be
Agreed, what's that phrase, "The best time to start was 20 years ago, the second best time is now"?
But it's also important to be a little kind to yourself, don't be too harsh on yourself for the things you didn't do or could have done differently. You can't go back in time.
I had a transplant for my recessed gum and the results are great. Maybe that could be an option for you too.
From your own mouth or from cadavers? Cadavers sounds freaky to me, from my own mouth seems like I'm just robbing Peter to pay Paul, but maybe it's worth it.
It was from the roof of my own mouth. Except for a bit of bleeding I had no complications whatsoever as it's just connective tissue that's taken. It regrows quite fast.
Out of curiosity, what habits would you adopt? Flossing? Or is there something else doctors recommend? A cursory search seems to bring up rather regular dental hygiene.
I had all the habits, I just wasn't prioritizing them if I was tired or sleeping late due to school/work/stuff. I probably should have prioritized set times to do them each day irregardless of what I was doing. Plus, I didn't take seriously the habit to brush for several minutes instead of several seconds.
Not the OP, but on top of cleaning the gaps between teeth well, I started going to dental hygienist four times a year and the expense seems to be worth it.
Nowadays my gums just don't bleed ever, period, even when the hygienist is scrapping away calculus.
Would love stem cells for gum recovery!
That's awesome! My sister got diabetes Type 1 few years ago and was loosing hope. That's a very great news for her and all the people that have to lived with it and who we told there was no cure when they got it.
I have wondered for awhile what just injecting [fresh] placental/umbilical cord tissue into people with various autoimmune issues may result in, as apparently it has powerful immune system regulators in it; I've not looked for related research yet though.
Interesting that the stem reprogramming technique was invented 20 years ago. I wonder if all who contributed to this over the years will get their due rewards. I feel they won’t, which makes me sad. Amazing results and huge potential for diabetes but also other conditions.