“We have the greatest collection of medical intellects that’s been assembled in one place since Frederick Banting discovered insulin.” – John L. Eastman, Co-Chair of the Advisory Committee at the Naomi Berrie Diabetes Center
And so began the 2017 Diabetes Research Panel, the annual event at the University Club in Manhattan that showcases the depth and breadth of the talent at the Naomi Berrie Diabetes Center at Columbia University Medical Center. The event (always a free-flowing and lively exchange of information between a well-informed audience and the panelists) featured basic scientists, clinical practitioners and translational investigators.
This year the panelists were Berrie Center Co-Directors, Rudy Leibel, MD, Christopher J. Murphy Professor of Diabetes Research, and Robin Goland, MD, the J. Merrill Eastman Professor of Clinical Diabetes; Domenico Accili, MD, Chief of the division of Endocrinology at Columbia University Medical Center and the Russell Berrie Foundation Professor of Diabetes; Dieter Egli, PhD, the Maimonides Assistant Professor of Developmental Cell Biology; noted immunologist and islet transplant expert, Megan Sykes, MD, the Michael J. Friedlander Professor of Medicine; Associate Professor and head of the pediatric diabetes program at the Berrie Center, Natasha Leibel, MD; and Assistant Professor and adult endocrinologist Magdalena Bogun, MD, who was recently selected to participate in the newly established NIH Type 1 Diabetes TrialNet Emerging Leader Program. For the first time, two diabetes educators (pediatric educator Emily Casciano, RD, CDE and adult educator Courtney Melrose, MPH, RD, CDE) were also on the panel.
The highlight of the evening was a 60-minute Q&A session with the audience, which included approximately 150 patients, friends and families from the Berrie Center who were mostly interested in the topic of type 1 diabetes (T1D). In fact, the first question was about the timeline for a cure—at which point panelists took turns discussing their different strategies to achieve it.
Dr. Sykes, head of the Columbia Center for Translational Immunology, talked about an approach in organ transplantation called “mixed chimerism” which “could cure both the autoimmune disease and allow the donor islets to be effective,” she said. It is the same approach that has been used for kidney transplant patients and has allowed them “to accept their donor kidneys without immunosuppressive medication for the last 15 years,” she added, “but with islets, it’s a little bit harder.”
One of the things required for islet transplantation to work will be a source of beta cells, Dr. Rudy Leibel pointed out. And for that, Dr. Sykes works closely with the panelist Dr. Egli, a basic cell biologist with an expertise in the creation of patient-specific, insulin-producing beta cells. “We know what we need to do in order to achieve a cure,” Dr. Egli said, “We have to produce beta cells at a clinical grade level and show that they work.”
Said Dr. Leibel: “I think it is perfectly rational and quite likely to be a potential solution to the question of how to get a long term cure for T1D. I am confident that Dieter will achieve his goal.”
Dr. Accili talked about his ground-breaking discovery five years ago that a group of cells in the gut, upon proper cues, have the ability to become glucose sensitive, glucose responsive, insulin- producing cells—opening up the possibility that gut insulin could substitute for pancreatic insulin as a cure for diabetes. Dr. Accili said that the research is moving at a fast pace and he has been working with various pharmaceuticals and venture companies; meanwhile, he said optimistically, “the research is moving at a rapid pace.”
Added Dr. Accili: “No stone is left unturned here at the Berrie Center. Whatever approaches can be explored are explored. And we’re positioning ourselves not only to be leaders but to leverage what other people have done.”
The diabetes educators answered a question about the new Medtronic hybrid system. Courtney Melrose, the adult diabetes educator, talked about what patients can expect at this early stage. “This is a great first step,” she said. “Our patients are eager to utilize the Medtronic 670G to fine-tune their diabetes management. However, it is still a hybrid and not a closed loop system. The patient will still need to be very involved in dosing and adjustment decisions. In the future, when the device can provide two hormones--both the insulin and the glucagon, and manage blood sugars according to a specific algorithm—that will be a huge advance!”
Added Emily Casciano, “From a pediatric point of view, we’re looking forward to getting our hands on this new device. A child’s insulin needs vary up to 30 percent each day. We know it’s not going to be appropriate for everyone, but it has the potential of helping a lot of kids get their A1Cs down.”
A question from the audience about whether the cure was a function of science or money led to a thought-provoking discussion from the panelists. “It’s not a direct function of money,” said Dr. Accili, “but it’s about allowing us to do what we think is doable—and that requires more money than we have.” Added Dr. Leibel, “if the NIH budget, which is already down 20 percent is cut another 20 percent, it will basically cripple the enterprise in a savage way that will resonate for decades to come.”
Next came a question about adult onset diabetes, triggers and prevention. “The primary trigger is in the genes,” said Dr. Accili. “The trigger varies, and it opens the door to something that’s been lurking behind the door all of the time. There are environmental triggers, but what gets lost in the debate, is that only some people exposed to the same trigger will get type 1 diabetes.”
Said Dr. Goland, “We don’t know why some people get it at 11 months and others much, much later in life, but we are studying the genetic underpinnings of type 1 diabetes through the NIH study called TrialNet.” Dr. Bogun talked about the three stages of diabetes—the first two stages manifest without full-blown diabetes symptoms. “If you have positive antibodies,” she said, “you can be put in a prevention trial which can delay the progression from one stage to another.”
The evening ended with an impassioned plea from John Eastman—“This is an existential moment for science,” he said, “not just for Columbia but for every and any other major institution. If we can add some support to what they’re doing here, it makes a lot of sense. How can we go to Congress and ask them not to cut the NIH budget, if we don’t help ourselves.”
The Eastman’s, John and Jodie and Jay and Katama, again pledged their support for the Berrie Center with another, generous $100,000 challenge grant that, if met, could raise a half million dollars for clinical and research programs. “It’s not enough to get a cure, but enough to say thank you for all the Berrie Center has done for us.”