This fall, at a Tedx conference organized in our community, Mark and I had the chance to meet with and hear a talk by Doug Melton — the Harvard professor who became a pioneer in the field of stem-cell biology when his son, and then his daughter, were diagnosed with type 1 diabetes. In April, Melton’s lab at Harvard’s Stem Cell Institute, where he is co-founding director, received a lot of attention for its discovery of betratrophin, a hormone that holds promise for the treatment of diabetes, especially type 2.
Talking with someone who knows so much about T1D on both a personal and a scientific level was fascinating, and Doug Melton gave us some insights that have been helpful as we have thought through Bisi’s care and diet. I told him how we had Bisi go gluten free when she was diagnosed, but that now that her honeymoon has waned we’re letting her eat things with gluten on special occasions. I have always had a hard time explaining the logic of the gluten-free decision to people—especially now that she’s no longer honeymooning, at least not as strongly as she was. (Our initial impetus was reading a study about a child who honeymooned for at least two years after going gluten-free.) But Melton helped give me the language to understand and visualize how going gluten free might be helpful biologically. He pointed out that the immune system of anyone with T1D is on high alert, because it has turned on itself and attacked the body’s beta cells. Gluten is also thought to provoke an inflammatory response—causing the immune system of someone like Bisi to go into even high gear. As Melton explained it, “Going gluten-free is kind of like putting an ice pack on a bruise; it calms the immune attack a bit.”
We also talked about Bisi’s honeymoon, and the fact that her insulin needs were extremely low for about a year. Melton’s response was that this was good news for her, since it meant that her immune system’s attack on her beta cells—though still ultimately successful—was relatively weak. I had never heard anyone talk about the diabetes immune attack in degrees before—only in black and white: that either your body attacks your beta cells or it doesn’t. So this was an interesting perspective on the potential variability of diabetes from one person to another.
And then we got to hear Melton give a talk about the work going on in his lab on stem cells and how it applies to type 1 diabetes. Below are some highlights. But take a look at the talk yourself—there’s much more to it than my summary here.
Melton spoke specifically about the power and potential of stem cells to create a new supply of beta cells to treat diabetes, though he pointed out that stem cells could be turned into many other types of cells to address many other types of diseases. “We are trying to take a cell and create mastery and dominion over it and make it become a pancreatic beta cell—make it do what we want,” he said.
As he pointed out, the drug industry has no incentive to cure type 1 diabetes. “From the drug industry perspective, insulin has become not a blockbuster drug—it’s beyond that. It’s a commodity. Twenty-five billion dollars worth a year is bought and sold and injected into people.” But someone whose children have T1D, and who is both fascinated by and has the capacity to understand—and maybe even influence—what is going on with diabetes at the cellular level: he has an incentive to try to cure this disease. “My project is relatively simple: instead of injecting yourself with insulin, why not give yourself the cells that make insulin and get rid of diabetes?”
Melton’s lab has spent the past decade trying to figure out the “molecular biography” of the beta cell, and he says they’re “in the red zone, almost over the goal line, in terms of making perfect cells.”
Of course, just having a new source for the cells will not stop the auto-immune attack, but Melton’s work (like that of Susan Bonner-Weir, who is also part of the Harvard Stem Cell Institute) at least shows us one potential path toward a cure.
Bisi sat in the aisle, trying unsuccessfully to take in a talk aimed for adults, but about a disease she knows intimately. Melton’s last image, though, was something Bisi could understand. It showed two stick figures, one with diabetes and a frown drawn on its face; another with a smiley face, representing life with normal blood sugar and no insulin injections, courtesy of an infusion of healthy beta cells. After seeing the sad-faced stick figure, Bisi turned to a friend sitting next to her and said, “That’s not how I look!” This is true, most of the time. But I think her smile will be even wider than it usually is when Melton and his team do cross that goal line.