The Most Vital Areas in Diabetes Research Today

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Do you ever wonder what gets a scientist’s blood pumping? What about diabetes research excites her? What makes her want to work harder to find that cure?   Look no further! As a researcher working toward a cure for diabetes, I present you with my top 5 list.

5. The standardization of science.

This is about as far as away as one can get from “sexy” science, but it is vital to the progression of research –and there is a reason laymen should care about it as much as I do. Most of the researchers I know would love to see standards in terms of protocols (or the “how we do everyday science”) to nomenclature (“what we call things”) to data analysis (“what does it all mean?”). You may wonder why this is important. Standardization of such things allows scientists to reproduce what others have done, which then reduces the waste of precious resources. We call this research rigor and transparency, and it protects those performing the science, as well as invaluable resources, including time, money, and precious one-of-a-kind reagents and tissues. In some instances, there are variations in the environment that prevent the complete standardization of protocols. Usually, these variations are documented in the scientific literature. You may be thinking “Well, haven’t people been working on this?” The answer would be “YES!” This is an evolving area of science, as new technologies arise, and new discoveries are made. It is something we as scientists must continually address as science moves forward.

4. Inflammation.

Inflammation is a broad reaching term that covers MANY disease conditions. Under MOST conditions, a little inflammation is a good thing. Inflammation is the way the body communicates with the immune cells to affect an attack against invaders. For example, when someone is infected with a virus or bacteria, the body has first responders that react, and tell other immune cells to react. This is what causes fevers, which can kill temperature sensitive viruses and bacteria. This is what directs the immune system to react in a very specific manner. Unfortunately, these invaders aren’t always invaders, and they can actually belong to functioning and vital organs in the body (i.e., the insulin-producing beta cells in the islets of Langerhans in the pancreas). Inflammatory responses can sometimes trigger a chain reaction that leads to unfortunate outcomes, including sepsis, diabetes (both type 1 and type 2), multiple sclerosis, and cardiovascular disease. We don’t always know WHY the inflammation begins, but in the case of autoimmune diseases, the inflammation is the likely stimulus for the out-of-control immune responses. From this perspective, we may find that by blocking some key inflammatory pathways, the risk of developing autoimmunity may decrease. Indeed, the horse is much easier to control while it’s still locked in the barn. There is a Catch-22 in this arena: Inflammation allows our bodies to fight off normal, everyday infections, so we NEED the ability to mount inflammatory responses. But prolonged inflammation is a bad thing. Therefore, we need to look for ways to keep the level of inflammation down without totally squelching it.

3. The Involvement of Viruses in the Development of Type 1 Diabetes.

If you are a person with Type 1 diabetes, you may wonder why I think this is cool. This is an area of research that has been hotly debated for more than 40 years. Much of the past data was anecdotal. Why, you may ask? This was partly due to a lack of standardization (see #5), and partly due to a lack of technology. More recent studies have made headway in determining whether or not viruses truly contribute to T1D. Of course, this is easier said than done. Our access to pancreas tissues from human donors is extremely limited. Thanks to groups like the Network for Pancreatic Organ Donors with Diabetes (nPOD), we scientists now have an opportunity to really look at human disease. However, what we see is only a brief snapshot of the disease within any patient. And it’s not clear that blood samples are enough to follow what is going on in the battlegrounds of the pancreas. One group is carefully dissecting this issue by coordinating studies in nPOD pancreas samples using the latest technology. I am proud and excited to be a part of the international efforts of the nPOD-Viral Working Group (see #1), and hope that we are able to shed light on this issue. Just imagine, if you will, what it would be like to offer a simple vaccine! Wouldn’t it be fabulous if that was all it took?

2. The Gut Microbiome.

You’ve likely read or heard about your gut bacteria, and how scientists and clinicians are developing a much greater understanding of the effects this additional “other organ” on our health and wellness. It’s truly amazing that there are more bacteria living in our gut than there are cells that make up our body! These bacteria have an enormous impact on the development of our immune systems. They can contribute to systemic inflammation, if the mix is right. They can affect the way we think. Yes, you read that correctly! Our gut flora talk with our brain cells! Certainly the use of antibiotics can alter the function of the gut microbiota. And viral infections can also alter the gut microbiome. It is not a stretch to see how this seemingly innocuous symbiont can tip the balance of health and wellness by increasing inflammation (see #4) or altering the body’s responses to viruses (see #3). Here’s where we have some control! We can take probiotics and pre-biotics, sure. But we can also eat well! The bacteria live in our digestive tract because they like what we eat. So when we eat nice, leafy greens, our “good” bacteria that can gain energy from those greens increase in number. This, in turn, causes them to push other strains of “bad” bacteria out of the system. After all, our guts only have but so much room! So if a person eats high-fat and high-sugar foods, which feed more pathogenic bacteria (in other words, bacteria that can cause disease), that person will likely see an increase in the total body inflammation. Since a large portion of our immune systems is influenced by the gut bacteria, it becomes easy to see how this can affect the development of inflammatory and autoimmune diseases. This is one area of scientific study that I think will yield many interesting results over the next decade.

1. Team Science.

Team science is another very cool development in the research world, at least in my book. I have been fortunate to work with the nPOD Consortium over the past 6 years, which espouses the ideals of team science. This Consortium, led by Mark Atkinson and Alberto Pugliese, has taken the leap to promote data sharing and frequent communications among all its investigators. Subsequently, the NIH has funded the Human Islets Research Network, which broadens the Team Science efforts in Type 1 diabetes research. By working together, I feel that we will gain much more ground in solving the enigmatic puzzles of science than we would by pursuing science in a vacuum, or in a purely competitive manner. Team science enables the wisest use of precious resources: time, money, tissue samples, and reagents. Results can be tested for concordance, or how closely they resemble one another, by different labs and different methods.  Without teamwork and team science, progress will come to a halt. With the increasing cost of performing experiments and publishing papers, as well as with the increased experimental burden placed on scientists in order to get the papers published, the independent scientist really does not stand a chance anymore. Since I started graduate school in 1996, we’ve gone from papers that have 4-5 figures with only 2 panels per figure to papers that have 5-8 figures, sometimes with upwards of 20 panels in one figure. That’s a 10-fold increase in the amount of data that is included in today’s published articles compared with those published 20 years ago! You can imagine that this expansion in data necessitates an expansion in funding to generate this data. Yet funding has not increased by that rate at all! We need to work together. And we are able to do this more easily than ever before with video conferencing, conference calls and shared data drives. Technology is a beautiful thing when it is contributing to a cure.

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Bob Doggett

Not enough to say thanks, Maggie from a type 1er who is nearing 50 years at the point of God knows how many needles. Could not be in the same room with you as far as your knowledge, but went to the Diabetes Institute in Miami last year and had renewed hope via Biohub results. People like you want to make me shoot for 50 and beyond, but optimism for me has disappeared like a slice of cheesecake in a non diabetic’s mouth.

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