"Cancer drug preserves insulin cells in diabetes" (Reuters)"What this study does is open the door to a whole new way to approaching type 1 diabetes," Dr. Mark Pescovitz of Indiana University, who led the study, said in a telephone interview.
Rituxan, known generically as rituximab, is made by Genentech, a unit of Roche Holding AG and Biogen Idec Inc. It was designed to wipe out immune cells known as B lymphocytes, which proliferate out of control in lymphoma.
The same cells are also involved in the autoimmune destruction of healthy cells and tissue seen in rheumatoid arthritis and, in theory, in juvenile diabetes.
Usually, by the time diabetes symptoms appear, 80 to 90 percent of those insulin-producing cells have been destroyed. The Pescovitz team gave Rituxan hoping to save the remaining cells.
The treatment worked at first and the body produced more insulin. But over time, the effects faded, and insulin production began to decline at the same rate as among people who received placebo.
Pescovitz said he was not disappointed. Further tests will show if repeated treatments with Rituxan or newer drugs that also eliminate B lymphocytes will keep insulin production up.
"Rituximab, B-Lymphocyte Depletion, and Preservation of Beta-Cell Function" (New England Journal of Medicine)
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I didn't know that so many cells were dead by the time symptoms appeared. In that sense Type 1 diabetes reminds me of Parkinson's disease and dementia, when there is already significant damage by the time a person is diagnosed and any kind of therapy can be implemented. As I currently work with a lot of people with dementia, many who have only recently been diagnosed or who are still in that process, I am often surprised that people have deteriorated so far before they have been picked up.
Any kind of treatment that works by reversing early changes or by slowing the process of deterioration (as with anticholinesterase inhibitors for dementia) will need to go hand in hand with systematic screening and referral services. It's a big ask, and would take significant money and time to implement, but it could be the best way to tackle many of these diseases - if we find anything that can work in the first place.
As far as systematic screenings for Type 1 diabetes go, many siblings of Type 1 diabetics are relatively regularly checked for blood sugar abnormalities.
This study focuses on newly-diagnosed diabetics, which is great, but there are many of us out there who are far beyond the window. There was a woman a few years ago (whom I can't find through Google due to my limited science knowledge) who had researched the blood marrow/faulty antibodies that are linked with Type 1 diabetes and other auto-immune diseases. She found that in healthy bodies there was a layer of some substance which prevented faulty antibodies from entering the bloodstream. She had done work with a proprietary chemical injection to correct this faulty layer and when the pancreases of those studied were no longer under attack from the faulty antibodies they regenerated beta cell tissue.
Again, I am not a scientist. I may be remembering this slightly wrong. But as a woman with Type 1 (for 20 years) I'm also interested in any applications for diabetics who've had the disease for a number of years.
Momma Pescovitz: I'm so glad the two of you were able to come home for Thanksgiving! So what have you boys been up to?
Mark: I published a paper in the New England Journal of Medicine about a new way to slow and possibly even stop the progression of type 1 diabetes, also known as juvenile-onset diabetes.
David: Uh... Boing-Boing.
As a person with an advanced form of MS, I have heard a lot about rituximab's potential to counter autoimmune diseases. I've also heard a lot about progressive multifocal leukoencephalopathy (commonly referred to as PML). It's an extremely nasty disease that kills or severely disables virtually all of its victims. The FDA has noted a connection between Rituxan use and PML and issued a corresponding warning. I don't think withrawl of the drug was seriously considered due to the nature of its intended use--treating a deadly form of cancer.
Even if the odds of contracting PML from Rituxan use are low (and they have not actually been fully assessed), I think it is important to note the connection here. It's not that I'm against using the stuff--I actually have had dozens of rounds of chemotherapy (cyclophosphamide) and will probably need to use something more questionable like rituxan soon--but it is important to note that it is a serious, possibly grave decision.
Just nachos? ;) jk
This was an interesting story all around. Aside from the great medical find, I think it's great that your brother is a photographer, and a medical scientist /on the side/.
@MrJM, Hahaha!!! Love it.
>The treatment worked at first and the body produced more insulin. But over time, the effects faded, and insulin production began to decline at the same rate as among people who received placebo.
genentech is a hold then?
@MRJM: Excepting that David's mother is still trying to figure out what a blog is, very funny.
This is exciting work. My daughter has juvenile rheumatoid arthritis (luckily mild so far), so I've been reading about the various immune system treatments that are being developed. The connections to Alzheimer's and diabetes are really interesting.
If the immune system were "wise" it probably wouldn't be causing Type 1 diabetes in the first place...
"By relying on such static drugs as Rituxan, individuals are further weakening their own, infinitely wiser immune systems."
I have to say I always find this attitude worrying. Our immune systems don't have an inherent wisdom; they are basically just a complex set of chemical reactions. If an immune system is malfunctioning badly, it can't tell that it is malfunctioning-- it just goes ahead and stops producing insulin, or attacks healthy tissues, or whatever. And it will continue to malfunction unless some external force (namely us) intercedes.
Or you know, what phisrow said!
mazel tov!
Could you possible provide references for your pertinent scientific sources that allow you to have a more poetic stance to the insane complexity that are our immune systems?
BTW, my partner experiences red and itchy dermatitis when he eats a range of foods including milk, soy, sunflower seeds etc. Perhaps you could provide some advice as to why his wise immune system has decided to impose limitations for him on these foods which are innocuous to me.
a) very exciting news! [even knowing the potential dangerous side effects of rituxan]
b) i wish people would stop calling it juvenile onset diabetes. i developed it at age 31, my cousin at age 24. i've also met someone who developed it at age 51 and my doctor said he diagnosed a woman with it age 63 last month. since it's so commonly [and mistakenly] assumed that type I doesn't happen to adults, people don't look for it when symptoms show up - i went to 5 doctors who didn't test me before ending up semi conscious in the emergency room where i was diagnosed.
if rituxan ends up working for this when people first start showing symptoms, it would be great if it would be applied to juvenile cases and the rare adult cases
May I ask how you would define the immune system?
Hmmm... homepathic medicine and death, or insulin treatment. As a Type I diabetic, I guess I'm going to choose insulin treatment, thank you.
Well, you DO sound pretty confident in your assertation.
Here's a better way to put it:
From the knowledge I have available to me, "Our immune systems...are basically just a complex set of chemical reactions..."
It's entirely possible that there are factors in the human system that modern science does not yet understand and cannot measure.
Of course, the same comment could apply to lovemycoffeehouse's orginal post.
It makes me think of a multi-sheet, highly inter-linked Excel spreadsheet I was working on, where every cell except for a few is based on another cell.
If you get the wrong result at the end, it's possible to go back and add numbers here and there, overwriting cell formulas, until you get the final result you need. I feel this is often the approach that modern medicine takes: get rid of the problem/symptom in the short term, without fully appreciating how the whole thing works together. And sometimes it's the only way.
But, you'll have screwed up the spreadsheet. It's a better approach to look at whole spreadsheet, understand how everything is connected, and adjust the input values at the beginning that then populate throughout.
While there is certainly value in research like this, as long as people don't truly understand how to eat properly and take care of their systems, it's not the safest or most efficient way to solve the problem for many sufferers.
Rates of type-1 diabetes are expected to double over the next decade (http://tinyurl.com/rypdtl), which would suggest there are some unknown external factors that cause it, not just loopy genes or something.
I've probably under-stated the complexity of the immune system- but it is still fundamentally a system governed by chemical reactions--as are all biological systems. That's how they work- cells and tissues communicate by chemical signalling.
But my background is in biology- so I am looking at it pragmatically.
Which is why I was curious to know lovemycoffeehouse's definition.
I'm absolutely not against holistic medicine, and 'common sense' when it comes to matters of health. What concerned me in lovemycoffeehouse's first post was the implication that our immune systems have 'wisdom'. I honestly feel that they do not. They are capable of signalling us when there is a problem- but it is ultimately up to us, and our ability to reason, to determine if the signal is accurate or not.
To go back to your spreadsheet analogy: the spreadsheet can show us errors, but it cannot correct these errors itself- it is limited to its programming. Our immune systems may be vastly more complex, and subtle in their actions but they are still just a system. It is up to us interpret them.
Sure hope the tests don't include the very nasty side-effects normally associated with Rituxan. I owe my own life to this designer drug, but its use is not without costs.
I received this drug before my second kidney transplant in June 2008. Without treatments like this, I would not have been able to get another transplant at all as I had developed too many antibodies. I haven't noticed any horrible side effects yet and I'm enjoying my new kidney. Many drugs are very dangerous, yes, but there are times when the treatment becomes worth the risk. It is nice to read about another possible use of this drug.
You haven't actually provided me with any evidence, just pseudoscience and self-help books. But thanks for trying.
You might have noticed that LMCH wasn't trying to provide you with evidence on your terms. She/he was simply sharing their own opinions and philosophy.
For the record, their are many studies showing the health benefits of fasting, for instance. You can find several with a simple google search. As much as the medical community might want to deny them, there are also well controlled studies demonstrating a health benefit to homeopathy.
But, you can go ahead and not search for these and assume they don't exist, it's really OK by me.
I'm actually fasting right now. It always makes me feel well. I haven't been to the doctor in 10 years, except for a fever in India and a sprained ankle in Chicago (and compulsory exams for my employment). When I'm sick, I take rest and wait it out. When I injure myself, I assume that the blood cleaned the wound, and don't do anything about it. I seem to get injured more than average, and have never had any sort of infection except when I covered one wound in neosporine gel.
Not that I'm necessarily advocating this, or recommending it to others. But, it work for me, and it has a good track record so far. I don't feel I have anything to prove to anybody.
All this is to say that, whatever term you might use for it biochemical feedback or bodily wisdom, the body does have powerful self-correcting mechanisms, and the best way to stay healthy is to keep them in optimal condition.
I'm all for taking good care of yourself, and not bugging a doctor with every ache and pain, but when you get REALLY sick or are diagnosed with a serious medical condition then it's time for a hospital visit, some good ol' fashioned pharmaceuticals, and advice from a clinical dietitian.
I see. So it's either holistic medicine or big mac's then?
The black and whiteness of your stance belies the depth of your understaning on the issue. A mile wide and an inch thin.
Also, Dick Gregory is a great, giving, funny man AND an absolute crank with nothing but 'it sounds right and occasionally works' to back up his lifelong crusade against peoples food issues. He helped a friend of mine lose 200 lbs in high school, for about 8 months.