Not All Beta Cells are Destroyed in Type 1 Diabetes

Dr. Susan Bonner-Weir conducts diabetes research on beta cells at Joslin Diabetes Center
Dr. Bonner-Weir is a Senior Investigator in the Section on Islet Transplantation and Cell Biology at Joslin and Associate Professor of Medicine at Harvard Medical School.

For a long time, doctors thought that the onset of type 1 destroyed all beta cells. But recent research coming out of Joslin is suggesting a different story.

Susan Bonner-Weir, PhD, Senior Investigator in Islet Cell and Regenerative Biology at Joslin and Professor of Medicine at Harvard Medical School is working on understanding how beta cells can still exist after years of type 1 diabetes.

The Joslin Medalist program honors people who have had type 1 diabetes for at least fifty years. Many of the honorees choose to participate in studies being conducted at Joslin that examine their lifestyles and genetic codes for clues to what keeps them living well with this disease for more than five decades. In one branch of this research, Dr. Bonner-Weir studies the pancreases of Medalists who have passed away and donated their organs to furthering diabetes research.

“The thing that is quite striking is, I’ve look at over 50 pancreases and every single one of them has some beta cells,” says Dr. Bonner-Weir. “These people had an average of 65 years with type 1 diabetes, but they still have beta cells.”

The most peculiar finding, though, is that these beta cells aren’t necessarily found within an islet. They instead crop up here and there throughout the pancreas. It appears that the pancreas can recognize that its ability to create insulin is being hampered by the autoimmune attack and can generate insulin-producing cells in new areas that are as-yet untouched by the autoimmune response.

According to Dr. Bonner-Weir, this pattern of beta cell regrowth probably means beta cell destruction isn’t a one-time occurrence. It appears that the body struggles to restore beta cell function while being repeatedly attacked by the autoimmune system.. “My interpretation is that you’re having a slow but continued regrowth of the beta cells, but the immune system is being activated again and kills off the new beta cells so that you’re only having a few lasting at any one time. You’re not accumulating them as you might if you didn’t have the autoimmunity,” she said.

Because of the ever-present autoimmune attack these beta cells can’t get enough traction to produce the amount of insulin the body needs, but knowing about this back and forth between beta cells and autoimmunity can open a new avenue of treatment in type 1 diabetes.

“If we understand that yes, you can have a significant amount of regrowth [of beta cells] in an adult human pancreas, the question becomes can you then get this process to build up enough [beta cells] to accumulate if you block the autoimmunity?” asks Dr. Bonner-Weir. She says that since it takes several years after diagnosis for most beta cells to be destroyed, there is a window of time even after diagnosis for this treatment to work. Doctors would need to first end the autoimmune attack, then stimulate the beta cell regeneration process. But if successful, they could reduce the requirement for injected insulin, or even completely remove the need for diabetes medication.

17 Comments

  1. I wonder if beta-cell regeneration/creation would then happen in those of us who have pancreatitis-induced diabetes(gland necrosis)? I have 0.1ng/mL c-peptide but yet negative tests for GAD65 and IA2c antibodies.

    • Interesting, I inicially thought that was the way it worked. Beta cells took to long for them to grow faster or stronger than the autoimmune activity, but if the immune system could slow down, the pancreas could recover itself. maybe?

  2. As an MSN, RN, CDE living with T1 x 30 years- this blows my mind. However, I can’t help but wonder if there is a window that closes with time where stopping the autoimmunity will no longer work. Seems like if beta cells are still being produced >65 yrs, why would suppressing the autoimmunity only work early in diagnosis? The other question is how do we donate our pancreas to diabetes research? I would most certainly do that!

  3. Very cool to learn that the human body is constantly trying to regenerate. But is it possible that the immune system attacks the beta cells because it sees/recognizes the possibility of some misfoldings in proteins? What if it’s trying to protect against toxic oligomers and fibers?

  4. As a Joslin medalist with 58 years under m belt, I had to wipe years from my eyes as I read this. I am not ready to give them my pancreas yet, but so proud to be part of the Joslin medalist studies.

  5. I just read an article in the Oprah magazine that talked about the possibility of a new vaccine called D-Sense. They might start human trials as soon as next year. It said that the vaccine would only work if the patient still had some functioning beta cells. My daughter has had type 1 for seven years. I wonder if she would even be a candidate if something like this became viable? It certainly makes me quite teary eyed thinking about it.

  6. Hi I celebrated my 50th year , being type 1 since the age of 9 which was managed using glass syringes & stainless needles along with testing of the urine. How times have changed. It would be incredible to think that a better way is clise at hand. I would definitely consider organ donation for the cause.
    Thanks to all of you for what you have done!
    Mark

  7. I wonder if an 88 year old with type 1 diabetes for 80 years could possibly have functioning beta cells or is this impossible to conjecture?

  8. This sounds very promising….good work! I am nearing the end of my life, having had Type 1 for 52 years and would either love to solve or donate my malfunctioning pancreas. Could you please help with either of these processes?

  9. This gives me so much hope! I was diagnosed at the age of 18 months old in 1967. I’ve now have had it 50 years and I know no other way of life!

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