Abigail Zuger used to say that from time to time the news, the headlines of the newspapers, the bar conversations are filled with “miracle drugs”. Medications capable of slowing down, of curing, of making us forget incurable diseases. The vast majority of these hopes in the form of medical treatment have something in common: they are lies, pure smoke, snake oil. However, there are some (one or two in each generation) that do change the world, that do save billions of lives. Perhaps the first thing we discovered was insulin.
42,000 punctures. The discovery of insulin and its development as a treatment is a story worthy of an epic. We are talking about a medicine that, in the case of type 1 diabetes, managed to catapult the life expectancy of patients from 1 year to more than 60. We are talking about something that keeps more than 537 million people alive and healthy today . That is why it is so exciting to live in a historical moment in which, for the first time, it seems feasible to be able to say “goodbye”.
20 years of waiting…. Over the past 20 years and after a time of enormous bioethical debate, stem cells have promised to be powerful enough to radically change entire areas of contemporary medicine: make improvements in patients with severe spinal cord injuries, recover hearts after heart attack, or curing diabetes by culturing and implanting islet cells (insulin-producing) in the pancreas. These were all attainable (“reasonable”) goals for this technology that have yet to materialize.
…that begin to bear fruit. Today, we are able to take the fibroblasts (a type of cell that proliferates in scars) that appear in the heart after a heart attack and reprogram them into perfectly functional cardiomyocytes. We have developed techniques capable of creating cartilage, bone or, and this is much more spectacular, perfectly functional thymus glands (the thymus glands are the body’s gland where T-cells mature, the cells responsible for coordinating the cellular immune response).
Unfortunately, we still cannot print tissues or organs with sufficient precision at the nanometer scale. It is something we are working on (something that is getting closer every day), but it still represents an important limitation because it is of little use to be able to reprogram cells if we cannot design structures that support them at a functional level. We have the pieces, but we lack the whole. That is why the case of diabetes is so fundamental: it is just the border where these limitations begin to disappear.
What about diabetes? One of the jewels in the crown was diabetes treatments. It is worth remembering that stem cells are a type of cell that can originate, under certain conditions, any other type of cell in the body. In other words, if we learned to use them, they would allow us to create new pancreatic islets (the cells that autoimmunity destroys in type 1 diabetes) and introduce them into a functional pancreas.
Because, in addition, this technology would allow us to do it without the availability and compatibility problems associated with current approaches to islet transplantation. Approaches that, it must be said, have also been giving good results at a clinical level for 20 years.
The first clinical trials begin to take shape. Finally and luckily, the first clinical trials are already underway. The one from Vertex Pharmaceuticals, for example, is working with 17 patients and the first of them, as it has been known, has been able to reduce the insulin that is injected by 92% about 150 days after the transplant.
It is still early to have all the data and, as I recalled at the beginning, it is best to be cautious. But it is still good news that, so many months after the first news about this successful treatment, the updates continue to be positive and “patient zero”, Brian Shelton, continues to lead a normal life.
What implications does all this have? The great promise of these technologies is that, in a few years, we will be able to cure diseases without treating them. In combination with genetic engineering techniques, we will be able to create cells (entire organs) that are not only ‘immune’ to genetic problems, but also capable of detecting other diseases and anticipating them. When we said that what awaits us is the “century of biology” we were not exaggerating: recent years of evidence and trials make it clear that it is only a matter of time.
Image | Matt C.
George is Digismak’s reported cum editor with 13 years of experience in Journalism