The Insulin Alternative

Illustrated by Angela Chen

Diabetes, a disease characterized by impaired glucose homeostasis due to a deficiency in pancreatic beta cell mass or function, currently affects over 300 million people around the world and costs just under two million dollars to care for in the United States alone. As of today, the most prominent treatment for diabetes consists of insulin injections, which provide patients with insulin that comes from other mammals, commonly pigs, so that they can properly metabolize and store glucose. Despite the popularity of the insulin injections, they remain a suboptimal treatment, as injections must be taken multiple times a day and patients are unable to regain adequate regulation of the original beta cells in the pancreas. Only forty percent of all patients are able to maintain a state of normal glucose concentration over a lifetime with the use of insulin. Therefore, while insulin injections can be used to reduce glycemic blood levels and other effects of diabetes, each injection is simply a temporary treatment, not a cure. The only way to cure diabetes would be to restore functionality in the pancreatic beta cells or replace them dysfunctional cells with new functioning beta cells. 

Transplantation of the whole pancreas has become a viable option to combat diabetes however, this procedure requires major surgical intervention and is associated with many complications. In addition, there is a great shortage of organs and only a few selected patients are able to undergo this procedure. Another avenue of interest has been replacement theory. In this procedure, an islet of cells from a healthy pancreas are transplanted into a diabetic’s pancreas. Islet replacement has been  shown to be very effective. Patients are able to start producing insulin on their own again and within a year, 88% of patients were able to achieve and maintain normal blood glucose levels. 

With islet transplantation being an area of research with great prospect, current research is looking into how the eliminate the greatest complication associated with this treatment. In certain instances, completely isolating healthy islets from the surrounding tissue is dangerous because when implanted into the unhealthy pancreas, the islet cannot perform proper interactions with the new extracellular matrix and the body causes the islet to undergo apoptosis, or programmed cell death. An ideal transplantation would therefore also provide an extracellular matrix that fosters beta cell survival. 

A new technology is looking to tackle these issues by producing acellular extracellular matrix scaffolds that can be repopulated with a patient’s own cells. The technology strips the cellular component from a tissue or an organ, using a technique known as decellularization. The result is a three dimensional template that is composed of only the extracellular matrix. This structure has both the original architecture of the pancreas as well as the biochemical cues of extracellular matrix. While still in testing, this technology could be used to produce an endless source of transplantable pancreases by combining the biological scaffolds with transplanted islets. This would allow diabetic patients to lean off of insulin injections in a safe and viable way and potentially completely halt the pathogenesis of diabetes in new patients (1). 

Edited by: Keerthana Chintalapati

Illustrated by: Angela Chen 

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