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Endocrinology


Type I Diabetes

Diabetes is a chronic medical condition characterized by dysregulation of blood glucose levels by the body's endocrine system. The WHO has recently classified diabetes as a global epidemic. The Lewin Group study estimated total health-care costs of $132 billion for the United States in 2002. The CDC estimates 10% of all diabetics are type I in etiology, amounting to nearly 2 million Americans and an overall annual per-capita healthcare expenditure of $13,243 compared to $2,560 for a non-diabetic. Since the onset of type I diabetes is often in childhood, the cumulative impact over a patient's lifetime is significant at a number of levels including quality of life, emotional stability, as well as the currently unavoidable late-stage sequela such as blindness, kidney damage, and cardiovascular disease. The costs associated with providing vigilant monitoring and care for patients with diabetes are high and will continue to increase barring a paradigm shift in the therapeutic approach.

Cure

Some investigators have proposed treating type I diabetes by transplanting hematopoietic stem cells from non-diabetic donors, but this approach is restricted to parental or related sibling donors and would not be widely applicable. Much attention has been paid to the treatment of diabetes using regenerative medicine approaches such as embryonic stem cell-derived islet cell transplantation. However, unlike type II diabetes, type I diabetes is caused by an autoimmune reaction against one's own islet cells. Thus, islet cell replacement is unlikely to significantly impact the quality of life of type I diabetics in the absence of preventing the continued autoimmune destruction process. For allogeneic ? cell transplantation to gain therapeutic relevance, two major hurdles -donor rejection and susceptibility to autoimmune destruction- must be overcome.

Prevention

Type I diabetes is caused by an immune-mediated process that involves the destruction of one's own pancreatic insulin producing tissue. The mechanisms that are responsible for this self-destruction remain unclear but are thought to involve a component of the immune system known as the cytotoxic arm. A number of general immunosuppressive medications have been shown to slow down or prevent the onset and/or progression of this autoimmune destruction. However, this therapeutic option is at the expense of serious drug-induced side effects. This has led to a need for an immunosuppressive therapy with minimal side effects. Although several stem cell companies are developing immunosuppressive mesenchymal stem cell (MSC) therapies, Escape believes these technologies will not meet current market needs due to the transient nature of the immunosuppressive effect (see Graft-Versus-Host Disease section).

2010 Escape Therapeutics, Inc. All rights reserved.

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