Report from Day One of the New Horizons in Diabetes Research conference in Sweden

The pancreas, the islet and the beta cell are very much the focus of Day One and I listen to researchers from three of the countries where DRWF and her affiliates fund research - the UK, the United States and Sweden.

First to speak is Dr Alejandro Caicedo from the University of Miami talking about the innervation of pancreatic islets. Straight off the plane from Florida thanks to delays with his flight and despite his jetlag, he shows very elegant studies on the nerves that reach around and into the islets of Langerhans innervating them, raising the possibility that islets communicate directly with the brain.

Dr Caciedo controversially asks the audience whether the alpha cells that sit alongside the beta cells within the islets of Langerhans could maybe even have a role in this as his group has shown that these cells, at least in mouse models, also release a neurotransmitter called acetylcholine but he concedes that the anatomy of the nerves that reach into the pancreas are very different between mice and humans.

The second speaker of the session is Dr Gustav Christoffersson, a local researcher from the University of Uppsala. He reminds us why diabetes is such a challenging condition to study – our cells of interest are the beta cells and these are tucked inside the islets of Langerhans which are, in turn, tucked inside the pancreas which is, in turn, tucked right in the middle of the body.

In a beautiful talk using innovative new imaging techniques, this group can actually look right inside the islet of Langerhans. Immune cells stained in vibrant green and red actually invading an individual islet and starting to destroy it. And this research identifies a class of cells within the immune system, somewhat ironically called bystander T-cells, that appear to play an important role in this.

From there, we move onto another talk from Dr Olov Andersson who is based at the world-famous Karolinska Institute in Stockholm. His group uses a genetically tractable animal model – the zebrafish – which is actually transparent so, when it comes to watching beta cell development, they can literally watch from the outside as cells stained to be visible under the microscope are viewed in the whole animal model.

It is a salient reminder that animal models are of huge importance in science and even the humble zebrafish is helping us to investigate in more detail the possible origins of new beta cells from ductal cells within the pancreas

And, finally, the UK is represented by Professor Frank Reimann from the University of Cambridge. He says that, because the gut is the largest endocrine organ in the body, hormones secreted from here have a huge effect on several different systems in the body, including, of course, the regulation of appetite.

This concept is taken forward by the charismatic Professor Tina Vilsboll from the University of Copenhagen in Denmark who walks a largely scientific audience through the multitude of clinical trials that have been conducted internationally on the GLP-1 receptor agonist drug class.

The results of these have been so convincing that, just as week or so ago, the European Society of Cardiology announced new guidelines, developed in collaboration with the European Association for the Study of Diabetes, that suggest that drug-naïve patients with atherosclerotic heart disease, or at a high or very high risk of cardiovascular disease, could be put straight onto this drug as a monotherapy without going through the usual first step of metformin monotherapy.

There are undoubtedly multifactorial reasons for the mechanisms of cardiovascular and chronic kidney disease reduction that are observed that are encouraging this new direction in guidelines including lowered glycaemia, a loss of body weight and important decreases in both blood pressure and blood lipids. It would seem that GLP-1 receptor agonist-based therapy is now a lot more than simply a glucose lowering drug!

The treatment landscape for type 2 diabetes is constantly evolving and Professor John Wilding from the University of Liverpool and a well-known face to those of us at the DRWF as a former chairman of the Research Advisory Board in the UK and the current chairman of Diabetes Wellness Sweden’s Junior Wellness Awards Research Advisory Board in Sweden, closes the session talking about the SGLT-2 inhibitor class of drug. A drug which has also been shown to have significant effects on weight loss, blood pressure and, most recently, on kidney outcomes too. The results of completed clinical trials are beginning to indicate that SGLT-2 inhibitors may now also be viewed as a cardiovascular drug and not just as a diabetes drug.

So, from the inside of an islet to the treatments that are actually being prescribed today to help people to manage their diabetes more effectively? Now, that’s quite a programme for Day One, Uppsala!

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