Researchers in the making:
On the path to a cure for diabetes
Shaheed Merani, 2007 McLeod Scholarship winner, is looking for ways to improve the Edmonton Protocol for type 1 diabetes patients.
In 1922 Banting, Best, and Collip discovered that injecting diabetes mellitus patients with the hormone insulin could significantly improve their quality of life. Diabetes patients produce high levels of blood glucose (blood sugar); insulin shots help regulate these levels, thereby avoiding serious medical complications. Ever since that initial discovery, researchers have been trying to go beyond managing the disease and actually find a cure. Shaheed Merani, winner of the 2007 Lionel E. McLeod Health Research Scholarship, awarded by AHFMR, is a member of the next generation of these researchers.
The University of Alberta M.D.-Ph.D. student works with AHFMR Scholar Dr. James Shapiro, a surgeon and diabetes researcher. Dr. Shapiro is renowned for his groundbreaking work in islet transplantation as a potential cure for diabetes, a method known worldwide as the Edmonton Protocol. Islets are tiny structures in the pancreas that contain as many as a thousand cells, including-most importantly for diabetics-the beta cell that produces insulin. Instead of transplanting the whole pancreas, which is a very invasive procedure, the Edmonton Protocol involves isolating hundreds of thousands of islets and injecting them into the portal vein of the liver. There the islets establish a new home and begin producing insulin.
During the initial trial in 2000, patients underwent islet transplantation surgery and received a combination of drugs to prevent rejection of the foreign tissue. Amazingly, all of the patients were able to abandon the daily injections of insulin they had needed to regulate their blood sugar. However, the treatment did not prove to be a cure. Five years after surgery the injected islets were producing significantly less insulin, and most patients had to begin insulin injections again. In spite of this setback, the researchers believe that the therapy has tremendous potential, and they continue to work in the area.
These days Dr. Shapiro's group are taking a two-pronged approach toward making islet transplantation more effective in the long term. One the one hand, they research a variety of immunosuppressant drugs to determine how best to prevent the body from rejecting transplanted islets. On the other hand, they also investigate ways to increase islet function after transplantation, in order to extend the life of islets and lengthen the period of time that patients can go without insulin injections.
In Merani's first major research project upon joining the lab, he found that islets become damaged by compression during the isolation procedure. It was a simple but vital finding, and it could improve the clinical methods used to obtain islets for transplantation. Since completing that study, however, Merani has switched gears.
"We're into using various hormonal peptides that may improve the function of the islets themselves, and necessitate fewer islets for transplantation, which is one goal of our work," he explains. One of these hormones can trigger higher levels of insulin release from islets in response to glucose, making it an exciting prospect for the lab. The same hormone also plays a role in preventing the death of beta cells and increasing the number of islet cells.
While this research is clearly still at the basic-science stage and far from ready for patient care, Merani is optimistic, "It's great to be part of a group that works with the clinical islet transplantation program. Our research can definitely have a direct impact on the work that's done in human patients."
Merani is looking forward to getting back to the clinic himself. He hopes to finish his doctoral work in the next two years, and then return to medical school to decide what specialty to pursue. Meanwhile he is clearly satisfied with his decision to return to his hometown of Edmonton for this part of his training. "The thing I really appreciate about the U of A is that there are so many opportunities for research. It was something that definitely drew me here." And it's something that will likely keep him here, because his experience in the lab has reinforced his interest in combining basic science with clinical medicine as he develops his career.
Furthermore, Merani has no complaints about Edmonton winters. That's when you'll find him on the ski hill, "keeping a healthy body and mind."