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Pediatric Diabetes Center
Slowing Down Diabetes

MU Children's Hospital is not only mid-Missouri's preeminent health care facility for children. By teaming up with the University of Missouri Columbia's School of Medicine, it is also mid-Missouri's pediatric health care research center. Here, physicians are able to combine their clinical expertise and scientific research skills to make groundbreaking pediatric health care discoveries.

One such physician is Amie VanMorlan who is both a physician and a researcher. She is a pediatric endocrinologist at Children's Hospital and an assistant professor of pediatric endocrinology at the University of Missouri's School of Medicine's Department of Child Health. Using both of these roles, VanMorlan has been able to combine her love of research with her dedication to clinical care in a unique way.

"I am extremely fortunate because I get to split my time in half," said VanMorlan. "I spend fifty percent of my time seeing young patients at Children's Hospital and the other fifty in the lab doing research on type 1 diabetes. It's a very unique position and I'm very excited about it."

She says her clinical practice helps her visualize the need for her research goal: find ways to stop or delay the onset of type 1 diabetes in children.

"In my clinical practice, I see how (type 1) diabetes is very hard on kids and their families," said VanMorlan. "Children who have it have to check their blood sugars six to eight times a day with a finger prick. They often have to give themselves four to six insulin shots per day and watch what they eat very carefully. It's a lot to ask of kids who are often only four of five years old. It's also very scary for the whole family. They are worried about the health of their child and have to rearrange everyone's lives around the disease."

VanMorlan's latest research work takes her deep into understanding the mechanisms of type 1 diabetes on a cellular level. To understand her research, one must first have some understanding of how the disease works.

Healthy bodies use insulin, a hormone produced by beta cells in the pancreas, to move blood sugar, called glucose, into cells where it is stored and later used for energy.

In people who have type 1 diabetes, their beta cells produce little or no insulin, causing the glucose to build up in the bloodstream instead of going to the body's cells for energy stores. The body's inability to use glucose for energy causes the symptoms of type 1 diabetes.

What causes the beta cells to malfunction is unknown, but most researchers agree that it is likely due to some sort of combination of a malfunction in the immune system coupled with an environmental trigger and a genetic susceptibly. Together, hose three things set off a cellular-level immune reaction that causes the body's white blood cells, or T-cells to mistakenly attack the pancreatic beta cells, leading to beta cell malfunction and eventual destruction. There are three (or four) types of T-cells and recent research has revealed the T17 type of T-cell as a "major player" in the beta cell destruction.

"When the beta cells are destroyed, they release antigens which are picked up by what we call an antigen presenting cell, because they present the antigens to the receptors," explained VanMorlan. "Those antigen presenting cells, called myeloid cells, sometimes have a receptor for interleukin 13, or IL-13, which we believe has an inhibitory effect on the action of the T17 cells.

VanMorlan's research is looking at what happens if they can genetically remove the IL-13 receptors from those myeloid cells in mice bred specifically to develop type one diabetes.

"What we expect and hope to see happen is that without the IL-13 receptor, these mice will develop type one diabetes sooner in their lives, or perhaps with greater severity of symptoms," said VanMorlan. "That will show us that we are actually on the right track, that the IL-13, if allowed to bind with its receptor, does do what we think it does to stop or slow the development of the disease."

VanMorlan's research work is in the beginning stages and may take three to five years to complete.

"We're looking now at very complex cellular biology and how this chain reaction works in mice," said VanMorlan. "Of course, our ultimate goal for this to lead to a better understanding of how the disease works. That way we can use our knowledge to create clinical applications from our findings so that we can stop or at least slow the onset of type 1 diabetes in people."

VanMorlan's research is detailed, meticulous and on the leading edge of type 1 diabetes understanding. It is projects like hers that will contribute to important cellular understanding, which will, one day, open the door to a cure.

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