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Gut Immune System Identified as New Target in Treating Diabetes

From left: Shawn and Dan Winer spearheaded lab work that could redefine diabetes as an autoimmune illness rather than a metabolic one. Image courtesy of UHN.

A commonly used drug to treat inflammatory bowel disease has been shown to lower blood sugar levels in obese mice, potentially identifying the gut immune system as a new and effective target in treating diabetes in humans.

“These results are novel and important because we have identified the immune system that lives in the gut as a new player in the control of blood sugar. This opens up the entire field of bowel immunology to the study of obesity and its complications such as high blood sugar,” said Dan Winer, MD, Diabetes Research Group in the Toronto General Research Institute (TGRI), whose laboratory spearheaded this work, along with his twin brother Shawn Winer, MD. Their research was published in Cell Metabolism online April 7.

Being overweight, especially around the abdomen or waistline, increases the chances of developing type 2 diabetes. In their previous work, the Winers demonstrated that immune cells inside abdominal fat cause the release of “pro-inflammatory” chemicals, which make the body less sensitive to insulin, the hormone that regulates blood sugar levels. This is known as insulin resistance-a major trigger for type 2 diabetes.

In this research, the focus shifted from the fat to the gut, where the Winers found that mice fed a high-fat, high-calorie diet had larger amounts of pro-inflammatory immune cells and less of the regulating cells that help end an immune response than in normal mice. The researchers found this same result in 14 humans, seven of whom were obese. The high-fat diet induces inflammatory changes in the immune cells in the bowel, upsetting the immune balance, which in turn sets off a chemical cascade, damaging the bowel wall, allowing bacterial products to leak into the blood stream. This leakage is what contributes to insulin resistance, when the cells can no longer respond to and use insulin effectively to stabilize blood sugar.

“If we could block the pro-inflammatory immune cells at the very beginning of this process, we could treat the disease more effectively,” said Shawn Winer, who is a gastrointestinal pathology fellow in the Laboratory Medicine Program at University Health Network (UHN). “By refocusing on the bowel, we open up many more therapeutic options as we already have a number of approved drugs available to treat an inflamed bowel.”

The researchers then targeted the bowel inflammation found in the obese mice with 5-ASA, or mesalamine, a commonly used drug to treat inflammatory bowel disease. They found that the drug reversed insulin resistance and lowered blood sugar significantly in the mice to near normal levels.

“By using this drug, we found that we could prevent type 2 diabetes in mice,” said Dan Winer, who is also an endocrine pathologist at UHN and an assistant professor in laboratory medicine and pathobiology at the University of Toronto. “If this works in humans, it could change the whole field of diabetes prevention and treatment.”

This article was adapted from information provided by UHN.