The Future Of

Type-2 Diabetes

Episode Summary

New nano capsules could spell an alternate effective treatment for type-2 diabetes – the world’s fastest growing health condition.

Episode Notes

New nano capsules could spell an alternate effective treatment for type-2 diabetes – the world’s fastest growing health condition.

Episode Transcription

Jessica Morrison:          00:00                This is The Future Of, where experts share their vision of the future and how their work is helping shape it for the better.

Jessica Morrison:          00:09                I'm Jessica Morrison. Type-2 diabetes is a medical condition in which the body is unable to produce enough insulin to combat the buildup of glucose in the bloodstream. The condition can lead to symptoms of constant hunger, fatigue, weight loss, and potentially death. Diabetes is the world's fastest growing chronic condition, with the number of people with type-2 diabetes growing in each country.

Jessica Morrison:          00:31                In this episode, I was joined by experts, Dr Ryusuke Takechi and Dr Hani Al-Salami from Curtin University, to discuss the growth of type-2 diabetes in the population and the work they're doing to prevent and treat it. If you'd like to find out more about this research, you can visit the links provided in the shownotes.

Jessica Morrison:          00:49                So Ryu, the number of people with type-2 diabetes is growing. Why is this?

Dr Ryusuke Takechi:      00:55                I think the two main factors: sugar and lack of exercise. So sedentary lifestyle that makes people just sit around and do nothing, it's the main driver and also the sugar intake. So people just don't realise, I think, how much sugar they're taking each day, soft drinks and cookies and snacks. So those two are the main drivers, I think.

Jessica Morrison:          01:19                And Hani, how would those who are being diagnosed with diabetes feel about their diagnosis?

Dr Hani Al-Salami:         01:26                You can imagine that no one likes to be diagnosed with diabetes. No one likes to feel that they're sick and they've got a problem that they will never fix, and they just have to take tablets for the rest of their lives. Look, when you talk to people, a lot of them tend to try to be positive. But then when you've known them for years and years, you get to realise that they have other problems. So for example, with the disease itself, it does have other things that affect their performance and behaviour as humans, even intimacy. There's a lot of things that can be interfered by having diabetes. They can be too lethargic, they fall asleep on the couch, they can't function as normal. They haven't got the energy they had before and this means that their interaction with their kids or their partners are not as good, which means that the partner now is not as happy, which means ... It just gets snowballing.

Dr Hani Al-Salami:         02:12                And it's like everything else. And that's where targeting it in a comprehensive, multifaceted, approach is far more robust, because you're not looking just at sugar in the blood, you're looking for the whole person. And that's where ... For example, in the hearing space that we've been doing, counselling is as important as treatment. And the reason is because if you don't counsel them and their life goes downhill, then the treatment and the therapy and the side-effects and everything else just go downhill.

Jessica Morrison:          02:41                You've developed nanotechnologies to treat type-2 diabetes. Can you explain what a nanotechnology is and how effective it could be in treating diabetes?

Dr Hani Al-Salami:         02:49                Yes. So one of the major obstacles to getting drugs where they're meant to go is the way the body absorb them. So for example, if you take a Panadol tablet, the Panadol tablet goes all the way to your tummy, to the gut and there it breaks down, and some of the drug gets taken in, some of the drug gets lost. So for example, if you've taken it for a headache and you want it to go to the brain, it's not going to just go to the brain, it goes to everywhere else. So that creates huge problems to us in terms of getting the right dose, because you know that you're going to lose so much of it so you have to give a bit more to achieve optimum results, and toxicity. So for every dollar we spend on a drug, we spend another dollar fixing problems that drug cause in the first place.

Dr Hani Al-Salami:         03:31                So to overcome such an obstacle, a professor called Thomas Chang, who's my ex-boss actually, he started the process of encapsulating enzyme, or hormones, or drug to make it more targeted. So for example, these nanotechnology are creating capsules on a nano-scale. So if you look at them, if it's in the water now we can't see them. It's so tiny, nano-scale. But the idea of it is by doing it this way and by designing the right matrix that encompass the actual drug, you design it in a way that when you give it to the patient it pretty much goes specific to where it's meant to go more than anywhere else. So, you minimise side effects. So that is one example of a drug that Ryu and I have been working on for the last so many years, in order to make it more selective to brain, rather than to the body. And by doing this we maximise effectiveness and also maximise safety.

Jessica Morrison:          04:26                And so, in the treatment of diabetes, why is this more effective targeted treatment beneficial?

Dr Hani Al-Salami:         04:33                Yes. So one side of our interest in treating diabetes is the brain. There's all this talk about the insulin resistance of the brain, which Ryu has been driving in terms of the pathophysiology of it. And then that necessitates the drug to go to the brain more than everywhere else. So I've been using nanotechnology established in my lab, in collaboration with drug companies that synthesise and customise our instruments and platforms for the last 10 years now, in order to design the right vehicle and delivery system to take that specific drug right into the brain where it's meant to be, doing the best effect for diabetes.

Jessica Morrison:          05:11                Why for diabetes, do we need treatment to go to the brain? What's going on there that affects the rest of the body for diabetes?

Dr Hani Al-Salami:         05:16                Yes. So this seems to be a side where lots of control over sugar regulations happen and it's still a work in progress. So these are theories that we hypothesise, that by controlling where drugs go ... It either could be the brain, it could be the pancreas and type of example and so forth, that can maximise impact and make the drug cling [to] areas in the brain. The brain is a very complex system. It's quite hard to get at, it's not designed to take things. If anything, it is to block things from getting through but sugar to feed it. So that's hence the sophistication of an advancement of using that technology specifically for that drug that we believe in, to play a major role in calming down lots of problems with diabetes, such as inflammation, for example, which underpins a lot of diseases, including diabetes.

Jessica Morrison:          06:04                What are we looking at for a timeline for when consumers can use it?

Dr Hani Al-Salami:         06:08                The thing with nano technology is and it started ... It's not a new technology. It started 40 years ago and only for the last, I would say five years, a drug or two started showing up in the market. And the reason is because the old technology relied heavily, and still, on using solvents and things that they are not completely safe – that's a cheap way to do it. That's why in the lab at Curtin I made sure when I came in here from Canada, that the system, the set up, is robust and TGA (Australian Therapeutic Goods Administration) aligned. So, the regulatory will be happy for me to produce the drug. So, the setup that we have is quite unique and that's how we managed to get the industry contracts and stuff like that.

Dr Hani Al-Salami:         06:50                But it does take a lot to prove safe. Safety remains the biggest thing. And with that, you don't want to treat someone for something and then cause another cancer or something else. You have to fix a problem and just keep it fixed.

Jessica Morrison:          07:01                So maybe five years, 10 years, if you're blue sky thinking?

Dr Hani Al-Salami:         07:06                I hope that will be the case. And it's not just that, it is getting the right drug out. And that remains the biggest pain in the neck, because there's so many possibilities. How do you know that will work and not that? And even if you're going to know this one works, what dose? For how long? Is it two days, twice a day and that's it, or is it forever? So it remains very, very difficult. Insulin, for example, it was discovered 1921 as an injection and for the last almost 100 years they've been trying to come up with something else that you can take orally, because no one likes to be injected the whole time. It's caused a lot of problems, and we still haven't got there yet. There is a clinical trial at the moment, but every time they try it, it just doesn't cut it. Or–

Jessica Morrison:          07:50                It's not as effective as what an injection is.

Dr Hani Al-Salami:         07:52                And one of the biggest problems facing us, for example with treatment, is that humans are so different. So our physiology is so different and not only this, today is different than yesterday, this morning, different than tonight because of the circumstances. So there's a lot of hormones. Steroids for example, get secreted far more in the morning than on night time. Cholesterol goes high at night. So it just depends on the time of the day. And for example, if you're anxious or you've got a problem, consumption of sugars changes. So how can you tailor to that?

Jessica Morrison:          08:24                There's no sort of one size fits all approach really when it comes to dosage.

Dr Hani Al-Salami:         08:28                Really one of the hardest thing is getting the dose right, and getting the dose to where it's meant to go. Not the whole body, which we have at the moment with capsule. I mean, capsule and tablets have been around for 200–300 years and they're still around. And we think, "Oh, with technology we should have been all ..." We're still that, so work in progress.

Jessica Morrison:          08:46                So you've both researched the link between type-2 diabetes and other health concerns, so specifically dementia and hearing loss. Can you both broadly explain why diabetes seems to be connected to so many other health issues?

Dr Ryusuke Takechi:      09:00                I think the main causal link between diabetes and dementia is not really established. So diabetes has lots of complications, so it causes lots of inflammation. It also induces oxidative stress, it also causes dysfunction in the vasculature, so your blood vessels get quite damaged. So those are maybe at the moment thought to be the main reasons that might be linked to the brain disorders like dementia. But the main things, we still don't know. We're still researching.

Dr Hani Al-Salami:         09:33                So think of diabetes as just one symptom of diabetes, really. So diabetes itself is a multifaceted pathophysiology that causes so many damages, and it just happens to be also causing high blood sugar to go up. And that's why a lot of the pathophysiology of diabetes underpins many of the other conditions, such as dementia. So as exactly as Ryu was saying, you have the damage in your blood vessel in the brain, for example. If you fix them up, you calm down some of the symptoms of diabetes. If you have high sugar levels, if you have inflammation sort of stress, then you're hearing also get impaired because these cells don't like to live in an environment where there's too much sugar in it, too much free radicals, oxidants and the like. So if you've got diabetes, you're twice as likely to get hearing loss. So one of the proposals, for example, for treating hearing loss has been antioxidants. They've always been proposed to be a potential treatment for hearing loss, because what they do is they vacuum the harsh environment these cells live in, in a way to calm them down, keep them happy.

Jessica Morrison:          10:36                I like the way you've said that. Keep the cells happy, keep them happy. What drives your research into diabetes and what outcomes are you hoping for?

Dr Ryusuke Takechi:      10:45                So well, I'm a nutritional biochemist by training. But I'm more doing the neuroscience research, so dementia research. My driver for diabetes research is probably ... It's the prevalence and it's the effect that ... It's affecting so many people around the world, especially in Australia. And some of the developing countries are now getting increasing those prevalence as well. So that's probably the main driver.

Jessica Morrison:          11:14                And what about you, Hani?

Dr Hani Al-Salami:         11:15                Similar. So just the fact that I could be next. Any one of us could be next. My kids could be next, father, mother, and so forth. So if I've got a kind of a healthy family, relatively speaking, but someone has to get the work done. And unless we kind of look at the bigger picture and see globally when you say a prevalence of 1%, 10, 15%. Hearing loss, for example, one in four Australians will have hearing loss by 2050. So it seems to be, although it's obvious, many people still don't realise the impact. And I think we just have been quite lucky to see things that other people have not seen, and be lucky to have such a cohort of people that I work with. Personally, I have been absolutely been very fortunate to meet and work with and be accepted to fail. So that's my drive and I love it. I just enjoy it so much, I think. Just too obsessed with my job, but it's great.

Jessica Morrison:          12:09                That's awesome. Like what you were saying Ryu about the prevalence of it, but then what we've just spoken about previously, it can lead it almost ... It leads to so many different ... Can potentially lead to so many different other diseases. So it's sort if we can hit this one, then it could help so many people in the future.

Dr Hani Al-Salami:         12:28                And that is important to look at it from a bigger picture, not just one problem. But what if it's wrong there? So you can see a problem, but it doesn't mean that everything else is fixed. I mean, at the moment you can have heart problems and you wouldn't even know that you have them. So that's the kind of a bigger picture approach and that's why, although my background with Ryu for example, are very different, we work very closely together and we complement each other. And not only us, but others as well on the team.

Jessica Morrison:          12:54                What do you wish you knew about type-2 diabetes 10 years ago?

Dr Ryusuke Takechi:      12:59                Not sure, actually. Well, I guess in terms of the diabetes research, it hasn't really progressed much, you know, past 10 years. We never made a breakthrough. It's still incurable.

Dr Hani Al-Salami:         13:14                So I guess my reply would be, I wish if I knew back then what I know now.

Dr Ryusuke Takechi:      13:20                Yeah.

Dr Hani Al-Salami:         13:21                Because if you think about it, for example, exactly as Ryu said. The first line of treatment of diabetes is called Metformin. And Metformin as a drug has been around for 50 odd years. The other one for the mainstream treatment for type-1 diabetes is insulin, and insulin was discovered in 1921. And we are still injecting it just like we did in 1921.

Jessica Morrison:          13:41                Yeah. So there hasn't really been ...

Dr Ryusuke Takechi:      13:43                No, no progress.

Jessica Morrison:          13:46                What makes it so tricky?

Dr Ryusuke Takechi:      13:47                It's complexity.

Jessica Morrison:          13:48                Yeah.

Dr Hani Al-Salami:         13:49                So we thought, "Oh, if you just fix the insulin, everything is fine." But then type-1 diabetic patients who continuously take insulin pedantically, half of them have fluctuation in their glucose levels outside the healthy norm, and they still die 10 years younger. So despite them doing the right thing for themselves, we've got the biggest discovery I've ever seen, which I think is one of the major discoveries of all mankind, personally. They're they're still not surviving long enough and not doing well in comparison.

Jessica Morrison:          14:18                To a healthy person of the same age and demographic. So would you say personally that you think the future of treating type-2 diabetes specifically is around this nanotechnology? That's where the future lies in terms of targeting it more effectively?

Dr Hani Al-Salami:         14:34                I think it's one part of the equation. I don't think it's enough by itself. I think it's having people like Ryu and others that understand the pathophysiology more. So from my side ... All what I know actually, you just have to deliver a drug, that's my thing, in a safe and effective manner. But then in terms of every pathophysiology, every damage at every level of the body, that's not my forte, that's someone else. So I think to answer the question, I think that technology is the future, but not just the only future. I think there's many other critical aspects, and even more important like what Ryu was doing, for example, which is understanding what happens not just in the body, in the brain, which I believe to be the centre. I mean, the brain is the centre of our controlling of the body and all our functions come from the brain in terms of the control.

Jessica Morrison:          15:21                Ryu, what do you believe is the future? If you're looking at it from your specialty, I suppose?

Dr Ryusuke Takechi:      15:27                It's a bit difficult. I think it's going to be ... You need to change the lifestyle, that's the main thing, but it's very hard to do it. That's why we just rely on the drugs. So nanotechnology, or those new technologies will help how those drugs will work so we don't have to take every day, or you don't have to take so much of it. So, that's the main future, I think.

Jessica Morrison:          15:51                It sounds like such a multifaceted approach, right? You were saying obviously nanotechnology is probably considered one part, and then you're saying it's sort of the lifestyle factors is the other. It really is. And then collaboration between specialties as well, right? That's where it's at.

Dr Hani Al-Salami:         16:05                I think collaboration is the only way forward. And you kind of just have to ignore the egos and just focus on getting the job done. And as I said, I've personally been very fortunate that I've got what I've got today, and very keen to progress.

Jessica Morrison:          16:21                What can we do now to safeguard our health into the future? So if you could give the people of today three pieces of advice – "do this, this, and this to ensure you don't develop type-2 diabetes in the future, or other chronic illnesses" – what would your advice be?

Dr Ryusuke Takechi:      16:38                That's pretty difficult, because we haven't solved this disease for 10, 20, 30 years. And three things won't probably do anything. But simple answer: live well. Well ... Eat well, sleep well, exercise well, maybe.

Dr Hani Al-Salami:         16:52                Just do whatever you think is healthy for you.

Dr Ryusuke Takechi:      16:55                Yeah.

Dr Hani Al-Salami:         16:55                And that's important. So one aspect of it is ... So for example ... I'll give you a quick example of what we thought was healthy is actually not healthy. For example, heavy exercise is not a good thing for you. And I know it sounds weird.

Jessica Morrison:          17:08                Cool. That's great. I haven't really been doing too much exercise lately.

Dr Hani Al-Salami:         17:11                And recent studies show that very intense exercise for a very short period of time produce far better results in terms of control than the two hours in the gym that you really invest every day, five days or six days a week. So I guess probably the biggest thing for me is people need just to educate themselves of what it is, what does it actually mean to live healthy, and it's quite different between people. And you to be ready if things don't go your way. So I think being prepared mentally is a key factor for survival, personally.

Jessica Morrison:          17:42                Fantastic. Thank you both so much for coming in today. Really, really fascinating episode. And it sounds like there is a very bright future with how this research is progressing in this space. So, thanks so much.

Dr Ryusuke Takechi:      17:54                Thank you.

Dr Hani Al-Salami:         17:54                Thanks for having me.

Jessica Morrison:          17:55                You've been listening to The Future Of, a podcast powered by Curtin University. If you've enjoyed this episode, please share it. And if you want to hear more from experts, stay up to date by subscribing to us on your favourite podcast app. Bye for now.