One in three adults with CF will develop CFRD, and although it’s a well-known condition, exactly how CFRD develops isn’t understood. We’re funding a Strategic Research Centre in this area in the hope that knowing what goes wrong may help doctors to detect the warning signs that CFRD is developing, and ultimately prevent it from happening at all.
Q. How is the pancreas like Cockney rhyming slang?
A. It’s just a case of apples and pears!
The pancreas is a long, pear-shaped tissue sitting in your abdomen near the start of your intestines. It produces enzymes to digest your food and regulates the sugar levels in your body. It has lots of different areas within it that do these jobs, and some people have used the analogy of an apple tree to explain what each bit of it does.
The ‘leaves’ of the pancreas ‘apple tree’ are oval shaped areas where digestive enzymes are made. After the enzymes are made they get transported to the intestines down tubes called ducts, starting off with smaller ducts that join together to get bigger and wider (the branches of the tree) as they get closer to the intestines. Dotted around the pancreas are tiny groups of cells called ‘islets’. The islets are responsible for keeping the sugar balance right, by releasing hormones, such as insulin and glucagon into the blood. The islets are the apples of the tree!
Q. How are insulin-producing cells of the pancreas like the character Sirius Black from Harry Potter?
A. Both are able to change their form into something else.
In Harry Potter, Sirius Black can turn himself into a black dog to protect himself during times of stress or danger (for example, when the Dementors attack Azkaban Prison!). Researchers have found that the insulin-producing cells in the pancreas can convert themselves into other types of cells at times of cellular stress too!
After the stress has gone away, the cells then go back to being insulin-producing cells. This clever process allows the pause in insulin production to be temporary rather than permanent, and therefore reversible. So far, this process has been identified in other forms of diabetes. Now, scientists within the CFRD SRC are looking to see if this also happens in CFRD. If it does, understanding this process could be a first step towards effectively reversing the condition.
Q. What do the insulin-producing cells of the pancreas have in common with characters in an Australian soap opera?
A. They both need good neighbours!
Whether it’s a warning about local burglaries or helping to look for lost pets, good neighbours make a difference. In comparison, bad neighbours can cause a lot of stress, as the insulin-producing islet cells in our pancreas are finding out to their cost! Researchers within the SRC believe that the insulin-producing cells are being adversely affected by neighbouring cells, which produce our digestive enzymes. This might be one cause of CF-related diabetes.
As the digestive cells within the pancreas become damaged and die, the body reacts by triggering inflammation, its way of trying to do repairs or tidy away dead cells. However, inflammatory chemicals in the wrong place or in excess can be harmful. Delivered into the digestive parts of the pancreas, the inflammatory chemicals move across to the neighbouring insulin-producing cells in the islets and cause disruption.
The next stage of the research will be to understand whether monitoring the release of inflammatory chemicals into the bloodstream could be used as an early warning sign that people might be developing CFRD.
In June 2020 we published a Research in focus report on CF-related diabetes. The report explains the impact CF-related diabetes has on the lives of people with CF, what we’ve learnt from our funding so far, and how a new Strategic Research Centre on How CF exocrine pancreatic disease may lead to CF-related diabetes could pave the way for insulin-injection free treatments in the future.