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  Back to Chat Transcript of Chat with Dr. Aaron I. Vinik
Dr. Aaron I. Vinik of The Diabetes Institutes Foundation was a guest speaker on December 10, 1998. Dr. Vinik has been working on islet cell regeneration and the reversal of neuropathy. He and his team discovered ilotropin, which is a pancreatic islet growth factor, and INGAP.

Thu Dec 10 1998 21:48:09 Eastern US
Aaron Vinik from 12.79.42.95
Hello all, I am online and happy to answer any questions that you might have. AIV

Thu Dec 10 1998 21:49:24 Eastern US
Melissa from 207.22.198.110
Here I am!

Thu Dec 10 1998 21:50:00 Eastern US
Melissa from 207.22.198.110
ahhh now it works! Some browsers have to use the alternate version of this room! don't know why! Whew, I'm glad to be here!

Thu Dec 10 1998 21:50:11 Eastern US
Aaron Vinik from 12.79.42.95
Delighte that you could make it AIV

Thu Dec 10 1998 21:51:42 Eastern US
Melissa from 207.22.198.110
You may want to change that update button... off to the right it tells you how often the room will automatically update! It always cuts me off when I leave that in!

Thu Dec 10 1998 21:51:47 Eastern US
Jeff Hitchcock from 206.112.197.133
Dr. Vinik and Melissa: I'm glad I could help. Melissa, call me if there are any problems. You have my phone number.

Thu Dec 10 1998 21:54:05 Eastern US
Melissa from 207.22.198.110
Thank you VERY much Jeff!! I can't tell you how much I appreciate it!

Thu Dec 10 1998 21:56:26 Eastern US
Sandy Donchess from 209.44.47.208
Dr. Vinik, can you tell us what kinds of animals have been given INGAP?

Thu Dec 10 1998 21:57:25 Eastern US
Aaron Vinik from 12.79.42.95
Joanne, I am sorry that you had trouble with following the dialogue and the questions and answer session in the last chat. I will try to summarize our research on islet regeneration briefly. Some years ago we noticed that wrapping a hamster pancreas in saran led to the formation of newislets. We harnessed this property and explored what it was that happened in a pancreas that allowed it to make new islets when wrapped. It turned out that the wrapped pancreas wasmaking a protein that we called ilotropin that was capable of stimulating pancreatic islets to grow when injected into other animals. We have now found that ilotropin contains a protein we have called INGAP that is capable of doing the same thing. We have treated animals with INGAP and have been able to reverse streptozotocin induced diabetes in a proportion of these animals. We have found the gene for INGAP and are busily working to find the best way to give INGAP, how much to give, by what route and if it is possible to turn the gene on without giving the protein. I hope this gets you started with a very brief summary of what it is that we are doing.

Thu Dec 10 1998 21:57:39 Eastern US
Melissa from 207.22.198.110
HI Sandy! You found us! :-) Thank goodness!

Thu Dec 10 1998 21:58:36 Eastern US
Sandy Donchess from 209.44.47.208
Melissa, I had "forbidden" problems until I removed the "/" at the end of the URL...

Thu Dec 10 1998 21:59:08 Eastern US
Aaron Vinik from 12.79.42.95
We have so far given INGAP only to hamsters. We plan on giving it to other animals when we have discovered how much we need to give and the best form and route to use for its administration. AIV

Thu Dec 10 1998 22:00:25 Eastern US
Sandy Donchess from 209.44.47.208
Dr. Vinik, have any of the hamsters been cured of diabetes? Also, how often do they have to be given INGAP?

Thu Dec 10 1998 22:00:39 Eastern US
Eric in Ohio from 158.23.35.31
Sorry for my ignorance Dr. Vinik, but what hospital or research group are youassociated with ? My daughter was dxd this past June at Childrens in Boston. We heard alot of talk about this research....

Thu Dec 10 1998 22:00:41 Eastern US
Melissa from 207.22.198.110
Sandy, my room is still down so I linked to this chat that Jeff has made for us!

Thu Dec 10 1998 22:00:45 Eastern US
Connie from 207.194.16.108
Hello, found you!! just listening!

Thu Dec 10 1998 22:01:21 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.11
Dr. Vinik,

Thanks for coming back to chat with us again. What series of steps must be taken and what obstacles do you see must be overcome before INGAP may be used clinically?

Thu Dec 10 1998 22:02:30 Eastern US
Terri from 207.144.100.152
Glad to finally find you

Thu Dec 10 1998 22:02:58 Eastern US
alan from 206.175.96.55
Thanks to Jeff

Thu Dec 10 1998 22:03:43 Eastern US
Sonia Cooper (sonia08@ibm.net) from 32.100.144.179
Dear Dr. Vinik, Your discovery is very interesting. Are you collaborating with Drs.Hering and Sutherland or any others that have succeeded in obtaining JDFI and NIH funding? Collaboration seems to be very much encouraged in recent RFAs.
Sonia

Thu Dec 10 1998 22:04:24 Eastern US
Aaron Vinik from 12.79.42.95
Hi there Judy, I don't know if you have joined us yet but all the same I will address the question you posed. I am sorry that you did not make it into the research study ad Loyola and that your condition is worsening. I presume that you are referring to nerve growth factor. Right now there are two major studies that are being conducted in the US with 1000 patients and one in the rest of the world with 1500 patients. You will be excited to hear that just 2 weeks ago the food and Drug Administration approved NGF for fast tracking. What this means is that if these two studies prove that the drug is effective there will be no hold up in getting it to the public. The studies azre due to end this March and the data will be examined soon thereafter. After that it is a question of assimilating the data in a form that is presentable to the FDA and hopefully all will go well. Hold Thumbs! AIV

Thu Dec 10 1998 22:04:34 Eastern US
Brad (rbknowles@msn.com) from 208.253.68.54
Dr. Vinik, are there any harmful side effects you've found in the hamsters you've administered INGAP to?

Thu Dec 10 1998 22:04:53 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Hi all! So glad you all could make it!

Thu Dec 10 1998 22:04:54 Eastern US
Linda/So. Utah from 207.49.61.119
Hi,

Thu Dec 10 1998 22:06:53 Eastern US
Sandy Donchess from 209.44.47.208
Dr. Vinik, Dr. Rolland Hebert recently stated that he was speaking to or collaborating with you and your team with respect to his claims about a "supplement" that seems to regenerate beta cells. Is this true?

Thu Dec 10 1998 22:07:24 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Wow!! Now I can't wait for next week;s forum! I know lots of people who are really interested in your work with Neuropathy! That's really exciting!

Thu Dec 10 1998 22:09:10 Eastern US
Aaron Vinik from 12.79.42.95
The Institution that I am associated with is the Strelitz Diabetes Institutes at Eastern Virginia Medical School in Norfolk Virginia.
So far we ahve not found any evidence of toxicity of INGAP when administered to hamsters. The surprising thing is that INGAP appears to target very specifically cells in the pancreas and no other site. Even more important is that when it is expressed it occurs only in regenerating pancreas and no other tissue. For these reasons we do not expect it to be toxic and do not expect it to have untoward effects on any iother tissue.

Thu Dec 10 1998 22:09:16 Eastern US
MAR (Richfam5@aol.com) from 205.188.196.33
Evening, All.

Thu Dec 10 1998 22:09:58 Eastern US
DaeDreamer from 208.194.210.81
Wow that was tough!!!!!!!!!!!!
Nice to have you again Dr.

Thu Dec 10 1998 22:10:04 Eastern US
Sonia Cooper (sonia08@ibm.net) from 32.100.144.179
Dr. Vinik, I hope you haven't already covered this but I was wondering how the following problems could be solved:
Keeping cells from continuing to grow indefinitely in vivo.
Getting cells to grow and produce insulin at the same time in a balanced way...it seems that they are often able to do one or the other but not both simultaneously.
Also,
have you been able to try INGAP on other tissues genetically designed to produce insulin other than islets?
Sonia

Thu Dec 10 1998 22:10:25 Eastern US
Sandy Donchess from 209.44.47.208
Hi, MAR. Good to see you.

Thu Dec 10 1998 22:11:13 Eastern US
Joann from 207.12.120.186
Hello

Thu Dec 10 1998 22:12:43 Eastern US
JoAnne (dan-joanne@msn.com) from 208.252.229.28
Hi Everyone. Thought I would stop by to see whats happening at the institute with Dr. Vinik

Thu Dec 10 1998 22:14:00 Eastern US
Aaron Vinik from 12.79.42.95
Please that you could join us again Dr Bachrach. We are making a whole lot of progress with INGAP and the immediate steps is to see if we can optimize dose and route of administration sao that we can effectively treat 100% of animals not the cure of 30-40% we have thus far achieved. We think that there may be other factors in
Ilotropin that are conducive to the optimum effects of INGAP and we are seeking these out. The question that will arise is that if you have a shot at curing 30-40% why not go for it immediately and in this regard we need to do all the pharmacology and pharmacodynamics to be comfortable that we can go ahead with human studies. Clearly that will require significnat finanacial support and backing.

Thu Dec 10 1998 22:16:09 Eastern US
Aaron Vinik from 12.79.42.95
Yes I do know Dr Hebert. We ahve had several conversations and he has been in contact with the people in my laboratory. So far we have received an extract freom him to test in the laboratory in vitro. We were unable top show that the extract had any effects on stimulating ductal cells to grow. More recently h has asked me if we would terst the extract in live animals and we would be delighte to do so.

Thu Dec 10 1998 22:16:11 Eastern US
Sandra Silvestri from 205.188.198.163
Hello everyone.

Thu Dec 10 1998 22:16:54 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Hello everyone! Sorry for the trouble with my room but MANY thanks to Jeff, who set up this room for us at the last minute!!

Dr. Vinik, is the JDF interested in what you're doing? Have you applied to them for financial support?

Thu Dec 10 1998 22:17:15 Eastern US
anomali from 207.172.209.199
Hello Room

Thu Dec 10 1998 22:17:16 Eastern US
MAR (richfam5@aol.com) from 205.188.196.33
Greetings Sandras

Thu Dec 10 1998 22:17:20 Eastern US
Brad (rbknowles@msn.com) from 208.253.68.54
When I hear the word cure I think myself, I've been waiting better than 40 years to hear this even at a succes rate of 30-40%, it sounds almost unbelieveable. It sounds as though many of us may actually be able to witness this before too long, or am I misunderstanding something?

Thu Dec 10 1998 22:17:24 Eastern US
Sandy Donchess from 209.44.47.208
Hi, Sandra. Good to see you.

Thu Dec 10 1998 22:17:53 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.11
Thanks, but it all seems so simple. The notion that all you have to do is administer a protein which causes differentiation of islets faster than the autoimmune process can destroy them is mind boggling (sp?) in its simplicity. Do antibodies develop to INGAP? I must say that unless there are some intolerable side effects, the notion of delivering INGAP by injection doesn't bother me, as long as it will achieve euglycemia and prevent long term complications.

Also, Welcome Sandra Sylvestri. We missed you last week.

Alan

Thu Dec 10 1998 22:18:51 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Hmmm... there was quite a conversation with Dr. Hebert on The Islet Foundation message board! I don't know if you were able to look at that this week! I sent the URL to Anna!

Thu Dec 10 1998 22:18:53 Eastern US
Aaron Vinik from 12.79.42.95
We do have collaborators all over the world, but Dr Sutherland, who is well funded for his research on transplantation is not one of them We intrinsically believe that transplantation can only solve the problem for very few people with diabetes and only when the problems with rejection and spontaneous cell death have been overcome. For this reason we have elected to collaborate with people who can assist us in bringing the idea that isletes can regenerate to fruition.

Thu Dec 10 1998 22:19:54 Eastern US
Daryl (BUGnut) (Texas_BUGnut@hotmail.com) from 38.240.45.2
Hello

Thu Dec 10 1998 22:20:04 Eastern US
anomali from 207.172.209.199
Dr. Vinik. Would you please give information to some of those present about how to get involved in the studies?? I have been involved w/you and Dr. Georges for years and have never been happier. The idea that I might be able to help to help find a cure feels good.

Thu Dec 10 1998 22:20:27 Eastern US
butterfly26 from 24.64.3.194
good evening...I am just going to listen in on the forum tonight

Thu Dec 10 1998 22:21:28 Eastern US
KenC from 209.161.246.23
Good Evening and Merry Christmas! Dr. V. - thanks for attending. QUESTION - are there any side effects to INGAP which have been identified?

Thu Dec 10 1998 22:22:07 Eastern US
Anna G - DIF from 152.205.11.194
Good evening everyone. Just thought that I would let you know that I am listening in.

Thu Dec 10 1998 22:22:09 Eastern US
Sandy Donchess from 209.44.47.208
Dr. Vinik, I guess I have a very basic question. Does the autoimmune process actually destroy beta cells? I don't understand how a dead cell can be brought back to life, so to speak.

Thu Dec 10 1998 22:22:27 Eastern US
Tomokazu Ise (caa11530@pop01.odn.ne.jp) from 143.90.116.143
Hello, everyone. I've come here again from Japan.

Thu Dec 10 1998 22:23:24 Eastern US
Brenda fr Wi from 12.2.97.191
Just listening in tonight!

Thu Dec 10 1998 22:24:21 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.11
As I understand it, the dead islet cells are not "brought back to life." Rather, "primordial" stem cells which have not yet differentiated into islets cells are stimulated to do so by INGAP. If this is not true, please correct me.

Thu Dec 10 1998 22:24:33 Eastern US
KenC from 209.161.246.23
I think I got my answer in your earlier "toxicity" comment.Thanks

Thu Dec 10 1998 22:24:52 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
I have to tell you Dr. Vinik, Kristina was excited to talk to the man who might find a cure for her! Do you think this is still years and years away from her?

Thu Dec 10 1998 22:25:41 Eastern US
Aaron Vinik from 12.79.42.95
Hi to all the folks that have joined us. I want to apologise to those of you whose questions I don't appear to be answering but my computer is jumping all ove the place and just when I think I have the jist of the question it pops off the screen. It is mind boggling to think that you could get even a 30-40% cure rate and we would like to capitalize on this. This was of course in Streptozotocin -induced diabetes in hamsters but, if this is directly translatable to humans it will be very rewarding
We have not yet found that animals develop antibodies to INGAP when it is administered by the intraperitoneal or subcutaneous route. We have however only used Western blots to detect these antibodies but the tecvhnique may be too crude to allow us to find soluble antibodies. We are working at the assay using radiolabeled INGAP to see if we can improve the sensitivety. AIV

Thu Dec 10 1998 22:26:18 Eastern US
KenC from 209.161.246.23
Melissa - Hmmmm. Timelines? Tough question! However, I second the motion!

Thu Dec 10 1998 22:27:13 Eastern US
Ruth from 208.153.85.113
Dr.Vinik, do you feel that a lack of funding is slowing the rate of your research ?

Thu Dec 10 1998 22:27:13 Eastern US
Jeff Hitchcock from 206.112.197.133
Dr. Vinik, you should click on Update and scroll down and click on never. You won't see the next question until you hit send/get msgs.

Thu Dec 10 1998 22:27:20 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Hi Anna! It's good to see you! anyone still wanting brochures and news articles sent "snail mail", email Anna at DIFCURE@aol.com :-)

Thu Dec 10 1998 22:28:11 Eastern US
Tomokazu Ise (caa11530@pop01.odn.ne.jp) from 143.90.116.143
Dr. Vinik, are you planning to extract human Ilotropin and INGAP from human pancreas?

Thu Dec 10 1998 22:28:19 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.11
Dr. Vinik,

Just curious... What was it about wrapping those hamster pancreases in saran wrap encouraged them to produce INGAP. Did the Saran wrap damage them and cause them to "try to regenerate"?

Thu Dec 10 1998 22:28:45 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Dr. Vinik, change your update number to the right to "never" so you have more control on the room! Also, instead of 20 messages, you can set it to show up to 50 messages at once! It's much easier to keep up then!

Thu Dec 10 1998 22:30:04 Eastern US
Beth from 209.42.74.73
Hi. Just watching for awhile here. With my daughter Sara, I'm still curious as to if her beta cells could be stimulated since even after 2 1/2 years she still seems to be producing insulin of her own.

Thu Dec 10 1998 22:30:10 Eastern US
Aaron Vinik from 12.79.42.95
Hello Brenda And Tomakazu-I hope I gotmthe spelling right. Dead cells cannot be brought back to life. In fact islet cells have a very low rate of replication even when they are alive. Many people have tried to make islets multiply-especially those people doing islet transplants. Some of the successful islet transplants habve required 12 donors to treat one person. There just would not be enough donors around to treat the pople who need it. That is why pople are anxious to find a means of making islets expand. Rather the primordial cell is present in the pancreas even years after the onset of diabetes. It is this cell that can be rejuvenated to differentiate into an adult endocrine cell.

Thu Dec 10 1998 22:30:30 Eastern US
KenC from 209.161.246.23
Dr. V. - How about answering how far you perceive you are away from Human Clinical Trials???? (Or are they underway)

Thu Dec 10 1998 22:31:30 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
This is probably a silly question... but what inspired you to use saran wrap on a pancreas? is saran wrap a common article found in a labratory? :-)

Thu Dec 10 1998 22:31:33 Eastern US
Aaron Vinik from 12.79.42.95
Mellisa thanks for the tip. Lets see if I get better at this now with those changes.

Thu Dec 10 1998 22:33:24 Eastern US
MAR (richfam5@aol.com) from 205.188.196.33
I'd like to "echo" Beth's question about salvaging cells while honeymooning. Will the efficacy of Ilotropin be effected by duration of diabetes? By presence or absence of antibodies?

Thu Dec 10 1998 22:34:02 Eastern US
Daryl (BUGnut) (Texas_BUGnut@hotmail.com) from 38.240.45.2
Melissa, I'm on my way...

Thu Dec 10 1998 22:35:06 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
See you when you get here Daryl!! :-)

Thu Dec 10 1998 22:35:43 Eastern US
KenC from 209.161.246.23
Hi, Darryl...Merry Christmas, y'all!

Thu Dec 10 1998 22:36:20 Eastern US
Aaron Vinik from 12.79.42.95
Why Saran. Well the truth is that it was cellophane originally but cellophane is the same as saran. Saran is freely available in the lab and the wrapp we use is the little band that you find on cigarette cartons. This seemed to work best of all. Why we thought of doing it was for an entirely different reason. We were trying to create a model of pancreatitis so that we could learn why when the process started it became relentless. We failed in this mission but notte that all the wrapped pancreases had 2-4 fold the number of islets. The wrapping process produces a partial obstruction that initiates the production of INGAP.

Thu Dec 10 1998 22:37:55 Eastern US
KenC from 209.161.246.23
Dr. V. - I'll repeat my question, in case you missed it. How or when do you perceive human clinical trials for INGAP?

Thu Dec 10 1998 22:38:03 Eastern US
Aaron Vinik from 12.79.42.95
Hi ther Dr Tomokazu, we have already extracted human INGAP and isolate the human INGAP gene. We published this in the J Clin Investigation last May.

Thu Dec 10 1998 22:38:53 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Wow! I'll never look at wrapped leftovers the same again! LOL

Thu Dec 10 1998 22:40:26 Eastern US
KenC from 209.161.246.23
Dr. V. - How would one access the Journal for your May article? Could you post it somewhere (perhaps this web page)

Thu Dec 10 1998 22:40:47 Eastern US
Sandy Donchess from 209.44.47.208
Dr. Vinik, do you know if all mammals have INGAP in their make-up?

Thu Dec 10 1998 22:41:18 Eastern US
Sonia Cooper (sonia08@ibm.net) from 32.100.144.179
Back to the idea of collaboration and follow-up on Dr. Bachrach's observations. Your model of stimulating growth combined with something like anti-cd3 to suppress the TH1 attack seems like an ideal protocol for new onset patients that still have some working islets. What do you think of a model of simultaneously stimulating growth with INGAP and suppressing the attack with anti cd3?

Thu Dec 10 1998 22:41:19 Eastern US
Tina from 204.71.51.4
Hello all, Dr. Vinik do you need to do more than one injection of INGAP in order to acheive the desired result?

Thu Dec 10 1998 22:41:28 Eastern US
sue from 205.217.25.78
whats INGAP

Thu Dec 10 1998 22:41:48 Eastern US
Aaron Vinik from 12.79.42.95
In reponse to the question of wheter funding is a limiting factor- this is always the problem. I am not saying you simply wnat to throw money at a problem and think that wqill solve it. When you have something as promising as INGAP intensifying the financial supporet with added minds and scientists will now doubt bring us to a solution earlier and therby bring closer the day when we can do this in humans. We had a perfect example of this when the Diabetes Institutes Foundation in Norfolk a couple of years ago poured extra resources into the lab and a project on trying to find the gene which would have taken many years was accomplished in just two.

Thu Dec 10 1998 22:43:00 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Here it is Ken! http://www.jci.org/cgi/content/full/99/9/2100?ck=nck

Thu Dec 10 1998 22:43:49 Eastern US
KenC from 209.161.246.23
Thanks, Melissa!

Thu Dec 10 1998 22:44:34 Eastern US
Sandra Silvestri from 205.188.198.163
Dr. Vinik, were funding problems the reason you entered a relationship with Lilly regarding INGAP?

Thu Dec 10 1998 22:46:37 Eastern US
Aaron Vinik from 12.79.42.95
I like the idea of simultaneously giving IMGAP and anti CD3 or for that matter any agent that will suppress the immune repsonse so that the newly formed islets will be protected from immune destruction. We have however been able to prevent and reverse the diabetes in the NOD mouse that as you know gets an immune form of destruction. WE can only presume that the rate of regenerationoutstripped the rate of destruction. We do believe that the pancrezatic islet cell mass is de[pendent upon a balance between formation and destruction. In the past it was a one way street and destruction was always the victor. We think we now have the means of outstripping the destructive forces but would welcome any means of evening out the battlefield.

Thu Dec 10 1998 22:46:46 Eastern US
Joann from 207.12.120.186
once human trials are approved will it involve children or just adults?

Thu Dec 10 1998 22:46:58 Eastern US
Sandra Silvestri from 205.188.198.163
Also, Dr.V. I wanted you to know that my father in law has his first tennis date in nine months tomorrow..thank you.

Thu Dec 10 1998 22:50:13 Eastern US
Beth from 209.42.74.73
This is just too slow. I'll read the archives later. Nite.

Thu Dec 10 1998 22:50:53 Eastern US
Aaron Vinik from 12.79.42.95
In the animal studies we have done this far we have given daily injections of INGASP for several weeks. We do not yet know how many are required, how often, what route and so forth. We have only recently had anough of the recombinant form of INGAP available to us to do the se experiments that are so vital before we canplan the human equivalents. We entered into a relationship with Lilly for a number of reasons. Lilly has outstanding scientists with expertise in protein chemistry and molecular biology. They hyave been a great help in advancing the project. It is also clear that when one wnats to transfer a research project form scinec into the arena of producing a drug, many many dollras are required and deep pockets are essential.

Thu Dec 10 1998 22:52:16 Eastern US
Judith from 206.112.27.100
Dr. Vinik, what controls the replication of the islets when you stimulate production with INGAP? Have there been problems with hyperinsulism?

Thu Dec 10 1998 22:52:16 Eastern US
Aaron Vinik from 12.79.42.95
Sandra that is the best piece of news I have heard for a while. Give them my best and tell them that Kay keeps me constantly apprised and I am thrilled.

Thu Dec 10 1998 22:53:27 Eastern US
Aaron Vinik from 12.79.42.95
Sorry Beth. I just don't weem to be able to get all the answers out fat tonite. If there is anything in the arvhives that is ogf interest post the question and I will get to it as soon as possible. Thanks for joining us all the same.

Thu Dec 10 1998 22:53:27 Eastern US
Judith from 206.112.27.100
Oops..."hyperinsulinism"

Thu Dec 10 1998 22:54:44 Eastern US
Ruth from 208.153.85.113
Dr.Vinik, what is the recombinant form of INGAP. Why has it only been very recently available?

Thu Dec 10 1998 22:55:06 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Take your time Dr. Vinik! You're only one person and there are alot of questions! :-) You're doing great!

Thu Dec 10 1998 22:56:27 Eastern US
Aaron Vinik from 12.79.42.95
I like the question of wheter or not we could go the other way and get hyperinsulinism or even exceesive growth of islets. What appears to be the case is that we are recreating normal ontogeny, i.e. it is a reenactment of what happens to the fetus in utero. When the islets jhave reached a critical number and size they cease growing. We have not seen inappropriately high insulin levels. nor have we seen pathologic increases in islet size or number. The normal restraining forces seem to be present and restrict unbrideled growth.

Thu Dec 10 1998 22:56:40 Eastern US
anomali from 207.172.209.199
Dr. Vinik. I pesonally appreciate more than you could know your coming here. Be your own pace and those of us that want to learn shall do so. Without impatience. Good night room.

Thu Dec 10 1998 22:56:47 Eastern US
Tina from 204.71.51.4
Have you been able to determine whether the "humanly induced" growth rate of islet cells causes the animals to have low blood sugar?

Thu Dec 10 1998 22:56:52 Eastern US
Sandra Silvestri from 205.188.198.163
Melissa is right. And remember that many will read this in archive form. I did last week and although I understood your frustration I thought you did a great job.

Thu Dec 10 1998 22:57:34 Eastern US
Sandra Silvestri from 205.188.198.163
Dr. V. that is very good news.

Thu Dec 10 1998 22:58:47 Eastern US
Tomokazu Ise (caa11530@pop01.odn.ne.jp) from 143.90.116.143
I have to leave now because my lunch time is over. Thank you Dr. Vinik and Melissa.

Thu Dec 10 1998 22:58:54 Eastern US
Tina from 204.71.51.4
Oops Sorry Dr. Vinik I see that you answered MY question before I asked it. That is promptness at it's best.

Thu Dec 10 1998 22:59:21 Eastern US
Marina from 216.75.26.102
This may be totally dumb but I'm going to risk it. Is INGAP kind of like an oncagene? I remember vaguely learning about how cancer is caused by a gene that is turned "on" (sometimes by stress). INGAP seems to turn itself on during times of pancreatic stress and result in mass replication. Is there any correlation here?

Thu Dec 10 1998 22:59:44 Eastern US
Judith from 206.112.27.100
That IS good news re: control of growth. I would think possible induction of malignancy would be a major concern.

Thu Dec 10 1998 22:59:54 Eastern US
Aaron Vinik from 12.79.42.95
The recombinant form of INGAP has been made in bacteria or in a cell tumor line using the INGAP gene as template. We neede first to identify the gene and then to develop a method that would work on making the protein in such a way that it assumed all the necessary primary adnsecondary characteristics that allow a protein to do its thing. In this repspect when we found the gene working with Lilly had a great deal to do with manufacturing the full length protein from the gene template since they had develope the method for other proteins and had the expertise in house.

Thu Dec 10 1998 23:00:12 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
It was good to see you Tomokazu! I'm always so pleased to see you here!

Thu Dec 10 1998 23:00:57 Eastern US
Aaron Vinik from 12.79.42.95
Induction of malignancy is of great concern whenever one stimulates growth. We have obseved animals for a lifetime and have yet to find a malignancy.

Thu Dec 10 1998 23:01:35 Eastern US
Judith from 206.112.27.100
Again...VERY good news!

Thu Dec 10 1998 23:03:15 Eastern US
Judith from 206.112.27.100
Can you hazard a guess as to how long it will be before this is in human clinical trials?

Thu Dec 10 1998 23:05:17 Eastern US
Judith from 206.112.27.100
And what approach will be used to prevent autoimmune destruction of the induced islets?

Thu Dec 10 1998 23:07:27 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Yes I'm really interested in what happens to those antibodies and how to protect those new cells! It's doubtfull that the antibodies have disappeared from Kristina's body...

Thu Dec 10 1998 23:10:31 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Hmmm... has everyone disappeared?

Thu Dec 10 1998 23:10:52 Eastern US
Megan from 208.169.217.98
I'm lurking...

Thu Dec 10 1998 23:10:55 Eastern US
Sandra Silvestri from 205.188.198.163
It's bedtime around here and Mom's on duty. Thank Dr. Vinik, Melissa and everyone who brought their questions. I learned a few things..always good news for me. Good night all.

Thu Dec 10 1998 23:10:59 Eastern US
Joann from 207.12.120.186
I am still here......

Thu Dec 10 1998 23:11:10 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.2
melissa, I'm still here.

Alan

Thu Dec 10 1998 23:11:15 Eastern US
MAR (richfam5@aol.com) from 205.188.196.41
Not at all, Melissa! Soaking up like a sponge.

Thu Dec 10 1998 23:11:22 Eastern US
Judith from 206.112.27.100
Seems that way, Melissa!

Thu Dec 10 1998 23:11:24 Eastern US
JoAnne (dan-joanne@msn.com) from 208.252.229.28
I'm still here Melissa

Thu Dec 10 1998 23:11:26 Eastern US
Brenda fr WI from 12.2.97.191
Yes, it has gotten pretty quiet!

Thu Dec 10 1998 23:11:31 Eastern US
Aaron Vinik from 12.79.42.95
The principle of action of oncogenes and factors that stimulate growth is not dissimilar. Your question is a smart one even if you don't believe it. For tumors to develop one usually needs more than one hit i.e. oncogene activation together with loss of some restraining activity or the activation of other pathways simultaneously. The difference between that and what one observes with INGAP treatment is that the growth is entirely regulated, there is only one hit, there is no loss of the restraining potential nor, do we intefere with it. Nonetheless we are vigilant for any signs that this might not be the case. We have not yet encountered a malignancy even in the lifetime of animals we have treated.
To answer the question of how late in the course of diabetes will this treatment be feasible. I tried to suggest to you that we think it may be indefinite when I relayed to you the story of the 65 year old male who had neogenesis and INGAP expression after having had type 1 diabetes virtually his whole life. It seems that these primordial cells are present in the lining system of the pancreas and that they are particularly hardy to all forms of assaults, immune, alcohol, poisons amongst others.

Thu Dec 10 1998 23:11:50 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Goodnight Sandra! It was good to see you!

Thu Dec 10 1998 23:12:19 Eastern US
Connie from 207.194.16.108
Still here!!

Thu Dec 10 1998 23:12:26 Eastern US
Brad (rbknowles@msn.com) from 208.253.68.54
Was really interested in the questions regarding the start of human clinical studies

Thu Dec 10 1998 23:13:17 Eastern US
Judith from 206.112.27.100
So you believe you can continue to induce an infinite number of islets, keeping ahead of autoimmune destruction?

Thu Dec 10 1998 23:14:16 Eastern US
Connie from 207.194.16.108
Brad those questions have been asked many times...

Thu Dec 10 1998 23:14:23 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.2
So, does it appear that INGAP alone will be a treatment for DM. This would not eliminate all the injections (I presume they would be required in an ongoing manner) of medications. I presume that one would no longer have to check glucose levels multiple times per day. Anything else?

Thu Dec 10 1998 23:15:02 Eastern US
Marina from 216.75.26.102
Thank you Dr. Vinik.

Thu Dec 10 1998 23:15:49 Eastern US
Sandy Donchess from 209.44.47.208
Before human clinical trials, would it be necessary to do animals such as mice, dogs, primates, etc?

Thu Dec 10 1998 23:15:51 Eastern US
Ruth from 208.153.85.113
Dr.Vinik. I'm confused now. What animals have studies been done on so far? I thought that i understood that they were done on hamsters, mice, dogs, and monkeys? Is that correct? Will your main focus now be on administration problems such as dosage and means of administering the protein. Thank you so much for speaking with us tonight.

Thu Dec 10 1998 23:15:59 Eastern US
Sonia Cooper (sonia08@ibm.net) from 32.100.144.179
Are you working at all with Chris Newgard's group on producing a bioengineered cell line? I apologize for continuing back toward colaboration, but it seems like this is helpful in obtaining accelerated funding.

Thu Dec 10 1998 23:16:15 Eastern US
Aaron Vinik from 12.79.42.95
Tina, The humanly induced growth of islet cells has so far not cause hypoglycemia. It is interesting that when we follow the animals over time they start making nore insulin than might be necessary and the body compensates by increasing its production of glucose and reducing the effectiveness of the insulin. With time there is a resetting of the homeostasis and the insulin levels return towards normal and the need for increased glucose production disappears.

Thu Dec 10 1998 23:16:17 Eastern US
Tina from 204.71.51.4
Once again, I thank you Dr. Vinik, Melissa, and also Jeff for having this open to us. I am sorry that I have to leave it so soon, but will look forward to reading the archives. Thanks again. T from WY

Thu Dec 10 1998 23:16:46 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Brad, if I understand correctly, it's almost impossible to tell EXACTLY when human trials will start due to the testing they still need to do to answer a few more questions concerning INGAP! and also funding is a major issue! He said INGAP was discovered in 2 years thanks to some funding they got! without it, the discovery would have taken much longer! So it'll depend on how much funding they can obtain!

Thu Dec 10 1998 23:17:46 Eastern US
Joann from 207.12.120.186
Bye Tina...

Thu Dec 10 1998 23:18:09 Eastern US
Brad (rbknowles@msn.com) from 208.253.68.54
Thanks Melissa.

Thu Dec 10 1998 23:18:28 Eastern US
Judith from 206.112.27.100
As he said, Lilly has DEEP pockets! After all, most of us are helping to line them!

Thu Dec 10 1998 23:19:52 Eastern US
MAR (richfam5@aol.com) from 205.188.196.41
" It is interesting that when we follow the animals over time they start making nore insulin than might be necessary and the body compensates by increasing its production of glucose and reducing the effectiveness of the insulin. With time there is a resetting of the homeostasis and the insulin levels return towards normal "
Dr. Vinik, you are a master of understatement if you refer to this as "interesting". I find this amazingly encouraging...miraculous. There's some hope here.

Thu Dec 10 1998 23:20:39 Eastern US
Aaron Vinik from 12.79.42.95
Sonia, we are not working with Chris Newgard's group on producing a bioengineered cell. This is proving to be a bigger undertaking than most people anticipated in the beginning when trying this approach Efrat in NY is trying a similar approach as is Ole Madsen in Denmark. The key difference is that we do not start with malignant cells or a clonal cell line but with a primordial cell and encourage it to differentiate and make insulin. We do not have to worry if it has the recognition machinery for glucose or that it will turn off in the absence of glucose or that it will resume its malignant characteristics in the body.

Thu Dec 10 1998 23:21:32 Eastern US
Faith from 12.77.157.36
I'm here too. Always just listening. My questions get asked and answered.

Thu Dec 10 1998 23:21:55 Eastern US
Joann from 207.12.120.186
Interesting.

Thu Dec 10 1998 23:22:09 Eastern US
Anna G - DIF from 152.205.11.194
Dr. Vinik, Judith has expressed the impression that Lilly is funding your research from its deep pockets. Would you kindly address that.

Thu Dec 10 1998 23:23:32 Eastern US
Aaron Vinik from 12.79.42.95
Ruth, you were not confused. We have identified INGAP in all the species you mention as well as seeing it when we have induced neogenesis. We have only treated hamsters with the recombinant INGAP and Ilotropin.

Thu Dec 10 1998 23:23:44 Eastern US
Brenda fr WI from 12.2.97.191
Thank you Dr. Vinik for giving us parents more hope for the future for our children!! Good night all...

Thu Dec 10 1998 23:24:40 Eastern US
hobie from 206.24.42.232
hello

Thu Dec 10 1998 23:25:25 Eastern US
Aaron Vinik from 12.79.42.95
Judith I wish tahat were true. Lilly has funded their own internal research on INGAP but has not supported ours. We have been depenent on the Diabetes Institutes Foundation and other charities to fund this nwork.

Thu Dec 10 1998 23:26:06 Eastern US
Judith from 206.112.27.100
Thank you for the clarification re: funding.

Thu Dec 10 1998 23:26:15 Eastern US
Joann from 207.12.120.186
I have to go, Thanks for the HOPE Dr. Vinik.
Goodnight everyone

Thu Dec 10 1998 23:27:10 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Ohhh thanks for clearing that up Dr. Vinik! I'm afraid I had been mixed up about what animals had been treated and which had only had INGAP identified!

Thu Dec 10 1998 23:28:34 Eastern US
anomali from 207.172.209.156
Thank you room for allowing me to lurk. Have great evenings,all and teriffic tomorrows.

Thu Dec 10 1998 23:28:34 Eastern US
Sandy Donchess from 209.44.47.208
Dr. Vinik, I spoke with a Lilly researcher who said that INGAP would require years of research. Can you tell us what Lilly is researching, and if your research is different?

Thu Dec 10 1998 23:28:34 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
have you applied for funding from JDF or NIH?

Thu Dec 10 1998 23:28:35 Eastern US
Aaron Vinik from 12.79.42.95
Alan, Those are interesting speculations. Some of the islet transplant work has been claimed as benig successful if the dose of insulin was reduced! Our target is to have people insulin free and that is the reason we are not sitting back and enjoying the 30-40% response.

Thu Dec 10 1998 23:29:59 Eastern US
Deborah (js50ds48@webtv.net) from 209.240.200.41
Hello all, missed it again will catch it in the archives , thanks again for all the info

Thu Dec 10 1998 23:30:29 Eastern US
MAR (richfam5@aol.com) from 205.188.196.41
Gee, Melissa, how about the ADA??? Don't forget the ADA...they've got LOTS of money!

Thu Dec 10 1998 23:31:23 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
How will you try to increase the response from 30-40% to 100%? (sorry if this was answered already)

Thu Dec 10 1998 23:31:30 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.2
What I am really asking is, Do you think INGAP can be used alone, or will it be part of a regimen of drugs necessary to achieve euglycemia?

Thu Dec 10 1998 23:31:46 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
LOL Lets not go there MAR!! hehehehehe

Thu Dec 10 1998 23:32:09 Eastern US
JoAnne (dan-joanne@msn.com) from 208.252.229.28
Dr. Vinik, Thank You for your lovely talk again. I will check in next week again. I miss your talks. Can't wait to return to the Tidewater area. Goodnite aal.

Thu Dec 10 1998 23:33:16 Eastern US
MAR (richfam5@aol.com) from 205.188.196.41
I'll be good, Melissa, but it KILLS me to know our kids are languishing for lack of funding research. Sorry.

Thu Dec 10 1998 23:33:24 Eastern US
Sandy Donchess from 209.44.47.208
MAR, Melissa, someone should go there...

Thu Dec 10 1998 23:33:39 Eastern US
Aaron Vinik from 12.79.42.95
Sandy, Lilly is researching turning INGAP into a drug, and we are trying to find ways of delivering it, whether it will be the protein or gene that should be given, if we can turn it on by other means or if the target or recptor can be found and activated. Ultimately our goals are similar we go about the problem very differently and the approach to making a drug and furthering the science are not exactly the same. I hope that helps you understand the differences.

Thu Dec 10 1998 23:34:01 Eastern US
Renee from 205.188.198.22
Night all..thank you Dr. Vinik for taking the time to educate us & keep us apprised of the status of your work..I've been lurking & look forward to reading the archives so I can more fully "digest" this wealth of information...

Thu Dec 10 1998 23:34:57 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Yes but not tonight Sandy!

Thu Dec 10 1998 23:35:37 Eastern US
Aaron Vinik from 12.79.42.95
Alan, if INGAP does what we hope it will and the individual is not far along the path of complications requiring other forms of intervention it should be the sole treatment.

Thu Dec 10 1998 23:36:39 Eastern US
Sandy Donchess from 209.44.47.208
Thank you so very much, Dr. Vinik, for being here and providing these explanations. I appreciate it very much, and I know everyone else does, too. Would that many others have the gumption to do as you are doing.

Thu Dec 10 1998 23:37:22 Eastern US
Sandy Donchess from 209.44.47.208
Melissa, I know. I wasn't going to go there tonight. It should be visited, though.

Thu Dec 10 1998 23:37:25 Eastern US
Ruth from 208.153.85.113
Dr. Vinik, I believe that many of us are wondering if there is anything we can do help you direct some funding toward your INGAP research. Would letter writing to the ADA or any other organization help you? Is there anything else that might help to deepen your pockets at the DRI?

Thu Dec 10 1998 23:37:43 Eastern US
Aaron Vinik from 12.79.42.95
Thank you all again for the super questions. Hope that the archiving will fix my typos otr next time I will bring a stenographer. Good Night all and thanks for being there. AIV

Thu Dec 10 1998 23:38:19 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Just send them to me Sandy and I'll have a forum! LOL The internet is becoming the best way to find and exchange information and finding an audience interested in what you have to say!

Thu Dec 10 1998 23:38:59 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.2
Dr. Vinik, That's great news. To me it really suggests that things are relatively far along (ignoring the FDA requirements for bringing a drug to market, of course!).
Thanks for joining us.

Thu Dec 10 1998 23:39:00 Eastern US
Sonia Cooper (sonia08@ibm.net) from 32.100.144.179
Dr Vinik, First, thank you for your very important discovery. One last question (I'll stick with my collaboration mantra), would you consider working with individuals like Haffler or Wegmann to determine what occurs with cytokine levels during administration? I'm not trying to play devil's advocate, I just know that a medical science review committee would want to know that you were considering some of these peripheral issues even if they aren't critical to the success of your experiments. Also, given the enrollments now of very high risk children in primary prevention studies, perhaps collaboration with these groups would be helpful? Also, for those looking to read some abstracts, just do a search on PubMed using the keywords "Vinik and diabetes" or INGAP at
http://www.ncbi.nlm.nih.gov/PubMed/
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9151782&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m_s
If you want automatic updates, you can put these key words into search tools that will give you weekly updates to any new publications....

Thu Dec 10 1998 23:39:26 Eastern US
Judith from 206.112.27.100
Thank you, Dr. Vinik.

Thu Dec 10 1998 23:39:27 Eastern US
Marina from 216.75.26.102
Thank you so much Dr. Vinik.

Thu Dec 10 1998 23:39:30 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
I've been going to that iGive.com website but it seems like a slow way to build up funds.... There must be a better way!

Thu Dec 10 1998 23:39:42 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.2
Melissa, I'm dying to know. What does LOL stand for?

Thu Dec 10 1998 23:40:21 Eastern US
Sandy Donchess from 209.44.47.208
Alan, Laughing Out Loud.

Thu Dec 10 1998 23:40:24 Eastern US
MAR (richfam5@aol.com) from 205.188.196.41
Goodnight, Dr. V, and thanks for the "sweet" dreams.

Thu Dec 10 1998 23:41:24 Eastern US
Alan F. Bachrach, M.D. (bachrach@mindspring.com) from 209.86.92.2
Thanks Sandy, I learned a lot tonight and the meaning of LOL was not the least of it.

Thu Dec 10 1998 23:41:34 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
LOL Laughing Out Loud, which, I happen to do alot of! :-)

Thu Dec 10 1998 23:41:36 Eastern US
Judith from 206.112.27.100
Thanks to Melissa and Jeff!

Thu Dec 10 1998 23:41:56 Eastern US
Anna G - DIF from 152.205.11.194
Ruth, Please consult the Diabetes Institutes Foundation website (www.dif.org) for more information about how you can help Dr. Vinik's research. And just for clarification, Dr. Vinik is not with the DRI, he is the research director of the Strelitz Diabetes Institutes at EAstern Virginia Medical School.

Thu Dec 10 1998 23:42:37 Eastern US
Sandy Donchess from 209.44.47.208
I second, third and fourth the Thanks to Melissa and Jeff.

Thu Dec 10 1998 23:42:55 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
Dr. Vinik, thanks for doing this tonight and putting up with the last minute change! I appreciate what you're doing very much and I'd love to help in any way that I can! Getting the word out and finding or passing on info online is what I do best!

Thu Dec 10 1998 23:43:48 Eastern US
Melissa (jrnysend@itexas.net) from 207.22.198.110
OHHH... wow, I had that one wrong Anna! Sorry!

Thu Dec 10 1998 23:44:44 Eastern US
Ruth from 208.153.85.113
Dr.Vinik Thank you for your discovery, the hope it brings, and for taking the time to inform us tonight. Good night.

Thu Dec 10 1998 23:44:49 Eastern US
Sonia Cooper (sonia08@ibm.net) from 32.100.144.179
http://www.jdfcure.org/grant%20application%20instructions2.htm
This is one of the avenues to obtain funding. Their director, Bob Goldstein, is really very helpful as well about offering suggestions.



                 
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