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Exclusive Interviews with the 2015 ADA Pathway Initiative Award Winners

By Mallika Tamboli, Alexander Wolf, and Maxwell Votey

Twitter summary: We interview @AmDiabetesAssn Pathway award-winners about their time in #diabetes research + where they want to take the field

Starting in 2012, the American Diabetes Association established the Pathway to Stop Diabetes initiative, a $1.6 million grant (paid over five years) to support the research of young up-and-coming scientists who are committed to working on innovative projects in diabetes. The Pathway Award is in many ways a beacon of hope for diabetes researchers navigating the present research-funding climate. As recent studies have demonstrated, diabetes research receives roughly 3% of public NIH research funding, despite the fact that one in five healthcare dollars are spent on diabetes and over 29 million people have diabetes. To put this into perspective, the NIH gives 16% of its funding to cancer research and 9% to HIV/AIDS research. Research in these disease areas has benefited tremendously from this level of funding, which is why the ADA Pathway Program is so critical. Breakthroughs require funding, and at a time when the public funding support for diabetes research is lacking, the ADA Pathway program is stepping in with the potential to drive some of the groundbreaking discoveries that diabetes so greatly needs.

Last year, diaTribe had the opportunity to interview the first group of award winners. Within only two years of receiving the grant, the 2014 Pathway recipients as a collective have published high profile papers, developed a patent, and successfully transitioned from training into faculty positions. Science research is a marathon, not a sprint, and it will be exciting to see these researchers continue to develop their work in the future.

We are excited to present our interviews (see below!) with the second round of Pathway grant recipients*. This year’s six winners represent a broad range of research areas in both type 1 and type 2 diabetes, from improving wound care to developing systems of closed-loop insulin and glucagon delivery. Three of them also have personal connections to diabetes, which certainly has influenced their passion for the field. These researchers truly represent the best-of-the-best, having been selected out of a competitive pool of 116 applicants to gain one of six final awards. Nominations for next year’s awards close on July 1, 2015. We send tremendous thanks to the generous funders of the ADA who have made the fabulous Pathway awards possible.

This year’s six Pathway award recipients include the following:

Celine Emmanuelle Riera, PhD (University of California, Berkeley) is leading research on the how the body's sensory systems impact metabolic disorders.

Stephanie Stanford, PhD (La Jolla Institute for Allergy and Immunology) is leading research on the interaction between genetics and environment in type 1 diabetes.

Thomas Delong, PhD (University of Colorado, Denver) is leading research on immune system malfunction in the development of type 1 diabetes.

Zhen Gu, PhD (North Carolina State University) is leading research on "synthetic vesicles" that could release insulin and glucagon in response to the body's glucose levels.

Marie-France Hivert, MD (Harvard Pilgrim Health Care) is leading research on maternal hyperglycemia during pregnancy and its impact on the child's future type 2 diabetes risk in adulthood.

Mayland Chang, PhD (University of Notre Dame) is leading research on enhancing wound care in people with diabetes.

Q&A with the ADA Pathway Grant Recipients

Q: What drew you to diabetes research?

Dr. Delong: As a type 1 diabetic myself, I have been interested in studying and defeating this disease for a long time. This is a very personal issue for me and I am dedicated to contributing to find a cure.

Dr. Riera: I am frightened by the incidence of type 2 diabetes in western countries and mainly in the USA. Before the discovery of insulin, diabetes was a fatal disease. Nowadays, we can treat the symptoms but we are still unable to cure diabetes and restore a healthy metabolism. I believe that more efficient cures will come out of scientific efforts and innovative research.

Dr. Hivert: My initial interest in diabetes emerged very early – even before medical school. I had the chance to work in a summer camp for children with diabetes (Bearskin Meadow Camp in California). Through medical school, my interest in diabetes and endocrinology continued to grow; then during residency, I gradually developed my interest for research, especially for prevention.

Dr. Gu: I joined Dr. Robert Langer’s lab at MIT as a postdoc in 2010, when he had just received a terrific grant from the Helmsley Charitable Trust Foundation for the “synthetic pancreas” research. I was supported by this grant and became more and more interested in diabetes research. My personal experience has also motivated me. My grandmother died of diabetic complications. When I was a kid, I enjoyed playing with syringes for insulin injections. 25 years ago, I even “invented” a toothbrush integrated with a syringe filled with toothpaste for lazy usage. Now in my own research lab, we can make toothpaste-like injectable insulin gels and micro-needle array patches for glucose-responsive smart insulin delivery.

Dr. Chang: Diabetes runs in my family. Diabetic wounds are an unmet medical need, as there is a paucity of research to understand why diabetic wounds do not heal and there are no drugs approved that facilitate or accelerate wound healing.

Q: Do you see yourself staying in diabetes research long-term?

Dr. Riera: Yes, absolutely! I think diabetes is a very young and exciting field. There is so much to discover.

Dr. Hivert: Yes, I love research. I also very much enjoy my clinical work at MGH diabetes center and the contact with patients, but I hope to bring better health to a larger population and on longer term by doing research in the field of diabetes.

Q: How can we motivate more young people to become engaged in diabetes/endocrinology?

Dr. Hivert: I think by giving them the chance to interact with people who have diabetes and to experience how advances in scientific medical knowledge and technology can make a difference in someone's life.

Dr. Gu: Two effective motivators: education and money. Early education about the severe consequences of diabetes and importance of diabetes research will attract more talented researchers to get involved. Our lab has developed an outreach module – “Engineering Our Way to Stop Diabetes” – for educating high school students and fresh undergraduate students, through open house events and summer internships. Money is certainly a powerful stimulus. Many young people have extremely creative ideas, but cannot move forward without grants.  

Q: What do you think is the biggest difficulty in diabetes research?

Dr. Gu: Funding is the biggest difficulty; if with sufficient funding, though, the next difficulty is collaboration – how to seamlessly fuse ideas from different areas together. You cannot expect generation of unique ideas from a pure science group or a pure engineering group.

Dr. Delong: We first need to understand the causes for these diseases. That’s not easy!

Dr. Chang: Diabetes research is multidisciplinary, requiring scientists of different disciplines and clinicians coming together to understand this disease. Diabetes results in numerous complications and it takes decades to see the symptoms.

Q: What areas of diabetes research do you think have the most unanswered questions or the greatest potential for new discoveries?

Dr. Riera: Our understanding of diabetes has long been restricted to a peripheral tissue disease that originates with a pancreatic dysfunction to produce insulin. In the last decade we have witnessed the emergence of new players in the onset of the disease: the central nervous system. Novel imaging and genetic technologies hold great potential to understand how the brain participates in the disease.

Dr. Delong: I always think of the insulin producing beta cells as a box full of unknown treasures. When I look at the secretory granules of beta cells (the ones that store and secrete insulin) I always think I am on a different planet and I keep my eyes open for new things. I am certain there is plenty to be found there.

Dr. Hivert: Early life determinants of diabetes. Imagine if we knew and could measure accurately the very early factors leading someone to be more at risk to develop diabetes over a lifetime. This could lead to better ways to prevent it. Understanding etiologic biologic phenomenon involved in progression to diabetes could also open the door to better targets for treatment.

Dr. Chang: I think if we can understand why diabetic wounds do not heal, it will prevent more than 70,000 lower-limb amputations that occur every year in the United States alone.

Q: What do you think is the most solvable problem in diabetes?

Dr. Gu: Islets implantation.

Dr. Delong: I think it is more important to address the most critical problems in diabetes, which in my opinion would be the prevention of diabetes (both type 1 and type 2).

Dr. Chang: Prevention of diabetes by eating better and incorporating physical activity. Just as smoking has substantially decreased, healthier eating habits and exercise can substantially decrease diabetes.

Q: If you had $10 billion to invest in diabetes research, how would you spend it?

Dr. Riera: That’s a lot of money! I would definitely distribute it among talented researchers and clinicians to combine basic science approaches with clinical studies. Longitudinal studies from diabetic patients, patients at risk and healthy patients...would allow the discovery and evaluation of clinical targets in a comprehensive manner.

Dr. Delong: For type 2 diabetes, I would probably invest a large portion of the money motivating people to eat healthy and exercise frequently. For type 1 diabetes, I would invest in beta cell regeneration and immune tolerance studies. I would also put money into closed loop insulin delivery systems. About half the money would go into disease prevention.

Q: What would be your advice to other young people starting off in the field?

Dr. Gu: “Think big and never give up.” This is advice my postdoc advisor Dr. Robert Langer often tells to his trainees. I just want to repeat it.

Dr. Riera: Don’t hesitate to think outside the box! There are many new things to discover and many opportunities to achieve original research.

Dr. Delong: If you want to enter a particular field in life sciences, study something completely different first. That gives you a different perspective on things. You may recognize things that are not as apparent to others. 

Dr. Hivert: Follow your passion!

Dr. Chang: Networking is important to bring scientists from various disciplines and clinicians together to solve biomedical problems.

* Unfortunately, we could not speak to Dr. Stanford prior to ADA; however, we look forward to learning more from her soon.

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