What’s next in endocrinology? Update from BMC Medicine at ENDO 2016

Recently, Boston welcomed over 9,000 delegates from all over the world, attending ENDO 2016. Here, the BMC Medicine team highlight some of the most innovative developments discussed at the meeting.

Many endocrinologists mark the annual ENDO meeting as a ‘must-attend’ event. However, given the broad effects of the endocrine system on the body, it also attracts basic scientists and clinical researchers working on anything from bone health, cancer, to lifestyle and environmental effects.

This year’s 98th Annual Meeting of the Endocrine Society was even more special than usual as it took place during the Society’s Centennial Celebration. Within the last century, much progress has been made in the field of endocrinology noted by a number of key discoveries, which have been awarded the Nobel Prize (including insulin discovery).

However, much remains to be understood about this complex and intricate system, as well as clinical practice; therefore the meeting also focused on some exciting new developments and technologies.

Future of diabetes therapy: stem cells, new insulins and the bionic pancreas

In the last few years, stem cell research and therapy have advanced rapidly, including studies on the Stem Cell Educator demonstrating its potential in treating type 1 and type 2 diabetes.

Insulin application using insulin pen
Insulin application using insulin pen
Mr Hyde at Czech Wikipedia

At the ENDO presidential plenary, Douglas Melton described recent work on development of insulin-producing human pancreatic beta cells.

His group has spent the last decade developing a safe way to obtain such cells using a single agent, bone morphogenetic protein-7, which also appears to have beneficial effects on insulin resistance. Remaining challenges include developing islets from these cells, and successfully transplanting these into type 1 diabetics.

As insulin administration remains the mainstay of therapy for type 1 and many type 2 diabetics, many sessions discussed advances in this field.

Chantal Mathieu gave an overview of novel insulin analogues in clinical practice and highlighted the main challenges in achieving optimum treatment, such as: intra-patient variability, late-onset and short-duration insulins. In addition, insufficient resemblance of the physiologic insulin profile requires patients to keep strict daily timelines regarding meals and insulin administration.

In order to make diabetes management easier some new ideas are being explored, such as concentrated insulins, combined therapies, smart insulin patch and oral insulins. In recent years, there has also been an explosion in smartphone apps allowing management of diseases, such as diabetes. But these are not without limitations, as highlighted in a recent systematic assessment of insulin dose calculator apps.

The bihormonal bionic pancreas though takes this field to the next level. Edward Damiano and Steven Russell described how the bionic pancreas can achieve blood glucose control by automatically making decisions about insulin and glucagon dosing every five minutes. The first trials were performed in 2013 and the results of the most recent trial, assessing home use will soon be published.

iPhone-based part of the "bionic pancreas", which monitors glucose levels and communicates with insulin and glucagon pumps to automatically dose the hormones into the bloodstream
iPhone-based part of the “bionic pancreas”, which monitors glucose levels and communicates with insulin and glucagon pumps to automatically dose the hormones into the bloodstream
Flickr - Intel Free Press

Oncofertility : preserving fertility in pediatric cancer patients

In another inspiring session, Teresa Woodruff gave an overview on ‘oncofertility’ – i.e. the intimate partnership between oncology care and fertility care. This is particularly important for pediatric and adolescent cancer patients facing a future of infertility as a result of cancer therapy. To address this need, Woodruff explained that recent work has involved bioengineering the human ovary.

Placing ovarian tissue strips into the preserving solution
Placing ovarian tissue strips into the preserving solution
Wzsuzsanna3 at Hungarian Wikipedia - Dr. Vereczkey Attila

Previous studies have focused on recreating the female reproductive tract and successful live births in a mouse infertility model, after transplantation of primordial follicles. A key component in successful fertility treatment is also in being able to identify a ‘good egg’.

Some further exciting recent work from Thomas O’ Hallorans group has found that zinc is taken up during fertilization, and that this can be a potential biomarker of quality of a mouse embryo. Woodruff emphasized that by 2036, oncofertility and designer ovarian bioprosthetics should be fully developed areas of treatment.

‘Omics’ in advancing endocrinology

In a metabolomics focused session, Christopher B. Newgard talked about the complex interplay between lipids and branched-chain amino acids (BCAAs) contributing to insulin resistance and conversion to type 2 diabetes. The promise for therapeutic approaches lies in BCAAs being responsive to dietary changes, and integrated metabolomics and transcriptomics studies to help understand the precise mechanisms.

DNA strand
DNA strand
iStock

Use of genetic testing in clinical practice revolves around deciding which patients may benefit from it and in identifying clinically applicable diagnostic and prognostic molecular markers.

For instance, Steven Paul Hodak and Bryan McIver looked specifically at thyroid nodules, which may remain benign for many years even when malignancy-specific RAS-oncogene is present, suggesting that clinical decisions require more tests.

So what does the future hold? As Mark Goodarzi explained during his overview on recent advances in genetics, thanks to bioinformatics and projects such as ENCODE, we’re on the cusp of accelerated functional characterization of genetic findings. In addition, if the power of open source data can be harnessed, there could be dramatic reductions in timeline for drug development.


 

As a general medical journal publishing influential research in all areas of clinical practice and translational medicine, BMC Medicine is always interested in receiving original research submissions addressing some of the most exciting developments in all these topics. Why not consider us for your next ground breaking research paper?

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