Clinical scientists at the Hotchkiss Brain Institute (HBI) in the Faculty of Medicine are starting a pilot study for local patients with type 1 diabetes, looking at the delivery of insulin through the nose as a potential new treatment for diabetic neuropathy, a diabetic nerve disease.

About 50 per cent of people with diabetes will develop the debilitating and painful nerve disease. Currently, the treatments for diabetic neuropathy are limited to pain management.  The lack of effective treatment options is prompting excitement about the potential of this new approach.

Dr. Cory Toth, a neurologist and Assistant Professor in the Department of Clinical Neurosciences, is co-leading the new study.  His laboratory work, which demonstrated that intranasal (delivered through the nasal passageway) insulin helps protect nerves in the brain and central nervous systems of mice, was published in the journal Diabetes. 

Now Toth will measure the impact on people. "The patients that I see in my practice develop problems where they can't feel their feet, stub their toes, develop wounds, and also deal with severe pain."

Jessica Revell is a 21-year-old who has type I diabetes. She hopes the new treatment can help her. Sometimes her pain is so severe she can't sleep and she requires strong painkillers. She's also had to withdraw from school courses and stop working. "If I could get off the pills I'm on and inhale a spray, I could get back to school full time to work towards my education degree. It would make a huge difference in my life," she says.

Toth says his research shows that nerves are deficient in insulin and that delivering drugs through the nose targets the nervous system while insulin delivered under the skin provides enough insulin to regulate sugars in the body but leaves insufficient amounts for nerves.Toth likens it to the nerves starving for insulin.

It is estimated that only 2 per cent of an insulin shot migrates to the brain and nerves, while approximately 98 per cent of insulin administered into the nose migrates directly to the brain.  Toth says that the insulin then travels along the nerves of the spinal cord to peripheral nerves providing the protection they need from degeneration.

Targeting drugs to the brain using the nose is not a new concept.  However, this is the first time that researchers have tried using this approach to target the nervous system and treat diabetic neuropathy.

"The concept is very exciting for the field of diabetic neuropathy. This innovative treatment promises help for the many people who suffer with unrelenting symptoms and pain due to diabetes related nerve disease," says scientist Dr. Vera Bril, an expert on diabetic neuropathy, Professor of Medicine at the University of Toronto and Krembil Family Chair in Neurology, University Health Network. 

Dr. Lawrence Korngut, Toth's colleague in the Department of Clinical Neurosciences and co-lead researcher on the pilot study, says, "As a physician, it's extremely frustrating not having a treatment. To think we may have a locally developed solution, or at least partial solution to the problem is very exciting." 

The pilot study is an important first step before moving on to a larger clinical trial.  The HBI's Clinical Research Unit is facilitating the transition of Toth's research from the laboratory to the clinic. 40 Calgarians with type 1 diabetes will take part in the study.

"This research was born and bred right here in Calgary," says HBI Director Samuel Weiss, PhD.  "Cory Toth and his colleagues have advanced this research from theory to proven scientific results. Now, they're moving the research from their laboratory to the clinic - exemplifying the translational research that the HBI strives for." 

The pilot study is supported by the HBI. Dr. Cory Toth is an Alberta Heritage Foundation for Medical Research (AHFMR) Clinical Investigator. Dr. Lawrence Korngut is an AHFMR clinical fellow.

About the Hotchkiss Brain Institute
The Hotchkiss Brain Institute at UCalgary, consists of more than 100 physicians and scientists who are dedicated to advancing neurological and mental health research and education. The Institute's research strengths in foundational neuroscience (axon biology and regeneration, cerebral blood flow and metabolism, synaptic transmission and neural systems) are leading to new treatments for neurological and psychiatric disorders, aimed at improving quality of life and patient care.  More information on the Hotchkiss Brain Institute can be found at www.hbi.ucalgary.ca

About the Faculty of Medicine at the University of Calgary
UCalgary's Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. We train the next generation of health practitioners and move new treatments and diagnostic techniques from the laboratory bench to the hospital bedside, improving patient care.  For more information visit http://medicine.ucalgary.ca/. or follow us on twitter.com @UofCMedicine

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