In this Exclusive Interview, Lora K. Heisler talks with Diabetes in Control Publisher Steve Freed during the ADA 2018 convention in Orlando about harnessing serotonin in the treatment of obesity and type 2 diabetes.
Steve Freed: We’re here at the American Diabetes Association 78th Scientific Sessions, and we have with us today a very special guest, Lora Heisler, and she received an award from the American Diabetes Association for Outstanding Scientific Achievement; very much it’s about her work that has “illuminated novel approaches for harnessing serotonin’s activity in the treatment of obesity and type 2 diabetes.” So maybe you can go into a little bit more detail — we don’t want you to do your whole presentation — just give us a little more detail of what that is all about.
Lora Heisler: So what I was interested in is trying to understand how we can treat obesity and type 2 diabetes, given that these are some of the biggest challenges to human health for our generation and future generations. And in particular what I was looking at is the brain. Is there something, is there a way that we can use the brain to improve these diseases. And I was interested in looking at particular chemicals within the brain, like the brain chemical called serotonin, and what we found is that medications that increase serotonin bio-availability not only reduce food intake and body weight, but they also improve blood sugar.
Steve Freed: That’s interesting. I think one of the questions I forgot to ask was, tell us a little bit about your practice and what you do.
Lora Heisler: So I’m a scientist and I work at the Rowett Institute in Scotland at the University of Aberdeen, and the Rowett is a big center with about 40 different group leaders and we’re all investigating nutrition and health, from molecules to man. And this is where my laboratory investigates how we can use the brain to improve type 2 diabetes.
Steve Freed: So what was the defining moment that led you to your field, because it’s certainly not a normal field you just jump into.Lora Heisler: Well I think really I was just fascinated by what the brain can do. You wouldn’t automatically — when you think about food intake, when you think about diabetes, you don’t think immediately about the brain. You think about different organs in our bodies. You think about the gut, you think about the pancreas. And so the idea that the brain could be used to influence blood sugar was kind of a new idea, and I jumped into it just because I was thinking the brain has homeostatic centers that control things like breathing, so presumably it would also be important in other essential functions.
Steve Freed: Obviously the brain does a lot of things. It accounts for everything you do. How does the brain, where does the brain play its role when it comes to diabetes?
Lora Heisler: Right. Well actually it’s a network. So it’s kind of, if you think about the the world atlas, you know actually there are different centers that are like different countries around the world and they all sort of talk to each other. So there are some key brain regions like the hypothalamus, but then the hypothalamus is receiving information from the pancreas, from the nutrients that we ingest from different gut hormones, and it’s all getting integrated and then that information is being communicated throughout the brain. And then that goes back down into the periphery to coordinate the response.
Steve Freed: So being a scientist at what point, or have you had those moments, where they were exciting, where you discovered something and you were wanting to scream out and yell?
Lora Heisler: Definitely. Well actually in research that was funded by the ADA when I was just starting out my career, I had this idea that this brain chemical serotonin could be used to improve type 2 diabetes. So I applied to the ADA, I got the funding to try this, and so I was really surprised when it actually worked, and what’s really exciting about this now is that this discovery has been tested in patients and it does seem to be working. And so you know my overall hope is that this will provide a new treatment option for people who are suffering from type 2 diabetes.
Steve Freed: What is the treatment actually?
Lora Heisler: So what it is, is a serotonin, and a serotonin binding to a particular receptor called the 5HT2C receptor. And what’s particularly exciting about this is that there already is a medication that’s in clinical use to treat human obesity. And so the idea is that we hope that we’ll be able to translate that into a treatment for type 2 diabetes.
Steve Freed: Is the study ongoing right now?
Lora Heisler: Well there are people who are on the medication for obesity treatment and there have been some published reports demonstrating that it’s also improving their diabetes independently of weight loss. So even in patients who aren’t losing a lot of weight they’re still seeing improvements in their diabetes.
Steve Freed: So you’re seeing a reduction of their A1cs?
Lora Heisler: Right.
Steve Freed: And that’s independent of their diet?
Lora Heisler: Well independent yes, presumably, because they’re not losing weight.
Steve Freed: So what are you working on now?
Lora Heisler: So what we’re working on now is kind of buoyed by that. We’re looking at, are there other medications that are in human use that can be re-purposed for diabetes treatment. And we’ve come across another actually pretty common drug that’s used to treat another disease, and we’ve been testing it in preclinical models and we found that it is improving diabetes as well. So I can’t tell you what it is because we’re hoping to publish it early next year.
Steve Freed: What’s the timeframe on it, approximately?
Lora Heisler: I mean we’re looking to publish the results, we’ve collected a lot of results over the past few years and we’re looking to publish it probably early next year. And then as I said the medications are already pretty widely used. So it’s just a matter of talking to regulatory bodies to see whether or not it could also be used for diabetes treatment.
Steve Freed: In a trial format, or is this a drug that’s been out there?
Lora Heisler: It’s been out there for many decades.
Steve Freed: So if somebody was starting out in your field, what advice would you give them?
Lora Heisler: So this is a really exciting time to be in science because there are a lot of new tools that are available that haven’t been available before, but there’s still a lot of unanswered questions. And so what I would advise people who are interested in getting into the field, is think about what is your big question that you want an answer to, and then pursue it, because the tools are out there now to do it. And don’t be afraid to go against convention because that’s when the biggest discoveries are made.
Steve Freed: Our newsletter goes out to medical professionals — pharmacists, nurses, physicians. So from your research and your studies and looking at the future, what would you like them to know?
Lora Heisler: Well I guess that I think what the research is demonstrating is that there are gonna be a lot of different ways that we can look to improve type 2 diabetes, not just one way. We don’t have to directly necessarily go to the tissues and to implement the desired effect, but rather we can think more broadly, like going for example to the brain or even just modifying diet. And when I say modifying diet, we already know that that diet is important not only in the development of diabetes but also in the treatment of diabetes. But recent research suggests that different aspects of diet, for example when you eat and specifically the types of food that you eat, can have an impact in controlling diabetes and also reversing it. So I think that that’s something to also think about, not just medications but what can we do just in changing our behavior.