Destroying intestinal mucosal layer regulates blood sugar level.

[kangaSue]

https://www.theguardian.com/society...-treatment-could-end-daily-insulin-injections

Dutch scientists have discovered that by destroying the mucous membrane in the small intestine and causing a new one to develop, it stabilises the blood sugar levels of people with type 2 diabetes.

In an hour long procedure, a tube with a small balloon in its end is inserted through the mouth down to the small intestine where the balloon is then inflated with hot water and the mucous membrane burned away by the heat. Within two weeks a new membrane develops, leading to an improvement in the patient’s health.

They are looking at it as a means to put an end to the daily insulin injections needed by some Diabetics. I find it interesting because gastroparesis is common in Diabetes too and suspected to tie in with problems of blood sugar regulation so I'm keen to see if this also helps with GI dysmotility but it could be something worth keeping an eye on to see if it might be able to be used as a measure to treat intestinal permeability too in growing a new membrane.

 

[Learner1]

Within two weeks a new membrane develops, leading to an improvement in the patient’s health.

Wonder exactly how this happens...

I know a few patients who seem to have extremely damaged linings, in each case through multiple courses of antibiotics over a few years, who don't seem to be able to get their gut linings calmed down and regrown.

And my oncologist told me to take 5g glutamune daily to help grow back my gut lining from the damage inflicted by chemotherapy.

After burning it away, its just supposed to reappear like magic?

This sounds like those studies that say the microbiome returns to normal within a month after an antibiotic course, which doesn't seem to happen in the real world...

 

[Hip]

Dutch scientists have discovered that by destroying the mucous membrane in the small intestine and causing a new one to develop, it stabilises the blood sugar levels of people with type 2 diabetes.

That's great news for diabetics, and also good news in terms of lowering national healthcare costs, as type 2 diabetes is by far the most expensive single disease to treat, accounting for nearly 10% of the total NHS annual budget.

Looks like the name for the procedure is duodenal mucosal resurfacing.

This 2016 article says: "To date, the mechanism of action remains unknown".

Could it be that killing the epithelial cells of the mucous membranes, you also wipe out the viral or intracellular bacterial infections living in those cells? Type 2 diabetes is linked to pathogens such as cytomegalovirus and enterovirus.


Some papers:
Duodenal Mucosal Resurfacing Elicits Improvement in Glycemic and Hepatic Parameters in Type 2 Diabetes—One-Year Multicenter Study Results

Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes: 6-Month Interim Analysis From the First-in-Human Proof-of-Concept Study

Ablation of the Duodenal Mucosa as a Strategy for Glycemic Control in Type 2 Diabetes: Role of Nutrient Signaling or Simple Weight Loss

 

[alex3619]

I would be very cautious about this type of therapy till a lot more research is done.

 

[kangaSue]

I see there's a few name for this procedure, Hydrothermal Duodenal Mucosal Resurfacing and Endoscopic Duodenal Mucosal Resurfacing are other variants.

It's only doing a superficial tissue ablation though, probably not unlike the physiological process that goes on everyday where the mucosa layer is in a constant state of repair.

https://www.sciencedirect.com/science/article/pii/S105251571630126X?via=ihub
Duodenal mucosal resurfacing: method for correcting duodenal metabolic signaling
Rationale for Targeting Duodenal Mucosa
Collectively, the observations described earlier support an approach that targets the duodenum mucosal surface for the treatment of metabolic disease without the need for placing a permanent implant. To this end, a novel endoscopic catheter system (Revita DMR system [Fractyl Laboratories, Inc, Lexington, MA]) was designed to deliver a hydrothermal exchange at the mucosal surface, resulting in superficial tissue ablation. Currently under investigation in the United States, the Revita DMR system holds a CE (Conformité Européene) mark in Europe.

As background, ablation is a common treatment modality for a wide variety of medical conditions (Table 1). Intervention involves the physical removal of superficial abnormal tissue and the regrowth and restoration of normal tissue through a stem cell–mediated healing response. The most anatomically analogous approach to DMR is endoscopic ablative therapy through either radiofrequency (Barrx, Covidien, Sunnyvale, CA) or argon plasma coagulation for Barrett’s esophagus, a precancerous condition and complication of gastroesophageal reflux disease, in which the normal squamous epithelium of the distal esophagus transforms to a columnar-lined intestinal metaplasia.45, 46 This treatment modality has become well established and its efficacy and safety are well described.47 Ablation is followed by restoration of the squamous epithelium.

A clinical trial of this procedure is being undertaken for type 2 Diabetics in the U.K.
http://revitatrial.com/patient/