Type 1 diabetes as a mad slasher movie script

This morning I posted on Facebook this Boston Magazine article about the recent discovery by Boston Children's Hospital that the autoimmune attack that results in type 1 diabetes originates with the ATP/P2X7R pathway.

One of my friends, a kindergarten teacher who lived next door to me for years in Malden, MA, commented on my post, "Ok...Elizabeth...I read this! Great news! But I just don't understand the cause...care to elaborate in non-medical terms?"

My response turned out to be pretty long and (if I do say so myself) kind of fun, so I thought I'd post it here, verbatim. I am not sure whether I really hit the mark full on with my explanation, but if anyone with more of a background cares to tweak it, feel free! Otherwise, enjoy.

OK, I'll try.

Type 1 diabetes is a disease that starts when immune cells called "T cells" attack the cells in the pancreas that make insulin, which are called pancreatic beta cells. We've known for a while that this is the problem, but what this breakthrough tells us is how that problem starts in the first place.

A "pathway" is a medical/scientific term for a chain of biochemical events in the body that send signals from one tissue or cell to another using hormones, enzymes, neurotransmitters. Think of pathways as being like a telecommunications network sending different signals — you can text, you can speak via phone, you can Skype, or you can send an email, all of which are different ways to accomplish the same goal: sending a message electronically from you to the person you're trying to reach. And there are also different outcomes that can be achieved by sending that message. if you dial a specific phone number, a signal is sent from your phone (which is a very specific place itself) to the phone on the other end. If someone picks up the phone, then the signal continues on its way — but if the person who answers isn't who you wanted to talk with, then the message you give ends up being different than if you were talking to the person you're trying to reach. If an answering machine picks up the phone, the signal continues but the end message is different again, because there's no return communication. If no one picks up the phone, the phone continues ringing until you decide to hang up, and no message is sent. Each of those represents a different option for the end results of signal transmission. Still with me?

So when they say they isolated a pathway called "ATP/P2X7R" that leads to diabetes, it's as though a specific phone call was made. Let's suppose this is the phone call, being made by a stupid teenage girl, whom we'll call Tina, playing a prank on an annoying neighbor:

"Hi, Mrs TCell? I'm Tina. Your husband Pancreatic BetaCell and I have been dating, and he has this plan to divorce you and walk off with all your assets. He's thinking about doping you up and taking nude photos of you and plastering them all over the internet. Thought you should know. Buh-bye."

So Tina has been playing this trick for weeks and all that's happened is, a lot of pissed off neighbors—that's the most common end result of this signal transmission. But then, *just this once*, she happens to call a Mrs. TCell who is particularly gullible and not very mentally well wrapped, and this Mrs. TCell gets infuriated and starts going after her spouse, Pancreatic BetaCell, with an axe. And having done him in, she can either stop right there, or she can become even more insane and look up EVERY guy named Pancreatic BetaCell on Google, and one by one she starts murdering them. Or worse: she recruits a whole ARMY of insane Mrs. TCells with a sense of grievance, and they ALL go after all the Pancreatic BetaCells.

And that's how you get diabetes. One obnoxious teenage prank call sending an unfortunate message = a signal down the ATP/P2X7R pathway to a particularly gullible and possibly defective T cell, who goes on a crazed rampage against innocent, confused, and soon very dead Pancreatic BetaCells.

So in essence, Boston Children's Hospital has just completed the detective work of sifting through the first Mrs TCell's phone records to figure out that the call that triggered her rampage against Pancreatic BetaCells everywhere came from Tina. Who hopefully is about to be sent to juvy hall.


This is awesome.

Thanks! I sort of think that in a REAL mad-slasher film, Tina the trollop would be required to act as a decoy so that the detective could catch Mrs TCell in the act. I wonder if the microbiologists at Boston Children's have considered that angle...?

Great explanation! Not that I would know, but it was entertaining and easy to follow. So, maybe there Is hope.

I'm seeing Amanda Bynes as Tina, Sandra Bullock as Mrs TCell, and maybe Patrick Dempsey as the detective. ;)

I love IT!!!!

I love it! I love slasher films too. It’s excellent.

That's a great script idea, and it certainly made me laugh. ;-)

Not to throw cold water, but in the interest of objectivity, that "announcement" is not entirely free of controversy. See this discussion.

Yeah, I know. But identifying the pathway is pretty important, even if the press release doesn't... QUITE... get it right.

It is naïve to draw overly rosy conclusions from something this preliminary.

In research at this level, it doesn't automatically follow that knowing the pathway points to a remedy. There are a great many possible reasons why that is so. Here's just one: identifying a pathway doesn't establish that it is the one and only pathway. By way of analogy, if your boat has three big leaks and you only plug one of them, the boat will still sink.

Consequently, and setting aside trivial matters -- such as the fact that the research hasn't been confirmed by anyone else, nor in humans -- celebration would be irresponsible at this point.

So, is this interesting? Certainly. Does it establish the possibility of a valid, workable therapy? It is much too early to even attempt to answer that question.

I understand all that. I think you're missing the point of the post. It's not saying anything about the pathway being the first step to "the cure" or even "a cure" — it's simply trying to help a friend understand what is meant by pathway.

I have to say, I loved this! As a new parent of a kid with Type1 it helped me grasp it a little bit. My son has Autsm as well and this is really hard. Taking five minutes and getting pissed off at stupid teenager Tina, made me feel loads better. And I used it to help my other kids understand a bit too. As a family of Autustics (I have 4) we’ve been I research studies and understand how preliminary these results are.

Wow, I never thought of it that way — as being cathartic.

Stupid Tina.

So your son has both? Autism & T1? there's a kid at Eric's school in the same situation. He's very high functioning and I gather that has actually been an asset to his diabetes management, because he is capable of focusing on how he feels and what his numbers are fairly intensively. Unlike Eric, who periodically says to me, "Mom, I don't need to be poked again. My blood sugar's fine." when I *know* he's been trending low, just because he doesn't want to be interrupted in building Lego spaceships of some sort.

No, I got the point. Just trying to illuminate another (different) side of the subject. Thinking out loud more than anything else -- I've been let down too often by supposedly "optimistic" news, so I guess there's something of a conditioned reflex there. If my comments caused pain, I apologize sincerely.

Heh. No pain. Takes a bit more than that to...


Sorry. That was my cat. Causing me pain.

This. Is. Amazing.