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A 1000000 and a half Americans are born with type one diabetes for them the only way to cope is constant vigilance hourly monitoring through painful blood and blank and difficult guesswork to calculate the amount of insulin needed to return to their baseline I'm sorry McConnell and with good reason we talk with doctors who are behind new technology in the work out of diabetes management and you think parents of children that type one diabetes a peace of mind that leap through the night. But 1st how often have we heard about new discoveries of the gene behind a particular trait or troubling to. Often that. Depends on massive databases of thousands of twins Judy Silber goes the scientific director of the mit led take 20 registry which they call matter for short it's a database of $50000.00 twin pairs at Virginia Commonwealth University that's being used to uncover new connections between our genes our health and the environment twins offer information that no other croupe provides because their natural experiment genetic overlap so they're unique no one else could provide that information about genetic a fact if you're looking for then perhaps then you could use individuals fascinated or you already with the whole notion of twins people who think I'm in the business because my mother was a twin she was an identical twin and she had her dental code written but it was really after the fact after my research that I became interested in that resemblance between my mother and her twin and actually me and my cousin for example my mother I would say is high on the neuroticism scale and her coat when her identical twin was high on the right of. Their children are 50 percent in their genes so I do with my mother and my cousin 50 percent of her genes with her mother but my mother is genetically identical to her mother so think the same person. Me and my cousin are much more highly related genetically than normal cousins and so if something is genetic you would see the resemblance between cousins in column half the not just cousins there are more similar than Cousins what other aspects of human behavior and proclivity have been really illuminated through twin studies I think this study is astonishing it was a man analysis which is just an aggregation of all the twin studies that have been . In the last 20 years or so they were looking at 1500 traits human traits on 40000000 twins and he. Was how you can fit it was across traits that on average are heritability of things like you know medical disorders psychiatric disorders Hey wait wait i.q. Was an average of 50 percent heritability and the remainder were due to the environment but across all the studies across the world it was very similar there was only one difference and on people be interested in that and I thought it was interesting when you look at anti-social behavior like the kids are in high school that's when the kids start acting out conduct order is one of the few training that has an influence of the family environment or it can reflect the peers so I think in part from parents who have been in mind that it's genetic maybe but really it's the social environment is that contributing to children acting out what about gender identification are we having the twins boring that are both heterosexual twins born her both not I think the jury's out on sexuality and that really yes I would have thought it would been conclusive I don't think so and the implications are there that I think they really have to study at replicate fightings I mean that's really important science replicability I mean you could come out with an interesting finding but someone else replicate it before you can draw conclusions and I said this big implications profound implications about that so I think we have to be very careful worldwide What are some of the big studies and questions that researchers are trying to answer at the twins now that we've demonstrated there's a genetic influence on most traits trying to find the genes and it's not that easy so they're looking at things like schizophrenia depression any h.d. Autism. There's not one that influences those things and that's one difficulty one challenges many many many. And you need tens of thousands of people right it's going to be the way it has been for cancer treatment it's a cocktail it's going to be the complex cocktail of genes that influences a given trait I think yes I think so and with things like schizophrenia autism. The environment is not that important so it's a lot easier to study you know getting the complexity of genes and environment you know interacting so they're looking at highly genetic traits what about the subject of bullying evidently twin studies have been used in looking into that that's a very interesting topic that I've been doing a lot of work on and so important it starts like this we know there's an effect a bullying on the actual commercial disturbance. And the interesting thing is it goes into young adulthood and many many studies have found that across the world the twin studies who looked at it that the effects are not just in childhood or adolescence but into 18 to 25 year olds we're looking at depression suicidality So that's the 1st thing to demonstrate that there truly is an effect now the fact could be causal or it can be attributed to other factors So for example if the child has a genetic liability to being bullied and a genetic liability to being suicidal then me account for the association there's a design a very powerful moment it's called the discordant twin design and you're looking at identical twins one has been bullied and the other has not been bullied if you find a higher rate for example of social anxiety in the twin it's been boy the 1st of their co twin who has not been going you can draw conclusions that it's causal it cannot be related to genetic liability that the twins share it's an environmental effect and there are different implications for treatment if it's causal you want to get rid of the Boeing but also if it's not in causal then maybe predisposing genetic factors that make a child more susceptible and those need to address if you're doing any kind of intervention the next step is what we call June expression and we've talked about the influence of the genes on the environment this environmental influence on the scenes and the discordant m.z. Twins design is very powerful in showing what's the true environmental effect and what is that effect on an expression now people know it's not just genes it's the expression on the genes have been turned on and turned off and it may be related to environmental trauma so how do you explain being bullied or traumatized and being depressed like what's the link How does that work well it may be explained by you know. Russian differences and that's what people are really trying to look at what about the area of giftedness are many people looking into that when it comes to the twin study David the closest thing is i.q. What is consistently is an identical twin correlation don't play point 91 very high point 8.9 and not identical twin correlation of half that indicating pure genes that's been replicated many times also when you look at identical twins raised apart you see a very strong association between i.q. And those twins and similarly would consistently if you look at children that have been interrupted to singletons I've been adopted they are much more similar in terms of their i.q. With their biological mother then with their adoptive mother so it all points to just a highly genetic effect on intellectual functioning people think that genes are static that's one of things we're finding as well they're not static to development so just because you have a gene doesn't mean it's expressed throughout your life and one important example of that is depression in girls at adolescence what it looks like in that pre-pubertal the girls are quite the Mortons in terms of their rates but m.p.u. Pretty depression in the girls really takes off and when we look at the twin correlations pre-pubertal and after puberty for the girls and the boys the heritability of depression really goes up for the girls so that it's indicating that there's a turning on of the a certain phase of development they call innovation and this is the attenuation where they they're minimised but the important point is that through development and differential expression of genes and they account for some very important phenomenon like for example children are raising their. Family about 18 and the effect of the family you know it's there the family environment but when you start to study through development those twins who go into college young adulthood you start seeing the effect of the genes so we see that things like up social attitudes so when their children are adolescence elect the attitudes of their parents but when they go out into the world then you start seeing genetic influences on things like attitudes really religiosity. Psychopathology those so it's changes depending where you are in development which interests you more genetics themselves or the environment they were raised in I would say I'm interested more in the environment but I'm interested in genes to the extent that they interact with the environment heritability is interesting but I'm more interested in mechanisms so you could have different mechanisms like them who are genetically sensitive to the environment. What happens to them what their parents do to them those kind of mechanisms that explain more and why and children have problems adult problems than pure genes Well thank you for talking with me about the twin database today with good reason you're very welcome. Judy Silber scientific director at the Mid Atlantic brain registry for junior Commonwealth University. Coming up next think diabetes. If you have tried one diabetes management. And deciding how much insulin to balance high blood sugar could involve a lot of guesswork. But now we're searchers are perfecting a new artificial pancreas which automate those difficult calculations and allows people to live with much worry. Brown are part of a team at the University of Virginia behind this new technology. I think the way that the artificial pancreas works and what it's actually trying to do is to help that individual manage their blood sugar and normally so many who has type one diabetes where you require insulin to deliver the insulin they have something called an insulin pump and those are devices that deliver the insulin to someone under their skin we have other devices that are what we call sensors and they kept what someone's blood sugar is doing and those 2 devices don't necessarily talk to one another to take action and so what an artificer pain Chris does is help figure out how much sense and I need right now how can I use the information I have available to predict what's going to happen. A while to a focus in Kaunas on the brain between the science or and the pump the brain is pretty complex mathematical algorithm that we have developed to really hear and for that in power when pinnacle study is so critical Piers that who's talking about the brain between existing existing pump some so if you have this sensor this device this replaces you having to think about it it will happen automatically that you'll your blood sugar level will be monitored throughout the day and night and tiny exactly appropriate doses pumped India. We have taken a real big. Fear out of the treatment of diabetes and that is the fear of a low blood sugar so people who require insulin constantly worry about whether or not they may take too much and develop low blood sugar and a little better Kimmie devastating in some situations and so what these devices are particularly good at doing is trying to avoid those real low blood sugars particularly while you're sleeping there. Haven't developed yet where the person who is trying to use when these artificial pancreas still have to consider what's happening to them and in particular everybody who has type one diabetes has think about their meals and how much they're going to eat how much to transform the lives of people with diabetes how how helpful Well one thing that really gets up every day working really hard on this is the impact it makes on people's lives and I can't tell you the number of times we finish this study they've been able to have access to the artificial pancreas and now it's time to give it back because. And at that moment parents. Athol are oftentimes in tears because it made such a difference to them and they just want to figure out how can I get how can I have this in my in my future we do a variety of clinical trials studying artificial pancreas and amps and other settings and to have parents come the next day and say for the 1st time I slept all night because it wasn't worried about my child and that that powerful in their lives and that gets back to why the times you know I made it can really help someone creates what they're really fearful of and a lot of times that's developing a low blood sugar in the middle a night when they're asleep and do people have to settle arms to wake up and inject themselves are coming otherwise usually just like to the night I think if you ask a parent of a child to type on they pretty much don't sleep night after night because they're worried about getting a check in the blood sugar you know where it's going even though there may be some alarms set and these automated systems really help take that burden off so they don't have to worry as much because it's going to take care of their travel how do children use them when they're talking. To be hard for a child just to get it in sleep mode back on well the system is largely automated there is of course communication with the user and from the surgeon that we have their own joiner on down to the age of 6 had no problems talk include the phone or communicating with the phone is a device to the point where we can count on that does being accurate and we can count on the reading of one that does is needed being accurate you don't have to 2nd guess. Well this is where we're running Guantanamo a large scale studies so there are some of these components of automatic insulin delivery but not the whole package of commercially available yet this is incremental progress so that goes the sound source of the insulin pumps out there various elements of full closed loop system are already out there for example there are systems that shut down insulin to prevent low blood sugar levels that's out there what I think the challenges with. Getting them in the hands of people are a many different things and one is of course affording them and we have struggled with different companies such as Medicare who has been debating about whether to support the use of some of these devices we've made some headway and they've made some really in my opinion good decisions to allow bigger segments of the population the u.s. To have access. But that's one of the other challenges that will will continue to be out there as more and more progress is me to improve the lives of people with diabetes in addition to the promise shown by the artificial pancreas What are some of the other approaches that researchers are taking for cures for diabetes I understand there is a regeneration effort underway Yes Or there are several approaches that are being tried by various groups including the University of Virginia beta so origination is one of those the beta cell to start with the cell that produces instant in the pancreas and therefore while it's not functional I can type on the beat is for we diminished functionality. It is replacement may be in order and the replacement includes transplantation a file that for example. Well it is there little in the Oregon noise in the in the bank that contains several cells including beta cells so that being transplanted that's the way to do pays better cell function there is regeneration through all the immunosuppression because the beta cell is killed by a person's own immune system there are other replacements try to just. Bait the cell in caps relation when. Put into a capsule that is then implanted in the person so there are several approaches out there based on biotechnology or surgery or other methods that are being tracked and we hope that they'll be great strides in that area and there's a lot of work trying to focus on that you are being cautious. Same way or do you think we could get to a biological cure for this through perhaps one of the 3 methods you are describing entirely possible but it's not imminent to the best of our knowledge we're still early gains. Are at their ailments this device their official pancreas might be useful for that or not just. To address this question we have to realize that the artificial pancreas is not necessarily a single function do it's a platform for technology development in the past 10 years while we're developing this particular system to automate insulin delivery and be to some number of other technologies have been developed and Pardo For example we know now how to precisely quantify the action of the human with the body system how to simulate it hold the moderate and how to control it and this creates a whole toolbox of various technologies that are not necessarily intended for automated insulin in the liver. But for other things including control of exercise weight loss and other application of that the upcoming as an offshoot of artificial Bunker's development circle of us bas