Welcome to our final daily summary of type 1 diabetes (T1D) research highlights from the ADA’s 73rd Scientific Sessions! Each night, we have been posting summaries of notable sessions and presentations. Below are two relevant sessions from Monday, June 24:
Diabetic kidney disease remains one of the most serious complications of T1D and yet the one that is perhaps proving the most difficult to treat or prevent. But new, sophisticated research is providing hope for finding solutions. In this session, JDRF-supported researchers and others reviewed cutting edge research findings that are beginning to unlock the pathways leading to diabetic kidney disease to yield future therapies. From microRNAs to transcriptional factors to protein kinase signaling, these researchers are applying the most advanced techniques to understanding the process leading to this major complication of T1D. Some research reported today has already advanced to the stage of developing compounds capable of blocking key disease factors and testing them in animal models. The session concluded with a review of the value of personalized medicine currently being employed effectively in the treatment of many cancers. Such an individualized approach using sophisticated genetic and metabolic analyses may be a model for the future treatment of diabetic kidney disease.
While curing type 1 diabetes is the ultimate goal for JDRF and the T1D scientific community, the road to a cure is complicated to navigate. While the urgency remains to deliver a cure as soon as possible, the reality is that a cure is likely to be longer-term result, with incremental advances over time that remove the burdens of T1D from people’s daily lives. This session focused on promising research that may ultimately lead to a cure for T1D and also highlighted the reality that a great deal of work remains to be done before we get there.
Todd Brusko, Ph.D., assistant professor at the University of Florida College of Medicine, kicked off the session by discussing cellular advances in the effort to halt and reverse the autoimmune process that leads to T1D by targeting regulatory t-cells, or Tregs, which are responsible for keeping the immune system in check. Ongoing research is attempting to bolster Tregs by identifying them and isolating them in the blood, expanding them in vitro (outside of the body), then reintroducing them into people with T1D. This research is entering Phase I trials in newly diagnosed adults. Dr. Brusko also discussed efforts to use umbilical cord blood to bolster Tregs, an area that has received JDRF support but has yet to show clinical success. Finally, he discussed future research, which may use nanoparticles to introduce antigen-specific agents to Tregs that so that they specifically suppress just the parts of the immune system responsible for T1D.
The next two speakers in the session discussed research that is focused on prevention and treatment of T1D, but that may ultimately play a role in curing the disease. Srinath Sanda, M.D., assistant professor of pediatrics at the University of California, San Francisco and a JDRF career development awardee, discussed the many current approaches to preventing T1D, including primary prevention through dietary intervention, secondary prevention through oral insulin and other techniques, using compounds to halt the autoimmune process in people who test positive for T1D antibodies, and using antigen-specific therapies to preserve beta cell function in newly diagnosed individuals. According to Dr. Sanda, future research will need to better understand the model of progression of T1D and where each potential intervention fits in, as well as the nature of beta cells themselves and how they may influence the course of the disease. Andrew Bremmer, M.D., Ph.D., associate professor of pediatrics at Vanderbilt University School of Medicine, provided an update on efforts to develop closed loop artificial pancreas (AP) systems. While this update may initially seem out of place in a session about curing T1D, he tied it to prevention and possibly cure by describing research using AP systems to achieve intensive glycemic control in newly diagnosed individuals with the hope that it will preserve insulin production, possibly by reducing stress on remaining beta cells. Data from the clinical trial testing this hypothesis is currently being compiled, and we look forward to its publication in the coming months.
The final speaker of the session, Sandra Puczynski, Ph.D., professor of medicine and director of clinical research development at Southern Illinois University School of Medicine, got to the heart of the matter by discussing the importance of balancing hope for curing T1D with reality. Dr. Puczynski shared her personal story of her daughter’s T1D diagnosis 28 years ago, and her own subsequent efforts to sustain hope for a cure by taking action. For Dr. Puczynski, action meant learning about and advocating for research to cure T1D by becoming active with JDRF and other T1D research entities. She described milestones that resulted in increased hope for a cure such as the Edmonton Protocol for islet transplantation in the early 2000s, and the Special Diabetes Program that allocates $150 million per year in federal funding for T1D research. According to Dr. Puczynski, now more than ever, government, the pharmaceutical industry, and non-profit organizations such as JDRF are collaborating on research and advocacy initiatives to support a cure.
At the same time, more education for people with T1D is necessary so that they can put reports of research advances in proper context and understand exactly how they contribute to the ultimate goal of a cure. Unfortunately, according to Dr. Puczynski, many reports of cure research are misleading and create false hope. She cited a recent article that talked about a research advance that could lead to a cure, when in fact the actual research paper published about the study had little to do with curing T1D as the article implied. Dr. Puczynski asserted that ultimately, it’s up to the research community and organizations like JDRF to be responsible and realistic, while also continuing to provide hope through their efforts to cure T1D.