Type 1 diabetes: current research approaches

Type 1 diabetes: current research approaches

Type 1 diabetes: current research approaches

Why do people ever develop type 1 diabetes? Which circumstances contribute to the development? Are there any factors that increase the risk of getting sick and those that may protect against it? A large number of scientific studies are currently underway worldwide to clarify these important questions. In particular, the role of genes and the importance of environmental influences, but also the effects of sex hormones during puberty are examined. The findings will help to develop new approaches for the prevention and treatment of the disease. Some are already being tested, with promising intermediate results.

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How does type 1 diabetes develop and what research is there to prevent the onset of the disease? Dr. Carolin Daniel, Institute for Diabetes Research at the Helmholtz Zentrum München in a video interview.

Here you can learn more about .

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In 2002, the National Institute of Diabetes and Digestive and K >

The intention of the TEDDY study is to identify factors in childhood development that lead to type 1 diabetes and the underlying autoimmunity. To this end, the pediatricians collect diverse data on vaccines, infections, geographical differences, eating habits, psychosocial factors and other environmental influences in children with risk genes for the disease. The examination of nasal swabs, blood and stool samples is also part of the program.

The analysis of the data aims to uncover possible causes of type 1 diabetes and, thus, the long-term goal of finding new, preventive treatments that can prevent the disease from the very beginning. In order to detect possible diabetes in advance and to observe the development of autoimmunity, the participants are regularly examined for disease-specific autoantibodies. With this, the scientists try to limit causes in time.

Not least thanks to the data from the TEDDY study, it is becoming more and more apparent that type 1 diabetes probably starts very early in life – very probably already in the first year of life. And the study brought even more findings to light. Thus, the administration of probiotics in the first weeks of life seems to protect high-risk children from the onset of the disease.

Immuntraining against diabetes?

For more than 20 years, scientists have been trying to permanently prevent or at least delay the onset of type 1 diabetes by “immuno-training”. Similar to desensitization in people with allergies, the immune system is supposed to learn to tolerate certain molecules, so that it does not come to the faulty attack on the body’s own structures.

These efforts are now increasingly bearing fruit. In 2015, one from the DFG Center for Regenerative Therapies Dresden the TU Dresden (CRTD) and the Institute for Diabetes Research (IDF), Helmholtz Zentrum München, led research team in the Pre-POINT study show that oral administration of insulin evidently causes the desired positive response of the immune system. Whether treatment with oral insulin actually protects children with a high risk of diabetes from the disease is now being investigated in a follow-up study (PrePointearly) tested. Even though no conclusive results are available, this therapy is currently considered one of the great hopes in the prevention of type 1 diabetes.

Therefore, the Global Platform for the Prevention of Autoimmune Diabetes (GPPAD), a consortium of several academic research institutes and clinics in Europe, launched a much larger project in 2017. In the coming years, they would like to see more than 300,000 newborns in five countries at increased risk for type 1 diabetes. 1 diabetes study (“Freder1k study” in Germany) and over 1,000 risk children preventively treat with insulin powder. The American Family Foundation Helmsley Charitable Trust finances this project.

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Can the disease process be stopped?

Not only children and adolescents are in studies for Type 1 Diabetes involved, but also adults. Here, various research approaches aim to destroy the insulin-producing Beta cells to stop or slow down. A promising option is the Therapy with monoclonal antibodies, which intervene at various points in the interaction of immune cells and thus slow down the autoimmune reaction.

In other autoimmune diseases, these drugs are already used successfully. The fact that they can also delay the progression of diabetes has been proven by scientific research. In order to use these therapies in routine treatment, dosage and safety have yet to be better researched. Another therapy option is the Transplantation of Langerhans Islands, the insulin-producing areas of the pancreas, from donor organs.

Affect intestinal germs and their bacterial signaling molecules immune function?

The Helmholtz Zentrum München is currently investigating on the mouse model against which parts of the beta-cell proteins the CD8-positive T cells involved in the autoimmune processes react. In the long term, the results of such studies provide potential for detailed risk assessment and preventive vaccination with such sections of the molecule. But also with regard to the role of the intestinal flora in type 1 diabetes mouse models are very interesting. Thus, studies on diabetes mouse models and wild-type mouse strains will now show whether it is actually effects by bacterial signaling molecules (so-called Autoinducer molecules) on the immune functions.

For this, it is first necessary to fathom the connection between a human’s intestinal flora and genetic make-up, nutritional factors and physical activity. In addition, microbial populations and their metabolic products need to be identified and linked to physiological parameters involved in the development of type 1 diabetes. The aim would be to influence the course of type 1 diabetes by interfering with this so-called intestinal microbiome. It would be conceivable to “positively tune” the intestinal immune system via food antigens, dietary foods or the intake of specific immunomodulatory agents, so that the development of type 1 diabetes is prevented or slowed down.

Stem cells for the regeneration of beta cells

Techniques for producing insulin-producing beta cells from embryonic or adult stem cells offer great medical potential. At the beginning of 2008 it turned out that from human embryonic stem cells won progenitor cells develop into insulin-producing cells in mice and protect diabetic mice from hyperglycemia.

Further animal experiments have since confirmed that this therapeutic approach is the control of both blood glucose Type 1 Diabetes as well as at Type 2 diabetes can actually improve. However, the treatment with embryonic stem cells is still in the experimental stage. Until people benefit, more research is needed.

Since there are ethical concerns over the use of embryonic stem cells, research on adult stem cells has gained in importance in recent years. For example, in 2007, geneticists at Tulane University’s Health Sciences Center in New Orleans showed that transplantation of human bone marrow progenitor cells into diabetic mice improves blood glucose levels. In the pancreas of the treated mice, new beta cells have formed, insulin production increased. How the surrounding tissue affects the stem cells in such a way that they produce insulin-producing beta cells has not yet been conclusively clarified.

The question of whether adult stem cells have the ability to mature into fully functional beta cells can not yet be conclusively answered. Induced pluripotent stem cells (iPS) are also a very promising alternative to embryonic stem cells. In 2016, two groups of researchers were able to breed functional beta cells from these cells, which both react to glucose and produce insulin. Read more about stem cell research in diabetes at Regenerative medicine.

Recognize early – treat well early

The Fr1da study in Bavaria "Recognize early type 1 diabetes – treat it well early", a Bavaria-wide screening program, have diabetologists to Prof. Dr. med. Anette-G. Ziegler of the Helmholtz Zentrum München was launched. The patronage has been taken over by the Bavarian Ministry of Health. The Fr1da study will offer all children between the ages of 2 and 5 a free check-up on typical diabetes antibodies that will help detect the disease well before it breaks out. A second effect: the early diagnosis gives the children and their family precious time to prepare themselves for dealing with the disease.

So far, the disease usually affects young patients and their families completely unexpectedly. Not infrequently, the diabetes is diagnosed only when there has been a life-threatening derailment of the metabolism. Many parents then blame themselves for not seeing the problem earlier.

Competent advice and support of families through clinics and practices

However, knowing that the risk of diabetes is elevated can also be stressful for the affected children and their parents. That is why the Fr1da participants, which include the PaedNetz Bayern and the Society for Newborn Screening, agree: Such a program only makes sense if parents and children receive expert advice and adequate treatment centers are available. For example, for the Frda study, there are several clinics and practices specializing in the diagnosis and treatment of children with diabetes. If necessary, a psychological care is offered.

The study should be carried out across Bavaria for 100,000 children between the ages of two and five. If it should be shown that such an investigation program is of great benefit for the children concerned and healthy children are not or only slightly affected, a national screening could follow , Worldwide there were no such large-scale examinations in terms of early diabetes detection. The Bavarian pilot study is considered groundbreaking, which is why even the US-based Juvenile Diabetes Research Foundation (JDRF) A million dollars. Similar projects are now in Saxony (Freder1k study) and Lower Saxony (Fr1dolin study) started.

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