Massive clinical study on type 1 diabetes patients

A massive clinical study on an approved psoriasis drug is now underway. The drug will be tested on people who have just been diagnosed with type 1 diabetes. The drug, according to the theory, could preserve the patient’s remaining insulin production.

Massive clinical study on type 1 diabetes patients
PhD student Arndís Ólafsdóttir and Professor Marcus Lind. Image Credit: Elin Lindström.

This massive project, financially supported by the Swedish Research Council in clinical treatment research, involves a large number of hospitals throughout Sweden. Marcus Lind, a Professor of Diabetology at the University of Gothenburg and Chief Physician responsible for clinical diabetes research at Sahlgrenska University Hospital/ Östra Hospital and NU-hospital Group, is in charge of the project.

Lind hints that the research could mean a huge change in the treatment of type 1 diabetes.

Of the mechanisms now being investigated for immunological treatment of type 1 diabetes, I have the greatest confidence in this one, but I am well aware of how difficult success will be.”

Marcus Lind, Professor, Diabetology, University of Gothenburg

An immunological disease

Type 1 diabetes is one of the most prevalent chronic diseases among children, but it can also strike adults. The disease is caused by the body’s own immune response, which kills beta cells in the pancreas, causing the body to no longer produce insulin.

Individuals with type 1 diabetes must take insulin injections or use an insulin pump for the rest of their lives and strictly track their blood sugar levels, which takes a lot of effort.

Because beta cells die slowly, everyone with newly diagnosed type 1 diabetes continues to make insulin during the early years of the condition.

They benefit greatly from the remaining insulin their body produces. If they could just maintain this production, treating type 1 diabetes would be much easier. So far, we have not had a good treatment for preventing beta cell death, but we have reason to believe that a medication currently approved for individuals with psoriasis could have a protective effect for individuals with type 1 diabetes.”

Marcus Lind, Professor, Diabetology, University of Gothenburg

Tests show the two stages of the disease

Researchers can now predict who will develop type 1 diabetes (stage 1 of type 1 diabetes) within a few years based on immunological patterns in the blood. They can see disturbances in the blood sugar pattern with stress tests about a year before the onset of the disease, even if diabetes criteria are not met (stage 2 of the disease). Clinical onset is classified as stage 3 when it occurs.

If we succeed in identifying the immunological mechanism that is central to the destruction of beta cells, we will also be able to screen children and adults in the future and treat them even before the onset of the disease. The disease will then be prevented from breaking out or counteracted so that it does not begin until much later in life.”

Marcus Lind, Professor, Diabetology, University of Gothenburg

Psoriasis and type 1 diabetes

The drug under study impacts the body’s immune response by impeding the protein interleukin-17, which appears to be an important signaling molecule in the process of beta cell destruction.

For the past few years, the drug has been used to treat psoriasis, a disease in which a particular type of white blood cell identified as TRM cells plays an important role in disease development, just as these cells appear to do in type 1 diabetes. These cells, among other things, act via IL-17, which is affected by the current treatment.

Professor Lind details, “In fact, research on type 1 diabetes and IL-17 has been going on for almost 20 years. Animal experiments have shown that stimulation of this signaling pathway accelerates the development of type 1 diabetes. Other studies have shown that this signaling pathway is usually overactivated in people with type 1 diabetes.

“It will be particularly interesting to evaluate for the first time whether the treatment can protect insulin-producing cells in the pancreas, in light of recent research on TRM cells in newly diagnosed type 1 diabetes, just as in psoriasis,” adds Professor Lind.

The recruitment of people with type 1 diabetes for a large multicenter study has begun. The research will include adults between the ages of 18 and 35 who have recently been diagnosed with type 1 diabetes and have a blood test that shows an ongoing immunological process affecting the beta cells. The study will include 127 individuals, with half being assigned to receive IL-17 inhibitors and half receiving a placebo in the control group.

Towards precision medicine

Many other studies are ongoing around the world in addition to the Swedish study now being performed at the University of Gothenburg. They are also looking for ways to treat the immunological cause of type 1 diabetes rather than just the symptoms, which has previously been the only treatment option.

Investigators of type 1 diabetes, like those of several other diseases, are now on the verge of precision medicine. Attempts to map various subgroups within type 1 diabetes have only recently begun to investigate, for example, a specific gene variation that causes a specific type of islet cell antibody to first appear.

Professor Lind concluded, “It is likely that treatment with IL-17 inhibitors may be more effective for certain subgroups. If the results from our study are encouraging, over time we can investigate certain immunological patterns or cell types in the blood that can be used to identify patient groups that respond best to the treatment.”

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