Clinical trials with immune modulatory agents have reduced the loss of C-peptide in patients with new onset Type 1 diabetes supporting the central role of immune mediated destruction of ? cells in the disease pathogenesis. However, the responses to these agents has been transient raising a question as to whether all of the destruction of ? cells is immune mediated or is also affected by environmental or genetic factors. This notion is supported by the observation that non-immunologic factors such as age and glucose control modify the responses to immune therapies and the kinetics of ? cell death. We hypothesize that effective treatment and prevention strategies need to address both the immune mediated and non-immune mediated factors that trigger ? cell death. However, our ability to address this issue is limited because we do not have a means of directly measuring ? cell death. The environmental factors, such as glucose, can affect ? cell function which has been the principle readout in clinical trials. In this proposal, we plan to use a novel assay of ? cell killing, involving detection of ? cell derived INS DNA to identify the rates of ? cell destruction in the progression of T1D and the effects of immune therapies on this process. We will test 3 interrelated hypotheses: First, that ? cell killing commences after immunologic initiation but prior to disease onset. Our preliminary data suggest that increased levels of ? cell killing can first be detected about 1 yr prior to clinical presentation. We will also determine whether epigenetic changes in the INS DNA can identify ? cell responses to stress during the progression of disease. Second, immune therapies have different effects on ? cell killing. Both recovery of dysfunctional ? cells and reduced killing may explain the recovery of ? cell function following metabolic stabilization but the different agents may not all have the same effects. Third, that environmental and genetic factors modify ? cell killing. We will use this measurement and the available metabolic, demographic, genetic, and clinical data from T1D prevention and intervention studies to identify the mechanisms of action of drugs and the factors that modify progression of the disease. Our studies represent a novel approach to identify factors that may modify responses to immune therapies and the progression of disease. They may develop new treatment strategies based on an improved understanding of the kinetics and mechanisms of disease pathogenesis.

Public Health Relevance

This proposal will address the mechanisms of ? cell death in natural history and treatment trials in Type 1 diabetes. We plan to use a novel assay to measure ? cell killing with statistical analysis across studies to identify environmental factors that may modulate disease progression and response to therapies.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type 1 Diabetes Targeted Research Award (DP3)
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Special Emphasis Panel (ZDK1-GRB-S (O5))
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Spain, Lisa M
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Yale University
Schools of Medicine
New Haven
United States
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Usmani-Brown, Sahar; Lebastchi, Jasmin; Steck, Andrea K et al. (2014) Analysis of ?-cell death in type 1 diabetes by droplet digital PCR. Endocrinology 155:3694-8
Tooley, James E; Herold, Kevan C (2014) Biomarkers in type 1 diabetes: application to the clinical trial setting. Curr Opin Endocrinol Diabetes Obes 21:287-92