The long-term objective of this proposal is the prevention of autoimmune mediated Type 1 diabetes mellitus (T1D). Many promising interventions must be tested in a safe and efficient manner in order to achieve this goal. A well-organized cooperative network of capable institutes, Type 1 Diabetes TrialNet, has greatly facilitated the prompt completion of many clinical trials needed to test these potential interventions. The application responds to the RFA to select the clinical centers that will form TrialNet for the next 3 to 5 years. The first goal of this proposal is to both continue and improve the infrastructure essential to completing the current TrialNet studies seeking to prevent T1D in subjects at risk for T1D and to preserve endogenous insulin secretion in subjects with new onset T1D. This section of the proposal reviews Stanford's seven-year experience as a TrialNet national center in central California. The proposal highlights Stanford's plans for extending and improving recruitment and retention activities for the next 3 to 5 years. These plans include both completing the current TrialNet studies and implementing the expected upcoming trials. Stanford is particularly excited about the soon to start TrialNet protocol, developed by Stanford, to test the glucose sensor enhanced strict glycemic control in subjects with new onset T1D. The second goal proposes a clinical study to develop and test a novel intervention using modified autologous dendritic cell therapy to preserve endogenous insulin secretion in subjects with new onset T1D in a multicenter TrialNet study. The proposal, Transgenic IL-4 expression by autologous dendritic cells in new onset Type 1 diabetes (aDC/IL-4), articulates Stanford's approach to testing this therapy in a collaborative manner with other centers in TrialNet. Studies using dendritic cells therapeutically have demonstrated no significant adverse events, so that it is now reasonable to consider this innovative approach as a possible therapy for diabetes prevention. This proposal describes both Phase 1 safety studies followed by Phase 2 efficacy studies using aDC/IL-4. Ultimately, this therapy will likely have a role in preventing T1D

Public Health Relevance

Type 1 diabetes mellitus is a serious life limiting disease that strikes predominantly in children and adolescents. The TrialNet clinical research network, the focus of the proposal, is charged with designing and conducting studies aimed at preventing or delaying the onset or progression of type 1 diabetes, both highly relevant public health goals

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01DK061042-12
Application #
8468682
Study Section
Special Emphasis Panel (ZDK1-GRB-R (O1))
Program Officer
Leschek, Ellen W
Project Start
2001-09-29
Project End
2014-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
12
Fiscal Year
2013
Total Cost
$657,024
Indirect Cost
$253,452
Name
Stanford University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Redondo, Maria J; Geyer, Susan; Steck, Andrea K et al. (2018) TCF7L2 Genetic Variants Contribute to Phenotypic Heterogeneity of Type 1 Diabetes. Diabetes Care 41:311-317
Sosenko, Jay M; Geyer, Susan; Skyler, Jay S et al. (2018) The influence of body mass index and age on C-peptide at the diagnosis of type 1 diabetes in children who participated in the diabetes prevention trial-type 1. Pediatr Diabetes 19:403-409
Ismail, Heba M; Xu, Ping; Libman, Ingrid M et al. (2018) The shape of the glucose concentration curve during an oral glucose tolerance test predicts risk for type 1 diabetes. Diabetologia 61:84-92
Culina, Slobodan; Lalanne, Ana Ines; Afonso, Georgia et al. (2018) Islet-reactive CD8+ T cell frequencies in the pancreas, but not in blood, distinguish type 1 diabetic patients from healthy donors. Sci Immunol 3:
Vecchio, Federica; Lo Buono, Nicola; Stabilini, Angela et al. (2018) Abnormal neutrophil signature in the blood and pancreas of presymptomatic and symptomatic type 1 diabetes. JCI Insight 3:
Redondo, Maria J; Steck, Andrea K; Sosenko, Jay et al. (2018) Transcription Factor 7-Like 2 (TCF7L2) Gene Polymorphism and Progression From Single to Multiple Autoantibody Positivity in Individuals at Risk for Type 1 Diabetes. Diabetes Care 41:2480-2486
Sanda, Srinath; Type 1 Diabetes TrialNet Study Group (2018) Increasing ICA512 autoantibody titers predict development of abnormal oral glucose tolerance tests. Pediatr Diabetes 19:271-276
Yeo, Lorraine; Woodwyk, Alyssa; Sood, Sanjana et al. (2018) Autoreactive T effector memory differentiation mirrors ? cell function in type 1 diabetes. J Clin Invest 128:3460-3474
Redondo, Maria J; Geyer, Susan; Steck, Andrea K et al. (2018) A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 41:1887-1894
Greenbaum, Carla J; Speake, Cate; Krischer, Jeffrey et al. (2018) Strength in Numbers: Opportunities for Enhancing the Development of Effective Treatments for Type 1 Diabetes-The TrialNet Experience. Diabetes 67:1216-1225

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