This submission from the Childrens Hospital of UPMC and the University of Pittsburgh responds to the TriaNet RFA DK-13-010. This group of investigators, with extensive experience who are a current TrialNet center, has the resources, and ability to add to our current large number of affiliates and a track record demonstrating our ability to continue TrialNet participation as a center. In order to answer the objective of the RFA we have described in detail our record of recruitment into clinical trials of new onset patients an relatives at risk, with our success being based on our very large patient population and longevity of our research team. Increased support from the new Clinical Network Hub will support us in expansion of our efforts and especially our work with affiliates to increase their involvement and recruitment efforts. We are also able to include our fellow trainees in the TrialNet Investigations to train the T1D clinical trialists of the future. Our investigators and nurses have been very involved with all national TrialNet activities and committees and plan to continue or increase this involvement. In addition our center has proposed a randomized double blinded trial to evaluate the efficacy of a new FDA approved diabetes-suppressive cell vaccine, consisting of autologous monocyte- derived dendritic cells treated ex vivo with antisense phosphorothioate-modified oligonucleotides targeting the primary transcripts of the CD40, CD80 and CD86 co-stimulatory molecules (immunoregulatory)(iDC). The initial trial in patients with new onset Type 1 diabetes (T1D) has been approved in principal by the TrialNet steering committee pending funding. As in all the TrialNet interventions, the hypotheses to be tested in this study are that gene-engineered autologous iDC can attenuate or suppress the autoimmunity in: a) newly- diagnosed T1D, sparing residual beta cell mass, with restoration of insulin secretion as assessed by stimulated C- peptide levels. b) relatives with disease predicting islet autoantibodies, to sustain insulin secretion and to prevent or delay progression to clinical T1D. Currently, other than immune suppression with considerable potential side effects, there is no other means to reverse or prevent new-onset T1D. Our goal is to develop safe, easily administered interventions to suppress the autoimmune disease process. The strength of this proposal is the expertise and experience of the investigators, well established collaborations across centers and a novel intervention strategy.

Public Health Relevance

Research over the past decade has clearly demonstrated that the development of autoantibodies directed against the islet cells that make insulin are present for a few to many before the development of clinically overt type 1 diabetes mellitus. This collaborative research effort is the only very large well-oiled consortium that can test diabetes intervention strategies that might delay or prevent Type 1 Diabetes

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01DK061058-13
Application #
8776489
Study Section
Special Emphasis Panel (ZDK1-GRB-J (M2))
Program Officer
Leschek, Ellen W
Project Start
2001-09-29
Project End
2019-04-30
Budget Start
2014-08-01
Budget End
2015-04-30
Support Year
13
Fiscal Year
2014
Total Cost
$510,913
Indirect Cost
$179,151
Name
University of Pittsburgh
Department
Pediatrics
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Fouts, Alexandra; Pyle, Laura; Yu, Liping et al. (2016) Do Electrochemiluminescence Assays Improve Prediction of Time to Type 1 Diabetes in Autoantibody-Positive TrialNet Subjects? Diabetes Care 39:1738-44
Narsale, Aditi; Moya, Rosita; Robertson, Hannah Kathryn et al. (2016) Data on correlations between T cell subset frequencies and length of partial remission in type 1 diabetes. Data Brief 8:1348-51
Bundy, Brian N; Krischer, Jeffrey P; Type 1 Diabetes TrialNet Study Group (2016) A model-based approach to sample size estimation in recent onset type 1 diabetes. Diabetes Metab Res Rev 32:827-834
Pugliese, Alberto; Boulware, David; Yu, Liping et al. (2016) HLA-DRB1*15:01-DQA1*01:02-DQB1*06:02 Haplotype Protects Autoantibody-Positive Relatives From Type 1 Diabetes Throughout the Stages of Disease Progression. Diabetes 65:1109-19
Hao, Wei; Gitelman, Steven; DiMeglio, Linda A et al. (2016) Fall in C-Peptide During First 4 Years From Diagnosis of Type 1 Diabetes: Variable Relation to Age, HbA1c, and Insulin Dose. Diabetes Care 39:1664-70
Bingley, Polly J; Boulware, David C; Krischer, Jeffrey P et al. (2016) The implications of autoantibodies to a single islet antigen in relatives with normal glucose tolerance: development of other autoantibodies and progression to type 1 diabetes. Diabetologia 59:542-9
DiMeglio, Linda A; Cheng, Peiyao; Beck, Roy W et al. (2016) Changes in beta cell function during the proximate post-diagnosis period in persons with type 1 diabetes. Pediatr Diabetes 17:237-43
Moya, Rosita; Robertson, Hannah Kathryn; Payne, Dawson et al. (2016) A pilot study showing associations between frequency of CD4(+) memory cell subsets at diagnosis and duration of partial remission in type 1 diabetes. Clin Immunol 166-167:72-80
Sims, Emily K; Chaudhry, Zunaira; Watkins, Renecia et al. (2016) Elevations in the Fasting Serum Proinsulin-to-C-Peptide Ratio Precede the Onset of Type 1 Diabetes. Diabetes Care 39:1519-26
Cabrera, Susanne M; Wang, Xujing; Chen, Yi-Guang et al. (2016) Interleukin-1 antagonism moderates the inflammatory state associated with Type 1 diabetes during clinical trials conducted at disease onset. Eur J Immunol 46:1030-46

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