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.
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
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