DUKPC 2018: what causes Type 1 and how do we cure it? – by Lucy Trelfa

 This was my first ever Diabetes UK Professional Conference, and what an amazing three days it was.

The immune system is something I’ve always wanted to know more about. Understanding the world of immune cells, antibodies and microbes is no easy feat. But I got the chance to hear from world-leading experts on each of these areas – and here’s what I learned.

T cells – friend or foe?

Professor Susan Wong is an immune system expert, and she gave a brilliant breakdown of the immune attack in Type 1 diabetes.

Turns out the ‘T cell’ is the culprit.

T cells are part of the immune cell family and they protect us from infection. Most T cells do a good job, but some go rogue and become ‘killer’ T cells.

In people with Type 1 diabetes, beta cells in the pancreas send signals that attract killer T cells. Over time, the killer T cells attack and destroy the beta cells. When enough of the beta cells have been destroyed, the symptoms of Type 1 appear.

Professor Wong wants to find a way to balance out the attack. Can we overpower the killer T cells and boost the good T cells, similar to a vaccine? What signals do the beta cells send out and can we stop them?

Going with your gut

She’s also interested in ‘triggers’ in the environment that could bring about Type 1 diabetes in people at risk, due to their genetics. Microbes might play a part, like a viral infection. However, Professor Wong is most interested in the microbes that live inside us: our gut bacteria.

Our gut bacteria is shaped very early on in life – by our genetics, but also by our mother’s diet during pregnancy and our feeding after birth. It plays an important role in helping the immune system develop, so upsetting the balance could be serious.

Could changing the composition of your gut bacteria help the immune system to control the number of killer T cells? Or could it do the opposite and help good T cells go rogue and cause Type 1?

Food for thought?

The causes of Type 1 diabetes are complicated. Thankfully, we have scientists like Professor Susan Wong working to understand the critical processes involved, and the timing of potential environmental triggers, so we can get closer to a cure. She is using Diabetes UK funding to work towards this, right now.

Finding a therapy

Insulin was discovered as a treatment for diabetes in 1921, by Frederick Banting and Charles H Best. That happened almost a century ago – but we haven’t had a better therapy for Type 1 diabetes since.

Many people rely on daily insulin to manage their diabetes, and its discovery has been lifesaving. But what about stopping Type 1 in its tracks, or preventing it from happening in the first place?

Professor Colin Dayan is taking what we know about the immune system in Type 1, and working out how to turn it into a therapy. This is called an immunotherapy.

Big up the beta cell

Professor Dayan explained that people with Type 1 diabetes who still produce a tiny amount of their own insulin have fewer diabetes-related complications, such as eye damage, and have fewer hypos. This suggests we should be trying to protect and preserve as many beta cells as possible, as early on as possible, if we’re going to help people with Type 1.

Going for gold

We know that Type 1 diabetes is autoimmune – the immune system mistakes the body’s own cells as a threat and attacks them. Professor Dayan explained that one way of trying to stop this attack is to help the body build up a tolerance to the ‘threatening’ cells and trick the immune system out of attacking.

This type of therapy is effective inside the lab, but only if you get the dose right, deliver it in the right way, and give the treatment the right number of times. It’s not as easy as swallowing a tablet twice a day.

Professor Dayan is looking at how to get specific molecules that help to build tolerance to the important places in the body, where they’re able to prevent the immune attack. He’s currently trialling a skin injection of gold nanoparticles, with the beneficial immune molecules attached to the gold. He’s hoping that this will be an effective way to deliver the therapy into the body, and the research continues.

Knowing more

Finding a cure for Type 1 diabetes isn’t a walk in the park, but we’ve got some brilliant brain power on our side. Together, they’re seeking to understand how we can stop Type 1 diabetes from developing.

In the meantime, people with Type 1 diabetes can take part in trials, to help scientists make these breakthroughs and make immunotherapies a reality.

 

If you’re interested in taking part in diabetes research, we list opportunities for getting involved on our website.

You can also read a round-up of all the research we’re funding to improve our understanding of the immune attack in Type 1 diabetes, and how we’re trying to find ways to stop it.

 

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