Introducing our new Harry Keen Fellow, Dr Richard Oram – by Kotryna Temcinaite
Last year at Diabetes UK we started a new tradition: awarding the prestigious Harry Keen Intermediate Fellowship. This Fellowship has been established in recognition of the life and work of Professor Harry Keen, a clinical pioneer who helped to shape the understanding of diabetes and its treatment. We believe in supporting the leaders of the future, and this Fellowship is set to support the next clinical research leaders in diabetes.
A year ago you met our first awardee, Dr Victoria Salem. Today I want to introduce you to our new Harry Keen Fellow, Dr Richard Oram. Richard is based in University of Exeter Medical School and over the next five years will be studying an extremely rare form of diabetes. But about all that in his own words…
Why diabetes research?
Richard explains: “I started as a kidney doctor, and diabetes is one of the commonest cause of kidney problems. A key factor that affected my choice to work on diabetes was that I had several young patients with Type 1 diabetes, who were unlucky enough to develop kidney problems very early in their life: in their late teens, twenties and thirties. And I think it was looking at the options these people had, looking at what bad luck they had, that motivated me to do Type 1 diabetes research.”
Battling the unknowns
“My major research interest is the biology of Type 1 diabetes. The key thing is that we don’t really understand why people develop Type 1 diabetes. And why people have their beta cells destroyed by the immune system at different rates.
“I really got into this field doing my PhD, when I focused on how well insulin-producing beta cells function in people with Type 1 diabetes. I measured their function in people with Type 1 diabetes, including those who had received islet transplants. One of the things we found was that the rate at which beta cells were lost was very variable. And many people, in fact most people, didn’t lose all of their beta cells.
“The question that my PhD led to was why is it so variable? Why do some people develop an immune attack and lose all of their beta cells very quickly, while there are other people with Type 1 diabetes who have a much more ‘slow burning’ process? And maybe if we learnt more about that, we could avoid rapid beta cell destruction.
“I also got interested in the age of diagnosis, because we know that people who are diagnosed with Type 1 diabetes younger, on average, lost their beta cells slightly more rapidly. But again, we don’t know why. As a broad theme now I’m focused on how fast people lose their beta cells and what things determine that speed.”
Studying the unusual to learn about the whole
“For the Harry Keen Fellowship, I am focused on one project. It comes from the principle that by studying very unusual forms of diabetes we might learn more about all of Type 1 diabetes as a whole.
“So I’m focusing on a unique group of people with Type 1 diabetes, who were diagnosed far earlier than it had previously been described. This comes from Exeter being the worldwide referral centre for neonatal diabetes, or diabetes diagnosed in the first six months of life.
“Neonatal diabetes is usually caused by a single genetic spelling mistake in a beta cell gene. This spelling mistake impairs insulin production. But using a new test that I’ve developed, called the Type 1 Diabetes Genetic Risk Score, we have proven that some of these people with neonatal diabetes actually developed an immune attack in the first six months of their life.
“Firstly, this is extremely unfortunate for people who are diagnosed so young, because Type 1 diabetes as an adult is challenging enough, but as a child – and as an extremely young child – it only gets more challenging. But the surprising thing to me, as a doctor and scientist, was that they developed immune attack at the age where your immune system hasn’t fully developed yet.”
“So the key question that I’m asking as a Harry Keen Fellow is: what led to these people developing an immune attack so extremely early? Is it something in their genes? Is it something in their immune system? Is it something in their environment, or is it just random bad luck? And if we can find the reason people develop Type 1 diabetes so extremely early, it might also tell us the key biological processes of Type 1 diabetes.”