Ezio Bonifacio, PhD

Disclosures

October 07, 2013

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Hello. I am Ezio Bonifacio, a professor at Dresden University in Germany. I am going to talk today about the prevention of type 1 diabetes. We often hear about cures for type 1 diabetes -- when will there be a cure?

Many people don't know that when a child presents in a coma or with very high blood glucose with type 1 diabetes, this process has already started several years beforehand, usually in the first years of life. In these children, their immune systems are switched on against themselves, against the insulin that is vital for life, and against the cells that produce insulin (beta cells) and eventually destroy these cells. This can take 20 or even 30 years, but they will eventually develop type 1 diabetes.

We try to change the immune system. Instead of an immune system that destroys the beta cells and removes their insulin, we try to alter it so that the immune system can no longer recognize insulin as a bad guy in the process and leaves the beta cells alone.

What we do is special because we do this very early in childhood. How does it work? Normally, to turn the immune system on, you need to be exposed to something that the immune system recognizes as foreign in the context of danger, such as a bacteria or virus, which causes some sort of inflammation. This activates the immune system against those proteins and perhaps some of the other proteins around it.

Along with other investigators around the world, we want to teach the immune system that insulin and the other beta-cell antigens are actually good guys -- to teach it to ignore insulin. Simply put, if we give the insulin and other antigens early in a very safe manner (for example, orally, intranasally, or perhaps transdermally), we hope that the immune system will learn that this can be tolerated. Through this, we hope that we will be able to get to the point of giving a vaccine to children.

Where are we? We can now do this with animals, and we have started doing this in children. We have almost completed an international trial in which we have been giving young children who are genetically at risk of developing type 1 diabetes increasing doses of insulin. We need to find out whether this has any effect. We need to see whether we have changed any of their immune systems. If we are able to do that, if we can show that, the next step will be to take that dose and that route and do a large trial.

How long before we have a vaccine, so that families can go to the doctor and the child will routinely get a vaccine as part of their early-childhood disease prevention program? In 10 years, we might be there.

Thank you very much for listening.

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