Secondary prevention focuses on preventing people from needing insulin treatment. This type of research is very similar to immune research to cure type 1 – the only difference is in the timing of when the treatment is to be given – before or after insulin is needed.
This work involves developing new treatments to retrain the immune system or protect beta cells, or indeed do both. And as we now know that even people who have lived with type 1 for many years may still have some surviving beta cells, developing both these treatments for people at risk of type 1 will also help us in our quest to cure type 1.
A key development of the last decade has been progress in understanding how to very specifically suppress the autoimmune attack that causes type 1 diabetes and the part of the immune system targeting involved with destroying beta cells, while leaving the rest of the immune system intact.
We know that a healthy immune system is usually very good at preventing autoimmunity, because it has its own ‘police force’ to make sure immune cells can’t damage health tissue. This police force is made up of cells called ‘regulatory T cells’, or Tregs for short. But Dr Tim Tree and his team have shown that people with type 1 have fewer of these Tregs, which allows the autoimmune reaction to get out of hand. His team are looking for ways to harness this knowledge to strengthen the Treg ‘police force‘ in people at risk of developing type 1.
Genetic research is also providing clues for how we might people from needing insulin. Work led by Professor John Todd has shown that a molecule called IL-2 has an important role to play in allowing immune cells to attack insulin producing beta cells. Dr Frank Waldron Lynch is now working with Professor Todd to put this discovery to the test in clinical trials, with people in the earliest stages of developing type 1 testing out a treatment that boosts levels of this molecule to see if it can halt the immune destruction of their insulin making cells.
Other research is looking to find ways to boost beta cell survival – research which may be useful not only in secondary prevention, but also in helping to prolong the survival of new beta cells in the body – whether given through an islet transplant or perhaps through regenerative treatments.