Type 1 diabetes: improving an experimental vaccine
First published on 9 December 2009
Updated on 14 December 2012
What did the project achieve?
The ultimate aim of this research is to develop a totally new way to tackle type 1 diabetes, which is sometimes described as a ‘diabetes vaccine’.
Children with type 1 diabetes lack insulin, because their immune system gets confused and destroys cells in the pancreas that make insulin. The purpose of a ‘diabetes vaccine’ is to stop the immune system’s attack on the pancreas.
“In theory, a ‘diabetes vaccine’ might mean children could keep any last vestiges of natural insulin production that they have when they are first diagnosed with diabetes”, explains Professor Dayan. “This might make it easier for children to control their blood sugar levels. A ‘diabetes vaccine’ might even stop children from developing diabetes in the first place, although this may be some years off.”
“In this research, we have found that treating the skin with steroids can prepare that area of skin to switch off the immune system,” says Dr Dayan. “This suggests that applying steroid creams to the skin before injecting the diabetes vaccine might improve its performance. We are currently refining the composition of our vaccine and checking its safety in preparation for clinical trials combining the steroid cream and the vaccine.”
This research was completed on 31 October 2011
The last 50 years have brought a major increase in the number of children with type 1 diabetes.1 Although daily insulin injections have proved life-saving, they can be difficult to manage and children remain at risk of developing long-term complications in later life, such as blindness, kidney failure and heart disease. Researchers believe it may one day be possible to ‘vaccinate’ against type 1 diabetes. Here, they are investigating whether applying certain creams to the skin before giving an experimental vaccine could improve its performance.
What's the problem and who does it affect?
On the increase
An estimated 350,000 people in the UK have type 1 diabetes; over 25,000 are children.2 Worryingly, the condition is increasingly being diagnosed in children, at a younger and younger age, with the biggest rise in the under fives.1
Once diagnosed, children with type 1 diabetes remain dependent on life-saving injections of the hormone insulin – normally two to four times a day – every day for the rest of their lives. Without insulin injections, dangerous fluctuations in the children’s blood sugar levels could prove fatal.
To achieve good control of their blood sugar levels, children must think about everything they eat and every physical activity they take part in. They must prick their fingers to test their blood four or more times a day and make appropriate adjustments to their insulin dose.
Not surprisingly, a large majority of children don’t manage to control their blood sugar levels well enough to prevent long-term complications.3 As the years go by, they face an ever increasing risk of developing serious complications, such as eyesight problems, kidney disease, foot ulcers, heart attacks and strokes. If blood sugar levels drop too low, they are also at risk of going into a coma. Better treatments are urgently needed.
What is the project trying to achieve?
Can skin creams help an experimental vaccine?
Children with type 1 diabetes lack insulin, because their immune systems get confused, attacking and destroying cells in the pancreas that make insulin. This is known as an autoimmune attack, because the child’s immune system is attacking part of his or her own body.
Researchers have already begun clinical trials of an immune system therapy, a type of vaccine, which they believe has the potential to prevent type 1 diabetes by discouraging the autoimmune attack on the pancreas. The vaccine contains a fragment of a naturally occurring protein called proinsulin.
Evidence suggests applying certain commonly used skin creams (steroids, vitamin D and/or retinoic acid) to the injection site before giving the vaccine might improve its performance. In this project, healthy volunteers are using the creams before being injected with harmless saline (salt water) solutions, and adults with type 1 diabetes are using the creams before receiving the trial vaccine. The researchers are studying skin samples to find out whether the creams can reduce inflammation around the injection site and encourage the immune system to protect cells in the pancreas from destruction.
What are the researchers' credentials?
|Project Leader||Dr C M Dayan MA MBBS FRCP PhD|
|Location||Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol.|
|Grant awarded||9 September 2009|
|Start date||1 June 2010|
|End date||31 October 2011|
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The researchers who are working on this project are world leaders in using protein fragments, such as the fragment of proinsulin that’s being used in this study, to influence the behaviour of the immune system in type 1 diabetes. They were the first to run a clinical trial using a fragment of proinsulin as a possible diabetes vaccine.
A long-standing collaboration between the project leader, Dr Colin Dayan, his research team and Professor Mark Peakman, of King’s College London, has brought much success. Over the last 9 years they have studied immune reactions in over 450 people with newly-diagnosed type 1 diabetes, recruited from a population that covers nearly 4 million people in the South West and South Wales. These studies, and the information derived from them, have put the researchers in a unique position to select candidate protein fragments for inclusion in a diabetes vaccine.
Who stands to benefit from this research and how?
Protecting children from diabetes
The researchers are investigating whether three different skin creams can boost the performance of an experimental diabetes vaccine. If the creams work, they will be used in much larger clinical trials of the vaccine, to find out whether treatment prevents, or minimises the severity of, diabetes.
When a child is first diagnosed with type 1 diabetes, his or her pancreas can often still produce some insulin, albeit in inadequate levels. The researchers believe vaccination might mean newly diagnosed children can keep these last vestiges of natural insulin production. Even low levels of naturally produced insulin could make it easier for children to control their blood sugar levels and might give some protection from long-term complications, such as eyesight problems, kidney failure and heart disease.
Vaccination might also benefit children who are at risk of developing diabetes in the future. Diagnostic tests can detect the early stages of the immune attack on the pancreas in children who are just two years old, sometimes five of more years before they develop the disease. The researchers believe that screening children, and giving the vaccine to those at risk, might stop them from developing diabetes. If successful, this could revolutionise the treatment of type 1 diabetes.
- Patterson CC, Dahlquist GG, Gyurus E, Green A & Soltesz G. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 2009; 373: 2027-33.
- Juvenile Diabetes Research Foundation. Annual Review 2008-9.
- McKinney PA, Feltbower RG, Stephenson CR & Reynolds C. Children and young people with diabetes in Yorkshire: a population-based clinical audit of patient data 2005/2006. Diabet Med 2008; 25:1276-82.