I understand there is research with a non-steroidal immunosuppressant for newly diagnosed kids with type 1 diabetes. Do you think that would work to basically vaccinate kids who were likely to get the disease?

For some years now, type�1A (autoimmune) diabetes has been recognised as a disorder of the immune system. It is also one in which the damage to the islet cells is a very slow process which has encouraged a variety of attempts at treatment in the so called preclinical phase before insulin supplements are needed or just after diagnosis.

Simplistically, there are two approaches to a solution. The first is immunosuppression. There have been a number of attempts to do this over the years starting with cortisone itself. The only one to date that seemed to be successful was a drug called cyclosporin, but, in the end, its use had to be stopped because it caused kidney damage. New drugs are still being tried, and one of the current trials is using MMF, a drug that is in vogue for transplant work. This approach remains in the experimental field and is not approved for general application.

The idea of vaccination is rather different and basically what is being attempted is to give a protein or a fragment of a protein that in a genetically predisposed person may induce the immune response that damages the islet cells in such a way that it induces a ‘protective’ lymphocyte response rather than a ‘destructive’ one. This response depends on the dose of the ‘antigen’ and the route by which it is given (i.e. by mouth or by injection). A national trial of subcutaneous insulin was not successful, and neither was the use of BCG, a nonspecific agent used for many years for tuberculosis.

As with immunosuppression, there are a variety of ongoing trials using insulin itself given by mouth or a fragment of the B chain of insulin subcutaneously and another, developed in Israel, uses a fragment of what is called heat shock protein or DiaPep 277. Again, nothing is yet approved for general use.

DOB