Three researchers from Type 1 Diabetes TrialNet will review the latest research on immune therapy for type 1 diabetes during a virtual presentation at the Scientific Sessions. The two-hour symposium, Immune Intervention During the Stages of Type 1 Diabetes Development—Type 1 Diabetes TrialNet, will begin at 8:00 a.m. CT Tuesday, June 16.

TrialNet is an international network of academic institutions, endocrinologists, physicians, scientists, and health care teams dedicated to type 1 diabetes research. The group offers risk screening for relatives of type 1 diabetes patients and conducts clinical studies with the goal of slowing and preventing disease progression.

Diane K. Wherrett, MD, FRCPC, will open the session by walking through the stages that lead to the development of type 1 diabetes. S. Alice Long, PhD, will review a clinical trial examining the responder characteristics for the immune therapy drug teplizumab in stage 2 patients. Laura M. Jacobsen, MD, will conclude the symposium by describing the immune characterization of another drug, anti-thymocyte globulin (ATG).

“It’s a good opportunity to learn a lot in a broad range of topics that actually complement and build off each other,” said Dr. Long, Manager of the Human Immunophenotyping Core Lab at Benaroya Research Institute at Virginia Mason.

Dr. Wherrett will review new data from TrialNet and other groups that help to explain the progression through the stages of type 1 diabetes.

“How we define stage 1 of diabetes, with two or more antibodies, is a pretty solid definition,” said Dr. Wherrett, Professor in the Department of Pediatrics, Division of Endocrinology, at the University of Toronto’s Banting & Best Diabetes Centre. “It’s very uncommon that people lose those antibodies, and once you get to stage 1, you’re on the path to developing type 1 diabetes. But there’s a huge amount of variability in how long that path takes.”

In addition to helping type 1 diabetes patients and their families understand the disease, defining stages of the disease provides an important the framework when designing clinical trials.

“The scientists who are doing more fundamental research need to recognize that stage 2 is a dynamic stage and ensure that samples from people at this stage are very clearly defined to help in interpreting their results,” Dr. Wherrett said.

Dr. Long’s presentation, “The Anti-CD3 Antibody Teplizumab Delays Type 1 Diabetes Onset in Stage 2 Type 1 Diabetes—Responder Characteristic,” will highlight the importance of studying the immune system in a clinical trial setting.

“For clinicians, it will really inform them of a future vision of how to diagnose and treat type 1 diabetes, which I think will change in their lifetimes,” Dr. Long said.

“We can find people that respond better and worse by immune signatures even though the trial is not powered to ask those questions,” she continued. “It’s exciting work because it informs us of the best use of the drugs and selection of possible future drugs that maybe do an even better job.”

Dr. Long will focus on the CD8-positive T cell exhausted population in the teplizumab trial.

“This population has been reported in the field of cancer to be a poor indicator of disease and, in fact, expansion of this CD8 population in autoimmunity seems to be protective,” she said. “We actually have a cell type to go after, to learn about its function, and track whether disease did well or not when this cell type is present.”

Dr. Jacobsen, Assistant Professor at University of Florida Health, will present the responder characteristics for another immune therapy, this one for patients with stage 3 or new-onset type 1 diabetes. Her presentation is titled “Response to Low-Dose Anti-thymocyte Globulin in Stage 3 Type 1 Diabetes.”