Autoimmunity and Childhood DiabetesIt is now understood that childhood diabetes is an autoimmune illness, and thus more similar to rheumatoid arthritis or multiple sclerosis than other forms of diabetes. The foresight of the founders of the Barbara Davis Center from the beginning led to the Center's focus on the autoimmunity of the disease. Studies by the immunologists in the BDC Research Division, combined with the Clinical Division, have led to the first clinical trials for the treatment of diabetes as an autoimmune illness.
Autoimmunity is a form of illness where the body's own white blood cells, which normally fight infection, make a mistake and turn on a part of one's own body. It could be compared to a corrupt policeman turning to crime in his own community. In childhood diabetes, these white blood cells target the cells which make insulin (the beta cells of the islets) and slowly, over time, kill so many of these cells that there is a lack of insulin and diabetes develops.
As insulin was the life-saving chemical for diabetes in 1921, we believe it is likely that pieces of insulin may be the key to the prevention, and potentially the cure, of diabetic autoimmunity. Dr. Dale Wegmann at our Center has discovered that the majority of "rogue" white blood cells of our best animal model of childhood diabetes react with a small piece of insulin. These white blood cells, when given to a non-diabetic mouse, are able to cause diabetes in weeks. Even more remarkable, the same piece of insulin can be used as a vaccine to prevent diabetes in mice, either given once as a subcutaneous injection or an intranasal injection. These studies, and many others, have brought us to an era of Type 1 diabetes research which we call "Vaccines and Genes." The most immediate clinical importance of our recognition that Type 1 diabetes is a slowly developing autoimmune disease is the realization that children with diabetes, and families of someone with diabetes, are at risk for other autoimmune illnesses. For example, approximately one in ten will develop thyroid autoimmunity (overactive or underactive). An overactive thyroid makes on lose weight, have bulging eyes, and feel too hot, while the opposite occurs with an underactive thyroid. These illnesses are simple to diagnose and usually much easier to treat than diabetes.
Autoimmunity develops in the setting of specific genes, some of which prevent, and some of which create, susceptibility. We do not yet know the trigger for childhood diabetes, but Dr. Marian Rewers, an epidemiologist, and Dr. Georgeanna Klingensmith have initiated the first diabetes genetic screening of newborns in the United States to discover the triggers for diabetes.
The immunologic "vaccines" we want are not only to prevent diabetes, but to prevent autoimmunity from destroying transplanted islets. The same process which causes diabetes targets the islets which should be able to cure diabetes. Drs. Ronald Gill and Mark Stegall, along with patient volunteers who have a kidney transplant because of diabetic kidney disease, have initiated studies of human islets transplanted in the forearm in order to identify and clone the human T cells causing diabetes.
Children's Diabetes Foundation at Denver
777 Grant Street, Suite 302
Denver, Colorado 80203
Barbara Davis Center for Childhood Diabetes
4200 East Ninth Avenue
Denver, Colorado 80262
Last Updated: Thursday August 29, 2002 21:02:12
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