Innovation and Translation

Spearhead of Diabetes Prevention

The incidence of a disease is rising, and no one knows why: For years doctors have observed that the number of cases of type 1 diabetes in children – especially young children – and adolescents is rising throughout the world. In Germany, the rate of new cases is currently increasing by three to five percent annually. The causes for this increase are still unknown; possible culprits may be environmental factors that have an effect in the womb or in early childhood, for example early nutrition, viral infections or changes in the immune system through improved hygiene, but also the development of the microbiome of the digestive system in early childhood and the bacterial colonization of the intestine.

The physician Ruth Chmiel and the biologist Florian Haupt explore new avenues for the prevention of type 1 diabetes. Through the oral and intranasal administration of insulin (in the image: insulin crystals) they are seeking to delay the onset of type 1 diabetes in risk patients. Source: HMGU

At the Institute of Diabetes Research at Helmholtz Zentrum München, scientists under the direction of Anette-Gabriele Ziegler are seeking to find the causes of type 1 diabetes, to elucidate the disease course and to combat the disease. Type 1 diabetes – in contrast to the much more frequent type 2 diabetes – is triggered by an autoimmune process. As a result of genetic alterations or environmental influences, the insulin-producing cells – the beta cells in the pancreas – are destroyed. Often children and adolescents are affected. When approximately 80 percent of these cells have failed, there is a dramatic rise in blood glucose levels leading to the outbreak of the disease. Without insulin treatment, the outcome of the disease would be fatal.

The physician Ruth Chmiel and the biologist Florian Haupt are working at the Institute of Diabetes Research to develop a vaccine against the dangerous disease. “By detecting certain antibodies in the blood we can diagnose the dysregulation of the immune system, which ultimately leads to the outbreak of the disease, at an early stage,” said Ruth Chmiel. “Practically all individuals in whom two or more of these antibodies have been detected develop type 1 diabetes within 15 to 20 years after diagnosis. If detected early, there is still time for preventive immunotherapy.”

Within the framework of the Intranasal Insulin Trial (INIT II) and the Oral Insulin Trial, the two scientists select appropriate German candidates who can participate in the trial of such a vaccine. Whoever has close relatives with type 1 diabetes and in whose blood the characteristic autoantibodies can be detected can take part in the trial. The subjects take one capsule with insulin daily or are treated with intranasal insulin spray once a week. “The immune system of the body can thus gradually get used to the insulin,” explained Chmiel. “It acts directly on the nasal mucosa and in this way does not disturb the metabolism.”

First successes of the vaccine have already been confirmed: Evaluations of a trial in the U.S. have shown that through the oral administration of insulin in young children and in individuals with high autoantibody titers, the onset of diabetes can be delayed significantly.

The trials in Munich will be accompanied by projects that address fundamental questions. “In translational projects at Helmholtz Zentrum München, we are studying how changes in the metabolism affect the development of type 1 diabetes,“ said Florian Haupt. “In addition, cells of the immune system are being analyzed to elucidate the underlying disease processes.” Helmholtz Zentrum München is now right at the interface of basic
research and the translation of the findings into medical practice. The Institute of Diabetes Research is, so-to-speak, the spearhead of diabetes research in Germany.