The ball is in the court of type 1 diabetes screening.
You don't hear much about it in consultation, but there are screening programs for type 1 diabetes (T1D) around the world. In France, it is the Innodia network that is in charge.
ASK (Autoimmunity Screening for Kids) in the state of Colorado and FR1DA in Bavaria are two reference programs in the screening of T1D that measure antibodies. The reason for screening is to avoid diabetic ketoacidosis and to prevent the announcement of the diagnosis out of the blue. T1D is determined in the presence of two antibodies. Researcher Marian Rewers suggests that screening begins at age two and that it can be repeated once or twice if the result is negative.
The development of these screening programs raises new questions. Among those mentioned by the day's speakers was the need to educate health professionals so that screening of relatives of people living with T1D is systematically suggested to their patients. We also need to work on clear and empathetic communication about the implications of screening. A negative test or the presence of a single antibody does not mean that the person screened will not develop T1D in the years to come. How do you explain this to the patients without them throwing their racket at the diabetologist? "It is time to screen and offer treatments that can change the course of the disease" concludes Professor Chantal Matthieu of Innodia.
More reliable than the prognosis of the French Open, T1D screening allows us to know with more certainty who will be the next loser of autoimmunity.
If you live in France or Europe, find the nearest type 1 diabetes screening center: https://www.innodia.eu/fr/map/
If you live in Northern Europe: https://diaunion.org/en/get-involved/#Registration
If you live in Germany: https://www.typ1diabetes-frueherkennung.de/
Patient Involvement in Research: Making the Game Fair for All.
For a fair game, Jeannette Soderberg, research director at the Juvenile Diabetes Research Foundation (JDRF), advocates for more patient involvement in clinical trials and at medical conferences. Soderberg points out that engaging patients in clinical trials saves money and speeds up the process. On the other hand, involving patients in scientific conferences increases the reach of scientific information, especially on social networks, which are the preferred communication channels during congress weeks. A conference in which patients are present generates twice as many tweets as a conference without patients. Tennis fans would say, "Open the Philippe Chatrier court!" We say, "Open the congresses!"
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Immunotherapy: tolerance and timing to get to the net.
Let immunosuppression take a leaf out of Rafael Nadal's book. Lucienne Chatenoud of the Necker Institute in Paris insists: "We absolutely must leave immunosuppression behind and aim for tolerance of the immune system."
Immunotherapies are considered today well beyond the long-established dogmas about T1D. The immune system is essential to protect against all the infections, viruses and tumors that might arise. But if it disappears from circulation, how do we get it to work in favor of the pancreas? That's the heart of the vision that is now being shared by ongoing research and clinical trials. The trend is to slow down cells and retrain those that are attacking, to make them more tolerant.
But if you want to achieve results by relying on a failing immune system, there are better times than others to do so. Therapeutic windows are beginning to be identified, but there is still a lack of effective biomarkers to accurately predict the phase changes of T1D and inform on its progression. If phase 3 corresponds to the diagnosis, it is already too advanced to hope for a reversal of the situation. This is not the case for phase 1, for example, where remission has been observed in mice: immune cells are once again tolerant and insulin-producing cells are preserved. The approval of Tzield, the first drug to delay the onset of T1D, is a first step. We still need to identify the preliminary phases and the signals that herald phase 1 in order to anticipate prevention more and more.
In immunology, as on clay courts, it is always beneficial to improve one's game and anticipate shots in order to score points.
Immunology: all in the racket?
Researchers interested in new immunotherapies to put a positive spin on T1D are relying on material that everyone has: genes. These genes are partly responsible for the development of T1D, along with environmental factors that are being identified through clinical trials. While much remains to be learned about them, it appears that the same genetic mutation can result in different ways. Several diseases with varied and serious health manifestations thus have a genetic point in common.
This is what Professor Frédéric Rieux-Laucat of the Imagine Institute in Paris shares with us. He invites us to consider a diagnosis of autoimmunity during childhood as an expression of a pediatric genetic disease. For him, there is a rational interest in looking for monogenic predispositions in patients diagnosed with T1D. At the same time, this implies opening up T1D to therapies that are common to several diseases, some of which are already in place.
Like the racket in the hands of tennis players, the same genetic material allows a variety of different strokes to be played: it remains to identify the training method that will give mastery.
Game, shit and match for B. longum?
The intestinal microbiota starts at birth with the vaginal and digestive microbes of the mother. Then weaning with dietary diversification is a critical period of immune education and bacterial enrichment not to be missed. Dysbiosis, caused by an antibiotic treatment for example, which disturbs the intestinal flora, can trigger diabetogenic autoimmunity and glycemic imbalance, explains Tommi Vatanen. In fact, a competitive gut bacterial mix (Nadal level) is essential to win the game of life. Escherischia Coli is a good stimulant, but this is not at all the case of Bacteroides, which are dominant in the West after having gradually replaced the beneficial bifidobacteria implanted by breastfeeding. Rest assured, this can be compensated by probiotics that reduce anti-islet immunity before and after the diagnosis of T1D. As for choosing the best probiotic strains, the artificial intelligence that models the molecules provides for this: it predicts the chemical reactions of the different bacterial strains with food. Bifidobacterium longum seems to be in the lead for the moment... of course, it is not present in the Western gut. An opportunity for industrial development for sure.