Jessica Dunne PhD Director Research JDRF Hello Jessica Dunne PhD Joined JDRF in September 2008 Lead for Prevention program since its inception in July 2012 14 yrs in immunologyinflammationvaccine research including in the pharma and biotech sectors ID: 774711
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Progression to Type None
Jessica Dunne, Ph.D.
Director, Research
JDRF
Slide2Hello…
Jessica Dunne, Ph.D.
Joined JDRF in September 2008, Lead for Prevention program since its inception in July 201214 yrs in immunology/inflammation/vaccine research including in the pharma and biotech sectorsSister-in-law (mis)diagnosed as adult 3 years ago.
Accelerating Progress
2
Slide33
JDRF – what motivates us?
Vision
A world without type 1 diabetes
Mission
Accelerating life-changing breakthroughs to
cure, prevent and treat
type 1 diabetes and its complications
Slide4Accelerating Progress
4
Overview
TYPE 1
DIABETES
Slide55
Slide6Accelerating Progress
6
Accelerating Progress Across the Pipeline
THE PLAN
Delivering
treatments
to
people with T1D
Expanding access to
the
latest T1D therapies through education
Ensuring treatments are affordable and accessible
Creating
FDA approval pathways
for
new
T1D treatments
Moving scientific discoveries from the laboratory to the real
world (Clinical Trials)
Identifying new approaches to cure, prevent and treat T1D
and
its
complications
Slide7RESEARCH PARTNERSHIPS
Jdrf’s
capabilities
7
IMPROVED OUTCOMES
INTERNATIONAL REACH (foundations)
Slide8JDRF Portfolio
Jit Patel
8
Artificial Pancreas
Metabolic Control
Beta cell Replacement
Prevention
Restoration
Complications
Slide9Prevention
Slide10Number of US youth <20 years with T1D projected to increase 3.3-fold by 2050
Diabetes Care
35 (12), 2515 (2012)
T1D is on the rise
Slide11What is the risk for developing type 1 diabetes among family members compared to the rest of the population?
no difference
3X greater risk
15X greater risk
Slide12Staging and Screening
Slide13T1D Disease Progression
Starting Point
Genetic Risk
The path to T1D starts here
Everyone who is diagnosed with T1D has the gene(s) associated with T1DGeneral population risk is 1 in 300Family members are at 15x greater risk to develop T1DRelative risk is 1 in 20
1
300
1
20
Slide14T1D Disease Progression
Progression by Population:
Essentially everyone with 2 or more autoantibodie
s will continue to progress towards clinical symptomsT1D starts when you develop two or more autoantibodies
Starting PointIf you have a relative:15x greater risk of developing T1D
Immune Response
Development of single
autoantibody
Genetic
Risk
Immune
Activation
Immune
Response
Type 1 Diabetes
Immune Activation
Beta cells are attacked
Slide15T1D develops in predictable stages
STAGE 1STAGE 2STAGE 3Blood sugarNormalAbnormalAbnormalSymptomsNoNoYesAutoantibodies2+2+2+
For people with 2 or more autoantibodies, the risk of developing symptomatic T1D is:51% within the next 5 years75% within the next 10 yearsAlmost 100% within the next 20 years
JAMA
309 (23), 2473-2479 (2013)
Diabetes Care
38 (10), 1964-1974 (2015)
Slide16Why Screen if No Preventative Therapy Currently Exists?
Significantly reduced risk for DKA in TEDDY antibody positive individuals
Up to 36% DKA at diagnosis in
general population
As low as 4-5
% in
with screening and monitoring (unpublished
)
Reduction of DKA can result in better long-term glucose control and lower HbA1c
Prevention
trials launched and launching
Moving the field forward through better understanding of disease progression
Slide17Childhood population-based risk screening: Age 3 and 4 years may be an optimal age in Germany
17
Ziegler, Diabetologia 2012
Age (year)
Incidence of islet autoantibodies in cases with multiple Abs amongst unselected FDRs
95% CI
0
10
5
15
20
25
6
4
0
2
14
12
10
8
16
18
Islet
AAb
seroconversion
(
case
per 1,000
person-years
)
2/3 of multiples
islet autoantibodies
occur before
age
4 years (JAMA).
~ 90% of youth T1D is after age 3 years
Slide18Screening can identify people at risk
Slide19T1D Disease Progression
19
Accelerate the clinical development of therapies by providing a common framework for Regulators, funders, academia and industry Identification of T1D in it’s earliest stages can lead to a decreased risk of diagnosis in DKAStaging diabetes allows us to treat T1D early to delay progression and ultimately prevent stage 3 (symptomatic T1D)Treating high blood pressure, allows us to treat the disease early and ultimately prevent a heart attack or stroke
Importance of staging
Slide20Does someone in your family have T1D?
Risk of T1D in relatives of individuals with T1D Identical Twin: 30-70%Multiple Affected First Degree Relatives: 20-50%Sibling: 8% (but if HLA risk genes identical:30-70%)OffspringFather: 5%Mother: 3%If no Family Hx- General Population: 0.4% (but if HLA risk genes: 4%) (Only 10-15% of newly diagnosed cases of T1D have a relative with T1D)
The Plan for a World without T1D
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Slide21TrialNet Disease Intervention
21
P2P
Pathway to Prevention
Determine where you are on the path
No cost1st and 2nd degree relativesScreens for autoantibodiesBased on resultsLook to enroll in clinical trial to preserve beta cell functionOr monitor for disease progression
Scott & Adam
Pathway to Prevention Participants
Keilyn
Pathway to Prevention Participant
Brooke, Emily & Ava
Pathway to Prevention Participants
Slide22TrialNet
Disease Intervention
22
P2P
Pathway to Prevention
Eligibility Requirements
Anyone between age 1 and 45 with a sibling, child or parent with type 1
Anyone between age 1 and 20 with a sibling, child, parent, cousin, uncle, aunt, niece, nephew, grandparent or half-sibling with T1D
Those under 18 who do not
have autoantibodies can be retested every year
Tracy Rodriguez
TrialNet
Coordinator, UCSF
Slide23Big Data
Slide24CONFIDENTIAL
24
JDRF-IBM Watson Partner for T1D Modeling
Slide25pre-TEDDY Cohorts Will Provide Initial Data
CONFIDENTIAL
25
DAISY 1993 – 2004 Colorado, USA •Children at increased genetic risk for T1D followed from birth
DEW-IT 2002 - Washington, USA • Cohort of children screened for HLA risk using newborn dried blood spot and followed for Ab surveillance
DIPP 1994 – 2009 Finland • Children at increased genetic risk for T1D followed from birth to age 15 years
DiPiS
2000 – 2004 Sweden
• Children with genetic risk for T1D followed from birth for 15 years
Slide26CONFIDENTIAL
26
Announcement has Generated Significant Interest
Slide27Microbiome
Slide28What is the gut microbiome?
28
We have 10x more
bactetrial
cells in our bodies than human cells
We
are walking
ecosystems!
These microbes are integrated into our biology: they
help us digest food, shape our immune system, alter our metabolism and evidence is even starting to show that they affect the nervous system, influencing our mood and
behavior.
Slide29Gut microbiome is altered in T1D
Cell Host & Microbe
17, 260-273 (2015)
Detection of 2+ autoantibodies
Symptom onset
Gut microbiome is associated with immunity
It develops differently in those who progress to symptomatic T1D
There could be a connection between the microbiome and T1D
Slide30Gut Microbiome in T1D Key Messages
30
Our guts are made up of trillions of microbes that play important roles in our biology
Through modern day practices, we may have altered our gut microbiomes in such a way to alter biological processes.
The rate of T1D has been increasing worldwide and may be linked to changes in the microbiome
If we could reset the microbiome at an early age, we may be able to prevent or delay the onset of T1D in some individuals.
Slide31Virus and disease etiology
Slide32Enteroviruses
RATIONALE:Enterovirus detected in new onset T1D pancreas (nPOD-V, DiViD); Islet cell damage in fatal enterovirus infections; Genetic association (IFIH1)Viral infections precede onset of T1D autoimmunity in some casesGAPS & POTENTIAL CHALLENGES:Need to confirm number of causative serotypesIndustry commitment to vaccine developmentGo/no-go data
Slide33Diabetes
60, 276 (2011)
Enterovirus
infection is linked to T1D
Stage 1: detection of 2+ autoantibodies
Enterovirus infections before autoantibodies are detected (
ie
, before stage 1) are more common in people who later develop T1D
There are many factors involved and researchers are working to understand them better
Slide34Funding additional epidemiological studies to strengthen the case for vaccine developmentFunding studies to detect viruses in pancreas in T1D and explore role for chronic viral infection in T1D (nPOD-V)Build the business/regulatory case
Type 1 Diabetes Enterovirus Vaccine: JDRF’s Role
nPOD Viral Group
Slide35The goals of nPOD are to:Maintain a network of procuring and characterizing, in a collaborative manner, pancreata and related tissues (spleen, lymph node, pancreatic lymph node, peripheral blood) from cadaveric organ donors with type 1 diabetes as well as those whom are islet autoantibody positive. Utilizing these tissues, investigators will work together to address key immunological, histological, viral, and metabolic questions related to how type 1 diabetes developsTo find out more information about nPOD, please visit www.jdrfnpod.org
The Plan for a World without T1D
35
Slide36Your Support
Capabilities
Plan
Vision
The Plan for a World without T1D
36
Slide37For more information about preventing T1D
www.jdrf.orgwww.pathway2prevention.orgwww.jdrfnpod.orgwww.askhealth.org
The Plan for a World without T1D
37
Slide38Summary
Prevention is importantAnd getting more important as T1D incidence increasesTools are now available that enable preventionStaging paradigm shows a predictable course for T1DScreening efforts are identifying people at riskNewT1D biomarkers are providing better screening toolsTherapeutic approaches are being discoveredEmerging from investigation of potential triggers including microbiome alteration and viral infectionEmerging from JDRF efforts in Immune Therapies, b Cell Survival Therapies and Metabolic ControlJDRF is not in this alonePartnering adds additional dollars, expertise and perspectives
38
Slide39What is the risk for developing type 1 diabetes among family members compared to the rest of the population?
no difference
3X greater risk
15X greater risk
Slide40The Plan for a World without T1D
40
Jessica Dunne, Ph.D
.
Director, Discovery Research
e:
jdunne@jdrf.org
o:
(212) 479-7595
m:
(917) 574-8056
New York, NY
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