Our scientists have discovered a marker in the immune system that can be used to predict which people with type 1 diabetes will benefit from an immunotherapy drug, unlocking its use to help stop the condition in its tracks.
Our researcher Professor Lucy Walker studied blood samples from people with type 1 diabetes who had taken part in a trial of an immunotherapy, called Abatacept. They found that by analysing a particular immune cell involved in the immune attack in type 1 diabetes they could make predictions about how well people will respond to Abatacept.
Reprogramming the immune system
Abatacept is a drug that’s already used to treat rheumatoid arthritis, which like type 1 diabetes is an autoimmune condition. It works by reprogramming the immune system so that it no longer attacks and destroys healthy tissue.
In a past trial with people newly diagnosed with type 1 diabetes – who still have some working insulin-producing cells – results suggested Abatacept could help to protect cells from further damage. But it was clear that while the immunotherapy worked really well for some people, in others it had no effect at all. This murky picture of the benefits of Abatacept prevented it from being taken forward into later phase clinical trials.
To help figure out why the treatment can benefit some people and not others, Professor Walker and her team at UCL, along with scientists from King's College London and AstraZeneca, went back to the samples from people who had been involved in the Abatacept trial.
Helper T cells helping to predict responses
They found that Abatacept reduced the numbers of a particular type of immune cell, called follicular helper T cells. Previously Professor Walker discovered that these cells are involved in the immune attack behind type 1 diabetes and are found at higher levels in people with the condition.
The research team also showed that treatment with Abatacept changed the helper T cells' characteristics. They then used machine learning to compare blood samples from people who responded well to Abatacept with those who didn’t show much of a response to the treatment.
They found that their machine learning algorithm was able to detect differences in the helper T cells of ‘responders’ and ‘non-responders’, even before treatment. This suggests these cells can be used as a biomarker to help decide which people will benefit from the immunotherapy.
The right people for the right trials
Excitingly, being able to tell in advance who is likely to benefit from taking Abatacept may reignite research into this drug as a treatment for type 1 diabetes.
Dr Elizabeth Robertson, our Director of Research, explained:
“Immunotherapies hold huge promise to slow the progression of type 1 diabetes in people newly diagnosed or at high risk of the condition, and to bring us closer to a cure. But, so far, research we’ve seen in this area over the years hasn’t translated into licensed, effective treatments.
“These new findings open the way for scientists to identify those most likely to respond to Abatacept, so they can invite the right people onto trials and ensure they are more likely to succeed. This means we could rapidly see this treatment licensed and given to those who would be most likely to benefit.
“Not only would this be a huge leap forward in how we treat type 1 diabetes and in changing lives, but it could also inspire new investment into immunotherapy research so that we can really see progress accelerate.”
Read more about how we’re supporting immunotherapy research in the UK and to make sure new treatments reach people with type 1 diabetes as soon as possible.
This research has been published in Nature Immunology.
