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Dr Ezio Bonifacio Explains Potential Interventions for Individuals At Risk of T1D


Ezio Bonifacio, PhD, describes the benefits of screening children for type 1 diabetes and what preventive interventions may be possible.

If we can apply something that even slightly reduces the risk of type 1 diabetes (T1D) in everybody, that would be the most effective way to reduce T1D numbers overall, said Ezio Bonifacio, PhD, a professor of diabetes and preclinical stem cell work at the Technical University of Dresden, in Germany.


What interventions are possible if screening does identify those at risk of T1D?

The dream is to prevent. To prevent the whole process would be fantastic. I always say that if we can apply something that reduces the risk, even a tiny amount in everybody, that's the most effective way to reduce the numbers overall. So what we call primary prevention for me is particularly important: What can we do very early in the first year of life, before they start the process of autoimmunity—these genetically at-risk children—to stop it? You can't treat them with heavy drugs, that's clear. They're perfectly well, they have a genetic risk, they have perhaps a 10% risk to get the disease.

The Global Platform for the Prevention of Autoimmune Diabetes, which I am very strongly part of—is the European platform funded, in fact, by largely US funding—it is trying and is doing 2 clinical trials, large trials, to try and prevent that whole process from starting. Genetically screening and intervening already in the first 6 months of life.

Oral insulin, where we think that if you teach the immune system before the whole process even starts, maybe we can tell the immune system, "Hey, look, the things that the beta cells are producing, in particular insulin, are actually safe. Don't make an immune response against it." And the reason [for] insulin is because that's the first target that we see in these children, often. So that's one trial; we've completed recruiting. More than 1000 babies have been recruited into that clinical trial. We started the next one.

Then after that, once the children are antibody positive, we have staging, which includes also metabolic. So if you have antibodies, and then some metabolic disturbances, that suggests you're going to get diabetes later. There we've had really the first breakthrough in prevention, which was the teplizumab anti-CD3 antibody. And I think that that's where we really have hope that we can intervene if we can identify these people through that later-screening antibodies, for example.

This interview was conducted in June 2021.

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