Published: 31 July 2024
A psoriasis drug can help treat children and adolescents with early-stage type-1 diabetes. Those are the findings of a study funded by an NIHR and Medical Research Council (MRC) partnership.
Results of the Cardiff University-led study have been published in Nature Medicine. They show how Ustekinumab preserves bodily production of insulin in type-1 diabetes. They help bring the goal of managing type-1 diabetes without insulin closer.
Ustekinumab is an established immunotherapy, used to treat psoriasis since 2009. It is an injection treatment which patients can give themselves at home. It provides effective treatment of over 100,000 patients with immune conditions, including:
- severe psoriasis
- psoriatic arthritis
- severe Crohn’s disease
- severe ulcerative colitis
The trial tested the treatment in 72 adolescents with recent-onset type-1 diabetes. All participants were aged 12-18.
Dr Danijela Tatovic, Cardiff University School of Medicine, said: “Type-1 diabetes occurs when the body’s immune system attacks and destroys the cells of the body that produce insulin. This eventually leaves the person dependent on insulin injections. Researchers are now developing ways to slow or halt the immune system attack. If such treatments can be started early, before all the insulin-making cells are lost, this could prevent or reduce the need for insulin.”
This study demonstrated that Ustekinumab can also preserve vital insulin-producing cells. The researchers also identified the specific immune cells that cause this destruction. This enables precise and targeted therapies to maximise benefits and minimise side effects.
Professor Tim Tree, King's College London, said: “We have found that Ustekinumab reduces the level of a tiny group of immune cells in the blood called Th17.1 cells. These cells make up only 1 in 1000 of blood immune cells, but they seem to play an important role in destroying insulin producing cells. This explains why Ustekinumab has so few side-effects. It targets the trouble-making cells, while leaving 99% of the immune system intact – a great example of precision medicine.”
Professor Colin Dayan, Clinical Professor at Cardiff University’s School of Medicine, said: “We tested this treatment in children and adolescents who already needed insulin treatment. It would be better if we could treat them at an earlier stage, while the children are still well, and prevent them needing insulin. Thankfully, Ustekinumab has a good enough safety record to be considered for use in children at this early stage.”
Ustekinumab was shown to cut the destructive impact of Th17 immune cells on cells producing insulin. After 12 months of using Ustekinumab, researchers found C-peptide levels were 49% higher. This is a sign that the body is producing insulin. This is the first clinical trial-based evidence for the role Th17 cells in type-1 diabetes.
The study also identified how immunotherapies may curb the destruction of insulin-producing cells. They target the body’s immune system, slowing the destruction of insulin-producing cells. This treats the underlying immune process rather than correcting insulin levels.
Dr Peter Taylor, Cardiff University's Systems Immunity Research Institute, said: “It is now possible with a simple finger-prick antibody test to detect children who will develop type-1 diabetes years before they need insulin. Combining screening in this way with early treatment with Ustekinumab seems a very promising approach to preventing the need for insulin. Further trials will be needed to confirm this.”
The study also involved researchers from:
- Kings College London
- Swansea University
- University of Calgary
The USTEKID study is funded by the Efficacy and Mechanism Evaluation (EME) Programme. The EME Programme is a partnership between NIHR and MRC. For more information about the study, please visit our Funding and Awards website.