Mark Atkinson, Ph.D.,is an AmericanDiabetes AssociationProfessor for DiabetesResearch, and <strong>the</strong>Director of <strong>the</strong> Centerfor Immunology andTransplantation at <strong>the</strong>University of Florida. Atkinson was amongst<strong>the</strong> first groups of researchers to identify<strong>the</strong> value of measuring immune responsesagainst <strong>GAD</strong>, and to describe <strong>the</strong> whiteblood cell response against this protein inpersons <strong>with</strong> <strong>the</strong> disease. Atkinson holdspositions on a number of scientific advisoryboards/research panels including <strong>the</strong>Juvenile Diabetes Foundation Inter-national(JDFI), <strong>the</strong> American Diabetes Associationand <strong>the</strong> National Institutes of Health (NIH).While Atkinson’s current research extends tounderstanding <strong>the</strong> molecular immunologicaland genetic mechanisms underlying <strong>the</strong> formationof diabetes, his primary researchgoal lies in <strong>the</strong> development of an effectivemethod for preventing insulin-dependentdiabetes. Professors Atkinson and NoelMaclaren were first to file a US patent for<strong>GAD</strong> and diabetes <strong>the</strong>rapy which is exclusivelylicensed by <strong>Diamyd</strong> Medical.More Effective Methods forpreventative Interventionβ cell MassLower Accuracy inDisease PredictionHigher Accuracy inDisease PredictionLess Effective Methodsfor PreventativeInterventionOnset of OvertType 1 DiabetesAbility to Predict Type 1DiabetesAbility to Predict Type 1DiabetesType 1 Diabetes: a Dilemmafor Clinical TreatmentTMark Atkinsonhroughout much of <strong>the</strong> lastdecade, guarded hope existedthat an agent capable of preventingor reversing Type 1diabetes would be uncovered.As of today, such an agentdoes not unequivocally exist. As a result, manyhave addressed <strong>the</strong> question ‘why?’ The answers tothis question are many; some of which are readilyaddressable, o<strong>the</strong>rs are by <strong>the</strong>ir nature more inherentlydifficult. Among <strong>the</strong> latter obstacles facing<strong>the</strong> diabetes prevention field is a situation that hasbeen referred to as <strong>the</strong> ‘treatment dilemma’. Awide body of evidence, both in animal models ofType 1 diabetes as well as in persons <strong>with</strong> or – atincreased risk for – <strong>the</strong> disease, supports <strong>the</strong>notion that <strong>the</strong> most effective interventions willbe those that are begun early in <strong>the</strong> autoimmunedisease process. In contrast, <strong>the</strong> process of diseaseprediction [that is, using immunologic (e.g. <strong>GAD</strong>auto<strong>anti</strong>bodies), genetic (e.g. HLA types), andmetabolic (e.g. glucose tolerance tests) markers of<strong>the</strong> disease to identify risk for eventual diseasedevelopment] is most accurate in <strong>the</strong> period closeto <strong>the</strong> onset of overt diabetes. As a result, a conflict(both ethical and clinical) exists wherein <strong>the</strong>most effective forms of <strong>the</strong>rapy may involve <strong>the</strong>early treatment of subjects in a period in whichdisease prediction is less accurate; a situation thathas positioned <strong>the</strong> need for a safe and benignform of <strong>the</strong>rapy against treating persons who maynever develop Type 1 diabetes. The identificationof such an idealized agent has thus far provenextremely difficult to uncover.Yet ano<strong>the</strong>r challenge relates to properlyaddressing, in combination, <strong>the</strong> questions of “whodo we treat” and “what agent will we use”? In <strong>the</strong>ory,attempts to prevent Type 1 diabetes will mostlikely address two distinct populations. The firstwould involve <strong>the</strong>rapy of high-risk individuals (e.g.<strong>GAD</strong>/islet auto<strong><strong>anti</strong>body</strong> positive relatives of aproband <strong>with</strong> Type 1 diabetes) or those who alreadyhave one form of <strong>the</strong> disease (e.g. LADA subjects).The second would be that of a generalpopulation approach such as is common practicefor vaccinations against infectious disease. Bothmodels have inherent strengths and weaknesses interms of <strong>the</strong>rapeutic intervention. In <strong>the</strong> lattermodel, a safe and benign <strong>the</strong>rapy capable of interrruptingadverse immune events/environmentalagents (e.g. a vaccine) or alterations in lifestyle providingavoidance of disease risk factors (e.g. diabetogenicdietary components) would ideally beimplemented while <strong>the</strong> costs associated <strong>with</strong> screeninggeneral populations forms a barrier. Indeed,one could speculate that in designing preventativemeasures <strong>with</strong>in <strong>the</strong> general population, <strong>the</strong> diseasefrequency and unpredictable time of onsetform major obstacles that screening would be eliminatedand vaccination would become universal.Performing clinical trials in increased-risk populationsor those already diagnosed <strong>with</strong> <strong>the</strong> diseasemay prove more cost effective (in terms of a trial)and efficient, yet in terms of humanitarian benefit,it could be argued that <strong>the</strong> general populationapproach may ultimately be more importantas approximately 85% of newly-diagnosedpatients have no family history of <strong>the</strong> disease.A final barrier for this discussion is <strong>the</strong> lack ofobvious candidates for <strong>the</strong> next round of largeprevention trials. As a result, current interest isdirected at studies involving recent-onset Type 1diabetes and LADA patients for <strong>the</strong> purpose ofidentifying new and perhaps more promisingagents such as diamyd . If diamyd is shown to beclinically effective, <strong>the</strong>n prospective, randomizedcontrolled studies <strong>with</strong> appropriate statisticalpower and objective endpoints can be designedand prevention strategies in different populationgroups at different stages of <strong>the</strong> disease processcan be undertaken. Not only will <strong>the</strong>se studiesascertain potential efficacy and safety, but shouldalso lead to greater insight into disease pathogenesis.page 32 dmccad june 2003
<strong>Diamyd</strong> S-100ß ConcentrationMeasurement ELISADetermination of S-100β protein concentrations in serum is used in neurologyto assess <strong>the</strong> extent of brain damage in stroke, in head injuries, during extracorporealcirculation and during circular arrest.It is also used for follow-up and prognosis of malignant melanoma.<strong>Diamyd</strong>, Inc has developed prototype ELISA kits for detecting <strong>the</strong> presence ofS-100ß protein in human serum/plasma.<strong>Diamyd</strong> S-100ß-<strong><strong>anti</strong>body</strong> ELISAS-100β auto<strong>anti</strong>bodies have recently been shown to be a possiblemarker for autoimmune diabetes. An article (Nature 2003*) shows evidencethat islet cell death is related to autoreactive T- and β-cellresponses to neighbouring peri-islet Schwann cells, which express S-100β protein. <strong>Diamyd</strong>, Inc has developed prototype ELISA kits fordetecting <strong>the</strong> presence of auto<strong>anti</strong>bodies to S-100ß protein in humanserum/plasma. The ELISA uses visual detection (requires a visibleplate reader that measures absorbance at 492 nm).page 32www.diamyd.comproducts@diamyd.compage 21dmccad june 2003
- Page 4 and 5: forewordResearch Scientists through
- Page 6 and 7: The Story ofGADRobert Dinsmoor1975R
- Page 8 and 9: Åke Lernmark, MD, Ph.D., and his c
- Page 10 and 11: theory, the immune system mistakenl
- Page 12 and 13: GAD Back to the Future…Åke Lernm
- Page 14 and 15: 100GAD in GraphsGAD65 DNA vaccinati
- Page 16 and 17: In Nature, Anything that CanHappen
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- Page 42 and 43: Diamyd’s Commercial Development o
- Page 44: T cell GAD65For use of GAD in immun