Researchers with the Janssen Pharmaceutical Companies of Johnson & Johnson recently announced a plan to prevent type 1 diabetes by intercepting the disease in its earliest stages and stopping its development before the onset of symptoms.
The group focused on diabetes, and potentially other diseases before they fully develop, through a venture called the Disease Interception Accelerator, or DIA. Launched in February, the new research platform seeks to reimagine how healthcare should work.
“We don’t view insulin as the (only) answer to type 1 diabetes,” said Joe Hedrick, Ph.D., a researcher at Janssen Research & Development, LLC. “We want to develop the ability to treat a person before they need insulin. That is the place we need to go.”
Hedrick further added that the team recognizes that insulin is a life-saving treatment and that advances in glucose control can and will dramatically improve the lives of those affected by type 1 diabetes, but ultimately DIA wants to intercept disease and see people maintain an insulin-independent state.
“Now you have a disease and you get treatment,” said Ben Wiegand, Ph.D., the Head of Janssen’s DIA group. “In the future we believe we can predict who will progress to disease and intercede before the disease presents itself. What today we call patients are people with illnesses. In the future what we’ll call patients are healthy people moving toward an illness.”
While ambitious, the approach as it applies to type 1 diabetes has garnered early support from JDRF. JDRF announced it will work with scientists at Janssen to identify the causes of type 1 diabetes with the goal of developing strategies to intercept the disease before symptoms appear.
“Through recent research discoveries, we now have the ability to better define the early stages of type 1 diabetes before the onset of clinical symptoms and the need for insulin injections,” said Richard Insel, M.D., JDRF’s chief scientific officer, in a statement. “This allows us to identify individuals in whom the type 1 diabetes disease process has started and to develop therapies to intercept it in order to maintain insulin independence. JDRF has long believed in preventive interventions and we are eager to support the Janssen DIA group in advancing this exciting science initiative in combatting type 1 diabetes.”
One key to intercepting type 1 diabetes is to understand what triggers it in the first place, according to Hedrick. “We have developed an interception hypothesis,” he said. “Clearly, type 1 diabetes starts years before insulin dependence. There is a window before onset in which we believe we can intercept the disease.”
Hedrick said the first priority for the DIA team is to “identify and prioritize critical pathways that drive the onset and progression to” type 1 diabetes. He said there are three factors the DIA team will be focusing on to identify and prioritize those pathways: Rebalancing the immune system; maintaining beta cell function; and identifying possible environmental triggers.
Rebalancing the immune system includes targeting cells that present as an autoantigen to the immune system, targeting so-called accessory cells of the immune system that might play a role in the early initiation of diabetes, and introducing an antigen-specific tolerance to the immune system, such as a tolerogenic vaccine that might help intercept the progression of the disease.
Maintaining the functionality of beta cells (the cells that secrete stored insulin) is critical to the success of forestalling the development of type 1 diabetes, Hedrick said. Areas the team will pursue include reducing endoplasmic reticulum stress on the cells that contributes to their death; inhibiting beta cell death from inflammatory factors; and developing drugs that help beta cells survive.
The last factor the DIA team will focus on is identifying and intercepting possible environmental factors that may lead to type 1 diabetes, such as viruses and other causative agents.
“This is not just a one-shot wonder,” Hedrick said. “It’s a comprehensive approach to intercepting the disease before it develops.”
Wiegand added that the effort was in its very early stages, having been launched only one month ago, and many questions still needed to be addressed.
“We’re really just at the start,” said Hedrick. “We’re still determining the specifics of how we’ll approach many aspects of this.”
Among those specifics is a budget for the project. Hedrick said a yearly spending plan will be decided by what the “science demands.”
Additionally, there are questions about how a screening process to test for diseases before they develop might operate. While no specific model for screening has been developed, Hedrick suggested that such screenings might simply become part of a regular pediatric visit.
One thing is certain. For this new model of healthcare to have a chance at succeeding, Janssen will need to work closely with many different research scientific, social, governmental, and corporate groups.
“Every conceivable partnership is going to be necessary,” Wiegand said. “We understand the challenges we face in having to change the current mindset about healthcare, and we feel it’s worth the effort.”