Scientists are casting a wide, tightly woven net with the goal of catching the causes of type 1 diabetes.
Study sites around the world are screening 220,800 healthy babies for genes that put them at risk for type 1 diabetes.
They expect to identify the genes in about 13,000 babies in this four-year screening. About half those babies will embark with their families on a 15-year journey that may help cure the disease.
"Our hope is to identify environmental factors that determine the risks for type 1 diabetes," says Dr. Jin-Xiong She, director of the Center for Biotechnology and Genomic Medicine at the Medical College of Georgia and Georgia Research Alliance Eminent Scholar in Genomic Medicine. "Once you know the risk factors, you can modulate the risk factors to prevent diabetes," says Dr. She, who five years ago sat around a table with other diabetes researchers to discuss such research opportunities. Those conversations led to a request for applications from the National Institutes of Health to investigate environmental triggers of the disease that turn the body's immune system on the insulin-producing cells of the pancreas.
A few dozen centers applied and six were chosen by NIH to meet again and devise a comprehensive plan for studying this expansive topic that includes nearly everything in child's life, from the water he drinks to when he eats his first cookie.
"Risk factors for type 1 diabetes include two major components. One is the genetic factors and the other is the environmental factors. They are about equally important," says Dr. She. "We have quite a few of the genes identified." In fact, Dr. She and his colleague Dr. Cong-Yi Wang, molecular geneticist, reported in the August 2004 issue of Nature Genetics the discovery of the fourth gene, dubbed SUMO-4. Having these genes increases a child's risk of developing type 1 diabetes tenfold.
But the environmental factors, which researchers such as Dr. She believe are responsible for the increasing incidence of the disease, are still elusive. "There are many suspects like cow's milk, like coxsackie viral infection (cause of the common, painful and blistering hand, foot and mouth disease) that have been suggested as triggers for type 1 diabetes. But the literature is very controversial: some studies are for it, some are against it," says Dr. She.
That's why TEDDY - The Environmental Determinants of Diabetes in the Young - was born.
The study includes newborns in four states and three countries. MCG is the lead site for seven hospitals, including MCG Medical Center, University Hospital and St. Joseph Hospital in Augusta; Northside Hospital in Atlanta; and three hospitals in Gainesville, Fla. Additional lead sites include Barbara Davis Center at the University of Colorado; Pacific Northwest Research Institute in Seattle; the University of Turku in Finland; Lund University in Sweden; and the Diabetes Research Institute in Munich, Germany. Moffitt Cancer Center and Research Institute at the University of South Florida is analyzing the extensive data collected by study sites as they enroll participants over the next four years.
TEDDY is similar to another screening study driven by Dr. She called PANDA - Prospective Assessment in Newborns for Diabetes Autoimmunity - which also uses a drop of blood taken from the umbilical cord or the traditional heel prick to screen newborns for high-risk genes. PANDA will follow those with the genes for five years.
While that study continues, the more expansive study that is following so many aspects of these children's lives is now getting priority when it comes to enrolling newborns, says Diane Hopkins, study coordinator for the Center for Biotechnology and Genomic Medicine and multi-site research manager for TEDDY in Georgia and Florida.
"The families make a real commitment to this research," she says. "We are asking them to record every time the child is sick, every time the child receives medication, whether it's over-the-counter or prescription. Every time the child goes to a health care provider, even if it's a well-baby visit, we want to know about it. When they go to the emergency after-hours clinic at 4 o'clock in the morning, we want to know. We are very much involved in what is going on with this child's health whether or not we suspect it has anything to do with type 1 diabetes. We are just throwing this giant net of what is happening with these babies and reeling in as many answers as we can before we know they are answers."