Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association

Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease

piggyBac is an effective tool for functional analysis of the Plasmodium falciparum genome

<p>Abstract</p> <p>Background</p> <p>Much of the <it>Plasmodium falciparum </it>genome encodes hypothetical proteins with limited homology to other organisms. A lack of robust tools for genetic manipulation of the parasite limits functional analysis of these hypothetical proteins and other aspects of the <it>Plasmodium </it>genome. Transposon mutagenesis has been used widely to identify gene functions in many organisms and would be extremely valuable for functional analysis of the <it>Plasmodium </it>genome.</p> <p>Results</p> <p>In this study, we investigated the lepidopteran transposon, <it>piggyBac</it>, as a molecular genetic tool for functional characterization of the <it>Plasmodium falciparum </it>genome. Through multiple transfections, we generated 177 unique <it>P. falciparum </it>mutant clones with mostly single <it>piggyBac </it>insertions in their genomes. Analysis of <it>piggyBac </it>insertion sites revealed random insertions into the <it>P. falciparum </it>genome, in regards to gene expression in parasite life cycle stages and functional categories. We further explored the possibility of forward genetic studies in <it>P. falciparum </it>with a phenotypic screen for attenuated growth, which identified several parasite genes and pathways critical for intra-erythrocytic development.</p> <p>Conclusion</p> <p>Our results clearly demonstrate that <it>piggyBac </it>is a novel, indispensable tool for forward functional genomics in <it>P. falciparum </it>that will help better understand parasite biology and accelerate drug and vaccine development.</p

Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.

Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease

CD -27°11535 : evidence for a triple system in the β Pictoris moving group

Funding: This work was supported in part by NASA grants NNX14AJ80G, 80NSSC21K0958 (E.L.N. and A.E.P.), and 21-ADAP21-0130 (E.L.N. and A.S.) and authored by employees of Caltech/IPAC under contract No. 80GSFC21R0032 with the National Aeronautics and Space Administration.We present new spatially resolved astrometry and photometry of the CD –27°11535 system, a member of the β Pictoris moving group consisting of two resolved K-type stars on a ∼20 yr orbit. We fit an orbit to relative astrometry measured from NIRC2, GPI, and archival NaCo images, in addition to literature measurements. However, the total mass inferred from this orbit is significantly discrepant from that inferred from stellar evolutionary models using the luminosity of the two stars. We explore two hypotheses that could explain this discrepant mass sum: a discrepant parallax measurement from Gaia due to variability, and the presence of an additional unresolved companion to one of the two components. We find that the ∼20 yr orbit could not bias the parallax measurement, but that variability of the components could produce a large-amplitude astrometric motion, an effect that cannot be quantified exactly without the individual Gaia measurements. The discrepancy could also be explained by an additional star in the system. We jointly fit the astrometric and photometric measurements of the system to test different binary and triple architectures for the system. Depending on the set of evolutionary models used, we find an improved goodness of fit for a triple system architecture that includes a low-mass (M = 0.177 ± 0.055 M⊙) companion to the primary star. Further studies of this system will be required in order to resolve this discrepancy, either by refining the parallax measurement with a more complex treatment of variability-induced astrometric motion or by detecting a third companion.Publisher PDFPeer reviewe

CGM Metrics Identify Dysglycemic States in Subjects from the TrialNet Pathway to Prevention Study

   OBJECTIVE  Continuous glucose monitoring (CGM) parameters may identify subjects at risk of progressing to overt type 1 diabetes. We aimed to determine whether CGM metrics provides additional insights into progression to clinical Stage 3 type 1 diabetes.  RESEARCH DESIGN AND METHODS  One hundred and five relatives of type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention Study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals, the baseline data is reported here. Three groups were evaluated: individuals with 1) Stage 2 type 1 diabetes (n=42) with ≥2 diabetes-related autoantibodies and abnormal OGTT; 2) Stage 1 type 1 diabetes (n=53) with ≥2 diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n=10).  RESULTS  Multiple CGM metrics were associated with progression to Stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (p = 0.01), ≥8% time ≥140 mg/dL (p=0.02), ≥5% time ≥160 mg/dL (p = 0.0001) and ≥8% of the time spent at glucose levels ≥160 mg/dL (p=0.02) were all associated with progression to Stage 3 disease. Stage 2 participants and those who progressed to Stage 3 also exhibited higher mean day-glucose values, spent more time with glucose values over 120, 140 and 160 mg/dL, and had greater variability. CONCLUSIONS  CGM could aid in the identification of subjects, including those with a normal OGTT, who are likely to rapidly progress to Stage 3 type 1 diabetes. </p

Low-Dose Anti-Thymocyte Globulin Preserves C-Peptide, Reduces HbA1c, and Increases Regulatory to Conventional T-Cell Ratios in New-Onset Type 1 Diabetes: Two-Year Clinical Trial Data

A three-arm, randomized, double-masked, placebo-controlled phase 2b trial performed by the Type 1 Diabetes TrialNet Study Group previously demonstrated that low-dose anti-thymocyte globulin (ATG) (2.5 mg/kg) preserved β-cell function and reduced HbA 1c for 1 year in new-onset type 1 diabetes. Subjects ( N = 89) were randomized to 1 ) ATG and pegylated granulocyte colony-stimulating factor (GCSF), 2 ) ATG alone, or 3 ) placebo. Herein, we report 2-year area under the curve (AUC) C-peptide and HbA 1c , prespecified secondary end points, and potential immunologic correlates. The 2-year mean mixed-meal tolerance test–stimulated AUC C-peptide, analyzed by ANCOVA adjusting for baseline C-peptide, age, and sex ( n = 82) with significance defined as one-sided P < 0.025, was significantly higher in subjects treated with ATG versus placebo ( P = 0.00005) but not ATG/GCSF versus placebo ( P = 0.032). HbA 1c was significantly reduced at 2 years in subjects treated with ATG ( P = 0.011) and ATG/GCSF ( P = 0.022) versus placebo. Flow cytometry analyses demonstrated reduced circulating CD4:CD8 ratio, increased regulatory T-cell:conventional CD4 T-cell ratios, and increased PD-1 + CD4 + T cells following low-dose ATG and ATG/GCSF. Low-dose ATG partially preserved β-cell function and reduced HbA 1c 2 years after therapy in new-onset type 1 diabetes. Future studies should determine whether low-dose ATG might prevent or delay the onset of type 1 diabetes