Research & Clinical Trials

Our research focuses on diabetes in pregnancy and health services research with growing involvement in Global Health Services for diabetes.

More than 9 million Canadians are living with diabetes or pre-diabetes. The financial burden of diabetes and its complications is enormous. By 2020, it is estimated that diabetes will cost the Canadian healthcare system $16.9 billion a year.  The frequency of both type 1 and type 2 diabetes has increased considerably in the last 50 years, reaching epidemic proportions, mostly due to changes in our environment & lifestyle.

Dr B Shah is engaged in epidemilogical research into type 2 diabetes mellitus, including gestational diabetes and the delivery of health care and outcomes for people with type 2 diabetes.

Dr. P Poussier focuses his research on type 1 diabetes. Specifically, he is identifying the genes that contribute to the development of the disease, characterizing the mechanisms through which these genes orchestrate the destruction of the pancreatic cells that produce insulin, and developing therapeutic approaches to prevent and/or slow down this destructive process. He is also characterizing the environmental factors that, together with susceptibility genes, are responsible for the development of type 1 diabetes.

Visit our research showcase to learn more about our researchers and their work.

Three examples of our research with strong potential for leading to therapeutic applications:

• Project 1 - Onset of Type 1 Diabetes - Pancreatic 'Keys'
  We are testing the idea that the onset of type 1 diabetes is predicated by the acquired capacity of cells of the immune system that are responsible for the destruction of insulin producing cells, to leave the blood stream and enter the pancreas where they will destroy the insulin secreting cells. There must therefore be a pancreas specific "homing" program that relies on a set of  "keys" on the surface of immune cells, which can open complementary "locks" present in the blood vessels and the pancreas.
  
  Recently, specific sets of such  "keys" and "locks" that are shared between animals and humans, have been well characterized for the migration of immune cells to the gut and the skin and are currently the target of therapeutic approaches for immunological diseases affecting these organs (like psoriasis, inflammatory bowel diseases). Using an animal model of type 1 diabetes, we have obtained evidence for the existence of a pancreas specific homing program imprinted in diabetogenic immune cells at the initiation of the disease process.
  
  Using this well controlled system, we are identifying the molecular "keys" allowing immune cells to migrate to the pancreas and subsequently induce diabetes, as well as the factor(s) that is responsible for the presence of these "keys" on the surface of diabetogenic cells. This identification will subsequently allow the rapid development of drugs to neutralize these "keys" in order to prevent, arrest or reverse the diabetogenic process.
• Project 2 - Testing the CCR5 'Key'
  In one animal model, we have identified one of these "keys" called CCR5 that unfortunately opens the door of the pancreas to the cells of the immune system responsible for the destruction of insulin secreting cells.
  
  Remarkably, there is a very small proportion of the human population who are congenitally deficient in this key and these people are protected from type 1 diabetes. Further, these people are also protected from AIDS because the AIDS virus uses this key to enter the organism. Importantly, the role of this key in AIDS has led to the development of drugs that neutralize this key and are currently approved for AIDS patients. These drugs have very lfew side effects.
  
  In order for a drug to be tested in patients suffering from type 1 diabetes, efficiency of this drug has to be demonstrated in two animals that are also susceptible to type 1 diabetes. Prevention of type 1 diabetes through therapeutic neutralization of the CCR5 has already been achieved in a mouse model of type 1 diabetes. We are currently engaged in studies to demonstrate that this will also the case in a  rat model of type 1 diabetes. Once these two demonstrations are obtained, we will be in a position to propose a clinical trial that will test one of the anti-CCR5 drugs already approved in AIDS treatment for its ability to prevent and/or slow down the destruction of insulin producing cells. To this end, we will apply to Trialnet, the organization that is responsible for performing the international drug trials in pre-diabetic and diabetic humans.
• Project 3 - Microorganisms & Diabetes
  We are testing the idea that recent advances in public health, including water and food sanitation, antibiotics and immunizations, have reduced childhood exposures to microorganisms that previously protected from immunological diseases like type 1 diabetes.
  
  The complex bacterial community that resides in our intestines (our microbiome) is essential for normal function of our immune system so changes in early childhood exposures in recent decades could alter immune responses.  Using special strains of animals that spontaneously develop type 1 diabetes with high frequency, we found that the composition of the intestinal microbiome can dramatically change the probability that these animals will develop type 1 diabetes. 
  
  Our team uses state-of-the-art genomic, immunological and computational approaches to study the interplay of susceptibility genes for type 1 diabetes and exposures to intestinal bacteria both in rodent models and in the largest international cohort of children in the world with high genetic risk for type 1 diabetes. Our goals are to develop therapeutic strategies using exposures to normal bacteria (called probiotics) to prevent or delay type 1 diabetes in our rodent models by exposing young animals, and to develop these protocols for use in children with diabetes risk factors.