TOPMAD Towards precision medicine in autoimmune diabetes through identifying signatures of beta-cell autoimmunity

A person’s own immune system can attack the insulin-producing beta-cells in the pancreas in several distinct ways, and this project aims to map those different attack routes for the first time. This matters because type 1 diabetes is currently treated as a single disease, but the immune attack that destroys beta-cells may vary from patient to patient. Without knowing which immune pathway is active, doctors cannot match treatments to the underlying cause. The researchers will study people with rare, extreme forms of autoimmune diabetes where the exact genetic trigger is already known. By comparing their immune profiles to those of people with standard type 1 diabetes, the team hopes to identify distinct “signatures” of beta-cell autoimmunity. If successful, this work could shift diabetes care from a one-size-fits-all approach toward precision medicine. Instead of broadly suppressing the immune system, future drugs could be targeted to block only the specific autoimmune pathway at work in a given patient. This is fundamental science with a clear translational goal: the signatures themselves are not treatments, but they would provide the diagnostic tool needed to design and test smarter, more personalised prevention strategies for type 1 diabetes.