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Julia Greenstein Transcript

Nov 25, 2017

To see this interview in full, click here.

Steve Freed: This is Steve Freed. We’re here at the American Diabetes Association 77th Scientific Studies and we’re here to present you some exciting interviews with some of the top endos from all over the world and it’s Dr. Greenstein and maybe you can give us a little history and talk about who you are and what you do.

Julia Greenstein: Sure, I’ve been at JDRF for about ten years. Prior to that I spent a lot of time in the biotech industry and as well in academic medicine, and I’m in charge of setting the tragedy across our cure and prevent portfolio, helping our teams make critical decisions about what JDRF will fund and how we’ll build our programs.

Steve Freed: So, let me ask you a couple of questions. You know with some of the new research, theories, and pathways you’ve heard about this week over here at ADA, how do they fit into the JDRF’s strategic plans for research? Anything new JDRF that might pursue based on what you have seen and learned this week?

Julia Greenstein: So, there’s a ton of exciting science going on in both type 1 and type 2 diabetes and we’re really excited about the more complete understanding we’re starting to get about the pathways involved in beta cell biology that can help a person with type 1 diabetes. It turns out that beta cell stress as well as the immune system are contributing to the pathways of initiating and continuing the destruction of the beta cells in type 1 and that gives us an opportunity to both look for pathways and therapies that could eliminate the beta cell stress. It also gives us the opportunity to understand better the autoimmune response and find ways to inhibit that.

Steve Freed: I always find it interesting because there’s so many studies going on. If you look back 50 years, how many studies did we have? And if you look at today, all the studies, we are seeing so many changes and so rapid in this day of new technology. I just saw a fellow who is here now, his CGM, which is half the price of the one that’s in the market place right now, is supposed to be even more accurate. The products are just unbelievable out there, you know for type 1 diabetes and even for type 2. I had spoken to another researcher while we’ve been here and they’re doing work on preventing diabetes. Not curing it, but preventing it so that you guys would be out of a job in 50 years. Okay.

Julia Greenstein: Well that’s our role. We want to put ourselves out of business.

Steve Freed: You know so there’s studies on helping to, you know, reduce the risk from all the complications from type 1 diabetes and now there’s studies they actually prevent diabetes. You wouldn’t call that a cure because it’s not going to help those people that already have it.

Julia Greenstein: Right.

Steve Freed: You know so what do you see out there that you think, that you feel is going to be possibly very successful?

Julia Greenstein: So, JDRF has really built up a portfolio in the area of prevention. I’m an immunologist by training and it’s easier to inhibit an immune response before it starts than it is after it starts and so we’re very interested in doing both, right? We understand that we have to treat people with type 1 diabetes, then that means interrupting an ongoing immune response. But if we can get into people before they start responding to their beta cells, we think it will be very much easier to deflect the immune system, so to speak. And we’re learning about what kinds of things the beta cell does that actually may trigger the immune response that causes type 1. And so it’s potential that we can inhibit that beta cell stress without even bothering an immune response control element in people for prevention and so we’re starting to learn about staging of type 1 diabetes. JDRF was instrumental in pulling together key opinion leaders and other societies engaged in type 1 diabetes research and we now have 3 stages of type 1: people who are autoantibody positive that still don’t have a beta cell defect or dysglycemia. Those people have type 1 diabetes if they have two separate autoantibodies. They will over the course, at least in children, over the next 5 to 10 years, get a diagnosis of clinical type 1 diabetes and so that gives us a patient population to start testing some potential interventions and we’re very excited about that.

Steve Freed: Now one of the results you’re presenting here is the Gleevec (imatinib) I guess. Something like that, study. Maybe you can give us a little bit of information about that.

Julia Greenstein: So Gleevec is a really interesting drug. It’s actually a drug that comes from the cancer field. It actually is a cure for CML and one of our basic science researchers found actually now almost 7 years ago that Gleevec had an effect both on the beta cell and on the immune response, and in an animal model of type 1 diabetes, could prevent or even reverse type 1. And so together with that investigator, JDRF elected to start a clinical trial in people with recent onset type 1 diabetes to see whether this cancer drug would have an impact on the immune response and on the beta cell in a person who has recent onset. And the results are getting presented this afternoon and we’re very excited that they’ve seen a signal in that population of individuals. Now it’s still very early day in terms of its data analysis, but it’s clear that we have prolonged what’s considered the “honeymoon period.” So there is some impact on the beta cell function and people who have type 1 diabetes, if they can maintain a little bit of beta cell function, we feel that there will be a clinical benefit in making it easier to control their diabetes. So again, as Aaron eluted to, a step to that cure. If we can make it easier for people, decrease the burden of resent onset type 1 diabetes, that gives us one clinical handle and then we can optimize the use of this drug and in combination with other drugs and hopefully have a more substantial clinical impact.

Steve Freed: Well you know I always felt, when I sit down with a type 1 patient, I say it’s really critical that you take care of yourself. That you monitor your blood sugars, you take your medicine when you need to, eat a healthier diet, be more physically active. If you can do that for the next ten years, you won’t have to worry about it anymore because hopefully we’ll have a cure by then. But god forbid you lose your kidneys and your eyesight and your limbs and they come out with a cure the next day, there’s nothing they can do, so you need to work hard and have a better life so when they do have a possible cure, that you’re going to be able to benefit from it.

Julia Greenstein: I mean that’s JDRF’s current strategy. We need to keep people with type 1 diabetes healthy. We have to make their lives easier. We have to make it easier for them to achieve the clinical goals that their physicians want them to achieve and we have to continue to fund enough work so we can prevent and cure this disease in the future.

Steve Freed: You know I was always mystified by the name that you gave to your organization, “Juvenile Diabetes.” When somebody hears that title they think well it has to do with kids, but we’re seeing much more from older people that get type 1 diabetes. So, any consideration in changing your name?

Julia Greenstein: Well you know it has been discussed but people recognize JDRF. It’s why we’ve gone to referring to ourselves as JDRF rather than sort of saying out “Juvenile Type 1 Diabetes Research Foundation.” But you know we’re now seeing 50% probably of diagnosis, first diagnosis, is in people over 18, so you’re right it’s not just a disease of children. It was certainly started by two moms of kids with type 1 diabetes and we’re probably even underestimating that because we hear stories all the time of people, especially adults, being misdiagnosed at the beginning. Type 1 and type 2 are really hard to diagnose in the adult population and that’s another important thing that our researchers are working on is trying to help the physicians diagnose type 1 and type 2 better.

Steve Freed: I want to thank you for your time.

Julia Greenstein: Thank you.

Steve Freed: Certainly I always find it interesting. You guys are at the head of motivating people to do more research and hopefully the NIH won’t drop all their funds or at least cut it in half. We’ll see what’s going to happen soon.

Julia Greenstein: Well we look forward to working forward with the NIH and with other government organizations like it.

Steve Freed: Well thanks again. Enjoy your time here.

Julia Greenstein: Thank you.