For patients living with diabetes, complications can persist even when the disease is well-controlled with synthetic insulin and monitoring. Treatments that intervene at the genetic level to reverse complications have the power to bring healing. At City of Hope, we are developing novel interventions, built on our expertise in understanding the complex genetic modifications that cause complications.
 
City of Hope is home to diabetes experts from all over the world, who are studying genetic and epigenetic signatures in patients, using data from the most well-known, longest-ranging diabetes clinical trial.
 
Results from recent studies will help us identify which prediabetic patients are at high risk for developing the disease, and which patients will develop debilitating complications. This information will lay the groundwork for using precision medicine approaches to help patients coping with, or at risk for, type 1 diabetes.
 
Of particular importance is our research in metabolic memory, a phenomenon in which cells “remember” diabetes and act like they are still diseased, even after normal glucose levels are achieved. Molecular changes that create metabolic memory could be caused by epigenetic mechanisms.
 
The field of epigenetics provides crucial understanding about the ways that changes to genes caused by environmental factors drive disease, specifically chemical modifications on DNA and surrounding proteins that can alter the ways in which genes are expressed, even without the gene itself experiencing a mutation.
 
This means that harmful complications can persist — and that patients are in need of prevention and interventions that address metabolic memory specifically. Understanding epigenetic mechanisms and their contribution to the persistence of diabetic complications is critical because it could suggest alternative targets for therapy to halt and reverse complications.
 
Landmark research published by City of Hope researchers showed, for the first time, a connection between complex epigenetic mechanisms, blood glucose levels and diabetic complications in patients with metabolic memory. This research provides direction for novel therapies to address complications and their prevention.