Two-Decade Dedication

Q & A with Dr. Bill Hagopian and Michael Killian: Two-Decade Dedication

• Millions of samples from blood draws to baby teeth.
• Dedicated staff for 26 years.
• Thousands of families bringing their children in from age 3 months to age 15.
• Dozens of insights that change how a devasting disease is treated.

This is work of Bill Hagopian, MD, PhD, and Michael Killian, Clinical Research Manager, in PNRI’s Hagopian Lab that focuses on type 1 diabetes.

Bill and Michael lead PNRI’s groundbreaking projects, the TEDDY and CASCADE studies, and share how their passion for discovery has fueled them for over two decades working together. These initiatives are not just about understanding type 1 diabetes but also preventing it. From tracking thousands of children for twenty years to developing early screening methods, their work is setting new standards in diabetes research.

We asked Bill and Michael about their exciting research to unravel the mysteries of type 1 diabetes. Here’s what they had to say. 

Q: What is the focus of your lab? 

Bill: Our lab is dedicated to understanding and preventing type 1 diabetes. We’re particularly focused on using immunology and molecular biology to predict who’s at risk and finding ways to stop the disease from progressing to the point where it becomes clinically apparent. 

Our lab is part of the TEDDY Study, which is an international collaboration with six other labs worldwide launched 20 years ago. TEDDY, which stands for “The Environmental Determinants of Diabetes in the Young,” is a large-scale research project aimed at identifying environmental triggers of type 1 diabetes in children. 

For two decades, TEDDY has been following 8,000 children with a high genetic risk for type 1 diabetes, tracking them from birth until they’re 15 years old to see if we can pinpoint what factors might cause the immune system to attack the pancreas, which is what happens in type 1 diabetes. This study is unique in its scale and scope and has been groundbreaking in identifying a wide range of factors—everything from vitamins and probiotics to specific viruses like enterovirus B—that can influence the autoimmune process leading to diabetes. One of the important outcomes of this work is the success we’ve seen in predicting and preventing diabetic ketoacidosis, a serious and potentially life-threatening complication that affects many children when they’re first diagnosed with type 1 diabetes.

Michael: Another major project in our lab is the CASCADE Study which focuses on screening children in Washington State for early markers of type 1 diabetes and celiac disease. If a child is found to be at increased risk, they are invited to a follow-up study for continued monitoring and education. The goal is to detect that risk as early as possible and help families manage potential health issues before symptoms become severe. 

Q: What sparked your interest in this work?

Bill: The mountain I chose to climb in my career is type 1 diabetes. I took a high school summer science program where I worked in a lab with a scientist who was doing mathematical modeling of blood glucose regulation. So, I was already in the diabetes area, even from high school. Then I explored biomedical engineering in college. But at the end of the day, I decided that engineering was maybe just a little too dry for me. I wanted to do something that would apply technology to medicine. And I really couldn’t decide whether I wanted to be a doctor or whether I wanted to be a scientist. So, I decided to become both. 

During my postdoc, I had the privilege of working with Åka Lernmark, a visionary Swedish scientist whose research focused on type 1 diabetes. Under his mentorship, I became deeply fascinated with the autoimmune aspects of the disease. In his lab, we identified Glutamic Acid Decarboxylase (GAD), leading to the first autoantibody assay. By then, I was hooked. I knew that type 1 diabetes research would be my life’s work.

But for me, it was never just about prediction. I wanted to go further and figure out how to prevent the disease. That’s where the real challenge and excitement lie—what do you do with this knowledge once you can predict it? Sure, by predicting, you can help people watch out for early signs, reduce the risk of dangerous complications like diabetic ketoacidosis, and generally prepare them better for what’s ahead. But like many others in the field, I wanted more—we wanted prevention.

And the science itself is fascinating—unraveling the complex interactions between genetics, the immune system, and environmental factors is like piecing together a puzzle that could have life-changing implications.

Michael: What really drew me to this work is the bigger picture. Yes, technology has made managing diabetes a lot easier, but there are still many people who struggle with the disease, even with the best tools available. Like Bill, the idea of prevention is what really hits home for me. Type 1 diabetes isn’t something you can just fix and move on from—it’s a lifelong commitment. The resources required to manage it are immense, and when we think about prevention, it’s not just about helping individuals avoid a tough diagnosis. It’s also about freeing up healthcare resources so they can be used elsewhere, which benefits society as a whole. That’s what really drives my passion for this work.

Q: What’s the most exciting thing happening in your lab right now?  

Michael: Reaching the final phase of collecting 20 years’ worth of samples from families for the TEDDY study is a monumental moment. It’s such a mix of emotions—pride, relief, and anticipation for what comes next. For two decades, we’ve been working together with families, gathering data that’s not just about numbers, but about their lives and stories. Every sample represents a family’s commitment to advancing our understanding of type 1 diabetes.

As we approach this final stretch, it’s incredible to think about the journey we’ve all been on. The long hours, the countless visits families have made, and the deep relationships formed—all of it has been leading to this. We’re on the cusp of unlocking insights that could have a profound impact on preventing type 1 diabetes, and that’s incredibly exciting. But it’s also a moment of reflection, recognizing the dedication of the families who stuck with us all these years and the researchers who’ve been relentless in their pursuit of answers.

Bill: I couldn’t agree more with Michael. This phase of the TEDDY Study is a testament to the power of collaboration and long-term vision in research. We’re not just closing a chapter; we’re setting the stage for new discoveries that could change the future of diabetes prevention.

To add to that, I’m very excited by the CASCADE Study as a significant step forward in our efforts to understand and prevent type 1 diabetes. By screening newborns in Washington State for early signs of both type 1 diabetes and celiac disease, we’re able to identify children at risk before symptoms even appear. This early detection is key—it gives us a chance to intervene sooner and potentially change the course of these diseases.

What excites me most about CASCADE is how it simplifies the process for families. Using leftover newborn screening blood samples, we can estimate a child’s risk without needing additional blood draws or appointments. This makes the process less invasive and more accessible, which is absolutely crucial for widespread adoption. It’s about making early screening a routine part of healthcare, ultimately improving outcomes for children at risk.

As we move forward, the insights we gain from CASCADE could lead to new prevention strategies, not just for type 1 diabetes but for other autoimmune conditions as well. This study represents a new frontier in pediatric care, one where we can use cutting-edge science to protect the health of future generations.

Q: How is your lab impacting science and medicine right now? 

Bill: Right now, both the TEDDY and CASCADE studies are making a significant impact on science and medicine. TEDDY, with its vast 20-year dataset, is giving us unprecedented insight into how type 1 diabetes develops over time, helping us identify early markers and potential triggers. This knowledge is crucial for developing preventive strategies.

Meanwhile, the CASCADE study is breaking new ground in early detection. By screening newborns for risk factors, we’re not only catching potential cases of type 1 diabetes and celiac disease early, but we’re also creating a model for proactive healthcare. Both studies are setting the stage for a future where we can intervene before these diseases fully take hold, which is a huge leap forward for patient care.

Q: How does working at an independent research institute benefit your work? 

Bill: Working at an independent research institute like PNRI is incredibly rewarding because it gives us the flexibility to take on long-term, high-risk projects that other institutions might shy away from. For instance, the TEDDY and CASCADE studies are both ambitious projects that require patience, innovation, and a willingness to explore new ideas. 

Knowing that our research could lead to a future where type 1 diabetes is no longer a life sentence is incredibly motivating. Every small breakthrough in the lab or clinic brings us one step closer to that reality. The support from the scientific community, the dedication of my colleagues, and the courage of the patients who participate in our studies all contribute to a strong sense of purpose. This work is challenging, yes, but it’s also deeply rewarding because of the potential impact it could have on so many lives. Doing this work at PNRI makes it possible.

Michael: It allows us to be more responsive to emerging research opportunities, like using new technologies to better understand type 1 diabetes or developing early screening methods that could change how we approach disease prevention. Being part of a place where we can push the boundaries of what’s possible in science is what makes our work so impactful.

Q: How can people support diabetes research?

Michael: Participating in clinical trials is one of the most impactful ways to support diabetes research. These studies are critical for testing new treatments and understanding type 1 diabetes—you’re directly contributing to the discovery of new treatments. 

Bill: Philanthropy is another vital piece, as research funding is always a challenge. It gives us the freedom to pursue high-risk, high-reward projects like the CASCADE study, where we’re exploring new frontiers in early detection and prevention of type 1 diabetes. Traditional funding often comes with specific constraints, but philanthropy allows us to be agile and responsive to emerging research opportunities. 

But don’t underestimate the power of awareness—talking about the importance of research and educating others can rally even more support for our efforts to tackle type 1 diabetes.

Q: How do you see the future of diabetes research? 

Bill: The future of diabetes research is incredibly exciting. With advances in technology, genomics, and immunology, we’re on the brink of major breakthroughs. We can now sequence entire genomes more affordably, pinpointing genetic risks with greater accuracy. Immunotherapy is also making strides, offering more effective treatments with fewer side effects. 

As personalized medicine becomes more prominent, we’re moving closer to tailored treatments and even prevention strategies. I’m optimistic that in the next decade, we’ll see transformative changes in how we treat and prevent type 1 diabetes.

Dive Deeper

Dive deeper into Dr. Hagopian’s and Michael’s work by listening to their podcast episode “Tracking Ghosts.” Connect with PNRI to learn more about the TEDDY and CASCADE studies and experience PNRI’s groundbreaking science in person.