Grace C. Nickel

Background: Interventions to prevent type 1 diabetes (T1D), an immune-mediated disease requiring lifelong treatment, remain limited. We sought to identify novel therapeutic targets for T1D through Mendelian randomization and colocalization using immune cell-derived instruments. Methods: We selected locally acting genetic variants from 14 transcriptomic studies to instrument expression of 8998 genes measured in immune cell types. Outcome associations were obtained from a T1D genome-wide association study that included 18,942 cases and 501,638 controls. Follow-up analyses included assessments of horizontal pleiotropy and novelty, as well as phenome-wide scans with colocalization (PheWAS-coloc) of instrumental variants. Results: We prioritized 21 genes ( CLNK , EED , LZTFL1 , MGAT4A , NAA38 , NFKB1 , PHACTR4 , PHLPP2 , PLEKHA1 , P2RY12 , REST , RGS14 , SERPINB6 , SESN3 , SLC25A29 , SPAG1 , STIM2 , THEMIS , TMEM80 , VSIR , ZNF217 ) that have not been identified in previous T1D genome-wide association studies. Notably, higher genetically predicted VSIR (encoding the immune checkpoint protein VISTA) was associated with decreased risk of T1D, providing human genetic support that complements existing animal-model evidence for VISTA’s protective role in autoimmune diseases. We also prioritized P2RY12 , which is targeted by several approved drugs, revealing a possible repurposing opportunity. PheWAS-coloc analyses further linked P2RY12 expression to Epstein-Barr virus EBNA-1 antibody levels, implicating a pathway relevant to autoimmunity. Conclusions: Our findings provide novel avenues for drug development and repurposing to prevent or delay T1D onset.

This piece critiques the exclusion of healthcare practitioners (HCPs) from the digital health innovation process. Drawing on “Sync fast and solve things—best practices for responsible digital health” by Landers et al., the editorial argues for the importance of inclusive co-creation, in which clinicians play an active role in developing digital health solutions. It emphasizes that without the meaningful involvement of HCPs, digital health tools risk being clinically irrelevant.