Jamie L. Felton, MD, was at a higher risk of developing Type 1 diabetes from the moment she was born.
Type 1 diabetes is an autoimmune disease, so there’s a higher risk for relatives of those who have the disease to also develop it. Felton’s father had it, so the family knew she was at higher risk. Knowing this, her family found an opportunity for her to participate in a Type 1 diabetes prevention trial, one of the first of its kind, at the Barbara Davis Center for Diabetes in Colorado.
Felton's parents explained that not only could the prevention trial potentially prevent her from developing Type 1 diabetes, but that anything learned from it could be used to help others by giving researchers a greater understanding of the disease.
During the trial's screening process, it was found that Felton had diabetes-related antibodies, now used to predict the development of the disease. Unfortunately, Felton’s disease progressed and she was diagnosed with diabetes, meaning she wouldn’t be able to continue participating in the trial.
The experience wasn't for nothing, though.
"Diabetes was introduced to me in a personal way through a lens of prevention, and that perspective has shaped my career," said Felton, an assistant professor of pediatrics at the Indiana University School of Medicine.
Felton always had a love for science growing up. She also had a close relationship with her childhood endocrinologist. For those reasons and her trial experience, she set her sights on pursuing medicine relatively early.
Attending medical school had always been her goal. Knowing this, Felton actually studied French at Davidson College while completing pre-med requirements. She was pushing herself, in a way, seeing if there was anything else she'd like to pursue aside from medicine. Ultimately, she was accepted into a program at the University of Texas Health Science Center at San Antonio.
However, she had a brief detour between Davidson and medical school. Her family had relocated from Colorado to Washington state and, because she hadn't been able to visit much in college, she wanted to spend some time closer to them.
She sought out work in Seattle and reached out to the University of Washington’s Diabetes Research Center, specifically Jerry P. Palmer, MD, its director.
Palmer, known internationally for his work as a diabetes researcher and for founding the Diabetes Care Center at UW, responded and asked Felton to call him. They spoke and Palmer offered her a position as a research technician in his lab.
"That's really where my introduction to diabetes immunology happened," Felton said. "He was really influential and supportive of the transition to medical school."
Felton went from medical school to a residency at the University of North Carolina, a return to the Tar Heel State, and on to a fellowship at the Vanderbilt University Medical Center.
Felton was interested in continuing down the path of research once her fellowship concluded, wanting to find the right environment as she began her career. One spot that kept popping up throughout her work was the IU School of Medicine.
She'd consistently heard about the support for research, diabetes research in particular, at IU and had the opportunity to meet faculty members like Carmella Evans-Molina, MD, PhD; Emily K. Sims, MD; and Linda A. DiMeglio, MD, MPH, at meetings during her fellowship.
Toward the end of her fellowship, it was suggested that Felton should reach out to DiMeglio. She found that the IU School of Medicine had just about everything she was looking for, and joined the faculty in 2018.
One of Felton's proudest achievements at the IU School of Medicine is getting the teplizumab infusion program up and running.
Teplizumab is a monoclonal antibody to CD3, a type of T-cell, given to patients over the course of 14 days. When diabetes-related antibodies, the same ones found in Felton during her first trial experience, are found in a patient, teplizumab can be given and has been shown to delay the onset of diabetes.
Bringing teplizumab, the first treatment approved to delay the onset of Type 1 diabetes, to IU required coordination between the infusion center and pharmacists. The first infusion, coordinated by Felton, took place in July 2023.
"I had the opportunity to make that happen," Felton said. "Being able to be a part of that, to advocate for that patient, I’m really proud of that."
Felton believes there are opportunities to modulate the immune system, similar to teplizumab, during different stages of disease progression. Her current work focuses on B-cells, believing alternative therapies could be developed that are more effective than current methods.
"Ultimately the goal is to develop something that can be given to individuals who are at risk of developing diabetes that results in them never having to deal with diabetes," Felton said.
It's that kind of research that has generated optimism in the field, Felton said. More work is being done every day, and she can feel the energy going into it.
Immune system modulation has been a long-term project, with the earliest studies of teplizumab taking place in the 1990s. Now, with the first agent's FDA approval in the rearview mirror, researchers like Felton have been invigorated to look for further opportunities for immune modulation.
Preventing the disease altogether is Felton's goal, with recent developments in immune modulation giving her, and others, hope for the future.
"Right now, it's a really exciting time to be living and working in the Type 1 diabetes space. Paradigms for how we diagnose and manage the disease are changing in real time," Felton said. "It's a privilege to be a small part of that change."
