SHIELD-T1D: Shingrix and GLP-1 Agonist for Beta-Cell Preservation in Recent-Onset Type 1 Diabetes.

Summary

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by progressive destruction of pancreatic beta cells mediated by autoreactive T lymphocytes, resulting in absolute insulin deficiency. Preservation of residual beta-cell function at the time of diagnosis is a critical therapeutic window, as even marginal endogenous insulin secretion - reflected by detectable C-peptide levels - is associated with improved glycemic control, reduced hypoglycemia burden, and decreased long-term vascular complication rates.

This study evaluates the hypothesis that combinatorial immunomodulation - using the AS01B adjuvant system within the Recombinant Zoster Vaccine (RZV; Shingrix, GSK) alongside metabolic and cytoprotective support via a GLP-1 receptor agonist (semaglutide) - can synergistically preserve residual beta-cell function in adults within 100 days of T1D diagnosis. The AS01B adjuvant system activates innate immune pathways that promote regulatory T-cell (Treg) expansion and shift the immunological milieu toward tolerance, while GLP-1 receptor agonism provides direct beta-cell cytoprotection, reduces glucotoxicity, and may suppress autoimmune cytokine signaling.

SHIELD-T1D is a randomized, double-blind, placebo-controlled, parallel-group Phase II clinical trial enrolling 240 adults (18-50 years) diagnosed with T1D within 100 days, with confirmed residual beta-cell function (stimulated C-peptide ≥0.2 nmol/L). Participants are randomized 1:1:1:1 to one of four arms: (1) Shingrix alone, (2) Semaglutide alone, (3) Shingrix + Semaglutide combination, or (4) dual placebo. The primary endpoint is change in 2-hour stimulated C-peptide AUC during a Mixed Meal Tolerance Test (MMTT) from baseline to 12 months.

This phase II randomized, double-blind, placebo-controlled multicenter trial will evaluate the efficacy and safety of the recombinant zoster vaccine (Shingrix) and a glucagon-like peptide-1 (GLP-1) receptor agonist, alone and in combination, for preservation of residual beta-cell function in adults with recent-onset type 1 diabetes. The working hypothesis is that combining AS01 adjuvant-mediated immunomodulation with the metabolic and cytoprotective actions of a GLP-1 receptor agonist will provide dual protection for pancreatic beta cells, slowing autoimmune destruction and improving functional insulin secretion compared with placebo.

Conditions

• Type 1 Diabetes Mellitus

Interventions

DRUG

Recombinant Zoster Vaccine (Shingrix; RZV)

Intervention 1: Recombinant Zoster Vaccine (Shingrix; RZV) Drug/Biological: Recombinant zoster vaccine (lyophilized VZV glycoprotein E antigen 50 μg + AS01B adjuvant system \[MPL 50 μg + QS-21 50 μg in liposomal formulation\]). Dose: 0.5 mL intramuscular injection (reconstituted per manufacturer's instructions). Schedule: Two doses - Month 0 and Month 2 (8-week interval). Route: Intramuscular (deltoid, non-dominant arm preferred). Manufacturer: GlaxoSmithKline (GSK). FDA Status: Approved for herpes zoster prevention; use in T1D is investigational (IND required). Mechanism of Action: AS01B adjuvant promotes DC maturation, Th1 polarization, and regulatory T-cell induction via TLR4 (MPL) and saponin (QS-21) pathways

DRUG

Semaglutide (Ozempic®)

Drug: Semaglutide - GLP-1 receptor agonist (acylated GLP-1 analogue with 94% sequence homology to native GLP-1). Dose Escalation: 0.25 mg SC once weekly (Weeks 1-4) → 0.5 mg SC once weekly (Weeks 5-24 months). Route: Subcutaneous injection (abdomen, thigh, or upper arm; rotate sites). Manufacturer: Novo Nordisk. FDA Status: Approved for T2D; investigational use in T1D (IND required). Mechanism of Action: GLP-1 receptor agonism enhances glucose-dependent insulin secretion, inhibits glucagon, promotes beta-cell survival and proliferation, reduces ER stress, and suppresses pro-inflammatory cytokine-mediated apoptosis (IL-1β, IFN-γ, TNF-α).

DRUG

Placebo (saline injection)

Saline placebo administered as intramuscular injection (matching RZV volume 0.5 mL) at Months 0 and 2, and/or as subcutaneous injection (matching semaglutide volume) once weekly for 24 months. Used in control and single-active arms to maintain blinding.

Sponsors & Collaborators

• Ministry of Health, Saudi Arabia

  lead OTHER_GOV

Principal Investigators

• Amr Ahmed, MD, PhD · Ministry of Health, Saudi Arabia

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

50 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2027-01-01

Primary Completion

2028-01-31

Completion

2028-12-31

Countries

• Saudi Arabia

Study Locations