Sequential Immune Modulation and Antigen-Specific Tolerance Induction for Disease Modification in Recent-Onset Type 1 Diabetes (MATIN-2)

May 20, 2026 updated by: Abdullah Kars

MATIN-2: Sequential Immune Modulation and Antigen-Specific Tolerance Induction for Disease Modification in Recent-Onset Type 1 Diabetes - A Mechanistic Framework and Phase I/II Protocol Proposal

This study tests a three-phase immune treatment for people recently diagnosed with Type 1 diabetes (within 6 months, with some insulin production remaining).

Phase 1 (weeks 1-2): Teplizumab, an anti-CD3 antibody, is given by infusion to slow immune attack on insulin-producing beta cells.

Phase 2 (months 2-9): Insulin is injected directly into a lymph node (intralymphatic immunotherapy, ILIT) alongside low-dose interleukin-2 to teach the immune system to tolerate insulin and expand protective regulatory T cells.

Phase 3 (months 10-24): Low-dose interleukin-2 is continued to maintain immune tolerance.

The main goal is to preserve the body's remaining insulin production (measured by C-peptide). Sixty adults aged 18-45 will be randomly assigned to the MATIN-2 protocol or standard care. Safety, immune markers, and HbA1c will also be monitored.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 18-45 years
  • Clinical diagnosis of Type 1 diabetes mellitus within 6 months of enrolment
  • Positive for at least one diabetes-related autoantibody (GAD65, IA-2, ZnT8, or IAA)
  • Detectable fasting or stimulated C-peptide ≥ 0.2 nmol/L
  • HbA1c ≤ 10% (86 mmol/mol)
  • Ability to provide written informed consent

Exclusion Criteria:

  • Prior immunosuppressive therapy within 3 months
  • Active or chronic infection (HIV, hepatitis B/C, tuberculosis)
  • Current or prior malignancy within 5 years (except non-melanoma skin cancer)
  • Pregnancy or breastfeeding
  • Severe renal impairment (eGFR < 30 mL/min/1.73m²)
  • Severe hepatic impairment (Child-Pugh C)
  • Known hypersensitivity to teplizumab or any excipient
  • Participation in another interventional trial within 30 days
  • Current systemic corticosteroid or immunomodulatory agent use
  • History of other autoimmune disease requiring immunosuppression
  • Absolute lymphocyte count < 1.0 × 10⁹/L
  • ALT or AST > 3× upper limit of normal
  • Haemoglobin < 100 g/L
  • Unwillingness to use contraception during study period

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: MATIN-2 Protocol
Three-phase sequential immunotherapy: teplizumab (Weeks 1-2), intralymphatic insulin immunotherapy + low-dose IL-2 (Months 2-9), maintenance low-dose IL-2 (Months 10-24)
Drug: Teplizumab
Anti-CD3 monoclonal antibody; 14-day IV infusion course at standard dosing (Days 1-14)
Biological: Intralymphatic Insulin Immunotherapy (ILIT)
Insulin antigen injected directly into inguinal lymph node; 3 injections at monthly intervals (Months 2-4) combined with low-dose IL-2
No Intervention: Standard Care
Conventional insulin therapy per standard clinical guidelines

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Stimulated C-peptide AUC
Time Frame: Baseline, 6, 12, and 24 months
Area under the curve of C-peptide response during mixed-meal tolerance test (MMTT); reflects residual beta-cell function
Baseline, 6, 12, and 24 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of Treatment-Emergent Adverse Events
Time Frame: Throughout 24 months
Safety assessment including serious adverse events, hypoglycaemia, and immune-related adverse events
Throughout 24 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Abdullah Kars

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

January 1, 2027

Primary Completion (Estimated)

December 31, 2029

Study Completion (Estimated)

June 1, 2030

Study Registration Dates

First Submitted

May 20, 2026

First Submitted That Met QC Criteria

May 20, 2026

First Posted (Actual)

May 27, 2026

Study Record Updates

Last Update Posted (Actual)

May 27, 2026

Last Update Submitted That Met QC Criteria

May 20, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • KHO-MATIN2-2026
  • CRD420261394024 (Registry Identifier: PROSPERO)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

De-identified individual participant data (IPD) will be shared upon reasonable request following publication of primary results. Data will include C-peptide measurements, immune marker profiles, HbA1c, and adverse event records.

IPD Sharing Time Frame

IPD will be available beginning 6 months after primary results publication, for a period of 5 years.

IPD Sharing Access Criteria

Researchers with a methodologically sound proposal may request access. Requests should be directed to the principal investigator (fly.pgs@hotmail.com). Data will be shared as de-identified datasets following execution of a data sharing agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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