CASCADE (Cascade Kids newborn screening)
Pacific Northwest Research Institute (Hagopian lab) with the Washington State Newborn Screening Program
A Washington-state program that screens for Type 1 diabetes and celiac risk using leftover newborn-screening blood spots, so families get a risk estimate with no extra blood draw, no appointment, and no cost. Higher-risk children are invited into monitoring.
The scorecard
Uses a genetic risk score to enrich for high-risk infants, then confirms with islet-autoantibody testing; the genetic step alone is a probabilistic risk estimate, so autoantibody follow-up is what establishes near-certain pre-clinical T1D.[3]
Higher-risk children enter a follow-up monitoring study with repeat sampling and symptom education, the pathway that lets families catch progression early and avoid DKA at onset.[1]
Designed as true population screening from residual newborn cards (target 75,000 samples over five years) across Washington state, reaching infants regardless of family history; geographically confined to one US state.[1]
The initial screen reuses the leftover state newborn-screening blood spot, so there is no new blood draw, no appointment, and no cost; only higher-risk children give fresh samples for monitoring.[1]
Free and open to consenting Washington families during the study, but it is a time-limited feasibility project (NIH/CDC/JDRF-supported) tied to one state's newborn-screening system, not a permanent service.[2]
The full picture
CASCADE (Combined Antibody Screening for Celiac and Diabetes Evaluation, branded Cascade Kids) is a Washington-state program, led by the Pacific Northwest Research Institute in partnership with the state Newborn Screening Program, that tests for Type 1 diabetes (T1D) and celiac risk using blood that has already been collected. After a family consents, the program reuses the leftover dried blood spot from routine state newborn screening, so the first step costs nothing, needs no appointment, and adds no needle.
Screening works in two stages. A genetic risk score on the newborn spot enriches for the infants most likely to develop autoimmunity; those flagged as higher-risk are invited into a follow-up study that adds islet-autoantibody testing and ongoing monitoring. Genetic risk alone is only a probability, so the autoantibody step is what identifies children with near-certain pre-clinical T1D.
The goal is reach: by riding existing newborn-screening infrastructure, CASCADE aims to screen on the order of 75,000 samples over five years across the general population, not just families with a history. Children found to be at risk receive monitoring and symptom education, the route to catching progression before diabetic ketoacidosis. Supported by the NIH, CDC, and JDRF/Breakthrough T1D, it is a feasibility effort confined to one state rather than a standing national service.
What's next for this
- →Feasibility readout from up to 75,000 residual newborn blood-spot screens, informing whether genetic-plus-autoantibody screening can ride existing newborn-screening infrastructure at scale
Sources
- [1]TEDDY and CASCADE: Type 1 Diabetes Research Studies · manufacturer
- [2]Newborn Screening Research — CASCADE study · regulatory
- [3]Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective · peer-reviewed · 2022-01-01