Immune intervention in type 1 diabetes

Abstract

Type 1 diabetes (T1D) is a chronic autoimmune disease that results in the specific immune destruction of insulin producing beta cells. Currently there is no cure for T1D and treatment for the disease consists of lifelong administration of insulin. Immunotherapies aimed at preventing beta cell destruction in T1D patients with residual c-peptide or in individuals developing T1D are being evaluated. Networks of researchers such as TrialNet and the Immune Tolerance Network in the U.S. and similar networks in Europe have been established to evaluate such immunotherapies. This review focuses on immune intervention for the prevention and amelioration of human T1D with a focus on potential immune suppressive, antigen specific and environmental therapies.

Figure 1

Hypothetical stages and loss of beta cells in an individual progressing to type 1A diabetes. Reproduced with permission from Eisenbarth, GS. From www.barbardaviscenter.org

Figure 2

Pancreatic section from a type 1 diabetic pancreatic organ donor showing lobular destruction of insulin producing beta cells in islets. On the left, there are islets with beta cells stained for insulin while the islets on the right lack beta cells and insulin staining. The histology section comes from the JDRF nPOD program, www.jdrfnpod.org.

Figure 3

Anti-CD3 monoclonal antibody treatment delays loss of C-peptide in new onset patients with type 1 diabetes. From Herold et al Diabetes 54:1763-9, 2005.