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Review
. 2021 Nov 5:12:764138.
doi: 10.3389/fendo.2021.764138. eCollection 2021.

Unravelling Checkpoint Inhibitor Associated Autoimmune Diabetes: From Bench to Bedside

Linda Wu  1   2   3   4 , Venessa H M Tsang  2   4 , Sarah C Sasson  4   5   6 , Alexander M Menzies  4   7   8 , Matteo S Carlino  4   8   9 , David A Brown  1   4   5   6 , Roderick Clifton-Bligh  2   4 , Jenny E Gunton  1   3   4
Affiliations
Review

Unravelling Checkpoint Inhibitor Associated Autoimmune Diabetes: From Bench to Bedside

Linda Wu et al. Front Endocrinol (Lausanne). .

Abstract

Immune checkpoint inhibitors have transformed the landscape of oncological therapy, but at the price of a new array of immune related adverse events. Among these is β-cell failure, leading to checkpoint inhibitor-related autoimmune diabetes (CIADM) which entails substantial long-term morbidity. As our understanding of this novel disease grows, parallels and differences between CIADM and classic type 1 diabetes (T1D) may provide insights into the development of diabetes and identify novel potential therapeutic strategies. In this review, we outline the knowledge across the disciplines of endocrinology, oncology and immunology regarding the pathogenesis of CIADM and identify possible management strategies.

Keywords: diabetes mellitus; immune checkpoint inhibitor (ICI); immune related adverse events; immunotherapy; type 1 diabetes.

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Conflict of interest statement

AM has served on advisory boards for BMS, MSD, Novartis, Roche, Pierre-Fabreand QBiotics. MC is an advisory board member for Amgen, BMS, Eisai, Ideaya, MSD, Nektar, Novartis, Oncosec, Pierre-Fabre, Qbiotics, Regeneron, Roche, Merck and Sanofi, and received honoraria from BMS, MSD, and Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of common differentials for ICI related hyperglycemia.
Figure 2
Figure 2
Proposed Pathogenesis of Checkpoint Inhibitor Associated Autoimmune Diabetes (CIADM).
Figure 3
Figure 3
Proposed diagnostic criteria and initial investigations in patients presenting with hyperglycaemia after immune checkpoint inhibitor use. GCS, Glasgow coma scale; BP, blood pressure; BGL, blood glucose level; ABG, arterial blood gas; HCO3-, serum bicarbonate; K+, serum potassium; TFTs, thyroid function tests.
See this image and copyright information in PMC

References

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