Übersicht über aktuelle Studien zur Prävention und Immunintervention des Diabetes mellitus Typ 1

Abstract

Immunomodulatory strategies in the management of type 1 diabetes mellitus (T1DM) have as their primary target the prevention of initiating islet autoimmunity (primary-), the secondary one is the progression to diabetes (secondary-) in non-diabetic persons at risk, and the decline of beta-cell function in new-onset patients (tertiary-prevention). This article reviews four recent immunointervention trials in patients with T1DM. (1) The Pre-POINT study is a primary prevention trial that will test whether vaccination with oral or nasal insulin can prevent the progression of islet autoimmunity and of T1DM in autoantibody-negative children who are genetically at high diabetes risk. (2) The Cord Blood study is a tertiary immunointervention trial that will test whether administration of autologous umbilical cord blood to children with T1DM can lead to regeneration of pancreatic islet insulin-producing beta-cells and improved blood glucose control. (3) The GAD Vaccination study will test whether vaccination with alum-formulated rhGAD65 (recombinant human glutamic acid decarboxylate) can preserve beta-cell function in 320 children with newly diagnosed T1DM, as has been suggested in a recent phase II study. (4) The AIDA study will test the beta-cell protective effect of interleukin-1-receptor antagonist Anakinra in 80 patients with T1DM, which has recently been shown to improve beta-cell function in patients with type 2 diabetes.

Innovative Treatments in Diabetes Type 1

“…Most of them show some response, such as the reduction of insulin need and improved glycemic control; however the effects are usually transient and based a positive c-peptide level. To date, the highest response measured as cessation of insulin therapy after the treatment is observed in patients undergoing immunoablation with hematopoietic stem cell transplantation [24][25][26]. Immunoablation is based on applying high doses of immunosuppressive therapy that enable destruction of the immune system with autoimmune clones.…”

“…Another important approach is inducing pluripotent stem (iPS) cells to develop into beta cells similarly to human embryonic stem cells having the ability to become fully developed beta cells [27] Changes, which take place during the treatment lead to the halt of autoimmune reaction and lead to the remission of diabetes in the majority of cases. So far, data published by two group's states initial remission rates of over 95% [24,25]. In follow up, some of the patients revert to insulin, usually in smaller doses when compared to prior treatment.…”