Vaccines For Type 1 Diabetes: Prevention or Reversal?

Abstract

: Type 1 diabetes mellitus (T1DM) is an autoimmune disease which leads to destruction of pancreatic β-cells, thereby causing insufficient insulin production. Globally, around 98, 200 children and adolescents below 15 years of age and almost 128,900 subjects below 20 years of age develop T1DM annually, along with severe complications deteriorating their quality of life. In India alone, around 15,900 incident cases below 15 years have reported annually. Hence, its prevention and reversal are significant. Unlike other chronic diseases, T1DM involves the presence of various autoantigens which can be targeted by proper immunisation. The development of reliable immuno-regulatory surrogate markers would be of a great benefit. Vaccines can be one of such strategies in the journey to prevent T1DM. It would not only benefit greatly to reduce the sufferings caused due to diabetic complications but could also help to reverse T1DM, by modulating the immunological autoantigenic reactions and prevent further degradation of pancreatic β-cells. This review collates a wide range of information related to the vaccine studies conducted in animal and human models to prevent and reverse T1DM.

Oral delivery of the intracellular domain of the insulinoma-associated protein 2 (IA-2ic) by bacterium-like particles (BLPs) prevents type 1 diabetes mellitus in NOD mice

“…Current treatment of T1DM mainly focuses on administration of exogenous insulin and improvement of eating habits, in combination with regular physical exercise and sleep. As one of the three broad categories of anticipated emerging and future therapies for T1DM (Powers, 2021 ), protection of endogenous pancreatic β cells by immunomodulation may be achieved by the T1DM vaccine, which may suppress the onset of autoimmune responses against T1DM-associated autoantigens and/or interrupt these autoimmune responses through the establishment of immunological tolerance (Desai et al., 2021 ). Induction of antigen-specific immune tolerance by oral vaccination with antigen-based vaccines has been widely tried to delay or prevent the onset of T1DM (Mao et al., 2020a , 2020b ).…”

“…It is noted that autoantibodies occur before the clinical onset of T1DM and this progression reflected by β-cell loss could take months or years. Thus, as a predictable disease (Simmons & Michels, 2015 ), the T1DM vaccine may be designed and applied to prevent and/or interrupt the autoimmune response against the above T1DM-related autoantigens by reinstating immunological tolerance to them, and finally, preventing and/or reversing T1DM (Desai et al., 2021 ). For this purpose, the above-mentioned oral tolerance therapy may represent a promising strategy.…”

Leverage biomaterials to modulate immunity for type 1 diabetes

“…By controlling the autoantigen immune response and halting further degeneration of pancreatic β-cells, vaccines have been demonstrated clear advantages in immunotherapy. It can not only significantly lessen the pain brought on by diabetes complications but even help reverse diabetes ( 18 ). Inflammation is a major contributor to T1D, hence, strategies for reducing or eliminating inflammation are frequently used in the vaccine selection and formulation process.…”

“…To restore the immune tolerance of the pancreatic microenvironment, it is essential to induce the expansion of Tregs ( 10 ). Autoantigen-based vaccines such as insulin and GAD 65 peptides could induce autoantigen-specific Tregs to treat T1D ( 18 ).…”

BCG Vaccination Status and its Relationship to Islet Autoantibodies in Children with Type 1 Diabetes

“…Bacille Calmette--Guerin (BCG) vaccine is proposed to have a possible role in preventing or reversing type 1 diabetes (T1D) through its immunomodulatory effects on the islet cells. [ 1 ] However, experimental and clinical studies using BCG vaccination in T1D have shown conflicting results. While some studies showed favorable effects of BCG vaccination on T1D autoimmunity or clinical remission, others showed opposite results.…”