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Regulatory T cells: Therapeutic Potential for Treating Transplant Rejection and Type I Diabetes
Published on: August 20, 2007
Current and future therapies for type 1 diabetes
Bernt Johan von Scholten1, Frederik F Kreiner1, Stephen C L Gough1
1Global Chief Medical Office, Novo Nordisk A/S, Søborg, Denmark.
Abstract:
In type 1 diabetes, insulin remains the mature therapeutic cornerstone; yet, the increasing number of individuals developing type 1 diabetes (predominantly children and adolescents) still face severe complications. Fortunately, our understanding of type 1 diabetes is continuously being refined, allowing for refocused development of novel prevention and management strategies. Hitherto, attempts based on immune suppression and modulation have been only partly successful in preventing the key pathophysiological feature in type 1 diabetes: the immune-mediated derangement or destruction of beta cells in the pancreatic islets of Langerhans, leading to low or absent insulin secretion and chronic hyperglycaemia. Evidence now warrants a focus on the beta cell itself and how to avoid its dysfunction, which is putatively caused by cytokine-driven inflammation and other stress factors, leading to low insulin-secretory capacity, autoantigen presentation and immune-mediated destruction. Correspondingly, beta cell rescue strategies are being pursued, which include antigen vaccination using, for example, oral insulin or peptides, as well as agents with suggested benefits on beta cell stress, such as verapamil and glucagon-like peptide-1 receptor agonists. Whilst autoimmune-focused prevention approaches are central in type 1 diabetes and will be a requirement in the advent of stem cell-based replacement therapies, managing the primarily cardiometabolic complications of established type 1 diabetes is equally essential. In this review, we outline selected recent and suggested future attempts to address the evolving profile of the person with type 1 diabetes.
Insights
Type 1 diabetes management is evolving beyond insulin. New strategies focus on protecting insulin-producing beta cells from immune attack and stress, aiming to prevent complications.
Area of Science:
- Immunology
- Endocrinology
- Metabolic Diseases
Background:
- Type 1 diabetes (T1D) management relies on insulin but fails to prevent severe complications in many patients, especially children and adolescents.
- Current immune suppression strategies have limited success in preventing the autoimmune destruction of pancreatic beta cells, the hallmark of T1D.
- Understanding T1D pathophysiology is advancing, necessitating novel prevention and management approaches.
Purpose of the Study:
- To review recent and proposed strategies for type 1 diabetes prevention and management.
- To highlight the shift towards beta cell-focused therapies.
- To address the management of cardiometabolic complications in established T1D.
Main Methods:
- Review of current literature on T1D pathophysiology and therapeutic strategies.
- Discussion of emerging beta cell rescue approaches, including antigen vaccination and drugs targeting beta cell stress.
- Consideration of autoimmune prevention and management of T1D complications.
Main Results:
- Immune suppression alone has not fully prevented beta cell destruction in T1D.
- Focus is shifting to protecting beta cells from inflammation and stress.
- Promising beta cell rescue strategies include oral insulin, peptide vaccines, verapamil, and GLP-1 receptor agonists.
Conclusions:
- Future T1D management requires a multi-faceted approach, including beta cell protection and addressing cardiometabolic complications.
- Antigen vaccination and beta cell protective agents represent promising therapeutic avenues.
- Continued research is crucial for refining T1D prevention and treatment strategies, especially for pediatric populations.
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