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Antibody screening in a population of children
M R Batstra1, G J Bruining, H J Aanstoot
1Erasmus University Medical School and Sophia Children's Hospital, Department of Pediatrics, Rotterdam, The Netherlands. Batstra@kgk.fgg.eur.nl
Insights
Large-scale trials for insulin-dependent diabetes mellitus (IDDM) are underway. Further research is needed to understand beta-cell autoimmunity and enable population-wide prediction for prevention.
Area of Science:
- Endocrinology
- Immunology
- Public Health
Background:
- First-degree relatives of patients with insulin-dependent diabetes mellitus (IDDM) are participating in large-scale intervention trials.
- Data from these trials may soon indicate the possibility of intervention, potentially extending to the general population.
Purpose of the Study:
- To review challenges in initiating large-scale IDDM intervention studies in the general population.
- To analyze the natural course of beta-cell autoimmunity and its implications for IDDM prediction.
- To assess the feasibility and potential impact of population-based IDDM prediction and screening.
Main Methods:
- Review of existing data and literature on IDDM natural history and prediction.
- Analysis of challenges in population-based prediction for IDDM.
- Discussion of the need for further research into predictive markers, natural course, psychosocial impact, and cost-effectiveness.
Main Results:
- While long-term population studies are limited, prediction for IDDM in the general population appears technically feasible and potentially powerful for prevention trials.
- Significant knowledge gaps exist regarding the natural course of beta-cell autoimmunity.
Conclusions:
- Initiating large-scale IDDM intervention studies requires addressing several challenges, notably understanding beta-cell autoimmunity.
- Population-based prediction for IDDM is feasible and crucial for developing effective prevention strategies.
- Further research is essential to identify optimal prediction markers and evaluate the broader impact of screening.
Abstract:
The first large-scale (secondary) intervention trials have been initiated in first-degree family members of patients with insulin-dependent diabetes mellitus (IDDM). Within a few years, data from these studies may suggest that intervention is possible, thereby opening similar approaches in the general population. However, before large-scale intervention studies can be initiated, several problems need to be solved. One of these problems is the lack of knowledge on the natural course of beta-cell autoimmunity. This review analyses this and other issues related to population-based prediction for IDDM. At present, no long-term follow-up studies are available in large-sized populations, but data show that prediction in the general population is both technically feasible and likely to have sufficient power to be useful in prevention trials. More data need to be generated, not only to determine which markers are most likely to give good prediction but also to obtain knowledge on the natural course, psychosocial impact and cost-effectiveness of screening.