Immunotherapy-Based Strategies for the Treatment of Autoimmune Diabetes: Searching for the Cure

Brett      E. Phillips; Massimo      Trucco

Abstract

Type 1 Diabetes is an autoimmune disease most often associated with elevated and uncontrolled blood glucose levels. Therefore patient education and treatment compliance is often focused on disease maintenance through insulin treatment and blood glucose control. Unfortunately insulin therapy alone does not prevent the formation of diabetic complications. In order to find a real cure, the underlying pathology of the disease must be directly addressed. Diabetes is caused by the initial rapid destruction of the insulin producing beta cells of the pancreas by autoreactive T-cells. The autoimmune process is also maintained through dendritic cell auto-antigen presentation and the production of autoantibodies by B cells. Only through some forms of immunotherapy can the immune system be rebalanced to assure the survival of the remaining beta cell population. These techniques include cell ablation, competitive decoy auto-antigens, reduced cell activation, and auto-antigen introduction. Here we will review the current state of these different technologies and their progression through clinical trials for the treatment of type 1 diabetes.

Keywords: Autoimmune Disease, Type 1 Diabetes, Immunotherapy, dendritic cells (DC), antigen-presenting cells (APC), antigen tolerance, Altered peptide ligands (APL), cell depletion, insulin, anti-inflammatory cytokines