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Treatment of type 2 diabetes by targeting interleukin-1: a meta-analysis of 2921 patients

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Abstract

With obesity and type 2 diabetes prevalence steadily increasing and no effective means in sight to support the population in obtaining and maintaining stable weight loss, there is an imminent need for pharmacological therapy to treat and prevent type 2 diabetes. Current anti-diabetic treatment is symptomatic, and very few drugs have both a strong preclinical rationale and clinical proof-of-principle as therapies targeting pathogenic processes in type 2 diabetes. The emerging appreciation of low-grade inflammation as a significant cause of insulin resistance and beta cell failure warrants exploring anti-inflammatory compounds as drug candidates. Since recent studies have demonstrated considerable phenotypic heterogeneity in the type 2 diabetic syndrome, the concept of one drug fits all is naïve, and biomarkers for the selection of type 2 diabetes subtypes for differentiated treatment based on genetic and pathogenic stratification are urgently needed. Biologics antagonizing the master pro-inflammatory cytokine interleukin-1 is one of the few principles specifically targeting low-grade inflammation in type 2 diabetes. Although early phase II studies were encouraging, subsequent underpowered studies and phase III studies designed primarily with cardiovascular endpoints have discredited the potential of anti-interleukin-1 approaches to treat the subgroup of patients that may benefit from this treatment. In this meta-analysis of 2921 individuals from eight phase I–IV studies, we demonstrate a significant overall HbA1c-lowering effect of interleukin-1 antagonism. Meta-regression analyses demonstrated a significant correlation between baseline C-reactive protein and C-peptide, and HbA1c outcome. The identification of further biomarkers for future clinical trials to define the potential of anti-interleukin-1 therapies in type 2 diabetes is urgently needed.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston University School of Medicine, 670 Albany Street, Boston, MA, 02118, USA

    Yachana Kataria

  2. Department of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Christina Ellervik

  3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, 2200, Copenhagen, Denmark

    Christina Ellervik

  4. Data and Development Support, Region Zealand, Alleen 15, 4180, Sorø, Denmark

    Christina Ellervik

  5. Department of Biomedical Sciences, University of Copenhagen, 3 Blegdamsvej, Copenhagen, Denmark

    Thomas Mandrup-Poulsen

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  1. Yachana Kataria
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Correspondence to Thomas Mandrup-Poulsen.

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This article is a contribution to the special issue on Inflammation and Type 2 Diabetes - Guest Editor: Marc Y. Donath

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Kataria, Y., Ellervik, C. & Mandrup-Poulsen, T. Treatment of type 2 diabetes by targeting interleukin-1: a meta-analysis of 2921 patients. Semin Immunopathol 41, 413–425 (2019). https://doi.org/10.1007/s00281-019-00743-6

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