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Immune Intervention in Children with Type 1 Diabetes

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Abstract

Not only T cells but also B cells play a role in the autoimmune process. Both monoclonal antiCD3 and antiCD20 antibodies seem efficacious. However, such treatments need to be refined to minimize adverse events. Use of autoantigens to create tolerance is a concept with great potential. GAD65 treatment has shown efficacy without adverse events thus far, and administration of the insulin B chain shows interesting immunologic effects. Other more or less speculative approaches to modulate the immune process need further studies with good design. Risks that are too serious cannot be motivated. In addition, as the β cells may die even though the autoimmune process is stopped, protective measures may be valuable (eg, active insulin treatment, and perhaps interleukin-1 receptor antagonists to reduce the nonautoimmune inflammation). Combination of immune intervention, protection of the β cells, and stimulation of regeneration may lead to a milder disease or even a cure in the future, and prevention is no longer unrealistic.

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Acknowledgments

Some immune intervention studies mentioned above, performed in Linköping, have been supported by the Swedish Child Diabetes Foundation (Barndiabetesfonden), the Swedish Research Council, the County Council of Östergötland, and the Regional Research Council (FORSS). A number of dedicated biomedical technicians and diabetes research nurses, as well as pediatricians, should be acknowledged.

Disclosure

Diamyd Medical has been/is a sponsor for the phase 2/3 trials (with Johnny Ludvigsson as PI) and has also given financial support for the investigator-initiated mechanistic studies led by Johnny Ludvigsson. Diamyd Medical AB was involved in the planning of the phase 2 study, but thereafter, this study was performed completely free from the influence of funding sources, and the same is true for the phase 3 trials. Investigators had free access to the raw data and could publish without sponsor consent. Johnny Ludvigsson has also been advisor to both GlaxoSmithKline and Johnson & Johnson regarding use of mAbs.

The Linköping Diabetes Immune Intervention study group

This study group included the following: Johnny Ludvigsson, Rosaura Casas, Stina Axelsson, Mikael Chéramy, Maria Hjorth, and Mikael Pihl.

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  1. Department of Clinical and Experimental Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping University, SE 581 85, Linköping, Sweden

    Johnny Ludvigsson

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Correspondence to Johnny Ludvigsson.

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Ludvigsson, J., for The Linköping Diabetes Immune Intervention study group. Immune Intervention in Children with Type 1 Diabetes. Curr Diab Rep 10, 370–379 (2010). https://doi.org/10.1007/s11892-010-0138-y

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