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Diabetes type 1: Can it be treated as an autoimmune disorder?

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Abstract

Type 1 Diabetes Mellitus (T1DM) is characterized by progressive autoimmune-mediated destruction of the pancreatic beta-cells leading to insulin deficiency and hyperglycemia. It is associated with significant treatment burden and necessitates life-long insulin therapy. The role of immunotherapy in the prevention and management of T1DM is an evolving area of interest which has the potential to alter the natural history of this disease.

In this review, we give insight into recent clinical trials related to the use of immunotherapeutic approaches for T1DM, such as proinflammatory cytokine inhibition, cell-depletion and cell-therapy approaches, autoantigen-specific treatments and stem cell therapies. We highlight the timing of intervention, aspects of therapy including adverse effects and the emergence of a novel lymphocyte crucial in T1DM autoimmunity. We also discuss the role of cardiac autoimmunity and its link to excess CVD risk in T1DM.

We conclude that significant advances have been made in development of immunotherapeutic targets and agents for the treatment and prevention of T1DM. These immune-based therapies promise preservation of beta-cells and decreasing insulin dependency. In their current state, immunotherapeutic approaches cannot yet halt the progression from a preclinical state to overt T1DM nor can they replace standard insulin therapy in existing T1DM. It remains to be seen whether immunotherapy will ultimately play a key role in the prevention of progression to overt T1DM and whether it may find a place in our therapeutic armamentarium to improve clinical outcomes and quality of life in established T1DM.

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Authors and Affiliations

  1. Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece

    Natalia G. Vallianou & Eleni Geladari

  2. Department of Endocrinology, Diabetes and Metabolic Diseases, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece

    Theodora Stratigou

  3. Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Athens, Goudi, Greece

    Theodora Stratigou & Maria Dalamaga

  4. Endocrinology Section, VA Boston Healthcare System, 1400 VFW Parkway West Roxbury, Boston, MA, 02132, USA

    Christopher M. Tessier & Christos S. Mantzoros

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  1. Natalia G. Vallianou
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  2. Theodora Stratigou
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  4. Christopher M. Tessier
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  5. Christos S. Mantzoros
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  6. Maria Dalamaga
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Contributions

Natalia Vallianou, MD, PhD was responsible for originating the idea for the manuscript, concept development, writing parts of the manuscript and Table, revisions, and final review. Theodora Stratigou, MD, PhD was involved in writing parts of the manuscript, revisions, Table and final review. Eleni Geladari, MD, PhD was responsible for writing parts of the manuscript, revisions, Table and final review. Christopher M Tessier, MD contributed to writing pars of the manuscript, revisions, final review and submission. Christos Mantzoros, MD, DSc, PhD h.c. mult was responsible for concept development, manuscript organization, writing parts of the manuscript, revisions and final review. Maria Dalamaga, MD, MSc, MPH, PhD contributed to manuscript organization, writing parts of the manuscript, revisions, concept development, and final review.

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Correspondence to Christopher M. Tessier.

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Key points

• T1DM is characterized by progressive autoimmune-mediated destruction of β-cells

• Immunotherapy may preserve β-cells and decrease insulin dependency

• At present, immunotherapy cannot halt the progression from preclinical to overt T1DM

• Cardiac autoimmunity may be linked to excess CVD risk in T1DM.

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Vallianou, N.G., Stratigou, T., Geladari, E. et al. Diabetes type 1: Can it be treated as an autoimmune disorder?. Rev Endocr Metab Disord 22, 859–876 (2021). https://doi.org/10.1007/s11154-021-09642-4

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  • DOI: https://doi.org/10.1007/s11154-021-09642-4

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