Targeting the IL-17/IFN-γ axis as a potential new clinical therapy for type 1 diabetes

• Review of recent therapeutic clinical trials in T1D
• Evidence for targeting the IL-17/IFN-γ axis as a clinical therapy for T1D
• Review of ustekinumab (antibody to p40 subunit of IL-12 and IL-23) use in psoriasis
• Rationale for a planned pilot study of ustekinumab in subjects with new-onset T1D

Type 1 diabetes (T1D) results from the autoimmune destruction of insulin-producing pancreatic beta cells. There is now mounting evidence that pro-inflammatory pathways, which are mediated by T cells that secrete IL-17 and IFN-γ, play a critical role in the loss of beta cells. These data suggest that blockade of T cells that secrete IL-17 and IFN-γ may halt or reverse disease in subjects with recent-onset T1D. Agents to facilitate this approach are currently in clinical use. Ustekinumab, a humanized monoclonal antibody that targets the shared p40 subunit of IL-12 and IL-23, has been used for the treatment of psoriasis, an indication for which it has proven to be safe and effective. In this review, we summarize the evidence that supports a combined pathogenic role of IL-17 and IFN-γ in the development of T1D, with the aim of providing a rationale for testing agents such as ustekinumab for the treatment of T1D.