Immune intervention in type 1 diabetes

Type 1 diabetes (T1D) is a chronic autoimmune disease that results in the specific immune destruction of insulin producing beta cells. Currently there is no cure for T1D and treatment for the disease consists of lifelong administration of insulin. Immunotherapies aimed at preventing beta cell destruction in T1D patients with residual c-peptide or in individuals developing T1D are being evaluated. Networks of researchers such as TrialNet and the Immune Tolerance Network in the U.S. and similar networks in Europe have been established to evaluate such immunotherapies. This review focuses on immune intervention for the prevention and amelioration of human T1D with a focus on potential immune suppressive, antigen specific and environmental therapies.

► Type 1 diabetes is a predictable disease with islet autoantibody determination.
► Most longstanding T1D patients have 1–2% remaining beta cells on pancreas evaluation.
► Treatment with anti-CD3 antibodies after diagnosis delays c-peptide loss for 1 year.
► Antigen specific and environmental therapies are being evaluated to prevent diabetes.
► Combination and targeted specific immune therapies are needed for prevention and cure.