ReviewNovel diagnostic and therapeutic approaches for autoimmune diabetes - A prime time to treat insulitis as a disease

- ECL-based autoantibody detection assays for insulin and GAD65 offer promising tools for screening prediabetic individuals
- ECL assays detect disease-relevant IgG autoantibodies earlier in infancy when compared to traditional autoantibody assays
- High-dose tolerance induction is a potential strategy for antigen specific prevention of type 1 diabetes

Type 1 diabetes is a progressive autoimmune disease with no curative treatment, making prevention critical. At the time of diagnosis, a majority of the insulin secreting β-cells have already been destroyed. Insulitis, lymphocytic infiltration to the pancreatic islets, is believed to begin months to years before the clinical symptoms of insulin deficiency appear. Insulitis should be treated as its own disease, for it is a known precursor to autoimmune diabetes. Because it is difficult to detect insulitic cellular infiltrates noninvasively, considerable interest has been focused on the levels of islet autoantibodies in blood as measurable diagnostic markers for islet autoimmunity. The traditional islet autoantibody detection assays have many limitations. New electrochemiluminescence-based autoantibody detection assays have the potential to overcome these challenges and they offer promising, cost-effective screening tools in identifying high-risk individuals for trials of preventive interventions. Here, we outline diagnostic and therapeutic strategies to overcome pancreatic β-cell destroying insulitis.