Immune Intervention in Children with Type 1 Diabetes

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.

KeywordsType 1 diabetes-Immune intervention-AntiCD3-AntiCD20-GAD65-Autoantigens-Vitamin D-β-Cell regeneration-Children