Authors: Wicklow, Brandy A; Polychronakos, Constantin

Source: Expert Review of Clinical Immunology, Volume 5, Number 1, January 2009 , pp. 55-62(8)

Publisher: Expert Reviews

Abstract:

Mounting evidence suggests insulin is an important and potentially initiating antigen in the pathogenesis of Type 1 diabetes. High-affinity insulin antibodies are found early in disease development and appear to predict progression. Insulin is the only Type 1 diabetes auto-antigen with exclusive pancreatic expression and the only one whose gene maps to a major susceptibility locus. Preclinical studies in rodent models of immune-mediated diabetes show great promise for the possibility of preventing disease by peripheral tolerization. Translation of this evidence to clinical trials of oral, intranasal and parenteral insulin to invoke immune tolerance and prevent diabetes has not proven successful to date, but promising results in a small subset of highest-risk individuals have maintained enthusiasm for this promising prevention strategy. Currently, studies of oral and intranasal insulin are ongoing to determine the optimal dose, timing and target population for Type 1 diabetes prevention.

Keywords: immune tolerance; immunotherapy; insulin auto-antibodies; prevention therapy; Type 1 diabetes

Document Type: Research article

DOI: http://dx.doi.org/10.1586/1744666X.5.1.55

Affiliations: 1: Department of Pediatrics, Division of Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, 2300 rue Tupper, Montreal, QC H3H1P3, Canada

Publication date: 2009-01-01

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• Expert Review of Clinical Immunology provides expert analysis and commentary regarding the performance of new therapeutic and diagnostic modalities in disease states with a strong immunologic component, such as allergic asthma, rheumatoid arthritis, inflammatory bowel disease, psoriasis and multiple sclerosis
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