Progress in the immunointervention of type-1 diabetes mellitus
Progress in the immunointervention of type-1 diabetes mellitus
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DOI：
10.1055/s-2007-980023
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发表时间：
1995-12-01
影响因子：
2.2
通讯作者：
Schernthaner, G
中科院分区：
文献类型：
--
作者：
Schernthaner, G
对临床确诊的1型糖尿病患者进行免疫抑制药物(环孢素A、硫唑嘌呤)的免疫干预研究表明，β细胞功能的改善并不充分和持久。由于80%-90%的β细胞团在1型糖尿病发作时已经被破坏，因此在1型糖尿病的早期阶段进行了烟酰胺和胰岛素(非肠道或口服)的干预研究。然而，免疫调节仅限于1型糖尿病的家族病例(仅占所有病例的10%)，因为在普通人群中不可能预测这种疾病。不能排除所述的免疫干预可能只是推迟而不是阻碍1型糖尿病的出现。通过BCG或GAD诱导耐受的干预措施是有希望的，但尚未在人类中预防1型糖尿病。最后，最有效的战略将是通过接种疫苗或暴露预防来进行初级预防。如果1型糖尿病被证明是一种通过分子模拟引起的疾病，即环境抗原的免疫，那么避免接触环境触发因素的策略(F.E.牛奶蛋白)或接种疫苗(F.E.可采用柯萨奇病毒蛋白PZ-c)。如果所有这些干预措施从长远来看都不有效，那么在基因转移技术得到改进后，研究应该集中在分子方法上。
Immunointervention studies with immunosuppressive drugs (Cyclosporin A, Azathioprine) in type-1 diabetic patients after clinical diagnosis demonstrated that improvement of beta-cell function is not sufficient and longlasting. Since 80-90% of the beta-cell mass are already destroyed at onset of type-1 diabetes, intervention studies with nicotinamide and insulin (parenteral or oral) were undertaken in the early phase of type-1 diabetes. However, immunomodulation is restricted to familial cases of type-1 diabetes (only 10% of all cases), since prediction of the disease is not possible in the general population. It cannot be excluded that the described immunintervention may only postpone but not hinder the manifestation of type-1 diabetes. Interventions with tolerance induction by BCG or GAD are promising, but did not yet result in prevention of type-1 diabetes in humans. Finally, the most effective strategy would be primary prevention by vaccination or exposure prophylaxis. Should type-1 diabetes prove to be a disease that is provoked through molecular mimicry, i.e. an immunization by an environmental antigen, then strategies to avoid contact with the environmental trigger (f.e. cow's milk protein) or to vaccinate against it (f.e. Coxsackie virus protein PZ-c) could be adopted. If all these interventions are not effective in the long term run, research should be concentrated on molecular approaches after improvement in gene transfer technology.