Type 1 diabetes intervention trials 2007: where are we and where are we going?
Type 1 diabetes intervention trials 2007: where are we and where are we going?
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DOI：
10.1097/med.0b013e32825a673b
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发表时间：
2007-08-01
期刊：
影响因子：
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通讯作者：
Schatz, Desmond A
中科院分区：
文献类型：
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作者：
Haller, Michael J;Gottlieb, Peter A;Schatz, Desmond A
审查目的：1型糖尿病（T1 D）的特征是自身免疫介导的胰腺β细胞破坏，最终导致绝对胰岛素缺乏。尽管对1型糖尿病自然史的认识有所提高，但我们尚未开发出一种干预措施来持续安全地预防或逆转1型糖尿病。本次审查探讨了从最近的1型糖尿病干预研究的经验教训，提出了有争议的问题，并寻求提供一个路线图，为未来的interventions.Recent发现：1型糖尿病干预研究的20世纪80年代表现出潜在的保留c-肽，但被遗弃，由于不可接受的副作用的代理人正在使用。新的免疫抑制剂和免疫调节剂的试点研究，改善副作用的概况，最近已证明在保留新发1型糖尿病患者的c-肽的承诺。其中几种药物，包括胰岛素，抗-CD 3，mycophenolate mofetil，daclizumab和抗-CD 20，目前正在测试中的多中心干预trials.Summary：无法治愈1型糖尿病强调了复杂的病理生理学的疾病，和我们的知识贫乏的确切病因触发和免疫机制，最终在疾病。虽然需要持续努力测试具有改善糖尿病潜力的个体药物，但采用多种安全药物的联合治疗可能是1型糖尿病干预研究的未来。
PURPOSE OF REVIEW: Type 1 diabetes (T1D) is characterized by autoimmune-mediated destruction of pancreatic beta cells culminating in absolute insulin deficiency. Despite enhanced knowledge of the natural history of type 1 diabetes we have yet to develop an intervention to consistently and safely prevent or reverse type 1 diabetes. This review explores the lessons learned from recent type 1 diabetes interventional studies, sets out controversial issues and seeks to provide a roadmap for future interventions.RECENT FINDINGS: The type 1 diabetes intervention studies of the 1980s demonstrated potential for preserving c-peptide, but were abandoned due to unacceptable side-effect profiles of the agents being used. Pilot studies of new immunosuppressive and immunomodulatory agents with improved side-effect profiles have recently demonstrated promise in preserving c-peptide in new-onset type 1 diabetes patients. Several of these agents, including insulin, anti-CD3, mycophenolate mofetil, daclizumab and anti-CD20, are currently being tested in multicenter intervention trials.SUMMARY: The inability to cure type 1 diabetes underscores the complex pathophysiology of the disease, and our poor knowledge of the precise etiological triggers and immunological mechanisms which culminate in the disease. While ongoing efforts to test individual agents with potential to ameliorate diabetes are needed, combination therapies employing multiple safe agents are likely to be the future of type 1 diabetes intervention studies.