Immune Mechanisms and Pathways Targeted in Type 1 Diabetes.

Immune Mechanisms and Pathways Targeted in Type 1 Diabetes.
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DOI:
10.1007/s11892-018-1066-5
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发表时间:
2018-08-30
影响因子:
4.2
通讯作者:
Brusko TM
Brusko TM
中科院分区:
医学2区
文献类型:
--
作者:
Jacobsen LM;Newby BN;Perry DJ;Posgai AL;Haller MJ;Brusko TM

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1984年首次报道免疫抑制剂环孢霉素可降低新发1型糖尿病(T1 D)患者的每日胰岛素剂量并改善血糖控制。虽然肾毒性限制了环孢素的广泛使用,但这一观察结果引发了合作努力,以确定能够安全地保护T1 D患者或有风险的患者的β细胞的免疫抑制剂。T1 D预测和早期诊断的进展,以及对疾病机制的扩展知识,促进了针对特定免疫细胞亚群,自身抗原和途径的试验。此外,通过使用代谢和免疫学读数定义了临床应答者和非应答者亚组。在此,我们回顾了在最近和正在进行的T1 D免疫治疗试验的背景下出现的T1 D生物标志物。我们还讨论了应答者/非应答者分析,以确定治疗机制,定义可操作的途径,并指导受试者选择,药物给药和未来T1 D试验的定制组合药物治疗。
The immunosuppressive agent cyclosporine was first reported to lower daily insulin dose and improve glycemic control in patients with new-onset type 1 diabetes (T1D) in 1984. While renal toxicity limited cyclosporine’s extended use, this observation ignited collaborative efforts to identify immunotherapeutic agents capable of safely preserving β cells in patients with or at risk for T1D. Advances in T1D prediction and early diagnosis, together with expanded knowledge of the disease mechanisms, have facilitated trials targeting specific immune cell subsets, autoantigens, and pathways. In addition, clinical responder and non-responder subsets have been defined through the use of metabolic and immunological readouts. Herein, we review emerging T1D biomarkers within the context of recent and ongoing T1D immunotherapy trials. We also discuss responder/non-responder analyses in an effort to identify therapeutic mechanisms, define actionable pathways, and guide subject selection, drug dosing, and tailored combination drug therapy for future T1D trials.
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