Diabetes mellitus typ 1 bei kindern und jugendlichen. Neues zur immunologie und prävention

Diabetes mellitus type 1 is a T-cell-mediated autoimmune disease. In the last years, there is a distinct increase of the incidence of the disease, especially in very young children and schoolchildren. Autoantibodies in the blood can be identified months and years before diabetes onset. Besides ICA, GADA, IA-2A and IAA, the Zinc-transporter-8 antibody becomes more important in the past years. Individuals with a high risk to develop diabetes can be identified with genetic tests and investigation of antibodies. Immunomodulatory therapeutic strategies in diabetes mellitus type 1 target to prevent initiation of islet autoimmunity (primary prevention) and progression to diabetes (secondary prevention), as well as a decline of β-cell-function in new onset patients (tertiary prevention). This article gives a review about immunology and recent immunointervention trials in diabetes mellitus type 1. The Pre Point Study is a trial that will test whether vaccination with oral insulin can prevent progressive islet autoimmunity and diabetes mellitus type 1 in autoantibody-negative children who are genetically at high diabetes risk (primary prevention trial). The INIT 2 Study investigates the efficiency of nasal insulin treatment in individuals who have already developed autoantibodies (secondary prevention). The GAD vaccination trial study will test whether vaccination with alum-formulated rhGAD65 can preserve β-cell-function in children with newly diagnosed diabetes mellitus type 1, as it has been suggested in a recent phase 2 study. The cord blood study investigates the effectivity of an infusion of autologous umbilical cord blood. The primary object of the Defend-2-study is to test the efficiency of otelixizumab (CD-3-antibody) in newly diagnosed patients with type 1 diabetes between 12 and 45 years (tertiary prevention).