Therapie des Typ-1-Diabetes im Wandel - Neue Möglichkeiten durch Immunintervention?

Background: Type 1 diabetes is an autoimmune disease. An interaction of genetic, immunologic and cell-toxic factors leads to the destruction of insulin producing beta cells in the pancreas of patients with type 1 diabetes. A number of immune therapeutics which are to improve the natural progress of the disease are currently evaluated in clinical trials. Methods: Selective research of the literature in databases (pubmed and clinicaltrials.gov, November 2010). Results: Immune therapeutics used in current clinical trials target different mechanisms of the immune system, like antigen presentation (antigen specific therapy, Rituximab), expansion of auto reactive t-cells (anti-CD3), and inflammation via cytokines (IL-1-antagonist). Immune therapeutics are not only applied after diabetes onset adjuvant to intensive insulin therapy, but also as primary prevention in children with a high diabetes risk or as secondary prevention in children, adolescent and adults with positive islet autoantibodies. Conclusion: Adjuvant immune therapeutics and combinations of different therapeutic principles may play an important role for future treatment of type 1 diabetes. The evaluation of drug safety will be crucial, so that therapies can be applied in early childhood or as preventive treatment.