Übersicht über aktuelle Studien zur Prävention und Immunintervention des Diabetes mellitus Typ 1

Zusammenfassung

Immunmodulatorische Therapieansätze bei Diabetes mellitus Typ 1 (T1DM) zielen auf die Verhinderung der Entstehung (Primär-) und Progression (Sekundär-) von Inselautoimmunität bei nicht-diabetischen Personen mit hohem Erkrankungsrisiko bzw. den Erhalt der β-Zell-Restfunktion bei Patienten mit neu-manifestiertem Diabetes (Tertiärprävention). Diese Arbeit soll einen Überblick über aktuelle Immuninterventionsstudien bei T1DM geben. 1.) Die Pre-POINT-Studie prüft eine Intervention mit oralem/nasalem Insulin, im Sinne einer Schutzimpfung, bei Autoantikörper-negativen Kindern mit hohem genetischem Diabetesrisiko. 2.) Die „Cord Blood Study” untersucht die Wirksamkeit einer Transfusion von autologem Nabelschnurblut bei Kindern mit T1DM im Hinblick auf die β-Zell-Regeneration und Verbesserung der Blutglukose-Kontrolle. 3.) In der „GAD Vaccination Study” soll die kürzlich in einer Phase-II-Studie nachgewiesene Wirkung einer rhGAD65-Impfung, die zum Erhalt der β-Zell-Restfunktion bei Patienten mit T1DM führte, in einer Phase-III-Studie mit 320 neu-erkrankten Kindern verifiziert werden. 4.) Die AIDA-Studie prüft die anti-inflammatorische/β-Zell-protektive Wirkung des Interleukin-1-Rezeptor-Antagonisten Anakinra bei 80 Patienten mit T1DM.

Abstract

Immunomodulatory strategies in the management of type 1 diabetes mellitus (T1DM) have as their primary target the prevention of initiating islet autoimmunity (primary-), the secondary one is the progression to diabetes (secondary-) in non-diabetic persons at risk, and the decline of β-cell function in new-onset patients (tertiary-prevention). This article reviews four recent immunointervention trials in patients with T1DM. (1) The Pre-POINT study is a primary prevention trial that will test whether vaccination with oral or nasal insulin can prevent the progression of islet autoimmunity and of T1DM in autoantibody-negative children who are genetically at high diabetes risk. (2) The Cord Blood study is a tertiary immunointervention trial that will test whether administration of autologous umbilical cord blood to children with T1DM can lead to regeneration of pancreatic islet insulin-producing β-cells and improved blood glucose control. (3) The GAD Vaccination study will test whether vaccination with alum-formulated rhGAD65 (recombinant human glutamic acid decarboxylate) can preserve β-cell function in 320 children with newly diagnosed T1DM, as has been suggested in a recent phase II study. (4) The AIDA study will test the β-cell protective effect of interleukin-1-receptor antagonist Anakinra in 80 patients with T1DM, which has recently been shown to improve β-cell function in patients with type 2 diabetes.

Schlüsselwörter

Diabetes mellitus Typ 1 - Immunprävention - Immunintervention - Interventionsstudie

Keywords

type 1 diabetes mellitus - immunoprevention - immunointervention - intervention trial

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