Moving towards efficient therapies in type 1 diabetes: to combine or not to combine?

Autoimmun Rev. 2007 Apr;6(5):315-22. doi: 10.1016/j.autrev.2006.09.013. Epub 2006 Oct 18.


Every year, thirty thousand people worldwide are diagnosed with type 1 diabetes mellitus (T1DM). T1DM, also called autoimmune diabetes, is a multifactorial disease affecting predisposed individuals and involving genetic susceptibilities, environmental triggers, as well as unbalanced immune responses. Auto-reactive T cells, produced during the pathogenesis, play an important role by specifically destroying the pancreatic insulin-producing beta-cells in the islets of Langerhans. Numerous therapeutic interventions have been tested, mostly in animal models, but also in humans. To date, only three phase II/III clinical trials have demonstrated safety and efficacy: anti-CD3 antibody, DiaPep277, and GAD65 (in patients with latent autoimmune diabetes in adults). Unfortunately, a significant number of patients did not respond positively and remained insulin-dependent after completion of therapy. Several reasons account for this. Firstly, the severity of the disease as well as the auto-aggressive T cell repertoire vary from patient to patient leading to a broad range of therapeutic efficacies, and secondly at the time of the treatment the number of remaining beta-cells will directly impact the level of insulin production post-treatment. In this review, we will provide some clues to enhance efficacy of future immuno-interventions in patients with T1DM. We suggest that combination therapies might be the best approach.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Clinical Trials as Topic
  • Diabetes Mellitus, Type 1 / etiology
  • Diabetes Mellitus, Type 1 / immunology
  • Diabetes Mellitus, Type 1 / therapy*
  • Drug Therapy, Combination*
  • Humans
  • Immunization*
  • Models, Biological