University Hospital Leuven, Department of Experimental Medicine and Endocrinology, KULeuven, Herestraat 49, B-3000 Leuven, Belgium.
Expert Opin Biol Ther. 2011 May;11(5):609-21. doi: 10.1517/14712598.2011.560568. Epub 2011 Mar 15.
Type 1 diabetes is caused by autoimmune destruction of insulin-producing β-cells. Intensive insulin therapy protects most patients against chronic complications of diabetes, but exposes patients to acute complications like hypoglycaemia and impacts on quality of life. Therapies that aim at protecting or restoring endogenous insulin secretion might help in decreasing the risk of severe hypoglycemia and long-term complications.
This article reviews the literature of clinical immunotherapy and β-cell transplantation in treatment of type 1 diabetes with specific focus on the effect on preserving and restoring β-cell mass.
Several studies in recent-onset type 1 diabetic patients have provided proof of principle that immunotherapy can preserve residual functional β-cell mass. The observation that this strategy is most effective early in the disease process opens possibilities of arresting and even preventing type 1 diabetes. In patients with too few or no surviving β-cells, current protocols of β-cell transplantation can restore functional β-cell mass up to 25% of levels in healthy controls. Unfortunately, both strategies to date are followed by progressive decline of endogenous insulin secretion later on. Strategies to restore functional β-cell mass to a higher level and to restore immune tolerance are thus needed.
1 型糖尿病是由胰岛素产生β细胞的自身免疫性破坏引起的。强化胰岛素治疗可以保护大多数患者免受糖尿病的慢性并发症影响，但会使患者面临低血糖等急性并发症，并影响生活质量。旨在保护或恢复内源性胰岛素分泌的治疗方法可能有助于降低严重低血糖和长期并发症的风险。
本文回顾了临床免疫疗法和β细胞移植治疗 1 型糖尿病的文献，特别关注对β细胞质量保护和恢复的影响。
最近在发病初期的 1 型糖尿病患者的几项研究提供了证据，证明免疫疗法可以保留残余的功能性β细胞数量。这一观察结果表明，这种策略在疾病早期最为有效，为阻止甚至预防 1 型糖尿病提供了可能。对于β细胞存活数量太少或没有的患者，目前的β细胞移植方案可以将功能性β细胞数量恢复到健康对照组的 25%左右。不幸的是，到目前为止，这两种策略都伴随着内源性胰岛素分泌的逐渐下降。因此，需要恢复功能性β细胞数量更高水平并恢复免疫耐受的策略。
