1 型糖尿病的免疫疗法试验:乔治·艾森巴思的贡献。

Immunotherapy trials for type 1 diabetes: the contribution of George Eisenbarth.

机构信息

Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.

出版信息

Diabetes Technol Ther. 2013 Jun;15 Suppl 2(Suppl 2):S2-13-S2-20. doi: 10.1089/dia.2013.0107.

Abstract

Type 1 diabetes (T1D) results from the autoimmune destruction of pancreatic β-cells, and as such it should respond to immunotherapy. George Eisenbarth gave many significant contributions to this field. He has been involved at some level in most immunotherapy trials during the past three decades. He was among the pioneers who attempted immunotherapy approaches in patients with recent-onset T1D. In the early 1980s he began studying relatives of those with the disease, leading to the concept that T1D was a chronic autoimmune disease, in which islet autoimmune responses would silently destroy β-cells and cause progressive impairment of insulin secretion, years to months before a diagnosis was made. Consequently, he was one of the first to attempt immune intervention in people at high risk of T1D. Throughout his career he developed autoantibody assays and predictive models (which included metabolic testing and later genetics) to identify individuals at risk of T1D. He provided seminal intellectual contributions and critical tools for prevention trials. His focus on insulin as a critical autoantigen led to multiple prevention trials, including the Diabetes Prevention Trial-Type 1 (DPT-1), which studied both parenteral and oral insulin. In the DPT-1 Oral Insulin Trial, a cohort with higher levels of insulin autoantibodies was identified that appeared to have delayed disease progression. Type 1 Diabetes TrialNet is conducting a new trial to verify or refute this observation. Moreover, George identified and tested in the mouse small molecules that block or modulate presentation of a key insulin peptide and in turn prevent the activation of insulin-specific T-lymphocytes. Thus, we believe his greatest contribution is yet to come, as in the near future we should see this most recent work translate into clinical trials.

摘要

1 型糖尿病(T1D)是由胰腺β细胞的自身免疫破坏引起的,因此它应该对免疫疗法有反应。George Eisenbarth 在这一领域做出了许多重要贡献。在过去的三十年里,他几乎参与了所有免疫治疗试验。他是尝试对近期发病的 T1D 患者进行免疫治疗方法的先驱者之一。早在 20 世纪 80 年代,他就开始研究患有这种疾病的患者的亲属,这导致了 T1D 是一种慢性自身免疫性疾病的概念,在这种疾病中,胰岛自身免疫反应会在做出诊断前数年至数月内默默地破坏β细胞并导致胰岛素分泌逐渐受损。因此,他是最早尝试对 T1D 高危人群进行免疫干预的人之一。在整个职业生涯中,他开发了自身抗体检测和预测模型(包括代谢测试和后来的遗传学),以识别有患 T1D 风险的个体。他为预防试验提供了开创性的智力贡献和关键工具。他对胰岛素作为关键自身抗原的关注导致了多项预防试验,包括糖尿病预防试验-1 型(DPT-1),该试验研究了肠内和口服胰岛素。在 DPT-1 口服胰岛素试验中,确定了一个具有更高胰岛素自身抗体水平的队列,该队列似乎延迟了疾病进展。1 型糖尿病试验网正在进行一项新的试验,以验证或反驳这一观察结果。此外,George 在小鼠中鉴定并测试了可以阻断或调节关键胰岛素肽呈递的小分子,从而阻止胰岛素特异性 T 淋巴细胞的激活。因此,我们相信他的最大贡献尚未到来,因为在不久的将来,我们应该看到这项最新工作转化为临床试验。

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