Department for Immunohematology and Blood Transfusion, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
Bayhill Therapeutics, Palo Alto, CA 94304, USA.
Sci Transl Med. 2013 Jun 26;5(191):191ra82. doi: 10.1126/scitranslmed.3006103.
In type 1 diabetes (T1D), there is an intense inflammatory response that destroys the β cells in the pancreatic islets of Langerhans, the site where insulin is produced and released. A therapy for T1D that targets the specific autoimmune response in this disease while leaving the remainder of the immune system intact, has long been sought. Proinsulin is a major target of the adaptive immune response in T1D. We hypothesized that an engineered DNA plasmid encoding proinsulin (BHT-3021) would preserve β cell function in T1D patients through reduction of insulin-specific CD8⁺ T cells. We studied 80 subjects over 18 years of age who were diagnosed with T1D within the past 5 years. Subjects were randomized 2:1 to receive intramuscular injections of BHT-3021 or BHT-placebo, weekly for 12 weeks, and then monitored for safety and immune responses in a blinded fashion. Four dose levels of BHT-3021 were evaluated: 0.3, 1.0, 3.0, and 6.0 mg. C-peptide was used both as an exploratory efficacy measure and as a safety measure. Islet-specific CD8⁺ T cell frequencies were assessed with multimers of monomeric human leukocyte antigen class I molecules loaded with peptides from pancreatic and unrelated antigens. No serious adverse events related to BHT-3021 were observed. C-peptide levels improved relative to placebo at all doses, at 1 mg at the 15-week time point (+19.5% BHT-3021 versus -8.8% BHT-placebo, P < 0.026). Proinsulin-reactive CD8⁺ T cells, but not T cells against unrelated islet or foreign molecules, declined in the BHT-3021 arm (P < 0.006). No significant changes were noted in interferon-γ, interleukin-4 (IL-4), or IL-10 production in CD4 T cells. Thus, we demonstrate that a plasmid encoding proinsulin reduces the frequency of CD8⁺ T cells reactive to proinsulin while preserving C-peptide over the course of dosing.
在 1 型糖尿病(T1D)中,存在强烈的炎症反应,该反应破坏了胰腺胰岛中产生和释放胰岛素的β细胞。长期以来,人们一直寻求针对这种疾病中特定自身免疫反应的 T1D 治疗方法,同时使免疫系统的其余部分保持完整。胰岛素原是 T1D 中适应性免疫反应的主要靶标。我们假设,编码胰岛素原的工程化 DNA 质粒(BHT-3021)通过减少胰岛素特异性 CD8+T 细胞,可在 T1D 患者中保留β细胞功能。我们研究了 80 名年龄在 18 岁以上的受试者,这些受试者在过去 5 年内被诊断患有 T1D。受试者按 2:1 的比例随机分为接受 BHT-3021 或 BHT-安慰剂肌内注射,每周一次,共 12 周,然后以盲法监测安全性和免疫反应。评估了 BHT-3021 的四个剂量水平:0.3、1.0、3.0 和 6.0mg。C 肽既用作探索性疗效指标,也用作安全性指标。使用单体人白细胞抗原 I 类分子与来自胰腺和无关抗原的肽负载的多聚体评估胰岛特异性 CD8+T 细胞频率。未观察到与 BHT-3021 相关的严重不良事件。与安慰剂相比,所有剂量的 C 肽水平均有改善,在 15 周时,1mg 组 BHT-3021 为(+19.5%,BHT-3021 比 BHT-安慰剂,P<0.026),而 BHT-安慰剂为(-8.8%)。BHT-3021 组的胰岛素原反应性 CD8+T 细胞下降,而对无关胰岛或外来分子的 T 细胞则没有下降(P<0.006)。在 CD4 T 细胞中未观察到干扰素-γ、白细胞介素-4(IL-4)或 IL-10 产生的显著变化。因此,我们证明了一种编码胰岛素原的质粒在给药过程中降低了对胰岛素原反应性 CD8+T 细胞的频率,同时保持了 C 肽。