Heath Katie E, Feduska Joseph M, Taylor Jared P, Houp Julie A, Botta Davide, Lund Frances E, Mick Gail J, McGwin Gerald, McCormick Kenneth L, Tse Hubert M
Department of Microbiology, Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Biomedicines. 2023 Jul 10;11(7):1948. doi: 10.3390/biomedicines11071948.
Type 1 diabetes (T1D) is an autoimmune disease culminating in the destruction of insulin-producing pancreatic cells. There is a need for the development of novel antigen-specific strategies to delay cell destruction, including combinatorial strategies that do not elicit systemic immunosuppression. Gamma-aminobutyric acid (GABA) is expressed by immune cells, β-cells, and gut bacteria and is immunomodulatory. Glutamic-acid decarboxylase 65 (GAD65), which catalyzes GABA from glutamate, is a T1D autoantigen. To test the efficacy of combinatorial GABA treatment with or without GAD65-immunization to dampen autoimmune responses, we enrolled recent-onset children with T1D in a one-year clinical trial (ClinicalTrials.gov NCT02002130) and examined T cell responses. We isolated peripheral blood mononuclear cells and evaluated cytokine responses following polyclonal activation and GAD65 rechallenge. Both GABA alone and GABA/GAD65-alum treatment inhibited Th1 cytokine responses over the 12-month study with both polyclonal and GAD65 restimulation. We also investigated whether patients with HLA-DR3-DQ2 and HLA-DR4-DQ8, the two highest-risk human leukocyte antigen (HLA) haplotypes in T1D, exhibited differences in response to GABA alone and GABA/GAD65-alum. HLA-DR4-DQ8 patients possessed a Th1-skewed response compared to HLA-DR3-DQ2 patients. We show that GABA and GABA/GAD65-alum present an attractive immunomodulatory treatment for children with T1D and that HLA haplotypes should be considered.
1型糖尿病(T1D)是一种自身免疫性疾病,最终会导致产生胰岛素的胰腺细胞被破坏。需要开发新的抗原特异性策略来延缓细胞破坏,包括不会引起全身免疫抑制的联合策略。γ-氨基丁酸(GABA)由免疫细胞、β细胞和肠道细菌表达,具有免疫调节作用。催化谷氨酸生成GABA的谷氨酸脱羧酶65(GAD65)是一种T1D自身抗原。为了测试联合使用GABA治疗(有无GAD65免疫)抑制自身免疫反应的疗效,我们招募了近期发病的T1D儿童参加一项为期一年的临床试验(ClinicalTrials.gov NCT02002130)并检测T细胞反应。我们分离外周血单个核细胞,并评估多克隆激活和GAD65再次刺激后的细胞因子反应。在为期12个月的研究中,无论是多克隆刺激还是GAD65再刺激,单独使用GABA以及GABA/GAD65-明矾治疗均抑制了Th1细胞因子反应。我们还研究了T1D中两个最高风险的人类白细胞抗原(HLA)单倍型HLA-DR3-DQ2和HLA-DR4-DQ8的患者对单独使用GABA和GABA/GAD65-明矾的反应是否存在差异。与HLA-DR3-DQ2患者相比,HLA-DR4-DQ8患者具有Th1偏向性反应。我们表明,GABA和GABA/GAD65-明矾为T1D儿童提供了一种有吸引力的免疫调节治疗方法,并且应该考虑HLA单倍型。