Winter W E, House D V, Schatz D
Department of Pediatrics, University of Florida, Gainesville 32610-0275, USA.
Drugs. 1997 Jun;53(6):943-56. doi: 10.2165/00003495-199753060-00004.
Insulin-dependent (type I) diabetes mellitus (IDDM) is the consequence of a chronic cell-mediated immune attack upon the insulin-producing beta-cells. Progressive insulinopenia is characteristic of individuals who eventually develop IDDM. Autoimmunity develops because of a failure in self-nonself discrimination. Autoimmunity is usually detected when autoantibodies are present in the patient's serum. However, autoantibodies are not synonymous with disease, as many autoantibody-positive individuals show no evidence of clinical disease. Studies initiated in the early 1980s demonstrated that short term remission from IDDM could be induced or lengthened with immunosuppressive therapy. However, no long term remissions were achieved. Current prevention strategies use a combination of autoantibody marker testing and beta-cell function testing to identify individuals with 'prediabetes'. The most useful autoantibodies for prediabetes screening include islet cell autoantibodies, insulin autoantibodies, glutamic acid decarboxylase autoantibodies and IA-2 autoantibodies. Immunointervention techniques have focused on protecting beta-cells from oxidative damage and developing tolerance to beta-cell autoantigens. Environmental manipulation may also be of benefit but its effectiveness is unproven. The pharmacist of the future may be involved in dispensing autoantigens, cytokines, anti-cytokine antibodies, anti-cytokine receptor antibodies, vaccines or viral vectors for gene therapy in the prevention of IDDM.
胰岛素依赖型（I型）糖尿病（IDDM）是针对产生胰岛素的β细胞的慢性细胞介导免疫攻击的结果。渐进性胰岛素缺乏是最终发展为IDDM的个体的特征。自身免疫的发展是由于自身与非自身识别功能的失败。当患者血清中存在自身抗体时，通常会检测到自身免疫。然而，自身抗体并不等同于疾病，因为许多自身抗体阳性个体没有临床疾病的证据。20世纪80年代初开始的研究表明，免疫抑制疗法可以诱导或延长IDDM的短期缓解。然而，并未实现长期缓解。目前的预防策略结合了自身抗体标志物检测和β细胞功能检测，以识别“糖尿病前期”个体。用于糖尿病前期筛查最有用的自身抗体包括胰岛细胞自身抗体、胰岛素自身抗体、谷氨酸脱羧酶自身抗体和IA-2自身抗体。免疫干预技术专注于保护β细胞免受氧化损伤以及培养对β细胞自身抗原的耐受性。环境调控可能也有益处，但其有效性尚未得到证实。未来的药剂师可能会参与调配自身抗原、细胞因子、抗细胞因子抗体、抗细胞因子受体抗体、疫苗或病毒载体，用于预防IDDM的基因治疗。
