Questioning Four Preconceived Ideas on Immunotherapy of Clinical Type 1 Diabetes: Lessons from Recent CD3 Antibody Trials

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The Review of Diabetic Studies,2005,2,3,116-120.
Type:November 2005
Author(s) affiliations:

Lucienne Chatenoud and Jean-François Bach

Université René Descartes Paris 5, INSERM U580, Hôpital Necker-Enfants Malades, Paris, France.


Patients presenting type 1 diabetes (T1D) are currently treated with insulin substitutive therapy that is remarkably successful. The treatment has, however, two major limitations that cannot be underestimated due to the major problems and/or discomfort they create, particularly in the numerous patients with unstable metabolic control or insufficient compliance to treatment. The first limitation is degenerative complications that remain an important concern even if their frequency has been dramatically reduced in patients with good metabolic control. The second is the worrisome daily constraints and risks (especially hypoglycemia) linked to regular insulin administration. Several alternatives to palliative insulin therapy have been proposed: pancreas or islet transplantation, β-cell regeneration and immunotherapy. The last strategy, which is in many regards the most straightforward and does not expose patients to the hazards and complications of cell therapy and transplantation, was initiated in the 1980s using cyclosporin in patients presenting newonset T1D[1-3]. Successful remission of disease was obtained with very limited side effects. When the drug was administered at reasonable doses, neither chronic nephrotoxicity nor infections were observed [1-5]. Read more...