[Type 1 diabetes mellitus, autoimmune disease: physiopathologic aspects and practical applications].
Type 1 (insulin-dependent) diabetes mellitus results from an autoimmune disease which is directed to insulin-secreting islet cells. In man, it is closely associated to definite major histocompatibility complex alleles. The islets are infiltrated by inflammatory cells (insulitis). Anti-islet cell autoantibodies are present in most patients and represent a valuable marker for the autoimmune reaction. The major role of autoreactive T lymphocytes has been demonstrated in animal models of spontaneous insulin-dependent diabetes (the BB rat and the NOD mouse). Such pathophysiological concepts already have clinical applications. The presence of anti-islet cell antibodies identifies patients with type 1 diabetes of slow onset who initially present with non-insulin dependent diabetes. In the same respect it is now feasible to predict the possible occurrence of diabetes in 'at risk' subjects (such as siblings of a diabetic patient) on the basis of HLA typing and the presence of markers of anti-beta cell immunity. Lastly, both in animal models and in human diabetes, it has been demonstrated that immune intervention can alter the course of anti-islet autoimmunity. From these results one may hope in the future to get preventive treatment of type 1 diabetes before the onset of metabolic disturbances.
Timsit
J
J
Service d'Immunologie Clinique, Hôpital Necker, Paris.
Boitard
C
C
Bach
J F
JF
D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007515:Islets of Langerhans / Q000276:immunology; D008285:Major Histocompatibility Complex / Q000276:immunology
D001323:Autoantibodies
Diabète de type 1, maladie auto-immune: aspects physiopathologiques et applications pratiques.