[Immunotherapeutic management of juvenile diabetes mellitus].
Differences between Type 1 and Type 2 Diabetes Mellitus are briefly outlined with special emphasis on the immune mechanism in the development of juvenile diabetes. Autoimmune nature of Type 1 diabetes is based on: association with genetic markers of histocompatibility mainly with the DR3 and DR4 haplotypes of the HLA system; anomalies of the humoral and cellular immunity present in a significant percentage of Type 1 diabetic patients, its association with other autoimmune diseases; the histological features of the affected pancreas and the prevention of experimental diabetes by immunosuppression. Trials on immunotherapy with immunosuppressors (Cyclosporine A and Azathioprine) and immunomodulators (Thymic hormone) were able to achieve a 50-60% index of clinical and functional remission for more than one year. With Thymic hormone and Azathioprine in combined administration the glycemic control and residual beta-cell function one year after stopping immunotherapy exhibited positive comparative results. Other trials on immunotherapy are outlined. Side effects of immunosuppression and future prospectives for immune approaches in Type 1 diabetes are commented.
Moncada
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Departamento de Endocrinología y Metabolismo, Universidad de Navarra, Pamplona, España.
D000328:Adult; D000818:Animals; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D003524:Cyclosporins / Q000009:adverse effects / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics; D006801:Humans; D007109:Immunity; D007165:Immunosuppression Therapy; D011379:Prognosis; D051381:Rats; D012074:Remission Induction; D013951:Thymus Hormones / Q000627:therapeutic use*
D003524:Cyclosporins; D006680:HLA Antigens; D013951:Thymus Hormones; D001379:Azathioprine
Abordaje inmunoterápico de la diabetes mellitus juvenil.