title: Immune depletion with cellular mobilization imparts immunoregulation and reverses autoimmune diabetes in nonobese diabetic mice.
abstract: OBJECTIVE
  The autoimmune destruction of beta-cells in type 1 diabetes results in a loss of insulin production and glucose homeostasis. As such, an immense interest exists for the development of therapies capable of attenuating this destructive process through restoration of proper immune recognition. Therefore, we investigated the ability of the immune-depleting agent antithymocyte globulin (ATG), as well as the mobilization agent granulocyte colony-stimulating factor (GCSF), to reverse overt hyperglycemia in the nonobese diabetic (NOD) mouse model of type 1 diabetes.
  
  
  METHODS
  Effects of each therapy were tested in pre-diabetic and diabetic female NOD mice using measurements of glycemia, regulatory T-cell (CD4+CD25+Foxp3+) frequency, insulitis, and/or beta-cell area.
  
  
  RESULTS
  Here, we show that combination therapy of murine ATG and GCSF was remarkably effective at reversing new-onset diabetes in NOD mice and more efficacious than either agent alone. This combination also afforded durable reversal from disease (>180 days postonset) in animals having pronounced hyperglycemia (i.e., up to 500 mg/dl). Additionally, glucose control improved over time in mice subject to remission from type 1 diabetes. Mechanistically, this combination therapy resulted in both immunological (increases in CD4-to-CD8 ratios and splenic regulatory T-cell frequencies) and physiological (increase in the pancreatic beta-cell area, attenuation of pancreatic inflammation) benefits.
  
  
  CONCLUSIONS
  In addition to lending further credence to the notion that combination therapies can enhance efficacy in addressing autoimmune disease, these studies also support the concept for utilizing agents designed for other clinical applications as a means to expedite efforts involving therapeutic translation.
authors.affiliation: Department of Pathology, University of Florida, Gainesville, Florida, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Parker
authors.forename: Song
authors.initials: S
authors.lastname: Xue
authors.forename: John J
authors.initials: JJ
authors.lastname: Alexander
authors.forename: Clive H
authors.initials: CH
authors.lastname: Wasserfall
authors.forename: Martha L
authors.initials: ML
authors.lastname: Campbell-Thompson
authors.forename: Manuela
authors.initials: M
authors.lastname: Battaglia
authors.forename: Silvia
authors.initials: S
authors.lastname: Gregori
authors.forename: Clayton E
authors.initials: CE
authors.lastname: Mathews
authors.forename: Sihong
authors.initials: S
authors.lastname: Song
authors.forename: Misty
authors.initials: M
authors.lastname: Troutt
authors.forename: Scott
authors.initials: S
authors.lastname: Eisenbeis
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.forename: Desmond A
authors.initials: DA
authors.lastname: Schatz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Haller
authors.forename: Mark A
authors.initials: MA
authors.lastname: Atkinson
mesh_terms: D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001786:Blood Glucose; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D050417:Insulin-Secreting Cells / Q000276:immunology; D007958:Leukocyte Count; D051379:Mice; D016688:Mice, Inbred NOD; D011236:Prediabetic State / Q000276:immunology; D050378:T-Lymphocytes, Regulatory / Q000276:immunology
chemical_list: D000961:Antilymphocyte Serum; D001786:Blood Glucose; D007166:Immunosuppressive Agents; D016179:Granulocyte Colony-Stimulating Factor