Efforts to prevent and halt autoimmune beta cell destruction.
Despite improvements in understanding of the natural history of type 1 diabetes (T1D), an intervention capable of consistently and safely preventing or reversing the disease has not been developed. The inability to cure this disorder is largely because of the complex pathophysiology of T1D, continued struggles to identify its precise etiologic triggers, and voids in understanding of the immunologic mechanisms that specifically target pancreatic beta cells. Rapidly improving technologies for managing T1D require critical discussions about equipoise, especially when considering interventions deemed high risk in terms of their safety. This article reviews the conceptual basis for prevention versus intervention trials in settings of T1D, past experiences of clinical trials studying these purposes, and controversial issues regarding disease interdiction, and seeks to provide a roadmap for future efforts to cure this disorder.
Haller
Michael J
MJ
Division of Endocrinology, Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610, USA. hallemj@peds.ufl.edu
Atkinson
Mark A
MA
Schatz
Desmond A
DA
D000818:Animals; D001323:Autoantibodies / Q000494:pharmacology; D015551:Autoimmunity / Q000502:physiology; D016923:Cell Death / Q000187:drug effects / Q000276:immunology; D064987:Cell- and Tissue-Based Therapy / Q000379:methods / Q000639:trends; D018890:Chemoprevention / Q000379:methods / Q000639:trends; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D050417:Insulin-Secreting Cells / Q000187:drug effects / Q000276:immunology* / Q000473:pathology; D008954:Models, Biological
D001323:Autoantibodies; D007166:Immunosuppressive Agents