title: Antigen-based vs. systemic immunomodulation in type 1 diabetes: the pros and cons.
abstract: In type 1 diabetic patients insulin-producing pancreatic β-cells are destroyed by an orchestrated immune process involving self-reactive auto-antigen-specific CD4⁺ and CD8⁺ T cells. Efforts to reverse or prevent this destructive immunological cascade have led to promising results in animal models, however, the transition to the clinic has yet been unsuccessful. In addition, current clinical studies lack reliable biomarkers to circumscribe end-point parameters and define therapeutic success. Here, we give a current overview of both antigen-specific and non-specific systemic immunomodulatory approaches with a focus on the therapies verified or under evaluation in a clinical setting. While both approaches have their advantages and disadvantages, rationally designed combination therapies may yield the highest therapeutic efficacy. In order for future strategies to be effective, new well-defined biomarkers need to be developed and the extrapolation process of dose, timing and frequency from in vivo models to patients needs to be carefully reconsidered.
authors: Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium.
authors: Sofie
authors: S
authors: Robert
authors: Hannelie
authors: H
authors: Korf
authors: Conny
authors: C
authors: Gysemans
authors: Chantal
authors: C
authors: Mathieu
mesh_terms: D000818:Animals; D001324:Autoantigens / Q000009:adverse effects / Q000627:therapeutic use*; D015551:Autoimmunity; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000276:immunology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D056747:Immunomodulation; D007165:Immunosuppression Therapy; D016233:Immunotherapy, Active; D057170:Translational Research, Biomedical
chemical_list: D001324:Autoantigens
keywords: Ag-specific; clinical trial; combination therapy; patient; systemic; therapy; type 1 diabetes
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