Journal
BIOMEDICINES
Volume 9, Issue 1, Pages -Publisher
MDPI
DOI: 10.3390/biomedicines9010042
Keywords
antibodies; autoantigen; autoimmunity; B cells; insulin; lymphocytes; type 1 diabetes
Categories
Funding
- Juvenile Diabetes Research Foundation [3-PDF-2019752-A-N]
- National Institutes of Health [K12 HD 043483]
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Islet autoantibodies are key biomarkers for predicting T1D risk, signaling immune tolerance breach by B lymphocytes. Strategies to prevent T1D development may involve eliminating T and B cells or disrupting T cell interactions, but global immune cell disruption poses risks, hence the focus on antigen-specific therapy for T1D prevention.
Islet autoantibodies are the primary biomarkers used to predict type 1 diabetes (T1D) disease risk. They signal immune tolerance breach by islet autoantigen-specific B lymphocytes. T-B lymphocyte interactions that lead to expansion of pathogenic T cells underlie T1D development. Promising strategies to broadly prevent this T-B crosstalk include T cell elimination (anti-CD3, teplizumab), B cell elimination (anti-CD20, rituximab), and disruption of T cell costimulation/activation (CTLA-4/Fc fusion, abatacept). However, global disruption or depletion of immune cell subsets is associated with significant risk, particularly in children. Therefore, antigen-specific therapy is an area of active investigation for T1D prevention. We provide an overview of strategies to eliminate antigen-specific B lymphocytes as a means to limit pathogenic T cell expansion to prevent beta cell attack in T1D. Such approaches could be used to prevent T1D in at-risk individuals. Patients with established T1D would also benefit from such targeted therapies if endogenous beta cell function can be recovered or islet transplant becomes clinically feasible for T1D treatment.
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