Antibody response to islet antigens in anti-CD4/prednisolone immune intervention of type 1 diabetes

Effect of photopheresis on lymphocyte population in children with newly diagnosed type 1 diabetes

In recent years photopheresis has been claimed to be an effective form of immunomodulation. It has also been shown to have an effect on the disease process at the onset of type 1 diabetes. In a double-blind, placebo-controlled randomized study, we analyzed if the effect of photopheresis in children with newly diagnosed diabetes is related to changes in the balance of lymhocyte populations. We also analyzed if lymphocyte subsets were related to recent infection, mild or aggressive disease manifestations, heredity, or gender. Nineteen children received active treatment with photopheresis, while 21 children received sham pheresis (placebo group). No influence of a history of previous infection, heredity, or certain clinical parameters on lymphocyte subsets was found. At the onset of type 1 diabetes, girls showed a higher proportion and a larger number of T cells (CD3+) and T-helper cells (CD4+) and a higher proportion of naïve CD4+ CD45RA+ cells. In the placebo group, an increase in the number of subsets with the activated phenotype in both the CD4(CD29+) and the CD8 (CD11a+) compartments was noted during the course of the study. These changes did not occur in the photopheresis group. No relation between lymphocyte subsets and clinical outcome was found 1 year after the treatment with photopheresis. In conclusion, we found no major effect of photopheresis on lymphocyte populations in a group of children with newly diagnosed type 1 diabetes. However, in the placebo group the proportions of activated CD4 and CD8 cells increased over time. Since these changes did not occur in the actively treated group, our findings suggest that photopheresis may have some suppressive effects.

Type 1 diabetes intervention trials: what have we learned? A critical review of selected intervention trials

Developing therapies to stop or slow the immune destruction of islets has been a goal of investigators in type 1 diabetes for several decades. This review of clinical interventions in patients with type 1 diabetes indicates both negative and positive outcomes with a variety of different therapeutic agents. An underlying theme of this article is that differences in study design may impact the outcome more than the therapy being tested. Thus, each of these results need to be considered in the context of important variables in study design. To date, there is no clear answer as to what study design is best to determine if an agent is effective against the diabetes disease process; however, the Immunology of Diabetes Society has recently developed guidelines for the conduct of these trials to facilitate comparisons of therapies in the future.

Treatment with antioxidants at onset of type 1 diabetes in children: a randomized, double-blind placebo-controlled study

BACKGROUND

In recent years different types of immune interventions have been tried at the onset of type 1 diabetes. Although some have shown effects, none have proven to be sufficiently effective to justify the inherent risks and side effects. Antioxidants have no or minimal side effects. If they can protect the beta cells against free oxygen radicals during the inflammatory process this would be a safe and cheap intervention. To evaluate this hypothesis a combination of various antioxidative agents was employed in a double-blind randomized study.

METHODS

The study group comprised 46 children aged 1-17 years at diagnosis. They were followed for 3 years: 2 years whilst taking the tablets and 1 year of follow-up. Twenty-four children were randomly allocated to active treatment with high doses of antioxidants and 22 children to placebo tablets. The tablets were the same size and tasted identical.

RESULTS

Twenty patients had for more than 1 month an insulin dose <0.5 U/kg in parallel with a normal HbA(1c) value and stable blood glucose values, but with no difference observed between those with and without active treatment. Nor was any significant difference observed regarding C-peptide values, fasting as well as stimulated. Whilst the antioxidants demonstrated no positive effect, they also had no negative side effects.

CONCLUSION

At diagnosis of type 1 diabetes in children, high doses of antioxidative agents have no effect either on the preservation of beta cell function or on metabolic balance.