Prevention of type 1 diabetes

Diubiquitin (Ubd) is a susceptibility gene for virus-triggered autoimmune diabetes in rats

Genetic studies of type 1 diabetes (T1D) have been advanced by comparative analysis of multiple susceptible and resistant rat strains with a permissive class II MHC haplotype, RT1(u). LEW.1WR1 (but not resistant LEW.1W or WF) rats are susceptible to T1D induced by a TLR3 agonist polyinosinic:polycytidylic acid followed by infection with parvovirus. We have mapped genetic loci for virus-induced T1D susceptibility, identifying a major susceptibility locus (Iddm37) near the MHC. The Iddm37 homologs on mouse and human chromosomes are also diabetes linked. We report that a major effect gene within Iddm37 is diubiquitin (Ubd). Gene expression profiling of pancreatic lymph nodes in susceptible and resistant rats during disease induction showed differences in Ubd transcript abundance. The LEW.1WR1 Ubd promoter allele leads to higher inducible levels of UBD than that of LEW.1W or WF. Using zinc-finger nucleases , we deleted a segment of the LEW.1WR1 Ubd gene and eliminated its expression. UBD-deficient rats show substantially reduced diabetes after viral infection. Complementary studies show that there may be another diabetes gene in addition to Ubd in the Iddm37 interval. These data prove that Ubd is a diabetes susceptibility gene, providing insight into the interplay of multiple genes and environmental factors in T1D susceptibility.

The potential role of dendritic cells in the therapy of Type 1 diabetes

Type 1 diabetes (T1D) is the result of T-cell mediated autoimmune destruction of pancreatic islet β-cells. The two current treatments for T1D are based on insulin or islet-cell replacement rather than the pathogenesis of T1D and remain problematic. Islet/pancreas transplantation does not cater for the majority of sufferers due to the lack of supply of organs and the need for continuous immunosuppression regimens. The mainstay treatment is insulin replacement, but this is disruptive to lifestyle and does not protect against severe long-term complications. An early vaccination and long-term restoration of immune tolerance to self-antigens in T1D patients (reversing the immunopathogenesis of the disease) would be preferable. Dendritic cells (DCs) are potent APCs and play an important role in inducing and maintaining immune tolerance. Targeting DCs through different DC surface molecules shows effective modulation of immune responses. Their feasibility for immunotherapy to prolong transplant survival and cancer immunotherapy has been demonstrated. Therefore, DCs could potentially be used in the treatment of autoimmune diseases. This review summarizes new insights into DCs as a potential therapeutic target for the treatment of T1D.

Diabetes prevention: perspectives and actions of one company

Diabetes, particularly type 2 diabetes mellitus (T2DM), has reached epidemic proportions in the U.S. and globally, highlighting the need for major improvements in treatment strategies for detecting, preventing, and slowing disease progression. Despite escalating treatment costs, diabetes care remains largely substandard, with hospitalizations for late-stage complications in particular placing a major burden on the healthcare system. Although considerable advances have been made in identifying the risk factors of diabetes and developing treatments, goals targeting prevention have remained elusive. Although there is currently no consensus regarding terminology among public health practitioners, the concept of prevention in terms of diabetes care runs the gamut from interventions used to avoid disease in individuals without risk factors (primordial prevention) to prevention of the consequences of established complications (quaternary prevention). Given the worldwide prevalence of diabetes, it is crucial to improve the quality of care for those diagnosed with overt diabetes, as well as those who have been identified as at risk for developing the disease. Earlier screening enables undiagnosed, asymptomatic individuals with diabetes to be identified sooner, managed more effectively, and where necessary, treated with the appropriate pharmacotherapeutic options in a timely manner. All stakeholders (including government, industry, professional, and patient groups) must partner in concert to address these vital issues so that treatment goals ultimately may be realized.

The nonskeletal effects of vitamin D: an Endocrine Society scientific statement

Significant controversy has emerged over the last decade concerning the effects of vitamin D on skeletal and nonskeletal tissues. The demonstration that the vitamin D receptor is expressed in virtually all cells of the body and the growing body of observational data supporting a relationship of serum 25-hydroxyvitamin D to chronic metabolic, cardiovascular, and neoplastic diseases have led to widespread utilization of vitamin D supplementation for the prevention and treatment of numerous disorders. In this paper, we review both the basic and clinical aspects of vitamin D in relation to nonskeletal organ systems. We begin by focusing on the molecular aspects of vitamin D, primarily by examining the structure and function of the vitamin D receptor. This is followed by a systematic review according to tissue type of the inherent biological plausibility, the strength of the observational data, and the levels of evidence that support or refute an association between vitamin D levels or supplementation and maternal/child health as well as various disease states. Although observational studies support a strong case for an association between vitamin D and musculoskeletal, cardiovascular, neoplastic, and metabolic disorders, there remains a paucity of large-scale and long-term randomized clinical trials. Thus, at this time, more studies are needed to definitively conclude that vitamin D can offer preventive and therapeutic benefits across a wide range of physiological states and chronic nonskeletal disorders.