The future of diabetes treatment

Despite successful development of several new therapies for the treatment of type 2 diabetes, including glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 inhibitors There is an ongoing effort to discover new treatment options that can reduce the risk of complications, improve safety and provide more effective glycemic control.

Insulin is considered the most innovative discovery in medicine. It was first isolated in 1921, allowing type 1 diabetes to become treatable rather than end-stage disease. But 100 years after its discovery, insulin is becoming more and more obsolete. Despite advances in automated incident delivery systems, individuals must make sincere efforts to manage their physiology. Despite the treatable nature of diabetes, life expectancy for people with type 1 diabetes is 12 years shorter than average.

As a result, the current paradigm for the prevention and treatment of type 2 diabetes is changing, and many therapies have emerged that address different aspects of the pathology of the disease, many of which are curative.

More and more attention has been paid to treatments for type 1 diabetes. The prospects for this treatment focus on replacing beta cells rather than supplying the body with insulin.

First reported evidence of dietary regulatory insulin secretion by differentiated stem cells in early 2021 and interim results during a multicenter clinical trial period 20 patient transplants were pancreatic endoderm cells derived from human pluripotent stem cells It has been constructed. Implant safety, tolerability, and efficacy were tested in 26 patients in a phase I / II study.

Another therapeutic approach to type 1 diabetes is a strategy to suppress or avoid the immune system. This is because type 1 diabetes is caused by an imbalanced autoreactive response of the immune system and can no longer tolerate itself. The ability of an organism to tolerate itself depends on the balance between central, peripheral, and organ-specific immune regulation. This disruption of homeostasis results in self-reactivity.

Antigen-specific immunotherapy is the administration of self-antigens and is associated with pancreatic islet antigen-specific toleration of CD4 + and CD8 + T cells in the context of type 1 diabetes. This can be achieved by several tolerant mechanisms, the most common of which are the recovery of regulatory T cells, effector T cells, etc.

Toleration refers to the tolerance of the immune system to specific antigens. In the context of diabetes, the antigen is on the surface of beta cells. There are many ways to achieve this, and immunotherapy works differently.

While some immunotherapies focus on targeting B cells, others improve the activity of both B cells and killer T cells, thus eliciting their destructive effects. You can not. Some therapies may also enhance the effects of regulatory T cells to prevent pancreatic autoreactivity.

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