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Yang X, He Z, Chen Q, Chen Y, Chen G, Liu C. Global research trends of diabetes remission: a bibliometric study. Front Endocrinol (Lausanne) 2023; 14:1272651. [PMID: 38089622 PMCID: PMC10715259 DOI: 10.3389/fendo.2023.1272651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Background Research on diabetes remission has garnered prominence in recent years. However, to date, no pertinent bibliometric study has been published. This study sought to elucidate the current landscape and pinpoint potential new research directions through a bibliometric analysis of diabetes remission. Methods We perused relevant articles on diabetes remission from January 1, 2000, to April 16, 2023, in the Web of Science. We utilized CiteSpace software and VOSviewer software to construct knowledge maps and undertake analysis of countries, institutional affiliations, author contributions, journals, and keywords. This analysis facilitated the identification of current research foci and forecasting future trends. Results A total of 970 English articles were procured, and the annual publication volume manifested a steady growth trend. Most of the articles originated from America (n=342, 35.26%), succeeded by China and England. Pertaining to institutions, the University of Newcastle in England proliferated the most articles (n=36, 3.71%). Taylor R authored the most articles (n=35, 3.61%), and his articles were also the most co-cited (n=1756 times). Obesity Surgery dominated in terms of published articles (n=81, 8.35%). "Bariatric surgery" was the most prevalently used keyword. The keyword-clustering map revealed that the research predominantly centered on diabetes remission, type 1 diabetes, bariatric surgery, and lifestyle interventions. The keyword emergence and keyword time-zone maps depicted hotspots and shifts in the domain of diabetes remission. Initially, the hotspots were primarily fundamental experiments probing the feasibilities and mechanisms of diabetes remission, such as transplantation. Over the course, the research trajectory transitioned from basic to clinical concerning diabetes remission through bariatric surgery, lifestyle interventions, and alternative strategies. Conclusion Over the preceding 20 years, the domain of diabetes remission has flourished globally. Bariatric surgery and lifestyle interventions bestow unique advantages for diabetes remission. Via the maps, the developmental milieu, research foci, and avant-garde trends in this domain are cogently portrayed, offering guidance for scholars.
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Affiliation(s)
- Xue Yang
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- KweiChow Moutai Hospital, Renhuai, China
| | - Zhiwei He
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Qilin Chen
- KweiChow Moutai Hospital, Renhuai, China
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu Chen
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chao Liu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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The role of cytokines and T-bet, GATA3, ROR-γt, and FOXP3 transcription factors of T cell subsets in the natural clinical progression of Type 1 Diabetes. Immunol Res 2023; 71:451-462. [PMID: 36595206 DOI: 10.1007/s12026-022-09355-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023]
Abstract
Th cells play an important role in pathogenesis of type 1 diabetes (T1D). Peripheral blood mononuclear cells were isolated from peripheral blood samples from newly diagnosed (ND), 1-year (1YD), and 5-year T1D (5YD) patients (n:8 of each group), 8 healthy controls (HC), and cultured for 24 h under unstimulated (US) and stimulated conditions. Cell ratios of Th1, Th2, Th17, Treg, and intracellular levels of IFN-γ, TNF-α, IL-10, TGF-β, IL-5, IL-13, IL-17, and IL-21 cytokines were evaluated using the flow cytometry. mRNA expressions of transcription factors T-bet, GATA3, ROR-γt, and FOXP3 of these cells were determined by real-time PCR. Reduced CD4+CD25high cell ratios were detected in ND. CD4+CD25high cells were found to be reduced in ND and 1YD compared to HC under IL-2-stimulated conditions. Intracellular IFN-γ and TNF-α levels were low in all patients under US and IL-12-stimulated conditions. IL-17A and IL-21 were found to be high in patients with IL-6-stimulated conditions. Expressions of IL-10 and TGF-β have been observed to be reduced in patients. Th1/Th2, Th17/Treg, and Th1/Treg ratios were higher in patient groups. FOXP3 and GATA3 mRNA expressions were found to be low in patients, while RORγt and T-bet mRNA levels were higher than HC. Th1, Th17, and Treg cells and their cytokines have been shown to be associated with type 1 diabetes.
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Cobo-Vuilleumier N, Gauthier BR. Time for a paradigm shift in treating type 1 diabetes mellitus: coupling inflammation to islet regeneration. Metabolism 2020; 104:154137. [PMID: 31904355 DOI: 10.1016/j.metabol.2020.154137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/26/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune disease that targets the destruction of islet beta-cells resulting in insulin deficiency, hyperglycemia and death if untreated. Despite advances in medical devices and longer-acting insulin, there is still no robust therapy to substitute and protect beta-cells that are lost in T1DM. Attempts to refrain from the autoimmune attack have failed to achieve glycemic control in patients highlighting the necessity for a paradigm shift in T1DM treatment. Paradoxically, beta-cells are present in T1DM patients indicating a disturbed equilibrium between the immune attack and beta-cell regeneration reminiscent of unresolved wound healing that under normal circumstances progression towards an anti-inflammatory milieu promotes regeneration. Thus, the ultimate T1DM therapy should concomitantly restore immune self-tolerance and replenish the beta-cell mass similar to wound healing. Recently the agonistic activation of the nuclear receptor LRH-1/NR5A2 was shown to induce immune self-tolerance, increase beta-cell survival and promote regeneration through a mechanism of alpha-to-beta cell phenotypic switch. This trans-regeneration process appears to be facilitated by a pancreatic anti-inflammatory environment induced by LRH-1/NR5A2 activation. Herein, we review the literature on the role of LRH1/NR5A2 in immunity and islet physiology and propose that a cross-talk between these cellular compartments is mandatory to achieve therapeutic benefits.
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Affiliation(s)
- Nadia Cobo-Vuilleumier
- Andalusian Center for Molecular Biology and Regenerative Medicine-CABIMER, Junta de Andalucia-University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Benoit R Gauthier
- Andalusian Center for Molecular Biology and Regenerative Medicine-CABIMER, Junta de Andalucia-University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, 28029 Spain.
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4
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Neuroinflammation in CNS diseases: Molecular mechanisms and the therapeutic potential of plant derived bioactive molecules. PHARMANUTRITION 2020. [DOI: 10.1016/j.phanu.2020.100176] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nie J, DuBois DC, Xue B, Jusko WJ, Almon RR. Effects of High-Fat Feeding on Skeletal Muscle Gene Expression in Diabetic Goto-Kakizaki Rats. GENE REGULATION AND SYSTEMS BIOLOGY 2017; 11:1177625017710009. [PMID: 28607540 PMCID: PMC5457139 DOI: 10.1177/1177625017710009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/17/2017] [Indexed: 12/16/2022]
Abstract
In the present report, we examined the responses of diabetic Goto-Kakizaki (GK) rats and control Wistar-Kyoto (WKY) rats fed either a standard chow or high-fat diet (HFD) from weaning to 20 weeks of age. This comparison included gene expression profiling of skeletal muscle using Affymetrix gene array chips. The expression profiling is interpreted within the context of a wide array of physiological measurements. Genes whose expressions are different between the 2 strains regardless of diet, as well as genes that differ between strains only with HFD, were identified. In addition, genes that were regulated by diet in 1 or both strains were identified. The results suggest that both strains respond to HFD by an increased capacity to oxidize lipid fuels in the musculature but that this adaptation occurs more rapidly in WKY rats. The results also demonstrated an impaired cytokine signalling and heightened inflammatory status in the GK rats.
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Affiliation(s)
- Jing Nie
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Debra C DuBois
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA.,Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bai Xue
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - William J Jusko
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Richard R Almon
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA.,Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Zhang J, Chen Z, Zhou Z, Yang P, Wang CY. Sumoylation Modulates the Susceptibility to Type 1 Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 963:299-322. [DOI: 10.1007/978-3-319-50044-7_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Alhusban A, Alkhazaleh E, El-Elimat T. Silymarin Ameliorates Diabetes-Induced Proangiogenic Response in Brain Endothelial Cells through a GSK-3 β Inhibition-Induced Reduction of VEGF Release. J Diabetes Res 2017; 2017:2537216. [PMID: 29209632 PMCID: PMC5676450 DOI: 10.1155/2017/2537216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/24/2017] [Indexed: 02/03/2023] Open
Abstract
Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. Additionally, it was found to induce a dysfunctional angiogenic response in the brain that was attributed to oxidative stress. Milk thistle seed extract (silymarin) has potent antioxidant properties, though its potential use in ameliorating diabetes-induced aberrant brain angiogenesis is unknown. Glycogen synthase kinase-3β is a regulator of angiogenesis that is upregulated by diabetes. Its involvement in diabetes-induced angiogenesis is unknown. To evaluate the potential of silymarin to ameliorate diabetes-induced aberrant angiogenesis, human brain endothelial cells (HBEC-5i) were treated with 50 μg/mL advanced glycation end (AGE) products in the presence or absence of silymarin (50, 100 μM). The angiogenic potential of HBEC-5i was evaluated in terms of migration and in vitro tube formation capacities. The involvement of GSK-3β was also evaluated. AGE significantly increased the migration and tube formation rates of HBEC-5i by about onefold (p = 0.0001). Silymarin reduced AGE-induced migration in a dose-dependent manner where 50 μM reduced migration by about 50%, whereas the 100 μM completely inhibited AGE-induced migration. Similarly, silymarin 50 μg/mL blunted AGE-induced tube formation (p = 0.001). This effect was mediated through a GSK-3β-dependent inhibition of VEGF release. In conclusion, silymarin inhibits AGE-induced aberrant angiogenesis in a GSK-3β-mediated inhibition of VEGF release.
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Affiliation(s)
- Ahmed Alhusban
- Clinical Pharmacy Department, College of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Enaam Alkhazaleh
- Clinical Pharmacy Department, College of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Tamam El-Elimat
- Medicinal Chemistry & Pharmacognosy Department, College of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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Talat MA, Sherief LM, El-Saadany HF, Rass AA, Saleh RM, Sakr MMH. The Role of Osteopontin in the Pathogenesis and Complications of Type 1 Diabetes Mellitus in Children. J Clin Res Pediatr Endocrinol 2016; 8:399-404. [PMID: 27353561 PMCID: PMC5197997 DOI: 10.4274/jcrpe.3082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is the most common chronic metabolic disorder of childhood and adolescence. Osteopontin plays a significant role in the development and progression of several autoimmune diseases. Moreover, osteopontin promotes adipose tissue inflammation, dysfunction, and insulin resistance. To investigate the levels of serum osteopontin in pediatric patients with T1DM and to explore if these levels have a role in the prediction of diabetes complications. METHODS This was a case-control study conducted at the Endocrinology unit of the Children's Hospital of Zagazig University in Egypt, from October 2014 to December 2015. Sixty patients with T1DM and 60 healthy subjects were enrolled. A detailed medical history was taken from all patients/parents. A full clinical examination including ophthalmoscopy was performed on all patients. Fasting blood glucose, hemoglobin A1c (HbA1c), urine albumin/creatinine ratio, and serum osteopontin levels were also determined in all subjects. RESULTS Patients with T1DM had significantly higher serum osteopontin levels compared with controls (mean ± standard deviation: 13.7±3.4 μg/L vs. 8.9±2.9 μg/L, p<0.001). Also, serum osteopontin concentrations were higher in patients with microalbuminuria than in patients with normal albumin excretion rate and in the control group. Similarly, those who had retinal disease had higher osteopontin concentrations than those without (16.8±2 vs. 12.4±3 mg/L; p=0.005). Serum osteopontin levels correlated with a diagnosis of T1DM, and in diabetic patients, correlated with higher systolic and diastolic blood pressure, body mass index values and with lower high density lipoprotein values, diagnosis of retinopathy, and microalbuminuria. No correlation was found between osteopontin levels and HbA1c, insulin dose, co-medications, and diabetes duration in T1DM patients. The association between high osteopontin levels and T1DM was independent from all confounders. CONCLUSION This study shows that increased osteopontin levels are independently associated with T1DM in pediatric patients and supports the hypothesis that osteopontin may have a role in the prediction of microvascular diabetes complications.
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Affiliation(s)
- Mohamed A. Talat
- Zagazig University Faculty of Medicine, Department of Pediatrics, Zagazig, Egypt
,* Address for Correspondence: Zagazig University Faculty of Medicine, Department of Pediatrics, Zagazig, Egypt Phone: +20 122 994 27 69 E-mail:
| | | | | | - Anwar Ahmed Rass
- Zagazig University Faculty of Medicine, Department of Pediatrics, Zagazig, Egypt
| | - Rabab M. Saleh
- Zagazig University Faculty of Medicine, Department of Pediatrics, Zagazig, Egypt
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Gregory PC, Hoffmann K, Kamphues J, Möeler A. The Pancreatic Duct Ligated (Mini)pig as a Model for Pancreatic Exocrine Insufficiency in Man. Pancreas 2016; 45:1213-26. [PMID: 27623555 DOI: 10.1097/mpa.0000000000000674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Modern therapy of pancreatic exocrine insufficiency (PEI) using pancreatic enzyme replacement therapy (PERT) has largely been very effective and has greatly helped in improving the nutritional status of patients with PEI and in increasing the life expectancy in cystic fibrosis. It is believed that the use of predictable large animal models could play an important role in assessing and developing new therapies. This article reviews the pancreatic duct ligated (adult) minipig as a chronic model of total PEI, with a detailed look at the influence of PEI and response to PERT on prececal compared to fecal digestibility, to directly investigate effects on protein and starch digestion and absorption. In addition, the piglet with PEI is reviewed as a model for PEI in young patients with the aim of further improving the therapy and nutritional status of young patients with cystic fibrosis.
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Affiliation(s)
- Peter Colin Gregory
- From the *Abbott Laboratories GmbH; and †Institute for Animal Nutrition, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Leete P, Willcox A, Krogvold L, Dahl-Jørgensen K, Foulis AK, Richardson SJ, Morgan NG. Differential Insulitic Profiles Determine the Extent of β-Cell Destruction and the Age at Onset of Type 1 Diabetes. Diabetes 2016; 65:1362-9. [PMID: 26858360 DOI: 10.2337/db15-1615] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/20/2016] [Indexed: 11/13/2022]
Abstract
Type 1 diabetes (T1D) results from a T cell-mediated destruction of pancreatic β-cells following the infiltration of leukocytes (including CD8(+), CD4(+), and CD20(+) cells) into and around pancreatic islets (insulitis). Recently, we reported that two distinct patterns of insulitis occur in patients with recent-onset T1D from the U.K. and that these differ principally in the proportion of infiltrating CD20(+) B cells (designated CD20Hi and CD20Lo, respectively). We have now extended this analysis to include patients from the Network for Pancreatic Organ Donors with Diabetes (U.S.) and Diabetes Virus Detection (DiViD) study (Norway) cohorts and confirm that the two profiles of insulitis occur more widely. Moreover, we show that patients can be directly stratified according to their insulitic profile and that those receiving a diagnosis before the age of 7 years always display the CD20Hi profile. By contrast, individuals who received a diagnosis beyond the age of 13 years are uniformly defined as CD20Lo. This implies that the two forms of insulitis are differentially aggressive and that patients with a CD20Hi profile lose their β-cells at a more rapid rate. In support of this, we also find that the proportion of residual insulin-containing islets (ICIs) increases in parallel with age at the onset of T1D. Importantly, those receiving a diagnosis in, or beyond, their teenage years retain ∼40% ICIs at diagnosis, implying that a functional deficit rather than an absolute β-cell loss may be causal for disease onset in these patients. We conclude that appropriate patient stratification will be critical for correct interpretation of the outcomes of intervention therapies targeted to islet-infiltrating immune cells in T1D.
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Affiliation(s)
- Pia Leete
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Abby Willcox
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Lars Krogvold
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alan K Foulis
- Department of Pathology, National Health Service Greater Glasgow and Clyde, Southern General Hospital, Glasgow, U.K
| | - Sarah J Richardson
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K.
| | - Noel G Morgan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K.
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Satin LS, Schnell S. Evidence for Residual and Partly Reparable Insulin Secretory Function and Maintained β-Cell Gene Expression in Islets From Patients With Type 1 Diabetes. Diabetes 2015; 64:2335-7. [PMID: 26106195 PMCID: PMC4477347 DOI: 10.2337/db15-0434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Leslie S Satin
- Department of Pharmacology, Brehm Center for Diabetes Research, University of Michigan Medical School, Ann Arbor, MI
| | - Santiago Schnell
- Department of Molecular & Integrative Physiology, Brehm Center for Diabetes Research, University of Michigan Medical School, Ann Arbor, MI
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Zhong J, Yu Q, Yang P, Rao X, He L, Fang J, Tu Y, Zhang Z, Lai Q, Zhang S, Kuczma M, Kraj P, Xu JF, Gong F, Zhou J, Wen L, Eizirik DL, Du J, Wang W, Wang CY. MBD2 regulates TH17 differentiation and experimental autoimmune encephalomyelitis by controlling the homeostasis of T-bet/Hlx axis. J Autoimmun 2014; 53:95-104. [DOI: 10.1016/j.jaut.2014.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/17/2014] [Accepted: 05/23/2014] [Indexed: 01/28/2023]
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Piłaciński S, Zozulińska-Ziółkiewicz DA. Influence of lifestyle on the course of type 1 diabetes mellitus. Arch Med Sci 2014; 10:124-34. [PMID: 24701225 PMCID: PMC3953982 DOI: 10.5114/aoms.2014.40739] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/12/2013] [Accepted: 06/02/2013] [Indexed: 12/15/2022] Open
Abstract
Type 1 diabetes (T1DM) is an autoimmune disease that requires insulin treatment from the time of diagnosis. Its clinical course depends on both genetic and environmental factors, and the lifestyle of a patient modulates their interaction. The evidence about the influence of lifestyle on the course of T1DM is increasing. In this paper, we present evidence on the relationship between lifestyle parameters and diabetes-related outcomes. We discuss the most commonly addressed factors associated with lifestyle, such as physical activity, nutrition and smoking, and those with sparse evidence in T1DM, such as socioeconomic status, sleep duration, psychological stress and illicit drugs intake.
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Affiliation(s)
- Stanisław Piłaciński
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
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Sherr JL, Ghazi T, Wurtz A, Rink L, Herold KC. Characterization of residual β cell function in long-standing type 1 diabetes. Diabetes Metab Res Rev 2014; 30:154-62. [PMID: 24115337 DOI: 10.1002/dmrr.2478] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/16/2013] [Accepted: 09/06/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Some patients with long-standing type 1 diabetes (T1D) maintain detectable levels of C-peptide. The quantitative and qualitative aspects of insulin secretion in these subjects have not been assessed, but may shed light on the basis for maintained β cell function. Our objective was to characterize insulin secretion in subjects with varying duration of T1D. METHODS Data from mixed-meal tolerance tests were collected in this cross-sectional study. We screened 58 subjects with T1D <1 year and 34 subjects with T1D >2 years, 20 of whom had previously participated in trials of anti-CD3 monoclonal antibody. Data from 38 historical non-diabetic controls were utilized. Insulin secretory rates were calculated from C-peptide levels from mixed-meal tolerance tests. Patterns and rates of insulin secretion were characterized along with relationships between insulin secretion and clinical parameters. RESULTS C-peptide was detected in 68% of subjects with T1D duration >2 years. Insulin secretion was negatively correlated with HgbA(1c) and insulin use. A decline in total insulin secretion was seen with increasing disease duration (p < 0.0001). More subjects with long duration of T1D had a delayed time to peak secretion compared with those with new onset T1D or non-diabetic subjects. Insulin and glucagon secretory responses appeared unrelated. CONCLUSIONS Meal-stimulated insulin secretory responses are seen in those with long-standing T1D and detectable C-peptide. Delayed insulin secretory responses are more common in individuals with longer disease duration. Residual insulin secretory responses are associated with improved clinical parameters.
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Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Diabetes Mellitus: New Challenges and Innovative Therapies. NEW STRATEGIES TO ADVANCE PRE/DIABETES CARE: INTEGRATIVE APPROACH BY PPPM 2013; 3. [PMCID: PMC7120768 DOI: 10.1007/978-94-007-5971-8_3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is a common chronic disease affecting an estimated 285 million adults worldwide. The rising incidence of diabetes, metabolic syndrome, and subsequent vascular diseases is a major public health problem in industrialized countries. This chapter summarizes current pharmacological approaches to treat diabetes mellitus and focuses on novel therapies for diabetes mellitus that are under development. There is great potential for developing a new generation of therapeutics that offer better control of diabetes, its co-morbidities and its complications. Preclinical results are discussed for new approaches including AMPK activation, the FGF21 target, cell therapy approaches, adiponectin mimetics and novel insulin formulations. Gene-based therapies are among the most promising emerging alternatives to conventional treatments. Therapies based on gene silencing using vector systems to deliver interference RNA to cells (i.e. against VEGF in diabetic retinopathy) are also a promising therapeutic option for the treatment of several diabetic complications. In conclusion, treatment of diabetes faces now a new era that is characterized by a variety of innovative therapeutic approaches that will improve quality of life in the near future.
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Abstract
The purpose of this article is to provide an overview that summarizes much in the way of our current state of knowledge regarding the pathogenesis and natural history of type 1 diabetes in humans. This information is presented to the reader as a series of seminal historical discoveries that, when advanced through research, transformed our understanding of the roles for the immune system, genes, and environment in the formation of this disease. In addition, where longitudinal investigations of these three facets occurred, their roles within the development of type 1 diabetes, from birth to symptomatic onset and beyond, are discussed, including their most controversial elements. Having an understanding of this disorder's pathogenesis and natural history is key for attempts seeking to understand the issues of what causes type 1 diabetes, as well as to develop a means to prevent and cure the disorder.
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Affiliation(s)
- Mark A Atkinson
- College of Medicine, Departments of Pathology and Pediatrics, The University of Florida, Gainesville, 32610-0275, USA.
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Brezar V, Culina S, Gagnerault MC, Mallone R. Short-term subcutaneous insulin treatment delays but does not prevent diabetes in NOD mice. Eur J Immunol 2012; 42:1553-61. [PMID: 22678909 DOI: 10.1002/eji.201242394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite encouraging results in the NOD mouse, type 1 diabetes prevention trials using subcutaneous insulin have been unsuccessful. To explain these discrepancies, 3-week-old NOD mice were treated for 7 weeks with subcutaneous insulin at two different doses: a high dose (0.5 U/mouse) used in previous mouse studies; and a low dose (0.005 U/mouse) equivalent to that used in human trials. Effects on insulitis and diabetes were monitored along with immune and metabolic modifications. Low-dose insulin did not have any effect on disease incidence. High-dose treatment delayed but did not prevent diabetes, with reduced insulitis reappearing once insulin discontinued. This effect was not associated with significant immune changes in islet infiltrates, either in terms of cell composition or frequency and IFN-γ secretion of islet-reactive CD8(+) T cells recognizing the immunodominant epitopes insulin B(15-23) and islet-specific glucose-6-phosphatase catalytic subunit-related protein (IGRP)(206-214). Delayed diabetes and insulitis were associated with lower blood glucose and endogenous C-peptide levels, which rapidly returned to normal upon treatment discontinuation. In conclusion, high- but not low-dose prophylactic insulin treatment delays diabetes onset and is associated with metabolic changes suggestive of β-cell "rest" which do not persist beyond treatment. These findings have important implications for designing insulin-based prevention trials.
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Affiliation(s)
- Vedran Brezar
- INSERM, U986, DeAR Lab Avenir, Cochin/Saint Vincent de Paul Hospital, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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18
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Steele JAM, Barron AE, Carmona E, Hallé JP, Neufeld RJ. Encapsulation of protein microfiber networks supporting pancreatic islets. J Biomed Mater Res A 2012; 100:3384-91. [PMID: 22767501 DOI: 10.1002/jbm.a.34281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/24/2012] [Accepted: 05/14/2012] [Indexed: 11/09/2022]
Abstract
Networks of discrete, genipin-crosslinked gelatin microfibers enveloping pancreatic islets were incorporated within barium alginate microcapsules. This novel technique enabled encapsulation of cellular aggregates in a spherical fibrous matrix <300 μm in diameter. Microfibers were produced by vortex-drawn extrusion within an alginate support matrix. Optimization culminated in a hydrated fiber diameter of 22.3 ± 0.4 μm, a significant reduction relative to that available through current gelatin microfiber spinning techniques, while making the process more reliable and less labor intensive. Microfibers were encapsulated at 40 vol % within 294 ± 4 μm 1.6% barium alginate microparticles by electrostatic-mediated dropwise extrusion. Pancreatic islets extracted from Sprague Dawley rats were encapsulated within the microparticles and analyzed over 21 days. Acridine orange and propidium iodide fluorescent viability staining and light microscopy indicated a significant increase in viability for islets within the fiber-embedded particles relative to fiber-free controls at days 7, 14, and 21. The fiber-embedded system also promoted cellular aggregate cohesion, reducing the incidence of dispersed islet morphologies within the capsules from 31 to 8% at day 21. Further enquiry into benefits of islet encapsulation within a protein fiber network will be the subject of future investigation.
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Affiliation(s)
- Joseph A M Steele
- Department of Chemical Engineering, Queen's University, Kingston, Ontario, Canada, K7L 3N6
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19
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Li CR, Baaten BJG, Bradley LM. Harnessing memory adaptive regulatory T cells to control autoimmunity in type 1 diabetes. J Mol Cell Biol 2011; 4:38-47. [PMID: 22116888 DOI: 10.1093/jmcb/mjr040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Type 1 diabetes (T1D) results from autoimmune destruction of insulin-producing β-cells in the pancreatic islets. There is an immediate need to restore both β-cell function and immune tolerance to control disease progression and ultimately cure T1D. Currently, there is no effective treatment strategy to restore glucose regulation in patients with T1D. FoxP3-expressing CD4(+) regulatory T cells (Tregs) are potential candidates to control autoimmunity because they play a central role in maintaining self-tolerance. However, deficiencies in either naturally occurring Tregs (nTregs) themselves and/or their ability to control pathogenic effector T cells have been associated with T1D. Here, we hypothesize that nTregs can be replaced by FoxP3(+) adaptive Tregs (aTregs), which are uniquely equipped to combat autoreactivity in T1D. Unlike nTregs, aTregs are stable and provide long-lived protection. In this review, we summarize the current understanding of aTregs and their potential for use as an immunological intervention to treat T1D.
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Affiliation(s)
- Cheng-Rui Li
- Infectious and Inflammatory Disease Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037, USA
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20
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Affiliation(s)
- Ping Yang
- Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Liang Li
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Cong-Yi Wang
- Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Center for Biotechnology and Genomic Medicine, Department of Pathology, Georgia Health Sciences University, Augusta, Georgia
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21
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Battaglia M, Roncarolo MG. Immune intervention with T regulatory cells: past lessons and future perspectives for type 1 diabetes. Semin Immunol 2011; 23:182-94. [PMID: 21831659 DOI: 10.1016/j.smim.2011.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/10/2011] [Indexed: 01/11/2023]
Abstract
In type 1 diabetes (T1D), insulin-producing pancreatic β-cells are attacked and destroyed by the immune system. Although man-made insulin is life-saving, it is not a cure and it cannot prevent long-term complications. In addition, most T1D patients would do almost anything to achieve release from the burden of daily glucose monitoring and insulin injection. Despite the formation of very large and promising clinical trials, a means to prevent/cure T1D in humans remains elusive. This has led to an increasing interest in the possibility of using T cells with regulatory properties (Treg cells) as a biological therapy to preserve and restore tolerance to self-antigens. In the present review we will attempt to consolidate learning from the past and to describe what we now believe could in the future become a successful Treg-cell based immune intervention in T1D.
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Affiliation(s)
- Manuela Battaglia
- San Raffaele Diabetes Research Institute, via Olgettina 58, 20132 Milan, Italy.
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22
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Herold KC, Pescovitz MD, McGee P, Krause-Steinrauf H, Spain LM, Bourcier K, Asare A, Liu Z, Lachin JM, Dosch HM. Increased T cell proliferative responses to islet antigens identify clinical responders to anti-CD20 monoclonal antibody (rituximab) therapy in type 1 diabetes. THE JOURNAL OF IMMUNOLOGY 2011; 187:1998-2005. [PMID: 21775681 DOI: 10.4049/jimmunol.1100539] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Type 1 diabetes mellitus is believed to be due to the autoimmune destruction of β-cells by T lymphocytes, but a single course of rituximab, a monoclonal anti-CD20 B lymphocyte Ab, can attenuate C-peptide loss over the first year of disease. The effects of B cell depletion on disease-associated T cell responses have not been studied. We compare changes in lymphocyte subsets, T cell proliferative responses to disease-associated target Ags, and C-peptide levels of participants who did (responders) or did not (nonresponders) show signs of β-cell preservation 1 y after rituximab therapy in a placebo-controlled TrialNet trial. Rituximab decreased B lymphocyte levels after four weekly doses of mAb. T cell proliferative responses to diabetes-associated Ags were present at baseline in 75% of anti-CD20- and 82% of placebo-treated subjects and were not different over time. However, in rituximab-treated subjects with significant C-peptide preservation at 6 mo (58%), the proliferative responses to diabetes-associated total (p = 0.032), islet-specific (p = 0.048), and neuronal autoantigens (p = 0.005) increased over the 12-mo observation period. This relationship was not seen in placebo-treated patients. We conclude that in patients with type 1 diabetes mellitus, anti-B cell mAb causes increased proliferative responses to diabetes Ags and attenuated β-cell loss. The way in which these responses affect the disease course remains unknown.
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Affiliation(s)
- Kevan C Herold
- Department of Immunobiology, Yale University, New Haven, CT 06511, USA.
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23
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He KHH, Lorenzo PI, Brun T, Jimenez Moreno CM, Aeberhard D, Ortega JV, Cornu M, Thorel F, Gjinovci A, Thorens B, Herrera PL, Meda P, Wollheim CB, Gauthier BR. In vivo conditional Pax4 overexpression in mature islet β-cells prevents stress-induced hyperglycemia in mice. Diabetes 2011; 60:1705-15. [PMID: 21521872 PMCID: PMC3114382 DOI: 10.2337/db10-1102] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To establish the role of the transcription factor Pax4 in pancreatic islet expansion and survival in response to physiological stress and its impact on glucose metabolism, we generated transgenic mice conditionally and selectively overexpressing Pax4 or a diabetes-linked mutant variant (Pax4R129W) in β-cells. RESEARCH DESIGN AND METHODS Glucose homeostasis and β-cell death and proliferation were assessed in Pax4- or Pax4R129W-overexpressing transgenic animals challenged with or without streptozotocin. Isolated transgenic islets were also exposed to cytokines, and apoptosis was evaluated by DNA fragmentation or cytochrome C release. The expression profiles of proliferation and apoptotic genes and β-cell markers were studied by immunohistochemistry and quantitative RT-PCR. RESULTS Pax4 but not Pax4R129W protected animals against streptozotocin-induced hyperglycemia and isolated islets from cytokine-mediated β-cell apoptosis. Cytochrome C release was abrogated in Pax4 islets treated with cytokines. Interleukin-1β transcript levels were suppressed in Pax4 islets, whereas they were increased along with NOS2 in Pax4R129W islets. Bcl-2, Cdk4, and c-myc expression levels were increased in Pax4 islets while MafA, insulin, and GLUT2 transcript levels were suppressed in both animal models. Long-term Pax4 expression promoted proliferation of a Pdx1-positive cell subpopulation while impeding insulin secretion. Suppression of Pax4 rescued this defect with a concomitant increase in pancreatic insulin content. CONCLUSIONS Pax4 protects adult islets from stress-induced apoptosis by suppressing selective nuclear factor-κB target genes while increasing Bcl-2 levels. Furthermore, it promotes dedifferentiation and proliferation of β-cells through MafA repression, with a concomitant increase in Cdk4 and c-myc expression.
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Affiliation(s)
- Kai Hui Hu He
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Petra I. Lorenzo
- Pancreatic Islet Development and Regeneration Unit, Department of Stem Cells, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), Seville, Spain
| | - Thierry Brun
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Carmen M. Jimenez Moreno
- Pancreatic Islet Development and Regeneration Unit, Department of Stem Cells, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), Seville, Spain
| | - Deborah Aeberhard
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Jorge Vallejo Ortega
- Pancreatic Islet Development and Regeneration Unit, Department of Stem Cells, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), Seville, Spain
| | - Marion Cornu
- Department of Physiology and Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Fabrizio Thorel
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Asllan Gjinovci
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Bernard Thorens
- Department of Physiology and Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Pedro L. Herrera
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Paolo Meda
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Claes B. Wollheim
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Benoit R. Gauthier
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
- Pancreatic Islet Development and Regeneration Unit, Department of Stem Cells, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), Seville, Spain
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24
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Katz JD, Janssen EM. Breaking T cell tolerance to beta cell antigens by merocytic dendritic cells. Cell Mol Life Sci 2011; 68:2873-83. [PMID: 21626409 DOI: 10.1007/s00018-011-0730-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 04/12/2011] [Accepted: 05/09/2011] [Indexed: 11/28/2022]
Abstract
In type 1 diabetes (T1D), a break in central and peripheral tolerance results in antigen-specific T cells destroying insulin-producing, pancreatic beta cells. Herein, we discuss the critical sub-population of dendritic cells responsible for mediating both the cross-presentation of islet antigen to CD8(+) T cells and the direct presentation of beta cell antigen to CD4(+) T cells. These cells, termed merocytic dendritic cells (mcDC), are more numerous in non-obese diabetic (NOD), and antigen-loaded mcDC rescue CD8(+) T cells from peripheral anergy and deletion, and stimulate islet-reactive CD4(+) T cells. When purified from the pancreatic lymph nodes of overtly diabetic NOD mice, mcDC can break peripheral T cell tolerance to beta cell antigens in vivo and induce rapid onset T cell-mediated T1D in young NOD mouse. Thus, the mcDC subset appears to represent the long-sought critical antigen-presenting cell responsible for breaking peripheral tolerance to beta cell antigen in vivo.
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Affiliation(s)
- Jonathan D Katz
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Research Foundation, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
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25
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Manesso E, Toffolo GM, Butler AE, Butler PC, Cobelli C. Shortened {beta}-cell lifespan leads to {beta}-cell deficit in a rodent model of type 2 diabetes. Am J Physiol Endocrinol Metab 2011; 300:E933-8. [PMID: 21343541 PMCID: PMC3279301 DOI: 10.1152/ajpendo.00504.2010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Since the fundamental defect in both type 1 and type 2 diabetes is β-cell failure, there is increasing interest in the capacity, if any, for β-cell regeneration. Insights into typical β-cell age and lifespan during normal development and how these are influenced in diabetes is desirable to realistically establish the prospects for β-cell regeneration as means to reverse the deficit in β-cell mass in diabetes. We assessed the mean β-cell age and lifespan by the classical McKendrick-von Foester equation that describes the age-based heterogeneity of β-cells in terms of the time-varying β-cell formation and loss estimated by a β-cell turnover model. This modeling approach was applied to evaluate β-cell lifespan in a rodent model of type 2 diabetes in comparison with nondiabetic controls. When rats were 10 mo old, mean β-cell lifespan was 1 mo vs. 6 mo in rats with type 2 diabetes vs. controls. A shortened β-cell lifespan in a rat model of type 2 diabetes results in a decrease in mean β-cell age and thus contributes to decreased β-cell mass.
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Affiliation(s)
- Erica Manesso
- Dept. of Information Engineering, Univ. of Padova, Via Gradenigo 6 B, 35129 Padova, Italy
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26
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Kouris I, Tsirmpas C, Mougiakakou SG, Iliopoulou D, Koutsouris D. E-Health towards ecumenical framework for personalized medicine via Decision Support System. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:2881-5. [PMID: 21095976 DOI: 10.1109/iembs.2010.5626308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of the present manuscript is to present the advances performed in medicine using a Personalized Decision Support System (PDSS). The models used in Decision Support Systems (DSS) are examined in combination with Genome Information and Biomarkers to produce personalized result for each individual. The concept of personalize medicine is described in depth and application of PDSS for Cardiovascular Diseases (CVD) and Type-1 Diabetes Mellitus (T1DM) are analyzed. Parameters extracted from genes, biomarkers, nutrition habits, lifestyle and biological measurements feed DSSs, incorporating Artificial Intelligence Modules (AIM), to provide personalized advice, medication and treatment.
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Affiliation(s)
- Ioannis Kouris
- School of Electrical and Computer Engineering, National Technical University of Athens, 9 Heroon Polytechneiou Str., 15780 Zografou, Greece.
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27
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Thunander M, Thorgeirsson H, Törn C, Petersson C, Landin-Olsson M. β-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up. Eur J Endocrinol 2011; 164:239-45. [PMID: 21088056 PMCID: PMC3022338 DOI: 10.1530/eje-10-0901] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The optimal treatment of latent autoimmune diabetes in adults (LADA) is not established. We explored whether early insulin treatment, which has shown beneficial effects in rodents and in human pilot studies, would result in better preservation of β-cell function or metabolic control, compared with conventional treatment. SUBJECTS AND METHODS Glucagon-stimulated C-peptide and HbAlc were evaluated at baseline and after 12, 24 and 36 months in 37 patients recently diagnosed with diabetes, aged ≥ 30 years, non-insulin-requiring and GADAb and/or ICA positive. Twenty patients received early insulin and 17 received conventional treatment (diet ± oral hypoglycaemic agents (OHA), metformin, some and/or sulfonylurea) and insulin when necessary. RESULTS Level of metabolic control, HbAlc, was preserved in the early insulin treated, while it significantly deteriorated in the conventionally treated. There was no significant difference between the groups in C-peptide after 12, 24 or 36 months, or in the decline of C-peptide. Only baseline C-peptide predicted a C-peptide of ≥ 0.5 nmol/l at 36 months. Gender, body mass index, antibody titres or HbAlc did not influence the levels of C-peptide or HbAlc at baseline or end-of-study, or the decline in C-peptide. Among the diet ± OHA-treated, 5/17 (30%) developed insulin dependency during the follow-up. No major hypoglycaemic events occurred. CONCLUSIONS Early insulin treatment in LADA leads to better preservation of metabolic control and was safe. Superior preservation of C-peptide could not be significantly demonstrated. Only baseline level of C-peptide significantly influenced C-peptide level after 3 years. Further studies exploring the best treatment in LADA are warranted.
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Affiliation(s)
- Maria Thunander
- Department of Endocrinology and Diabetology, Lund University Hospital, Lund, Sweden.
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Mehmeti I, Lenzen S, Lortz S. Modulation of Bcl-2-related protein expression in pancreatic beta cells by pro-inflammatory cytokines and its dependence on the antioxidative defense status. Mol Cell Endocrinol 2011; 332:88-96. [PMID: 20933054 DOI: 10.1016/j.mce.2010.09.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/03/2010] [Accepted: 09/28/2010] [Indexed: 12/27/2022]
Abstract
Pro-inflammatory cytokines are key mediators in the selective and progressive destruction of insulin-producing beta cells during type 1 diabetes development. However, the mechanisms of cytokine-induced beta cell apoptosis are not fully understood. This study demonstrates that pro-inflammatory cytokines strongly modified the expression of the anti-apoptotic protein Bcl-2 and the pro-apoptotic BH3-only proteins Bad, Bim, and Bid in primary rat islets and insulin-producing RINm5F cells. Overexpression of mitochondrially located catalase (MitoCatalase) specifically increased basal Bcl-2 and decreased basal Bax expression, suppressed cytokine-mediated reduction of Bcl-2, and thereby prevented the release of cytochrome c, Smac/DIABLO and the activation of caspase-9 and -3. Thus, cytokine-mediated decrease of Bcl-2 expression and the sequentially changed Bax/Bcl-2 ratio are responsible for the release of pro-apoptotic mitochondrial factors, activation of caspase-9, and ultimately caspase-3. These results indicate that activation of the intrinsic/mitochondrial apoptosis pathway is essential for cytokine-induced beta cell death and the mitochondrial generation of reactive oxygen species, in particular mitochondrial hydrogen peroxide, differentially regulates the Bax/Bcl-2 ratio.
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Affiliation(s)
- Ilir Mehmeti
- Institute of Clinical Biochemistry, Hannover Medical School, 30623 Hannover, Germany
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29
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Abstract
INTRODUCTION/BACKGROUND Type 1 diabetes is a chronic autoimmune condition characterized by destruction of insulin-producing β cells within the pancreatic islets. It is associated with considerable morbidity and mortality. Incidence levels are rising worldwide. SOURCES OF DATA Pubmed search (Nov 2010) using keywords: Type 1 diabetes, prevention, trials, immunotherapy. AREAS OF AGREEMENT The causes of disease are multifactorial with genetic and environmental factors playing a part. There is a long pre-clinical period before the onset of overt symptoms, which may be amenable to therapeutic intervention to prevent disease. AREAS OF CONTROVERSY The exact nature of causative environmental factors is unknown and much debated. Immunotherapeutic intervention may therefore represent the best option for disease prevention. GROWING POINTS Enhancement of 'regulatory' immune mechanisms currently shows the most promise as an approach to disease prevention. AREAS TIMELY FOR DEVELOPING RESEARCH Clinical trials of early immunotherapeutic intervention may be the answer to disease prevention.
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Affiliation(s)
- S L Thrower
- School of Clinical Sciences, University of Bristol, and Second Floor, Learning and Research, Southmead Hospital, Bristol BS10 5NB, UK
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30
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Zhang C, Wang M, Racine JJ, Liu H, Lin CL, Nair I, Lau J, Cao YA, Todorov I, Atkinson M, Zeng D. Induction of chimerism permits low-dose islet grafts in the liver or pancreas to reverse refractory autoimmune diabetes. Diabetes 2010; 59:2228-36. [PMID: 20530743 PMCID: PMC2927945 DOI: 10.2337/db10-0450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To test whether induction of chimerism lowers the amount of donor islets required for reversal of diabetes and renders the pancreas a suitable site for islet grafts in autoimmune diabetic mice. RESEARCH DESIGN AND METHODS The required donor islet dose for reversal of diabetes in late-stage diabetic NOD mice after transplantation into the liver or pancreas was compared under immunosuppression or after induction of chimerism. Recipient mice were monitored for blood glucose levels and measured for insulin-secretion capacity. Islet grafts were evaluated for beta-cell proliferation, beta-cell functional gene expression, and revascularization. RESULTS With immunosuppression, transplantation of 1,000, but not 600, donor islets was able to reverse diabetes when transplanted into the liver, but transplantation of 1,000 islets was not able to reverse diabetes when transplanted into the pancreas. In contrast, after induction of chimerism, transplantation of as few as 100 donor islets was able to reverse diabetes when transplanted into either the liver or pancreas. Interestingly, when lower doses (50 or 25) of islets were transplanted, donor islets in the pancreas were much more effective in reversal of diabetes than in the liver, which was associated with higher beta-cell replication rate, better beta-cell functional gene expression, and higher vascular density of graft islets in the pancreas. CONCLUSIONS Induction of chimerism not only provides immune tolerance to donor islets, but also markedly reduces the required amount of donor islets for reversal of diabetes. In addition, this process renders the pancreas a more superior site than the liver for donor islets in autoimmune mice.
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Affiliation(s)
- Chunyan Zhang
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
| | - Miao Wang
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
| | - Jeremy J. Racine
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
- Irell and Manella Graduate School of Biological Sciences of City of Hope, Duarte, California
| | - Hongjun Liu
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
| | - Chia-Lei Lin
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
| | - Indu Nair
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
| | - Joyce Lau
- Eugene and Ruth Roberts Summer Student Academy of City of Hope, Duarte, California
| | - Yu-An Cao
- Stanford University School of Medicine, Stanford, California
| | - Ivan Todorov
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
- Irell and Manella Graduate School of Biological Sciences of City of Hope, Duarte, California
| | - Mark Atkinson
- University of Florida College of Medicine, Gainesville, Florida
| | - Defu Zeng
- Departments of Diabetes Research and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, California
- Irell and Manella Graduate School of Biological Sciences of City of Hope, Duarte, California
- Corresponding author: Defu Zeng,
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31
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Haller MJ, Atkinson MA, Schatz DA. Efforts to prevent and halt autoimmune beta cell destruction. Endocrinol Metab Clin North Am 2010; 39:527-39. [PMID: 20723818 PMCID: PMC2925042 DOI: 10.1016/j.ecl.2010.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite improvements in understanding of the natural history of type 1 diabetes (T1D), an intervention capable of consistently and safely preventing or reversing the disease has not been developed. The inability to cure this disorder is largely because of the complex pathophysiology of T1D, continued struggles to identify its precise etiologic triggers, and voids in understanding of the immunologic mechanisms that specifically target pancreatic beta cells. Rapidly improving technologies for managing T1D require critical discussions about equipoise, especially when considering interventions deemed high risk in terms of their safety. This article reviews the conceptual basis for prevention versus intervention trials in settings of T1D, past experiences of clinical trials studying these purposes, and controversial issues regarding disease interdiction, and seeks to provide a roadmap for future efforts to cure this disorder.
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Affiliation(s)
- Michael J Haller
- Division of Endocrinology, Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610, USA.
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32
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Affiliation(s)
- Mark Peakman
- Department of Immunobiology, National Institute for Health Research, Comprehensive Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, King's College London, London, U.K
- Corresponding authors: Mark Peakman, , and Matthias von Herrath,
| | - Matthias von Herrath
- Center for Type 1 Diabetes Research, La Jolla Institute for Allergy and Immunology, La Jolla, California
- Corresponding authors: Mark Peakman, , and Matthias von Herrath,
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33
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Carey C, Purohit S, She JX. Advances and challenges in biomarker development for type 1 diabetes prediction and prevention using omic technologies. ACTA ACUST UNITED AC 2010; 4:397-410. [PMID: 20885991 DOI: 10.1517/17530059.2010.508492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD: Biomarkers are essential for the identification of high risk children as well as monitoring of prevention outcomes for type 1 diabetes (T1D). AREAS COVERED IN THIS REVIEW: This review discusses progress, opportunities and challenges in biomarker discovery and validation using high throughput genomic, transcriptomic and proteomic technologies. The authors also suggest potential solutions to deal with the current challenges. WHAT THE READER WILL GAIN: Readers will gain an overview of the current status on T1D biomarkers, an integrated review of three omic technologies, their applications and limitations for biomarker discovery and validation, and a critical discussion of the major issues encountered in biomarker development. TAKE HOME MESSAGE: Better biomarkers are still urgently needed for T1D prediction and prevention. The high throughput omic technologies offer great opportunities but also face significant challenges that have to be solved before their potential for biomarker development is fully realized.
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Affiliation(s)
- Colleen Carey
- Medical College of Georgia, Center for Biotechnology and Genomic Medicine, 1120 15th St., Augusta, 30912, USA
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Misler S. The isolated pancreatic islet as a micro-organ and its transplantation to cure diabetes: celebrating the legacy of Paul Lacy. Islets 2010; 2:210-24. [PMID: 21099316 PMCID: PMC3322537 DOI: 10.4161/isl.2.4.12156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/20/2010] [Accepted: 04/22/2010] [Indexed: 02/07/2023] Open
Abstract
Over the past three decades the pancreatic islet of Langerhans has taken center stage as an endocrine micro-organ whose glucoregulatory function is highly explicable on the basis of the increasingly well understood activities of three highly interactive secretory cells. Islet dysfunction underlies both type 1 and type 2 diabetes mellitus (DM); its protection from immune attack and gluco-and lipo-toxicity may prevent the development of DM; and its replacement by non-surgical transplantation may be curative of DM. During a career marked by vision, focus and tenacity, Paul Lacy contributed substantially to the development of each of these concepts. In this review we focus on Lacy's contribution to the development of the concept of the islet as a micro-organ, how this foreshadowed our current detailed understanding of single cell function and cell-cell interactions and how this led to a reduced model of islet function encouraging islet transplantation. Next, we examine how clinical allotransplantation, first undertaken by Lacy, has contributed to a more complex view of the interaction of islet endocrine cells with its circulation and neighboring tissues, both "in situ" and after transplantation. Lastly, we consider recent developments in some alternative approaches to treatment of DM that Lacy could glimpse on the horizon but did not have the chance to participate in.
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Affiliation(s)
- Stanley Misler
- Departments of Internal Medicine (Renal Division) and Cell Biology/Physiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
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Raskin P, Mohan A. Emerging treatments for the prevention of type 1 diabetes. Expert Opin Emerg Drugs 2010; 15:225-36. [DOI: 10.1517/14728211003694631] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Cernea S, Herold KC. Monitoring of antigen-specific CD8 T cells in patients with type 1 diabetes treated with antiCD3 monoclonal antibodies. Clin Immunol 2010; 134:121-9. [PMID: 19837003 DOI: 10.1016/j.clim.2009.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 08/22/2009] [Accepted: 09/12/2009] [Indexed: 01/11/2023]
Abstract
The way in which anti-CD3 monoclonal antibodies (mAbs) modify human immune responses in type 1 diabetes (T1DM) is not known. We prepared a panel of Class I HLA-A2.1 tetramers with peptides from diabetes-associated antigens and studied the frequency and phenotype of the cells in patients with T1DM and blood donors and in patients treated with anti-CD3 mAb (Teplizumab). More patients with T1DM showed positive staining for at least 1 tetramer using frozen and fresh samples (p<0.05). Three months following treatment with anti-CD3 mAb, the proportion of GAD65- and InsB-peptide reactive CD8+ T cells increased (p<0.05). The phenotype of these cells was modulated from naïve to effector memoryRA+. We concludethat Class I MHC tetramers can identify antigen specific CD8+ T cells in patients with T1DM. The frequency of certain specificities increases after treatment with anti-CD3 mAb. Their modulated phenotype may have functional consequences for their pathogenicity.
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Affiliation(s)
- Simona Cernea
- Department of Immunobiology, Yale University, 10 Amistad Street, 131D, New Haven, CT 06520, USA
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Sena CM, Bento CF, Pereira P, Seiça R. Diabetes mellitus: new challenges and innovative therapies. EPMA J 2010; 1:138-63. [PMID: 23199048 PMCID: PMC3405309 DOI: 10.1007/s13167-010-0010-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/04/2010] [Indexed: 12/25/2022]
Abstract
Diabetes mellitus is a widespread disease prevalence and incidence of which increases worldwide. The introduction of insulin therapy represented a major breakthrough in type 1 diabetes; however, frequent hyper- and hypoglycemia seriously affects the quality of life of these patients. New therapeutic approaches, such as whole pancreas transplant or pancreatic islet transplant, stem cell, gene therapy and islets encapsulation are discussed in this review. Regarding type 2 diabetes, therapy has been based on drugs that stimulate insulin secretion (sulphonylureas and rapid-acting secretagogues), reduce hepatic glucose production (biguanides), delay digestion and absorption of intestinal carbohydrate (alpha-glucosidase inhibitors) or improve insulin action (thiazolidinediones). This review is also focused on the newer therapeutically approaches such as incretin-based therapies, bariatric surgery, stem cells and other emerging therapies that promise to further extend the options available. Gene-based therapies are among the most promising emerging alternatives to conventional treatments. Some of these therapies rely on genetic modification of non-differentiated cells to express pancreatic endocrine developmental factors, promoting differentiation of non-endocrine cells into β-cells, enabling synthesis and secretion of insulin in a glucose-regulated manner. Alternative therapies based on gene silencing using vector systems to deliver interference RNA to cells (i.e. against VEGF in diabetic retinopathy) are also a promising therapeutic option for the treatment of several diabetic complications. In conclusion, treatment of diabetes faces now a new era that is characterized by a variety of innovative therapeutic approaches that will improve quality-life and allow personalized therapy-planning in the near future.
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Affiliation(s)
- Cristina M. Sena
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Subunit 1, polo 3, Azinhaga de Santa Comba, Celas, 3000-354 Coimbra, Portugal
- IBILI, University of Coimbra, Coimbra, Portugal
| | - Carla F. Bento
- IBILI, University of Coimbra, Coimbra, Portugal
- Centre of Ophthalmology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paulo Pereira
- IBILI, University of Coimbra, Coimbra, Portugal
- Centre of Ophthalmology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raquel Seiça
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Subunit 1, polo 3, Azinhaga de Santa Comba, Celas, 3000-354 Coimbra, Portugal
- IBILI, University of Coimbra, Coimbra, Portugal
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Herold KC, Brooks-Worrell B, Palmer J, Dosch HM, Peakman M, Gottlieb P, Reijonen H, Arif S, Spain LM, Thompson C, Lachin JM. Validity and reproducibility of measurement of islet autoreactivity by T-cell assays in subjects with early type 1 diabetes. Diabetes 2009; 58:2588-95. [PMID: 19675135 PMCID: PMC2768166 DOI: 10.2337/db09-0249] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Type 1 diabetes results from an immunemediated destruction of beta-cells, likely to be mediated by T lymphocytes, but the sensitivity, specificity, and other measures of validity of existing assays for islet autoreactive T-cells are not well established. Such assays are vital for monitoring responses to interventions that may modulate disease progression. RESEARCH DESIGN AND METHODS We studied the ability of cellular assays to discriminate responses in patients with type 1 diabetes and normal control subjects in a randomized blinded study in the U.S. and U.K. We evaluated the reproducibility of these measurements overall and to individual analytes from repeat collections. RESULTS Responses in the cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays could differentiate patients from control subjects with odds ratios of 21.7, 3.44, and 3.36, respectively, with sensitivity and specificity as high as 74 and 88%. The class II tetramer and U.S. ELISPOT assays performed less well. Despite the significant association of the responses with type 1 diabetes, the reproducibility of the measured responses, both overall and individual analytes, was relatively low. Positive samples from normal control subjects (i.e., false positives) were generally isolated to single assays. CONCLUSIONS The cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays can distinguish responses from patients with type 1 diabetes and healthy control subjects. The limited reproducibility of the measurements overall and of responses to individual analytes may reflect the difficulty in detection of low frequency of antigen-specific T-cells or variability in their appearance in peripheral blood.
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Abstract
Type 1 diabetes is a chronic autoimmune condition resulting from T cell-mediated destruction of the insulin-producing cells in the islets of Langerhans. Its primary cause remains unknown, but it has been established that the clinical presentation is preceded by a long prodrome. This enables individuals at high risk of disease to be identified and offers the possibility of intervention to prevent clinical disease. Many groups are working in this field, concentrating on manipulation of environmental exposures that are potential triggers of autoimmunity and on immunomodulation strategies that aim to prevent destruction of beta-cells. Some interventions have shown promising results in early trials, but effective disease prevention remains elusive. This article reviews current progress in the field.
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Affiliation(s)
- S L Thrower
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK
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From pumps to prevention: recent advances in the treatment of type 1 diabetes. Drug Discov Today 2009; 14:973-81. [DOI: 10.1016/j.drudis.2009.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 06/07/2009] [Accepted: 06/25/2009] [Indexed: 02/06/2023]
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Rewers M, Gottlieb P. Immunotherapy for the prevention and treatment of type 1 diabetes: human trials and a look into the future. Diabetes Care 2009; 32:1769-82. [PMID: 19794002 PMCID: PMC2752911 DOI: 10.2337/dc09-0374] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marian Rewers
- From the Barbara Davis Center, University of Colorado, Health Sciences Center, Denver, Colorado
| | - Peter Gottlieb
- From the Barbara Davis Center, University of Colorado, Health Sciences Center, Denver, Colorado
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Norquay LD, D'Aquino KE, Opare-Addo LM, Kuznetsova A, Haas M, Bluestone JA, White MF. Insulin receptor substrate-2 in beta-cells decreases diabetes in nonobese diabetic mice. Endocrinology 2009; 150:4531-40. [PMID: 19574401 PMCID: PMC2754683 DOI: 10.1210/en.2009-0395] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Insulin receptor substrate-2 (Irs2) integrates insulin-like signals with glucose and cAMP agonists to regulate beta-cell growth, function, and survival. This study investigated whether increased Irs2 concentration in beta-cells could reduce beta-cell destruction and the incidence of type 1 diabetes in nonobese diabetic (NOD) mice. NOD mice were intercrossed with C57BL/6 mice overexpressing Irs2 specifically in beta-cells to create NOD(Irs2) mice. After backcrossing NOD(Irs2) mice for 12 generations, glucose homeostasis and diabetes incidence were compared against NOD littermates. Compared with 12-wk-old NOD mice, the progression of severe insulitis was reduced and islet mass was increased in NOD(Irs2) mice. Moreover, the risk of diabetes decreased 50% in NOD(Irs2) mice until the experiment was terminated at 40 wk of age. Nondiabetic NOD(Irs2) mice displayed better glucose tolerance than nondiabetic NOD mice throughout the duration of the study and up to the age of 18 months. The effect of Irs2 to increase islet mass and improve glucose tolerance raised the possibility that NOD(Irs2) mice might have an increased capacity to respond to anti-CD3 antibody, which can induce remission of overt diabetes in some NOD mice. Anti-CD3 antibody injections restored glucose tolerance in newly diabetic NOD and NOD(Irs2) mice; however, anti-CD3-treated NOD(Irs2) mice were less likely than NOD mice to relapse during the experimental period because they displayed 10-fold greater beta-cell mass and mitogenesis. In conclusion, increased Irs2 attenuated the progression of beta-cell destruction, promoted beta-cell mitogenesis, and reduced diabetes incidence in NOD(Irs2) mice.
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Affiliation(s)
- Lisa D Norquay
- Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Howard Hughes Medical Institute, Boston, Massachusetts 02115, USA
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Manesso E, Toffolo GM, Saisho Y, Butler AE, Matveyenko AV, Cobelli C, Butler PC. Dynamics of beta-cell turnover: evidence for beta-cell turnover and regeneration from sources of beta-cells other than beta-cell replication in the HIP rat. Am J Physiol Endocrinol Metab 2009; 297:E323-30. [PMID: 19470833 PMCID: PMC2724115 DOI: 10.1152/ajpendo.00284.2009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Type 2 diabetes is characterized by hyperglycemia, a deficit in beta-cells, increased beta-cell apoptosis, and islet amyloid derived from islet amyloid polypeptide (IAPP). These characteristics are recapitulated in the human IAPP transgenic (HIP) rat. We developed a mathematical model to quantify beta-cell turnover and applied it to nondiabetic wild type (WT) vs. HIP rats from age 2 days to 10 mo to establish 1) whether beta-cell formation is derived exclusively from beta-cell replication, or whether other sources of beta-cells (OSB) are present, and 2) to what extent, if any, there is attempted beta-cell regeneration in the HIP rat and if this is through beta-cell replication or OSB. We conclude that formation and maintenance of adult beta-cells depends largely ( approximately 80%) on formation of beta-cells independent from beta-cell duplication. Moreover, this source adaptively increases in the HIP rat, implying attempted beta-cell regeneration that substantially slows loss of beta-cell mass.
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Affiliation(s)
- Erica Manesso
- 1Department of Information Engineering, University of Padua, Padua, Italy
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Waldron-Lynch F, Herold KC. Advances in Type 1 diabetes therapeutics: immunomodulation and beta-cell salvage. Endocrinol Metab Clin North Am 2009; 38:303-17, viii. [PMID: 19328413 DOI: 10.1016/j.ecl.2009.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Refinements in our understanding of the pathogenic mechanisms of Type 1 diabetes from studies of animal models and clinical observation have led to new clinical trials to prevent disease progression and restore the loss of beta-cells that defines the disease. Antigen-specific agents have shown initial promise and non-antigen-specific agents now have improved safety compared with older agents. In addition, preclinical studies with other agents have shown efficacy. Ultimately, a combination of immunologic and cellular therapies may be needed to restore metabolic control. Agents that augment recovery of dysfunctional beta-cells, and other compounds that may be able to induce beta-cell replication, are logical additions once immune tolerance is achieved.
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Abstract
The use of anti-CD3 monoclonal antibodies (mAbs) has moved from the bench to the bedside. The experience with the anti-human CD3 mAb OKT3 for treatment of transplant rejection identified limitations that were largely overcome with the creation of humanized non-FcR binding antibodies: Teplizumab, Otelixizumab and Visilizumab. Preclinical studies showed the ability of the drugs to reverse hyperglycaemia in diabetic non-obese diabetic (NOD) mice providing rationale for clinical trials with the agents. The former two drugs have been tested in subjects with new onset type 1 diabetes. They have both shown, in randomized clinical trials, an ability to reduce the loss of insulin production over the first 2 years of the disease. In addition, the need for exogenous insulin to maintain glucose control has been reduced. However, these agents alone do not restore normal glucose control, and future approaches will likely require combinations of agents with complementary immune or metabolic activity.
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Affiliation(s)
- Adam Kaufman
- Department of Immunobiology, Yale University, New Haven, CT 06520, USA
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46
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Gao S, Wang X. Predicting Type 1 Diabetes Candidate Genes using Human Protein-Protein Interaction Networks. ACTA ACUST UNITED AC 2009; 2:133. [PMID: 20148193 PMCID: PMC2818071 DOI: 10.4172/jcsb.1000025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Proteins directly interacting with each other tend to have similar functions and be involved in the same cellular processes. Mutations in genes that code for them often lead to the same family of disease phenotypes. Efforts have been made to prioritize positional candidate genes for complex diseases utilize the protein-protein interaction (PPI) information. But such an approach is often considered too general to be practically useful for specific diseases. Results In this study we investigate the efficacy of this approach in type 1 diabetes (T1D). 266 known disease genes, and 983 positional candidate genes from the 18 established linkage loci of T1D, are compiled from the T1Dbase (http://t1dbase.org). We found that the PPI network of known T1D genes has distinct topological features from others, with significantly higher number of interactions among themselves even after adjusting for their high network degrees (p<1e-5). We then define those positional candidates that are first degree PPI neighbours of the 266 known disease genes to be new candidate disease genes. This leads to a list of 68 genes for further study. Cross validation using the known disease genes as benchmark reveals that the enrichment is ~17.1 fold over random selection, and ~4 fold better than using the linkage information alone. We find that the citations of the new candidates in T1D-related publications are significantly (p<1e-7) more than random, even after excluding the co-citation with the known disease genes; they are significantly over-represented (p<1e-10) in the top 30 GO terms shared by known disease genes. Furthermore, sequence analysis reveals that they contain significantly (p<0.0004) more protein domains that are known to be relevant to T1D. These findings provide indirect validation of the newly predicted candidates. Conclusion Our study demonstrates the potential of the PPI information in prioritizing positional candidate genes for T1D.
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Affiliation(s)
- Shouguo Gao
- Department of Physics & the Comprehensive Diabetes Center, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL 35294, USA
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Parry CS, Brooks BR. A new model defines the minimal set of polymorphism in HLA-DQ and -DR that determines susceptibility and resistance to autoimmune diabetes. Biol Direct 2008; 3:42. [PMID: 18854049 PMCID: PMC2590596 DOI: 10.1186/1745-6150-3-42] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 10/14/2008] [Indexed: 11/12/2022] Open
Abstract
Background The mechanism underlying autoimmune diabetes has been difficult to define. There is a strong genetic contribution and numerous studies associate the major histocompatibility complex, especially the class II region, with predisposition or resistance. However, how these molecules are implicated remains obscure. Presentation of the hypothesis We have supplemented structural analysis with computational biophysical and sequence analyses and propose an heuristic for distinguishing between human leukocyte antigen molecules that predispose to insulin dependent diabetes mellitus and those that are protective. Polar residues at both β37 and β9 suffice to distinguish accurately between class II alleles that predispose to type 1 diabetes and those that do not. The electrostatic potential within the peptide binding pocket exerts a strong influence on diabetogenic epitopes with basic residues. Diabetes susceptibility alleles are predicted to bind autoantigens strongly with tight affinity, prolonged association and altered cytokine expression profile. Protective alleles bind moderately, and neutral alleles poorly or not at all. Non-Asp β57 is a modifier that supplements disease risk but only in the presence of the polymorphic, polar pair at β9 and β37. The nature of β37 determines resistance on one hand, and susceptibility or dominant protection on the other. Conclusion The proposed ideas are illustrated with structural, functional and population studies from the literature. The hypothesis, in turn, rationalizes their results. A plausible mechanism of immune mediated diabetes based on binding affinity and peptide kinetics is discussed. The number of the polymorphic markers present correlates with onset of disease and severity. The molecular elucidation of disease susceptibility and resistance paves the way for risk prediction, treatment and prevention of disease based on analogue peptides. Reviewers This article was reviewed by Eugene V. Koonin, Michael Lenardo, Hossam Ashour, and Bhagirath Singh. For the full reviews, please go to the Reviewers' comments section.
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Affiliation(s)
- Christian S Parry
- Computational Biophysics Section, Laboratory of Computational Biology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-9314, USA.
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Sherr J, Sosenko J, Skyler JS, Herold KC. Prevention of type 1 diabetes: the time has come. ACTA ACUST UNITED AC 2008; 4:334-43. [PMID: 18446141 DOI: 10.1038/ncpendmet0832] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 03/03/2008] [Indexed: 01/12/2023]
Abstract
Improved understanding of the pathogenesis of type 1 diabetes mellitus has completely changed our view of this disease in the past 25 years-from an acute, fulminant disease, to a chronic, autoimmune process. Information on genetic and serologic markers has increased our ability to identify individuals at risk. Prospectively gathered data indicate that, with a combination of immunologic and metabolic studies, children with a 6-year risk of disease higher than 90% can be identified due to an ongoing immune process. They differ from children with overt disease only in the time it will take for glucose levels to rise above a diagnostic threshold. Therapies to change the progression of beta-cell loss have been tested in patients with newly diagnosed type 1 diabetes. With improved predictive capabilities and agents that can have longer-lasting effects than those tested more than 10 years ago, new prevention studies are underway. These studies are large and costly but the risks posed by such interventions compare favorably with those of developing hyperglycemia and of future complications portended by the diagnosis of diabetes. In this Review we discuss risk-stratification techniques and how they are applied, other diagnostic criteria, and outcomes from diabetes-prevention trials.
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Affiliation(s)
- Jennifer Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Körner A, Tóth-Heyn P, Dezsőfi A, Veres G, Madácsy L, Arató A. Occurence of thyroid autoimmunity in children with type 1 diabetes mellitus. Orv Hetil 2008; 149:401-6. [DOI: 10.1556/oh.2008.28153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ismert, hogy azok a betegek, akikben egy autoimmun betegség már kialakult, fokozottan veszélyeztetettek más autoimmun betegségek fellépésével szemben. Korábban a szerzők kimutatták, hogy 1-es típusú diabéteszben szenvedő betegekben a coeliakia előfordulása gyakoribb, mint a háttérpopulációban. Az autoimmun pajzsmirigybetegség az 1-es típusú diabétesz leggyakoribb társbetegsége, amely általában az élet második évtizedében, az 1-es típusú diabétesz manifesztációját követően lép fel.
Célkitűzés:
Mindezek alapján a szerzők megvizsgálták a thyreoidea-autoimmunitás, illetve az autoimmun pajzsmirigybetegségek előfordulási gyakoriságát 1-es típusú diabéteszben szenvedő betegekben. Választ kerestek arra a kérdésre is, hogy változik-e a thyreoidea-autoimmunitás prevalenciája azokban a gyermekekben, akik a diabétesz mellett coeliakiában is szenvednek.
Módszerek:
268 1-es típusú diabéteszben, valamint 48 1-es típusú diabéteszben és coeliakában szenvedő betegben az autoimmun pajzsmirigybetegségek irányába szűrővizsgálatot végeztek a thyreoglobulin- és a peroxidáz-ellenes antitestek vizsgálatával. Pozitivitás esetén a betegséget a pajzsmirigyfunkció vizsgálatával, illetve ultrahang elvégzésével igazolták.
Eredmények:
Vizsgálataik szerint a pajzsmirigyellenes antitestek előfordulási gyakorisága szignifikánsan magasabb volt azokban az 1-es típusú diabéteszes betegekben, akik egyidejűleg coeliakában is szenvedtek (1-es típusú diabétesz: 43 (16%), 1-es típusú diabétesz + coeliakia: 16 (33,3%,
p
< 0,01). A thyreoiditis talaján kialakult hypothyreosis is gyakrabban fordult elő azokban a diabéteszes betegekben, akik coeliakiásak voltak.
Következtetések:
A szerzők hangsúlyozzák, hogy a coeliakiában szenvedő 1-es típusú diabéteszes betegekben az autoimmun pajzsmirigybetegség fellépésének nagyobb valószínűsége miatt ennek a populációnak az autoimmun pajzsmirigybetegségek iránti rendszeres szűrése feltétlenül indokolt.
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Affiliation(s)
- Anna Körner
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest Bókay János u. 53. 1083
| | - Péter Tóth-Heyn
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest Bókay János u. 53. 1083
| | - Antal Dezsőfi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest Bókay János u. 53. 1083
| | - Gábor Veres
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest Bókay János u. 53. 1083
| | - László Madácsy
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest Bókay János u. 53. 1083
| | - András Arató
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest Bókay János u. 53. 1083
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Combination Therapy With Epidermal Growth Factor and Gastrin Delays Autoimmune Diabetes Recurrence in Nonobese Diabetic Mice Transplanted With Syngeneic Islets. Transplant Proc 2008; 40:529-32. [DOI: 10.1016/j.transproceed.2008.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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