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My name is Robert Hilbrands from the Diabetes Research Center
and the Diabetes Clinic of the Brussels Free University, VUB, in Belgium.
Over the last two decades,
there have been important advances in
immune therapy for patients with autoimmune type 1 diabetes.
I will be discussing the role of antibodies that have played a major role in
these advances, and have been studied in several well-designed clinical trials.
They have been shown to preserve
residual pancreatic beta-cell function when
treatment is started at the time of diagnosis of the disease.
More recently, they have also been effective in delaying the clinical onset
of type 1 diabetes in individuals at high risk for developing type 1 diabetes.
Type 1 diabetes is an autoimmune disease that is characterized by a T-cell mediated,
selective destruction of the beta-cells in the pancreas by
autoreactive CD4-positive and CD8-positive T-cells.
The disease can manifest at any age,
but is most frequently diagnosed in young children.
Patients with type 1 diabetes present with
hyperglycemia at the time of diagnosis, and require
immediate insulin treatment to prevent
chronic complications from hyperglycemia and ketoacidosis.
Insulin treatment has to be maintained for the rest of their lives in order to
survive, and this places a very large burden on the life of a type 1 diabetic patient.
Strict glycemic control is necessary to prevent
chronic micro- and macrovascular complications from type 1 diabetes.
Achieving this goal
can lead to the occurrence of hypoglycemia with insulin treatment, which can result in
serious life-threatening events and also place a lot of
stress on the daily life of these patients and their relatives.
It is only since the late 1960s that
an autoimmune origin of type 1 diabetes has been suggested.
This was first suspected after examination of
pathological samples of type 1 diabetic patients who died soon after clinical onset.
These samples showed an inflammatory infiltrate (which can be seen
here) inside and around the islets of Langerhans, as you can see on this slide.