Immunopathogenesis of type 1 diabetes and the possibility of influencing autoimmune insulitis – what’s new?
Abstract
Type 1 diabetes mellitus is consequence of autoimmune insulitis which is significantly more heterogeneous than previously thought. histopathological findings in autoimmune insulitis differ according to the age of the individual, which also reflects the pathogenetic heterogeneity of the disease. immune intervention strategies should be adapted to this heterogeneity. With this in mind, specific endotypes of the disease have begun to be described. a breakthrough step was the approval of teplizumab (a monoclonal anti-cD3 antibody) in the United States in 2022 as the first so-called disease-modifying drug for people in ii. stage of diabetes development (this stage is characterized by the presence of two or more autoantibodies and prediabetic dysglycemia). teplizumab effectively delays progression to clinical diabetes by about two years on average. this fact stimulates the development of population-wide screening programs that, with the help of autoantibody testing (according to the determination of genetic risk or separately), aim to select individuals suitable for the application of various preventive measures.