ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Certain HLA genes on the short arm of chromosome 6 increase the risk for insulin-dependent diabetes mellitus. The rapid progress in direct sequence analysis has not only increased our understanding of the magnitude of HLA-DRandDQclass II protein polymorphisms, but has also provided new information on the association and linkage between HLA and insulin-dependent diabetes mellitus. The marked linkage disequilibrium between theDQandDRloci has made it difficult to pinpoint the strongest association. Current data indicate that the DQB1*0302-A1*0301 (DQ8) haplotype is stronger than anyDR4subtype, but thatDR3is stronger than the linked DQB1*0201-A1*0501 (DQ2) haplotype. The difference between positively and negatively associated haplotypes such as DQ6 (DQB1*0602-DQA1*0201) or DQ7 (DQB1*0301-DQA1*0301) may be explained, not by single amino acids, but rather by the physicochemical properties of the peptide binding region, the T-cell receptor recognition area, or both of these class II molecules.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Insulin-dependent diabetes mellitus is a T-cell-mediated autoimmune disease. Both CD4 and CD8 T cells arc necessary for diabetes onset, and it is not clear yet which of the T-cell subsets exert the elector function (cytokine release or cytotoxicity). Most available data suggest that the islet-specific T-cell repertoire is not restricted to any V TcR gene. The role of regulatory cytokines (Th2cells) is under investigation.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In this review we focus on recent developments m immunotherapy of insulin-dependent diabetes mellitus in experimental animal models. Due to the autoimmune characteristics of this disease, efforts at effective therapies have been primarily directed at regulating the pathogenic T-cell response, either by broad-spectrum or by antigen-specific treatments. In the past year, more information has been made available on the use of a variety of agents that suppress or stimulate the immune system and thereby alter the inflammatory response. Progress has also been made using a newer, more direct approach in which the antigen receptors of the autoreactive T cells are targeted.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Efforts continue to better define antibody-antigen systems in the prediction of insulin-dependent mellitus (IDDM). Among the several described, four seem to attract the most attention,ie, islet cell antibodies, autoantibodies to insulin, glutamic acid decarboxylase antibodies, and antibodies to a “37-k antigen”. In terms of prediction, workers are fast moving from family studies to screening populations at large, in which the majority of new cases of IDDM occur annually. Some genetic markers have been consolidated and others expanded, whereas those related to cell-mediated immune parameters are growing in importance. Presenting or delaying the clinical onset of IDDM in individuals truly susceptible to the disease remains the ultimate aim. This review focuses on recent developments in this area.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Enhanced understanding of the natural history of the prediabetic period has made the disease more predictable in both nondiabetic relatives of affected persons and in the general population. That the disease is immune-mediated and involves the interaction of genetic and environmental factors (probably operating in early childhood) is now well established. Because the course of the disease can usually be measured in years, a window of opportunity for its prevention can be seized upon and exploited. The design of several large multicenter trials worldwide has engendered cautious optimism that the day is not too far away when insulin-dependent diabetes can be safely prevented.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In this review we update progress on a variety of new approaches to insulin therapy. The Diabetes Complication and Control Trial has shifted the question of diabetes control from whether improved glycemic control reduces the occurrence of long-term complications to how to achieve this improved glycemic control. The goals of improving insulin delivery systems are to maintain glycemic control by creating more physiologic means of delivering insulin, to avoid severe hypoglycemia, and to maintain a sense of well-being. This review concentrates on advances in basal-bolus therapy and alternative routes of insulin administration. Novel approaches, including somatic gene therapy, glucagon-like peptide, and insulin-like growth factor are introduced. Pancreatic and islet-cell transplantation, glucose sensors, and closed-loop insulin delivery devices are covered in detail elsewhere in this issue.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

With the recent report of the results of the Diabetes Control and Complications Trial, there can be little doubt that hyperglycemia is a major determinant of the long-term vascular complications of insulin-dependent diabetes mellitus. Better blood glucose control should become a primary goal for all diabetic patients However, successful and safe implementation of intensive diabetes therapy may not be possible for all diabetic patients. Hypoglycemia, regimen compliance, and availability of resources are the most significant remaining barriers to overcome before implementation of intensive diabetes therapy will be realistic for the majority of diabetic subjects.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Type 1 diabetes in humans is a chronic autoimmune disease. Present treatments are difficult and not always effective. Because of this, a number of therapies aimed at altering the immune response have been tried in patients with a new onset of diabetes. Although some of these therapies have been promising, they are limited by the near-total β-cell destruction that has already occurred at the lime of onset of clinical diabetes. Because of this limitation, recent efforts in immunotherapy have focused on an earlier, prediabetic stage, in which there are more functioning β cells remaining. After a number of small controlled trials and a few pilot trials, investigators around the world are now collaborating on three different multicenter, randomized, controlled trials of intervention for Type 1 diabetes: the Diabetes Prevention Trial Type 1 (DPT-1), a National Institutes of Health-sponsored trial in the United States that will study the effects of parenteral and oral insulin in high-risk relatives; the European Nicotinamide Diabetes intervention Trial (ENDIT), a Canadian-European trial that will give nicotinamide to islet-cell antibody-positive relatives; and a Finnish-Canadian trial that will compare high-risk newborns fed cow-based formula with those receiving a non-cow-based formula for 6 months.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

For a type I diabetic patient, a whole-organ pancreas transplant is the best option for permanent restoration of normoglycemia. This paper reviews data from the International Pancreas Transplant Registry and the literature from the past few years to provide an overview on the current status of pancreas transplantation. The use of living-related versus cadaveric donors, a review of surgical technique, the detection and treatment of rejection, and the effects of pancreas transplantation on the complications of diabetes are considered. The role of pancreas transplants alone (without simultaneous kidney transplants) in the control of diabetes is examined.

ISSN:1068-3097    

出版商:OVID    

年代:1995

数据来源: OVID