PROGRESS IN THE IMMUNOINTERVENTION OF TYPE-1 DIABETES-MELLITUS

Immunointervention studies with immunosuppressive drugs (Cyclosporin A , Azathioprine) in type-1 diabetic patients after clinical diagnosis d emonstrated that improvement of beta-cell function is not sufficient a nd longlasting. Since 80-90% of the beta-cell mass are already destroy ed at onset of type-1 diabetes, intervention studies with nicotinamide and insulin (parenteral or oral) were undertaken in the early phase o f type-1 diabetes. However, immunomodulation is restricted to familial cases of type-1 diabetes (only 10% of all cases), since prediction of the disease is not possible in the general population. It cannot be e xcluded that the described immunintervention may only postpone but not hinder the manifestation of type-1 diabetes. Interventions with toler ance induction by BCG or GAD are promising, but did not yet result in prevention of type-1 diabetes in humans. Finally, the most effective s trategy would be primary prevention by vaccination or exposure prophyl axis. Should type-1 diabetes prove to be a disease that is provoked th rough molecular mimicry, i.e. an immunization by an environmental anti gen, then strategies to avoid contact with the environmental trigger ( f.e. cow's milk protein) or to vaccinate against it (f.e. Coxsackie vi rus protein PZ-c) could be adopted. If all these interventions are not effective in the long term run, research should be concentrated on mo lecular approaches after improvement in gene transfer technology.