Pathophysiology of immune-mediated (type 1) diabetes mellitus - Potential for immunotherapy

Type 1 diabetes mellitus is a chronic T cell-mediated disease resulting fro m autoimmune destruction of pancreatic p-cells. This process leads to progr essive and irreversible failure of insulin secretion. Development of the di sease involves both genetic and environmental factors. Genetic predispositi on is mainly connected with the human leucocyte antigen (HLA) region, which encodes structures responsible for antigen presentation. A comprehensive m olecular understanding of the pathogenesis of the disease is essential for the design of rational and well tolerated means of prevention. This paper describes recent experimental and clinical findings and elucidat es the current possibilities for immunotherapy of type 1 diabetes. The natu re of breakdown of self-tolerance and the mechanisms involved in its recove ry are discussed.