Chapter 48 - Humoral Immunity in Type 1 Diabetes Mellitus

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Abstract

Type 1 diabetes mellitus (T1DM) (formerly known as insulin-dependent diabetes mellitus) is the conventional example of a T-cell-mediated disease, which selectively targets pancreatic β cells. T1DM presents a complex interaction between genetic and environmental factors, most of which have yet to be identified. The immunologic diagnosis of autoimmune diseases relies primarily on the detection of autoantibodies in the serum of T1DM patients. Although their pathogenic significance remains incompletely defined, they have the great advantage of serving as surrogate markers for specific progression to the insulin requiring stage of the disease.

Autoantibodies are some of the most potent risk determinants for autoimmune diseases, with relative risks exceeding 100, and the archetypical model for the application of autoantibodies is T1DM. Seminal studies have suggested that using a combination of humoral immunologic markers gives a higher predictive value for T1DM progression and great sensitivity without significant loss of specificity.

There is both a growing effort and a large opportunity for exploring novel strategies alone or in combination with immunomodulation with the ultimate goal to find the cure for T1DM. Autoantibodies directed against islet targets serve as key markers to enroll newly diagnosed T1DM patients and their family members in these intervention trials.

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