移植治疗在儿童与青少年1型糖尿病治疗中的应用进展
收稿日期: 2022-02-28
网络出版日期: 2022-05-13
基金资助
国家自然科学基金项目(82170910);国家自然科学基金项目(81903341)
Advances in transplantation therapy in the treatment of type 1 diabetes in children and adolescents
Received date: 2022-02-28
Online published: 2022-05-13
儿童与青少年1型糖尿病的患病率在近数十余年来呈现明显的上升趋势,传统的药物治疗方法可有效地改善血糖,但无法达到根治的目的。移植治疗作为一种可能达到根治目标的治疗方案受到越来越多的关注,主要包括胰岛移植、干细胞移植以及胰腺移植。移植后伴随的排异反应、胰岛细胞炎症及凋亡反应等仍是目前限制移植治疗在1型糖尿病治疗中应用的重大瓶颈,未来有望通过一氧化碳暴露或调节性T细胞治疗等相关方法得到一定突破。目前移植治疗在1型糖尿病中的研究主要集中在动物研究或成人临床试验中,关于儿童与青少年1型糖尿病移植治疗的研究报道相对较少。粪菌移植未来有望成为1型糖尿病辅助治疗的方法,达到辅助改善胰岛功能的目的。
陈瑶 , 王秀敏 . 移植治疗在儿童与青少年1型糖尿病治疗中的应用进展[J]. 临床儿科杂志, 2022 , 40(5) : 334 -338 . DOI: 10.12372/jcp.2022.22e0253
Prevalence of type 1 diabetes in children and adolescents rises in decades of years. Medication could keep the serum level of glucose in a reasonable range rather than cure the disease. Transplantation, mainly islet transplantation, stem cell transplantation and pancreas transplantation, has attracted more attention for the possibility of curing type 1 diabetes. Rejection, islet inflammation and apoptosis hinder a successful transplantation, which may be relieved by carbon monoxide or regulatory T cell therapies. Most of studies about transplantation treatment for type 1 diabetes were on animals or adults, with few on children and adolescents. Furthermore, fecal microbiota transplantation could halt progression of human new-onset type 1 diabetes, which could be an adjuvant therapy in future days.
Key words： transplantation; child; adolescent; type 1 diabetes
| [1] | American Diabetes Association Professional Practice Committee, American Diabetes Association Professional Practice Committee, Draznin B, et al. Classification and diagnosis of diabetes: standards of medical care in diabetes-2022[J]. Diabetes Care, 2022, 45(Suppl 1): S17-S38. |
| [2] | Wherrett DK, Chiang JL, Delamater AM, et al. Defining pathways for development of disease-modifying therapies in children with type 1 diabetes: a consensus report[J]. Diabetes Care, 2015, 38(10): 1975-1985. |
| [3] | Chiang JL, Maahs DM, Garvey KC, et al. Type 1 diabetes in children and adolescents: A position statement by the American diabetes association[J]. Diabetes Care, 2018, 41(9): 2026-2044. |
| [4] | Chamberlain JJ, Kalyani RR, Leal S, et al. Treatment of type 1 diabetes: Synopsis of the 2017 American diabetes association standards of medical care in diabetes[J]. Ann Intern Med, 2017, 167(7): 493-498. |
| [5] | Gamble A, Pepper AR, Bruni A, et al. The journey of islet cell transplantation and future development[J]. Islets, 2018, 10(2): 80-94. |
| [6] | Chetboun M, Jannin A, Kerr-Conte J, et al. 1921-2021: From insulin discovery to islet transplantation in type 1 diabetes[J]. Ann Endocrinol (Paris), 2021, 82(2): 74-77. |
| [7] | Brooks AM, Oram R, Home P, et al. Demonstration of an intrinsic relationship between endogenous C-peptide concentration and determinants of glycemic control in type 1 diabetes following islet transplantation[J]. Diabetes Care, 2015, 38(1): 105-112. |
| [8] | Vantyghem MC, Raverdy V, Balavoine AS, et al. Continuous glucose monitoring after islet transplantation in type 1 diabetes: an excellent graft function (β-score greater than 7) Is required to abrogate hyperglycemia, whereas a minimal function is necessary to suppress severe hypoglycemia (β-score greater than 3)[J]. J Clin Endocrinol Metab, 2012, 97(11): E2078- E2083. |
| [9] | Shapiro AM, Pokrywczynska M, Ricordi C. Clinical pancreatic islet transplantation[J]. Nat Rev Endocrinol, 2017, 13(5): 268-277. |
| [10] | Dugbartey GJ. Carbon monoxide in pancreatic islet transplantation: A new therapeutic alternative to patients with severe type 1 diabetes mellitus[J]. Front Pharmacol, 2021, 12: 750816. |
| [11] | Marfil-Garza BA, Hefler J, Bermudez De Leon M, et al. Progress in translational regulatory T cell therapies for type 1 diabetes and islet transplantation[J]. Endocr Rev, 2021, 42(2): 198-218. |
| [12] | Tootee A, Nikbin B, Ghahary A, et al. Assessment of immune-alternations and their correlations with therapeutic outcomes of transplantation of autologous Mesenchymal and Allogenic fetal stem cells in patients with type 1 diabetes: a study protocol[J]. J Diabetes Metab Disord, 2021, 20(1): 1067-1073. |
| [13] | Lu J, Shen SM, Ling Q, et al. One repeated transplantation of allogeneic umbilical cord mesenchymal stromal cells in type 1 diabetes: an open parallel controlled clinical study[J]. Stem Cell Res Ther, 2021, 12(1): 340. |
| [14] | Voltarelli JC, Couri CE, Stracieri AB, et al. Autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus[J]. JAMA, 2007, 297(14): 1568-1576. |
| [15] | Malmegrim KC, de Azevedo JT, Arruda LC, et al. Immunological balance is associated with clinical outcome after autologous hematopoietic stem cell transplantation in type 1 diabetes[J]. Front Immunol, 2017, 8:167. |
| [16] | Lindahl JP, Hartmann A, Horneland R, et al. Improved patient survival with simultaneous pancreas and kidney transplantation in recipients with diabetic end-stage renal disease[J]. Diabetologia, 2013, 56(6): 1364-1371. |
| [17] | Chudek J, Kolonko A, Ziaja J, et al. Beneficial effect of successful simultaneous pancreas-kidney transplantation on plasma profile of metalloproteinases in type 1 diabetes mellitus patients[J]. J Clin Med, 2021, 10(17): 3800. |
| [18] | Cho JA, Chinnapen DJF. Targeting friend and foe: Emerging therapeutics in the age of gut microbiome and disease[J]. J Microbiol, 2018, 56(3): 183-188. |
| [19] | Mariño E, Richards JL, McLeod KH, et al. Gut microbial metabolites limit the frequency of autoimmune T cells and protect against type 1 diabetes[J]. Nat Immunol, 2017, 18(5): 552-562. |
| [20] | de Groot P, Nikolic T, Pellegrini S, et al. Faecal microbiota transplantation halts progression of human new-onset type 1 diabetes in a randomised controlled trial[J]. Gut, 2021, 70(1): 92-105. |
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