ESPE Yearbook of Paediatric Endocrinology

World J Diabetes. 2020;11(10):400–415. doi: 10.4239/wjd.v11.i10.400

Based on a review of the proposed mechanisms of the development of T1DM, the authors provide an overview of oral tolerance therapies for T1DM conducted in both animal models and clinical trials. This key paper also outlines its future perspectives.

As a mainly T cell-mediated autoimmune disease, T1D is characterized by insulin deficiency resulting from the destruction of pancreatic β-cells. The understanding of many aspects of T1DM, such as its epidemiology, pathobiology, pathogenesis, clinical manifestations, and complications, has been greatly promoted by extensive research performed during only the past decades. Unfortunately, these findings have not yet been translated into an effective treatment. The ideal treatment should efficiently and safely restore the destroyed immune balance in a long-lasting manner, preventing or even topping the destruction of β-cells. As a type of immune hypo-responsiveness to the orally administrated antigen, oral tolerance may be induced by enhancement of regulatory T cells (Tregs) or by anergy/deletion of other T cells, depending on the dosage of orally administrated antigen. Acting as an antigen-specific immunotherapy, oral tolerance therapy for T1DM has been mainly performed in animal models, although some clinical trials have been completed or are ongoing. Some of these actually use orally administered insulin powder as the key antigen.