Zusammenfassung
Interventionsansätze zum Betazellerhalt: In einer Pilotstudie zur Primärprävention wurden bei Kindern mit genetischem Diabetesrisiko erste Erfolge mit hypoallergener Säuglingsnahrung erzielt. In der Sekundärprävention bei Kindern mit HLA-Risikogen und positiven Antikörpern hat die intra-nasale Applikation von Insulin enttäuscht. Mit der Tertiärprävention gelingt es bis zu einem bestimmten Maß, durch antientzündliche, antigenspezifische und T-Zell-gerichtete Therapien die Progression der Betazellzerstörung zu verlangsamen. Biologischer Betazellersatz: Eine Pankreas- oder Insel(zell)transplantation ermöglicht die Behandlung, Rückbildung und Prävention von Diabetesfolgekrankheiten. Vorrangiges Ziel ist die Vermeidung häufiger, schwerer Hypoglykämien infolge einer schwer gestörten Hypoglykämiewahrnehmung/-gegenregulation.
Abstract
Interventional approaches to beta cell preservation: In a pilot study, initial attempts at primary prevention by preserving islet beta cells have been successful with highly hydrolyzed milk formula in children who are at high genetic risk of diabetes. Attempts at secondary prevention by intranasal application in children with a high-risk HLA genotype and positive islet autoantibodies have been disappointing. But in tertiary prevention anti-inflammatory, antigen-directed and T-cell targeted treatment has been partially successful in slowing down the destruction of beta cells. Biological beta cell substitution: Transplantation of a vascularised pancreas or islet cells results in disease regression and the prevention of secondary/tertiary complications of diabetes. A principal aim is the avoidance of frequent, severe hypoglycaemic episodes resulting from markedly reduced awareness of hypoglycaemia or its counter-regulation.
Schlüsselwörter
Typ-1-Diabetes - Immunprävention - Pankreastransplantation - Inselzelltransplantation
Keywords
type 1 diabetes - immunoprevention - islet transplantation - pancreas transplantation
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Prof. Dr. med. Mathias D. Brendel
Med. Klinik und Poliklinik III Universitätsklinik
Dresden
Fetscherstr. 74, Haus 10
01307 Dresden
PD Dr. Nanette C. Schloot
Institut für Klinische Diabetologie am Deutschen Diabetes-Zentrum Universität Düsseldorf
Auf'm Hennekamp 65
40225 Düsseldorf