Immunotherapies of Type 1 Diabetes: Modulation, Tolerance, Reconstitution and Replacement

Type 1 diabetes (T1D) is a chronic disease characterized by autoimmune destruction of pancreatic cells, resulting in a lack of insulin secretion. Current treatments mainly rely on exogenous insulin supply. Although automated insulin infusion systems can effectively control blood sugar, they cannot reverse immunopathology or restore endogenous insulin secretion. This article divides emerging treatments for T1D into three categories: immune regulation, immune tolerance induction, and cell regeneration and replacement. Immunomodulatory methods such as anti-CD3 antibodies (such as Teplizumab) and mesenchymal stem cell (MSC) infusion have shown some promise in preserving cell function; tolerance induction therapy is based on autoantigens, such as insulin and GAD65 vaccines, but the efficacy is greatly affected by individual HLA differences. Emerging CAR-Tregs have higher specificity and potential. Regenerative and replacement therapies such as hematopoietic stem cell transplantation and islet-like cell transplantation have significant efficacy, but the need for immunosuppression remains their main challenge. At present, most treatments are still in the clinical trial stage. In the future, we can try to combine therapies with multiple mechanisms in order to achieve a more lasting and fundamental therapeutic effect.