Intralymphatic Injection of Autoantigen in Type 1 Diabetes

• Published in: The New England journal of medicine Vol. 376; no. 7; pp. 697 - 699
• Main Authors: Ludvigsson, Johnny, Wahlberg, Jeanette, Casas, Rosaura
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 16.02.2017
• Subjects: Aluminum sulfate; Antigens; Area Under Curve; Autoantigens - administration & dosage; Autoantigens - adverse effects; C-Peptide - blood; Cytokines; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - drug therapy; Drug Therapy, Combination; Fasting; Glutamate decarboxylase; Glutamate Decarboxylase - administration & dosage; Glutamate Decarboxylase - adverse effects; Glutamic acid; Historically Controlled Study; Humans; Injection; Injections, Intralymphatic - adverse effects; Lymphatic system; Patients; Peptides; Pilot Projects; Vitamin D; Vitamin D - therapeutic use; Vitamins - therapeutic use; Young Adult; Sweden
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMc1616343

Preserved beta-cell function may improve outcomes in patients with type 1 diabetes. In this pilot trial, residual beta-cell function was preserved in six patients after direct intralymphatic injection of alum-formulated glutamic acid decarboxylase with oral vitamin D. To the Editor: Residual insulin secretion decreases complications and improves quality of life in patients with type 1 diabetes. However, effective interventions to preserve residual beta-cell function are lacking. Antigen-based therapy requires adequate presentation to T cells. Treatment with antigen-based therapy with the use of glutamic acid decarboxylase (GAD65) has been encouraging but not sufficiently effective. 1 To render the presentation of GAD65 antigen to T cells in the lymph nodes more efficient than has previously been described, 2 , 3 we now report the administration of GAD65 autoantigen directly into an inguinal lymph node rather than subcutaneously. We also added oral vitamin . . .