[Immunotherapy and cell therapy in type 1 diabetes : Current state of research].
Type 1 diabetes begins as an autoimmune disease and can already be diagnosed in the presymptomatic early stage by detecting at least two positive islet autoantibodies (stage 1, International Classification of Diseases, 10th Revision, German Modification [ICD-10-GM]: R76.80; stage 2, ICD-10-GM: R73.00). Immunomodulatory therapies can slow disease progression and delay the clinical manifestation of type 1 diabetes. In parallel, cell therapy for β‑cell replacement is gaining increasing importance as a strategy to restore endogenous insulin production.
This article provides an overview of the current status of immunotherapies and cell therapies in type 1 diabetes.
The review "The future of type 1 diabetes therapy" by Ziegler et al. (2025) served as the basis. In addition, current guidelines, original articles, and selected studies on immunotherapies and β‑cell replacement therapies were considered.
With teplizumab, the first disease-modifying therapy for stage 2 type 1 diabetes is available. It delays the transition to clinically manifest type 1 diabetes (stage 3) by an average of 2-3 years. Other immunomodulatory therapeutic approaches show preservation of residual β‑cell function in stage 3 type 1 diabetes but are not yet approved for this indication. Stem-cell-based β‑cell replacement therapies are currently being clinically investigated in people with advanced diabetes and impaired awareness of hypoglycemia.
Immunotherapies and cell therapies mark a paradigm shift in the treatment of type 1 diabetes. In the future, combination therapies will be particularly important to improve the durability of therapeutic effects, as will strategies to protect transplanted cells from alloimmunity and autoimmunity.
This article provides an overview of the current status of immunotherapies and cell therapies in type 1 diabetes.
The review "The future of type 1 diabetes therapy" by Ziegler et al. (2025) served as the basis. In addition, current guidelines, original articles, and selected studies on immunotherapies and β‑cell replacement therapies were considered.
With teplizumab, the first disease-modifying therapy for stage 2 type 1 diabetes is available. It delays the transition to clinically manifest type 1 diabetes (stage 3) by an average of 2-3 years. Other immunomodulatory therapeutic approaches show preservation of residual β‑cell function in stage 3 type 1 diabetes but are not yet approved for this indication. Stem-cell-based β‑cell replacement therapies are currently being clinically investigated in people with advanced diabetes and impaired awareness of hypoglycemia.
Immunotherapies and cell therapies mark a paradigm shift in the treatment of type 1 diabetes. In the future, combination therapies will be particularly important to improve the durability of therapeutic effects, as will strategies to protect transplanted cells from alloimmunity and autoimmunity.
Authors
Schill Schill, Schwenker Schwenker, Reinmüller Reinmüller, Achenbach Achenbach, Ziegler Ziegler
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