Inflammation and type 2 diabetes: from basic science to treatment

Excerpt

Many discoveries in science have the following history: it starts with a controversy, then it becomes common knowledge, followed by a hype, then the first drawbacks appear, and eventually the concept is implemented by perseverant scientists. With respect to the role of the immune system in type 2 diabetes, the controversy lasted several years, which clearly delayed clinical translation. The reasons for the long-duration of the controversy include the novelty of the concept and moral aspects. As type 2 diabetes is often perceived as self-inflicted and due to a lack of discipline in life-style behaviour, some specialists of the “innocent” immune type 1 diabetes were reluctant to acknowledge associations between the diseases. As will become apparent to the reader of this issue of the Seminars in Immunopathology, in the meantime, the controversy has past. Particularly convincing is the meta-analysis by Kataria and colleagues, which included 2921 patients with type 2 diabetes treated with an IL-1 antagonist [1]. They show a highly significant reduction in glycated haemoglobin. Importantly, beyond the control of glycaemia, targeting the IL-1 system may also improve complications of diabetes such as cardiovascular diseases and heart failure. Indeed, the large phase 3 CANTOS study demonstrated that a single subcutaneous injection of an anti-IL-1β antibody every 3 months significantly lowers rate of recurrent cardiovascular events [2] and also of heart failure, especially in patients with diabetes [3]. Further, during the first 12 months of the study, IL-1 antagonism also showed a glucose-lowering effect [4]. After this period, however, anti-diabetic drugs were freely adjusted in all patients, masking the pure anti-IL-1beta effect. These results nicely confirm previous diabetes-devoted studies using IL-1 antagonists [5‐10]. …