Antigen specific immunotherapy to restore antigen-specific tolerance in type 1 diabetes and Graves’ disease


 Type 1 diabetes and Graves’ disease are chronic autoimmune conditions, characterised by a dysregulated immune response. In type 1 diabetes, there is beta cell destruction and subsequent insulin deficiency whereas in Graves’ disease, there is unregulated excessive thyroid hormone production. Both diseases result in significant psychosocial, physiological and emotional burden. There are associated risks of diabetic ketoacidosis and hypoglycaemia in type 1 diabetes and risks of thyrotoxicosis and orbitopathy in Graves’ disease. Advances in the understanding of the immunopathogenesis and response to immunotherapy in type 1 diabetes and Graves’ disease have facilitated the introduction of targeted therapies to induce self-tolerance, and subsequently, the potential to induce long-term remission if effective. We explore current research surrounding the use of antigen specific immunotherapies, with a focus on human studies, in type 1 diabetes and Graves’ disease including protein based, peptide based, dendritic-cell based and nanoparticle-based immunotherapies, including discussion of factors to be considered when translating immunotherapies to clinical practice.