Type 1 diabetes induced by immune checkpoint inhibitors. 2020

Rui Zhang, and Xiao-Ling Cai, and Liu Liu, and Xue-Yao Han, and Li-Nong Ji
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China.

With the increasing use of immune checkpoint inhibitors (ICI) including anti-cytotoxic T lymphocyte associated antigen-4 (CTLA-4) and anti-programmed cell death-1 (PD-1) in cancers, ICI-induced type 1 diabetes has been reported throughout the world. In this review, we aim to summarize the characteristics of this disease and discuss the mechanism of it. As an immune-related adverse event, type 1 diabetes developed after the administration of anti-PD-1 or anti-PD-ligand 1 (PD-L1) in the combination with or without anti-CTLA-4. It usually presented with acute onset, and 62.1% of the reported cases had diabetic ketoacidosis. Only a third of them had positive autoantibodies associated with type 1 diabetes. Susceptible HLA genotypes might be associated. T-cell-stimulation by blocking of the interaction of PD-1 and PD-L1 in pancreatic β cells was the main mechanism involved in the pathology. Insulin was the only effective treatment of ICI-induced type 1 diabetes. In conclusions, ICI-induced type 1 diabetes is a potentially life-threating adverse event after the immunotherapy of cancers. Screening and early recognition is important. Further investigation of the mechanism may help to better understand the pathology of type 1 diabetes.

UI MeSH Term Description Entries
D007155 Immunologic Factors Biologically active substances whose activities affect or play a role in the functioning of the immune system. Biological Response Modifier,Biomodulator,Immune Factor,Immunological Factor,Immunomodulator,Immunomodulators,Biological Response Modifiers,Biomodulators,Factors, Immunologic,Immune Factors,Immunological Factors,Modifiers, Biological Response,Response Modifiers, Biological,Factor, Immune,Factor, Immunological,Factors, Immune,Factors, Immunological,Modifier, Biological Response,Response Modifier, Biological
D007167 Immunotherapy Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. Immunotherapies
D009369 Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Neoplasm,Cancer,Malignant Neoplasm,Tumor,Tumors,Benign Neoplasms,Malignancy,Malignant Neoplasms,Neoplasia,Neoplasm,Neoplasms, Benign,Cancers,Malignancies,Neoplasias,Neoplasm, Benign,Neoplasm, Malignant,Neoplasms, Malignant
D003922 Diabetes Mellitus, Type 1 A subtype of DIABETES MELLITUS that is characterized by INSULIN deficiency. It is manifested by the sudden onset of severe HYPERGLYCEMIA, rapid progression to DIABETIC KETOACIDOSIS, and DEATH unless treated with insulin. The disease may occur at any age, but is most common in childhood or adolescence. Diabetes Mellitus, Brittle,Diabetes Mellitus, Insulin-Dependent,Diabetes Mellitus, Juvenile-Onset,Diabetes Mellitus, Ketosis-Prone,Diabetes Mellitus, Sudden-Onset,Diabetes, Autoimmune,IDDM,Autoimmune Diabetes,Diabetes Mellitus, Insulin-Dependent, 1,Diabetes Mellitus, Type I,Insulin-Dependent Diabetes Mellitus 1,Juvenile-Onset Diabetes,Type 1 Diabetes,Type 1 Diabetes Mellitus,Brittle Diabetes Mellitus,Diabetes Mellitus, Insulin Dependent,Diabetes Mellitus, Juvenile Onset,Diabetes Mellitus, Ketosis Prone,Diabetes Mellitus, Sudden Onset,Diabetes, Juvenile-Onset,Diabetes, Type 1,Insulin Dependent Diabetes Mellitus 1,Insulin-Dependent Diabetes Mellitus,Juvenile Onset Diabetes,Juvenile-Onset Diabetes Mellitus,Ketosis-Prone Diabetes Mellitus,Sudden-Onset Diabetes Mellitus
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000082082 Immune Checkpoint Inhibitors Drugs that block negative regulator IMMUNE CHECKPOINT proteins (e.g., PD-1 RECEPTOR and CTLA-4 ANTIGEN) thereby increasing suppressed immune activation in immunotherapies. CTLA-4 Inhibitor,CTLA-4 Inhibitors,Cytotoxic T-Lymphocyte-Associated Protein 4 Inhibitor,Cytotoxic T-Lymphocyte-Associated Protein 4 Inhibitors,Immune Checkpoint Blockade,Immune Checkpoint Blockers,Immune Checkpoint Inhibition,Immune Checkpoint Inhibitor,PD-1 Inhibitor,PD-1 Inhibitors,PD-1-PD-L1 Blockade,PD-L1 Inhibitor,PD-L1 Inhibitors,Programmed Cell Death Protein 1 Inhibitor,Programmed Cell Death Protein 1 Inhibitors,Programmed Death-Ligand 1 Inhibitors,Blockade, PD-1-PD-L1,CTLA 4 Inhibitor,CTLA 4 Inhibitors,Checkpoint Blockade, Immune,Checkpoint Blockers, Immune,Checkpoint Inhibition, Immune,Checkpoint Inhibitor, Immune,Checkpoint Inhibitors, Immune,Cytotoxic T Lymphocyte Associated Protein 4 Inhibitor,Cytotoxic T Lymphocyte Associated Protein 4 Inhibitors,Inhibitor, PD-1,PD 1 Inhibitor,PD 1 Inhibitors,PD 1 PD L1 Blockade,PD L1 Inhibitor,PD L1 Inhibitors,Programmed Death Ligand 1 Inhibitors
D060908 CTLA-4 Antigen An inhibitory T CELL receptor that is closely related to CD28 ANTIGEN. It has specificity for CD80 ANTIGEN and CD86 ANTIGEN and acts as a negative regulator of peripheral T cell function. CTLA-4 antigen is believed to play role in inducing PERIPHERAL TOLERANCE. CTLA-4 Protein,Cytotoxic T-Lymphocyte Antigen 4,Antigens, CD152,CD152 Antigen,Cytotoxic T-Lymphocyte-Associated Antigen 4,Antigen, CD152,Antigen, CTLA-4,CD152 Antigens,CTLA 4 Antigen,CTLA 4 Protein,Cytotoxic T Lymphocyte Antigen 4,Cytotoxic T Lymphocyte Associated Antigen 4

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