Type 1 diabetes induced by immune checkpoint inhibitors.
10.1097/CM9.0000000000000972
- Author:
Rui ZHANG
1
;
Xiao-Ling CAI
1
;
Liu LIU
2
;
Xue-Yao HAN
1
;
Li-Nong JI
1
Author Information
1. Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China.
2. Department of Endocrinology and Metabolism, Guiyang Hospital of Guizhou Aviation Industry Group, Guiyang, Guizhou 550009, China.
- Publication Type:Review
- MeSH:
CTLA-4 Antigen;
Diabetes Mellitus, Type 1/chemically induced*;
Humans;
Immune Checkpoint Inhibitors;
Immunologic Factors/therapeutic use*;
Immunotherapy/adverse effects*;
Neoplasms/drug therapy*
- From:
Chinese Medical Journal
2020;133(21):2595-2598
- CountryChina
- Language:English
-
Abstract:
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.
