Gut and the induction of immune tolerance in type 1 diabetes.

The origin of beta-cell specific autoimmunity is not known in Type 1 diabetes. Several studies of this disease in animal models indicate that the manifestation of autoimmune diabetes can be modified by factors which influence the gut immune system. Some indirect evidence from studies in patients with Type 1 diabetes also suggests that aberrant function of the gut immune system may be involved in the development of this disease. These studies have encouraged the search for treatments interfering with mucosal immunity for the prevention of Type 1 diabetes. Our understanding of the function of the gut immune system in humans is, however, limited and the use of drugs (e.g. oral antigens or immune adjuvants) which modify the function of the gut immune system may involve serious problems. In this review, the possible role of the gut immune system in the development of beta-cell autoimmunity and Type 1 diabetes is discussed with special reference to the putative therapeutic implications. Copyright 1999 John Wiley & Sons, Ltd.