Abstract

Objective— The autoimmune destruction of β cells in type 1 diabetes (T1D) results in a loss of insulin production and glucose homeostasis. As such, an immense interest exists for the development of therapies capable of attenuating this destructive process through restoration of proper immune recognition. Therefore, we investigated the ability for the immune depleting agent anti-thymocyte globulin (ATG), as well as the mobilization agent granulocyte-colony stimulating factor (G-CSF), to reverse overt hyperglycemia in the non-obese diabetic (NOD) mouse model of T1D.

Research design and methods— Effects of each therapy were tested in pre-diabetic and diabetic female NOD mice using measurements of glycemia, regulatory T cell (CD4+CD25+Foxp3+) frequency, insulitis, and/or beta cell area.

Results— Here, we show that combination therapy of murine ATG and G-CSF was remarkably effective at reversing new onset diabetes in NOD mice, and more efficacious than either agent alone. This combination also afforded durable reversal from disease (>180 days post-onset) in animals having pronounced hyperglycemia (i.e., up to 500mg/dl). Additionally, glucose control improved over time in mice subject to remission from T1D. Mechanistically, this combination therapy resulted in both immunological (increases in CD4:CD8 ratios and splenic regulatory T cell frequencies) and physiological (increase in the pancreatic β cell area, attenuation of pancreatic inflammation) benefits.

Conclusions— In addition to lending further credence to the notion that combination therapies can enhance efficacy in addressing autoimmune disease, these studies also support the concept for utilizing agents designed for other clinical applications as a means to expedite efforts involving therapeutic translation.