The laboratory of O. Neyrolles is supported by the Centre National de la Recherche Scientifique, the Fondation pour la Recherche Médicale

(FRM), the Agence Nationale de la Recherche, the European Union, and the Fondation Mérieux. G. Lugo-Villarino holds a fellowship from FRM. The funders had no role in the decision to publish this article or in its preparation. The authors declare no financial or commercial conflict of interest. “
“Insulin-dependent (type 1) diabetes is a prototypic organ-specific autoimmune disease resulting from the selective destruction of insulin-secreting β cells within pancreatic islets of Langerhans by an immune-mediated inflammation involving autoreactive CD4+ and CD8+ T lymphocytes which infiltrate pancreatic islets. Current treatment is substitutive, i.e. chronic use of exogenous insulin which, in spite of significant advances, is still associated with major constraints selleck inhibitor (multiple daily injections, risks of hypoglycaemia) and lack of effectiveness over the long term in preventing severe degenerative complications. Finding a cure for autoimmune diabetes by establishing effective immune-based therapies is a real medical health challenge, as the disease incidence increases steadily in industrialized countries. As the disease affects mainly children and young adults, any candidate immune therapy must therefore be safe and

avoid a sustained depression of immune responses with the attendant problems of recurrent infection and drug Rapamycin toxicity. Thus, inducing or restoring immune tolerance to target autoantigens, controlling the pathogenic response while preserving the host reactivity to exogenous/unrelated antigens, appears to be the ideal approach. Our objective is to review the major progress accomplished over the last 20 years towards that aim. In addition, we would like to present another interesting possibility to access new preventive strategies cAMP based on the ‘hygiene hypothesis’, which proposes a causal link between the increasing incidence

of autoimmune diseases, including diabetes, and the decrease of the infectious burden. The underlying rationale is to identify microbial-derived compounds mediating the protective activity of infections which could be developed therapeutically. Identifying insulin-dependent or type 1 diabetes (T1D) as a polygenic autoimmune inflammatory disease is a relatively recent finding which occurred by the end of the 1970s. The academic diabetes community reacted rapidly to this important discovery, concentrating efforts to approach, first, the major issue of the early diagnosis of the immunological disease and secondly, to devise immune-based therapeutic strategies to delay and/or prevent disease progression. Compared to other autoimmune diseases, approaching the pathophysiology of T1D was problematic because of the difficulties in having direct access to the target organ in patients.