In the next 10 years, alternative medicine will continue to dominate the market

Business News Agency January 12 News Type 1 Diabetes (T1D), also known as juvenile or insulin-dependent diabetes mellitus, is an autoimmune and metabolic disease characterized by T cells that cause pancreatic β-cell damage, which in turn causes insulin. Insufficient secretion and high blood sugar. In 2007, there were 437,500 children with type 1 diabetes worldwide. Each year, 70,000 new children with type 1 diabetes under the age of 14 are newly added worldwide. The annual growth rate is 3%, especially in younger children.

At present, the etiology of type 1 diabetes is still not clear. It is generally believed that genetic genetic defects, environmental factors, and metabolic changes are the main causes of the disease's occurrence and development. Insulin deficiency in type 1 diabetes leads to increased gluconeogenesis and esterification, increased metabolism of free fatty acids, production of ketone bodies, and ultimately diabetic ketoacidosis. The main clinical symptoms are ketone bodies, which can cause coma, death, and chronic hyperglycemia. Chronic high blood sugar can induce a variety of large and small vascular diabetic complications, including cardiovascular disease, kidney disease, diabetic retinitis and peripheral neuropathy.

Drug discovery is imminent

At present, insulin replacement therapy is the first-line treatment for the life-saving of diabetic patients. Traditionally, the focus of the pharmaceutical industry has focused on the development of innovative insulin that is more convenient and administered through other routes. It is understood that the world’s seven major pharmaceutical markets have diagnosed and received about 1.84 million people with type 1 diabetes, and the market for therapeutic drugs for type 1 diabetes has reached US$2 billion.

Although insulin replacement therapy can save the lives of patients with type 1 diabetes, it does not cure the disease and may even cause hypoglycemia, but it does not prevent complications. Therefore, the development of drugs that can change the course of the disease is imminent.

The immune drug market is limited

Currently, the most advanced treatment strategy is to delay the progression of type 1 diabetes by inducing immune tolerance or regulating autoimmunity, the second immune and inflammatory response.

New vaccines are under development, including the glutamic acid decarboxylase 65 kDa isoform (GAD65) and BHT-3021. Non-antigen-specific immunomodulators such as the CD3 monoclonal antibodies Otelixizumab and Teplizumab are also under development.

Due to the mechanism of action, these drugs may harm normal immune system function. In addition, many FDA-approved immunomodulators are in clinical trials.

Although the vaccine can delay or prevent the further decline of β cell function, once the patient is diagnosed with type 1 diabetes, only 10% to 20% of the β cells function normally. Therefore, the vaccine-based tolerability pathway is most effective in patients at high risk of type 1 diabetes. However, this type of treatment is less effective in patients who have already lost most of the beta cells that have lost their function. Early in the onset of type 1 diabetes, non-antigen-specific immunomodulators are most effective in patients before clinical symptoms develop into diabetes.

Overall, there is a limited market size for this type of immunomedic for treatment of diabetes, based on the limited safety of non-antigen-specific therapies or the benefit from this treatment.

The regeneration route faces challenges

When the metabolic needs such as pregnancy or obesity increase, the beta cell population expands. This means that it can be replicated and differentiated into beta cells through different endocrine or non-endocrine cells, thus providing hope for those who have already lost β cells to eventually recover through endogenous cells.

Currently, it has been found that certain specific peptides and growth factors such as gastrin and glucagon-like peptide growth factor 1 (GLP1) can expand the β cell population, thereby making animal models of type 1 diabetes lacking due to immunosuppressive agents. Blood sugar returned to normal. Two drugs approved by the FDA, dipeptidyl peptidase 4 (DPP4) inhibitors and proton pump inhibitors, increase the levels of GLP1 and gastrin in the circulation of non-obese diabetic (NOD) mice. In the human body to provide a theoretical basis for testing.

Cell pathways include hepatocytes, progenitors, dendritic cells, and xenotransplants, and these pathways are currently bringing scientifically exciting opportunities. In addition, in addition to the scientific and technical challenges faced by cell-based therapeutics, they also face greater barriers to approval. Before any of these products are on the market, these issues need to be resolved.

Combination drugs have potential

Any regenerative treatment may be hampered by an uncontrolled autoimmune response. Therefore, the combination of safe, antigen-specific resistance therapies and upcoming regenerative therapies will be the next step in the development of new drugs.

After pregnancy, the maternal immune system is slightly inhibited, thereby tolerating the development of the fetus and stimulating the expression of active factors for fetal growth and development. A recent study showed that patients with chronic type 1 diabetes exhibit pregnancy-induced beta cell function and blood glucose improvement. This study provided support for the use of tolerant drugs and regenerative therapies in combination with natural analogs. This combination has great potential for the development of type 1 diabetes modulator drugs.

Market evolution is promising

Judging from the current R&D channels for the treatment of type 1 diabetes, insulin replacement therapy will continue to dominate the market for the next 10 years. In the long run, tolerant drugs, antigen-specific and β-cell-specific regenerative drugs that are currently in early development will provide a very promising platform for the development of disease-modifying drugs. Although only one of these drugs will be marketed first, combination therapy will be the most effective way to treat type 1 diabetes for a long time.

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