BCG Therapy for Type 1 Diabetes: Restoration of Balanced Immunity and Metabolism

Willem M Kühtreiber; Denise L Faustman

doi:10.1016/j.tem.2018.11.006

BCG Therapy for Type 1 Diabetes: Restoration of Balanced Immunity and Metabolism

Trends Endocrinol Metab. 2019 Feb;30(2):80-92. doi: 10.1016/j.tem.2018.11.006. Epub 2018 Dec 29.

Authors

Willem M Kühtreiber¹, Denise L Faustman²

Affiliations

¹ Department of Medicine, Immunobiology Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
² Department of Medicine, Immunobiology Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: faustman@helix.mgh.harvard.edu.

PMID: 30600132
DOI: 10.1016/j.tem.2018.11.006

Abstract

The bacillus Calmette-Guerin (BCG) vaccine is a microorganism developed as a vaccine for tuberculosis 100 years ago and used as therapy for bladder cancer 40 years ago. More recently, BCG has shown therapeutic promise for type 1 diabetes (T1D) and several other autoimmune diseases. In T1D, BCG restored blood sugars to near normal, even in patients with advanced disease of >20 years duration. This clinically important effect may be driven by resetting of the immune system and the shifting of glucose metabolism from overactive oxidative phosphorylation, a state of minimal sugar utilization, to aerobic glycolysis, a state of high glucose utilization, for energy production. The mechanistic findings support the Hygiene Hypothesis and reveal the immune and metabolic synergy of mycobacterial reintroduction in modern humans.

Keywords: BCG vaccine; TNF; Tregs; aerobic glycolysis; oxidative phosphorylation; type 1 diabetes.

Publication types

Review

MeSH terms

Autoimmune Diseases / blood
Autoimmune Diseases / drug therapy*
BCG Vaccine / therapeutic use*
Blood Glucose / drug effects
Diabetes Mellitus, Type 1 / blood
Diabetes Mellitus, Type 1 / drug therapy*
Humans
Models, Biological

Substances

BCG Vaccine
Blood Glucose