Anti-programmed cell death 1 therapy triggering diabetic ketoacidosis and fulminant type 1 diabetes

Excerpt

Programmed cell death 1 (PD-1) is a co-inhibitory molecule expressed on effector T cells and is involved in regulation of immune checkpoints. One of the known ligands of PD-1 protein is programmed cell death ligand 1 (PDL-1), which is expressed in many tumor cells. Activation of PD-1/PDL-1 axis results in suppression of anti-tumor immune checkpoints. Pembrolizumab is an immunoglobulin G4 monoclonal antibody targeting PD-1 molecule that increases immune response and induces anti-tumor activity. It has been approved for treating metastatic melanoma and is currently on clinical investigation for several other tumors including non-small cell lung cancer. On the other hand, PD-1 or PDL-1 blockade induced type 1 diabetes mellitus (T1DM) in non-obese prediabetic mice regardless of age [1]. In humans, few case reports of anti-PD-1 therapy induced T1DM have been reported including one case of fulminant T1DM [2, 3]. Here, we described a case of new-onset fulminant T1DM after anti-PD-1 therapy along with measures of glucose and C-peptide levels before and after the therapy. …