Teplizumab: promises and challenges of a recently approved monoclonal antibody for the prevention of type 1 diabetes or preservation of residual beta cell function.

INTRODUCTION: Type 1 diabetes (T1D) is a chronic autoimmune endocrinopathy with increasing incidence that results in the depletion of pancreatic beta cells and exogenous insulin dependence. Despite technological advances in insulin delivery, disease control remains suboptimal, while previous immunotherapy options have failed to prevent T1D. Recently, teplizumab, an immunomodulating monoclonal antibody, was approved to delay or prevent T1D. AREAS COVERED: Five randomized controlled trials have tested different regimens of administration, mostly 14-day schemes with dose escalation. In participants with new-onset T1D, teplizumab delayed C-peptide decline, improved glycemic control, and reduced insulin demand for a median of 1 or 2 years. Studies in at-risk relatives of patients showed a decrease in T1D incidence during 2 years of follow-up. Subgroups of responders with unique metabolic and immunological characteristics were identified. Mild to moderate adverse effects were reported, including transient rash, cytopenia, nausea, vomiting, and infections. EXPERT OPINION: Teplizumab marks a turning point in T1D therapy. Areas of future research include the ideal population for screening, cost-effectiveness, and challenges in treatment accessibility. More studies are essential to evaluate the ideal duration of the regimen, the potential benefit of combinations with other drugs, and to identify endophenotypes with a high probability of response.

The use of Indocyanine green in endocrine surgery of the neck: A systematic review.

BACKGROUND: The insufficient reliability of preoperative imaging technology and limited convenience of intraoperative visualizing techniques have been associated with difficulty in surgical navigation in neck endocrine surgery. Indocyanine green (ICG) fluorescence imaging has stood out as the real-time intraoperative guide amidst research for novel modalities, with an emerging use in endocrine surgery. METHODS: We performed a systematic review of the PubMed, Scopus and Embase databases, to identify published studies on parathyroid and thyroid operations employing ICG. Well-described articles were selected according to 7 criteria and analyzed per operation type and organ structure. RESULTS: Twenty-one articles matched our selection criteria. Dosage, equipment, and techniques are well-described in literature. ICG was found to significantly enhance the surgical experience and outcomes. Occasional discrepancy among studies was attributed to the lack of standard quantification of values and divergence of study designs. CONCLUSION: The most successful applications of ICG are:Future research is needed for standard quantification of fluorescence intensity and objective comparisons.