become less prominent over the first few months of insulin therapy further damage to beta cells is occurring during this time thus the present results imply that disease modifying interventions should be initiated as quickly as possible after diagnosis the observation that many of the observed changes in gene expression resolve with insulin therapy provides a rationale for the beneficial effects of aggressive glycemic control early in the disease in preserving residual beta cell function 34 our results also suggest several promising therapeutic targets the elevation in plasma cells could be treated by attacking precursor b cells and as mentioned a trial of rituximab anti cd20 is already underway elevated expression of ptgs2 and thus presumably high prostaglandin levels could be treated with non steroidal anti inflammatory agents sodium salicylate was first suggested as a treatment for diabetes in the 19 th century 35 the marked elevation in il1b expression could be treated with anakinra il 1 receptor antagonist protein which has proven highly effective in sojia 23 blockers of chemokine receptors including ccr1 have reached phase 2 clinical trials as anti inflammatory agents 36 in addition to providing rationales for therapeutic interventions abnormalities detected in the present study might ultimately provide useful biomarkers for the efficacy of disease modifying interventions subjects the study was approved by the institutional review boards of ut southwestern medical center and baylor.