A2 Refereed review article in a scientific journal
Possible heterogeneity of initial pancreatic islet beta-cell autoimmunity heralding type 1 diabetes
Authors: Lernmark Åke, Akolkar Beena, Hagopian William, Krischer Jeffrey, McIndoe Richard, Rewers Marian, Toppari Jorma, Vehik Kendra, Ziegler Anette-G.; The TEDDY Study Group
Publisher: WILEY
Publication year: 2023
Journal: Journal of Internal Medicine
Journal name in source: JOURNAL OF INTERNAL MEDICINE
Journal acronym: J INTERN MED
Volume: 294
Issue: 2
First page : 145
Last page: 158
Number of pages: 14
ISSN: 0954-6820
DOI: https://doi.org/10.1111/joim.13648
Web address : https://doi.org/10.1111/joim.13648
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/179739669
The etiology of type 1 diabetes (T1D) foreshadows the pancreatic islet beta-cell autoimmune pathogenesis that heralds the clinical onset of T1D. Standardized and harmonized tests of autoantibodies against insulin (IAA), glutamic acid decarboxylase (GADA), islet antigen-2 (IA-2A), and ZnT8 transporter (ZnT8A) allowed children to be followed from birth until the appearance of a first islet autoantibody. In the Environmental Determinants of Diabetes in the Young (TEDDY) study, a multicenter (Finland, Germany, Sweden, and the United States) observational study, children were identified at birth for the T1D high-risk HLA haploid genotypes DQ2/DQ8, DQ2/DQ2, DQ8/DQ8, and DQ4/DQ8. The TEDDY study was preceded by smaller studies in Finland, Germany, Colorado, Washington, and Sweden. The aims were to follow children at increased genetic risk to identify environmental factors that trigger the first-appearing autoantibody (etiology) and progress to T1D (pathogenesis). The larger TEDDY study found that the incidence rate of the first-appearing autoantibody was split into two patterns. IAA first peaked already during the first year of life and tapered off by 3-4 years of age. GADA first appeared by 2-3 years of age to reach a plateau by about 4 years. Prior to the first-appearing autoantibody, genetic variants were either common or unique to either pattern. A split was also observed in whole blood transcriptomics, metabolomics, dietary factors, and exposures such as gestational life events and early infections associated with prolonged shedding of virus. An innate immune reaction prior to the adaptive response cannot be excluded. Clarifying the mechanisms by which autoimmunity is triggered to either insulin or GAD65 is key to uncovering the etiology of autoimmune T1D.
Downloadable publication This is an electronic reprint of the original article. |  |
