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Lernmark, * ; Akolkar, B.* ; Hagopian, W.* ; Krischer, J.* ; McIndoe, R.* ; Rewers, M.* ; Toppari, J.* ; Vehik, K.* ; Ziegler, A.-G.

Possible heterogeneity of initial pancreatic islet beta-cell autoimmunity heralding type 1 diabetes.

J. Intern. Med. 294, 145-158 (2023)
Postprint DOI PMC
Open Access Hybrid
Creative Commons Lizenzvertrag
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.
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Publication type Article: Journal article
Document type Review
Keywords Autoantibodies ; Autoimmune Disease ; Autoimmunity ; Immunity ; Type 1 Diabetes Mellitus ; Virus Etiology; Hl-a Antigens; Amino-acid; Environmental Determinants; Genetic Risk; Autoantibody Appearance; Respiratory-infections; Early-childhood; Gut Microbiome; Young Teddy; Children
Language english
Publication Year 2023
HGF-reported in Year 2023
ISSN (print) / ISBN 0954-6820
e-ISSN 1365-2796
Journal Journal of Internal Medicine
Quellenangaben Volume: 294, Issue: 2, Pages: 145-158 Article Number: , Supplement: ,
Publisher Wiley
Publishing Place 111 River St, Hoboken 07030-5774, Nj Usa
Reviewing status Peer reviewed
Institute(s) Institute of Diabetes Research (IDF)
POF-Topic(s) 30201 - Metabolic Health
Research field(s) Helmholtz Diabetes Center
PSP Element(s) G-502100-001
Grants Juvenile Diabetes Research Foundation (JDRF)
Centers for Disease Control and Prevention (CDC)
National Institute of Environmental Health Sciences (NIEHS)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
National Institute of Allergy and Infectious Diseases (NIAID)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
TEDDY families

Swedish Foundation for Strategic Research
Strategic Research Area Exodiab
Vinnova
Interreg European Regional Development Fund
Swedish Research Council
University of Colorado
NIH/NCATS Clinical and Translational Science Awards
DOI 10.1111/joim.13648
WOS ID 000988193700001
Scopus ID 85159167827
PubMed ID 37143363
Erfassungsdatum 2023-10-06
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