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Diabetologia. 2018 May;61(5):1193-1202. doi: 10.1007/s00125-018-4561-y. Epub 2018 Feb 5.

Coxsackievirus B1 infections are associated with the initiation of insulin-driven autoimmunity that progresses to type 1 diabetes.

Author information

1
Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, PL 100, 33014 Tampereen yliopisto, Tampere, Finland. Amirbabak.sioofy.khojine@staff.uta.fi.
2
Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, PL 100, 33014 Tampereen yliopisto, Tampere, Finland.
3
Vactech Ltd, Tampere, Finland.
4
Fimlab laboratories, Pirkanmaa Hospital District, Tampere, Finland.
5
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
6
Biomeditech, University of Tampere, Tampere, Finland.
7
Institute of Biomedicine, Research Centre of Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.
8
Department of Paediatrics, Turku University Hospital, Turku, Finland.
9
Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland.
10
Department of Clinical Microbiology, Turku University Hospital, Turku, Finland.
11
Department of Paediatrics, PEDEGO Research Unit, Medical Research Centre, Oulu University, Hospital and University of Oulu, Oulu, Finland.
12
Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
13
Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
14
Tampere Centre for Child Health Research, Tampere University Hospital, Tampere, Finland.
15
Folkhälsan Research Centre, Helsinki, Finland.

Abstract

AIMS/HYPOTHESIS:

Islet autoimmunity usually starts with the appearance of autoantibodies against either insulin (IAA) or GAD65 (GADA). This categorises children with preclinical type 1 diabetes into two immune phenotypes, which differ in their genetic background and may have different aetiology. The aim was to study whether Coxsackievirus group B (CVB) infections, which have been linked to the initiation of islet autoimmunity, are associated with either of these two phenotypes in children with HLA-conferred susceptibility to type 1 diabetes.

METHODS:

All samples were from children in the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) study. Individuals are recruited to the DIPP study from the general population of new-born infants who carry defined HLA genotypes associated with susceptibility to type 1 diabetes. Our study cohort included 91 children who developed IAA and 78 children who developed GADA as their first appearing single autoantibody and remained persistently seropositive for islet autoantibodies, along with 181 and 151 individually matched autoantibody negative control children, respectively. Seroconversion to positivity for neutralising antibodies was detected as the surrogate marker of CVB infections in serial follow-up serum samples collected before and at the appearance of islet autoantibodies in each individual.

RESULTS:

CVB1 infections were associated with the appearance of IAA as the first autoantibody (OR 2.4 [95% CI 1.4, 4.2], corrected p = 0.018). CVB5 infection also tended to be associated with the appearance of IAA, however, this did not reach statistical significance (OR 2.3, [0.7, 7.5], p = 0.163); no other CVB types were associated with increased risk of IAA. Children who had signs of a CVB1 infection either alone or prior to infections by other CVBs were at the highest risk for developing IAA (OR 5.3 [95% CI 2.4, 11.7], p < 0.001). None of the CVBs were associated with the appearance of GADA.

CONCLUSIONS/INTERPRETATION:

CVB1 infections may contribute to the initiation of islet autoimmunity being particularly important in the insulin-driven autoimmune process.

KEYWORDS:

Coxsackievirus group B; Glutamic acid decarboxylase autoantibody (GADA); Insulin autoantibody (IAA); Islet autoimmunity; Logistic regression; Plaque reduction assay; Type 1 Diabetes Prediction and Prevention (DIPP); Virus neutralising antibodies

PMID:
29404673
DOI:
10.1007/s00125-018-4561-y

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