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Fulminant type 1 diabetes—an important subtype in East Asia
Author(s) -
Imagawa Akihisa,
Hanafusa Toshiaki
Publication year - 2011
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.1236
Subject(s) - fulminant , immune system , immunology , enterovirus , type 1 diabetes , diabetes mellitus , type 2 diabetes , pancreatic islets , human leukocyte antigen , biology , medicine , virology , virus , antigen , islet , endocrinology
Fulminant type 1 diabetes is defined as a subtype of type 1 diabetes with a remarkably acute onset. A nationwide survey identified that this variant accounts for approximately 20% of acute‐onset type 1 diabetic patients in Japan. Recent studies indicate that this is not a minor subtype in other East Asian countries. As genetic factors, we revealed association of HLA‐DR‐DQ, HLA‐B and CTLA‐4 to fulminant type 1 diabetes. As an environmental factor, viral infection would contribute to the development of this subtype. Cellular infiltration to islets was detected soon after the onset but not observed 1 month after the onset. Macrophages and T cells were the main components of the infiltrates. Enterovirus RNA and Toll‐like receptor‐3 expression, a signature of viral infection, was also observed. These findings suggest that viral infection in the susceptible individual might trigger anti‐viral immune response and that pancreatic beta cells are rapidly destroyed through the accelerated immune reaction. Copyright © 2011 John Wiley & Sons, Ltd.