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The role of the gut in β‐cell autoimmunity and type 1 diabetes: a hypothesis
Author(s) -
Vaarala Outi
Publication year - 2000
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1046/j.1399543x.2000.010408.x
Subject(s) - autoimmunity , immune system , immunology , type 1 diabetes , medicine , insulitis , diabetes mellitus , beta cell , pancreatic islets , autoimmune disease , immunity , islet , endocrinology , antibody
The origin of autoimmunity leading to the destruction of insulin‐producing β‐cells is not known. Several studies suggest that a link exists between the gut immune system and the islets infiltrating lympocytes. Inflamed pancreatic islets express the same adhesion molecules involved with the homing of gut‐associated lymphocytes. The manifestation of autoimmune diabetes in the animal models can be modified by dietary factors, which cause changes in the cytokine production by islet‐infiltrating lymphocytes. Increased risk of type 1 diabetes has been associated with an early introduction of cows' milk formula in infancy, indicating that triggering of the gut immune system in early infancy may contribute to the later development of β‐cell autoimmunity. Enhanced immune reactivity to cow milk (CM) proteins in the patients with type 1 diabetes suggests aberrant regulation of the gut immune system in this disease. In the patients with newly diagnosed type 1 diabetes, anti‐glutamate decarboxylase (GAD)‐reactivity was found in the subpopulation of lymphocytes expressing gut‐associated homing receptor α4β7. Based on these findings, the hypothesis that aberrant function of the gut immune system would lead to the development of β‐cell autoimmunity and type 1 diabetes has recently received a lot of attention. The possibility that regulation of the gut immune system is not normal in subjects at risk of autoimmune diabetes should be considered when treatments interfering with mucosal immunity for the prevention of type 1 diabetes are planned.