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Onset of type 1 diabetes mellitus in infancy after enterovirus infections
M Lönnrot1, M Knip, M Roivainen
1Department of Virology, University of Tampere, Medical School and University Hospital of Tampere, Finland.
Insights
Early enterovirus infections in infants may trigger the autoimmune process leading to Type 1 diabetes. This case highlights the critical role of early-life viral exposure in the development of Type 1 diabetes.
Area of Science:
- Virology
- Immunology
- Endocrinology
Background:
- Enterovirus infections are implicated in the pathogenesis of Type 1 diabetes.
- Prospective studies suggest viral involvement occurs before clinical diagnosis, potentially in utero.
- Understanding the early triggers of Type 1 diabetes is crucial for prevention strategies.
Observation:
- A case study of an infant diagnosed with Type 1 diabetes at 14 months of age.
- The infant experienced two enterovirus infections before 12 months of age, with the first possibly occurring at birth.
- Low maternal enterovirus antibodies and limited breastfeeding were noted, increasing susceptibility.
Findings:
- The first enterovirus infection was followed by the development of beta-cell autoimmunity.
- Clinical Type 1 diabetes was diagnosed shortly after the second enterovirus infection.
- This case supports the hypothesis linking early-life enterovirus exposure to Type 1 diabetes development.
Implications:
- Enterovirus infections, particularly in early infancy, may initiate or accelerate the beta-cell destruction leading to Type 1 diabetes.
- The findings underscore the importance of early viral surveillance and potential interventions in high-risk infants.
- The study design demonstrates feasibility for large-scale birth-cohort studies investigating Type 1 diabetes etiology.
Abstract:
Enterovirus infections may initiate and accelerate the beta-cell damaging process leading to Type 1 (insulin-dependent) diabetes mellitus (Type 1 DM). Recent prospective studies have suggested that this can happen long before overt disease and even in utero. We describe an infant, followed regularly from birth, who progressed to clinical Type 1 DM at the age of 14 months. He had a strong enterovirus exposure exceptionally early in life; the first enterovirus infection occurred before the age of 3 months and the second between the age of 9 and 12 months. The first infection probably occurred at birth, when the child had symptoms of a respiratory infection. This infection was followed by the appearance of beta-cell autoimmunity, and clinical Type 1 DM was diagnosed shortly after the second infection. The child had a low level of maternal enterovirus antibodies and short duration of breast-feeding, both associated with increased risk for enterovirus infections during the fetal period and infancy. This case fits with the current hypothesis that enterovirus infections can induce the process resulting in Type 1 DM, especially when occurring early in life. Furthermore, this demonstrates the feasibility of the present study design, which is applicable also in large-scale birth-cohort studies.