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Etiology of Autoimmune Islet Disease: Timing Is Everything

Life is about timing. —Carl Lewis The understanding of autoimmune type 1 diabetes is increasing, and examining etiology separate from pathogenesis has become crucial. The components to explain type 1 diabetes development have been known for some time. The strong association with HLA has been researc...

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Autor principal: Lernmark, Åke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336011/
https://www.ncbi.nlm.nih.gov/pubmed/34155043
http://dx.doi.org/10.2337/dbi18-0034
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author Lernmark, Åke
author_facet Lernmark, Åke
author_sort Lernmark, Åke
collection PubMed
description Life is about timing. —Carl Lewis The understanding of autoimmune type 1 diabetes is increasing, and examining etiology separate from pathogenesis has become crucial. The components to explain type 1 diabetes development have been known for some time. The strong association with HLA has been researched for nearly 50 years. Genome-wide association studies added another 60+ non-HLA genetic factors with minor contribution to risk. Insulitis has long been known to be present close to clinical diagnosis. T and B cells recognizing β-cell autoantigens are detectable prior to diagnosis and in newly diagnosed patients. Islet autoantibody tests against four major autoantigens have been standardized and used as biomarkers of islet autoimmunity. However, to clarify the etiology would require attention to time. Etiology may be defined as the cause of a disease (i.e., type 1 diabetes) or abnormal condition (i.e., islet autoimmunity). Timing is everything, as neither the prodrome of islet autoimmunity nor the clinical onset of type 1 diabetes tells us much about the etiology. Rather, the islet autoantibody that appears first and persists would mark the diagnosis of an autoimmune islet disease (AID). Events after the diagnosis of AID would represent the pathogenesis. Several islet autoantibodies without (stage 1) or with impaired glucose tolerance (stage 2) or with symptoms (stage 3) would define the pathogenesis culminating in clinical type 1 diabetes. Etiology would be about the timing of events that take place before the first-appearing islet autoantibody.
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spelling pubmed-83360112021-08-20 Etiology of Autoimmune Islet Disease: Timing Is Everything Lernmark, Åke Diabetes Perspectives in Diabetes Life is about timing. —Carl Lewis The understanding of autoimmune type 1 diabetes is increasing, and examining etiology separate from pathogenesis has become crucial. The components to explain type 1 diabetes development have been known for some time. The strong association with HLA has been researched for nearly 50 years. Genome-wide association studies added another 60+ non-HLA genetic factors with minor contribution to risk. Insulitis has long been known to be present close to clinical diagnosis. T and B cells recognizing β-cell autoantigens are detectable prior to diagnosis and in newly diagnosed patients. Islet autoantibody tests against four major autoantigens have been standardized and used as biomarkers of islet autoimmunity. However, to clarify the etiology would require attention to time. Etiology may be defined as the cause of a disease (i.e., type 1 diabetes) or abnormal condition (i.e., islet autoimmunity). Timing is everything, as neither the prodrome of islet autoimmunity nor the clinical onset of type 1 diabetes tells us much about the etiology. Rather, the islet autoantibody that appears first and persists would mark the diagnosis of an autoimmune islet disease (AID). Events after the diagnosis of AID would represent the pathogenesis. Several islet autoantibodies without (stage 1) or with impaired glucose tolerance (stage 2) or with symptoms (stage 3) would define the pathogenesis culminating in clinical type 1 diabetes. Etiology would be about the timing of events that take place before the first-appearing islet autoantibody. American Diabetes Association 2021-07 2021-07-28 /pmc/articles/PMC8336011/ /pubmed/34155043 http://dx.doi.org/10.2337/dbi18-0034 Text en © 2021 by the American Diabetes Association https://www.diabetesjournals.org/content/licenseReaders may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.
spellingShingle Perspectives in Diabetes
Lernmark, Åke
Etiology of Autoimmune Islet Disease: Timing Is Everything
title Etiology of Autoimmune Islet Disease: Timing Is Everything
title_full Etiology of Autoimmune Islet Disease: Timing Is Everything
title_fullStr Etiology of Autoimmune Islet Disease: Timing Is Everything
title_full_unstemmed Etiology of Autoimmune Islet Disease: Timing Is Everything
title_short Etiology of Autoimmune Islet Disease: Timing Is Everything
title_sort etiology of autoimmune islet disease: timing is everything
topic Perspectives in Diabetes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336011/
https://www.ncbi.nlm.nih.gov/pubmed/34155043
http://dx.doi.org/10.2337/dbi18-0034
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