Fulminant type 1 diabetes - an important subtype in East Asia
Fulminant type 1 diabetes - an important subtype in East Asia
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DOI：
10.1002/dmrr.1236
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发表时间：
2011-11-01
影响因子：
8
通讯作者：
Hanafusa, Toshiaki
中科院分区：
文献类型：
--
作者：
Imagawa, Akihisa;Hanafusa, Toshiaki
暴发性1型糖尿病被定义为1型糖尿病的一种亚型，起病非常急性。一项全国性的调查发现，在日本急性发作的1型糖尿病患者中，这种变异约占20%。最近的研究表明，在其他东亚国家，这不是一个次要的亚型。作为遗传因素，我们揭示了人类白细胞抗原-DR-DQ、人类白细胞抗原-B和CTLA-4与暴发型1型糖尿病的相关性。作为一种环境因素，病毒感染将促进这一亚型的发展。发病后不久即可检测到胰岛细胞浸润，但发病1个月后未见细胞浸润。巨噬细胞和T细胞是浸润物的主要成分。还观察到肠道病毒RNA和Toll样受体-3的表达，这是病毒感染的标志。这些发现表明，易感个体的病毒感染可能会触发抗病毒免疫反应，胰腺β细胞通过加速的免疫反应迅速被破坏。版权所有(C)2011 John Wiley&Sons，Ltd.
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 antiviral immune response and that pancreatic beta cells are rapidly destroyed through the accelerated immune reaction. Copyright (C) 2011 John Wiley & Sons, Ltd.