Etiology of fulminant type 1 diabetes with reference to enteroviral infection

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1.Enterovirus antibodies in the sera of patients with fulminant type 1 diabetes.We have investigated 19 patients with recent-onset fulminant type 1 diabetes, 18 patients with recent-onset typical type 1A diabetes, and 19 healthy controls. IgM, IgG, and IgA subclasses of antibodies to enterovirus were determined by ELISA. IgA antibody titres to enterovirus were significantly higher in fulminant type 1 diabetes than in typical type 1A diabetes (p=0.033) and controls (p=0.0003). IgM antibodies to enterovirus were not detected in any subject. In conclusion, high titres of enterovirus IgA-antibodies in serum suggest recurrent enterovirus infections in fulminant type 1 diabetic patients indicating higher susceptibility to enteroviral infections among them. Such infections may have pathogenetic importance for the triggering of fulminant type 1 diabetes.2.Identification of enterovirus-derived antigen in autopsy specimens with fulminant type 1 diabetesWe analyzed an autopsy case of fulminant type 1 diabetes died soon after the onset of overt diabetes by using immunohistochemical methods. We found positive staining of enterovirus capsid antigen, VP1, in the specimens. It was strongly stained in exocrine pancreas and weakly in islet area with remained beta cells. These findings suggest that enterovirus targeted to human pancreas at least in part of fulminant diabetes.