Pathogenesis Of Insulin-dependent Diabetes Mellitus Research Articles

Inhibition of hyaluronan synthesis restores immune tolerance during autoimmune insulitis (THER5P.919)

Abstract We recently reported that abundant deposits of the extracellular matrix polysaccharide hyaluronan (HA) characterize autoimmune insulitis in human type 1 diabetes (T1D) but the significance of these deposits was unclear. Here, we demonstrate that HA is critical for the pathogenesis of autoimmune diabetes. Using the DO11.10xRIPmOVA (DORmO) mouse model of T1D, we show that HA deposits are temporally and anatomically associated with the development of insulitis. Moreover, treatment with an inhibitor of HA synthesis, 4‑methylumbelliferone (4-MU), halted progression to diabetes even after the onset of insulitis. 4-MU reduced HA accumulation, constrained effector T-cells to non-destructive insulitis, and increased numbers of intra-islet Foxp3+ regulatory T-cells (Treg). Consistent with this, Treg differentiation was inhibited by HA and anti-CD44 antibodies and rescued by 4-MU in an ERK1/2-dependent manner. These data may explain how peripheral immune tolerance is impaired in tissues under autoimmune attack, including islets in T1D. We propose that 4-MU, already an approved drug used to treat biliary spasm, could be repurposed to prevent, and possibly treat, T1D in at-risk individuals.

Type 1 diabetes pathogenesis - Prevention???

Pathogenesis of type 1 diabetes is multi-faceted, including, autoimmunity, genetics and environment. Autoimmunity directed against pancreatic islet cells results in slowly progressive selective beta-cell destruction (“Primary autoimmune insulitis”), culminating over years in clinically manifested insulin-dependent diabetes mellitus (IDDM). Circulating serum autoantibodies directed against the endocrine cells of the islets of Langerhans (Islet cell autoantibodies - ICAb) are an important hallmark of this disease. Assays for islet cell autoantibodies have facilitated the investigation and understanding of several facets in the pathogenesis of autoimmune diabetes. Their applications have extended into clinical practice and have opened new avenues for early preclinical prediction and preventive prophylaxis in IDDM/type 1 DM. Recently, surprisingly, differences in insulin content between T1DM islets, as well as, ‘patchy’ or ‘lobular’ destruction of islets have been described. These unique pathobiological phenomena, suggest that beta cell destruction may not always be inexorable and inevitably complete/total, and thus raise hopes for possible therapeutic interruption of beta cell autoimmunity – destruction and cure of type 1 diabetes. “Recurrent or secondary autoimmune insulitis” refers to the rapid reappearance of islet cell autoantibodies post pancreas transplant, and selective islet beta cell destruction in the grafted pancreas [never forgetting or “anamnestic” beta cell destructive memory], in the absence of any graft pancreas rejection [monozygotic twin to twin transplantation]. The one definite environmental factor is congenital rubella, because of which a subset of children subsequently develop type 1 diabetes. The putative predisposing factors are viruses, gluten and cow's milk. The putative protective factors include gut flora, helminths, viral infections, and Vitamin D. Prevention of T1DM can include: Primary prevention strategies before the development of autoantibodies and Secondary prevention regimens after autoantibody development. Once islet cell autoantibodies have developed, the goal is to establish a therapeutic regimen to preserve at least 90% of the beta cells, and prevent the development of hyperglycaemia. The targets for T1DM reversal should include autoimmunity, beta cell regeneration and protection of beta cell mass. Anti-CD3 teplizumab and anti-CD3 otelixizumab have been shown to provide C-peptide preservation. The unanswered questions in diabetes research include elimination of autoimmune memory responses, reestablishment of immune self-tolerance, and mechanisms of disease initiation.

CD8+ CD122+ PD-1- effector cells promote the development of diabetes in NOD mice.

It is well established that CD4 and CD8 T cells are required for the initiation of autoimmune diabetes in NOD mice. However, different subsets of CD4 or CD8 cells may play different roles in the initiation of insulitis. In this study, we evaluated the role of the previously described CD8(+) CD122(+) in this process. We found that prediabetic NOD mice have an almost 50% reduction of CD8(+) CD122(+) T cells in their secondary lymphoid organs compared with BL/6 or Balb/c mouse strains. This reduction is explained by the lack of the regulatory CD8(+) CD122(+) PD-1(+) cell population in the NOD mice, as we found that all CD8(+) CD122(+) T cells from prediabetic NOD mice lack PD-1 expression and regulatory function. Depletion of CD8(+) CD122(+) PD-1(-) cells through injection of anti-CD122 mAb in prediabetic female NOD mice reduced the infiltration of mononuclear cells into the Langerhans islets and delayed the onset and decreased the incidence of overt diabetes. In addition, we found that transfer of highly purified and activated CD8(+) CD122(+) PD-1(-) cells, together with diabetogenic splenocytes from NOD donors to NOD SCID recipients, accelerates the diabetes development in these mice. Together, these results demonstrate that CD8(+) CD122(+) PD-1(-) T cells from NOD mice are effector cells that are involved in the pathogenesis of autoimmune diabetes.

Soluble Fas as a programmed cell death marker before and after antioxidant vitamins supplement in type 1 diabetes and high-risk children

Background/Aim Considerable evidence indicates that increased oxidative stress and induction of apoptosis signaled through the Fas pathway appear to play an important role in the pathogenesis of autoimmune diabetes. The present study aimed to detect the soluble Fas (sFas) as apoptotic marker and the total antioxidant capacity (TAC) in type 1 diabetes (T1D) and high-risk group children and whether it is altered by antioxidant vitamin supplement. Patients and methods Forty-five participants were included in the study and divided into three groups: group 1 comprised 15 children with new onset diabetes; group 2 included 15 diabetic children with long-standing diabetes; and group 3 comprised 15 individuals of patient's relatives. Serum levels of sFas and TAC were measured and compared between groups before and after antioxidant vitamin supplementation. Results The highest level of sFas was found in group 2 (2196.7 ± 579 pg/ml), however, with no statistical significance; after vitamins supplementation, its level showed significant decrease to reach 1156.6 ± 460.8 pg/ml ( P = 0.01). Similar tendency of serum Fas decrease was observed in the group of relatives after vitamins supplementation (2088.3 ± 396.5 vs. 1426.7 ± 140.9, P P < 0.05). Conclusion One month of treatment with antioxidants vitamins supplement increased the antioxidant activity in long-standing T1D children and resulted in significant reduction in sFas level, suggesting the importance of this therapeutics in reducing apoptosis changes in children with T1D.

The PTPN22 1858T allele but not variants in the proximal promoter region ofIL-21gene is associated with the susceptibility to type 1 diabetes and the presence of autoantibodies in a Brazilian cohort

Interleukin (IL)-21 and protein tyrosine phosphatase non-receptor 22 (PTPN22) regulate lymphocyte function and have been implicated in the pathogenesis of autoimmune diabetes. We sequenced the proximal promoter of the IL-21 gene for the first time and analysed the PTPN22 1858T polymorphism in type 1A diabetes (T1AD) patients and healthy controls (HC). We correlated the frequencies of islet and extra-pancreatic autoantibodies with genotypes from both loci. The case series comprised 612 T1AD patients and 792 HC. Genotyping of PTPN22 C1858T was performed on 434 T1AD patients and 689 HC. The -448 to +83 base pairs (bp) region of the IL-21 gene was sequenced in 309 Brazilian T1AD and 189 HC subjects. We also evaluated human leucocyte antigen (HLA) DR3/DR4 alleles. The frequencies of glutamic acid decarboxylase (GAD65), tyrosine phosphatase-like protein (IA)-2, anti-nuclear antibody (ANA), thyroid peroxidase (TPO), thyroglobulin (TG), thyrotrophin receptor autoantibody (TRAb), anti-smooth muscle (ASM) and 21-hydroxylase (21-OH) autoantibodies were higher in T1AD patients than in HC. The PTPN22 1858T allele was associated with an increased risk for developing T1AD [odds ratio (OR) = 1·94; P < 0·001], particularly in patients of European ancestry, and with a higher frequency of GAD65 and TG autoantibodies. HLA-DR3/DR4 alleles predominated in T1AD patients. A heterozygous allelic IL-21 gene variant (g.-241 T > A) was found in only one patient. In conclusion, only PTPN22 C1858T polymorphism and HLA-DR3 and/or DR4 alleles, but not allelic variants in the 5'-proximal region of the IL-21 gene were associated with T1AD risk. Patients with T1AD had increased frequencies of anti-islet-cell, anti-thyroid, anti-nuclear, anti-smooth muscle and anti-21-OH autoantibodies. The C1858T PTPN22 polymorphism was also associated with a higher frequency of GAD65 and TG autoantibodies.

Erratum to: Interleukin-15 plays an essential role in the pathogenesis of autoimmune diabetes in the NOD mouse

Fig. 6 Inhibition of IL-15 signalling in NOD mice decreases type 1 diabetes. (a) Female NOD mice were administered, by i.p. injection, 200 μg TM-β1 mAb (white circles, n012) or control mAb (black circles, n08) three times a week for 4 weeks (indicated by the grey bar). Injected mice were followed for diabetes development up to 7 months of age. Data from mice from two different experiments were pooled. p<0.01 (logrank test) The online version of the original article can be found at http://dx.doi.org/ 10.1007/s00125-012-2675-1.

Immune Regulatory Properties of Allogeneic Adipose-Derived Mesenchymal Stem Cells in the Treatment of Experimental Autoimmune Diabetes

Adipose-derived mesenchymal stem cells (ADMSCs) display immunosuppressive properties, suggesting a promising therapeutic application in several autoimmune diseases, but their role in type 1 diabetes (T1D) remains largely unexplored. The aim of this study was to investigate the immune regulatory properties of allogeneic ADMSC therapy in T cell–mediated autoimmune diabetes in NOD mice. ADMSC treatment reversed the hyperglycemia of early-onset diabetes in 78% of diabetic NOD mice, and this effect was associated with higher serum insulin, amylin, and glucagon-like peptide 1 levels compared with untreated controls. This improved outcome was associated with downregulation of the CD4+ Th1-biased immune response and expansion of regulatory T cells (Tregs) in the pancreatic lymph nodes. Within the pancreas, inflammatory cell infiltration and interferon-γ levels were reduced, while insulin, pancreatic duodenal homeobox-1, and active transforming growth factor-β1 expression were increased. In vitro, ADMSCs induced the expansion/proliferation of Tregs in a cell contact–dependent manner mediated by programmed death ligand 1. In summary, ADMSC therapy efficiently ameliorates autoimmune diabetes pathogenesis in diabetic NOD mice by attenuating the Th1 immune response concomitant with the expansion/proliferation of Tregs, thereby contributing to the maintenance of functional β-cells. Thus, this study may provide a new perspective for the development of ADMSC-based cellular therapies for T1D.

Potential mechanisms explaining why hydrolyzed casein‐based diets outclass single amino acid‐based diets in the prevention of autoimmune diabetes in diabetes‐prone BB rats

It remains controversial whether avoidance of dietary diabetogenic triggers, such as cow's milk proteins, can prevent type 1 diabetes in genetically susceptible individuals. Here, different extensive casein hydrolysates (HC) and single amino acid (AA) formulations were tested for their effect on mechanisms underlying autoimmune diabetes pathogenesis in diabetes-prone BioBreeding rats. Intestinal integrity, gut microbiota composition and mucosal immune reactivity were studies to assess whether these formulations have differential effects in autoimmune diabetes prevention. Diabetes-prone BioBreeding rats received diets in which the protein fraction was exchanged for the different hydrolysates or AA compositions, starting from weaning until the end of the experiment (d150). Diabetes development was monitored, and faecal and ileal samples were collected. Gut microbiota composition and cytokine/tight junction mRNA expression were measured by quantitative polymerase chain reaction. Cytokine levels of ileum explant cultures were measured by ELISA, and intestinal permeability was measured in vivo by lactulose-mannitol assay. Both HC-diet fed groups revealed remarkable reduction of diabetes incidence with the most pronounced effect in Nutramigen®-fed animals. Interestingly, AA-fed rats only showed delayed autoimmune diabetes development. Furthermore, both HC-fed groups had improved intestinal barrier function when compared with control chow or AA-fed animals. Interestingly, higher IL-10 levels were measured in ileum tissue explants from Nutramigen®-fed rats. Beneficial gut microbiota changes (increased Lactobacilli and reduced Bacteroides spp. levels) were found associated especially with HC-diet interventions. Casein hydrolysates were found superior to AA-mix in autoimmune diabetes prevention. This suggests the presence of specific peptides that beneficially affect mechanisms that may play a critical role in autoimmune diabetes pathogenesis.

Interleukin-15 plays an essential role in the pathogenesis of autoimmune diabetes in the NOD mouse

IL-15, induced by innate immune stimuli, promotes rheumatoid arthritis and inflammatory bowel disease. However, its role in autoimmune type 1 diabetes is unclear. Our aim is to define the role of IL-15 in the pathogenesis of diabetes in the NOD mouse model. We generated NOD.Il15(-/-) mice expressing a polyclonal repertoire of T cell antigen receptor (TCR) or a transgenic TCR and monitored diabetes onset and insulitis. NOD Scid.Il15(-/-) (full name NOD.CB17-Prkdc (scid)/NCrCrl) and NOD Scid.gamma (full name NOD.Cg-Prkdc(scid) Il2rg ( tm1Wjl )/SzJ) mice were used to distinguish the requirement for IL-15 signalling in CD8(+) T cells and antigen-presenting cells (APCs) to induce disease. We examined the effect of blocking IL-15 signalling on diabetes onset in NOD mice. At 7 months of age, more than 75% of the NOD Il15(-/-) female mice remained diabetes free compared with only 30% in the control group. Diabetes incidence was also decreased in 8.3-NOD (full name NOD Cg-Tg[TcraTcrbNY8.3]-1Pesa/DvsJ).Il15(-/-) mice expressing a highly pathogenic transgenic TCR on CD8(+) T cells. Adoptive transfer of splenocytes from diabetic NOD and 8.3-NOD donors induced disease in NOD Scid recipients but not in NOD Scid.Il15(-/-) or NOD Scid.gamma mice. Transient blockade of IL-15 signalling at the onset of insulitis prevented diabetes in NOD mice. Our results show that IL-15 is needed for the initial activation of diabetogenic CD8(+) T cells as well as for sustaining the diabetogenic potential of antigen-stimulated cells, acting on both CD8(+) T cells and on APCs. Our findings demonstrate a critical role for IL-15 in the pathogenesis of autoimmune diabetes and suggest that IL-15 is a promising therapeutic target.

IL-7 receptor blockade reverses autoimmune diabetes by promoting inhibition of effector/memory T cells

To protect the organism against autoimmunity, self-reactive effector/memory T cells (T(E/M)) are controlled by cell-intrinsic and -extrinsic regulatory mechanisms. However, how some T(E/M) cells escape regulation and cause autoimmune disease is currently not understood. Here we show that blocking IL-7 receptor-α (IL-7Rα) with monoclonal antibodies in nonobese diabetic (NOD) mice prevented autoimmune diabetes and, importantly, reversed disease in new-onset diabetic mice. Surprisingly, IL-7-deprived diabetogenic T(E/M) cells remained present in the treated animals but showed increased expression of the inhibitory receptor Programmed Death 1 (PD-1) and reduced IFN-γ production. Conversely, IL-7 suppressed PD-1 expression on activated T cells in vitro. Adoptive transfer experiments revealed that T(E/M) cells from anti-IL-7Rα-treated mice had lost their pathogenic potential, indicating that absence of IL-7 signals induces cell-intrinsic tolerance. In addition to this mechanism, IL-7Rα blockade altered the balance of regulatory T cells and T(E/M) cells, hence promoting cell-extrinsic regulation and further increasing the threshold for diabetogenic T-cell activation. Our data demonstrate that IL-7 contributes to the pathogenesis of autoimmune diabetes by enabling T(E/M) cells to remain in a functionally competent state and suggest IL-7Rα blockade as a therapy for established T-cell-dependent autoimmune diseases.

Dynamic changes of the Th17/Tc17 and regulatory T cell populations interfere in the experimental autoimmune diabetes pathogenesis

A balance between proinflammatory (Th17 and Tc17) and anti-inflammatory (regulatory T cells) subsets of T cells is essential to maintain immunological tolerance and prevent the onset of several autoimmune diseases, including type 1 diabetes. However, the kinetics of these subsets and disease severity during the streptozotocin (STZ)-induced diabetes course has not been determined. Thus, susceptible C57BL/6 mice were administrated with multiple low doses of STZ and we evaluated the frequency/absolute number of these T cell subsets in the pancreatic lymph nodes (PLNs) and spleen and Th1, Th17, Treg cytokine production in the pancreatic tissue. At different time points of the disease progression (6, 11, 18 and 25 days after the last STZ administration), the histopathological alterations were also evaluated by H&E and immunohistochemistry staining. During the initial phase of diabetes development (day 6), we noted increased numbers of CD4+ and CD8+ T cells in spleen and PLNs. At the same time, the frequencies of Th17 and Tc17 cells in PLNs were also enhanced. In addition, the early augment of interferon gamma (IFN-γ), tumoral necrosis factor (TNF-α), IL-6 and IL-17 levels in pancreatic tissue correlated with pancreatic islet inflammation and mild β-cell damage. Notably, the absolute number of Treg cells increased in PLNs during over time when compared to control group. Interestingly, increased IL-10 levels were associated with control of the inflammatory process during the late phase of the type 1 diabetes (day 25). In agreement, mice lacking the expression of IL-17 receptor (Il17r) showed impairment in STZ-induced diabetes progression, reduced peri-insulitis and beta cells preservation when compared with wild-type mice. Our findings suggest that dynamic changes of pathogenic Th17/Tc17 and regulatory T cell subsets numbers is associated with early strong inflammation in the pancreatic islets followed by late regulatory profile during the experimental STZ-induced diabetes course.

The Dual Effects of B Cell Depletion on Antigen-Specific T Cells in BDC2.5NOD Mice

B cells play a critical role in the pathogenesis of autoimmune diabetes. To investigate the mechanisms by which B cell depletion therapy attenuates islet β cell loss and particularly to examine the effect of B cells on both diabetogenic and regulatory Ag-specific T cells, we generated a transgenic BDC2.5NOD mouse expressing human CD20 on B cells. This allowed us to deplete B cells for defined time periods and investigate the effect of B cell depletion on Ag-specific BDC2.5 T cells. We depleted B cells with anti-human CD20 Ab using a multiple injection protocol. We studied two time points, before and after B cell regeneration, to examine the effect on BDC2.5 T cell phenotype and functions that included antigenic response, cytokine profile, diabetogenicity, and suppressive function of regulatory T (T(reg)) cells. We found unexpectedly that B cell depletion induced transient aggressive behavior in BDC2.5 diabetogenic T cells and reduction in T(reg) cell number and function during the depletion period. However, after B cell reconstitution, we found that more regenerated B cells, particularly in the CD1d(-) fraction, expressed immune regulatory function. Our results suggest that the regenerated B cells are likely to be responsible for the therapeutic effect after B cell depletion. Our preclinical study also provides direct evidence that B cells regulate both pathogenic and T(reg) cell function, and this knowledge could explain the increased T cell responses to islet Ag after rituximab therapy in diabetic patients in a recent report and will be useful in design of future clinical protocols.

Radical innate regulation of autoimmune diabetes

Radical innate regulation of autoimmune diabetes

Effect of influenza A virus non-structural protein 1(NS1) on a mouse model of diabetes mellitus induced by Streptozotocin

Type 1 diabetes (T1D) is a chronic autoimmune disease caused by proinflammatory autoreactive T cells that mediate the selective destruction of insulin-producing β cells via both direct and indirect mechanisms. Many immune cells and proinflammatory cytokines are involved in the pathogenesis of autoimmune diabetes. Immune intervention is effective for the prevention and treatment of T1D by blocking the autoimmune assault to β cells. The non-structural protein 1(NS1) of influenza A viruses is a non-essential virulence factor encoded on segment 8 that has multiple accessory functions, including suppression of innate immunity and adaptive immunity, inhibition of apoptosis and activation of phosphoinositide 3-kinase (PI3K). This research investigated whether the expression of NS1 can prevent and treat diabetes mellitus induced by Streptozotocin (STZ). The NS1 expressing plasmid pEGFP-C2/NS1 was constructed and injected intramuscularly to both thighs of mice. Its effect on mice was observed. Intramuscular delivery of pEGFP-C2/NS1 resulted in reduction in hyperglycemia and diabetes incidence, with an increase in insulin. pEGFP-C2/NS1 could also increase glycogen and regulated serum cytokine levels. In addition, by comparison to the mice treated with empty vector pEGFP-C2, ameliorative insulitis was observed in the mice treated with recombinant plasmid pEGFP-C2/NS1. This result suggests that the expression of NS1 is effective for the prevention and treatment of diabetes mellitus induced by STZ in a mouse model.

IL-17 Silencing Does Not Protect Nonobese Diabetic Mice from Autoimmune Diabetes

The long-held view that many autoimmune disorders are primarily driven by a Th1 response has been challenged by the discovery of Th17 cells. Since the identification of this distinct T cell subset, Th17 cells have been implicated in the pathogenesis of several autoimmune diseases, including multiple sclerosis and rheumatoid arthritis. Type 1 diabetes has also long been considered a Th1-dependent disease. In light of the emerging role for Th17 cells in autoimmunity, several recent studies investigated the potential of this subset to initiate autoimmune diabetes. However, direct evidence supporting the involvement of Th17 cells in actual pathogenesis, particularly during spontaneous onset, is lacking. In this study, we sought to directly address the role of IL-17, the cytokine by which Th17 cells are primarily characterized, in the pathogenesis of autoimmune diabetes. We used lentiviral transgenesis to generate NOD mice in which IL-17 is silenced by RNA interference. The loss of IL-17 had no effect on the frequency of spontaneous or cyclophosphamide-induced diabetes. In contrast, IL-17 silencing in transgenic NOD mice was sufficient to reduce the severity of myelin oligodendrocyte glycoprotein-induced experimental autoimmune encephalomyelitis, consistent with reports that IL-17 deficiency is protective in this experimental model of multiple sclerosis. We concluded that IL-17 is dispensable, at least in large part, in the pathogenesis of autoimmune diabetes.

IFN-γ induced by IL-12 administration prevents diabetes by inhibiting pathogenic IL-17 production in NOD mice

Interleukin 12 (IL-12) is a pivotal Th1-associated cytokine and a potent immunoregulatory molecule. However, the role of IL-12 in inducing immune tolerance that prevents insulitis and inhibits type 1 diabetes (T1D) remains unknown. The aim of this study was to investigate whether intermittent administration of IL-12 could prevent the development of T1D in nonobese diabetic (NOD) mice. We examined whether IL-12 treatment prevented diabetes by injecting different doses of IL-12 into NOD mice and compared the incidence of diabetes and insulitis in NOD mice with the incidence in control mice. Furthermore, we investigated the potential mechanisms of IL-12-mediated prevention of diabetes and insulitis. The expression of pro-inflammatory and immunoregulatory cytokines was measured before and following therapeutic administration of IL-12 in NOD mice. Our data demonstrated that both the absolute number and the function of DCs were impaired in NOD mice and that the levels of the Th17-associated pro-inflammatory cytokines, IL-1β, IL-6 and IL-23, were elevated in NOD mice compared with age-matched BALB/c and C57BL/6 mice. However, treatment of NOD mice with IL-12 suppressed insulitis and increased the number of healthy islets, and the levels of IL-17, IL-1β, IL-6 and IL-23 were significantly decreased. Moreover, IL-12 treatment of NOD mice induced the secretion of IFN-γ, a potent inhibitor of Th17 cells. These data indicated that intermittent administration of IL-12 prevented diabetes by inducing IFN-γ, suppressing the pathogenic IL-17-producing cells and reducing the expression of Th17-associated pro-inflammatory cytokines. Our results suggest a promising strategy for the treatment of human T1D and other Th17 cell-mediated autoimmune diseases.

Role of TLR2 in the pathogenesis of autoimmune diabetes and its therapeutic implication

Recently, a couple of articles suggested the possibility that apoptosis of pancreatic β-cells induces inflammatory/immune responses to β-cells. Such a theory is based on the assumption that apoptotic cells can, under certain circumstances, induce immune responses, inflammatory and autoimmune disorders, which is in contrast to the dogma that apoptotic cells result in immunosuppression and necrotic cells provoke inflammation/immunity. We observed that late apoptotic β-cells with secondary necrosis elicited inflammatory responses in macrophages through the toll-like receptor 2 (TLR2)/MyD88/nuclear factor-κB signalling pathway. Late apoptotic cells also induced TLR2-dependent maturation of dendritic cells and then activation of autoreactive T-cells. TLR2 knockout mice showed defective priming of diabetogenic T-cells by apoptotic β-cells in the pancreatic lymph nodes. Furthermore, TLR2 deficiency conferred a significant protection against type 1 diabetes (T1D) and insulitis in T1D animal models. These findings present evidence suggesting that apoptosis of pancreatic β-cells could be one of the initial events in T1D and provide a novel strategy for therapeutic or preventive intervention in T1D.

Type 1 diabetes—not all in the genes

AbstractThe incidence of autoimmune diseases is appreciable and increasing. Type 1 diabetes is one such disease, and is, in part, determined genetically, involving many genes (up to 40 at the last count), but they alone cannot account for the frequency of the disease, indicating that non‐genetic factors are important [Leslie et al., 2004; Weets et al., 2002]. The character of such non‐genetic factors is important to understand since the prevention or modulation of such factors provides a more likely source of a cure for type 1 diabetes. Non‐genetic factors play a major role in causing type 1 diabetes as shown by studies of twins, populations that have migrated, and populations with changing disease incidence [Hermann et al., 2003; Weets et al., 2002]. Disproportionate maternal influences on disease‐risk suggest that critical disease‐inducing environmental events operate very early in life, even in utero [Leslie et al., 2004]. Firm evidence for a role of viral infections in the etiology of type 1 diabetes comes from a recent demonstration that four rare variants of interferon‐producing genes are each associated with a 50% reduction in type 1 diabetes risk [Nejentsev et al., 2009]. Early infant diet affects type 1 diabetes development, while exposure to westernized heat‐processed food could be relevant given the close relationship between disease incidence and the gross national product of European countries [Leslie et al., 2004]. Epigenetic regulation could mediate environmental influences and is a candidate for that elusive “missing heritability” in the pathogenesis of autoimmune diabetes, e.g. in peripheral blood monocyte activation [Beyan et al., 2010]. In summary, epidemiological evidence favors the induction of childhood‐onset type 1 diabetes by an environmental event, possibly a virus or a dietary factor, or both, operating over a finite period in early childhood. J. Med. Virol. 83:1670–1670, 2011. © 2011 Wiley‐Liss, Inc.

Interleukin-7 promotes autoimmune disease by enabling memory T cells to escape PD-1-mediated tolerance (164.21)

Abstract An important challenge in the therapy of immune-mediated inflammatory diseases is to control established disease, largely because autoreactive memory T lymphocytes are difficult to suppress or eliminate. Memory T cells depend on interleukin-7 (IL-7) for their generation and maintenance and genomic studies have associated the cytokine’s receptor, IL-7Rα, with increased risk for autoimmune diseases such as type 1 diabetes. Here we show that IL-7Rα blockade reverses hyperglycemia in the non-obese diabetic (NOD) mouse model of type 1 diabetes. Diabetogenic memory T cells deprived of IL-7 signals remained present in the lymphoid organs but expressed the inhibitory molecule Programmed Death 1 (PD-1), which is critical for preventing autoimmunity. Blocking the interaction of PD-1 with its ligand, PD-L1, in cured mice rapidly induced hyperglycemia, demonstrating that this mechanism inhibited memory responses to pancreatic islets after IL-7Rα blockade. Conversely, IL-7 suppressed PD-1 expression after T cell activation, indicating that IL-7 contributes to the pathogenesis of autoimmune diabetes by keeping memory T cells in a functionally competent, tolerance-resistant state. Our data uncover a novel link between IL-7 and the PD-1/PD-L1 tolerance pathway and identify IL-7Rα blockade as a potential therapeutic approach to induce PD-1-mediated inhibition of pathogenic memory T cells in established T cell-dependent inflammatory diseases.

The Role of T-Cell Costimulatory Pathways in Regulation of Autoimmune Diabetes

Many factors contribute to the pathogenesis of autoimmune diabetes. Targets for treating this debilitating disease will become more apparent by understanding the nature of immune activation. This review examines the possibility of targeting costimulation and discusses the molecules found on the T cell and the antigen-presenting cell (APC) that participate in T-cell activation. The B7-1/B7-2:CD28/cytotoxic T lymphocyte antigen-4 (CTLA-4) pathway has been shown to be crucial in regulating T-cell activation and tolerance. Novel members of the B7-CD28 superfamily have recently been discovered, and they appear to be particularly important for regulating the responses of previously activated T cells. Superimposition of inhibitory signals, such as those delivered by CTLA-4 and the programmed death (PD)-1-PD-1 ligand (PD-L1) pathway, leads to a complex network of positive and negative costimulatory signals, the integration of which modulates immune responses. Furthermore, expression of the B7 homolog B7-H4 on cells in peripheral tissues indicates new mechanisms for regulating T-cell responses. This review focuses on our current understanding of the members of the B7:CD28 superfamily and discusses their therapeutic potential in autoimmune diabetes.