Type 1 diabetes is a chronic (life-long) autoimmune disease that prevents your pancreas from making insulin. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, it can also develop in adults. The exact cause of type 1 diabetes is unknown but in this week’s podcast, I interview Ake Lernmark, MD, PhD. His research interest in autoimmune type 1 diabetes dates back before his islet cell surface antibodies report in 1978. Which was followed by the first islet autoantigen, the 64K in 1982. He also discovered the genetic association between HLA-DQ and autoimmune diabetes. He helped develop the “Golden Standard” which is used to detect newborns for diabetes risk and other diseases. His Swedish laboratory is the largest TEDDY location which screened and followed newborns at increased genetic risk for type 1 diabetes and celiac disease. His personal interest is to uncover the mechanisms that allow prolonged infections and the immune response to deviate to autoimmunity. I brought him on the show to share what is next in type one diabetes research.
What’s new for Type 1 Diabetes (T1D), Autoimmune Diabetes? In may 2023, The Journal of Internal Medicine, Published a study, In the TEDDY study, the highest risk Genotypes HLA DR-DQ (DR3-DQ2/DR4-DQ8,DR4-DQ8/DR4-DQ8 and DR3-DQ2/DR3-DQ2), revealed T1D in less than 50% of the enrolled infants.
The conclusion is these HLA genotypes are not primarily associated with T1D. The primary association is with the first-appearing islet autoantibody. The first-appearing autoantibody was split into two patterns. autoantibodies against insulin (IAA), first peaked already during the first year of life and taper off by 3–4 years of age. The other pattern is glutamic acid decarboxylase (GADA) first appears by 2–3 years of age to reach a plateau by about 4 years. Clarifying autoimmunity is triggered to either insulin or GAD65 is key to the cause of autoimmune T1D.
What is glutamic acid decarboxylase (GADA)? GAD is an enzyme and is made by the islet cells of the pancreas. GAD autoantibodies attack the pancreas.
What Is a HLA Genotype? HLA is short for Human Leukocyte Antigens. HLA are proteins that play a significant role in disease and immune defense. HLA is inherited as a “set” of the three HLA groups, A, B, DR. This set is known as a “haplotype”.
For more information on what is new withT1 Diabetes? listen to Episode #50 with Dr. Ake Lernmark