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Enterovirus infection linked to type 1 diabetes
Yeung WG. BMJ. 2011;342:d35.
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Researchers have found a “clinically significant association” between enterovirus infection and type 1 diabetes. Children with type 1 diabetes are about 10 times more likely to have had an enterovirus infection than children without diabetes.
A systematic review and meta-analysis were designed to review the link between current enterovirus infection diagnosed with molecular testing with the development of autoimmunity or type 1 diabetes. Using PubMed and EMBASE, researchers in Australia found 24 papers and two abstracts that met their criteria. All were observational cohort or case-control studies that measured enterovirus RNA or viral protein in blood, stool or tissue of patients with prediabetes and diabetes. In total, data on more than 4,440 participants were studied.
Results of the meta-analysis revealed a significant association between enterovirus infection and type 1 diabetes-related autoimmunity (OR=3.7; 95% CI, 2.1-6.8) and clinical type 1 diabetes (OR=9.8; 95% CI, 5.5-17.4).
“Larger prospective studies would be needed to establish a clear temporal relation between enterovirus infection and the development of autoimmunity and type 1 diabetes,” researchers wrote in the British Medical Journal study abstract.
More knowledge about a possible link between enteroviruses and type 1 diabetes may help researchers develop new strategies to battle diabetes, Didier Hober, MD, PhD, professor of virology, and Famara Sane, PharmD, research assistant, both at University Lille in France, wrote in an accompanying editorial. They also said more research is needed, as these data contrast with data from a previous meta-analysis which found no association between enteroviruses and type 1 diabetes.
“The incidence rate of type 1 diabetes has increased over the past 25 years at an annual rate of 3%, but this cannot be explained only by genetic modifications in the population. It has therefore been suggested that environmental factors … can play a role in the pathogenesis of the disease.
“Viruses of the enterovirus genus, which have an RNA genome, are the most likely candidates, especially serotypes like coxsackie B virus belonging to the human enterovirus B species,” Hober and Sane wrote. However, they said it is “unclear whether enteroviruses are involved in all patients or just some.”
The link may be related to interplay between viruses, pancreatic beta cells, innate and adaptive immune systems and the patient genotype, according to Hober and Sane.
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