title: High titres of IgA antibodies to enterovirus in fulminant type-1 diabetes.
abstract: OBJECTIVE
  We have recently proposed that fulminant type-1 diabetes is a novel subtype of type-1 diabetes with abrupt onset of insulin-deficient hyperglycaemia without islet-related autoantibodies. The pathogenesis is still unknown, but flu-like symptoms are frequently observed before the onset of disease of this subtype. Enterovirus infection is a candidate environmental factor causing type-1 diabetes. The aim of this study was to determine whether enterovirus infection contributes to the development of fulminant type-1 diabetes.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  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. IgG titres were lower in autoimmune diabetes than fulminant type and controls (p=0.014 and 0.019, respectively).
  
  
  CONCLUSIONS
  High titres of enterovirus IgA antibodies in serum suggest recurrent enterovirus infection in fulminant type-1 diabetic patients, indicating higher susceptibility to enteroviral infections among them. Such infections might have pathogenetic importance in the triggering of fulminant type-1 diabetes.
authors.affiliation: First Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan. aimag@poh.osaka-med.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Imagawa
authors.forename: T
authors.initials: T
authors.lastname: Hanafusa
authors.forename: H
authors.initials: H
authors.lastname: Makino
authors.forename: J-I
authors.initials: JI
authors.lastname: Miyagawa
authors.forename: P
authors.initials: P
authors.lastname: Juto
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000821:virology*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000276:immunology / Q000821:virology; D004769:Enterovirus Infections / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D012016:Reference Values
chemical_list: D000914:Antibodies, Viral; D006442:Glycated Hemoglobin; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M