title: The effect of HLA class II, insulin and CTLA4 gene regions on the development of humoral beta cell autoimmunity.
abstract: OBJECTIVE
  The aim of this study was to explore the contribution of genetic factors to the emergence of beta-cell-specific humoral autoimmunity.
  
  
  METHODS
  We analysed the effect of HLA class II, insulin (INS; -23 HphI variant) and cytotoxic T-lymphocyte-associated protein 4 (CTLA4 [+49 and CT60]) genes on the appearance of beta-cell-specific autoantibodies in a large population-based birth cohort recruited in Finland. Infants carrying increased risk HLA DQB1 genotypes were monitored for the appearance of autoantibodies (islet cell autoantibodies [ICA], insulin autoantibodies [IAA], glutamic acid decarboxylase autoantibodies [GADA] and islet antigen 2 antibodies [IA-2A]). Those who developed beta-cell-specific autoantibodies were studied (n=574, mean follow-up time: 4.9 years; range 0.5-9.3).
  
  
  RESULTS
  IAA emerged at a higher rate in children with the -23 HphI AA INS genotype than in those carrying AT or TT variants (hazard ratio 2.1, 95% CI 1.4-2.9, p<0.001). This effect of the INS locus was present in both HLA DQB1 risk groups. The appearance of IAA showed a strong association also with the HLA DRB1*0401 allele (hazard ratio 13.1, 95% CI 1.8-93.4, p<0.001). The development of IA-2A was also somewhat accelerated by the DRB1*0401 variant (p=0.03). Isolated ICA positivity was independent of the HLA and INS genotypes. None of the humoral immune markers showed association with the CTLA4 gene.
  
  
  CONCLUSIONS
  The INS and the DRB1 loci appear to contribute to the pathogenesis of type 1 diabetes by initiating/modifying insulin-specific autoimmunity. The emergence of IAA represents a crucial step in the development of beta cell autoimmunity in young children, in whom the appearance of GADA and IA-2A is linked to IAA.
authors: JDRF Centre for Prevention of Type 1 Diabetes in Finland, Turku, Finland. robert.hermann@utu.fi
authors: Robert
authors: R
authors: Hermann
authors: A P
authors: AP
authors: Laine
authors: R
authors: R
authors: Veijola
authors: T
authors: T
authors: Vahlberg
authors: S
authors: S
authors: Simell
authors: J
authors: J
authors: Lähde
authors: O
authors: O
authors: Simell
authors: M
authors: M
authors: Knip
authors: J
authors: J
authors: Ilonen
mesh_terms: D000917:Antibody Formation / Q000235:genetics*; D015703:Antigens, CD; D000943:Antigens, Differentiation / Q000235:genetics*; D001327:Autoimmune Diseases / Q000235:genetics*; D060908:CTLA-4 Antigen; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005387:Finland; D005802:Genes, MHC Class II; D006683:HLA-DQ Antigens / Q000235:genetics; D059866:HLA-DQ beta-Chains; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006801:Humans; D007223:Infant; D007328:Insulin / Q000235:genetics; D007330:Insulin Antibodies / Q000235:genetics; D007515:Islets of Langerhans / Q000276:immunology*
chemical_list: D015703:Antigens, CD; D000943:Antigens, Differentiation; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D006683:HLA-DQ Antigens; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C553505:HLA-DRB1*04:01 antigen; D007328:Insulin; D007330:Insulin Antibodies