title: Fulminant type 1 diabetes--an important subtype in East Asia.
abstract: Fulminant type 1 diabetes is defined as a subtype of type 1 diabetes with a remarkably acute onset. A nationwide survey identified that this variant accounts for approximately 20% of acute-onset type 1 diabetic patients in Japan. Recent studies indicate that this is not a minor subtype in other East Asian countries. As genetic factors, we revealed association of HLA-DR-DQ, HLA-B and CTLA-4 to fulminant type 1 diabetes. As an environmental factor, viral infection would contribute to the development of this subtype. Cellular infiltration to islets was detected soon after the onset but not observed 1 month after the onset. Macrophages and T cells were the main components of the infiltrates. Enterovirus RNA and Toll-like receptor-3 expression, a signature of viral infection, was also observed. These findings suggest that viral infection in the susceptible individual might trigger anti-viral immune response and that pancreatic beta cells are rapidly destroyed through the accelerated immune reaction.
authors: Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Yamadaoka, Suita, Osaka, Japan. aimagawa@endmet.med.osaka-u.ac.jp
authors: Akihisa
authors: A
authors: Imagawa
authors: Toshiaki
authors: T
authors: Hanafusa
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000652:urine; D060908:CTLA-4 Antigen / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis*; D004769:Enterovirus Infections / Q000150:complications; D005202:Asia, Eastern; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015235:HLA-B Antigens / Q000276:immunology; D059811:HLA-DRB1 Chains / Q000097:blood; D006801:Humans; D050417:Insulin-Secreting Cells / Q000276:immunology / Q000473:pathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014777:Virus Diseases / Q000276:immunology
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D060908:CTLA-4 Antigen; D006442:Glycated Hemoglobin; D015235:HLA-B Antigens; D059811:HLA-DRB1 Chains; C517652:hemoglobin A1c protein, human