title: Intrafamilial spread of enterovirus infections at the clinical onset of type 1 diabetes.
abstract: BACKGROUND
  At the clinical onset of type 1 diabetes mellitus (T1D), enterovirus (EV) infections are suspected to play a role. EVs in blood are seen as a possible biomarker of T1D. EV infections may occur in temporal and geographic clusters and may spread within families.
  
  
  OBJECTIVE
  We checked whether EVs were present in the blood of newly diagnosed diabetic probands and of their consenting siblings and parents. We aimed at evaluating the frequency of EV infection, whether infections were spreading within families, and which EV species were involved.
  
  
  METHODS
  Blood was drawn from 24 newly diagnosed diabetic children/adolescents and their family members (20 siblings and 41 parents). Blood donors and non-diabetic children/adolescents diagnosed with overweight/short stature were used as controls. RNA was extracted from plasma/leukocytes. Reverse-transcription polymerase chain reaction assays capable of detecting virtually all EV types and of giving preliminary species identification were used.
  
  
  CONCLUSIONS
  EV genomes were found in the blood of 19 of 24 (79%) diabetics, 12 of 20 (60%) non-diabetic siblings, 26 of 41 (63%) parents, and 1 of 29 (3%) pediatric controls. EVs of the A, B, C, and D species were detected, with the B and C species more prevalent. Probands and virus-positive members of each family consistently shared the same EV species. During follow-up, 4 of 20 (20%) siblings of diabetic probands developed T1D with a latency of 3-25 months. In conclusion, infection by different EV species is highly prevalent at the clinical onset and extends to family members. EV may represent a precipitating factor of T1D. However, the disease only develops in a subset of infected individuals.
authors.affiliation: Pediatric Diabetes Unit, Department of Clinical and Experimental Medicine, University of Insubria Medical School, Varese, Italy. alessandro.salvatoni@uninsubria.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salvatoni
authors.forename: Andreina
authors.initials: A
authors.lastname: Baj
authors.forename: Giuliana
authors.initials: G
authors.lastname: Bianchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Federico
authors.forename: Martina
authors.initials: M
authors.lastname: Colombo
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniolo
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications / Q000276:immunology / Q000821:virology*; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000276:immunology / Q000821:virology*; D029821:Enterovirus A, Human / Q000145:classification / Q000276:immunology / Q000302:isolation & purification; D029822:Enterovirus B, Human / Q000145:classification / Q000276:immunology* / Q000302:isolation & purification; D030015:Enterovirus C, Human / Q000145:classification / Q000276:immunology* / Q000302:isolation & purification; D030016:Enterovirus D, Human / Q000145:classification / Q000276:immunology / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D058889:Molecular Typing; D010290:Parents; D015995:Prevalence; D035781:Siblings
keywords: PCR; adolescent; autoantibodies; biomarker; child; enterovirus; family; parent; pathogenesis; sibling; type 1 diabetes; virology; virus