title: Differential Insulitic Profiles Determine the Extent of β-Cell Destruction and the Age at Onset of Type 1 Diabetes.
abstract: Type 1 diabetes (T1D) results from a T cell-mediated destruction of pancreatic β-cells following the infiltration of leukocytes (including CD8(+), CD4(+), and CD20(+) cells) into and around pancreatic islets (insulitis). Recently, we reported that two distinct patterns of insulitis occur in patients with recent-onset T1D from the U.K. and that these differ principally in the proportion of infiltrating CD20(+) B cells (designated CD20Hi and CD20Lo, respectively). We have now extended this analysis to include patients from the Network for Pancreatic Organ Donors with Diabetes (U.S.) and Diabetes Virus Detection (DiViD) study (Norway) cohorts and confirm that the two profiles of insulitis occur more widely. Moreover, we show that patients can be directly stratified according to their insulitic profile and that those receiving a diagnosis before the age of 7 years always display the CD20Hi profile. By contrast, individuals who received a diagnosis beyond the age of 13 years are uniformly defined as CD20Lo. This implies that the two forms of insulitis are differentially aggressive and that patients with a CD20Hi profile lose their β-cells at a more rapid rate. In support of this, we also find that the proportion of residual insulin-containing islets (ICIs) increases in parallel with age at the onset of T1D. Importantly, those receiving a diagnosis in, or beyond, their teenage years retain ∼40% ICIs at diagnosis, implying that a functional deficit rather than an absolute β-cell loss may be causal for disease onset in these patients. We conclude that appropriate patient stratification will be critical for correct interpretation of the outcomes of intervention therapies targeted to islet-infiltrating immune cells in T1D.
authors: Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K.
authors: Pia
authors: P
authors: Leete
authors: Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K.
authors: Abby
authors: A
authors: Willcox
authors: Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Lars
authors: L
authors: Krogvold
authors: Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Knut
authors: K
authors: Dahl-Jørgensen
authors: Department of Pathology, National Health Service Greater Glasgow and Clyde, Southern General Hospital, Glasgow, U.K.
authors: Alan K
authors: AK
authors: Foulis
authors: Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K. s.richardson@exeter.ac.uk.
authors: Sarah J
authors: SJ
authors: Richardson
authors: Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K. n.g.morgan@exeter.ac.uk.
authors: Noel G
authors: NG
authors: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000465:Algorithms; D018951:Antigens, CD20 / Q000378:metabolism*; D001327:Autoimmune Diseases / Q000276:immunology / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D001344:Autopsy; D001402:B-Lymphocytes / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007328:Insulin / Q000378:metabolism*; D008297:Male; D010179:Pancreas / Q000276:immunology / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D010195:Pancreatitis / Q000276:immunology / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D006113:United Kingdom; D055815:Young Adult
chemical_list: D018951:Antigens, CD20; D007328:Insulin