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A Prospective Study of the Role of Coxsackie B and Other Enterovirus Infections in the Pathogenesis of IDDM
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1995
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Clinical SymptomsImmunologyViral PathogenesisMaternal ImmunizationViral PersistenceGastrointestinal VirusClinical IddmProspective StudyInfection ControlHealth SciencesAutoimmune DiseaseCoxsackievirus B InfectionsVirologyGestational DiabetesOther Enterovirus InfectionsClinical MicrobiologyInborn Error Of ImmunityEpidemiologyCoxsackie BPathogenesisDiabetesDiabetes MellitusVirus-host InteractionMedicine
Coxsackievirus B infections have been linked to insulin‑dependent diabetes mellitus, but their initiating role in progressive beta‑cell damage remains unclear. This prospective study was designed to evaluate whether coxsackie B and other enterovirus infections trigger and accelerate beta‑cell destruction leading to IDDM. The study examined three cohorts—an intrauterine exposure series of 96 mothers with IDDM children versus 96 controls, a sibling cohort of 22 siblings who developed IDDM versus 110 controls, and a case‑control series of 90 newly diagnosed IDDM children versus 90 controls—using capture radioimmunoassay to detect significant rises in serum IgG, IgM, or IgA against enterovirus antigens. Enterovirus antibodies were markedly higher in mothers whose children developed IDDM, especially when onset occurred before age 3, and siblings who later developed IDDM had nearly twice the frequency of serologically confirmed enterovirus infections compared with controls, a difference evident both near diagnosis and several years prior. Abstract truncated at 250 words.
Coxsackievirus B infections have been associated with clinical manifestation of insulin-dependent diabetes mellitus (IDDM) in several studies, but their initiating role in the slowly progressing beta-cell damage is not known. This is the first prospective study designed to assess the role of coxsackie B and other enterovirus infections in the induction and acceleration of this process. Three separate series were studied: 1) an intrauterine exposure series comprising 96 pregnant mothers whose children subsequently manifested IDDM and 96 control mothers whose children remained nondiabetic; 2) a cohort of 22 initially unaffected siblings of diabetic children who were followed until they developed clinical IDDM (mean observation time, 29 months) and 110 control siblings who remained nondiabetic; 3) a case-control series comprising 90 children with newly diagnosed IDDM and 90 control subjects. Enterovirus infections were identified on the basis of significant increases in serum IgG, IgM, or IgA class antibodies against a panel of enterovirus antigens (capture radioimmunoassay). Enterovirus antibodies were significantly elevated in pregnant mothers whose children subsequently manifested IDDM, particularly in cases in which IDDM appeared at a very young age, before the age of 3 years (P < 0.005). Serologically verified enterovirus infections were almost two times more frequent in siblings who developed clinical IDDM than in siblings who remained nondiabetic (mean, 1.0 vs. 0.6 infections/follow-up year; P < 0.001). This difference was seen both close to the diagnosis of IDDM and several years before diagnosis. (ABSTRACT TRUNCATED AT 250 WORDS)