Enterovirus Infection, CXC Chemokine Ligand 10 (CXCL10), and CXCR3 Circuit
Open Access
- 29 July 2009
- journal article
- case report
- Published by American Diabetes Association in Diabetes
- Vol. 58 (10), 2285-2291
- https://doi.org/10.2337/db09-0091
Abstract
OBJECTIVE Fulminant type 1 diabetes is characterized by the rapid onset of severe hyperglycemia and ketoacidosis, with subsequent poor prognosis of diabetes complications. Causative mechanisms for accelerated β-cell failure are unclear. RESEARCH DESIGN AND METHODS Subjects comprised three autopsied patients who died from diabetic ketoacidosis within 2–5 days after onset of fulminant type 1 diabetes. We examined islet cell status, including the presence of enterovirus and chemokine/cytokine/major histocompatibility complex (MHC) expressions in the pancreata using immunohistochemical analyses and RT-PCR. RESULTS Immunohistochemical analysis revealed the presence of enterovirus-capsid protein in all three affected pancreata. Extensive infiltration of CXCR3 receptor–bearing T-cells and macrophages into islets was observed. Dendritic cells were stained in and around the islets. Specifically, interferon-γ and CXC chemokine ligand 10 (CXCL10) were strongly coexpressed in all subtypes of islet cells, including β-cells and α-cells. No CXCL10 was expressed in exocrine pancreas. Serum levels of CXCL10 were increased. Expression of MHC class II and hyperexpression of MHC class I was observed in some islet cells. CONCLUSIONS These results strongly suggest the presence of a circuit for the destruction of β-cells in fulminant type 1 diabetes. Enterovirus infection of the pancreas initiates coexpression of interferon-γ and CXCL10 in β-cells. CXCL10 secreted from β-cells activates and attracts autoreactive T-cells and macrophages to the islets via CXCR3. These infiltrating autoreactive T-cells and macrophages release inflammatory cytokines including interferon-γ in the islets, not only damaging β-cells but also accelerating CXCL10 generation in residual β-cells and thus further activating cell-mediated autoimmunity until all β-cells have been destroyed.Keywords
This publication has 50 references indexed in Scilit:
- Amplification of Autoimmune Response through Induction of Dendritic Cell Maturation in Inflamed TissuesThe Journal of Immunology, 2009
- Vessel-Specific Toll-Like Receptor Profiles in Human Medium and Large ArteriesCirculation, 2008
- Coxsackie B4 virus infection of β cells and natural killer cell insulitis in recent-onset type 1 diabetic patientsProceedings of the National Academy of Sciences of the United States of America, 2007
- Fulminant type 1 diabetes: a novel clinical entity requiring special attention by all medical practitionersNature Clinical Practice Endocrinology & Metabolism, 2007
- Sensitive, Seminested PCR Amplification of VP1 Sequences for Direct Identification of All Enterovirus Serotypes from Original Clinical SpecimensJournal of Clinical Microbiology, 2006
- Cure of Chronic Viral Infection and Virus-Induced Type 1 Diabetes by Neutralizing AntibodiesClinical and Developmental Immunology, 2006
- Two Cases of “Fulminant” Type 1 Diabetes Suggesting Involvement of AutoimmunityAnnals of the New York Academy of Sciences, 2003
- A Novel Subtype of Type 1 Diabetes MellitusNew England Journal of Medicine, 2000
- In situ analysis of pancreatic islets in rats developing diabetes. Appearance of nonendocrine cells with surface MHC class II antigens and cytoplasmic insulin immunoreactivity.JCI Insight, 1988
- In Situ Characterization of Autoimmune Phenomena and Expression of HLA Molecules in the Pancreas in Diabetic InsulitisNew England Journal of Medicine, 1985