Coxsackievirus and Type 1 Diabetes: Diabetogenic Mechanisms and Implications for Prevention.

IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Alexia Carré, Federica Vecchio, Malin Flodstrom-Tullberg, Sylvaine You, Roberto Mallone
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引用次数: 7

Abstract

The evidence for an association between coxsackievirus B (CVB) infection, pancreatic islet autoimmunity, and clinical type 1 diabetes is increasing. Results from prospective cohorts and pancreas histopathology studies have provided a compelling case. However, the demonstration of a causal relationship is missing, and is likely to remain elusive until tested in humans by avoiding exposure to this candidate viral trigger. To this end, CVB vaccines have been developed and are entering clinical trials. However, the progress made in understanding the biology of the virus and in providing tools to address the long-standing question of causality contrasts with the scarcity of information about the antiviral immune responses triggered by infection. Beta-cell death may be primarily induced by CVB itself, possibly in the context of poor immune protection, or secondarily provoked by T-cell responses against CVB-infected beta cells. The possible involvement of epitope mimicry mechanisms skewing the physiological antiviral response toward autoimmunity has also been suggested. We here review the available evidence for each of these 3 non-mutually exclusive scenarios. Understanding which ones are at play is critical to maximize the odds of success of CVB vaccination, and to develop suitable tools to monitor the efficacy of immunization and its intermingling with autoimmune onset or prevention.

柯萨奇病毒与1型糖尿病:致糖尿病机制及其预防意义。
越来越多的证据表明柯萨奇病毒B (CVB)感染、胰岛自身免疫和临床1型糖尿病之间存在关联。来自前瞻性队列和胰腺组织病理学研究的结果提供了一个令人信服的案例。然而,缺乏因果关系的证明,并且可能仍然难以捉摸,直到在人类中进行测试,避免接触这种候选病毒触发器。为此,已研制出CVB疫苗,并已进入临床试验阶段。然而,在了解病毒生物学和提供解决长期存在的因果关系问题的工具方面取得的进展与关于感染引发的抗病毒免疫反应的信息匮乏形成鲜明对比。β细胞死亡可能主要是由CVB本身引起的,可能是在免疫保护较差的情况下,或者是由t细胞对CVB感染的β细胞的反应引起的。表位模仿机制可能参与扭曲自身免疫的生理抗病毒反应。我们在这里回顾了这三种非互斥情景的现有证据。了解哪些因素在起作用,对于最大限度地提高CVB疫苗接种的成功率,以及开发合适的工具来监测免疫效果及其与自身免疫性发病或预防的相互作用至关重要。
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来源期刊
Endocrine reviews
Endocrine reviews 医学-内分泌学与代谢
CiteScore
42.00
自引率
1.00%
发文量
29
期刊介绍: Endocrine Reviews, published bimonthly, features concise timely reviews updating key mechanistic and clinical concepts, alongside comprehensive, authoritative articles covering both experimental and clinical endocrinology themes. The journal considers topics informing clinical practice based on emerging and established evidence from clinical research. It also reviews advances in endocrine science stemming from studies in cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology.
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