In This Issue of Diabetes

摘要

Newly identified autoantibodies may help in the screening and diagnosis of type 1 diabetes. Although autoantibodies such as GAD65, ICA, and IA-2 are associated with increased risk of type 1 diabetes, none of these is universally present in type 1 diabetic patients, and even combinations of these autoantibodies do not predict type 1 diabetes onset with certainty. The absence of reliable immunologic markers for the screening and diagnosis of type 1 diabetes not only hinders efforts to identify high-risk individuals prior to disease onset, but it also impedes understanding of the various mechanisms that underpin β-cell destruction in these patients. This issue of Diabetes features findings on two new autoantibodies that are strongly associated with type 1 diabetes (p. 3022). The new report summarizes findings from studies in which serum samples from patients with type 1 diabetes and type 2 diabetes and normal glucose tolerant patients were profiled with protein microarrays containing nearly 9,500 proteins. This work led to the identification of two autoantibodies-anti-EEF1 A1 and anti-UBE2L3-that were expressed more abundantly in the type 1 diabetic patients relative to the other groups. To validate these findings, the abundance of these autoantibodies was examined in two separate cohorts that contained a mix of patients including people with type 1 diabetes, type 2 diabetes, latent autoimmune diabetes of adults, Graves disease, and people with normal glucose tolerance. The validation studies not only confirmed that anti-EEF1 A1 and anti-UBE2L3 were significantly more abundant in type 1 diabetic patients, but the data also showed that more than 40% of GAD-negative patients were positive for one or both of the newly identified autoantibodies. In fact, the new autoantibodies increased the proportion of type 1 diabetic patients with evidence of autoimmunity from 76.3 to 86%. These intriguing new findings suggest that there may be new tools on the horizon that can help improve the screeninq and diaqnosis of type 1 diabetes.