Persistent coxsackievirus B infection and pathogenesis of type 1 diabetes mellitus

This Review highlights evidence that persistent enterovirus infections, particularly coxsackievirus B, trigger and/or accelerate islet autoimmunity in susceptible individuals, thereby leading to type 1 diabetes mellitus (T1DM). The potential for vaccination or antiviral therapies to prevent T1DM onset is also considered. Enteroviruses are believed to trigger or accelerate islet autoimmunity in genetically susceptible individuals, thereby resulting in loss of functional insulin-producing beta-cells and type 1 diabetes mellitus (T1DM). Although enteroviruses are primarily involved in acute and lytic infections in vitro and in vivo, they can also establish a persistent infection. Prospective epidemiological studies have strongly associated the persistence of enteroviruses, especially coxsackievirus B (CVB), with the appearance of islet autoantibodies and an increased risk of T1DM. CVB can persist in pancreatic ductal and beta-cells, which leads to structural or functional alterations of these cells, and to a chronic inflammatory response that promotes recruitment and activation of pre-existing autoreactive T cells and beta-cell autoimmune destruction. CVB persistence in other sites, such as the intestine, blood cells and thymus, has been described; these sites could serve as a reservoir for infection or reinfection of the pancreas, and this persistence could have a role in the disturbance of tolerance to beta-cells. This Review addresses the involvement of persistent enterovirus infection in triggering islet autoimmunity and T1DM, as well as current strategies to control enterovirus infections for preventing or reducing the risk of T1DM onset.

Automated summary

This review highlights the role of persistent enterovirus infections in triggering islet autoimmunity and type 1 diabetes mellitus (T1DM), and discusses the potential of vaccination or antiviral therapies in preventing T1DM onset.