Environmental factors in the etiology of type 1 diabetes


  • Hans K. Åkerblom,

    Corresponding author
    • Biomedicum Helsinki Institute, B.P. 700, Haartmaninkatu 8, FIN-00029 HUS, Finland.
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      Hans K. Åkerblom is an emeritus professor of pediatrics, University of Helsinki. He has over the last two decades studied the epidemiology, etiology and pathogenesis, prediction and prevention of type 1 diabetes in children. He is the Principal Investigator of the international nutritional primary prevention study TRIGR.

  • Outi Vaarala,

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      Outi Vaarala is professor of pediatric immunology at Linköping University, Linköping, Sweden, and works also at the National Public Health Institute, Helsinki, Finland. Her group is interested in the role of gut immune system in the regulation of beta cell specific immune response and development of type 1 diabetes.

  • Heikki Hyöty,

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      Heikki Hyöty is currently assistant professor of virology at the University of Tampere, Finland. He has been working with virus-induced autoimmunity and the role of virus infections in type 1 diabetes for over 15 years. His research has mainly focused on human studies and particularly the evaluation of viral etiology in large-scale prospective series.

  • Jorma Ilonen,

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      Dr. Jorma Ilonen is working at the Institute of Microbiology and Pathology of the University of Turku. He has a long experience in immunogenetic studies of autoimmune diseases, especially type 1 diabetes. These studies have focused on HLA genes and the mechanisms how their polymorphism is affecting the disease susceptibility.

  • Mikael Knip

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      Mikael Knip is professor of pediatrics, University of Helsinki. His research in type 1 diabetes has concentrated on the etiology, pathogenesis, prediction and prevention of the disease, with a particular emphasis on risk markers of the disease.


Type 1 diabetes is considered to be an autoimmune disease in which T lymphocytes infiltrate the islets of pancreas and destroy the insulin producing beta cell population. Besides antigen specificity, the quality of immune reactivity against islet cell antigen(s) is an important determinant of the beta cell destruction. Much evidence indicates that the function of the gut immune system is central in the pathogenesis, as the regulation of the gut immune system may be aberrant in type 1 diabetes. The role of virus infections in the pathogenesis of type 1 diabetes has been supported by substantial new evidence suggesting that one virus group, enteroviruses, may trigger the beta-cell damaging process in a considerable proportion of patients. The latest evidence comes from studies indicating the presence of viral genome in diabetic patients and from prospective studies confirming epidemiological risk effect. If this association holds still true in ongoing large-scale studies, intervention trials should be considered to confirm causality. Of the dietary putative etiological factors, cow's milk proteins have received the main attention. Many studies indicate an association between early exposure to dietary cow's milk proteins and an increased risk of type 1 diabetes. The question will be answered by a large scale, prospective, randomized, international intervention trial. Another dietary factor in need of more studies is the deficiency of vitamin D. Among toxins, N-nitroso compounds are the main candidates. An interaction of genetic and environmental factors is important in evaluating the possible role of a certain environmental factor in the etiology of type 1 diabetes. © 2002 Wiley-Liss, Inc.