Enteroviruses, type 1 diabetes and hygiene: a complex relationship
Article first published online: 4 JAN 2010
Copyright © 2009 John Wiley & Sons, Ltd.
Reviews in Medical Virology
Volume 20, Issue 2, pages 106–116, March 2010
How to Cite
Tracy, S., Drescher, K. M., Jackson, J. D., Kim, K. and Kono, K. (2010), Enteroviruses, type 1 diabetes and hygiene: a complex relationship. Rev. Med. Virol., 20: 106–116. doi: 10.1002/rmv.639
- Issue published online: 26 FEB 2010
- Article first published online: 4 JAN 2010
- Manuscript Accepted: 1 OCT 2009
- Manuscript Revised: 29 SEP 2009
- Manuscript Received: 19 JUL 2009
- Juvenile Diabetes Research Foundation (S.T.)
- National Institutes of Health (S.T.; K.M.D.)
- National Multiple Sclerosis Society (K.M.D.)
Type 1 diabetes (T1D) is an autoimmune disease in which the immune system mounts an attack on the host's insulin-producing β cells. Because most cases of T1D cannot be attributed only to individual genetics, it is strongly inferred that there is a significant environmental contribution, such as infection, impacting disease development. The human enteroviruses (HEV) are common picornaviruses often implicated as triggers of human T1D, although precisely which of the numerous HEV may be involved in human T1D development is unknown. Experiments using non-obese diabetic (NOD) mice, commonly used to model T1D, show that induction of T1D by HEV infection in NOD mice is a multifactorial process involving both the virus and the host. Interestingly, results demonstrate that HEV infection of NOD mice can also induce long-term protection from T1D under certain conditions, suggesting that a similar mechanism may occur in humans. Based upon both experimental animal and observational human studies, we postulate that HEV have a dual role in T1D development and can either cause or prevent autoimmune disease. Whichever outcome occurs depends upon multiple variables in the host-virus equation, many of which can be deduced from results obtained from NOD mouse studies. We propose that the background to the sharply rising T1D incidences observed in the 20th century correlates with increased levels of hygiene in human societies. Viewing T1D in this perspective suggests that potential preventative options could be developed. Copyright © 2009 John Wiley & Sons, Ltd.