Type 1 diabetes autoimmunity highlights celiac disease risk
medwireNews: A study in children has highlighted a possible relationship between type 1 diabetes and celiac disease and provides insights into the preclinical stages of these conditions.
The researchers found that early markers of autoimmunity to the two diseases occurred together more often than would be expected in the general population.
Type 1 diabetes autoimmunity was a risk factor for developing celiac disease autoimmunity, but the reverse was not true.
And nongenetic factors appeared to contribute to the co-occurrence observed, leading the researchers to suggest that local immune responses as well as exposure to gluten and microbial infections could be involved.
The findings come from 5891 children enrolled as infants in the TEDDY study, all of whom had HLA antigen genotypes placing them at high risk for type 1 diabetes. The children were assessed regularly over a median 66 months for the development of persistent islet autoantibodies (IAs) to identify type 1 diabetes autoimmunity and tissue transglutaminase autoantibodies (tTGAs) to identify celiac disease autoimmunity, as well as for both clinical diseases.
William Hagopian (Northwest Research Institute, Seattle, Washington, USA) and colleagues identified IAs alone in 367 children and tTGAs alone in 808 children. Both IAs and tTGAs were observed in 90 children, which exceeded the expected number of 70. Among the 90 children with both markers, IAs preceded tTGAs more often than vice versa, at 68% compared with 27%, respectively.
Having IAs was associated with a significantly increased risk for developing tTGAs, with a hazard ratio (HR) of 1.48, whereas having TGAs did not significantly increase the risk for IAs.
The researchers found that children with a family history of type 1 diabetes, HLA-DR3/4 genotypes, and the single-nucleotide polymorphism rs3184504 at SH2B3 had a significantly greater risk for co-occurring celiac disease and type 1 diabetes autoimmunity, with HRs of 2.80, 1.94, and 1.53, respectively. This was after adjusting for country, gender, family history, and other genetic loci.
However, the analyzed factors did not fully account for the observed co-occurrence of autoimmunity.
Reporting in Pediatrics, the researchers say their results “support the notion that children found to have IAs (for example through family screening or population-based prediction) should be screened for tTGAs as is the practice for [type 1 diabetes] children.”
By Anita Chakraverty
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