Follicular T Cells May Play a Role in Development of Type I Diabetes Interview with:

Tuure Kinnunen, MD, PhD Academy Research Fellow School of Medicine, University of Eastern Finland Kuopio, Finland

Dr. Tuure Kinnunen

Tuure Kinnunen, MD, PhD
Academy Research Fellow
School of Medicine, University of Eastern Finland
Kuopio, Finland What is the background for this study?

Response: Type 1 diabetes is an autoimmune disease where the immune system destroys the insulin-producing beta cells in the pancreas. It typically manifests in childhood and early adolescence.

Diabetes-associated autoantibodies are highly predictive of type 1 diabetes risk and they can be typically detected in the blood of patients even years before the onset of the disease.

Follicular helper T cells are a recently described type of immune cells that have a central role in activating B cells, which in turn are responsible for producing antibodies. Since the emergence of autoantibodies is a common feature of type 1 diabetes development, it is plausible that follicular T helper cells have a role in the disease process. This notion is also supported by evidence recently generated in the murine models of type 1 diabetes. What are the main findings?

Response: In the current study, we used blood samples from the Finnish DIPP follow-up study, where children with an increased genetic risk for developing type 1 diabetes are longitudinally followed for the development of the disease. We observed that the frequency of circulating follicular T helper cells increased close to the onset of clinical type 1 diabetes. Moreover, the phenomenon was only observed in a subgroup of children that were positive for multiple diabetes-associated autoantibodies at the onset of the disease. What should readers take away from your report?

Response: Together with recent results by other research groups our current findings suggest that follicular T helper cells may have a role in type 1 diabetes pathogenesis. Moreover, our results lend support to the idea that different disease endotypes, i.e. disease subgroups with distinct pathological mechanisms, exist in type 1 diabetes and that these could be distinguished based on the pattern of autoantibodies detected in the blood samples of patients. What recommendations do you have for future research as a result of this study?

Response: Our results support the concept that immune therapies targeting follicular T helper cells or their signature cytokine IL-21 may be effective in the prevention of type 1 diabetes. Also, the question of whether type 1 diabetes patients can be stratified in to different subgroups with distinct underlying immunopathogenetic pathways is an important one. By understanding disease heterogeneity better we could identify individuals that would better respond to one or another intervention. Thank you for your contribution to the community.

Tyyne Viisanen, Emmi-Leena Ihantola, Kirsti Näntö-Salonen, Heikki Hyöty, Noora Nurminen, Jenni Selvenius, Auni Juutilainen, Leena Moilanen, Jussi Pihlajamäki, Riitta Veijola, Jorma Toppari, Mikael Knip, Jorma Ilonen, Tuure Kinnunen.Circulating CXCR5 PD-1 ICOS Follicular T Helper Cells Are Increased Close to the Diagnosis of Type 1 Diabetes in Children with Multiple Autoantibodies. Diabetes, October 2016 DOI: 10.2337/db16-0714

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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