COXSACKIE-B VIRUS-INFECTION AND BETA-CELL AUTOANTIBODIES IN NEWLY-DIAGNOSED IDDM ADULT PATIENTS

Background: Environmental agents such as viruses have been identified as potentially important determinants of insulin-dependent diabetes me llitus (IDDM). Enterovirus infections, Coxsackievirus B especially, co uld be linked to the beta cell damaging process and to the onset of cl inical IDDM, Objectives: Enteroviral (EV) infection and beta cell auto immunity were studied in adult patients at the onset of IDDM. Study de sign: A total of 14 newly diagnosed-IDDM patients with ketosis or keto acidosis were compared to, anteriorly diagnosed IDDM patients with met abolic decompensation, non-IDDM patients with metabolic decompensation and healthy adults. EV infection was studied by genomic RNA detection in whole blood using a RT-PCR assay. In order to assess the level of beta cell autoantibodies at the time of the initial metabolic decompen sation, serum specimens from IDDM patients were tested for GAD65 antib odies and islet cell antibodies (ICAs). Results: Coxsackie B3 or B4 vi rus genome was detected and genotyped in five of 14 (35.7%) newly diag nosed IDDM patients and in one of 12 (8%) patients in the course of ID DM. By contrast, none of the 12 non-IDDM patients and none of the 15 h ealthy adults was positive for enterovirus RNA detection in whole bloo d. Positive GAD65 antibodies and ICAs assays were not significantly co rrelated to a positive EV-RNA detection. Conclusion: The present study demonstrates that Coxsackie B virus RNA sequences can be detected in the peripheral blood from adult patients at the onset or in the course Of IDDM and suggests that a Coxsackie B virus infection could initiat e or accelerate beta cell autoimmune damaging process. (C) 1998 Elsevi er Science B.V. All rights reserved.