Manipulating the Type 1 Diabetes Disease Process, Man Versus Mouse
- Jerry P. Palmer, MD
- From the University of Washington, Department of Medicine, Division of Metabolism, Endocrinology and Nutrition; and the Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington
In their article in this month’s issue of Diabetes Care, Hummell et al. (1) tested the hypothesis that gluten is a driving antigen for type 1 diabetes-associated islet autoimmunity. They convincingly demonstrated that elimination of dietary gluten for 12 months in humans positive for at least two type 1 diabetes-associated autoantibodies does not consistently alter the titers of these antibodies. The study is well done and carefully analyzed. Their conclusion that gluten does not drive islet autoantibody production in type 1 diabetes, as it does in celiac disease, seems very appropriate. Yet, because the β-cell lesion of type 1 diabetes is T-cell and not antibody mediated, and because antibody and T-cell responses to the same antigen can be markedly different or even reciprocally related, they cannot conclude that the underlying type 1 diabetes disease process in humans is not altered by elimination of dietary gluten for 12 months.
Nonetheless, I feel that studies such as this are extremely important because they provide information that allows us to compare specific aspects of the type 1 diabetes disease process in man versus mouse. A tremendous amount has …
