Probiotic intervention in infancy is not associated with development of beta cell autoimmunity and type 1 diabetes

Excerpt

To the Editor: The initiators of the autoimmune process in the pancreatic islets leading to type 1 diabetes remain enigmatic. The close association of pancreas with the immunologically highly active gut makes the latter, together with the intestinal microbiota, a prime suspect in the process. Duodenal specimens of individuals with type 1 diabetes have shown distinct inflammation, even in the absence of an HLA genotype compatible with coeliac disease [1]. Furthermore, several inflammatory markers have been shown to be type 1 diabetes-specific in duodenal samples from individuals with type 1 diabetes [2]. Changes in inflammatory markers were associated with alterations in the relative and absolute densities of bacteria in the duodenal specimens [2]. The analysis of microbiota in stool samples from individuals who later progressed to type 1 diabetes suggested that at the time of the appearance of diabetes-associated autoantibodies, the intestinal microbiota shows dysbiosis characterised by decreased bacterial diversity and reduced quantities of bacteria producing butyrate and lactate [3]. Related to the microbiota, exposure to bacterial lipopolysaccharide has been implicated to affect the training of the infant immune system either favouring an increased predisposition to immune-mediated diseases such as type 1 diabetes and allergy or providing relative resistance to such diseases, depending on the specific lipopolysaccharide concerned [4]. …