Dr Ezio Bonifacio Describes Genetic, Environmental Factors Associated With T1D Diagnoses

Ezio Bonifacio, PhD, explains factors associated with childhood type 1 diabetes incidence and why more research is needed among minority populations.

Researchers do not study type 1 diabetes enough in minority populations, said Ezio Bonifacio, PhD, a professor of diabetes and preclinical stem cell work at the Technical University of Dresden, in Germany.


Do we know what genetic or environmental factors "tip the balance" of development of type 1 diabetes (T1D)? Are some factors more important than others, or is the development due to a mix of factors?

We know a lot more about the genetics than the environmental factors, some very good gene regions that tell us a lot about why children may get the autoimmunity and then diabetes. Then we have a whole lot of others that contribute a little bit. So there's probably, I don't know, 80 regions of the chromosome that contribute a little bit, some more than others. HLA, which is associated with lots of immune-related diseases, is the main contributor, but we also have the insulin gene itself, which is important in the risk for T1D. Children who have the HLA susceptibility and the insulin susceptibility have got a higher risk. As I said, we use that, we create scores, and we can identify those more likely to go. On the environment, yes, there is a mix. I think when we say someone can have the highest genetic risk, but that they're not certain to get diabetes, and even with all the right genes, let's say, or the wrong genes. There must be some other factors that are involved and we've known that for a long time, it's just difficult to pinpoint one. Virus keeps on coming up. But we haven't really found the virus or a specific virus. There's probably a lot of environmental factors that tip it. Some of them will sort of tip it towards developing the autoimmunity, and then there's a stage where these children who have these antibodies eventually progress to a clinical disease. Some take months, some take 10-20 years. Probably there's some environmental factors, again, it might be a virus, that push it at that point.

Can we tell why T1D incidence seems to be rising among children from minority groups?

Very good question, and the question poses actually, one of our failures. We don't study minority groups anywhere near enough. I don't think that's just a T1D issue. I think it's an issue in general. Personally, I think that that's where we need to work a lot harder. I think there's been a lot of effort to say we have to include and particularly study minority groups, but we haven't got enough information. We know that genetically, they're slightly different. But they tend to have similar but different proportions of the genetic risk. In terms of minorities, we know one factor at least, that pushes more diabetes, and that is related to lifestyle. Some of the minority groups perhaps have more lifestyles that are associated with poor health, in general, or perhaps obesity. Some of these factors, we know, can compound the genetic and other factors to increase the likelihood of getting diabetes in childhood. There are studies in America in fact, many studies in America, good studies in America, that have shown that much more than in Europe, but it's clearly an area that requires a lot more effort.

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