Genetic Risk Factors for CVD in Type 1 Diabetes: The DCCT/EDIC Study

Diabetes Care ◽  
2021 ◽  
pp. dc202388
Author(s):  
Ionut Bebu ◽  
Sareh Keshavarzi ◽  
Xiaoyu Gao ◽  
Barbara H. Braffett ◽  
Angelo J. Canty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Genetic Risk ◽  
Genetic Risk Factors

scholarly journals Novel genetic risk factors influence progression of islet autoimmunity to type 1 diabetes

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Suna Onengut-Gumuscu ◽  
Umadevi Paila ◽  
Wei-Min Chen ◽  
Aakrosh Ratan ◽  
Zhennan Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Genetic Risk ◽  
Viral Infections ◽  
Genetic Risk Factors ◽  
Islet Autoimmunity ◽  
Islet Autoantibody ◽  
Critical Pathways ◽  
Genome Wide

Abstract Type 1 diabetes arises from the autoimmune destruction of insulin-producing beta-cells of the pancreas, resulting in dependence on exogenously administered insulin to maintain glucose homeostasis. In this study, our aim was to identify genetic risk factors that contribute to progression from islet autoimmunity to clinical type 1 diabetes. We analyzed 6.8 million variants derived from whole genome sequencing of 160 islet autoantibody positive subjects, including 87 who had progressed to type 1 diabetes. The Cox proportional-hazard model for survival analysis was used to identify genetic variants associated with progression. We identified one novel region, 20p12.1 (TASP1; genome-wide P < 5 × 10–8) and three regions, 1q21.3 (MRPS21–PRPF3), 2p25.2 (NRIR), 3q22.1 (COL6A6), with suggestive evidence of association (P < 8.5 × 10–8) with progression from islet autoimmunity to type 1 diabetes. Once islet autoimmunity is initiated, functional mapping identified two critical pathways, response to viral infections and interferon signaling, as contributing to disease progression. These results provide evidence that genetic pathways involved in progression from islet autoimmunity differ from those pathways identified once disease has been established. These results support the need for further investigation of genetic risk factors that modulate initiation and progression of subclinical disease to inform efforts in development of novel strategies for prediction and intervention of type 1 diabetes.

scholarly journals Genetic risk factors affecting mitochondrial function are associated with kidney disease in people with Type 1 diabetes

2015 ◽  
Vol 32 (8) ◽  
pp. 1104-1109 ◽  
Author(s):  
E. J. Swan ◽  
R. M. Salem ◽  
N. Sandholm ◽  
L. Tarnow ◽  
P. Rossing ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Mitochondrial Function ◽  
Genetic Risk ◽  
Genetic Risk Factors ◽  
Factors Affecting

Genetic risk factors for type 1 diabetes

The Lancet ◽  
2016 ◽  
Vol 387 (10035) ◽  
pp. 2331-2339 ◽  
Author(s):  
Flemming Pociot ◽  
Åke Lernmark
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Genetic Risk ◽  
Genetic Risk Factors

General population screening for childhood type 1 diabetes: is it time for a UK strategy?

2021 ◽  
pp. archdischild-2021-321864
Author(s):  
Rachel Elizabeth Jane Besser ◽  
Sze May Ng ◽  
John W Gregory ◽  
Colin M Dayan ◽  
Tabitha Randell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Genetic Risk ◽  
Genetic Risk Factors ◽  
Population Based ◽  
Screening Strategy ◽  
Smooth Transition ◽  
Islet Autoantibodies ◽  
Awareness Campaigns

Type 1 diabetes (T1D) is a chronic autoimmune disease of childhood affecting 1:500 children aged under 15 years, with around 25% presenting with life-threatening diabetic ketoacidosis (DKA). While first-degree relatives have the highest risk of T1D, more than 85% of children who develop T1D do not have a family history. Despite public health awareness campaigns, DKA rates have not fallen over the last decade. T1D has a long prodrome, and it is now possible to identify children who go on to develop T1D with a high degree of certainty. The reasons for identifying children presymptomatically include prevention of DKA and related morbidities and mortality, reducing the need for hospitalisation, time to provide emotional support and education to ensure a smooth transition to insulin treatment, and opportunities for new treatments to prevent or delay progression. Research studies of population-based screening strategies include using islet autoantibodies alone or in combination with genetic risk factors, both of which can be measured from a capillary sample. If found during screening, the presence of two or more islet autoantibodies has a high positive predictive value for future T1D in childhood (under 18 years), offering an opportunity for DKA prevention. However, a single time-point test will not identify all children who go on to develop T1D, and so combining with genetic risk factors for T1D may be an alternative approach. Here we discuss the pros and cons of T1D screening in the UK, the different strategies available, the knowledge gaps and why a T1D screening strategy is needed.

scholarly journals Prediction of autoimmune diabetes and celiac disease in childhood by genes and perinatal environment: Design and initial aims of the PAGE study

2014 ◽  
Vol 24 (1-2) ◽  
Author(s):  
Lars C. Stene ◽  
Geir Joner ◽  
Ketil Størdal
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Blood Plasma ◽  
Genetic Risk ◽  
Autoimmune Diabetes ◽  
Genetic Risk Factors ◽  
Host Cells ◽  
Full Cohort

Type 1 diabetes and celiac disease result from misdirected immune mediated destruction of host cells, and are among the most common chronic diseases in children. Despite changes in incidence over the past 3 decades, little is known about non-genetic risk factors (except for dietary gluten for celiac disease). Norway is among the countries in the world with the highest incidence of these two diseases. We describe here plans and study design for the PAGE study (Prediction of Autoimmune diabetes and celiac disease in childhood by Genes and perinatal Environment). PAGE is a sub-study within the Norwegian Mother and Child Cohort study, including follow-up of more than 100,000 pregnancies. Children who develop type 1 diabetes or celiac disease are identified via linkage to the Norwegian Patient Register and the Norwegian Childhood Diabetes Registry, with complementing information from questionnaires. The overall aim is to test hypotheses about potential non-genetic risk factors for type 1 diabetes and for celiac disease, with focus on factors operating early in life. In addition to a full cohort analysis of factors registered in questionnaires, we will analyse biomarkers in maternal blood plasma and cord blood plasma. Mothers and children will be genotyped for well-established susceptibility polymorphisms. Biomarkers will be analysed in cases and controls within the cohort. Factors to be tested in the full cohort include infant feeding, diet and dietary supplements in the mother during pregnancy and in the child, and use of antibiotics and non-prescription drugs. Biomarkers to be tested include 25-hydroxyvitamin D, markers of immune activation, and small metabolites (metabolomics). We will also explore the potential role of maternal cells in the fetal circulation (maternal microchimerism) in later risk of celiac disease and type 1 diabetes.

Marked Elevation of Serum Lactate Dehydrogenase (LDH) in Primary Myelofibrosis: Clinical and Prognostic Correlates

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3113-3113 ◽  
Author(s):  
Sahrish Shah ◽  
Mythri Mudireddy ◽  
Daniela Barraco ◽  
Curtis A. Hanson ◽  
Rhett P. Ketterling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lactate Dehydrogenase ◽  
Genetic Risk ◽  
Leukocyte Count ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Primary Myelofibrosis ◽  
Genetic Risk Factors ◽  
Marked Elevation

Abstract Background Increased serum levels of lactate dehydrogenase (LDH) typically accompany primary myelofibrosis (PMF) and might be linked to increased cell turnover from clonal myeloproliferation, including leukocytosis, low grade hemolysis and extra-medullary hematopoiesis in the liver. Despite the fact that serum LDH has been extensively utilized as a prognostic marker in both lymphoid neoplasms and solid tumors, there are limited studies in PMF that have systematically examined the clinical significance of the degree of serum LDH elevation in PMF. Methods Study patients fulfilled the 2016 WHO criteria for the diagnosis of PMF, including both pre-PMF and overt PMF (Blood. 2016;127:2391). Additional selection criteria included the availability of serum LDH at time of referral. Marked elevation of serum LDH was defined as a value of ≥1000 U/L (i.e. over 4-fold increase from the upper limit of the normal range for our institution, which was 122-222 U/L), based on preliminary analysis of the threshold for prognostic effect. Targeted next generation sequencing was used to screen for prognostically-relevant mutations (Blood 2015126:354). Statistical analyses considered clinical and laboratory parameters obtained at time of initial referral to the Mayo Clinic. Results LDH values in overt PMF versus pre-PMF: The entire study population consisted of 357 patients, including 311 with overt PMF and 46 with pre-PMF. The median serum LDH level was 514 U/L (range 136-2263): overt PMF 532 U/L (range 136-2263); pre-PMF 401 U/L (range 180-1237) (p=0.0003). Accordingly, in order to avoid the confounding effect of the difference in serum LDH level between overt PMF and pre-PMF, and considering the small number of patients with pre-PMF, further analysis was limited to the 311 patients with overt PMF. Patient characteristics: The 311 patients (median age 64 years; 66% males) with overt PMF included 205 (66%) JAK2, 49 (16%) type 1/like CALR, 13 (4%) type 2/like CALR, 16 (5%) MPL mutated cases and 28 (9%) were "triple-negative". DIPSS-plus risk distribution was 31% high, 43% intermediate-2, 15% intermediate-1 and 12% low; 30% displayed red cell transfusion-dependency and 37% abnormal karyotype, including 14% with unfavorable karyotype. 184 patients were screened for ASXL1 mutations with 42% mutated and 205 for SRSF2 mutations with 16% mutated. Clinical correlates of markedly elevated LDH (≥1000 U/L): Among all 311 study patients with overt PMF, 37 (12%) displayed marked elevation of LDH (≥1000/L). Patients with marked elevation of LDH displayed significantly higher leukocyte count (p=0.005; R-squared = 0.05), circulating blast percentage (p=0.03; R-squared = 0.07) and SRSF2 mutational frequency (44% vs 12%; p<0.0001). Survival analysis: After a median follow up of 3 years, 199 (64%) deaths and 31 (10%) leukemic transformations were documented. In univariate analysis, increased serum LDH level was associated with inferior survival, both as a continuous variable (p=0.002) and as a categorical variable with the cutoff level of 1000 U/L (HR 2.02, 95% CI 1.3-3.1; p=0.001); the survival effect LDH ≥1000/L was independent of DIPSS-plus (HR 1.6, 95% CI 1.1-2.5). Other variables that were significantly associated with shortened survival, on univariate analysis, included all 8 DIPSS-plus variables (p≤0.01 in all instances), absence of CALR type 1/type 1-like (p<0.0001) and presence of ASXL1 (p<0.0001) or SRSF2 (p=0.0006) mutations. In multivariable analysis that included only genetic risk factors, serum LDH retained its significance (HR 2.2, 95% CI 1.3-3.6), along with absence of CALR type 1/type 1-like, or presence of ASXL1 or SRSF2 mutations or unfavorable karyotype. In multivariable analysis that included only clinical variables, serum LDH ≥1000/L was again independently predictive of poor survival (HR 1.7, 95% CI 1.1-2.6), along with age >65 years, hemoglobin <10 g/dL, platelets <100 x 10(9)/L, leukocyte count >25 x 10(9)/L and constitutional symptoms. Patients with marked LDH elevation were also more likely to undergo leukemic transformation (HR 3.1, 95% CI 1.2-7.6). Conclusion The current study suggests that marked elevation of serum LDH in PMF indicates aggressive tumor biology that is currently not accounted for by established clinical or genetic risk factors; the low R-squared values seen in relation to leukocyte count and circulating blasts are consistent with this assumption. Disclosures No relevant conflicts of interest to declare.

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