Perspectives in Diabetes Neonatal -Cell Apoptosis A Trigger for Autoimmune Diabetes?

In neonatal rodents, the -cell mass undergoes a phase of remodeling that includes a wave of apoptosis. Using both mathematical modeling and histochemical detection methods, we have demonstrated that -cell apoptosis is significantly increased in neonates as compared with adult rats, peaking at ~2 weeks of age. Other tissues, including the kidney and nervous system, also exhibit neonatal waves of apoptosis, suggesting that this is a normal developmental phenomenon. We have demonstrated that increased neonatal -cell apoptosis is also present in animal models of autoimmune diabetes, including both the BB rat and NOD mouse. Tr a d i t i o n a l l y, apoptosis has been considered a process that does not induce an immune response. However, recent studies indicate that apoptotic cells can do the following: 1) display autoreactive antigen in their surface blebs; 2) preferentially activate dendritic cells capable of priming tissue-specific cytotoxic T-cells; and 3) induce the formation of autoantibodies. These findings suggest that in some circumstances physiological apoptosis may, in fact, initiate a u t o i m m u n i t y. Initiation of -cell–directed autoimmunity in murine models appears to be fixed at ~15 days of age, even when diabetes onset is dramatically accelerated. Taken together, these observations have led us to hypothesize that the neonatal wave of -cell apoptosis is a trigger for -cell–directed autoimmunity. Diabetes 4 9 :1–7, 2000