Coxsackievirus B1 Is Associated With Induction of β-Cell Autoimmunity That Portends Type 1 Diabetes

  1. Heikki Hyöty2,15
  1. 1Vactech Ltd., Tampere, Finland
  2. 2Department of Virology, School of Medicine, University of Tampere, Tampere, Finland
  3. 3School of Health Sciences, University of Tampere, Tampere, Finland
  4. 4Sanofi Pasteur, Marcy L’Etoile, France
  5. 5The Science Center of Pirkanmaa Hospital District, Tampere, Finland
  6. 6Nutrition Unit, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
  7. 7Department of Pediatrics, Tampere University Hospital, Tampere, Finland
  8. 8Department of Pediatrics, Turku University Central Hospital, Turku, Finland
  9. 9Immunogenetics Laboratory, University of Turku, Turku, Finland
  10. 10Department of Clinical Microbiology, University of Eastern Finland, Kuopio Finland
  11. 11Institute of Clinical Medicine and Oulu University Hospital, Department of Pediatrics, University of Oulu, Oulu, Finland
  12. 12Folkhälsan Research Center, Helsinki, Finland
  13. 13Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
  14. 14Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland
  15. 15Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
  1. Corresponding author: Heikki Hyöty, heikki.hyoty{at}
  1. O.H.L. and H.Ho. contributed equally to this work.


The rapidly increasing incidence of type 1 diabetes implies that environmental factors are involved in the pathogenesis. Enteroviruses are among the suspected environmental triggers of the disease, and the interest in exploring the possibilities to develop vaccines against these viruses has increased. Our objective was to identify enterovirus serotypes that could be involved in the initiation of the disease process by screening neutralizing antibodies against 41 different enterovirus types in a unique longitudinal sample series from a large prospective birth-cohort study. The study participants comprised 183 case children testing persistently positive for at least two diabetes-predictive autoantibodies and 366 autoantibody-negative matched control children. Coxsackievirus B1 was associated with an increased risk of β-cell autoimmunity. This risk was strongest when infection occurred a few months before autoantibodies appeared and was attenuated by the presence of maternal antibodies against the virus. Two other coxsackieviruses, B3 and B6, were associated with a reduced risk, with an interaction pattern, suggesting immunological cross-protection against coxsackievirus B1. These results support previous observations suggesting that the group B coxsackieviruses are associated with the risk of type 1 diabetes. The clustering of the risk and protective viruses to this narrow phylogenetic lineage supports the biological plausibility of this phenomenon.


  • Received April 22, 2013.
  • Accepted August 1, 2013.

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