Fatty acid binding protein-4 promotes autoimmune diabetes by recruitment and activation of pancreatic islet macrophages.

Both innate and adaptive immune cells are critical players in autoimmune destruction of insulin-producing β-cells in type 1 diabetes. However, the early pathogenic events triggering the recruitment and activation of innate immune cells in islets remain obscure. Here we show that circulating fatty acid binding protein 4 (FABP4) level is significantly elevated in type1 diabetes patients and their first-degree relatives, and positively correlates with the titers of several islet autoantibodies. In non-obese diabetic (NOD) mice, increased FABP4 expression in islet macrophages starts from the neonatal period, well before the occurrence of overt diabetes. Furthermore, the spontaneous development of autoimmune diabetes in NOD mice is markedly reduced by pharmacological inhibition or genetic ablation of FABP4, or adoptive transfer of FABP4-deficient bone marrow cells. Mechanistically, FABP4 activates innate immune responses in islets by enhancing the infiltration and polarization of macrophages to pro-inflammatory M1 subtype, thus creating an inflammatory milieu required for activation of diabetogenic CD8+ T cells and shift of CD4+ helper T cells towards the Th1 subtypes. These findings demonstrate FABP4 as an early mediator for β-cell autoimmunity by facilitating crosstalk between innate and adaptive immune cells, suggesting that pharmacological inhibition of FABP4 may represent a promising therapeutic strategy for autoimmune diabetes.