Fulminant Autoantibody-Negative and Type 1A Diabetes Phenotypes in a Korean HLA Identical Dizygotic Twin

Type 1 diabetes is a complex, heterogenous autoimmune disease. Many genetic and environmental factors are thought to be involved in type 1 diabetes pathogenesis as shown in other autoimmune disorders. Although some immune-related genes such as HLA, AIRE, and CTLA-4 have been elucidated about their association in pathogenesis, the detailed genetic factors causing type 1 diabetes are unclear. In a study of twins with type 1 diabetes, significant subsets of monozygotic and dizygotic twins did not progress to clinical diabetes (1), suggesting that genetic heterogeneity and other random factors are crucial for type 1 diabetic pathogenesis, even in twins. Typically, type 1 diabetes is initiated by an autoimmune response against β-cells and followed by progressive defect of insulin secretion from β-cells. These results cause hyperglycemia and transient, usually partial remission, and finally lead to complete insulinopenia. Since Imagawa et al. …