Letter | Published:

Autoimmunity against a defective ribosomal insulin gene product in type 1 diabetes

Nature Medicine volume 23, pages 501507 (2017) | Download Citation

Abstract

Identification of epitopes that are recognized by diabetogenic T cells and cause selective beta cell destruction in type 1 diabetes (T1D) has focused on peptides originating from native beta cell proteins. Translational errors represent a major potential source of antigenic peptides to which central immune tolerance is lacking1,2. Here, we describe an alternative open reading frame within human insulin mRNA encoding a highly immunogenic polypeptide that is targeted by T cells in T1D patients. We show that cytotoxic T cells directed against the N-terminal peptide of this nonconventional product are present in the circulation of individuals diagnosed with T1D, and we provide direct evidence that such CD8+ T cells are capable of killing human beta cells and thereby may be diabetogenic. This study reveals a new source of nonconventional polypeptides that act as self-epitopes in clinical autoimmune disease.

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Acknowledgements

We thank H.-J. Aanstoot (Diabeter), L. Mearin (Department of Pediatrics, LUMC), L. Wicker and J. Todd (Cambridge University, UK) for providing patient blood samples; M. Peakman (King's College, London, UK) for kindly sharing the PPI-specific CD8+ T cell clone; S.J. Cramer, M.J.W.E. Rabelink, T.J.M. Pool, K. Franken and A.H. de Ru for expert technical support; and J.R.F. Abreu for qDot analysis. This work is supported by the Dutch Diabetes Research Foundation, the DON Foundation and the Juvenile Diabetes Research foundation.

Author information

Author notes

    • Arnaud Zaldumbide
    •  & Bart O Roep

    These authors contributed equally to this work.

Affiliations

  1. Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands.

    • Maria J L Kracht
    • , Rob C Hoeben
    •  & Arnaud Zaldumbide
  2. Departments of Immunohematology & Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.

    • Maria J L Kracht
    • , Menno van Lummel
    • , Tatjana Nikolic
    • , Antoinette M Joosten
    • , Sandra Laban
    • , Arno R van der Slik
    •  & Bart O Roep
  3. Center for Proteomics & Metabolomics, Leiden University Medical Center, Leiden, the Netherlands.

    • Peter A van Veelen
  4. Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.

    • Françoise Carlotti
    •  & Eelco J P de Koning
  5. Department of Diabetes Immunology, Diabetes & Metabolism Research Institute at the Beckman Diabetes Research Institute, City of Hope, Duarte, California, USA.

    • Bart O Roep

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Contributions

B.O.R., R.C.H. and A.Z. conceived and directed the project and wrote the manuscript. M.J.L.K. performed the key experiments and analyzed the data. P.A.v.V. performed mass spectrometry experiments. A.M.J. and S.L. cloned DRiP1–9-specific CTLs. M.v.L., T.N. and A.R.v.d.S. selected patient samples, performed ELISPOT assay and characterized CD8+ clones. F.C. and E.J.P.d.K. provided human islets.

Competing interests

Leiden University Medical Center has filed international patent applications (EP16152400.4 and EP16154295.6) related to the insulin DRiP polypeptide (inventors B.O.R. and A.Z.).

Corresponding author

Correspondence to Bart O Roep.

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DOI

https://doi.org/10.1038/nm.4289

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