Modulation of Type 1 Diabetes Risk by the Intestinal Microbiome
Purpose of Review
The purpose of this review is to summarize potential modulations of the intestinal microbiome aimed at preventing or delaying progression to overt type 1 diabetes in the light of recently identified perturbations of the gut microbiota associated with the development of type 1 diabetes.
Accumulated data suggest that the gut microbiota is involved at two different steps in the evolution of type 1 diabetes. At the first step, the intestinal tract is colonized by a microbial community unable to provide an adequate education of the immune system. As a consequence, the infant acquires susceptibility to immune-mediated diseases, type 1 diabetes included. At the other step, the young child seroconverts to positivity for diabetes-associated autoantibodies. This is preceded or accompanied by a decrease in the diversity of the intestinal microbiota and an increased abundance of Bacteroides species. These changes will affect the disease process promoting progression toward overt type 1 diabetes.
By providing specific probiotics, one can affect the colonization of the intestinal tract in the newborn infant or strengthen the immune education in early life. Human milk oligosaccharides function as nutrients for “healthy” bacteria. Dietary interventions applying modified starches can influence the numbers and activities of both autoreactive and regulatory T cells and provide protection against autoimmune diabetes in non-obese diabetic mice. Modulation of the intestinal microbiome holds the promise of effective protection against human type 1 diabetes.
KeywordsType 1 diabetes Microbiome Microbiota Prebiotics Probiotics Diet
Research that is relevant for this review is and has been supported by the following grants: Juvenile Diabetes Research Foundation International (grants 4-1998-274, 4-1999-731, 4-2001-435), European Union (grant BMH4-CT98-3314), Novo Nordisk Foundation, Academy of Finland (Centre of Excellence in Molecular Systems Immunology and Physiology Research 2012-2017, Decision No. 250114), Special Research Funds for University Hospitals in Finland, Sigrid Juselius Foundation, Finska Läkaresällskapet, and Medicinska understösföreningen Liv och Hälsa.
Compliance with Ethical Standards
Conflict of Interest
Mikael Knip and Jarno Honkanen declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
The studies included in this review involving human participants and performed by any of the authors have been approved by the appropriate institutional research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all individual participants included in the studies or from their guardians if the participant was a minor.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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