Autoimmunity in insulin-dependent diabetes mellitus.

Genetic susceptibility, environmental factors and immune mechanisms are implicated in the pathogenesis and etiology of insulin-dependent diabetes mellitus. The onset of the disease is associated with a major loss of beta cells, and inflammatory cells may be seen in and around the islets of Langerhans. Insulin-dependent diabetes is often associated with autoimmune endocrinopathies. Antipancreatic cell-mediated autoimmunity is found predominantly in young patients with insulin-dependent diabetes of recent onset as are antibodies reactive with cytoplasmic components or cell surface determinants of islet cells. Antibodies reactive with live islet cells may mediate complement-dependent cytotoxicity. The antigen(s) in the islet cells remain(s) to be identified and characterized. Further studies will be necessary to determine whether autoimmunity is the cause of beta-cell destruction or whether it is a consequence of damages caused by exogenous agents in susceptible persons.