Editorial [Hot Topic: Nutritional Modulation of Autoimmune Diabetes (Guest Editor: Fraser W. Scott)]

Type 1 diabetes (T1D) develops as a result of a complex and poorly understood self-targeting immune reaction that destroys the insulin-producing β-cells in the pancreatic islets of Langerhans. Environmental factors are thought to play a major role in this process and likely influence the success of β-cell replacement therapies. Unfortunately, the identification of these agents and the mechanisms by which they promote diabetes remain unclear. Nonetheless, data are accumulating from studies of diabetesprone animals and humans that strengthen the proposition that diet is an important determinant of diabetes outcome. These studies emphasize a key role for selected dietary constituents, defective gut barrier function, gut immune cell activation, the maintenance of glucoregulation, islet homeostasis/ regeneration and overall immune dysregulation in diabetes pathogenesis. In this issue, internationally recognized experts review recent findings that implicate dietary components in T1D, explore the role of the gastrointestinal tract, provide lessons from the role of wheat in celiac disease, and describe the effort to identify candidate dietary molecules and understand their role in pancreas biology and metabolism. The study of nutritional effects on diabetes expression is a challenging but useful paradigm for environmental modification of this complex chronic disease. As we begin to understand the integrative biology of diabetes-related dietary constituents, we move closer to understanding the origins of T1D. The upshot of these discussions is that we must learn how to modify the environment to prevent or delay the process that destroys β-cells. One of the most important sources of bioactive agents from our environment is the food we eat. We should not be surprised that the pancreas which plays a key role in digestion of food and nutrient uptake is itself strongly influenced by food constituents which may also up- or down-regulate the largest collection of immune cells in the body within the gutassociated lymphoid tissues. Understanding how diet alters diabetes outcome could lead to relatively harmless and economical interventions that delay onset or possibly prevent this disease in some individuals or even permit enhanced survival of transplanted islets. We can but hope!