The inflammatory path toward type 1 diabetes begins during pregnancy

Abstract

Abstract Type 1 diabetes (T1D) is increasing globally, yet the earliest biological determinants remain poorly defined, particularly in general population studies. We studied the Swedish population-based ABIS birth cohort (n = 16,683) to identify early-life risk factors. Olink proteomic analysis (n = 286 controls, n = 146 cases) of inflammatory signals at birth shows differential abundance years before diagnosis (mean age 12.6 years), with proteins enriched for neutrophil migration, cytotoxicity, extracellular matrix remodeling, and immune regulation. Several markers remain significant in spite of prenatal and perinatal factors including family history of diabetes, and are associated with differences in compounds like stearic acid, lysine, glutamine, and persistent, environmental toxicants perfluorodecylethanoic acid and perfluorooctane sulfonate (PFOS). Using machine learning, we identify a protein subset that predicts T1D with high accuracy (AUC = 0.89 ± 0.02), independently of HLA genetic risk. These findings suggest that innate and tissue-remodeling pathways are perturbed at birth, possibly reflecting early β-cell vulnerability. Identifying these disruptions at birth with a non-invasive method opens a window for prevention, protecting β-cells before the inflammatory attack on islets begins.