Case report: type 1 XXXX in monozygotic quadruplets.

@entity6 @entity1840 @entity4666 @entity686 @entity1800 @entity1723 @entity20300 @entity792
@entity1723 ( @entity1723 ) is an @entity792 characterized by the lack of insulin due to an autoimmune destruction of pancreatic beta cells. Here, we report a unique case of a family with naturally conceived quadruplets in which @entity1723 was diagnosed in two quadruplets simultaneously. At the same time, the third quadruplet was diagnosed with the pre- @entity6 stage. Remarkably, all four quadruplets were positive for anti-islet cell antibodies, @entity1840 and IA-A2. Monozygotic status of the quadruplets was confirmed by testing 14 different short tandem repeat polymorphisms. Serological examination confirmed that all quadruplets and their father suffered from a recent enteroviral infection of EV68-71 serotype. To assess the nature of the molecular pathological processes contributing to the development of @entity6 , immunocompetent cells isolated from all family members were characterized by gene expression arrays, immune-cell enumerations and cytokine-production assays. The microarray data provided evidence that @entity1800 , and @entity20300 and @entity4666 cytokine signalling contributed to the onset of @entity1723 in two of the quadruplets. The propensity of stimulated immunocompetent cells from non- @entity6 members of the family to secrete high level of @entity686 further corroborates this conclusion. The number of T regulatory cells as well as plasmacytoid and/or myeloid dendritic cells was found diminished in all family members. Thus, this unique family is a prime example for the support of the so-called 'fertile-field' hypothesis proposing that genetic predisposition to anti-islet autoimmunity is 'fertilized' and precipitated by a @entity1800 leading to a fully blown @entity1723 .
