, Volume 62, Issue 6, pp 1100–1103 | Cite as

Large enteroviral vaccination studies to prevent type 1 diabetes should be well founded and rely on scientific evidence. Reply to Skog O, Klingel K, Roivainen M et al [letter]

  • Jessica L. DunneEmail author
  • Sarah J. RichardsonEmail author
  • Mark A. Atkinson
  • Maria E. Craig
  • Knut Dahl-Jørgensen
  • Malin Flodström-Tullberg
  • Heikki Hyöty
  • Richard E. Lloyd
  • Noel G. Morgan
  • Alberto Pugliese

To the Editor: We are pleased that Skog et al [1] have accepted the challenge to respond to our recent ‘For Debate’ article [2]. In this, we proposed that both vaccination and trials with antiviral therapies are warranted, based on decades of studies implicating an association between enterovirus infections and type 1 diabetes. It is pleasing to observe these conclusions were similarly supported by Skog et al [1].

However, while supporting our overall conclusions, the authors also challenged several pieces of evidence cited in our article, and we believe it important to respond to each challenge. First, Skog et al question the value of antiviral therapies at clinical onset of type 1 diabetes because they contend that the evidence for viral infection post diagnosis is weak [1]. In response, we would cite the growing evidence for: (1) chronic autoimmunity and persistent insulin secretion extending for many years after diagnosis [3, 4, 5]; (2) the existence of beta cell dysfunction at...


Antiviral agents Clinical trials DiViD Enterovirus Islet nPOD 



Protein kinase R


Viral protein 1


Contribution statement

All authors were responsible for drafting the article and revising it critically for important intellectual content. All authors approved the version to be published.


Work in the authors’ laboratories is supported by the South-Eastern Norway Regional Health Authority (grant to K.D.-J.), the Novo Nordisk Foundation (grants to KD-J and MF-T), the Swedish Child Diabetes Foundation (grant to MF-T), the Swedish Research Council (grant to MF-T), and by the PEVNET (Persistent Virus Infection in Diabetes Network) Study Group funded by the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement number 261441 PEVNET. Some of the authors (AP, SJR, NGM, HH, MAA, REL and MF-T) are supported by JDRF 3-SRA-2017-492-A-N, which funds the nPOD Virus Group in collaborative studies of virus infections in the pancreas with type 1 diabetes. Studies in the Exeter laboratory were supported by a JDRF-CDA award (5-CDA-2014-221-A-N to SJR), and by grant support from MRC (MR/P010695/1) and Diabetes UK (15/0005364) to SJR and NGM. MEC is supported by an Australian National Health and Medical Research Council (NHMRC) Practitioner fellowship [APP1045777]

Duality of interest

HH is a shareholder and member of the Board of Vactech Ltd., which develops picornavirus vaccines. RAI, HH and MF-T serve on the scientific advisory board of Provention Bio Inc., which is developing an enterovirus vaccine.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.JDRFNew YorkUSA
  2. 2.Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
  3. 3.Departments of Pathology and Pediatrics, College of MedicineUniversity of FloridaGainesvilleUSA
  4. 4.School of Women’s and Children’s Health, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  5. 5.Department of Pediatric and Adolescent MedicineOslo University HospitalOsloNorway
  6. 6.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  7. 7.Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska InstitutetKarolinska University HospitalStockholmSweden
  8. 8.Faculty of Medicine and Life SciencesUniversity of TampereTampereFinland
  9. 9.Fimlab LaboratoriesPirkanmaa Hospital DistrictTampereFinland
  10. 10.Department of Molecular Virology and MicrobiologyBaylor College of MedicineHoustonUSA
  11. 11.Diabetes Research Institute, Miller School of MedicineUniversity of MiamiMiamiUSA
  12. 12.Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Miller School of MedicineUniversity of MiamiMiamiUSA
  13. 13.Department of Microbiology and Immunology, Miller School of MedicineUniversity of MiamiMiamiUSA

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