Children who develop type 1 diabetes early in life show low levels of carnitine and amino acids at birth: does this finding shed light on the etiopathogenesis of the disease?

• Published in: Nutrition & diabetes Vol. 3; no. 10; p. e94
• Main Authors: la Marca, G, Malvagia, S, Toni, S, Piccini, B, Di Ciommo, V, Bottazzo, G F
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2013; Nature Publishing Group
• Subjects: 692/420; 692/699/2743/1313/1418; Clinical Nutrition; Diabetes; Epidemiology; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Original; original-article; carnitines; type 1 diabetes; amino acids; thymic central tolerance
• ISSN: 2044-4052; 2044-4052
• DOI: 10.1038/nutd.2013.33

Background: Children and adolescents with overt type 1 diabetes (T1D) have been found to show an altered carnitine profile. This pattern has not previously been analyzed in neonates before onset of the disease. Materials and methods: Fifty children who developed T1D during the first 6 years of life, born and living in the Tuscany and Umbria Regions of Italy, were identified and 200 controls were recruited into the study. All newborns were subjected to extended neonatal screening by mass spectrometry at 48–72 h of life. Four controls for each of the 50 index cases were taken randomly and blinded in the same analytical batch. The panel used for neonatal screening consists of 13 amino acids, free carnitine, 33 acyl-carnitines and 21 ratios. All Guthrie cards are analyzed within 2 days of collection. Results: Total and free carnitine were found to be significantly lower in neonates who later developed T1D compared with controls. Moreover, the concentrations of the acyl-carnitines – acetyl- L -carnitine (C2), proprionylcarnitine (C3), 3-hydroxyisovalerylcarnitine (C5OH), miristoylcarnitine (C4), palmitoylcarnitine (C16) and stearoylcarnitine (C18) – were also significantly low in the cases vs controls. Furthermore, total amino-acid concentrations, expressed as the algebraic sum of all amino acids tested, showed a trend toward lower levels in cases vs controls. Conclusions: We found that carnitine and amino-acid deficit may be evident before the clinical appearance of T1D, possibly from birth. The evaluation of these metabolites in the neonatal period of children human leukocyte antigen genetically at ‘risk’ to develop T1D, could represent an additional tool for the prediction of T1D and could also offer the possibility to design new strategies for the primary prevention of the disease from birth. Editor's Note: This paper demonstrates that infants with a low level of carnitine at birth have a higher risk of developing Type 1 diabetes mellitus later in childhood. While this is a retrospective cohort study and needs to be confirmed, the possibility exists that assessment of carnitine status at birth may allow identification of children who need closer follow up to intervene early in the development of diabetes. Additional studies are needed to identify the mechanisms of this finding.