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¹ Autoimmunity and Transplantation Division, The Walter and Eliza Hall Institute of Medical Research, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
² The Department of Biochemistry and Molecular Biology and ImmunoID, The University of Melbourne, Victoria 3010, Australia
³ St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia
⁴ The Protein Crystallography Unit, Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
⁵ Benaroya Research Institute, Seattle, WA 98101

CORRESPONDENCE Stuart I. Mannering: mannering{at}wehi.edu.au OR Anthony W. Purcell: apurcell{at}unimelb.edu.au

The autoimmune process that destroys the insulin-producing pancreatic ß cells in type 1 diabetes (T1D) is targeted at insulin and its precursor, proinsulin. T cells that recognize the proximal A-chain of human insulin were identified recently in the pancreatic lymph nodes of subjects who had T1D. To investigate the specificity of proinsulin-specific T cells in T1D, we isolated human CD4⁺ T cell clones to proinsulin from the blood of a donor who had T1D. The clones recognized a naturally processed, HLA DR4–restricted epitope within the first 13 amino acids of the A-chain (A1–13) of human insulin. T cell recognition was dependent on the formation of a vicinal disulfide bond between adjacent cysteine residues at A6 and A7, which did not alter binding of the peptide to HLA DR4. CD4⁺ T cell clones that recognized this epitope were isolated from an HLA DR4⁺ child with autoantibodies to insulin, and therefore, at risk for T1D, but not from two healthy HLA DR4⁺ donors. We define for the first time a novel posttranslational modification that is required for T cell recognition of the insulin A-chain in T1D.

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