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CVB4 was reported to persistently infect primary cultures of thymic epithelial and fetal cells, leading to higher inflammatory cytokine and class I HLA expression and decreased IGF2 gene and protein expression ( IGF2 expression in the thymus is important because it plays a role in insulin tolerance by serving as a self-antigen of the insulin family during T cell maturation and selection against autoreactive T cells ( 4.5 Studies supporting no association between enteroviral infection and T1D A major limitation in the field is that the majority of data supporting an association between enteroviral infection and T1D have been obtained from epidemiological studies, and a definitive mechanistic link remains to be fully elucidated

2023 May 1;46(5):998-1004