Severe Acute Respiratory Syndrome Coronavirus 2 As A Potential Cause Of Type 1 Diabetes Facilitated By Spike Protein Receptor Binding Domain Attachment To Human Islet Cells: An Illustrative Case Study And Experimental Data

Aims Aim of this study is to report severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, responsible for coronavirus disease 2019 (COVID-19), as a possible cause for type 1 diabetes by providing an illustrative clinical case of a man aged 45 years presenting with antibody-negative diabetic ketoacidosis post-recovery from COVID-19 pneumonia and to explore the potential for SARS-CoV-2 to adhere to human islet cells.Methods Explanted human islet cells from three independent solid organ donors were incubated with the SARS-CoV-2 spike protein receptor biding domain (RBD) fused to a green fluorescent protein (GFP) or a control-GFP, with differential adherence established by flow cytometry.Results Flow cytometry revealed dose-dependent specific binding of RBD-GFP to islet cells when compared to control-GFP.Conclusions Although a causal basis remains to be established, our case and in vitro data highlight a potential mechanism by which SARS-CoV-2 infection may result in antibody-negative type 1 diabetes.