Differences in immune cell profiles around the time of islet autoimmunity seroconversion in children with and without type 1 diabetes

Seroconversion (SV) marks the initiation of islet autoimmunity (IA) and pre-clinical phase of type 1 diabetes, yet the contributions of immune cells beyond cytotoxic T cells remain unclear. We applied high-resolution immune cell-type deconvolution using peripheral blood DNA methylation data from nested case-control samples of the Diabetes Autoimmunity Study in the Young (DAISY; n=151) and The Environmental Determinants of Diabetes in the Young (TEDDY; n=166) to estimate immune cell proportions across pre-SV and SV timepoints and construct functional ratios, such as the neutrophil-to-lymphocyte ratio (NLR). Using linear models, we evaluated differences between type 1 diabetes cases and controls at pre-SV, SV, and the change across timepoints. Pre-SV, cases had higher NLR and lower CD4T/CD8T cell ratios. At SV, the combined B-CD4T-CD8T memory/naïve ratio was reduced in cases. From pre-SV to SV, cases showed attenuations in NLR, B-memory/naïve, and B-CD4T-CD8T memory/naïve ratios. These patterns may reflect delayed or disrupted immune maturation with the persistence or expansion of naïve cells or impaired transition to memory subsets following antigen exposure. Our findings highlight early shifts in innate and adaptive immune cell dynamics during type 1 diabetes pathogenesis and support immune cell ratios as potential biomarkers for risk stratification and mechanistic insight.