Is there evidence for post-translational modification of beta cell autoantigens in the aetiology and pathogenesis of type 1 diabetes?

Størling and colleagues hypothesise in this issue (Diabetologia DOI: 10.1007/s00125-013-3045-3 ) that post-translational modification (PTM) of autoantigens might create tissue-specific neo-epitopes that could trigger type 1 diabetes. Data on PTM of islet autoantigens are scarce and readers should not believe that the PTM hypothesis is supported by strong experimental evidence. The proposed genetic factors are many but their possible contribution is conjectural. There is a lack of a rational approach to test the PTM hypothesis at the different stages of type 1 diabetes. Research that carefully addresses each stage of the type 1 diabetes disease process is warranted to advance our understanding of autoimmune (type 1) diabetes.