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Cow's Milk, Bovine Serum Albumin, and IDDM: Can We Settle the Controversies?

Bovine serum albumin (BSA) is a constituent of cows milk whey and meat, and it is a common additive in processed foods because of its high resistance to degradation. Patients with recently diagnosed IDDM often have significant abnormalities in cellular and humoral immunity to different cows milk proteins, including BSA (1-9). There is epidemiological evidence that exposure of genetically diabetes-susceptible infants to intact foreign protein such as cow's milk-based formula before the age of 3 months carries with it an elevated risk to develop the disease (10-12). The relationship between BSA and IDDM has engendered much debate because elevated, diabetes-associated BSA antibodies were reported in a rather variable percentage of diabetic individuals, including one completely negative report (Table 1). Abnormal patient T-cell reactivity to BSA has been mapped to a single peptide fragment, the ABBOS epitope, which has structural homology with the Tep69 epitope of an islet cell antigen, ICA69 (13,14), which was identified as a target of diabetic autoimmunity in four independent laboratories (15-18). Because of the variability in the detection of abnormal BSA immunity in IDDM patients, the "BSA hypothesis" (see below) has generated criticism, and its debate became almost synonymous with that of intact cows milk protein as a diabetes risk factor in very young infants (19). Here, we will briefly review these issues and discuss how data just reported by Alting and van Beresteijn in Diabetes Care (20) may explain some of the difficulties surrounding the measurement of anti-BSA antibodies in IDDM patients. These authors (20) analyzed physicochemical characteristics of BSA that affect its behavior in immunoassays of anti-BSA antibodies. With a specific focus on the ABBOS region (21), their measurements of the ABBOS accessibility to antibody binding in native and degraded BSA may explain some of the controversy surrounding the presence or absence of an association between abnormal immunity to BSA and IDDM and reduce it to technical issues. That this would be of more than passing interest is evident from continuing publications of data and editorial opinion on these topics in more than a dozen papers this year (7,9,18-20,22-29), not counting ours (12,30-34).