A microRNA-based dynamic risk score for type 1 diabetes.

Identifying individuals at high risk of type 1 diabetes (T1D) is crucial as disease-delaying medications are available. Here we report a microRNA (miRNA)-based dynamic (responsive to the environment) risk score developed using multicenter, multiethnic and multicountry ('multicontext') cohorts for T1D risk stratification. Discovery (wet and dry lab) analysis identified 50 miRNAs associated with functional β cell loss, which is a hallmark of T1D. These miRNAs measured across n = 2,204 individuals from four contexts (4C: Australia, Denmark, Hong Kong SAR People's Republic of China, India) led to a four-context, miRNA-based dynamic risk score (DRS) that effectively stratified individuals with and without T1D. Generative artificial intelligence was used to create an enhanced four-context, miRNA-based DRS, which offered good predictive power (area under the curve = 0.84) for T1D stratification in a separate multicontext validation dataset (n = 662), and accurately predicted future exogenous insulin requirement at 1 hour of islet transplantation. In a clinical trial assessing the imatinib drug therapy, baseline miRNA signature, rather than clinical characteristics, distinguished drug responders from nonresponders at 1 year. This study harnessed machine learning/generative artificial intelligence approaches, identifying and validating a miRNA-based DRS for T1D discrimination and treatment efficacy prediction.