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3.2 Immunity Existing research on the pathogenesis of LADY is limited, but numerous studies have indicated that LADA is primarily caused by cell-mediated immunity ( It is well-established that autoreactive CD8 + T cells, upon recognizing antigenic determinants expressed on islet β-cell surfaces in association with MHC-I molecules, exert cytotoxic effects via degranulation and perforin release ( + T cells are a major component of the insulitis immune cell infiltrate in patients with LADA ( + T cell levels are lower in LADA than in T1DM ( Increasing evidence links innate immunity to the pathogenesis of autoimmune diabetes ( Islet autoantibodies are generally considered an epiphenomenon rather than a key pathogenic factor in islet cell destruction, but they are widely used to distinguish autoimmune from non-autoimmune diabetes and can indicate the strength of autoimmunity ( 2 -terminal epitope of the GAD65 protein (GAD65-N) to the middle region epitope of the GAD65 protein(GAD65-M) ( Gut microbiota plays a critical role in postnatal immune system development

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