Mechanistically, one can easily envision that, once initiated with one antigen, for example insulin or GAD in the case of T1D – chronic inflammation and local activation of APCs will lead to presentation of more autoantigens, either in their native form or also altered, for example by disulfide bond formation, deamidation, citrullination, or phosphorylation (47). Here, INS is linked to type 1 diabetes mellitus.