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2014 ; 99
(6
): E1040-4
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Masked and overt autoantibodies specific to the DPD epitope of 65-kDa glutamate
decarboxylase (GAD65-DPD) are associated with preserved ?-cell functional reserve
in ketosis-prone diabetes
#MMPMID24601691
Oak S
; Gaur LK
; Radtke J
; Patel R
; Iyer D
; Ram N
; Gaba R
; Balasubramanyam A
; Hampe CS
J Clin Endocrinol Metab
2014[Jun]; 99
(6
): E1040-4
PMID24601691
show ga
CONTEXT: Ketosis-prone diabetes (KPD), defined by presentation with diabetic
ketoacidosis (DKA), comprises 4 subgroups based on the presence or absence of
islet cell autoantibodies (A(-) or A(+)) and ?-cell functional reserve (?(-) or
?(+)). Among A(+) KPD, autoantibody epitope reactivity to 65-kDa glutamate
decarboxylase (GAD65), defined by monoclonal GAD65Ab(DPD), was associated with
greater ?-cell functional reserve. In a majority of healthy individuals, GAD65Ab
are present in the sera but are masked by anti-idiotypic antibodies; in contrast,
overtly GAD65Ab-positive patients with autoimmune type 1 diabetes patients lack
these anti-idiotypic antibodies. OBJECTIVE: Our objective was to determine the
presence of masked and overt GAD65Ab(DPD) in relation to ?-cell function and
genetic risk factors in KPD patients. DESIGN: We investigated the associations of
masked and overt GAD65Ab(DPD) with ?-cell functional reserve, and their
relationship with human leukocyte antigen (HLA) class II haplotypes linked to
autoimmune diabetes susceptibility or resistance, in a large KPD cohort.
PATIENTS: Adult KPD patients (n = 384) were followed longitudinally in a research
clinic. MAIN OUTCOME MEASURES: ?-Cell function, autoantibody status, GAD65Ab
epitopes, and HLA class II haplotypes were evaluated. RESULTS: Overall, KPD
patients with ?-cell functional reserve (?(+) subgroups) showed significantly
higher frequency of masked GAD65Ab(DPD) than patients without ?-cell functional
reserve (?(-) subgroups): 112 of 144 (79%) compared with 59 of 100 (59%),
respectively (P = .002). Masked or overt GAD65Ab(DPD) were also more frequent
among autoantibody-positive patients with preserved ?-cell functional reserve
(A(+)?(+) KPD) than those lacking ?-cell function (A(+)?(-) KPD): 77% compared
with 55% (P = .01). The susceptibility HLA haplotypes DQA1*0301/DQB1*0302 and
DQA1*0301/DQB1*0201 were associated with absence of overt or masked GAD65Ab(DPD)
(odds Ratios 2.3 and 2.2, respectively). CONCLUSIONS: Masked GAD65Ab(DPD) are
strongly associated with preserved ?-cell functional reserve among patients with
KPD. Absence of GAD65Ab(DPD) reactivity is associated with 2 HLA class II
susceptibility haplotypes for autoimmune type 1 diabetes.
|Adult
[MESH]
|Autoantibodies/*blood
[MESH]
|Cell Count
[MESH]
|Diabetes Mellitus, Type 1/complications/immunology/physiopathology
[MESH]