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Deprecated: Implicit conversion from float 300.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Clin+Endocrinol+Metab 2014 ; 99 (6): E1040-4 Nephropedia Template TP
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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 PMID24601691show 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.