Glutamate decarboxylases and autoimmunity in insulin-dependent diabetes

Spontaneous and tetracosactide-induced anti-ACTH antibodies in man

CONTEXT

During a clinical trial of regular tetracosactide depot injections, four of 13 patients with autoimmune Addison's disease (AAD) developed adverse reactions immediately following tetracosactide injections. We wished to investigate whether these adverse effects could be due to the production of circulating antitetracosactide (ACTH1-24 ) antibodies.

DESIGN

Anti-ACTH binding activity was investigated using immunoblotting and ELISA on sera from participants in the trial (n = 13; baseline and after tetracosactide exposure), 131 unrelated patients with AAD, 92 patients with Graves' disease (GD), 15 patients with isolated ACTH deficiency and 102 controls. Immunohistochemistry of human pituitary tissue sections was also performed using pooled sera.

RESULTS

Bands at approximately 4 and 6 kDa, corresponding to ACTH1-24 and full-length ACTH1-39, respectively, were found in 10 of 13 (77%) of sera from trial patients exposed to tetracosactide, including all those who had an adverse reaction. This is in contrast with healthy control sera, which showed no binding. The same 10 subjects also showed high levels of binding to tetracosactide by ELISA, along with 21% of patients with AAD, 14% of patients with GD (both P < 0·001 compared to controls) and 1 isolated ACTH deficiency patient (7% of 15). These sera also recognized native ACTH in human pituitary sections.

CONCLUSION

Our study demonstrates that repeated administration of depot tetracosactide can lead to anti-ACTH1-24 autoreactivity. In addition, a significant number of patients with AAD and GD also had similar, spontaneous, anti-ACTH reactivity. The presence of these antibodies could mediate some of the adverse effects or explain the well-described phenomenon of resistance to chronic ACTH therapy.

The peripheral GABAergic system as a target in endocrine disorders

In addition to its well-recognized function as a cerebral inhibitory transmitter, less well established is the role of GABA in peripheral nervous and endocrine systems. We summarize current evidence that GABA serves as a neurotransmitter or neuromodulator in the autonomic nervous system and as a hormone or trophic factor in non-neuronal peripheral tissue as well. GABA is widely distributed in endocrine tissues including the pituitary, pancreas, adrenal glands, uterus, ovaries, placenta and testis. Moreover, GABA is involved in the pathophysiology of endocrine disorders such as diabetes mellitus, diseases of adrenal glands and reproductive tracts. Current literature indicates that the peripheral GABA system in the autonomic nervous system, endocrine and immune systems is as yet nearly an unexplored target for diagnosis and drug treatment.

Biochemical characteristics of the gamma-aminobutyric acid system in the insulinoma cell lines HIT-T15, RIN-m5F, betaTC3, and comparison with rat brain

BACKGROUND

gamma-aminobutyric acid (GABA) is the most abundant inhibitory neurotransmitter in the mammalian brain. Both GABA and its synthesizing enzyme, L-glutamate decarboxylase (GAD), are also present in the insulin-secreting pancreatic beta cells, in which its physiologic role is unclear. We have studied several aspects of the GABA system in the insulinoma cell lines HIT-T15, RIN-m5F, and betaTC3 in comparison with rat brain tissue.

METHODS

Insulinoma cell lines and embryonic rat brain cortex neurons were cultured. GAD activity was determined by a radioenzymatic method and the presence of GAD(67) protein was assessed by immunocytochemistry. Amino acid content and the effect of different conditions on the release of endogenous GABA were measured by HPLC and fluorometric detection after o-phthaldialdehyde derivatization. [3H]GABA was used for measuring the uptake of the amino acid in the insulinoma cultures and in rat forebrain synaptosomes.

RESULTS

The three insulinoma lines possess GABA and GAD activity at levels of approximately 20% compared with adult rat brain cortex. Dissimilar from the latter, in insulinoma cultures enzyme activity was not enhanced by addition of an excess of the coenzyme pyridoxal-5'-phosphate. Immunocytochemical visualization of GAD showed that the cells in both neuronal cultures and insulinoma lines were GAD(67)-positive, similar to Purkinje cell somata of adult rat cerebellar cortex. [3H]GABA uptake in the cell lines was approximately 10% of that in rat forebrain synaptosomes and showed less ionic and temperature dependence. In both cultured cerebral neurons and RINm5F cells, the addition of arginine induced the release of GABA, whereas neither high K(+) concentration nor glucose had any effect.

CONCLUSIONS

The insulinoma cell lines studied possess the same GAD(67) form of the enzyme present in brain. RIN line cells are capable of transporting glutamate. In these cells as well as in cultured cortical neurons, arginine stimulates the release of GABA and glutamate probably as the result of its electrogenic transport. Insulinoma cell lines may therefore be useful to study GABA metabolism and function in pancreatic beta cells.

GABA(A) receptors mediate inhibition of T cell responses

We describe the presence of functional GABA(A) receptors on T cells. GABA inhibited anti-CD3 and antigen-specific T cell proliferation in vitro in a dose-dependent manner that was 1) mimicked by the GABA(A) receptor agonist muscimol (but not the GABA(B) receptor agonist baclofen), 2) blocked by GABA(A) receptor antagonists and a GABA(A) receptor Cl- channel blocker (picrotoxin) and 3) enhanced by pentobarbital. These data suggest that GABA(A) receptors mediate this immune inhibition and that these receptors can be modulated in a similar fashion to their neuronal counterparts. Finally, GABA inhibited DTH responses in vivo. Thus, pharmacological modulation of GABA(A) receptors may provide new approaches to modulate T cell responses in inflammation and autoimmune disease.

Oligodendrocyte-specific expression and autoantigenicity of transaldolase in multiple sclerosis

Although the etiology of multiple sclerosis (MS) is unknown, there is compelling evidence that its pathogenesis is mediated through the immune system. Molecular mimicry, i.e., crossreactivity between self-antigens and viral proteins, has been implicated in the initiation of autoimmunity and MS. Based on homology to human T cell lymphotropic virus type I (HTLV-I) a novel human retrotransposon was cloned and found to constitute an integral part of the coding sequence of the human transaldolase gene (TAL-H). TAL-H is a key enzyme of the nonoxidative pentose phosphate pathway (PPP) providing ribose-5-phosphate for nucleic acid synthesis and NADPH for lipid biosynthesis. Another fundamental function of the PPP is to maintain glutathione at a reduced state and, consequently, to protect sulfhydryl groups and cellular integrity from oxygen radicals. Immunohistochemical analyses of human brain sections and primary murine brain cell cultures demonstrated that TAL is expressed selectively in oligodendrocytes at high levels, possibly linked to production of large amounts of lipids as a major component of myelin, and to the protection of the vast network of myelin sheaths from oxygen radicals. High-affinity autoantibodies to recombinant TAL-H were detected in serum (25/87) and cerebrospinal fluid (15/20) of patients with MS. By contrast, TAL-H antibodies were absent in 145 normal individuals and patients with other autoimmune and neurological diseases. In addition, recombinant TAL-H stimulated proliferation and caused aggregate formation of peripheral blood lymphocytes from patients with MS. Remarkable amino acid sequence homologies were noted between TAL-H and core proteins of human retroviruses. Presence of crossreactive antigenic epitopes between recombinant TAL-H and HTLV-I/human immunodeficiency virus type 1 (HIV-1) gas proteins was demonstrated by Western blot analysis. The results suggest that molecular mimicry between viral core proteins and TAL-H may play a role in breaking immunological tolerance and leading to a selective destruction of oligodendrocytes in MS.

Spontaneous loss of T-cell tolerance to glutamic acid decarboxylase in murine insulin-dependent diabetes

Insulin-dependent diabetes mellitus (IDDM) in non-obese diabetic (NOD) mice results from the T-lymphocyte-mediated destruction of the insulin-producing pancreatic beta-cells and serves as a model for human IDDM. Whereas a number of autoantibodies are associated with IDDM, it is unclear when and to what beta-cell antigens pathogenic T cells become activated during the disease process. We report here that a T-helper-1 (Th1) response to glutamate decarboxylase develops in NOD mice at the same time as the onset of insulitis. This response is initially limited to a confined region of glutamate decarboxylase, but later spreads intramolecularly to additional determinants. Subsequently, T-cell reactivity arises to other beta-cell antigens, consistent with intermolecular diversification of the response. Prevention of the spontaneous anti-glutamate decarboxylase response, by tolerization of glutamate decarboxylase-reactive T cells, blocks the development of T-cell autoimmunity to other beta-cell antigens, as well as insulitis and diabetes. Our data suggest that (1) glutamate decarboxylase is a key target antigen in the induction of murine IDDM; (2) autoimmunity to glutamate decarboxylase triggers T-cell responses to other beta-cell antigens, and (3) spontaneous autoimmune disease can be prevented by tolerization to the initiating target antigen.

Cloning and sequence analysis of a murine cDNA encoding glutamate decarboxylase (GAD65)

We report the cloning and cDNA sequence of murine GAD65. Murine GAD65 is comprised of 585 amino acids and shares a high degree of homology with human and rat GAD65, with most divergences occurring near their amino-termini. The murine GAD65 sequence will allow evaluation of the role of this gene in murine neurogenetic and autoimmune diseases.