Anticardiolipin and anti-beta2 glycoprotein I antibody concentrations in patients with type 2 diabetes mellitus

Antiphospholipid antibodies in patients with dysglycaemia: A neglected cardiovascular risk factor?

BACKGROUND

Cardiovascular disease is a serious complication in patients with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance. Research focusing on the identification of potential markers for atherothrombotic disease in these subjects is warranted. The antiphospholipid syndrome is a common acquired prothrombotic condition, defined by a combination of thrombotic events and/or obstetric morbidity and positivity of specific antiphospholipid antibodies. Available information on antiphospholipid antibodies in dysglycaemia is scarce.

OBJECTIVE

This study investigates the association between antiphospholipid antibodies and dysglycaemia.

PATIENTS/METHODS

The PAROKRANK (periodontitis and its relation to coronary artery disease) study included 805 patients, investigated 6-10 weeks after a first myocardial infarction, and 805 matched controls. Participants without known diabetes (91%) underwent an oral glucose tolerance test. Associations between antiphospholipid antibodies (anti-cardiolipin and anti-β2 glycoprotein-I IgG, IgM and IgA) and dysglycaemia were analysed.

RESULTS

In total, 137 (9%) subjects had previously known type 2 diabetes and 371 (23%) newly diagnosed dysglycaemia. Compared with the normoglycaemic participants, those with dysglycaemia had a higher proportion with first myocardial infarction (61% vs 45%, p < 0.0001) and were more often antiphospholipid antibody IgG positive (8% vs 5%; p = 0.013). HbA1c, fasting glucose and 2-h glucose were significantly associated to antiphospholipid antibody IgG. Odds ratios (ORs) were 1.04 (95% confidence interval [CI] 1.02-1.06), 1.14 (95% CI 1.00 - 1.27) and 1.12 (95% CI 1.04 - 1.21), respectively, after adjustments for age, gender and smoking.

CONCLUSIONS

This study reports an association between antiphospholipid antibody IgG positivity and dysglycaemia. Further studies are needed to verify these findings and to investigate if antithrombotic therapy reduces vascular complications in antiphospholipid antibody positive subjects with dysglycaemia.

Autoantibody detection is not recommended for chronic pancreatitis: a cross-sectional Study of 557 patients

BACKGROUND

Autoimmune factor was regarded as one of the risk factors in the pathogenesis of chronic pancreatitis (CP), especially for autoimmune pancreatitis (AIP). However, whether autoimmune factor plays a role in non-AIP CP or not was unknown.

METHODS

Hospitalized patients with non-AIP CP from January 2010 to October 2016 were detected for 22 autoantibodies at the time of hospital admission. Autoantibodies with frequency > 0.5% were enrolled to calculate the frequency in historial healthy controls through literature search in PubMed. Differentially expressed autoantibodies were determined between patients and historial healthy controls, and related factors were identified by multivariate logistic regression analysis.

RESULTS

In a total of 557 patients, 113 cases were detected with 19 kinds of positive autoantibodies, among them anti-β2-glycoprotein I (β2-GPI) antibody was most frequent (9.16%). Compared with historial healthy controls, the frequencies of serum β2-GPI and anti SS-B antibody in patients were significantly higher, while frequencies of anti-smooth muscle antibody and anticardiolipin antibody were significantly lower (all P < 0.05). Multivariate logistic regression analysis result showed that diabetes mellitus (OR = 2.515) and common bile duct stricture (OR = 2.844) were the risk factors of positive β2-GPI antibody in patients while diabetes mellitus in first-/second-/third-degree relatives (OR = 0.266) was the protective factor. There were no related factors for other three differentially expressed autoantibodies.

CONCLUSIONS

Four autoantibodies were expressed differentially between patients with non-AIP CP and historial healthy controls. Due to limited significance for diagnosis and treatment of chronic pancreatitis, autoantibodies detection is not recommended conventionally unless suspected of AIP.

Antiphospholipid Antibodies and Renal Impairment Parameters in Diabetic Nephropathy: Preliminary Data

OBJECTIVE

Antiphospholipid antibodies (aPL Abs) represented an independent factor that was associated with the occurrence and/or progression of nephropathy in patients with antiphospholipid syndrome, but their role in diabetic nephropathy is not elucidated. Therefore, we evaluated the association of aPL Abs with the renal impairment parameters in patients with diabetic nephropathy.

METHODS

Concentrations of analyzed antibodies were measured by enzyme-linked immunosorbent assay.

RESULTS

Cystatin C and anticardiolipin (aCL) antibodies of the immunoglobulin (Ig) G ( r = .349, P = .004) and the IgM isotype ( r = .316, P = .009) were in positive correlation. The IgG isotype of the aCL Abs was in positive correlation with creatinine ( r = .252, P = .038), urea ( r = .241, P = .048), and uric acid ( r = .271, P = .025). The concentrations of the IgG isotype of the aCL Abs were significantly different between subgroups of patients with diabetic polyneuropathy and patients without this clinical finding (Mann-Whitney, P = .033).

CONCLUSION

This is the first report on positive correlation between aCL Abs and renal impairment parameters. Larger studies are necessary for elucidation whether this association is involved in further progression of the disease.

Upper extremity venous thrombosis associated with primary antiphospholipid syndrome and immunoglobulin M nephropathy in diabetes mellitus type II

Antiphospholipid syndrome (APS) is a disorder characterized by antiphospholipid antibody positivity, arterial or venous thrombosis, and fetal loss. In APS, renal as well as vascular and glomerular involvement is observed. Systemic lupus erythematosus and other connective tissue diseases should be excluded to diagnose primary APS. Immunoglobulin M (IgM) nephropathy is characterized by single or dominant IgM deposition in glomerular mesangium. It often presents with hematuria and proteinuria. In a 45-year-old female patient admitted to our clinic with diabetes mellitus and proteinuria, fundus examination did not reveal diabetic retinopathy but a high anticardiolipin IgM and venous thrombosis in the upper extremity were observed. Renal biopsy revealed IgM nephropathy. The patient was diagnosed with primary APS and IgM nephropathy. Cyclophosphamide and steroid treatment was started. Her proteinuria decreased as a result of the treatment. Although, it is reported in the literature that primary APS coexists with other glomerulonephritis, we did not detect coexistence of primary APS and IgM nephropathy.

Anticardiolipin antibodies in patients with type 2 diabetes mellitus

BACKGROUND

There is controversy about an increased prevalence of antiphospholipid antibodies in diabetic patients. The possible implications are little known.

METHODS

We prospectively studied all consecutive outpatients with type 2 diabetes mellitus (DM) attended to in an Internal Medicine office. IgM and IgG anticardiolipin antibodies (ACA) were determined by standardized enzyme-linked immunoassay.

RESULTS

Fifty-six patients were included. Only one patient (1.8%) had a titer of IgM ACA higher than 15 MPL units and no patient had a titer of IgG ACA higher than 15 GPL units. Six patients (10.7%) had low IgM ACA titers (4-15 MPL units) and 18 patients (32.1%) had low IgG ACA titers (4-15 GPL units). There were no differences in the frequencies of a low IgM or IgG ACA titer or in the means of IgM and IgG ACA titers in patients with complicated and uncomplicated DM, with and without cardiovascular disease, with and without nephropathy, or with and without retinopathy.

CONCLUSIONS

Moderate to high ACA titers must be exceptional in patients with type 2 DM. Low ACA titers may occur in patients with type 2 DM. These low titers do not seem to be associated with complicated DM, cardiovascular disease, nephropathy or retinopathy.