Glutamate decarboxylase (GAD) autoantibody epitope shift during the first year of type 1 diabetes

Islet autoantibodies present in association with Ljungan virus infection in bank voles (Myodes glareolus) in northern Sweden

Bank voles are known reservoirs for Puumala hantavirus and probably also for Ljungan virus (LV), a suggested candidate parechovirus in type 1 diabetes etiology and pathogenesis. The aim of this study was to determine whether wild bank voles had been exposed to LV and if exposure associated to autoantibodies against insulin (IAA), glutamic acid decarboxylase 65 (GADA), or islet autoantigen-2 (IA-2A). Serum samples from bank voles (Myodes glareolus) captured in early summer or early winter of 1997 and 1998, respectively, were analyzed in radio binding assays for antibodies against Ljungan virus (LVA) and Puumala virus (PUUVA) as well as for IAA, GADA, and IA-2A. LVA was found in 25% (189/752), IAA in 2.5% (18/723), GADA in 2.6% (15/615), and IA-2A in 2.5% (11/461) of available bank vole samples. LVA correlated with both IAA (P = 0.007) and GADA (P < 0.001), but not with IA-2A (P = 0.999). There were no correlations with PUUVA, detected in 17% of the bank voles. Compared to LVA negative bank voles, LVA positive animals had higher levels of both IAA (P = 0.002) and GADA (P < 0.001), but not of IA-2A (P = 0.205). Levels of LVA as well as IAA and GADA were higher in samples from bank voles captured in early summer. In conclusion, LVA was detected in bank voles and correlated with both IAA and GADA but not with IA-2A. These observations suggest that exposure to LV may be associated with islet autoimmunity. It remains to be determined if islet autoantibody positive bank voles may develop diabetes in the wild. J. Med. Virol. 89:24-31, 2017. © 2016 Wiley Periodicals, Inc.

Detection of autoantibodies against reactive oxygen species modified glutamic acid decarboxylase-65 in type 1 diabetes associated complications

Background

Autoantibodies against glutamate decarboxylase-65 (GAD₆₅Abs) are thought to be a major immunological tool involved in pathogenic autoimmunity development in various diseases. GAD₆₅Abs are a sensitive and specific marker for type 1 diabetes (T1D). These autoantibodies can also be found in 6-10% of patients classified with type 2 diabetes (T2D), as well as in 1-2% of the healthy population. The latter individuals are at low risk of developing T1D because the prevalence rate of GAD₆₅Abs is only about 0.3%. It has, therefore, been suggested that the antibody binding to GAD₆₅ in these three different GAD₆₅Ab-positive phenotypes differ with respect to epitope specificity. The specificity of reactive oxygen species modified GAD₆₅ (ROS-GAD₆₅) is already well established in the T1D. However, its association in secondary complications of T1D has not yet been ascertained. Hence this study focuses on identification of autoantibodies against ROS-GAD₆₅ (ROS-GAD₆₅Abs) and quantitative assays in T1D associated complications.

Results

From the cohort of samples, serum autoantibodies from T1D retinopathic and nephropathic patients showed high recognition of ROS-GAD₆₅ as compared to native GAD₆₅ (N-GAD₆₅). Uncomplicated T1D subjects also exhibited reactivity towards ROS-GAD₆₅. However, this was found to be less as compared to the binding recorded from complicated subjects. These results were further proven by competitive ELISA estimations. The apparent association constants (AAC) indicate greater affinity of IgG from retinopathic T1D patients (1.90 × 10^-6 M) followed by nephropathic (1.81 × 10^-6 M) and uncomplicated (3.11 × 10^-7 M) T1D patients for ROS-GAD₆₅ compared to N-GAD₆₅.

Conclusion

Increased oxidative stress and blood glucose levels with extended duration of disease in complicated T1D could be responsible for the gradual formation and/or exposing cryptic epitopes on GAD₆₅ that induce increased production of ROS-GAD₆₅Abs. Hence regulation of ROS-GAD₆₅Abs could offer novel tools for analysing and possibly treating T1D complications.

Kinetics of the post-onset decline in zinc transporter 8 autoantibodies in type 1 diabetic human subjects

CONTEXT

Zinc transporter 8 (ZnT8) is a newly discovered islet autoantigen in human type 1A diabetes (T1D).

OBJECTIVE

The objective was to document changes in ZnT8 autoantibody (ZnT8A) titer and prevalence after onset of disease in relationship to 65 kDa glutamate decarboxylase antibody (GADA) and islet cell antigen antibody (IA2A).

DESIGN/PATIENTS

Autoantibody radioimmunoprecipitation assays were performed on sera from three groups: 21 individuals monitored every 3 months from diagnosis for 2.5 yr; 61 individuals monitored at six monthly intervals for 5-12 yr; and a cross-sectional study of 424 patients with T1D of 20-57 yr duration. Circulating C-peptide was determined as an index of residual β-cell function.

RESULTS

ZnT8A titers declined exponentially from clinical onset of T1D with a t(1/2) ranging from 26 to 530 wk, similar to C-peptide (23-300 wk). Life-table analysis of antibody prevalence to 12 yr indicated that ZnT8A measured with either Arg325 or Trp325 probes persisted for a shorter interval than IA2A. Although prevalence of ZnT8A, IA2A, and GADA were comparable at disease onset (70.4 vs. 73.4 vs. 64%), only 6.7% of individuals remained ZnT8A positive after 25 yr compared with 19.5% for IA2A and 25.9% for GADA. Titers of ZnT8A and IA2A in seropositive individuals decreased progressively, whereas GADA remained elevated consistent with periodic reactivation of GADA humoral autoimmunity.

CONCLUSIONS

ZnT8 humoral autoreactivity declines rapidly in the first years after disease onset and is less persistent than IA2A or GADA in the longer term. ZnT8A determination may be a useful measure of therapeutic efficacy in the context of immune-based clinical interventions.

Autoantibodies in diabetes

Islet cell autoantibodies are strongly associated with the development of type 1 diabetes. The appearance of autoantibodies to one or several of the autoantigens-GAD65, IA-2, or insulin-signals an autoimmune pathogenesis of beta-cell killing. A beta-cell attack may be best reflected by the emergence of autoantibodies dependent on the genotype risk factors, isotype, and subtype of the autoantibodies as well as their epitope specificity. It is speculated that progression to beta-cell loss and clinical onset of type 1 diabetes is reflected in a developing pattern of epitope-specific autoantibodies. Although the appearance of autoantibodies does not follow a distinct pattern, the presence of multiple autoantibodies has the highest positive predictive value for type 1 diabetes. In the absence of reliable T-cell tests, dissection of autoantibody responses in subjects of genetic risk should prove useful in identifying triggers of islet autoimmunity by examining seroconversion and maturation of the autoantibody response that may mark time to onset of type 1 diabetes. The complexity of the disease process is exemplified by multiple clinical phenotypes, including autoimmune diabetes masquerading as type 2 diabetes in youth and adults. Autoantibodies may also provide prognostic information in clinically heterogeneous patient populations when examined longitudinally.

Pancreatic islet fibrosis in rock hyraxes (Procavia capensis), Part 1: Case histories, clinical pathology, and epizootiology

Two adult female rock hyraxes (Procavia capensis) at the Dallas Zoo were confirmed with spontaneous diabetes mellitus from 1997-2000, whereas a third animal with a similar clinical presentation never became hyperglycemic. The pancreas in all three animals showed pancreatic islet fibrosis (PIF). Retrospective examination of medical records for rock hyraxes acquired by this collection or born into it from 1991-2002 identified eight more animals affected with PIE All affected animals, including three males and eight females, were 1-7 yr of age and presented either with vague clinical signs of soft feces and rough hair coat or were acutely moribund or dead. Clinical pathology data was available for seven of the animals before onset of overt clinical signs and revealed inappropriate hyperglycemia in six, as well as elevated serum concentrations of creatine phosphokinase, amylase, and lipase in all seven animals. Pedigree evaluation did not support a familial pattern for PIE Review of the histopathology findings from nine other zoologic collections with rock hyrax deaths during the study period identified six institutions with 12 additional cases genetically unrelated to the incident collection. Histopathology and viral serology did not support an infectious cause. Analysis of serum anti-islet and anti-insulin antibodies did not suggest autoimmune disease, and none of the animals had known exposure to toxic substances. Limited nutritional analyses did not support a nutritional basis for the condition, and the cause for PIF remains unknown.

Is innervation an early target in autoimmune diabetes?

In the non-obese diabetic (NOD) mouse, a spontaneous model of type 1 diabetes (T1D), recent evidence suggests that Schwann cells (Scs) and neurons surrounding insulin-producing beta cells of the islets of Langerhans are destroyed before beta cells. During normal perinatal development, macrophages (MPhi) are involved in phagocytosis of apoptotic neurons. Pertinently, MPhi are already present at birth in NOD pancreata. Their possible abnormal control of nerve phagocytosis, together with transient beta-cell hyperactivity and lymphocyte anomalies, might conjointly participate in T1D pathogenesis.

Preservation of enzyme activity and antigenicity after mutagenesis of the membrane anchoring domain of GAD65

The smaller isoform of glutamic acid decarboxylase, GAD65, is an important autoantigen implicated in the pathogenesis of type 1 diabetes whereas the larger isoform, GAD67 appears to play no major role. The primary difference between the two isoforms resides in the N-terminal part of the molecule including the GAD65 membrane-anchoring domain. The aim of this study was to generate mutants of the membrane targeting domain spanning amino acids 24 to 31 of GAD65 to determine effects on enzyme activity and antibody recognition. Three GAD65 mutants were generated by substituting two, nine or eleven nucleotides coding for the membrane targeting with the corresponding bases of GAD67. SDS-PAGE and Western blotting wildtype (wt) and mutated GAD65 ascertained that they were of similar size and recognized GAD65-specific antibodies. No difference in enzymatic activity was found between the mutants and wt GAD65. GAD65 antibody positive sera from type 1 diabetes patients immunoprecipitated mutated GAD65 whether two, nine or eleven nucleotides were replaced. Mono-or polyclonal antibodies to the N-terminal region demonstrated that the mutated GAD65 with two or nine nucleotides replaced was immunoprecipitated markedly better than wt whereas no difference was detected using antibodies specific for the PLP-binding site in the middle part of GAD65 or the C-terminal region. Taken together, these data suggest that no major conformational changes have been introduced by mutating the membrane-anchoring domain of GAD65.

Stable GAD65 autoantibody epitope patterns in type 1 diabetes children five years after onset

Autoantibodies to GAD65 (GAD65Ab) are prominent in type 1 diabetes. These autoantibodies may be present both years before and after the clinical diagnosis of type 1 diabetes and are widely used as a marker for the disease. Recently it has been demonstrated that progression to type 1 diabetes is accompanied by GAD65Ab epitope maturation. Here we examine whether autoantibody maturation processes also progress after the clinical diagnosis of type 1 diabetes. Antibody reactivity to GAD65, GAD67 and GAD65/67 fusion proteins was measured by radioimmunoassays in 62 children with type 1 diabetes. Samples were taken at diagnosis and five years later. While the overall GAD65Ab level declined over time, the epitope pattern was remarkably stable with no significant changes in binding pattern. Loss of GAD65Ab-positivity was associated with significantly lower GAD65Ab indices at diagnosis compared to patients' sera that remained GAD65Ab-positive. The decrease in GAD65Ab levels did not correlate to residual C-peptide levels. Our data suggest that processes controlling GAD65Ab levels and epitope binding patterns remain stable during the first five years of type 1 diabetes.

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.

Evaluation of a novel radioimmunoassay using 125I-labelled human recombinant GAD65 for the determination of glutamic acid decarboxylase (GAD65) autoantibodies

Autoantibodies to the islet cell 65-kilodalton isoform of glutamic acid decarboxylase (GAD65) are present in most patients with type 1 diabetes mellitus years before the clinical manifestation of the disease. GAD65 autoantibodies are also present in a subset of patients with type 2 diabetes who frequently become insulin dependent. In the present study, we evaluated a new, commercially available radioimmunoprecipitation assay for measuring GAD65 autoantibodies using 125I-labelled human recombinant GAD65. Results obtained with this assay were compared with those obtained by a reference assay based on 35S-labelled recombinant GAD65. Analyses were performed on 67 patients with type I diabetes, 350 with type 2 diabetes, and 150 apparently healthy individuals. An excellent agreement was found between the results obtained by the 125I-GAD65 assay and those obtained by the reference method. The receiver operating characteristic (ROC) curve analysis was used to evaluate the sensitivity and specificity of the two assays. The sensitivity of each assay was determined from the results of the 67 type 1 patients, while the specificity was based on the 150 healthy individuals. Based on the ROC curves, the two assays appeared identical, with a sensitivity of 84% and a clinical specificity of 98%. In conclusion, based on our results, this simple, one-step centrifugation, high-capacity 125I-GAD65 assay has the same sensitivity and specificity as the reference assay and is highly suitable to detect GAD65 autoantibodies in human samples.