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Molina JM, Medina PG, Gomez RA, Herrera JR, Martínez NL, Hernández B, García Y. Autoantibodies against beta cells to predict early insulin requirements in pediatric patients with clinically diagnosed type 2 diabetes. World J Diabetes 2024; 15:1717-1725. [DOI: 10.4239/wjd.v15.i8.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Autoimmunity has emerged as a probable disease modifier in patients with clinically diagnosed type 2 diabetes mellitus (T2DM), that is, patients who have insulin resistance, obesity, and other cardiovascular risk factors, suggesting that the presence of glutamic acid decarboxylase (anti-GAD65), islet antigen 2 (anti-IA2), and zinc transporter 8 (anti-Zn8T) antibodies could have deleterious effects on beta cell function, causing failure and earlier requirement for insulin treatment.
AIM To evaluate anti-GAD65, anti-IA2 and anti-Zn8T as predictors of early insulin requirement in adolescents with a clinical diagnosis of T2DM.
METHODS This was a case–control study in patients with clinically diagnosed with T2DM (68 cases and 64 controls with and without early insulin dependence respectively), male and female, aged 12–18 years. Somatometry, blood pressure, glucose, insulin, C-peptide, glycated hemoglobin A1c, and lipid profiles were assessed. ELISA was used to measure anti-GAD65, anti-IA2, and anti-Zn8T antibodies. Descriptive statistics, Pearson's χ2 test, Student's t test, and logistic regression was performed. P < 0.05 was considered statistically significant.
RESULTS There were 132 patients (53.8% female), with a mean age was 15.9 ± 1.3 years, and there was a disease evolution time of 4.49 ± 0.88 years. The presence of anti-GAD65, anti-IA2, and anti-Zn8T positivity was found in 29.5%, 18.2%, and 15.9%, respectively. Dividing the groups by early or no insulin dependence showed that the group with insulin had a higher frequency of antibody positivity: anti-GAD65 odds ratio (OR): 2.42 (1.112–5.303, P = 0.026); anti-IA2: OR: 1.55 (0.859–2.818, P = 0.105); and anti-Zn8T: OR: 7.32 (2.039–26.279, P = 0.002).
CONCLUSION Anti-GAD65 positivity was high in our study. Anti-GAD65 and anti-Zn8T positivity showed a significantly depleted beta cell reserve phenotype, leading to an increased risk of early insulin dependence.
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Affiliation(s)
- Jorge M Molina
- Department of Endocrinology, Children’s Hospital Federico Gomez, Mexico 06720, Mexico
| | - Patricia G Medina
- Department of Endocrinology, Children’s Hospital Federico Gomez, Mexico 06720, Mexico
| | - Rita A Gomez
- National Medical Center "Siglo XXI", UMAE Hosp Especialidades, Unidad Invest Med Epidemiol Clin, Mexican Social Security Institute, Mexico 06720, Mexico
| | - Julia R Herrera
- Research Division, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico 06720, Mexico
| | - Nancy L Martínez
- Epidemiology Research Unit in Endocrinology and Nutrition, Federico Gómez Children’s Hospital, Mexico 06720, Mexico
| | - Brenda Hernández
- Epidemiology Research Unit in Endocrinology and Nutrition, Federico Gómez Children’s Hospital, Mexico 06720, Mexico
| | - Yesenia García
- Department of Endocrinology, Comprehensive Health Unit for Trans Persons, Mexico 11340, Mexico
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Ansari MA, Chauhan W, Shoaib S, Alyahya SA, Ali M, Ashraf H, Alomary MN, Al-Suhaimi EA. Emerging therapeutic options in the management of diabetes: recent trends, challenges and future directions. Int J Obes (Lond) 2023; 47:1179-1199. [PMID: 37696926 DOI: 10.1038/s41366-023-01369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/04/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
Diabetes is a serious health issue that causes a progressive dysregulation of carbohydrate metabolism due to insufficient insulin hormone, leading to consistently high blood glucose levels. According to the epidemiological data, the prevalence of diabetes has been increasing globally, affecting millions of individuals. It is a long-term condition that increases the risk of various diseases caused by damage to small and large blood vessels. There are two main subtypes of diabetes: type 1 and type 2, with type 2 being the most prevalent. Genetic and molecular studies have identified several genetic variants and metabolic pathways that contribute to the development and progression of diabetes. Current treatments include gene therapy, stem cell therapy, statin therapy, and other drugs. Moreover, recent advancements in therapeutics have also focused on developing novel drugs targeting these pathways, including incretin mimetics, SGLT2 inhibitors, and GLP-1 receptor agonists, which have shown promising results in improving glycemic control and reducing the risk of complications. However, these treatments are often expensive, inaccessible to patients in underdeveloped countries, and can have severe side effects. Peptides, such as glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), are being explored as a potential therapy for diabetes. These peptides are postprandial glucose-dependent pancreatic beta-cell insulin secretagogues and have received much attention as a possible treatment option. Despite these advances, diabetes remains a major health challenge, and further research is needed to develop effective treatments and prevent its complications. This review covers various aspects of diabetes, including epidemiology, genetic and molecular basis, and recent advancements in therapeutics including herbal and synthetic peptides.
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Affiliation(s)
- Mohammad Azam Ansari
- Department of Epidemic Disease Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia.
| | - Waseem Chauhan
- Department of Hematology, Duke University, Durham, NC, 27710, USA
| | - Shoaib Shoaib
- Department of Biochemistry, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sami A Alyahya
- Wellness and Preventive Medicine Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh, 11442, Saudi Arabia
| | - Mubashshir Ali
- USF Health Byrd Alzheimer's Center and Neuroscience Institute, Department of Molecular Medicine, Tampa, FL, USA
| | - Hamid Ashraf
- Rajiv Gandhi Center for Diabetes and Endocrinology, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad N Alomary
- Advanced Diagnostic and Therapeutic Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh, 11442, Saudi Arabia.
| | - Ebtesam A Al-Suhaimi
- King Abdulaziz & his Companions Foundation for Giftedness & Creativity, Riyadh, Saudi Arabia.
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Yang L, Zhang X, Liu Q, Wen Y, Wang Q. Update on the ZNT8 epitope and its role in the pathogenesis of type 1 diabetes. Minerva Endocrinol (Torino) 2023; 48:447-458. [PMID: 38099391 DOI: 10.23736/s2724-6507.22.03723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Type 1 diabetes (T1D) is an organ-specific chronic autoimmune disease mediated by autoreactive T cells. ZnT8 is a pancreatic islet-specific zinc transporter that is mainly located in β cells. It not only participates in the synthesis, storage and secretion of insulin but also maintains the structural integrity of insulin. ZnT8 is the main autoantigen recognized by autoreactive CD8+ T cells in children and adults with T1D. This article summarizes the latest research results on the T lymphocyte epitope and B lymphocyte epitope of ZnT8 in the current literature. The structure and expression of ZnT8, the role of ZnT8 in insulin synthesis and its role in autoimmunity are reviewed. ZnT8 is the primary autoantigen of T1D and is specifically expressed in pancreatic islets. Thus, it is one of biomarkers for the diagnosis of T1D. It has broad prospects for further research on immunomodulators for the treatment of T1D.
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Affiliation(s)
- Liu Yang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xuejiao Zhang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Liu
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Wen
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Wang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China -
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Bulum T, Vučić Lovrenčić M, Knežević Ćuća J, Tomić M, Vučković-Rebrina S, Duvnjak L. Relationship between β-Cell Autoantibodies and Their Combination with Anthropometric and Metabolic Components and Microvascular Complications in Latent Autoimmune Diabetes in Adults. Biomedicines 2023; 11:2561. [PMID: 37761002 PMCID: PMC10526032 DOI: 10.3390/biomedicines11092561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS Our study aimed to investigate the relationship between three autoantibodies and their combination with anthropometric and metabolic components and microvascular complications in patients with latent autoimmune diabetes in adults (LADA). METHODS Our study included 189 LADA patients divided into four subgroups according to the autoantibodies present: glutamic acid decarboxylase autoantibodies (GADA) only; zinc transporter-8 autoantibodies (ZnT8A)+GADA; insulinoma-associated-2 autoantibodies (IA-2)+GADA; and ZnT8+IA-2+GADA. RESULTS Compared to GADA positivity only, patients with ZnT8+GADA positivity and ZnT8+IA-2+GADA positivity had a shorter diabetes duration and lower body mass index (BMI); patients with ZnT8+GADA positivity were younger and showed an increase in glomerular filtration rate, while those with ZnT8+IA-2+GADA positivity had lower C-peptide and lower insulin resistance measured with HOMA2-IR. In a multiple regression analysis, ZnT8 positivity was associated with lower BMI (p = 0.0024), female sex (p = 0.0005), and shorter duration of disease (p = 0.0034), while IA-2 positivity was associated with lower C-peptide levels (p = 0.0034) and shorter diabetes duration (p = 0.02). No association between antibody positivity and microvascular complications of diabetes, including retinopathy, neuropathy, and microalbuminuria, as well as with variables of glucose control and β-cell function were found. CONCLUSION The results of our study suggest that ZnT8 and IA-2 autoantibodies are present in a significant number of LADA patients and associated with clinical and metabolic characteristics resembling classic type 1 diabetes. Due to increased LADA prevalence, earlier identification of patients requiring frequent monitoring with the earlier intensification of insulin therapy might be of special clinical interest.
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Affiliation(s)
- Tomislav Bulum
- Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- Medical School, University of Zagreb, 10000 Zagreb, Croatia
| | - Marijana Vučić Lovrenčić
- Clinical Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
- Scientific Research Unit, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Jadranka Knežević Ćuća
- Clinical Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Sandra Vučković-Rebrina
- Department of Neurology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Lea Duvnjak
- Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- Medical School, University of Zagreb, 10000 Zagreb, Croatia
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Chandran L, Singh S A, Vellapandian C. Diagnostic Dilemmas and Current Treatment Approaches in Latent Onset Autoimmune Diabetes in Adults: A Concise Review. Curr Diabetes Rev 2023; 19:1-9. [PMID: 35331118 DOI: 10.2174/1573399818666220324095918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
Latent Onset Autoimmune Diabetes in Adults (LADA) is an autoimmune disorder between T1DM and T2DM and is often misdiagnosed as T2DM due to its late-onset. The disease is characterized by β-cell failure and slow progression to insulin dependence. Early diagnosis is significant in limiting disease progression. C-peptide levels and autoantibodies against β-cells are the most critical diagnostic biomarkers in LADA. The review aims to provide an overview of the biomarkers used to diagnose LADA, and the following treatment approaches. We have summarized LADA's pathophysiology and the autoantibodies involved in the condition, diagnostic approaches, and challenges. There are clear shortcomings concerning the feasibility of autoantibody testing. Finally, we have explored the treatment strategies involved in the management of LADA. In conclusion, the usual management includes treatment with metformin and the addition of low doses of insulin. Newer oral hypoglycaemic agents, such as GLP-1RA and DPP-4 inhibitors, have been brought into use. Since the disease is not entirely understood at the research level and in clinical practice, we hope to encourage further research in this field to assess its prevalence. Large randomized controlled trials are required to compare the efficacy of different available treatment options.
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Affiliation(s)
- Lakshmi Chandran
- Department of Pharmacy Practice, SRM Institute of Science and Technology (SRMIST) (Formerly SRM University), Kattankulathur, Chengalpattu District, Chennai - 603203, Tamilnadu, India
| | - Ankul Singh S
- Department of Pharmacology, SRM Institute of Science and Technology (SRMIST) (Formerly SRM University), Kattankulathur, Chengalpattu District, Chennai - 603203, Tamilnadu, India
| | - Chitra Vellapandian
- Department of Pharmacology, SRM Institute of Science and Technology (SRMIST) (Formerly SRM University), Kattankulathur, Chengalpattu District, Chennai - 603203, Tamilnadu, India
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Miller A, Joseph S, Badran A, Umpaichitra V, Bargman R, Chin VL. Increased Rates of Hospitalized Children with Type 1 and Type 2 Diabetes Mellitus in Central Brooklyn during the COVID-19 Pandemic. Int J Pediatr 2023; 2023:4580809. [PMID: 37101938 PMCID: PMC10125760 DOI: 10.1155/2023/4580809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/17/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023] Open
Abstract
Following reports of increased new-onset diabetes and worse severity of DKA for children with diabetes following SARS-CoV-2 infection, we studied hospitalization rates for children with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in our center during the citywide shutdown. Methods. We conducted a retrospective chart review of children admitted to our two hospitals from January 1, 2018, to December 31, 2020. We included ICD-10 codes for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS), and hyperglycemia only. Results. We included 132 patients with 214 hospitalizations: 157 T1DM, 41 T2DM, and 16 others (14 steroid induced, 2 MODY). Overall admissions rates for patients with all types of diabetes were 3.08% in 2018 to 3.54% in 2019 (p = 0.0120) and 4.73% in 2020 (p = 0.0772). Although there was no increase of T1DM admissions across all 3 years, T2DM admission rates increased from 0.29% to 1.47% (p = 0.0056). Newly diagnosed T1DM rates increased from 0.34% in 2018 to 1.28% (p = 0.002) in 2020, and new-onset T2DM rates also increased from 0.14% in 2018 to 0.9% in 2020 (p = 0.0012). Rates of new-onset diabetes presenting with DKA increased from 0.24% in 2018 to 0.96% in 2020 (p = 0.0014). HHS increased from 0.1% in 2018 to 0.45% in 2020 (p = 0.044). The severity of DKA in newly diagnosed was unaffected (p = 0.1582). Only 3 patients tested positive for SARS-CoV-2 infection by PCR. Conclusion. Our urban medical center is located in Central Brooklyn and serves a majority who are Black. This is the first study investigating pediatric diabetes cases admitted to Brooklyn during the first wave of the pandemic. Despite the overall pediatric admissions declining in 2020 due to the citywide shutdown, overall hospitalization rates in children with T2DM and in new-onset T1DM and T2DM increased, which is not directly associated with active SARS-CoV-2 infection. More studies are needed to elucidate the reason for this observed increase in hospitalization rates.
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Affiliation(s)
- Assia Miller
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Shalu Joseph
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Ahmed Badran
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Vatcharapan Umpaichitra
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Renee Bargman
- New York City/Health+Hospitals Corporation, Kings County Hospital, Brooklyn, NY 11203, USA
| | - Vivian L. Chin
- Department of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
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Higgins J, Zeitler P, Drews KL, Arslanian S, Copeland K, Goland R, Klingensmith G, Lipman TH, Tollefsen S. ZnT8 autoantibody prevalence is low in youth with type 2 diabetes and associated with higher insulin sensitivity, lower insulin secretion, and lower disposition index. J Clin Transl Endocrinol 2022; 29:100300. [PMID: 35601597 PMCID: PMC9120949 DOI: 10.1016/j.jcte.2022.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/25/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
Aim ZnT8 autoantibody positivity (ZnT8+) is associated with risk for type 1 diabetes and with metabolic complications in adults. Our aim was to assess prevalence of ZnT8 + in the Treatment of T2D in Adolescents and Youth (TODAY) cohort and describe associated phenotypic outcomes. Methods TODAY participants were 13.98 ± 2.03 years with a confirmed diagnosis of T2D, BMI percentile of 97.69 ± 3.32 (64% female), and GAD- and IA2- at baseline. ZnT8 autoantibodies were measured at baseline and end of study. Results 3 of 687 participants (0.29%) were ZnT8 + and there was one conversion (0.15%) from ZnT8- to ZnT8 + during the study. ZnT8A + individuals had higher HbA1c, HDL and LDL cholesterol, and IL-1β concentrations, and lower BMI, IL-6, and triglyceride concentrations compared to the TODAY cohort and ZnT8A- individuals. They also had higher insulin sensitivity with lower insulin secretion and disposition index, metabolically resembling T1D. All ZnT8 + participants experienced loss of glycemic control on randomized treatment, but exhibited lower rates of diabetic complications than other groups. Conclusion Given the low rate of complications in ZnT8 + individuals, ZnT8 likely does not impact the clinical course of the disease in this population.
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Affiliation(s)
- Janine Higgins
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Philip Zeitler
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kimberly L. Drews
- George Washington University Biostatistics Center, Rockville, United States
| | - Silva Arslanian
- UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kenneth Copeland
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Robin Goland
- Columbia University, New York, NY, United States
| | | | - Terri H. Lipman
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sherida Tollefsen
- Saint Louis University Health Sciences Center, Saint Louis, MO, United States
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Qiu J, Xiao Z, Zhang Z, Luo S, Zhou Z. Latent autoimmune diabetes in adults in China. Front Immunol 2022; 13:977413. [PMID: 36090989 PMCID: PMC9454334 DOI: 10.3389/fimmu.2022.977413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a type of diabetes caused by slow progression of autoimmune damage to pancreatic beta cells. According to the etiological classification, LADA should belong to the autoimmune subtype of type 1 diabetes (T1D). Previous studies have found general immune genetic effects associated with LADA, but there are also some racial differences. Multicenter studies have been conducted in different countries worldwide, but it is still unclear how the Chinese and Caucasian populations differ. The epidemiology and phenotypic characteristics of LADA may vary between Caucasian and Chinese diabetic patients as lifestyle, food habits, and body mass index differ between these two populations. The prevalence of LADA in China has reached a high level compared to other countries. The prevalence of LADA in China has reached a high level compared to other countries, and the number of patients with LADA ranks first in the world. Previous studies have found general immune genetic effects associated with LADA, but some racial differences also exist. The prevalence of LADA among newly diagnosed type 2 diabetes patients over the age of 30 years in China is 5.9%, and LADA patients account for 65% of the newly diagnosed T1D patients in the country. As a country with a large population, China has many people with LADA. A summary and analysis of these studies will enhance further understanding of LADA in China. In addition, comparing the similarities and differences between the Chinese and the Caucasian population from the perspectives of epidemiology, clinical, immunology and genetics will help to improve the understanding of LADA, and then promote LADA studies in individual populations.
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Xenou M, Zoupas I, Lygnos D, Fousteris E. Diabetic ketoacidosis as first presentation of latent autoimmune diabetes in adults in a patient with hashitoxicosis as first presentation of Hashimoto's thyroiditis: a case report. J Med Case Rep 2022; 16:297. [PMID: 35918735 PMCID: PMC9347147 DOI: 10.1186/s13256-022-03523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Latent autoimmune diabetes in adults is an infrequent form of autoimmune diabetes mellitus, while Hashimoto’s thyroiditis, the most common thyroid disease in adults, rarely manifests as thyrotoxicosis. The concurrent initial presentation of these two autoimmune disorders is extremely rare. Case presentation A 29-year-old male of Albanian descent presented after being hospitalized owing to diabetic ketoacidosis. The diagnosis of type 1 diabetes mellitus was placed, and intensified insulin therapy was initiated. Medical history was not of significance except a 5 kg weight loss within 2 months. The patient presented with recurrent episodes of hypoglycemia, and the doses of preprandial and basal insulin were reduced. The differential diagnosis included type 1 diabetes mellitus “honeymoon” period or another type of diabetes mellitus. His serological tests only revealed positive autoantibodies against glutamic acid decarboxylase 65 and C-peptide. The diagnosis leaned toward latent autoimmune diabetes in adults, and the therapeutic approach involved cessation of preprandial insulin therapy, regulation, and subsequent discontinuation of basal insulin and introduction of metformin. Two years later, basal insulin was reintroduced along with a glucagon-like peptide-receptor agonist and metformin. Further physical examination during the initial visit disclosed upper limb tremor, lid lag, excessive sweating, increased sensitivity to heat, and tachycardia. Laboratory tests were indicative of hashitoxicosis (suppressed level of thyroid-stimulating hormone, high levels of total and free thyroid hormones, positive anti-thyroglobulin and anti-thyroid peroxidase, and negative anti-thyroid-stimulating hormone receptor). Thyroid-stimulating hormone level was spontaneously restored, but an increase was observed during follow-up. Levothyroxine was administrated for 2 years until the patient had normal thyroid function. Conclusions The prevalence of thyroid autoantibodies in patients with latent autoimmune diabetes in adults ranges from 20% to 30%. This correlation can be attributed to genetic involvement as well as disorders of immune tolerance to autoantigens. Hence, this report gives prominence to the holistic approach and consideration of comorbidities in patients with diabetes mellitus.
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Affiliation(s)
- Maria Xenou
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece.,Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zoupas
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece. .,Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitrios Lygnos
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece
| | - Evangelos Fousteris
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece
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Costa JR, Mestre A, Miranda MS, Ferreira FH, Abuowda Y. A Case of Late Diagnosis of Latent Autoimmune Diabetes in Adults. Cureus 2022; 14:e21826. [PMID: 35282513 PMCID: PMC8904035 DOI: 10.7759/cureus.21826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/05/2022] Open
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Wang Z, Guo L, Chen S, Guan J, Powell M, Furmaniak J, Rees Smith B, Chen L. Characteristic phenotype of Chinese patients with adult-onset diabetes who are autoantibody positive by 3-Screen ICA™ ELISA. Acta Diabetol 2022; 59:189-196. [PMID: 34533636 PMCID: PMC8841311 DOI: 10.1007/s00592-021-01778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023]
Abstract
AIMS To assess the prevalence of diabetes-associated autoantibodies in Chinese patients recently diagnosed with adult-onset diabetes and to evaluate the potential role of the autoantibody markers for characterization of disease phenotype in the patient population. METHODS The study included 1273 recent-onset adult patients with phenotypic type 2 diabetes mellitus (T2DM). Serum samples were tested using the 3-Screen ICA™ ELISA (3-Screen) designed for combined measurement of GADAb and/or IA-2Ab and/or ZnT8Ab. 3-Screen positive samples were then tested for individual diabetes-associated and other organ-specific autoantibodies. Clinical characteristics of patients positive and negative in 3-Screen were analysed. RESULTS Forty-four (3.5%) of the T2DM patients were positive in 3-Screen, and 38 (86%) of these were also positive for at least one of GADAb, IA-2Ab and ZnT8Ab in assays for the individual autoantibodies. 3-Screen positive patients had lower BMI, higher HbA1c, lower fasting insulin levels and lower fasting C-peptide levels compared to 3-Screen negative patients. Analysis using a homeostatic model assessment (HOMA2) indicated that HOMA2-β-cell function was significantly lower for the forty-four 3-Screen positive patients compared to 3-Screen negative patients. Twenty (45%) 3-Screen positive patients were also positive for at least one thyroid autoantibody. CONCLUSIONS The 3-Screen ELISA has been used successfully for the first time in China to detect diabetes autoantibodies in patients with phenotypic T2DM. 3-Screen positive patients presented with poorer β cell function.
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Affiliation(s)
- Zhida Wang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Liang Guo
- FIRS Laboratories, RSR Ltd Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
| | - Shu Chen
- FIRS Laboratories, RSR Ltd Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
- RSR Tianjin Biotech Ltd, Haitai Green Area, Hi Huayuan Industrial Park, Tianjin, 300384, China
| | - Jun Guan
- RSR Tianjin Biotech Ltd, Haitai Green Area, Hi Huayuan Industrial Park, Tianjin, 300384, China
| | - Michael Powell
- FIRS Laboratories, RSR Ltd Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
| | - Jadwiga Furmaniak
- FIRS Laboratories, RSR Ltd Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
| | - Bernard Rees Smith
- FIRS Laboratories, RSR Ltd Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
- RSR Tianjin Biotech Ltd, Haitai Green Area, Hi Huayuan Industrial Park, Tianjin, 300384, China
| | - Liming Chen
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
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12
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Fakhfakh R, Kmiha S, Tahri S, Feki S, Zouidi F, Abida O, Hachicha M, Kammoun T, Masmoudi H. Autoantibodies to Zinc Transporter 8 and SLC30A8 Genotype in Type 1 Diabetes Childhood: A Pioneering Study in North Africa. J Diabetes Res 2022; 2022:2539871. [PMID: 35656360 PMCID: PMC9152414 DOI: 10.1155/2022/2539871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/22/2022] [Accepted: 04/29/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) occurs as a result of insulin deficiency due to destructive lesions of pancreatic β cells. In addition to classical autoantibodies (Abs) to islet cell antigens, antizinc transporter 8 Abs (ZnT8-Ab) have been recently described in T1D. OBJECTIVE As no data on ZnT8-Ab in Tunisian patients has been reported, we aim to evaluate the relationships between ZnT8-Ab, ZnT8 coding gene (SLC30A8) promoter polymorphism, and T1D risk in newly diagnosed children. METHODS ZnT8-Ab were measured in the serum of T1D newly affected children (n = 156) who were admitted to the pediatric department of the Hedi Chaker University Hospital of Sfax. Rs13266634 was genotyped in T1D children and 79 of their first-degree parents. The SPSS software was used to analyze the serological data. Allelic association analysis was conducted with family-based association tests implemented in the FBAT program v1.5.1. RESULTS ZnT8-Ab was detected in 66/156 (42.3%) of T1D newly diagnosed children. Among them, 6 (9%) presented ZnT8-Ab as the only humoral marker. The inclusion of ZnT8-Ab increased the number of Ab-positive patients to 90% and reduced the negative ones by 27%. There was no evidence of any overtransmission of any allele of the rs13266634 C/T polymorphism from parents to affected T1D children, nor of any correlation with any clinical or serological parameter. After the T1D disease onset age adjustment, a significant association was observed with the C allele suggesting that it could have a susceptibility role. CONCLUSION ZnT8-Ab appears as a relevant diagnostic marker for T1D in Tunisian children, especially at the onset of the disease as teenagers.
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Affiliation(s)
- Raouia Fakhfakh
- Autoimmunity, Cancer, And Immunogenetics Research Laboratory, University Hospital Habib Bourguiba of Sfax, Tunisia
| | - Sana Kmiha
- Pediatrics Department, University Hospital Hedi Chaker of Sfax, Tunisia
| | - Safa Tahri
- Autoimmunity, Cancer, And Immunogenetics Research Laboratory, University Hospital Habib Bourguiba of Sfax, Tunisia
| | - Sawsan Feki
- Autoimmunity, Cancer, And Immunogenetics Research Laboratory, University Hospital Habib Bourguiba of Sfax, Tunisia
| | - Ferjeni Zouidi
- Autoimmunity, Cancer, And Immunogenetics Research Laboratory, University Hospital Habib Bourguiba of Sfax, Tunisia
| | - Olfa Abida
- Autoimmunity, Cancer, And Immunogenetics Research Laboratory, University Hospital Habib Bourguiba of Sfax, Tunisia
| | - Mongia Hachicha
- Pediatrics Department, University Hospital Hedi Chaker of Sfax, Tunisia
| | - Thouraya Kammoun
- Pediatrics Department, University Hospital Hedi Chaker of Sfax, Tunisia
| | - Hatem Masmoudi
- Autoimmunity, Cancer, And Immunogenetics Research Laboratory, University Hospital Habib Bourguiba of Sfax, Tunisia
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13
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González-Villar F, Pérez-Bravo F. Determination of autoantibodies in dogs with diabetes mellitus. Vet World 2021; 14:2694-2698. [PMID: 34903927 PMCID: PMC8654766 DOI: 10.14202/vetworld.2021.2694-2698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: The classification of diabetes mellitus (DM) in dogs has been controversial as currently canine insulin-dependent DM is classified together with absolute insulin deficiency, non-insulin-dependent DM, and relative insulin deficiency. Studies on human autoantibodies evaluated in canines with DM, such as anti-glutamic acid decarboxylase (GAD65), anti-islet antigen 2 (IA2), and anti-zinc transporter isoform 8 (ZnT8), have been inconclusive. Thus, this study was designed to establish the serological profile of anti-GAD65, anti-IA2, and anti-ZnT8 antibodies in a group of dogs with and without DM. Materials and Methods: Sixty-one dogs, including 31 patients with DM (with and without insulin treatment) and 30 patients without DM (normal weight and obese), were included for determining autoantibodies using a human enzyme-linked immunosorbent assay (ELISA) detection system for type 1 DM. Results: This study found the presence of anti-IA2 antibodies in 58% of the sample (18/31 patients with DM); however, the presence of anti-GAD65 was not detected, and anti-ZnT8 was found in 3 (9.6%) patients with DM. Conclusion: This study showed a higher positive frequency of anti-IA2 antibodies in a sample of canine with DM, indicating that alterations in the signaling vesicle tyrosine phosphatase 2 lead to lower insulin release and thus to an increase in patients’ glycemia. These preliminary results should be taken with caution and corroborated by a canine-specific assay when an ELISA is available for such determination.
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Affiliation(s)
- Franco González-Villar
- Doctoral Program in Silvoagropecuary and Veterinary Sciences, University of Chile, South Campus, 11315 Santa Rosa, La Pintana, Santiago, Chile
| | - Francisco Pérez-Bravo
- Department of Nutrition, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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14
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Zhang M, Wang X, Wang R, Shu J, Zhi X, Gu C, Pu L, Cai C, Yang W, Lv L. Clinical study of autoantibodies in type 1 diabetes mellitus children with ketoacidosis or microalbuminuria. J Clin Lab Anal 2021; 36:e24164. [PMID: 34861060 PMCID: PMC8761425 DOI: 10.1002/jcla.24164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
Aims The study aimed to investigate the value of autoantibodies in predicting the risk of ketoacidosis or microalbuminuria in children with type 1 diabetes mellitus. Methods Clinical data and laboratory indicators of 80 patients with type 1 diabetes admitted to the Department of Endocrinology in Tianjin Children's Hospital, from June 2017 to March 2019, were retrospectively analyzed. The patients were divided into two groups: diabetes without ketoacidosis group (n = 20) and diabetes with ketoacidosis group (n = 60). The differences in general data, laboratory test indexes, and autoantibodies between the two groups were analyzed. Finally, ROC curves and multivariate logistic regression analysis were used to explore the value of autoantibodies in patients with ketoacidosis or microalbuminuria. Results A total of 80 children with type 1 diabetes were assessed, including 35 boys and 45 girls, ranging in age from 10 months to 15 years. The concentration of GADA, IA2A, and ZnT8A was not statistically different between the two groups, but the positive rate of ZnT8A was statistically significant (p = 0.038) and had a diagnostic value for the occurrence of ketoacidosis (p = 0.025). ZnT8A‐positive patients had a higher titer of IA2A and a more frequent prevalence of GADA and IA2A than ZnT8A‐negative patients (p < 0.01). In multivariate logistic regression analyses, the presence of positive ZnT8A was associated with a higher risk of microalbuminuria independent of age, sex, and BMI (OR = 4.184 [95% CI 1.034~16.934], p = 0.045). Conclusions The positive ZnT8A had diagnostic value for ketoacidosis in children with type 1 diabetes and had the highest specificity among the three kinds of autoantibodies. Moreover, ZnT8A positivity was related to a higher titer of IA2A and more frequent occurrence of multiple diabetes‐related autoantibodies. Besides, the presence of positive ZnT8A was an independent risk factor of microalbuminuria in children with type 1 diabetes. Therefore, we can infer that positive ZnT8A may be related to ketoacidosis and microalbuminuria, accelerating the progression of T1DM.
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Affiliation(s)
- Mingying Zhang
- Department of Pediatric Endocrinology, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Xinhui Wang
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Rui Wang
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Jianbo Shu
- Institute of Pediatric (Tianjin Key Laboratory of Birth Defects for Prevention and Treatment), Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Xiufang Zhi
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Chunyu Gu
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Linjie Pu
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Chunquan Cai
- Institute of Pediatric (Tianjin Key Laboratory of Birth Defects for Prevention and Treatment), Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China.,Department of Pediatric Neurosurgery, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Wei Yang
- Tianjin Medical Device Evaluation and Inspection Center, Tianjin, China
| | - Ling Lv
- Department of Pediatric Endocrinology, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
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15
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Bhola S, Cave EM, Bhana S, Crowther NJ, Padoa CJ. Zinc transporter 8 (ZnT8) autoantibody prevalence in black South African participants with type 1 diabetes. BMC Endocr Disord 2021; 21:151. [PMID: 34271898 PMCID: PMC8285837 DOI: 10.1186/s12902-021-00812-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Autoantibodies to β-cell specific antigens are markers of type 1 diabetes. The most recently identified autoantibodies are targeted to the zinc transporter 8 (ZnT8) protein located in the membrane of β-cell insulin secretory granules. The prevalence of ZnT8 autoantibodies in newly diagnosed participants with type 1 diabetes has been found to range from 33 to 80 %. Due to the lack of data on the immunological aetiology of type 1 diabetes in African populations, this study aimed to determine the prevalence of ZnT8 autoantibodies in black South Africans with type 1 diabetes and whether ZnT8 autoantibody positivity was associated with age at diagnosis and disease duration. METHODS Participants with type 1 diabetes and controls were recruited from the greater Johannesburg area, South Africa. Positivity for ZnT8, GAD65 and IA2 autoantibodies was determined by ELISA. RESULTS Participants with type 1 diabetes (n = 183) and controls (n = 49) were matched for age (29.1 ± 9.53 vs. 27.3 ± 7.29, respectively; p = 0.248). The mean age at diagnosis for participants with type 1 diabetes was 20.8 ± 8.46 years. The prevalence of ZnT8 autoantibody positivity was 17.5 % (32 of 183) in participants with type 1 diabetes with a median disease duration of 7.00 [2.00; 11.0] years. ZnT8 autoantibody prevalence in newly diagnosed participants (< 1 year duration) was 27.3 % (6 of 22). Logistic regression analysis found an association between ZnT8 autoantibody positivity and shorter disease duration (OR: 0.9 (0.81-1.00); p = 0.042). In addition, ZnT8 autoantibody positivity was significantly associated with an increased chance of being GAD65 (OR: 3.37 (1.10-10.3)) and IA2 (OR: 8.63 (2.82-26.4)) autoantibody positive. Multiple regression analysis found no association between ZnT8 autoantibody positivity and age at diagnosis. However, the presence of ≥ 2 autoantibodies was associated with a younger age at diagnosis of type 1 diabetes when compared to participants with ≤ 1 autoantibody (B = -5.270; p = 0.002). CONCLUSIONS The presence of ZnT8 autoantibodies was not related to a younger age at diagnosis in black South African patients with type 1 diabetes. However, the greater the numbers of autoantibodies present in an individual the earlier the age at diagnosis. ZnT8 autoantibodies decline with disease duration in the black South African population.
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Affiliation(s)
- Sureka Bhola
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- National Health Laboratory Service, Johannesburg, South Africa.
| | - Eleanor M Cave
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sindeep Bhana
- Department of Medicine, Chris Hani Baragwanath Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | - Carolyn J Padoa
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
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Jones AG, McDonald TJ, Shields BM, Hagopian W, Hattersley AT. Latent Autoimmune Diabetes of Adults (LADA) Is Likely to Represent a Mixed Population of Autoimmune (Type 1) and Nonautoimmune (Type 2) Diabetes. Diabetes Care 2021; 44:1243-1251. [PMID: 34016607 PMCID: PMC8247509 DOI: 10.2337/dc20-2834] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/11/2021] [Indexed: 02/03/2023]
Abstract
Latent autoimmune diabetes of adults (LADA) is typically defined as a new diabetes diagnosis after 35 years of age, presenting with clinical features of type 2 diabetes, in whom a type 1 diabetes-associated islet autoantibody is detected. Identifying autoimmune diabetes is important since the prognosis and optimal therapy differ. However, the existing LADA definition identifies a group with clinical and genetic features intermediate between typical type 1 and type 2 diabetes. It is unclear whether this is due to 1) true autoimmune diabetes with a milder phenotype at older onset ages that initially appears similar to type 2 diabetes but later requires insulin, 2) a disease syndrome where the pathophysiologies of type 1 and type 2 diabetes are both present in each patient, or 3) a heterogeneous group resulting from difficulties in classification. Herein, we suggest that difficulties in classification are a major component resulting from defining LADA using a diagnostic test-islet autoantibody measurement-with imperfect specificity applied in low-prevalence populations. This yields a heterogeneous group of true positives (autoimmune type 1 diabetes) and false positives (nonautoimmune type 2 diabetes). For clinicians, this means that islet autoantibody testing should not be undertaken in patients who do not have clinical features suggestive of autoimmune diabetes: in an adult without clinical features of type 1 diabetes, it is likely that a single positive antibody will represent a false-positive result. This is in contrast to patients with features suggestive of type 1 diabetes, where false-positive results will be rare. For researchers, this means that current definitions of LADA are not appropriate for the study of autoimmune diabetes in later life. Approaches that increase test specificity, or prior likelihood of autoimmune diabetes, are needed to avoid inclusion of participants who have nonautoimmune (type 2) diabetes. Improved classification will allow improved assignment of prognosis and therapy as well as an improved cohort in which to analyze and better understand the detailed pathophysiological components acting at onset and during disease progression in late-onset autoimmune diabetes.
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Affiliation(s)
- Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
- MacLeod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
| | - Timothy J McDonald
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
- Blood Sciences, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
| | | | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
- MacLeod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
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17
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Moosaie F, Meftah N, Deravi N, Abouhamzeh K, Firouzabadi FD, Khaloo P, Mansournia MA, Fatemi Abhari SM, Nakhjavani M, Esteghamati A. Prevalence of diabetes-associated autoantibodies among patients presenting with type 2 diabetes and related metabolic differences. Prim Care Diabetes 2021; 15:169-174. [PMID: 32798203 DOI: 10.1016/j.pcd.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To explores the prevalence of autoantibodies (zinc transporter 8 autoantibodies (ZnT8A), antibodies to insulin (IAAs), glutamic acid decarboxylase autoantibody (GAD65)), the relation of the type of positive autoantibody and the number of positive autoantibodies with the glycemic and lipid profile of the patients with LADA (Latent Autoimmune Diabetes in Adults) and compares it to the metabolic profile of patients presenting with type 2 diabetes (T2DM). METHODS 263 patients with T2DM were recruited for this cross-sectional study in Tehran, Iran. Data from patients included complete medical history, GAD65, ZnT8A, IAA and routine metabolic laboratory workup. Assay for autoantibodies were conducted using ELISA kits. The association between autoantibodies and glycemic and lipid profile of patients with diabetes was assessed using univariate and multivariate regression analysis. RESULTS Our study revealed that among 263 patients with T2DM, 29 (11%) cases were positive for IAAs, 9 (3.4%) for ZnT8A, and 12 (4.6%) for GAD65. Six (2.3%) of the patients had triple positive antibodies. Patients with positive results were younger, had lower body mass index (BMI), c-peptide, triglyceride, low-density lipoprotein (LDL), and higher high-density lipoprotein (HDL), HbA1c and fasting blood glucose (FBG) levels. Triple antibody positivity was significantly associated with lower levels of C-Peptide, Triglycerides, FBG, and HbA1c compared to triple negative antibodies. CONCLUSION Patients with LADA positive for either of the autoantibodies (GAD65, ZnT8 and IAA) presented with worse glycemic control. Measurement of these autoantibodies can assist in discrimination of these patients and help with earlier control of glycemic profile.
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Affiliation(s)
- Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Meftah
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Student's Research committee, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kosar Abouhamzeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Baumann K, Kesselring K, Lampasona V, Walschus U, Kerner W, Wassmuth R, Schlosser M. Autoantibodies against zinc transporter 8 further stratify the autoantibody-defined risk for type 1 diabetes in a general population of schoolchildren and have distinctive isoform binding patterns in different forms of autoimmune diabetes: results from the Karlsburg Type 1 Diabetes Risk Study. Diabet Med 2021; 38:e14389. [PMID: 32799407 DOI: 10.1111/dme.14389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate the diagnostic relevance of autoantibodies against zinc transporter 8 (ZnT8) in schoolchildren from the general population as well as in people with autoimmune diabetes. METHODS A total of 137 schoolchildren positive for at least one of the three major diabetes-associated autoantibodies, without diabetes heredity or preselection on HLA typing, from the Karlsburg Type 1 Diabetes Risk Study, as well as 102 people at type 1 diabetes onset, 88 people with latent autoimmune diabetes in adults and 119 people with type 2 diabetes, were analysed for different ZnT8 autoantibody variants. RESULTS Zinc transporter 8 autoantibody positivity was found in 18% of autoantibody-positive schoolchildren, with a noticeable association with other autoantibodies associated with type 1 diabetes and disease progression. Furthermore, ZnT8 autoantibody positivity was associated with diabetes progression in schoolchildren positive for autoantibodies against insulinoma-associated antigen-2 (IA-2) and, importantly, in seven IA-2 autoantibody-negative schoolchildren. Additionally, ZnT8 autoantibodies were found in 56% of people with type 1 diabetes, predominantly directed against all three ZnT8 variants and comparable to schoolchildren with multiple autoantibodies. In contrast, ZnT8 autoantibodies were detected in 10% of people with latent autoimmune diabetes in adults, none of them with reactivity to all three isoforms. CONCLUSION Zinc transporter 8 autoantibodies are useful markers for prediction of type 1 diabetes in a general population, further stratifying the risk of progression in autoantibody-positive children. ZnT8 autoantibodies are also important markers in adult-onset diabetes, with a completely different reaction pattern in type 1 diabetes in comparison to latent autoimmune diabetes in adults, and may therefore help to differentiate between the two forms.
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Affiliation(s)
- K Baumann
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medical Center Greifswald, Greifswald, Germany
| | - K Kesselring
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medical Center Greifswald, Greifswald, Germany
| | - V Lampasona
- Diabetes Research Institute (SR-DRI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - U Walschus
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medical Center Greifswald, Greifswald, Germany
| | - W Kerner
- Center of Diabetes and Metabolic Disorders, Karlsburg, Germany
| | - R Wassmuth
- Department of Quality Management, University Medical Center Duesseldorf, Duesseldorf, Germany
| | - M Schlosser
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medical Center Greifswald, Greifswald, Germany
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Abstract
Diabetes mellitus is a chronic heterogeneous metabolic disorder with complex pathogenesis. It is characterized by elevated blood glucose levels or hyperglycemia, which results from abnormalities in either insulin secretion or insulin action or both. Hyperglycemia manifests in various forms with a varied presentation and results in carbohydrate, fat, and protein metabolic dysfunctions. Long-term hyperglycemia often leads to various microvascular and macrovascular diabetic complications, which are mainly responsible for diabetes-associated morbidity and mortality. Hyperglycemia serves as the primary biomarker for the diagnosis of diabetes as well. In this review, we would be focusing on the classification of diabetes and its pathophysiology including that of its various types.
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Affiliation(s)
- Mujeeb Z Banday
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh Hospital, Srinagar, Kashmir, India
| | - Aga S Sameer
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Centre, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Saniya Nissar
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh Hospital, Srinagar, Kashmir, India
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Buzzetti R, Tuomi T, Mauricio D, Pietropaolo M, Zhou Z, Pozzilli P, Leslie RD. Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes 2020; 69:2037-2047. [PMID: 32847960 PMCID: PMC7809717 DOI: 10.2337/dbi20-0017] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
A substantial proportion of patients with adult-onset diabetes share features of both type 1 diabetes (T1D) and type 2 diabetes (T2D). These individuals, at diagnosis, clinically resemble T2D patients by not requiring insulin treatment, yet they have immunogenetic markers associated with T1D. Such a slowly evolving form of autoimmune diabetes, described as latent autoimmune diabetes of adults (LADA), accounts for 2-12% of all patients with adult-onset diabetes, though they show considerable variability according to their demographics and mode of ascertainment. While therapeutic strategies aim for metabolic control and preservation of residual insulin secretory capacity, endotype heterogeneity within LADA implies a personalized approach to treatment. Faced with a paucity of large-scale clinical trials in LADA, an expert panel reviewed data and delineated one therapeutic approach. Building on the 2020 American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus for T2D and heterogeneity within autoimmune diabetes, we propose "deviations" for LADA from those guidelines. Within LADA, C-peptide values, proxy for β-cell function, drive therapeutic decisions. Three broad categories of random C-peptide levels were introduced by the panel: 1) C-peptide levels <0.3 nmol/L: a multiple-insulin regimen recommended as for T1D; 2) C-peptide values ≥0.3 and ≤0.7 nmol/L: defined by the panel as a "gray area" in which a modified ADA/EASD algorithm for T2D is recommended; consider insulin in combination with other therapies to modulate β-cell failure and limit diabetic complications; 3) C-peptide values >0.7 nmol/L: suggests a modified ADA/EASD algorithm as for T2D but allowing for the potentially progressive nature of LADA by monitoring C-peptide to adjust treatment. The panel concluded by advising general screening for LADA in newly diagnosed non-insulin-requiring diabetes and, importantly, that large randomized clinical trials are warranted.
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Affiliation(s)
- Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiinamaija Tuomi
- Division of Endocrinology, Abdominal Center, Helsinki University Hospital, Institute for Molecular Medicine Finland FIMM and Research Program for Clinical and Molecular Metabolism, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
- Lund University Diabetes Center, University of Lund, Malmo, Sweden
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, CIBERDEM, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - Massimo Pietropaolo
- Division of Endocrinology, Diabetes and Metabolism, Diabetes Research Center, Baylor College of Medicine, Houston, TX
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University and Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
- Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, U.K
| | - Richard David Leslie
- Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, U.K.
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Bost C, Jordan T, Magali D, Françoise F, Nicole F. Anti-ZnT8 autoantibodies: A new marker to be screened in patients with anti-adrenal antibodies. Clin Chim Acta 2020; 511:1-6. [PMID: 32946793 DOI: 10.1016/j.cca.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/04/2020] [Accepted: 09/13/2020] [Indexed: 01/21/2023]
Abstract
Patients with autoimmune Addison's disease (AAD) can develop other autoimmune diseases. They often display autoantibodies other than anti-adrenal cortex autoantibodies (ACA) which could be of interest in predicting the development of other diseases such as type 1 diabetes (T1D). Among the well-established autoantibodies associated with T1D, anti-ZnT8 autoantibodies (ZnT8A) could be found in absence of anti-GADA and anti-IA2A. Thus, the aim of our study was to evaluate the prevalence of ZnT8A in a cohort of AAD patients. The presence of ZnT8A was studied in 36 patients (19 children and 17 adults) displaying ACA. ZnT8A were detected in both children and adults with an overall prevalence of 19%. The results also indicated that ZnT8A were associated with coexisting T1D in more than 70% of this population regardless of age. Even if the titer of ZnT8A for the one third of patients without T1D was low, they have to be followed due to the potential risk of developing T1D. ZnT8A in those cases could also be a marker of autoimmunity associated to the adrenal gland destruction in AAD. As ZnT8A screening has been included in the diagnostic investigation of T1D, it should also be incorporated in the autoantibodies screening panel of the AAD population.
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Affiliation(s)
- Chloé Bost
- Immunology Laboratory, IFB, Toulouse University Hospital, 31000 Toulouse, France.
| | - Teoli Jordan
- Immunology Laboratory, Hospices Civils of Lyon, 69495 Pierre-Bénite, France.
| | - Dechomet Magali
- Immunology Laboratory, Hospices Civils of Lyon, 69495 Pierre-Bénite, France.
| | - Fortenfant Françoise
- Immunology Laboratory, IFB, Toulouse University Hospital, 31000 Toulouse, France.
| | - Fabien Nicole
- Immunology Laboratory, Hospices Civils of Lyon, 69495 Pierre-Bénite, France.
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Latent Autoimmune Diabetes in Adults: A Review of Clinically Relevant Issues. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:29-41. [PMID: 32424495 DOI: 10.1007/5584_2020_533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Latent autoimmune diabetes in adults (LADA) is still a poorly characterized entity. However, its prevalence may be higher than that of classical type 1 diabetes. Patients with LADA are often misclassified as type 2 diabetes. The underlying autoimmune process against β-cell has important consequences for the prognosis, comorbidities, treatment choices and even patient-reported outcomes with this diabetes subtype. However, there is still an important gap of knowledge in many areas of clinical relevance. We are herein focusing on the state of knowledge of relevant clinical issues than may help in the diagnosis and management of subjects with LADA.
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Yohena S, Penas-Steinhardt A, Muller C, Faccinetti NI, Cerrone GE, Lovecchio S, Ridner E, Valdez S, Frechtel G. Immunological and clinical characteristics of latent autoimmune diabetes in the elderly. Diabetes Metab Res Rev 2019; 35:e3137. [PMID: 30743316 DOI: 10.1002/dmrr.3137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Latent autoimmune diabetes in adults (LADA) is determined by both a noninsulin-dependent clinical presentation and an autoimmune pathogenic process. Glutamic acid decarboxylase antibody (GADA) constitutes the most important marker, although IA-2A and ZnT8A also define LADA presentation. Type 2 diabetes mellitus (T2DM) is the most prevalent type particularly over 65 years old. Studies about autoimmunity in this age group are scarce. OBJECTIVE The aim of this work was to determine whether three autoantibodies for diabetes autoimmunity were present in elderly T2DM patients, and to assess the distinctive clinical features of autoantibody-positive patients. RESEARCH DESIGN AND METHODS We recruited 153 patients with diabetes with onset of diabetes after 65 years of age and a BMI under 30 kg/m2 . RESULTS The prevalence of at least one of the autoantibodies was 15.68% (24/153). The most prevalent autoantibody was GADA with 8.49% (13/153), followed by ZnT8A with 6.50% (10/153) and IA2A with 1.96% (3/153). The autoimmunity-positive group presented higher HbA1c (7.01 ± 1.98 vs 6.35 ± 1.01; P = 0.007) and more prevalent insulin therapy (25% vs 10.85%; P = 0.047). GADA-positive patients with diabetes presented higher FPG (7.79 ± 3.79 mmol/L vs 6.43 ± 1.6 mmol/L; P = 0.014) and insulin therapy more frequently (46% vs 10.71%; p = 0.015). GADA titre levels in the individuals with BMI under 27 kg/m2 were higher (35.00 ± 4.20) than those in the group with BMI over 27 kg/m2 (8.83 ± 3.041; P = 0.0005). CONCLUSION Autoantibodies GADA and Znt8A may be useful markers in identifying a subgroup of older patients with a clinical presentation of diabetes which could be characterized as latent autoimmune diabetes in the elderly.
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Affiliation(s)
- Silvina Yohena
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Alberto Penas-Steinhardt
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
- National University of Luján, Department of Basic Sciences, Computational Genomics Laboratory, Luján, Buenos Aires, Argentina
| | | | - Natalia I Faccinetti
- Chair of Immunology, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Gloria E Cerrone
- Institute of Immunology, Genetics and Metabolism, Clinical Hospital and Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
- Chair of Genetics, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Silvia Lovecchio
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Edgardo Ridner
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Silvina Valdez
- Chair of Immunology, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Gustavo Frechtel
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
- Institute of Immunology, Genetics and Metabolism, Clinical Hospital and Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
- Chair of Genetics, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
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24
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Luk AOY, Lau ESH, Lim C, Kong APS, Chow E, Ma RCW, Chan JCN. Diabetes-Related Complications and Mortality in Patients With Young-Onset Latent Autoimmune Diabetes: A 14-Year Analysis of the Prospective Hong Kong Diabetes Register. Diabetes Care 2019; 42:1042-1050. [PMID: 30967437 DOI: 10.2337/dc18-1796] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Young-onset diabetes is heterogeneous in etiology and disease progression. We compared the incidence of diabetes-related complications and mortality in patients with young-onset type 2 diabetes with or without anti-GAD antibodies and patients with type 1 diabetes. We determined changes in glycemic control before and after commencement of insulin therapy stratified by antibody status. RESEARCH DESIGN AND METHODS Between 1994 and 2012, 1,504 consecutively enrolled patients with type 2 diabetes who had received a diagnosis at <40 years of age and had available anti-GAD antibody status and 251 patients with type 1 diabetes from the Hong Kong Diabetes Register were followed for incident cardiovascular disease (CVD), end-stage renal disease (ESRD), severe hypoglycemia, and all-cause mortality until June 2015. Information on insulin use and HbA1c levels during follow-up was obtained. RESULTS Anti-GAD antibodies were positive in 8.1% of patients with type 2 diabetes (GAD+). By multivariate Cox regression, patients with GAD+ had a lower hazard of CVD (hazard ratio [HR] 0.43, P = 0.048), a higher hazard of severe hypoglycemia (HR 1.63, P = 0.032), and a similar hazard of ESRD and mortality compared with counterparts without anti-GAD antibodies (GAD-). Compared with patients with type 1 diabetes, ESRD was more likely to develop (HR 2.91, P = 0.043) in patients with GAD+, but no differences were detected in the hazards of severe hypoglycemia, CVD, and mortality. Among new insulin users (n = 304), patients with GAD+ had larger reductions in HbA1c than patients with GAD-after 12 months of insulin use (-2.30 ± 3.80% [25 ± 42 mmol/mol] vs -0.72 ± 1.86% [8 ± 20 mmol/mol], P = 0.05). CONCLUSIONS Anti-GAD positivity identifies a group of patients with a different prognosis compared with patients without antibodies and those with type 1 diabetes. Patients with GAD+ responded differently to insulin compared with patients with GAD-.
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Affiliation(s)
- Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China .,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Asia Diabetes Foundation, Hong Kong Special Administrative Region, People's Republic of China
| | - Cadmon Lim
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Anti-HERV-W Env antibodies are correlated with seroreactivity against Mycobacterium avium subsp. paratuberculosis in children and youths at T1D risk. Sci Rep 2019; 9:6282. [PMID: 31000760 PMCID: PMC6472397 DOI: 10.1038/s41598-019-42788-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
Recent evidence points at the role that human endogenous retroviruses (HERVs) may play through the activation of genes integrated across the human genome. Although a variety of genetic/epigenetic mechanisms maintain most HERVs silenced, independent environmental stimuli including infections may transactivate endogenous elements favoring pathogenic conditions. Several studies associated exposures to Mycobacterium avium subsp. paratuberculosis (MAP) with increased anti-MAP seroreactivity in T1D patients. Here, we assessed humoral responses against HERV envelope antigens (HERV-KEnv and HERV-WEnv) and four MAP-derived peptides with human homologs in distinct populations: Sardinian children at T1D risk (rT1D) (n = 14), rT1D from mainland Italy (n = 54) and Polish youths with T1D (n = 74) or obesity unrelated to autoimmunity (OB) (n = 26). Unlike Sardinian rT1D, youths displayed increased anti-HERV-WEnv Abs prevalence compared to age-matched OB or healthy controls (24.32 vs. 11.54%, p = 0.02 for Polish T1D/OB and 31.48 vs. 11.90%, p = 0.0025 for Italian rT1D). Anti-HERV-KEnv responses showed variable trends across groups. A strong correlation between Abs levels against HERV-WEnv and homologous peptides was mirrored by time-related Abs patterns. Elevated values registered for HERV-WEnv overlaped with or preceded the detection of T1D diagnostic autoantibodies. These results support the hypothesis of MAP infection leading to HERV-W antigen expression and enhancing the production of autoantibodies in T1D.
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26
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Xiang Y, Huang G, Zhu Y, Zuo X, Liu X, Feng Q, Li X, Yang T, Lu J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Weng J, Jia W, Liu Z, Ji L, Yang W, Leslie RD, Zhou Z. Identification of autoimmune type 1 diabetes and multiple organ-specific autoantibodies in adult-onset non-insulin-requiring diabetes in China: A population-based multicentre nationwide survey. Diabetes Obes Metab 2019; 21:893-902. [PMID: 30471182 DOI: 10.1111/dom.13595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the prevalence of adult-onset autoimmune diabetes (ADM) and predisposition to autoimmune diseases by quantifying serum organ-specific autoantibodies in people with phenotype of type 2 diabetes (T2D). MATERIALS AND METHODS We included a nationally representative sample of 46 239 adults aged ≥20 years from 14 provinces, of whom 4671 had diabetes, plus 1000 control subjects with normal glucose tolerance (NGT). Participants were screened centrally for autoantibodies to glutamic acid decarboxylase (GAD), islet antigen 2 (IA2) and zinc transporter isoform-8 (Znt8) and were defined as having ADM where positive for these antibodies. We then assayed thyroid peroxidase (TPO), tissue transglutaminase (tTG) and 21-hydroxylase (21-OH) autoantibodies in randomly selected participants with ADM and in age-matched, sex-matched and non-ADM controls with T2D plus controls with NGT. RESULTS Post-normalization, the standardized prevalence rate of ADM was 6.0% (95% confidence interval [CI] 5.3-6.8) in initially non-insulin-requiring participants with ADM, corresponding to six million adults in China, in whom adjusted antibody positivity was: TPO autoantibodies 16.3% (95% CI 10.8-21.8), tTG autoantibodies 2.1% (95% CI 0.0-4.2), and 21-OH autoantibodies 1.8% (95% CI -0.2 to 3.8). Those participants with ADM who were GAD autoantibody-positive had high risk of TPO autoantibody positivity (odds ratio [OR] 2.39, P = 0.0031) and tTG autoantibody positivity (OR 6.98, P = 0.027), while those positive for IA2 autoantibodies had a high risk of tTG autoantibody positivity (OR 19.05, P = 0.001). CONCLUSIONS A proportion of people with phenotype of T2D in China have ADM, with diabetes-associated autoantibodies, and may be at risk of developing other organ-specific autoimmune diseases; therefore, it may be clinically relevant to consider screening such Chinese populations.
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Affiliation(s)
- Yufei Xiang
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Gan Huang
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Yaxi Zhu
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Xuan Zuo
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Xinyuan Liu
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Qiong Feng
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Tubao Yang
- School of Public Health, Central South University, Changsha, China
| | - Juming Lu
- Department of Endocrinology and Metabolism, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jie Liu
- Department of Endocrinology and Metabolism, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dalong Zhu
- Department of Endocrinology and Metabolism, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiapu Ge
- Department of Endocrinology and Metabolism, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lixiang Lin
- Departments of Endocrinology and Metabolism, Fujian Provincial Hospital, Fuzhou, China
| | - Li Chen
- Department of Endocrinology and Metabolism, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaohui Guo
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing, China
| | - Zhigang Zhao
- Department of Endocrinology and Metabolism, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qiang Li
- Department of Endocrinology and Metabolism, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianping Weng
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yatsen University, Guangzhou, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai, China
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, Virginia
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Wenying Yang
- Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Beijing, China
| | | | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Centre for Metabolic Diseases, Changsha, China
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Shi X, Huang G, Wang Y, Liu Z, Deng C, Li X, Zheng P, Zhou Z. Tetraspanin 7 autoantibodies predict progressive decline of beta cell function in individuals with LADA. Diabetologia 2019; 62:399-407. [PMID: 30594957 DOI: 10.1007/s00125-018-4799-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/27/2018] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate whether tetraspanin 7 autoantibodies (TSPAN7A) are valuable in predicting poor beta cell function in individuals with latent autoimmune diabetes in adults (LADA). METHODS The cross-sectional study involved participants with LADA (n = 173), type 1 diabetes (n = 158), type 2 diabetes (n = 204) and healthy control participants (n = 170). The longitudinal study involved 53 participants with LADA, with a 3-year follow-up. In both cohorts, TSPAN7A in the sera were measured by a luciferase immunoprecipitation system assay, and physical and clinical characteristics were recorded. RESULTS The prevalence of TSPAN7A in LADA, type 1 diabetes, type 2 diabetes and healthy control participants was 21.4% (37/173), 26% (41/158), 0.5% (1/204) and 1.2% (2/170), respectively. Importantly, measurement of TSPAN7A significantly increased the number of individuals with LADA found to be positive for multiple antibodies (32.4% vs 22%; p < 0.001). Further logistic regression analysis demonstrated that positivity for TSPAN7A (OR 2.87, p = 0.034), disease duration (OR 1.83, p = 0.019) and GAD antibody titre (OR 2.67, p = 0.009) were risk factors for beta cell function in LADA, while BMI (OR 0.34, p = 0.001) was a protective factor. In the prospective study in individuals with LADA, the median annual decrease in rates of fasting C-peptide and 2 h postprandial C-peptide in individuals who were positive for TSPAN7A was significantly higher when compared with the decrease in those who were negative for TSPAN7A (34.6% vs 7.9%, p = 0.043 and 33.2% vs 11%, p = 0.041, respectively). CONCLUSIONS/INTERPRETATION TSPAN7A are valid islet autoantibodies for use in East Asian populations with autoimmune diabetes and can discriminate individuals with LADA who have lower beta cell function after disease progression.
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Affiliation(s)
- Xiajie Shi
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Gan Huang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Yanfei Wang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Chao Deng
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Xia Li
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Peilin Zheng
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China.
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China.
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28
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Shruthi S, Mohan V, Maradana MR, Aravindhan V. In silico identification and wet lab validation of novel cryptic B cell epitopes in ZnT8 zinc transporter autoantigen. Int J Biol Macromol 2019; 127:657-664. [PMID: 30710592 DOI: 10.1016/j.ijbiomac.2019.01.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 11/25/2022]
Abstract
Zinc transporter 8 (ZnT8) is a novel immunodominant autoantigen, associated with Type-1 diabetes. A non-synonymous polymorphism (R325W) in its gene is associated with Type-2 diabetes. In this study, we performed an in silico B cell epitope prediction followed by wetlab validation of ZnT8. Apart from the previously characterized polymorphic epitope (BE-5 TAASR*DS), two novel epitopes BE-2 (N-terminus) and BE-6 (C-terminus) were identified. Wet lab validation of these epitopes was carried out by measuring ZnT8 specific isotypes (IgG, IgM and IgA) in the sera of Normal Glucose Tolerant (NGT), Type-1 diabetic (T1DM) and Type-2 diabetic (T2DM) patients by indirect ELISA. Unexpectedly, compared to NGT, significantly decreased levels of IgG and IgA isotypes was seen in T1DM subjects without complications. IgM levels were reduced in T1DM subjects with retinopathy. Newly diagnosed T1DM subjects initiated on insulin therapy showed an increase in IgA and decrease in IgM titre. Like T1DM, significantly reduced level of IgG, IgM and IgA was seen in T2DM subjects. For the first time, we have identified novel cryptic B cell epitopes in ZnT8 autoantigen against which the naturally occurring autoantibody levels were found to be reduced in diabetes.
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Affiliation(s)
- Sugumar Shruthi
- Dept of Genetics, Dr ALM PG IBMS, University of Madras, Taramani, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control, International Diabetes Federation (IDF) Centre for Education, Chennai, India
| | - Muralidhara Rao Maradana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control, International Diabetes Federation (IDF) Centre for Education, Chennai, India; The Francis Crick Institute, London NW1 1AT, UK
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29
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Zinc transporter 8 autoantibody (ZnT8A) by ELISA for diagnosing type 1 diabetes among Chinese people. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-018-0637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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30
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Nishimura A, Matsumura K, Kikuno S, Nagasawa K, Okubo M, Mori Y, Kobayashi T. Slowly Progressive Type 1 Diabetes Mellitus: Current Knowledge And Future Perspectives. Diabetes Metab Syndr Obes 2019; 12:2461-2477. [PMID: 31819572 PMCID: PMC6886592 DOI: 10.2147/dmso.s191007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Slowly progressive type 1 insulin-dependent diabetes mellitus (SPIDDM), sometimes referred to as latent autoimmune diabetes in adults (LADA), is a heterogeneous disease that is often confused with type 1 and type 2 diabetes. As a result, there were few diagnostic criteria for this disorder until 2012, when the Japan Diabetes Society established criteria that could be used in clinical practice. A primary question is whether pathologic markers for type 1 or type 2 diabetes are present in the pancreas of patients with SPIDDM, because the phenotype of SPIDDM is similar to both type 1 and type 2 diabetes. Recent studies clarified pathologic findings in the pancreas of patients with SPIDDM, which included T-cell-mediated insulitis, a marker of type 1 diabetes; pseudoatrophic islets (islets specifically devoid of beta cells), another hallmark of type 1 diabetes; and a lack of amylin (ie, islet amyloid polypeptide) deposition to the islet cells, a pathologic marker of type 2 diabetes. In terms of preventing the loss of beta-cell function in patients with SPIDDM, several studies have shown that some drugs, including dipeptidyl peptidase-4 inhibitors, are effective. There is an increased need for early diagnosis of SPIDDM to preserve beta-cell function. This review presents updated findings on the pathogenesis and immunologic findings of the affected pancreas, diagnostic markers, risk factors for progression of beta-cell dysfunction, epidemiology, clinical features, diagnostic strategies, prevention strategies, and clinical options for patients with SPIDDM.
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Affiliation(s)
- Akihiro Nishimura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kimio Matsumura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Shota Kikuno
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kaoru Nagasawa
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Minoru Okubo
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Yasumichi Mori
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Tetsuro Kobayashi
- Division of Immunology and Molecular Medicine, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Correspondence: Tetsuro Kobayashi Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-Ku, Tokyo, JapanTel +81-3-3588-1111Fax +81-3-3582-7068 Email
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Sørgjerd EP. Type 1 Diabetes-related Autoantibodies in Different Forms of Diabetes. Curr Diabetes Rev 2019; 15:199-204. [PMID: 30058495 DOI: 10.2174/1573399814666180730105351] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 04/29/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Autoantibodies against Glutamic Acid Decarboxylase (GADA), insulinoma antigen-2 (IA- 2A), insulin (IAA) and the most recently Zinc Transporter 8 (ZnT8A) are one of the most reliable biomarkers for autoimmune diabetes in both children and adults. They are today the only biomarkers that can distinguish Latent Autoimmune Diabetes in Adults (LADA) from phenotypically type 2 diabetes. As the frequency of autoantibodies at diagnosis in childhood type 1 diabetes depends on age, GADA is by far the most common in adult onset autoimmune diabetes, especially LADA. Being multiple autoantibody positive have also shown to be more common in childhood diabetes compared to adult onset diabetes, and multiple autoantibody positivity have a high predictive value of childhood type 1 diabetes. Autoantibodies have shown inconsistent results to predict diabetes in adults. Levels of autoantibodies are reported to cause heterogeneity in LADA. Reports indicate that individuals with high levels of autoantibodies have a more type 1 diabetes like phenotype and individuals with low levels of autoantibody positivity have a more type 2 diabetes like phenotype. It is also well known that autoantibody levels can fluctuate and transient autoantibody positivity in adult onset autoimmune diabetes have been reported to affect the phenotype.
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Affiliation(s)
- Elin Pettersen Sørgjerd
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Pieralice S, Pozzilli P. Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management. Diabetes Metab J 2018; 42:451-464. [PMID: 30565440 PMCID: PMC6300440 DOI: 10.4093/dmj.2018.0190] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a heterogeneous disease characterized by a less intensive autoimmune process and a broad clinical phenotype compared to classical type 1 diabetes mellitus (T1DM), sharing features with both type 2 diabetes mellitus (T2DM) and T1DM. Since patients affected by LADA are initially insulin independent and recognizable only by testing for islet-cell autoantibodies, it could be difficult to identify LADA in clinical setting and a high misdiagnosis rate still remains among patients with T2DM. Ideally, islet-cell autoantibodies screening should be performed in subjects with newly diagnosed T2DM, ensuring a closer monitoring of those resulted positive and avoiding treatment of hyperglycaemia which might increase the rate of β-cells loss. Thus, since the autoimmune process in LADA seems to be slower than in classical T1DM, there is a wider window for new therapeutic interventions that may slow down β-cell failure. This review summarizes the current understanding of LADA, by evaluating data from most recent studies, the actual gaps in diagnosis and management. Finally, we critically highlight and discuss novel findings and future perspectives on the therapeutic approach in LADA.
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Affiliation(s)
- Silvia Pieralice
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Paolo Pozzilli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK.
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Rogowicz-Frontczak A, Pilacinski S, Wyka K, Wierusz-Wysocka B, Zozulinska-Ziolkiewicz D. Zinc transporter 8 autoantibodies (ZnT8-ab) are associated with higher prevalence of multiple diabetes-related autoantibodies in adults with type 1 diabetes. Diabetes Res Clin Pract 2018; 146:313-320. [PMID: 30465779 DOI: 10.1016/j.diabres.2018.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/27/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
AIM The study aimed to assess the prevalence of zinc transporter 8 autoantibodies (ZnT8-ab), other diabetes-related autoantibodies and clinical manifestation of type 1 diabetes in adults, depending on age of the onset of disease. METHODS 119 patients with type 1 diabetes, 66 at age <35 years (T1DM < 35) and 53 T1DM at age ≥35 years (T1DM ≥ 35). We assessed clinical features, GAD-ab, IA2-ab, ICA, ZnT8-ab and thyroid peroxidase antibodies (ATPO). RESULTS In T1DM < 35 lower initial serum C-peptide concentration was observed and diabetes ketoacidosis (DKA) was more common. ATPO positivity was more prevalent in T1DM ≥ 35 (35.8 vs 21.2%, p = 0.04). The prevalence of GAD-ab, IA2-ab and ZnT8-ab was similar in both groups, the titres of IA2-ab and ICA were higher in T1DM < 35 but titre of ZnT8-ab was higher in T1DM ≥ 35. The majority of T1DM < 35 patients were positive for three autoantibodies (40.9%), while T1DM ≥ 35 subjects most often presented with only one (30.2%) antibody, most commonly GAD-ab (81.2%). 45% T1DM < 35 and 34% T1DM ≥ 35 subjects were positive for ZnT8-ab. ZnT8-ab positive patients had higher titre and more frequent occurrence of multiple diabetes-related autoantibodies than ZnT8-ab negative patients. CONCLUSIONS Adults with T1DM < 35 and T1DM ≥ 35 differ in the severity of autoimmune response at diagnosis. ZnT8-ab positivity is related to higher titre and more frequent occurrence of multiple diabetes-related autoantibodies.
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Achenbach P, Hawa MI, Krause S, Lampasona V, Jerram ST, Williams AJK, Bonifacio E, Ziegler AG, Leslie RD. Autoantibodies to N-terminally truncated GAD improve clinical phenotyping of individuals with adult-onset diabetes: Action LADA 12. Diabetologia 2018; 61:1644-1649. [PMID: 29619531 PMCID: PMC6445455 DOI: 10.1007/s00125-018-4605-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS Adult-onset type 1 diabetes, in which the 65 kDa isoform of GAD (GAD65) is a major autoantigen, has a broad clinical phenotype encompassing variable need for insulin therapy. This study aimed to evaluate whether autoantibodies against N-terminally truncated GAD65 more closely defined a type 1 diabetes phenotype associated with insulin therapy. METHODS Of 1114 participants with adult-onset diabetes from the Action LADA (latent autoimmune diabetes in adults) study with sufficient sera, we selected those designated type 1 (n = 511) or type 2 diabetes (n = 603) and retested the samples in radiobinding assays for human full-length GAD65 autoantibodies (f-GADA) and N-terminally truncated (amino acids 96-585) GAD65 autoantibodies (t-GADA). Individuals' clinical phenotypes were analysed according to antibody binding patterns. RESULTS Overall, 478 individuals were f-GADA-positive, 431 were t-GADA-positive and 628 were negative in both assays. Risk of insulin treatment was augmented in t-GADA-positive individuals (OR 4.69 [95% CI 3.57, 6.17]) compared with f-GADA-positive individuals (OR 3.86 [95% CI 2.95, 5.06]), irrespective of diabetes duration. Of 55 individuals who were f-GADA-positive but t-GADA-negative, i.e. with antibody binding restricted to the N-terminus of GAD65, the phenotype was similar to type 2 diabetes with low risk of progression to insulin treatment. Compared with these individuals with N-terminal GAD65-restricted GADA, t-GADA-positive individuals were younger at diagnosis (p = 0.005), leaner (p < 0.0001) and more often had multiple diabetes-associated autoantibodies (28.3% vs 7.3%; p = 0.0005). CONCLUSIONS/INTERPRETATION In individuals with adult-onset diabetes, presence of N-terminally truncated GAD65 autoantibodies is associated with the clinical phenotype of autoimmune type 1 diabetes and predicts insulin therapy.
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Affiliation(s)
- Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764, Munich-Neuherberg, Germany.
- Forschergruppe Diabetes, Technische Universität München, at Klinikum rechts der Isar, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany.
| | - Mohammed I Hawa
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK
| | - Stephanie Krause
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technische Universität München, at Klinikum rechts der Isar, Munich, Germany
| | - Vito Lampasona
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Samuel T Jerram
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK
| | - Alistair J K Williams
- Diabetes and Metabolism, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Ezio Bonifacio
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- DFG Research Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Technische Universität Dresden, Dresden, Germany
| | - Anette G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technische Universität München, at Klinikum rechts der Isar, Munich, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - R David Leslie
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK.
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Pozzilli P, Pieralice S. Latent Autoimmune Diabetes in Adults: Current Status and New Horizons. Endocrinol Metab (Seoul) 2018; 33:147-159. [PMID: 29947172 PMCID: PMC6021307 DOI: 10.3803/enm.2018.33.2.147] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 12/16/2022] Open
Abstract
Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogeneous than young-onset autoimmune diabetes and shares clinical and metabolic characteristics with both type 2 and type 1 diabetes. Patients with LADA are considered by having highly variable β-cell destruction, different degrees of insulin resistance and heterogeneous titre and pattern of islet autoantibody, suggesting different pathophysiological pathways partially explaining the heterogeneous phenotypes of LADA. To date the heterogeneity of LADA does not allow to establish a priori treatment algorithm and no specific guidelines for LADA therapy are available. These subjects are mostly treated as affected by type 2 diabetes, a factor that might lead to the progression to insulin-dependency quickly. A personalised medicine approach is necessary to attain optimal metabolic control and preserve β-cell function to decrease the risk of long-term diabetes complications. Recent data concerning the use of oral antidiabetic agents as dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 receptor agonists indicate up-and-coming results in term of protect C-peptide levels and improving glycaemic control. This review summarises current knowledge on LADA, emphasising controversies regarding its pathophysiology and clinical features. Moreover, we discuss data available about novel therapeutic approaches that can be considered for prevention of β-cell loss in LADA.
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Affiliation(s)
- Paolo Pozzilli
- Department of Endocrinology & Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary, University of London, London, UK.
| | - Silvia Pieralice
- Department of Endocrinology & Diabetes, University Campus Bio-Medico, Rome, Italy
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Niechciał E, Rogowicz-Frontczak A, Piłaciński S, Fichna M, Skowrońska B, Fichna P, Zozulińska-Ziółkiewicz D. Autoantibodies against zinc transporter 8 are related to age and metabolic state in patients with newly diagnosed autoimmune diabetes. Acta Diabetol 2018; 55:287-294. [PMID: 29327148 PMCID: PMC5829102 DOI: 10.1007/s00592-017-1091-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/19/2017] [Indexed: 01/02/2023]
Abstract
AIMS To assess the prevalence of ZnT8-ab and its correlation to other autoimmune markers and diabetic ketoacidosis occurrence in children and adults with T1DM onset. METHODS The study included 367 patients (218 children; 149 adults) at the T1DM onset. Selected diabetes-related autoantibodies such as GAD-ab, IA2-ab, ZnT8-ab were tested before the initiation of insulin therapy. Diabetic ketoacidosis was defined as glucose concentration > 13.9 mmol/l, pH < 7.30, concentration of HCO3 < 15 mmol/l, presence of ketone bodies in the blood and urine. RESULTS The autoantibodies pattern differs in both study groups. Children were mostly positive for two (37.8%) and three (49.5%) autoantibodies, whereas adults for one (32.2%) and two (30.7%). The most frequently detected autoantibodies in youth were ZnT8-ab (81.1%) and IA2-ab (80.7%), while in adults GAD-ab (74.8%). ZnT8-ab (p < 0.0001) titers were significantly higher in children, but adults had higher titer of GAD-ab (p < 0.0001) and IA2-ab (p < 0.0001). Children developed more frequently diabetic ketoacidosis (28.4 vs. 10.7%, p = 0.0002). ZnT8-ab (p = 0.002) and IA2-ab (p = 0.008) were reported mostly in individuals with ketoacidosis. A correlation between the number of positive antibodies and the severity of ketoacidosis was observed (Rs - 0.129 p = 0.014). ZnT8-ab were associated with a greater risk of ketoacidosis independent of gender, age group and the autoantibodies number [OR = 2.44 (95% CI 1.0-5.94), p = 0.04]. CONCLUSIONS Children are at greater risk of ketoacidosis at the diagnosis of diabetes. ZnT8-ab and IA2-ab are commonly detected in children, while adults have frequently higher titer of GAD-ab. ZnT8-ab are associated with more acute diabetes onset.
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Affiliation(s)
- Elżbieta Niechciał
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland.
| | - Anita Rogowicz-Frontczak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza Street 2, 60-101, Poznan, Poland
| | - Stanisław Piłaciński
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza Street 2, 60-101, Poznan, Poland
| | - Marta Fichna
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-101, Poznan, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska Street 32, 60-479, Poznan, Poland
| | - Bogda Skowrońska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland
| | - Dorota Zozulińska-Ziółkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza Street 2, 60-101, Poznan, Poland
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Lounici Boudiaf A, Bouziane D, Smara M, Meddour Y, Haffaf EM, Oudjit B, Chaib Mamouzi S, Aouichat Bouguerra S. Could ZnT8 antibodies replace ICA, GAD, IA2 and insulin antibodies in the diagnosis of type 1 diabetes? Curr Res Transl Med 2018; 66:1-7. [PMID: 29487039 DOI: 10.1016/j.retram.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/18/2018] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The zinc transporter 8 (ZnT8) is an islet β-cell secretory granule membrane protein coded by the SLC30A8 gene, identified as a novel autoantigen in human type 1 diabetes (T1D). As no data of ZnT8ab in Algerian patients have been reported, we aim to evaluate the prevalence of ZnT8ab in young Algerians with T1D and determine whether ZnT8ab could be a better diagnostic tool to replace the other conventional autoantibodies detected in patients with type 1 diabetes. For this purpose, we evaluated the prevalence of islets cells antibodies (ICA), glutamic acid decarboxylase (GAD), islet antigen type 2 (IA2), insulin (IA) autoantibodies (ab) and for the first time in Algeria, the zinc transporter 8 (ZnT8) in young Algerian patients with type 1 diabetes. PATIENTS AND METHODS In our cross-sectional study, 160 patients between 1 and 35 years old, diagnosed with type 1 diabetes were enrolled. ICAab was analyzed by indirect immunofluorescence (IIF), GADab, IA2ab, IAab and ZnT8ab were analyzed by ELISA, fasting blood glucose was performed by enzymatic method (glucose-oxidase) and HbA1c by turbid metric method. RESULTS Our cohort was composed with 74 males and 86 females (OR=1.16); the mean of age was 14.09 [1-35] years old and the median diabetes duration was 4.10 [1-18] years. Our cohort had a mean of HbA1c of 9.22 [5.40-15]%, the mean of birth weight was 3360.52 [2200-4800]g; the mean of BMI was 19.30 [16.04-22.46]kg/m2. Out of 160 patients, 44 (27.5%) were under mother breastfeeding and 116/160 (72.5%) were under artificial feeding. One antibody, at least, was found in 94.38% and the ZnT8ab was significantly more positive in females (70.3%) than in males (10.7%) (***P=8.033×10-15). The concentration of ZnT8ab was higher in females than in males (females=122.25UI/mL versus males=51.38UI/mL; *P=0.03); ICAab, GADab and ZnT8ab were more present in patients with consanguineous parents (***P=0.0002, *P=0.019 and *P=0.03; respectively) CONCLUSION: Our study on ZnT8ab in T1D is the first in the Maghreb region and we observed a prevalence of 46.25%. The positivity of ZnT8ab enabled us to classify in T1DA 50% of diabetics with obvious T1D phenotype and negative routine autoantibodies, thus ZnT8ab is a good tool for differential diagnosis of type 1 diabetes. According to our results, a simultaneous analysis for ZnT8 and IA2 autoantibodies can be a better and efficient diagnosis of type 1A diabetes from the beginning of the disease.
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Affiliation(s)
- A Lounici Boudiaf
- Laboratory of Cellular and Molecular Physiopathology, Institute of Natural Sciences, University of Technological Sciences, Houari Boumediene, Algiers, Algeria.
| | - D Bouziane
- Pediatric department, Ain Taya Teaching Hospital, Algiers, Algeria
| | - M Smara
- Laboratory of Immunology, Faculty of Medicine, University of Algiers 1, Algiers Military Hospital, Mohamed Seghir Nekkache, Algiers, Algeria
| | - Y Meddour
- Laboratory of Immunology, Faculty of Medicine, University of Algiers 1, Algiers Military Hospital, Mohamed Seghir Nekkache, Algiers, Algeria
| | - E M Haffaf
- Nuclear Medicine Department, Faculty of Medicine, University of Algiers 1, Algiers Military Hospital, Mohamed Seghir Nekkache, Algiers, Algeria
| | - B Oudjit
- Pediatric department, Faculty of Medicine, University of Algiers 1, Algiers Military Hospital, Mohamed Seghir Nekkache, Algiers, Algeria
| | - S Chaib Mamouzi
- Laboratory of Immunology, Faculty of Medicine, University of Algiers 1, Algiers Military Hospital, Mohamed Seghir Nekkache, Algiers, Algeria
| | - S Aouichat Bouguerra
- Laboratory of Cellular and Molecular Physiopathology, Institute of Natural Sciences, University of Technological Sciences, Houari Boumediene, Algiers, Algeria
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Risk of beta-cell autoimmunity presence for progression to type 1 diabetes: A systematic review and meta-analysis. J Autoimmun 2018; 86:9-18. [DOI: 10.1016/j.jaut.2017.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 12/18/2022]
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Rizo IM, Apovian CM. Diabetic Ketoacidosis Post Bariatric Surgery. Front Endocrinol (Lausanne) 2018; 9:812. [PMID: 30697192 PMCID: PMC6340926 DOI: 10.3389/fendo.2018.00812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/27/2018] [Indexed: 12/20/2022] Open
Abstract
In patients with type 2 diabetes, bariatric surgery can lead to significant improvements in glycemic control and diabetes remission. We present a case of a Hispanic female with type 2 diabetes phenotype who underwent bariatric surgery and post-operatively stopped her insulin therapy due to multiple reasons, including decreased oral intake and concern for hypoglycemia. Ultimately, she developed diabetic ketoacidosis. She does not fit into the classical type 2 diabetes or type 1 diabetes definition but into the heterogeneous subgroup of diabetes called ketosis-prone diabetes.
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Katahira M, Ogata H, Ito T, Miwata T, Goto M, Nakamura S, Takashima H. Association of Autoimmune Thyroid Disease with Anti-GAD Antibody ELISA Test Positivity and Risk for Insulin Deficiency in Slowly Progressive Type 1 Diabetes. J Diabetes Res 2018; 2018:1847430. [PMID: 30116734 PMCID: PMC6079579 DOI: 10.1155/2018/1847430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 12/28/2022] Open
Abstract
The presence of antiglutamic acid decarboxylase antibody (GADA) is required for the diagnosis of slowly progressive type 1 diabetes (SPT1D). We examined the factors influencing GADA determination by radioimmunoassay (GADA-RIA) and by enzyme-linked immunosorbent assay (GADA-ELISA). Sixty patients with SPT1D and 154 patients with type 2 diabetes were examined by both GADA-RIA and GADA-ELISA and for the presence of autoimmune thyroid disease (AITD). We compared the clinical characteristics of these patients based on the positivity or negativity of GADA-RIA and GADA-ELISA, and the existence or nonexistence of AITD. Thirty of 60 (50.0%) GADA-RIA-positive patients were GADA-ELISA negative, whereas none of the 154 GADA-RIA-negative patients were GADA-ELISA positive. Concomitant AITD was significantly less in patients with GADA-RIA and without GADA-ELISA and was significantly more in patients with GADA-RIA and GADA-ELISA. In GADA-RIA-positive patients, there was no significant difference in the GADA-RIA titer among the GADA-ELISA-negative patients with and without AITD, and the GADA-ELISA-positive patients without AITD; whereas the frequency of insulin deficiency was significantly higher in the patients with AITD and/or GADA-ELISA than in those without AITD and GADA-ELISA. Examination of GADA-ELISA and AITD in GADA-RIA-positive patients might be useful in predicting insulin deficiency in these patients.
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Affiliation(s)
- Masahito Katahira
- Aichi Prefectural University School of Nursing and Health, Nagoya 463-8502, Japan
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Hidetada Ogata
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Takahiro Ito
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Tsutomu Miwata
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Megumi Goto
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Shizuka Nakamura
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
- Department of General Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Hiromi Takashima
- Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
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Zaharieva E, Kamenov Z, Velikova T, Tsakova A, El-Darawish Y, Okamura H. Interleukin-18 serum level is elevated in type 2 diabetes and latent autoimmune diabetes. Endocr Connect 2018; 7:179-185. [PMID: 29217651 PMCID: PMC5776671 DOI: 10.1530/ec-17-0273] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Interleukin-18 (IL-18) is an inflammatory cytokine found to be elevated in obesity, metabolic syndrome and type 2 diabetes (T2D) as a part of the chronic low-grade inflammatory process in these states. The aim of the study was to evaluate the interleukin level in patients with latent autoimmune diabetes of the adults (LADA) in comparison to that in T2D subjects. MATERIALS AND METHODS IL-18 was analyzed through enzyme-linked immunosorbent assay in 76 participants with T2D and 24 with LADA and 14 control subjects. Evaluation was also carried out in body mass index (BMI)- and glycemic control-matched diabetic patients. RESULTS The serum concentration of IL-18 was higher in patients with T2D (389.04 ± 203.44 pg/mL) and LADA (327.04 ± 144.48 pg/mL) than that in control subjects (219.88 ± 91.03 pg/mL), P < 0.05. However, it was not significantly different between both diabetic groups (P = 0.255) despite higher IL-6 (4.78 ± 5.84 vs 1.79 ± 0.96 pg/mL, P < 0.001) and hs-CRP (2.60 ± 1.70 vs 1.29 ± 1.20 mg/L, P = 0.002) level in T2D patients. The results were persistent in BMI-matched subjects with diabetes (IL-18 = 403.48 ± 226.32 vs 329.30 ± 146.30 pg/mL, respectively for T2D and LADA, P = 0.391). The correlations in T2D group concerning HDL cholesterol (r = -0.377, P = 0.001), postprandial glucose (r = 0.244, P = 0.043), IL-6 (r = 0.398, P < 0.001) and hs-CRP (r = 0.427, P = 0.001) were not confirmed in LADA and control subjects. CONCLUSION The IL-18 serum level was higher in T2D and LADA than that in control subjects, but did not differ between both diabetic groups, even when they were BMI matched. Correlations with lipid, glycemic and inflammatory parameters were present in T2D only.
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Affiliation(s)
- Emanuela Zaharieva
- Department of Internal MedicineUniversity Hospital Alexandrovska, Clinic of Endocrinology, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Zdravko Kamenov
- Department of Internal MedicineUniversity Hospital Alexandrovska, Clinic of Endocrinology, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Tsvetelina Velikova
- Department of Clinical ImmunologyUniversity Hospital St. Ivan Rilski, Laboratory of Clinical Immunology, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Adelina Tsakova
- Department of Clinical LaboratoryUniversity Hospital Alexandrovska, Central Clinical Laboratory, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Yosif El-Darawish
- Laboratory of Tumor Immunology and Cell TherapyHyogo College of Medicine, Hyogo, Japan
| | - Haruki Okamura
- Laboratory of Tumor Immunology and Cell TherapyHyogo College of Medicine, Hyogo, Japan
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Wessels I, Maywald M, Rink L. Zinc as a Gatekeeper of Immune Function. Nutrients 2017; 9:E1286. [PMID: 29186856 PMCID: PMC5748737 DOI: 10.3390/nu9121286] [Citation(s) in RCA: 357] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022] Open
Abstract
After the discovery of zinc deficiency in the 1960s, it soon became clear that zinc is essential for the function of the immune system. Zinc ions are involved in regulating intracellular signaling pathways in innate and adaptive immune cells. Zinc homeostasis is largely controlled via the expression and action of zinc "importers" (ZIP 1-14), zinc "exporters" (ZnT 1-10), and zinc-binding proteins. Anti-inflammatory and anti-oxidant properties of zinc have long been documented, however, underlying mechanisms are still not entirely clear. Here, we report molecular mechanisms underlying the development of a pro-inflammatory phenotype during zinc deficiency. Furthermore, we describe links between altered zinc homeostasis and disease development. Consequently, the benefits of zinc supplementation for a malfunctioning immune system become clear. This article will focus on underlying mechanisms responsible for the regulation of cellular signaling by alterations in zinc homeostasis. Effects of fast zinc flux, intermediate "zinc waves", and late homeostatic zinc signals will be discriminated. Description of zinc homeostasis-related effects on the activation of key signaling molecules, as well as on epigenetic modifications, are included to emphasize the role of zinc as a gatekeeper of immune function.
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Affiliation(s)
- Inga Wessels
- Institute of Immunology, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
| | - Martina Maywald
- Institute of Immunology, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
| | - Lothar Rink
- Institute of Immunology, Faculty of Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
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Buzzetti R, Zampetti S, Maddaloni E. Adult-onset autoimmune diabetes: current knowledge and implications for management. Nat Rev Endocrinol 2017; 13:674-686. [PMID: 28885622 DOI: 10.1038/nrendo.2017.99] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult-onset T1DM. The extensive heterogeneity of adult-onset autoimmune diabetes is apparent beyond the distinction between classic adult-onset T1DM and LADA. LADA is characterized by genetic, phenotypic and humoral heterogeneity, encompassing different degrees of insulin resistance and autoimmunity; this heterogeneity is probably a result of different pathological mechanisms, which have implications for treatment. The existence of heterogeneous phenotypes in LADA makes it difficult to establish an a priori treatment algorithm, and therefore, a personalized medicine approach is required. In this Review, we discuss the current understanding and gaps in knowledge regarding the pathophysiology and clinical features of adult-onset autoimmune diabetes and highlight the similarities and differences with classic T1DM and type 2 diabetes mellitus.
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Affiliation(s)
- Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Simona Zampetti
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Via Álvaro del Portillo 21, 00128, Rome, Italy
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Skevaki C, Van den Berg J, Jones N, Garssen J, Vuillermin P, Levin M, Landay A, Renz H, Calder PC, Thornton CA. Immune biomarkers in the spectrum of childhood noncommunicable diseases. J Allergy Clin Immunol 2017; 137:1302-16. [PMID: 27155027 DOI: 10.1016/j.jaci.2016.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
A biomarker is an accurately and reproducibly quantifiable biological characteristic that provides an objective measure of health status or disease. Benefits of biomarkers include identification of therapeutic targets, monitoring of clinical interventions, and development of personalized (or precision) medicine. Challenges to the use of biomarkers include optimizing sample collection, processing and storage, validation, and often the need for sophisticated laboratory and bioinformatics approaches. Biomarkers offer better understanding of disease processes and should benefit the early detection, treatment, and management of multiple noncommunicable diseases (NCDs). This review will consider the utility of biomarkers in patients with allergic and other immune-mediated diseases in childhood. Typically, biomarkers are used currently to provide mechanistic insight or an objective measure of disease severity, with their future role in risk stratification/disease prediction speculative at best. There are many lessons to be learned from the biomarker strategies used for cancer in which biomarkers are in routine clinical use and industry-wide standardized approaches have been developed. Biomarker discovery and validation in children with disease lag behind those in adults; given the early onset and therefore potential lifelong effect of many NCDs, there should be more studies incorporating cohorts of children. Many pediatric biomarkers are at the discovery stage, with a long path to evaluation and clinical implementation. The ultimate challenge will be optimization of prevention strategies that can be implemented in children identified as being at risk of an NCD through the use of biomarkers.
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Affiliation(s)
- Chrysanthi Skevaki
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH Baldingerstr, Marburg, Germany
| | - Jolice Van den Berg
- International Inflammation (in-FLAME) Network of the World Universities Network; Department of Immunology/Microbiology Rush University Medical Center Chicago, Chicago, Ill
| | - Nicholas Jones
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Johan Garssen
- International Inflammation (in-FLAME) Network of the World Universities Network; Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Beta Faculty, Utrecht University, Utrecht, The Netherlands
| | - Peter Vuillermin
- International Inflammation (in-FLAME) Network of the World Universities Network; Child Health Research Unit, Barwon Health, School of Medicine, Deakin University, Geelong, Australia
| | - Michael Levin
- International Inflammation (in-FLAME) Network of the World Universities Network; Division of Asthma and Allergy, University of Cape Town, and the Department of Pediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa
| | - Alan Landay
- International Inflammation (in-FLAME) Network of the World Universities Network; Department of Immunology/Microbiology Rush University Medical Center Chicago, Chicago, Ill
| | - Harald Renz
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH Baldingerstr, Marburg, Germany
| | - Philip C Calder
- International Inflammation (in-FLAME) Network of the World Universities Network; Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, and NIHR Southampton Biomedical Research Centre, Southampton University Hospital NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Catherine A Thornton
- International Inflammation (in-FLAME) Network of the World Universities Network; Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, Wales.
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Hughes LE, Ford C, Ekbote A, Gama R. Clinical utility of measuring both glutamic acid decarboxylase antibodies and islet cell antibodies in the diagnosis of latent autoimmune diabetes in adults - is it cost-effective? Ann Clin Biochem 2017; 54:623-624. [PMID: 28490183 DOI: 10.1177/0004563217712535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Clare Ford
- Clinical Chemistry, New Cross Hospital, Wolverhampton, UK
| | - Anjala Ekbote
- Clinical Chemistry, New Cross Hospital, Wolverhampton, UK
| | - Rousseau Gama
- Clinical Chemistry, New Cross Hospital, Wolverhampton, UK
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Abstract
Type 1 diabetes mellitus (T1DM), also known as autoimmune diabetes, is a chronic disease characterized by insulin deficiency due to pancreatic β-cell loss and leads to hyperglycaemia. Although the age of symptomatic onset is usually during childhood or adolescence, symptoms can sometimes develop much later. Although the aetiology of T1DM is not completely understood, the pathogenesis of the disease is thought to involve T cell-mediated destruction of β-cells. Islet-targeting autoantibodies that target insulin, 65 kDa glutamic acid decarboxylase, insulinoma-associated protein 2 and zinc transporter 8 - all of which are proteins associated with secretory granules in β-cells - are biomarkers of T1DM-associated autoimmunity that are found months to years before symptom onset, and can be used to identify and study individuals who are at risk of developing T1DM. The type of autoantibody that appears first depends on the environmental trigger and on genetic factors. The pathogenesis of T1DM can be divided into three stages depending on the absence or presence of hyperglycaemia and hyperglycaemia-associated symptoms (such as polyuria and thirst). A cure is not available, and patients depend on lifelong insulin injections; novel approaches to insulin treatment, such as insulin pumps, continuous glucose monitoring and hybrid closed-loop systems, are in development. Although intensive glycaemic control has reduced the incidence of microvascular and macrovascular complications, the majority of patients with T1DM are still developing these complications. Major research efforts are needed to achieve early diagnosis, prevent β-cell loss and develop better treatment options to improve the quality of life and prognosis of those affected.
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Zaharieva ET, Velikova TV, Tsakova AD, Kamenov ZA. Prevalence of Positive Diabetes-Associated Autoantibodies among Type 2 Diabetes and Related Metabolic and Inflammatory Differences in a Sample of the Bulgarian Population. J Diabetes Res 2017; 2017:9016148. [PMID: 28573146 PMCID: PMC5441118 DOI: 10.1155/2017/9016148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/22/2017] [Accepted: 04/11/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The study aimed to estimate the prevalence of unrecognized cases with positive autoantibodies among type 2 diabetes (T2D) in a sample of the Bulgarian population and to compare some metabolic and inflammatory markers to those of patients having negative autoantibodies and subjects with latent autoimmune diabetes (LADA). METHODS Patients with T2D, patients with LADA, and control participants were enrolled. Antiglutamic acid decarboxylase, anti-insulinoma-associated 2, and antizinc transporter 8 autoantibodies were assayed through ELISA. C-reactive protein and interleukin 6 (IL-6) and tumor necrosis factor alpha were assessed. RESULTS Ten percent of patients with T2D had positive autoantibodies. They had lower body mass index (p = 0.014), worse glycemic control (HbA1c, p = 0.033), and better HDL cholesterol (p = 0.026) than those in negative autoantibodies cases. Compared to LADA, glycemia and anthropometric data did not differ significantly but metabolic syndrome was more prevalent among newly found cases with positive autoantibodies (p = 0.046). Their level of inflammatory markers was similar to that of patients having negative autoantibodies (p > 0.05), but IL-6 was higher when compared to LADA (p = 0.002). CONCLUSION Prevalence of patients having positive autoantibodies within T2D in the analyzed sample of the Bulgarian population was 10%. They shared common metabolic features with subjects with LADA, but inflammatory phenotype was closer to that of T2D.
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Affiliation(s)
- Emanuela Tsvetkova Zaharieva
- University Hospital Alexandrovska, Clinic of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
- *Emanuela Tsvetkova Zaharieva:
| | - Tsvetelina Veselinova Velikova
- University Hospital St. Ivan Rilski, Laboratory of Clinical Immunology, Department of Clinical Immunology, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Adelina Dimitrova Tsakova
- University Hospital Alexandrovska, Central Clinical Laboratory, Department of Clinical Laboratory, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Zdravko Asenov Kamenov
- University Hospital Alexandrovska, Clinic of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
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Dayton KA, Silverstein J. What the Primary Care Provider Needs to Know to Diagnose and Care for Adolescents with Type 1 Diabetes. J Pediatr 2016; 179:249-255.e1. [PMID: 27663214 DOI: 10.1016/j.jpeds.2016.08.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/06/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Kristin A Dayton
- University of Florida Shands Children's Hospital, Division of Pediatric Endocrinology, Gainesville, FL.
| | - Janet Silverstein
- University of Florida Shands Children's Hospital, Division of Pediatric Endocrinology, Gainesville, FL
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50
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Silko YV, Nikonova TV, Ivanova ON, Stepanova SM, Shestakova MV, Dedov II. [Latent autoimmune diabetes of adults (LADA): The informative value of autoantibodies]. TERAPEVT ARKH 2016; 88:42-45. [PMID: 27801418 DOI: 10.17116/terarkh2016881042-45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM To investigate the prevalence of autoantibodies (autoAbs) associated with the development of type 1 diabetes mellitus (T1DM) in latent autoimmune diabetes of adults (LADA) in the Russian Federation. SUBJECTS AND METHODS A total of 96 patients (46 women and 50 men) with LADA were examined. All the patients underwent an immunological examination including the determination of autoAbs, such as glutamic acid decarboxylase autoAbs (GADA), islet antigen-2 auto-Abs (IA-2A), islet cell cytoplasmic auto-Abs (ICA), zinc transporter 8 auto-Abs (ZnT8A), and insulin auto-Abs (IAA). RESULTS GADAs were found in 61.5% of the examinees. ICAs were detected in 24%, IA-2As were observed in 57.3%. AutoAbs were more frequently observed in combination than alone. IAAs were least commonly seen in 8.3% and only in combinations. ZnT8As were found in 52.1% of the examinees and they were present alone in 5.2%. CONCLUSION The antibodies that are most frequently observed in LADA are GADAs, IA-2As and ZnT8As. It is insufficient to identify only GADAs, as the latter are found in only 61.5% of the patients. IA-2As and ZnT8As, which are present in 57.3% and 52.1% of the patients, respectively, should also be used in the diagnosis of LADA. ICAs are much less commonly seen and along with IAAs may be additional markers for LADA.
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Affiliation(s)
- Yu V Silko
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - T V Nikonova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - O N Ivanova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - S M Stepanova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - M V Shestakova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - I I Dedov
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
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