Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Meeting report: Spontaneous lesions and diseases in wild, captive-bred, and zoo-housed nonhuman primates and in nonhuman primate species used in drug safety studies

The combination of loss of habitat, human population encroachment, and increased demand of select nonhuman primates for biomedical research has significantly affected populations. There remains a need for knowledge and expertise in understanding background findings as related to the age, source, strain, and disease status of nonhuman primates. In particular, for safety/biomedical studies, a broader understanding and documentation of lesions would help clarify background from drug-related findings. A workshop and a minisymposium on spontaneous lesions and diseases in nonhuman primates were sponsored by the concurrent Annual Meetings of the American College of Veterinary Pathologists and the American Society for Veterinary Clinical Pathology held December 3-4, 2011, in Nashville, Tennessee. The first session had presentations from Drs Lowenstine and Montali, pathologists with extensive experience in wild and zoo populations of nonhuman primates, which was followed by presentations of 20 unique case reports of rare or newly observed spontaneous lesions in nonhuman primates (see online files for access to digital whole-slide images corresponding to each case report at http://www.scanscope.com/ACVP%20Slide%20Seminars/2011/Primate%20Pathology/view.apml). The minisymposium was composed of 5 nonhuman-primate researchers (Drs Bradley, Cline, Sasseville, Miller, Hutto) who concentrated on background and spontaneous lesions in nonhuman primates used in drug safety studies. Cynomolgus and rhesus macaques were emphasized, with some material presented on common marmosets. Congenital, acquired, inflammatory, and neoplastic changes were highlighed with a focus on clinical, macroscopic, and histopathologic findings that could confound the interpretation of drug safety studies.

Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial

BACKGROUND

Cholinesterase inhibitors produce small improvements in cognitive and global assessments in Alzheimer's disease. We aimed to determine whether donepezil produces worthwhile improvements in disability, dependency, behavioural and psychological symptoms, carers' psychological wellbeing, or delay in institutionalisation. If so, which patients benefit, from what dose, and for how long?

METHODS

565 community-resident patients with mild to moderate Alzheimer's disease entered a 12-week run-in period in which they were randomly allocated donepezil (5 mg/day) or placebo. 486 who completed this period were rerandomised to either donepezil (5 or 10 mg/day) or placebo, with double-blind treatment continuing as long as judged appropriate. Primary endpoints were entry to institutional care and progression of disability, defined by loss of either two of four basic, or six of 11 instrumental, activities on the Bristol activities of daily living scale (BADLS). Outcome assessments were sought for all patients and analysed by logrank and multilevel models.

FINDINGS

Cognition averaged 0.8 MMSE (mini-mental state examination) points better (95% CI 0.5-1.2; p<0.0001) and functionality 1.0 BADLS points better (0.5-1.6; p<0.0001) with donepezil over the first 2 years. No significant benefits were seen with donepezil compared with placebo in institutionalisation (42% vs 44% at 3 years; p=0.4) or progression of disability (58% vs 59% at 3 years; p=0.4). The relative risk of entering institutional care in the donepezil group compared with placebo was 0.97 (95% CI 0.72-1.30; p=0.8); the relative risk of progression of disability or entering institutional care was 0.96 (95% CI 0.74-1.24; p=0.7). Similarly, no significant differences were seen between donepezil and placebo in behavioural and psychological symptoms, carer psychopathology, formal care costs, unpaid caregiver time, adverse events or deaths, or between 5 mg and 10 mg donepezil.

INTERPRETATION

Donepezil is not cost effective, with benefits below minimally relevant thresholds. More effective treatments than cholinesterase inhibitors are needed for Alzheimer's disease.

Fully automated radioligand binding filtration assay for membrane-bound receptors

Here we describe a fully automated, hands-free radioligand filtration binding assay for dopamine D3 receptors. Three separate instruments were linked in tandem to perform the following operations: The Genmate and Genesis were linked to perform liquid handling, incubation, and the scheduling operations, while an automated harvester was used to perform rapid filtration. To minimize carryover of compounds, disposable tips were used for diluting and dispensing the compounds. A custom-designed tip holder was used to handle loading and pipetting by the Genmate 96-well pipettor. The assay for 84 compounds with six concentrations that spans six logs can be completed within 4 h. The reproducibility of the individual data point (cv < 10% between duplicates) and Ki (cv < 20%) is superior to that determined by manual procedures. Ki values of various dopamine ligands determined by the hands-free procedure are similar to published values. This technology reduces hands-on time (at least 70%), minimizes exposure to radioligands (up to 95%), and improves the reproducibility of results. The technology is applicablefor high-throughput screening and rapid determination of structure-activity relationship of compounds for many other membrane-bound receptors.

Isotopic evidence for a terrestrial source of organic compounds found in martian meteorites Allan Hills 84001 and Elephant Moraine 79001

Stepped-heating experiments on martian meteorites Allan Hills 84001 (ALH84001) and Elephant Moraine 79001 (EETA79001) revealed low-temperature (200 to 430 degrees Celsius) fractions with a carbon isotopic composition delta13C between -22 and -33 per mil and a carbon-14 content that is 40 to 60 percent of that of modern terrestrial carbon, consistent with a terrestrial origin for most of the organic material. Intermediate-temperature (400 to 600 degrees Celsius) carbonate-rich fractions of ALH84001 have delta13C of +32 to +40 per mil with a low carbon-14 content, consistent with an extraterrestrial origin, whereas some of the carbonate fraction of EETA79001 is terrestrial. In addition, ALH84001 contains a small preterrestrial carbon component of unknown origin that combusts at intermediate temperatures. This component is likely a residual acid-insoluble carbonate or a more refractory organic phase.

Induction of small intestinal adenocarcinomas in Wistar rats administered amsacrine

Amsacrine is an aminoacridine that binds to DNA by intercalation. Because amsacrine interferes with DNA synthesis it has potent genotoxic and cytotoxic properties. To define its tumorigenic nature, amsacrine was studied in a 104-week carcinogenicity bioassay using Wistar rats. Treatment regimen consisted of 6 cycles of intravenous administration over 5 consecutive days followed by 23 days without drug to allow for recovery from cytotoxicity. Doses were 0.25, 1 and 3 mg/kg. At 3 mg/kg mortality was excessive reaching 100% of males by Week 90 and 96% of females at Week 104. Deaths were associated with either tumor induction or cytotoxicity. Multisystemic tumor development manifested in a dose-related fashion. The incidence of small intestinal adenocarcinomas was particularly striking owing to the rarity of these neoplasia in Wistar rats. Small intestinal adenocarcinomas that were well-differentiated presented as pedunculated masses or were sessile masses derived from flat mucosa. Mucin-secreting adenocarcinomas showed poorly-differentiated histologic pattern with absence of crypt or villus structures. We postulate that they are variants of the neoplasia derived from flat mucosa wherein the loss of histologic architecture is the sequela of protracted secretion and accumulation of mucin leading ultimately to extensive tumor remodeling. As amsacrine is primarily excreted in bile, direct exposure to this genotoxic agent was a probable factor in tumorigenesis like small intestinal carcinogens such as 1,2-dimethylhydrazine and azoxymethane.

A stress management program: inpatient-to-outpatient continuity

Stress is a factor in many modern illnesses. The development of coping skills to deal with stress is an occupational therapy goal for many patients. The program presented here uses stress management techniques to improve the situational coping skills of adult psychiatric patients. When discharged to the outpatient clinic, the patients in this program continue to learn and practice stress management techniques to increase relaxation and lessen anxiety. A case example is presented.

An automated, high-capacity method for measuring jumping latencies on a hot-plate

A high-capacity automated apparatus for conducting analgetic screening in mice with an entirely objective endpoint is described. A thermostatically controlled hot-plate apparatus is interfaced with a minicomputer for recording jump latencies, which appear to reflect an affective component of pain. In a model experiment, morphine and naloxone were tested at four temperatures and at four times during the day. As expected, latencies were temperature-dependent, with no significant diurnal variation. The apparatus records latencies to both first and tenth jumps, providing a gross estimate of possible motor depressant effects. Morphine significantly increased latencies to first jump, but did not alter the time between first and tenth jumps, suggesting that motor depression did not occur.