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Musso G, Zoccarato M, Gallo N, Plebani M, Basso D. Hook-effect in MAGLUMI immunoassay for serum anti-GAD antibodies in neurological disorders: When "wrong" matrix is the right choice. Clin Chim Acta 2024; 558:119679. [PMID: 38642630 DOI: 10.1016/j.cca.2024.119679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/26/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
Antibodies against glutamic acid decarboxylase (anti-GAD) are a valuable diagnostic tool to detect severe autoimmune conditions as type 1 diabetes mellitus (T1DM) and anti-GAD related neurological disorders, having the latter more often anti-GAD concentrations in serum multiple times higher than in the former. Automated immunoassays, either with ELISA or chemiluminescent technology, are validated for diagnostic use in serum with analytical ranges suitable for T1DM diagnosis. In a patient presenting with a suspected autoimmune ataxia, anti-GAD testing on an automated chemiluminescent immunoassay (CLIA) resulted in slightly abnormal concentrations in serum (39.2 KIU/L) and very high concentrations in CSF (>280 KIU/L), thus prompting to proceed to serum dilutions to exclude a false negative result and a misdiagnosis. Different dilutions of serum resulted in nonlinear concentrations with endpoint result of 276,500 KIU/L at dilution 1:1000. CSF dilution was instead linear with endpoint result of 4050 KIU/L. In this case report we found that anti-GAD testing in CSF was essential to establish the clinical diagnosis and to suspect hook-effect in serum due to the excess of autoantibodies in this severe autoimmune condition.
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Affiliation(s)
- G Musso
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy.
| | - M Zoccarato
- Neurology Unit, Ospedale Sant'Antonio, University-Hospital of Padova, Padova, Italy
| | - N Gallo
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - M Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - D Basso
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
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2
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Affiliation(s)
- Valdemar Grill
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Elin Sørgjerd
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | - Ingrid Hals
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Research, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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3
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Emekli AS, Parlak A, Göcen NY, Kürtüncü M. Anti-GAD associated post-infectious cerebellitis after COVID-19 infection. Neurol Sci 2021; 42:3995-4002. [PMID: 34328578 PMCID: PMC8322110 DOI: 10.1007/s10072-021-05506-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/18/2021] [Indexed: 12/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread rapidly all over the world. Besides severe pneumonia, it causes multisystemic disease, including neurological findings. Here, we present a patient with anti–glutamic acid decarboxylase (anti-GAD) antibody-associated cerebellitis developed after COVID-19 infection. The patient responded well to the immune treatments. Our knowledge about SARS-CoV-2 infection–related neurological disorders is limited. New data are needed to recognize the clinical spectrum of autoimmune neurological disorders that emerges after SARS-CoV-2 infection.
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Affiliation(s)
- Ahmed Serkan Emekli
- Department of Neurology, Karabuk University Training and Research Hospital, Karabuk, Turkey.
| | - Asuman Parlak
- Department of Neurology, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Nejla Yılmaz Göcen
- Department of Infectious Diseases, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Aguiar TS, Dantas JR, Cabral DB, Rêgo CCS, Zajdenverg L, Salles GF, Alves-Leon SV, Rodacki M, Lima MA. Association between high titers of glutamic acid decarboxylase antibody and epilepsy in patients with type 1 diabetes mellitus: A cross-sectional study. Seizure 2019; 71:318-321. [PMID: 31525611 DOI: 10.1016/j.seizure.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Individuals with type 1 diabetes mellitus (T1D) are at higher risk of epilepsy. T1D is a progressive immune-mediated disease and the etiology of epilepsy remains unknown in most. Glutamic acid decarboxylase (GAD) catalyzes GABA formation. GABA-secreting neurons and pancreatic beta cells are the major cells expressing GAD. METHODS Cross-sectional study. Patients with T1D from a multiethnic population underwent GADA measurement to investigate possible association between T1D and epilepsy of unknown etiology. RESULTS T1D patients were analyzed (n = 375). Overall frequency of epilepsy was 5.9% (n = 22). Frequency of epilepsy of unknown etiology was 3.2% (n = 12). Of these, 8 (2.1%) had idiopathic generalized epilepsy (IGE) and 4 (1.1%) MRI-negative temporal lobe epilepsy (TLE). Patients with T1D and epilepsy of unknown etiology did not show differences in GADA frequency (83.3% vs 50%; p = 0.076); however, their titers were higher (106.9 ± 136.5 IU/mL; median 7; IQR 1.65-256 vs 10.2 ± 14.5 IU/ml; median 4.3; IQR 1.9-8.9; p = 0.019) compared to patients without epilepsy. Moreover, epilepsy of unknown etiology was associated with GADA titers ≥ 100 UI/mL [odds ratio (OR) 4.42, 95% CI 2.36-8.66]. CONCLUSION Epilepsy frequency was elevated in patients with T1D and multiethnic background. Presence of epilepsy of unknown etiology was associated with high titers of GADA in this population with long-standing T1D, which has different ethnic and genetic background compared to previous studies. Further prospective studies are required to identify if GADA presence or its persistence are directly responsible for epilepsy in individuals with T1D.
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Affiliation(s)
- Tiago S Aguiar
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil.
| | - Joana R Dantas
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Débora B Cabral
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Cláudia Cecília S Rêgo
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil; Departamento de Neurologia, Universidade Federal do Estado do Rio de Janeiro UNIRIO, Brazil
| | - Lenita Zajdenverg
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Gil Fernando Salles
- Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Soniza V Alves-Leon
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil; Departamento de Neurologia, Universidade Federal do Estado do Rio de Janeiro UNIRIO, Brazil
| | - Melanie Rodacki
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Marco Antonio Lima
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
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Abstract
An autoimmune disorder of the central nervous system, stiff person syndrome, frequently presents with increased titers of 65KD anti-glutamic acid decarboxylase (anti-GAD) antibodies. The clinical phenomenology of this syndrome includes stiffness, ataxia, vertigo due to horizontal gaze-evoked and downbeat vertical nystagmus, and dysmetria of saccades and reaching movements. Here, we describe a novel phenomenology of syndrome of anti-GAD antibody, non-position-dependent upbeat nystagmus and superimposed horizontal gaze-evoked nystagmus. Lack of gravity dependence of primary position upbeat nystagmus, intense nystagmus on up-gaze, relatively stable gaze on downward orientation, and the exponentially decaying waveform suggests neural integrator dysfunction. The titer of anti-GAD in our patient (30 U/ml) was consistent with a variant called "low-titer anti-GAD syndrome". In addition of presenting as an unusual manifestation of a rare neurological syndrome, this case presents a neurochemical correlate of upbeat nystagmus in GABA-mediated control system involving horizontal and vertical neural integrators. Furthermore, the variant of "low-titer anti-GAD syndrome" suggests that GABAergic system may be affected at lower level or antibodies, and/or the epitopes of antibody in those with full-blown clinical syndrome, but low titers of anti-GAD may be different.
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Affiliation(s)
- Daniel Feldman
- Department of Neurology, Cleveland VA Medical Center, University Hospitals, Cleveland, OH, 44022, USA
| | | | - Aasef G Shaikh
- Department of Neurology, Cleveland VA Medical Center, University Hospitals, Cleveland, OH, 44022, USA.
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El-Abassi R, Soliman MY, Villemarette-Pittman N, England JD. SPS: Understanding the complexity. J Neurol Sci 2019; 404:137-149. [PMID: 31377632 DOI: 10.1016/j.jns.2019.06.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 05/31/2019] [Accepted: 06/17/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Stiff-person syndrome (SPS), first described in 1956 by Moersch and Woltman, is a progressive autoimmune disorder with core features of chronic fluctuating progressive truncal and limb rigidity and painful muscle spasms leading to gait difficulties, falls and an appearance that resembles tin soldiers. The syndrome is a rare, highly disabling disorder of the central nervous and frequently results in significant disability. Understanding of the etiology, clinical spectrum, diagnostic workup and therapeutic modalities for this painful and disabling disorder has vastly evolved over the past few years with more confidence in classifying and treating the patients. The purpose of this review is to increase the awareness, early detection, and treatment of this disabling disease. METHOD PubMed was searched, all date inclusive, using the following phrases: stiff person syndrome,anti-Glutamic acid decarboxylase (Anti-GAD) antibody syndrome, Progressive encephalomyelitis with rigidity and myoclonus (PERM), and Paraneoplastic Stiff Person syndrome. No filters or restrictions were used. A total of 888 articles were identified. RESULTS The results were narrowed to 190 citations after excluding non-English and duplicate reports. Clinical presentation, laboratory testing, treatment, and prognosis were categorized and summarized. DISCUSSION In this article we will discuss the epidemiology, presentation and classification. Explain the pathophysiology of SPS and the autoimmune mechanisms involved. Discuss the diagnostic approach and treatments available, as well as, the prognosis and outcome.
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Affiliation(s)
- Rima El-Abassi
- Department of Neurology, Louisiana State University School of medicine, New Orleans, USA.
| | - Michael Y Soliman
- Department of Neurology, Louisiana State University School of medicine, New Orleans, USA
| | | | - John D England
- Department of Neurology, Louisiana State University School of medicine, New Orleans, USA
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Shahbazian H, Aleali AM, Rashidi H, Latifi SM, Rashidi M, Yazdanpanah L, Zaman F, Payami SP, Moradi L, Jahanshahi A, Sedaghat A, Zakerkish M, Moradi M. Frequency of type I and II diabetes in newly diagnosed diabetic patients: Measuring C-Peptide level. Diabetes Metab Syndr 2019; 13:1833-1835. [PMID: 31235102 DOI: 10.1016/j.dsx.2019.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
AIMS Diabetes mellitus is a metabolic disease that manifested as hyperglycemia due to the defect in secretion or function of insulin. This study aimed was to survey about frequency type I and II diabetes in newly diagnosed diabetic patients base on c-peptide and anti-glutamate acid decarboxylase (GAD) tests. MATERIALS & METHODS This study was conducted as a prospective study on 70 diabetic patients aged 15-45 years old who referred to diabetes clinics in Ahvaz city during 2012-2014 and their diabetes was diagnosed for the first time, but their type of diabetes was not clinically definitive. Patients with anti-GAD positive and fasting C-peptide level of less than 0.65 were diagnosed as type I diabetes. Patients with anti-GAD negative fasting C-peptide level of greater than or equal to 0.65 were considered as type II diabetes. RESULTS Eighty two patients (49 males and 33 females) with a mean age of 21.64 ± 4.36 years (range 15-34) and a mean BMI of 22.05 ± 4.41 kg/m2 (range 14-18) were studied. Twenty three patients (28.5%) had type I diabetes and 59 patients (71.95%) had type II diabetes. In patients with type I diabetes, the mean BMI was 24.86 ± 2.36 kg/m2 and the number of patients with family history (56.22%) was higher. In type II diabetic patients, the number of women (62.71%) was higher than that of men. CONCLUSION Anti-GAD test can be used as a predictive test for early diagnosis of disease and screening of people with a diagnosis of diabetes based on the type of diabetes.
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Affiliation(s)
- Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Armaghan Moravej Aleali
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Homeira Rashidi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Seyed Mahmoud Latifi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mojtaba Rashidi
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Leila Yazdanpanah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Ferdos Zaman
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Seyed Peyman Payami
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Leila Moradi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Alireza Jahanshahi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Alireza Sedaghat
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mehrnoosh Zakerkish
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mitra Moradi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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8
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Vinke AM, Schaper FLWVJ, Vlooswijk MCG, Nicolai J, Majoie MHJM, Martinez Martinez P, Hoffmann C, Damoiseaux JGMC, Rouhl RPW. Anti-GAD antibodies in a cohort of neuropsychiatric patients. Epilepsy Behav 2018; 82:25-28. [PMID: 29579551 DOI: 10.1016/j.yebeh.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Antiglutamate decarboxylase (anti-GAD) antibodies are associated with several neurological manifestations, like epilepsy and movement disorders. However, in daily neurological practice, it remains hard to define when to test for anti-GAD antibodies in patients with neurologic and/or psychiatric symptoms. Therefore, here, we report the patient characteristics of a large retrospective cohort of patients tested for anti-GAD antibodies in clinical practice and compare the characteristics of anti-GAD positive and anti-GAD negative patients. METHODS We blindly assessed relevant clinical symptoms and comorbidities and functional outcome with the modified Rankin Scale (mRS) in a retrospective observational cohort of all patients in which the decision to assess anti-GAD levels had been made based solely on the presence of possible associated neurological and/or psychiatric symptoms (N=119). RESULTS Out of 119 patients, 17 (14.3%) were anti-GAD positive. The anti-GAD positive patients had a median age of 30years (range: 3-64; 2 children). They all had epilepsy, with 8 (47%) patients reporting cognitive complaints. Psychiatric symptoms were less prevalent in anti-GAD positive patients, only 1 anti-GAD positive patient (6%) versus 34 anti-GAD negative patients (33%) reported psychiatric symptoms (p=0.021). The most frequent comorbidity of anti-GAD positive patients was diabetes mellitus type 1 (n=8). Twelve (71%) and 13 (78%) of the anti-GAD positive patients were functionally independent at the time of diagnosis and after one year, respectively (mRS score: 0 to 2). There was no significant difference in functional status at any time during follow-up compared with the anti-GAD negative group. CONCLUSION Antiglutamate decarboxylase (anti-GAD) antibodies relate to epilepsy with or without cognitive complaints. However, psychiatric symptoms were almost absent in anti-GAD positive patients, and the presence of anti-GAD antibodies contributed little to the prognosis in our cohort.
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Affiliation(s)
- Anita M Vinke
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Frédéric L W V J Schaper
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Neuroscience, Maastricht University, The Netherlands
| | - Mariëlle C G Vlooswijk
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Joost Nicolai
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Marian H J M Majoie
- Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands;; School of Health Professions Education, Maastricht University, The Netherlands
| | - Pilar Martinez Martinez
- Department of Neuroscience, Maastricht University, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Carolin Hoffmann
- Department of Neuroscience, Maastricht University, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Jan G M C Damoiseaux
- Department of Central Diagnostic Laboratory, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands;.
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Abstract
A 52 year-old female with no significant medical problems presented with left-sided weakness, unsteady gait and speech disturbance. It was thought that she had neuro-inflammation and she remained clinically stable. Several years later, she was diagnosed with latent autoimmune diabetes of adulthood. Her neurological symptoms deteriorated and she was admitted into hospital. The cerebrospinal fluid was normal, as were an array of blood tests. Imaging tests, including magnetic resonance imaging, computerised tomography and positron emission tomography scans were normal. However, her anti-glutamic acid decarboxylase antibody serum level, which had been taken in the diabetes outpatient clinic, returned at 2,000,000 IU/mL (normal range 0-10). This led to the diagnosis of glutamic acid decarboxylase (GAD) positive cerebellar ataxia. She was treated with plasma exchange and intravenous immunoglobulins and over next 12 weeks her symptoms improved. Our case highlights the need for appropriate treatment of patients with GAD positive cerebellar ataxia to achieve good outcomes.
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Affiliation(s)
- Rebecca J Ward
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | - Biju Jose
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Roby J Abraham
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Mine K, Hirakawa K, Kondo S, Minami M, Okada A, Tsutsu N, Yokogawa Y, Hibio Y, Kojima F, Fujimoto S, Kurisaki H, Anzai K, Yoshikai Y, Nagafuchi S. Subtyping of Type 1 Diabetes as Classified by Anti-GAD Antibody, IgE Levels, and Tyrosine kinase 2 (TYK2) Promoter Variant in the Japanese. EBioMedicine 2017; 23:46-51. [PMID: 28826655 PMCID: PMC5605380 DOI: 10.1016/j.ebiom.2017.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 12/14/2022] Open
Abstract
Objective Type 1 diabetes (T1D) is known to be caused by Th1 cell-dependent autoimmunity. Recently, we reported that TYK2 promoter variant serves as a putative virus-induced diabetes susceptibility gene associated with deteriorated interferon-dependent antiviral response. TYK2 is also related to HIES, that is, Th2 cell-dependent. Therefore, TYK2 promoter variant may be also associated with the pathogenesis of T1D, modulating Th1/Th2 balance. Research Design and Methods We assessed the association between anti- GAD Ab, IgE levels, and TYK2 promoter variant among 313 T1D patients, 184 T2D patients, and 264 YH controls in the Japanese. Results T1D patients had elevated IgE (median, 56.7 U/ml; p < 0.0001) compared with T2D patients (22.5 U/ml) and controls (43.3 U/ml). Contrary to our expectations, there was no correlation between TYK2 promoter variant and IgE levels. We found that T1D could be subtyped as four groups based on anti-GAD Ab and IgE profile: Subtype 1, anti-GAD Ab positive and non-elevated IgE (47.0%); Subtype 2, anti-GAD Ab negative and non-elevated IgE (35.1%); Subtype 3, anti-GAD Ab positive and elevated IgE (10.9%); and Subtype 4, anti-GAD Ab negative and elevated IgE (7.0%). In Subtype 2, a significantly higher incidence was observed in T1D cases carrying the TYK2 promoter variant (OR, 2.60; 95%CI, 1.03–6.97; p = 0.032), and also showing a flu-like syndrome at diabetes onset (OR, 2.34; 95%CI, 1.27–4.35; p = 0.003). Interpretation Anti-GAD Ab and IgE profiling helps classifying T1D into four groups that recognize variable pathogenic bases of T1D. T1D can be subtyped into 4 groups based on anti-GAD Ab, IgE levels and TYK2 promoter variant. Only one subtype, without anti-GAD Ab or elevated IgE, was associated with TYK2 promoter variant and flu-like syndrome. Profiling of T1D by anti-GAD Ab and IgE levels is useful to realize the variable immuno-pathogenesis of T1D.
Since TYK2 gene is associated with T1D and HIES, we assessed the association between anti-GAD Ab, IgE levels, and TYK2 promoter variant in patients with T1D. Consequently, T1D can be subtyped into 4 distinct groups based on these clinical laboratory and genetic markers. Only those patients without anti-GAD Ab or elevated IgE were associated with TYK2 promoter variant and with flu-like syndrome at the diabetes onset, suggestive of association with virus-induced diabetes. This study describes the usefulness of subtyping of T1D with variable immunological bases and provides a clue to delineate the pathogenesis of T1D.
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Affiliation(s)
- Keiichiro Mine
- Division of Host Defense, Medical Institute of Bioregulation, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Kanako Hirakawa
- Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Shiori Kondo
- Matsuyama Red Cross Hospital, 1, Bunkyo-machi, Matsuyama-shi, Ehime, Japan.
| | - Masae Minami
- Minami Masae Naika Clinic, 1-4-6, Heiwa, Minami-ku, Fukuoka, Japan.
| | - Akira Okada
- Okada Naika Clinic, 7-8-8, Hakozaki, Higashi-ku, Fukuoka, Japan.
| | - Nobutaka Tsutsu
- Department of Diabetes and Metabolism, Fukuoka Red Cross Hospital, 3-1-1, Minami-ku, Fukuoka, Japan.
| | | | - Yumi Hibio
- Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan; Center for Clinical Laboratory Examination, Fukuoka Medical Association, 1-6-9, Sawara-ku, Fukuoka, Japan.
| | - Fumiko Kojima
- Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Shuji Fujimoto
- Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Hironori Kurisaki
- Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Keizo Anzai
- Department of Hepatology, Diabetes and Endocrinology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga, Japan.
| | - Yasunobu Yoshikai
- Division of Host Defense, Medical Institute of Bioregulation, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Seiho Nagafuchi
- Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan; Department of Hepatology, Diabetes and Endocrinology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga, Japan.
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Rolim I, Duarte N, Barata G, Costa J, Gardete-Correia L, Boavida J, Duarte R, Raposo J, Peerally Z, Catarino M, Penha-Gonçalves C. Immunoglobulin M gene association with autoantibody reactivity and type 1 diabetes. Immunogenetics 2017; 69:429-437. [PMID: 28534223 PMCID: PMC5486809 DOI: 10.1007/s00251-017-0999-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/04/2017] [Indexed: 01/07/2023]
Abstract
Several lines of evidence show that autoimmune responses evolving in type 1 diabetes (T1D) patients include the generation of multi-reactive autoantibody (AutoAb) repertoires, but their role in T1D pathogenesis remains elusive. We tested the hypothesis that variants at the immunoglobulin heavy chain (IGH) locus are genetic determinants of AutoAbs against pancreatic antigens and contribute to T1D susceptibility. With this aim, two independent study designs were used: a case-control study and a family-based cohort comprising a total of 240 T1D patients, 172 first-degree relatives (mother and/or father), and 130 unrelated healthy controls living in Portugal. We found that three SNPs in the IGH locus show suggestive association with T1D with the highest nominal association at rs1950942 (in the IGHM-IGHJ gene region) in both the case-control study (P = 9.35E-03) and the family-based cohort (P = 3.08E-03). These SNPs were also associated with IgG AutoAbs against pancreatic antigens and with AutoAb multi-reactivity in T1D patients. Notably, we found that the SNP with the highest association with T1D susceptibility and IgG autoantibody reactivity (rs1950942) was also associated with anti-GAD IgM reactivity in T1D patients (P = 5.98E-03) and in non-affected parents (P = 4.17E-03). This finding implies that IGH association with autoreactive IgM is detectable irrespective of disease status.These results suggest that genetic variants at the IgM gene region of the IGH locus contribute to antibody autoreactivity and are associated with T1D. We propose that the control of autoantibody generation by IGH polymorphisms is a component of the complex architecture of T1D genetic susceptibility.
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Affiliation(s)
- Inês Rolim
- Instituto Gulbenkian de Ciência, Apartado 14, P-2781-901, Oeiras, Portugal.,Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Nádia Duarte
- Instituto Gulbenkian de Ciência, Apartado 14, P-2781-901, Oeiras, Portugal
| | - Gabriela Barata
- Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal.,Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal
| | - João Costa
- Instituto Gulbenkian de Ciência, Apartado 14, P-2781-901, Oeiras, Portugal
| | - Luís Gardete-Correia
- Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal
| | - José Boavida
- Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal
| | - Rui Duarte
- Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal
| | - João Raposo
- Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal
| | - Zulmira Peerally
- Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal
| | | | - Carlos Penha-Gonçalves
- Instituto Gulbenkian de Ciência, Apartado 14, P-2781-901, Oeiras, Portugal. .,Portuguese Diabetes Association, Education and Research Center, Lisbon, Portugal.
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12
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Petrijan T, Menih M. Low-Titre GAD Antibody-Associated Late-Onset Cerebellar Ataxia with a Significant Clinical Response to Intravenous Immunoglobulin Treatment. Cerebellum 2017; 16:868-871. [PMID: 28321713 DOI: 10.1007/s12311-017-0851-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antiglutamic acid decarboxylase antibody-associated cerebellar ataxia (GAD-Abs CA) is a rare, but increasingly detected, autoimmune neurological disorder characterized by the clinical presence of a cerebellar syndrome concomitant with positive GAD-Abs levels in serum and cerebrospinal fluid (CSF). It represents 3% of all immune-mediated sporadic CAs. Low-titre GAD-Abs CA is an even rarer subtype of GAD-Abs CA. We report on a 68-year-old woman with a 3-year history of progressive gait ataxia. In addition to the modified Rankin Scale (mRS), we used two other objective scales to evaluate CA severity, i.e. the International Cooperative Ataxia Rating Scale (ICARS) and the Scale for Assessment and Rating of Ataxia (SARA). Series of CT and MRI showed atrophy of the cerebellum. Except for the glycated haemoglobin (HbA1c) levels, all other routine laboratory examinations were within normal limits. Autoimmune laboratory examinations showed positive (25.8 U/mL) serum GAD-Abs levels. The GAD antibody index was <1.0. The CSF analysis showed no oligoclonal immunoglobulin bands. Intravenous immunoglobulin (IVIg) therapy was started and significant improvement was observed. The diagnosis of low-titre GAD-Abs CA was established.
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Affiliation(s)
- Timotej Petrijan
- Department of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Marija Menih
- Department of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
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13
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di Biase L, Assenza G, Iorio R, Melgari JM, Salomone G, Marano M, Muda AO, Di Lazzaro V. Efficacy of oral corticosteroids therapy in anti-glutamic acid decarboxylase antibodies cerebellar ataxia. Parkinsonism Relat Disord 2016; 30:78-80. [PMID: 27236207 DOI: 10.1016/j.parkreldis.2016.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Lazzaro di Biase
- Institute of Neurology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Oxford, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, University College London, London, UK.
| | - Giovanni Assenza
- Institute of Neurology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Raffaele Iorio
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy
| | - Jean-Marc Melgari
- Institute of Neurology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy; Institute of Neurology, Caravaggio Treviglio Hospital, Treviglio BG, Italy
| | - Gaetano Salomone
- Institute of Neurology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Massimo Marano
- Institute of Neurology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Andrea Onetti Muda
- Department of Pathology, Pathology Unit, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Institute of Neurology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
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14
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Almarzouqi SJ, Morgan ML, Carvounis PE, Lee AG. Autoimmune-Related Retinopathy and Optic Neuropathy Accompanied by Anti-GAD Antibodies. Neuroophthalmology 2015; 39:195-200. [PMID: 27928356 DOI: 10.3109/01658107.2015.1050744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/10/2015] [Accepted: 05/10/2015] [Indexed: 11/13/2022] Open
Abstract
Autoimmune-related retinopathy and optic neuropathy is characterized by visual loss in the presence of antibodies against retina or optic nerve antigens in the absence of neoplasia. We report a case with progressive central visual loss accompanied by latent autoimmune diabetes in an adult. Visual fields, multimodal imaging and electrophysiological testing showed characteristic changes without evidence of neoplasia on positron emission tomography. Immunologic testing revealed abnormal reactivity against a 20 kDa optic nerve antigen and 40 kDa and 62 kDa retina antigens along with antibodies against anti-glutamic acid decarboxylase, a constellation which we believe to be unique.
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Affiliation(s)
| | - Michael L Morgan
- Department of Ophthalmology, Houston Methodist Hospital , Houston, Texas, USA
| | | | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas, USA, ; Baylor College of Medicine, Houston, Texas, USA, ; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, Texas, USA, ; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA, ; Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA, and ; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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15
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Marinović I, Pivalica D, Aljinović J, Vlak T, Škorić E, Martinović Kaliterna D. Extremely rare coincidence of non-radiographic axial spondyloarthropathy HLA-B27 positive and Stiff Person Syndrome--rheumatologist point of view. Mod Rheumatol 2013; 26:278-80. [PMID: 24289195 DOI: 10.3109/14397595.2013.857837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive stiffness and rigidity of truncal muscles accompanied with co-contraction of agonist-antagonist muscles. Our 51-year-old female patient was presented for the first time to physiatrists in 2006 and diagnosed with axial-spondyloarthropathy (SpA) HLA-B27 positive. SPS was diagnosed 7 years after initial symptoms. SPS should be taken into consideration in HLA-B27 positive patients if stiffness of paravertebral and abdominal muscles progresses during SpA therapy.
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Affiliation(s)
- Ivanka Marinović
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Dinko Pivalica
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Jure Aljinović
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Tonko Vlak
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Ela Škorić
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Dušanka Martinović Kaliterna
- b Department of Rheumatology and Clinical Immunology , University Hospital Split, School of Medicine in Split , Split , Croatia
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