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Raha O, Chowdhury S, Dasgupta S, Raychaudhuri P, Sarkar BN, Raju PV, Rao VR. Approaches in type 1 diabetes research: A status report. Int J Diabetes Dev Ctries 2010; 29:85-101. [PMID: 20142874 PMCID: PMC2812756 DOI: 10.4103/0973-3930.53126] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 05/29/2009] [Indexed: 12/18/2022] Open
Abstract
Type 1 diabetes is a multifactorial disease with an early age of onset, in which the insulin producing beta cell of the pancreas are destroyed because of autoimmunity. It is the second most common chronic disease in children and account for 5% to 10% of all diagnosed cases of diabetes. India is having an incidence of 10.6 cases/year/100,000, and recent studies indicate that the prevalence of type 1 diabetes in India is increasing. However in view of poor health care network, there is no monitoring system in the country. Of the 18 genomic intervals implicated for the risk to develop type 1 diabetes, the major histocompatibility complex (MHC) region on chromosome 6p21.31 has been the major contributor estimated to account for 40-50%, followed by 10% frequency of INS-VNTR at 5' flanking region of the insulin gene on chromosome 11p15.5. However, population studies suggest that > 95% of type 1 diabetes have HLA-DR3 or DR4, or both, and in family studies, sibling pairs affected with type 1 diabetes have a non-random distribution of shared HLA haplotypes. As predisposing genetic factors such as HLA alleles are known, immunological interventions to prevent type 1 diabetes are of great interest. In the present study we have reviewed the status of molecular genetics of the disease and the approaches that need to be adopted in terms of developing patient and suitable control cohorts in the country.
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Affiliation(s)
- Oindrila Raha
- Anthropological Survey of India, 27-Jawaharlal Nehru Road, Kolkata, West-Bengal - 700 016, India
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Lapolla A, Dalfrà MG, Fedele D. Diabetes related autoimmunity in gestational diabetes mellitus: is it important? Nutr Metab Cardiovasc Dis 2009; 19:674-682. [PMID: 19541464 DOI: 10.1016/j.numecd.2009.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 02/06/2009] [Accepted: 04/01/2009] [Indexed: 01/29/2023]
Abstract
Some GDM women show autoantibody positivity during and after pregnancy and pancreatic autoantibodies can appear for the first time in some patients after delivery. Autoantibody positivity is often accompanied by a high frequency of DR3 and DR4 alleles, which are classically related to the development of type 1 diabetes and, although not all studies agree on this point, by an immunological imbalance expressed by the behaviour of the lymphocyte subpopulation, which can be seen as diabetic anomalies overlapping with the immunological changes that occur during pregnancy. It is worth emphasizing that such patients may develop classical type 1 diabetes during and/or after their pregnancy or they may evolve, often some years after their pregnancy, into cases of latent autoimmune diabetes of adulthood (LADA). Autoimmune GDM accounts for a relatively small number of cases (about 10% of all GDM) but the risk of these women developing type 1 diabetes or LADA is very high, so these patients must be identified in order to prevent the severe maternal and fetal complications of type 1 diabetes developing in pregnancy, or its acute onset afterwards. Since women with autoimmune GDM must be considered at high risk of developing type 1 diabetes in any of its clinical forms, these women should be regarded as future candidates for the immunomodulatory strategies used in type 1 diabetes.
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Affiliation(s)
- A Lapolla
- Department of Clinical and Surgical Sciences-Chair of Metabolic Disease, Padova University, Via Giustiniani n 2, 35100 Padova, Italy.
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Murgia C, Orrù M, Portoghese E, Garau N, Zedda P, Berria R, Motzo C, Sulis S, Murenu M, Paoletti AM, Melis GB. Autoimmunity in gestational diabetes mellitus in Sardinia: a preliminary case-control report. Reprod Biol Endocrinol 2008; 6:24. [PMID: 18588707 PMCID: PMC2459179 DOI: 10.1186/1477-7827-6-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 06/29/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We previously reported a high prevalence (22.3%) of gestational diabetes mellitus (GDM) in a large group of Sardinian women, in contrast with the prevalence of Type 2 diabetes. Sardinia has an unusual distribution of haplotypes and genotypes, with the highest population frequency of HLA DR3 in the world, and after Finland, the highest prevalence of Type 1 diabetes and Autoimmune-related Diseases. In this study we preliminarily tested the prevalence of serological markers of Type 1 diabetes in a group of Sardinian GDM patients. METHODS We determined glutamic decarboxylase antibodies (anti-GAD65), protein tyrosine phosphatase ICA 512 (IA2) antibodies (anti-IA2), and IAA in 62 GDM patients, and in 56 controls with matching age, gestational age and parity. RESULTS We found a high prevalence and very unusual distribution of antibodies in GDM patients (38.8%), the anti-IA2 being the most frequent antibody. Out of all our GDM patients, 38.8% (24 of 62) were positive for at least one antibody. Anti-IA2 was present in 29.0 % (18 out of 62) vs. 7.1% (4 out of 56) in the controls (P < 0.001). IAA was present in 14.5% (9 out of 62) of our GDM patients, and absent in the control subjects (P < 0.001). Anti-GAD65 was also present in GDM patients, with a prevalence of 3.2% (2 out of 62) while it was absent in the control group (P = NS). Pre-gestational weight was significantly lower (57.78 +/- 9.8 vs 65.9 +/- 17.3 P = 0.04) in auto-antibodies- positive GDM patients. CONCLUSION These results are in contrast with the very low prevalence of all antibodies reported in Italy. If confirmed, they could indicate that a large proportion of GDM patients in Sardinia have an autoimmune origin, in accordance with the high prevalence of Type 1 diabetes.
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Affiliation(s)
- Cinzia Murgia
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Marisa Orrù
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Elaine Portoghese
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Nicoletta Garau
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Pierina Zedda
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Rachele Berria
- Department of Obstetrics and Gynecology, Case Western Reserve University, 44109 Cleveland, Ohio, USA
| | - Costantino Motzo
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Simonetta Sulis
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Michela Murenu
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Anna Maria Paoletti
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
| | - Gian Benedetto Melis
- Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e Fisiopatologia della Riproduzione Umana, Universita' degli Studi di Cagliari, Italy
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de Leiva A, Mauricio D, Corcoy R. Diabetes-related autoantibodies and gestational diabetes. Diabetes Care 2007; 30 Suppl 2:S127-33. [PMID: 17596460 DOI: 10.2337/dc07-s204] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alberto de Leiva
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Avinguda Sant Antoni M. Claret, 167, 08025, Barcelona, Spain.
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Colman PG, McNair PD, Gellert S, Kewming K, Schmidli RS, Steele CE, Harrison LC. Development of autoantibodies to islet antigens during childhood: implications for preclinical type 1 diabetes screening. Pediatr Diabetes 2002; 3:144-8. [PMID: 15016154 DOI: 10.1034/j.1399-5448.2002.30304.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Serum islet antibodies signify increased risk for type 1 diabetes (T1D). Knowledge of the relationship between age and seroconversion would guide screening for at-risk individuals. We aimed to determine the effectiveness of islet antibody screening in early childhood, in particular the proportion of negative children who subsequently seroconverted. METHODS We identified 554 children with a first-degree relative with T1D who had tested negative for islet cell antibodies (ICA) and insulin autoantibodies (IAA) when first screened at a mean age of 7.2 yr. Of 423 who were eligible, 350 consented to re-testing for ICA and IAA and antibodies to glutamic acid decarboxylase (GADAb) and tyrosine phosphatase-like insulinoma antigen IA-2 (IA2Ab) at a mean age of 11.1 yr. GADAb and IA2Ab were measured in 239 of the initial stored samples. RESULTS Of the 350 children who tested negative at first screening, 12 (3.4%) subsequently seroconverted, becoming positive for ICA (n = 4), IAA (n = 7), GADAb (n = 6) or IA2Ab (n = 2). Of 239 initially negative for ICA and IAA, 8/239 (3.3%) now tested positive for GADAb (n = 7) or IA2Ab (n = 1). Four of these children were positive for GADAb in both tests; the one child initially positive for IA2Ab only was positive for all four antibodies 4.6 yr later and developed diabetes. CONCLUSION Screening for ICA and IAA failed to identify 2-3% of genetically at-risk children who subsequently developed islet antibodies. Testing for GADAb and IA2Ab would not have avoided this. Maximizing the sensitivity of detecting risk for T1D requires repeat screening for islet antibodies throughout childhood.
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Affiliation(s)
- Peter G Colman
- Department of Diabetes and Endocrinology, Walter and Eliza Hall Institute of Medical Research, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Kasimiotis H, Fida S, Rowley MJ, Mackay IR, Zimmet PZ, Gleason S, Rabin DU, Myers MA. Antibodies to SOX13 (ICA12) are associated with type 1 diabetes. Autoimmunity 2001; 33:95-101. [PMID: 11264788 DOI: 10.3109/08916930108995994] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
SOX13 is an islet cell autoantigen (ICA12), identified by antibody screening of an islet cDNA library, using sera from patients with Type 1 diabetes. We ascertained the frequency of antibody reactivity to SOX13 and compared it with other Type 1 diabetes autoantibody reactivities. Antibodies were measured by radioimmunoprecipitation (RIP) using (35) S labelled SOX13 expressed in rabbit reticulocyte lysate. Sera from 109 subjects with Type 1 diabetes, 29 with Type 2 diabetes, 144 with other autoimmune diseases and from 201 controls were tested for anti-SOX13, and results were compared with the frequency of antibodies to glutamic acid decarboxylase (anti-GAD), islet cell antigen 512 (anti-ICA512) and islet cell cytoplasm (ICA). Anti-SOX13 were detected in 20 (18.3%) of 109 subjects with Type 1 diabetes, and more frequently in adults than in children (29% vs 10%). Anti-SOX13 usually occurred with anti-GAD but rarely with anti-ICA512. Seven sera positive for anti-SOX13 did not react with either GAD, ICA512 or islet cell cytoplasm indicating that anti-SOX13 represented a distinct population of antibodies. Reactivity to SOX13 represents a further autoantibody response in adults with Type 1 diabetes and may provide a useful disease marker in subjects in whom other autoantibody tests are negative.
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Affiliation(s)
- H Kasimiotis
- Department of Biochemistry and Molecular Biology, Monash University, Wellington Road Clayton, 3168 Australia
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Schiel R, Müller UA. GAD autoantibodies in a selection-free population of insulin-treated diabetic patients: indicator of a high prevalence of LADA? Diabetes Res Clin Pract 2000; 49:33-40. [PMID: 10808061 DOI: 10.1016/s0168-8227(00)00139-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Up to the present only few data have been available concerning the prevalence of diabetes-specific autoantibodies (anti-GAD, ICA, IAA, IA-2) in unselected populations, in particular in type 2 diabetic patients. Hence, the aim of the present study was to determine the prevalence of anti-GAD in a selection-free population of insulin-treated diabetic patients. Accordingly, 90% of all the insulin-treated diabetic patients (type 1, n=127, type 2, n=117) aged 16-60 years and living in the city of Jena (100242 inhabitants) were examined. In order to test sera for anti-GAD, serum samples were taken in 75% of type 1 (n=95) and in 80% of insulin-treated type 2 diabetic (n=94) patients. RESULTS In the group of type 1 diabetic patients 55% of the patients tested were positive for anti-GAD. But, interestingly, in the type 2 group, a total of 21% patients were positive. With respect to this high percentage of anti-GAD positive type 2 diabetic patients it must be suggested that the frequency of patients with latent autoimmune diabetes mellitus in adults (LADA) was underestimated in the past.
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Affiliation(s)
- R Schiel
- Department of Internal Medicine II, University of Jena Medical School, D-07740, Jena, Germany.
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Maclaren N, Lan M, Coutant R, Schatz D, Silverstein J, Muir A, Clare-Salzer M, She JX, Malone J, Crockett S, Schwartz S, Quattrin T, DeSilva M, Vander Vegt P, Notkins A, Krischer J. Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2 and IA-2beta predict immune-mediated (Type 1) diabetes in relatives. J Autoimmun 1999; 12:279-87. [PMID: 10330299 DOI: 10.1006/jaut.1999.0281] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report here our prospective study of 15,224 non-diabetic, first-degree relatives of probands with immune-mediated (type 1) diabetes (IMD), of which 135 were found to eventually develop diabetes. We determined islet cell, insulin, GAD65, insulinoma-associated antigen-2 and 2beta autoantibodies (ICA, IAA, GAD65A, IA-2A and IA-2betaA), on the first available serum samples. The latter three autoantibodies were however assayed on subsets of the relatives with and without ICA, IAA and/or GAD65A, plus most of the relatives who developed diabetes. Of the relatives who progressed to diabetes, 94% had at least one of these autoantibodies on the first screening, while ICA proved to be the most sensitive single marker (sensitivity 74%). Risk of diabetes was however negligible when ICA was found in the absence of the others (5-year risk=5.3%), but increased dramatically whenever two or more autoantibodies were present (5-year risk=28.2% and 66.2%, respectively). The most predictive combination of markers was ICA plus IA-2A and/or IA-2beta A. Loss of first phase insulin release to IVGTT also occurred only in those ICA-positive relatives who had one or more of the other autoantibodies. The data suggests that significant beta-cell damage is seen only when the underlying autoimmunity has spread to multiple antigenic islet cell determinants. Combinations of the autoantibodies occurred most often in relatives with the highest risk HLA-DR/DQ phenotypes. These data document that only relatives positive for at least two or more of these five autoantibodies are at significant risk of diabetes themselves. Intervention trials for the prevention of type 1 diabetes could be designed based on testing for these autoantibodies alone, without the need for HLA typing and IVGTT testing.
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Affiliation(s)
- N Maclaren
- Departments of Pediatrics and Biometry and Genetics, Louisiana State University Medical School at the Research Institute for Children, New Orleans, LA, USA
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