Hillman M, Törn C, Landin-Olsson M
Department of Clinical Sciences, Lund University, Lund, Sweeden.
Clin Exp Immunol. 2009 Aug;157(2):255-60. doi: 10.1111/j.1365-2249.2009.03939.x.
Autoantibodies against glutamic acid decarboxylase 65 (GADA) are found frequently in patients with autoimmune diabetes. Immunoglobulin (Ig)G(1) is the most frequent subclass among the GADA IgG subclasses. IgG(4) is a more common subclass in latent autoimmune diabetes in adults (LADA) at clinical onset compared to type 1 diabetes. The aim of this work was to study the different GADA-IgG subclass profiles during a 3-year follow-up in these groups of autoimmune diabetes. Adult-onset subjects, classified as either type 1 (n = 40) or LADA (n = 43), were included in the study. New samples were collected every year from these patients. In addition to conventional GADA analyses, GADA-IgG subclasses were also analysed with a radioimmunoprecipitation assay using biotin-conjugated antibodies (directed against human IgG subclasses and IgM) and streptavidin Sepharose. During 3 years' follow-up, all the IgG subclass levels decreased in type 1 diabetes - IgG(1): P < 0.001; IgG(2): P < 0.001; IgG(3): P < 0.001; IgG(4): P < 0.05 (Friedman's' test) - while levels remained stable for all four subclasses in LADA. GADA IgM, however, decreased in both groups (P < 0.001). Patients with LADA have higher GADA IgG(3) and IgG(4) at clinical onset and seem to maintain the levels and profile of their IgG subclasses up to 3 years after clinical onset, while all the GADA IgG subclass levels decrease in type 1 diabetic patients. This indicates a persistent different immune response in LADA compared to type 1 diabetes and further indicates the difference in pathogenesis.
自身免疫性糖尿病患者体内经常能检测到谷氨酸脱羧酶65(GADA)自身抗体。免疫球蛋白(Ig)G(1)是GADA IgG亚类中最常见的亚类。与1型糖尿病相比,IgG(4)是成人隐匿性自身免疫性糖尿病(LADA)临床发病时更常见的亚类。本研究旨在观察这些自身免疫性糖尿病患者在3年随访期间不同的GADA-IgG亚类谱。研究纳入了成年发病的受试者,分为1型糖尿病组(n = 40)和LADA组(n = 43)。每年从这些患者中采集新样本。除了常规的GADA分析外,还使用生物素偶联抗体(针对人IgG亚类和IgM)和链霉亲和素琼脂糖通过放射免疫沉淀法分析GADA-IgG亚类。在3年的随访期间,1型糖尿病患者所有IgG亚类水平均下降——IgG(1):P < 0.001;IgG(2):P < 0.001;IgG(3):P < 0.001;IgG(4):P < 0.05(Friedman检验)——而LADA组所有四个亚类的水平保持稳定。然而,两组的GADA IgM均下降(P < 0.001)。LADA患者在临床发病时GADA IgG(3)和IgG(4)水平较高,且在临床发病后3年内似乎保持其IgG亚类的水平和谱型,而1型糖尿病患者所有GADA IgG亚类水平均下降。这表明LADA与1型糖尿病相比存在持续不同的免疫反应,进一步提示了发病机制的差异。