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Aspects of humoral immunity in a prospective study of type I (insulin-dependent) diabetic subjects treated with insulins of different purity
Diabetologia
Aspects of Humoral Immunity in a Prospective Study of Type I (Insulin-Dependent) Diabetic Subjects Treated with Insulins of Different Purity
M. Iavicoli 0 1
L. Ventriglia 0 1
U. Di Mario 0 1
C. Galfo a n d D. A n d r e a n i 0 1
0 I Cattedra di MedicinaCostituzionaleed Endocrinologia,Universitfidegli Studi di Roma , Rome , Italy
1 Dr. M. Iavicoli II Clinica Medica Policlinico Umberto l 00161 Rome Italy
Summary. In 41 Type 1 (insulin-dependent) diabetic patients, islet cell antibodies, anti-insulin antibodies, and immune complexes measured by two different methods (the Clq solid phase assay and the conglutinin binding test) were studied at diagnosis, and the influence of treatment with insulins of different purity was investigated during the first year of treatment. Twenty subjects were treated with conventional insulins (group 1) while 21 were treated with monocomponent porcine insulins (group 2). The prevalence of islet cell antibodies significantly decreased during the 12-month study period in the 41 patients. From the first month anti-insulin antibodies were always significantly higher in group 1 than in group 2. At diagnosis the prevalence of both types of immune complexes in the 41 patients was higher than in normal subjects. The ira-
Type 1 diabetes; anti-insulin antibodies; islet cell antibodies; immune complexes; Clq solid phase assay; conglutinin binding test; monocomponent insulins
-
9 Springer-Verlag1983
Islet cell antibodies, anti-insulin antibodies a n d
imm u n e complexes have been demonstrated in the sera of
diabetic subjects. Islet cell antibodies have been f o u n d
in Type 1 (insulin-dependent) diabetic patients at
diagnosis a n d in non-diabetic patients with other
autoimm u n e diseases. The role of these antibodies in the
pathogenesis o f Type I diabetes remains to be elucidated
[
1-3
]. Anti-insulin antibodies are present in most
insulin-treated diabetic patients. It has been established that
anti-insulin antibodies m a y play a role in the transient
complications o f insulin treatment (i. e. allergic
reactions, insulin resistance, etc.), whereas no influence on
late diabetic complications has yet been demonstrated
[
4-9
].
It has been suggested that the presence o f islet cell
a n d anti-insulin antibodies in the circulation m a y
reflect the presence o f circulating i m m u n e complexes [
10,
11
]. Circulating i m m u n e complexes have been
described in a large percentage o f Type I diabetic patients
at the time o f diagnosis [12] and in some cases with
severe complications [
13
]. Detection methods based u p o n
different principles have also revealed the presence o f
heterogeneous populations of i m m u n e complexes [14,
rnune complexes measured by the Clq solid phase method
showed a significant and progressive reduction during the
follow-up period, whereas the immune complexes assayed by
conglutinin showed no significant variation in the same
period. The presence of Clq immune complexes was found to
correlate with the occurrence of islet cell antibodies both at
diagnosis and during the follow-up period. The presence of
conglutinin immune complexes, on the other hand, tended to
parallel the increase of anti-insulin antibody levels.
15]. A correlation was recognized in some of these
studies between i m m u n e complexes detected by the solid
phase C l q binding test a n d the presence of islet cell
antibodies [
16
], whilst in others a correlation appeared
to exist between i m m u n e complexes detected by
conglutinin binding assay a n d insulin treatment [
17
].
The present investigation was carried out in a group
o f patients at the time o f clinical diagnosis o f Type I
diabetes. These patients were treated with either
conventional insulin or m o n o c o m p o n e n t insulin a n d were
observed at regular intervals for one year.
The aim of the present study was to attempt to
correlate circulating i m m u n e complexes (detected by C l q
a n d conglutinin) a n d the presence o f islet cell a n d
antiinsulin antibodies, bearing in m i n d the type a n d
duration o f the diabetes a n d antigenicity o f the insulin used
in the treatment.
Patients and Methods
Forty-onenewlydiagnosedTypeI diabeticpatients,with age at onset
< 30 years, were included in the study before insulin treatment was
started. Twenty of these patients (12 males and eight females,mean
1
0
M. Iavicoli et al.: Humoral Immunity in Type I Diabetic Subjects
age 9 years, range 5-11 years) were treated with conventional insulins
(group 1), whereas 21 (15 males and six females, mean age 13 years,
range 8-22 years) were treated with monocomponent porcine insulins
(group 2). Patients were randomly assigned to each group. Blood
samples were collected at diagnosis and 1, 3, 6 and 12 months later in all
patients.
A series of 189 blood donors was also studied to determine the
normal range of the immune complex assays. Islet cell antibodies
were assayed by indirect immunofluorescence on cr (...truncated)