Pancreatic Islet Autoantibodies as Predictors of Type 1 Diabetes

Many autoimmune diseases, such as lupus erythematosis and type 1 diabetes, are caused by autoantibodies. An autoantibody is an antibody (a protein) produced by the immune system of an individual, which is directed against a different protein of the the same individual.

An antibody is typically produced in response to a foreign protein in the body, for example, an infectious organism.  The immune system is usually able to recognize and ignore the body’s own cells and not produce antibodies against them.  At times, however, the immune system fails to recognize a protein in the body as “self” and produces autoantibodies which attack the protein.  This can lead to tissue or organ inflammation and damage. 

There is limited information in the scientific literature concerning the predictability of type 1 diabetes based on specific types of pancreatic islet autoantibodies, either alone or in combination. Pancreatic islet cells produce insulin, a hormone that allows cells in the body to absorb glucose from the blood.

A study published in the December 2009 issue of Diabetes Care attempted to determine which pancreatic islet autoantibodies, or what combination of autoantibodies, best predict type 1 diabetes.  Subjects were taken from the Diabetes Prevention Trial-Type 1, who were previously screened for islet cell autoantibodies (ICAs).

Autoantibodies to glutamate decarboxylase (GAD65), insulinoma-associated antigen-2 (ICA512), and insulin (micro-IAA [mIAA]) were measured in participants of the study.  The participants were then followed for the occurrence of type 1 diabetes. As it turns out, autoantibody number was highly predictive of type 1 diabetes.  Single autoantibodies ICA, GAD65, and ICA512 were all similarly predictive of type 1 diabetes. However, no subjects with mIAA as single autoantibodies developed type 1 diabetes.

The data, examined by corresponding author Jay M. Sosenko in the Division of Endocrinology, University of Miami, Miami, Florida, and colleagues, revealed that that the number of autoantibodies is highly predictive of type 1 diabetes. However, mIAA is less predictive of type 1 diabetes than other autoantibodies. The authors concluded that autoantibody number, and the type of autoantibody must be carefully considered in planning future prevention trials for type 1 diabetes.

This information about the process of developing the autoimmune disease diabetes moves us closer to the point that we can predict and prevent it from occurring -closer to a cure.

Diabetes Care December 2009

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