Insulin Antibodies in Pregnancy

Spellacy, W.N.; Goetz, F. C.

doi:10.1016/s0140-6736(63)90118-1

Cited by 49 publications

(13 citation statements)

References 27 publications

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“…The suggestion rested on the fact that passively acquired maternal antibodies persist in the newborn for approximately 12-16 weeks, a period similar to the common duration of transient neonatal diabetes. Direct evidence of such a mechanism is lacking, however, and, furthermore, infants of mothers with diabetes mellitus do not get temporary diabetes, though many of them receive maternal insulin antibodies transplacentally (Spellacy and Goetz, 1963).…”

Section: Discussionmentioning

confidence: 99%

Transient Neonatal Diabetes Mellitus in Sibs

Ferguson¹,

Mliner²

1970

Archives of Disease in Childhood

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The infant was breast-fed and sucked well. However, he failed to gain weight, and on the 15th day began to vomit occasionally. On the 19th day he was transferred to the Children's Ward for further investigation. He then weighed 2065 g., was marasmic, wide-eyed, and thirsty, with a rectal temperature of 39*4 'C.( Fig.). Blood sugar, 720 mg./100 ml.; CSF sugar, 405 mg./100 ml.; CSF protein, chloride, and cell count normal; blood urea, 77 mg./100 ml.; urine contained 2% sugar but no ketones.A subcutaneous infusion of 1/5 normal saline was given. All urine voided was collected and tested for sugar and acetone. Soluble insulin was given two or three times daily in doses ranging from 2 to 6 units.Ketones were never found in the urine. Administered insulin totalled 12 units daily for most of the first fortnight, but thereafter the dose gradually fell. No attempt was made to keep the urine entirely sugarfree because of the particular dangers of hypoglycaemia in infancy. However, at 5 weeks a brief hypoglycaemic convulsion occurred which was terminated by intravenous glucose. From the start of treatment there was immediate clinical improvement and a steady gain in weight.At 6 weeks intermittent vomiting, abdominal distension, fever, and diarrhoea developed, associated on three occasions (2, 3, and 6 January 1964) with serum potassium over 7 mEq/l., and with low sodium and chloride levels. On these dates blood sugar levels of 550, 770, and 60 mg./100 ml. were recorded. The 24-hour urinary 17-oxosteroid and total oxogenic steroid excretion (5-6 January) were 0 * 15 and 0 * 64 mg., respectively. Blood urea was 30 mg./100 ml. and blood culture was negative. There was a tachycardia of 200/min., and the systolic blood pressure in the arm by the flush technique was 75 mm. Hg. Adrenal insufficiency was suspected and desoxycorticosterone acetate 1 mg. daily and subcutaneous 1/5 normal saline were administered from [7][8][9][10]

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Section: Discussionmentioning

confidence: 99%

Transient Neonatal Diabetes Mellitus in Sibs

Ferguson¹,

Mliner²

1970

Archives of Disease in Childhood

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“…Moreover, with insulin antibodies in excess, 100 per cent of recovery of the added insulin can be obtained (figure 2), in agreement with the report of Spellacy and Goetz. 61 Whether or not there are protein carriers of insulin in normal serum remains controversial. Berson et al 29 have concluded that radioactive fragments of hormone bound to plasma proteins represent damaged fragments.…”

Section: Discussionmentioning

confidence: 99%

Studies on Experimental Insulin Immunity: I. Dynamics of Insulin Immunity in the Guinea Pig

Horino

Blumenthal

1966

Diabetes

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Insulin half life and the formation and characterization of the insulin-binding antibodies have been studied in the guinea pig both in vivo and in vitro. The antigen-antibody complexes have also been studied utilizing cellulose column electrophoresis and Sephadex G-200 column filtration. In addition, a quantitative assay procedure for insulin-binding antibodies has been employed. In normal guinea pigs the injected insulin-I-125 is carried by at least two serum proteins, presumably albumin and an α. globulin, or more specifically 4.5S and 19S proteins. In immune animals the insulin-antibody complexes are represented by a single peak in the (β-γ globulin region on column electrophoresis; they are distinguishable from the uncomplexed antibodies which are 7S γ1 and 7S γ1 globulins. The precipitating insulin antibody also appears to be a 7S globulin. Moreover, the insulin-antibody complexes occur as a single component in the 19S fraction on Sephadex G-200 filtration, and if the complex were a single molecule it would have a molecular weight equivalent of about 630,000. During the immunization process the insulin binding antibody titer increases progressively in association with an elevation of 7S globulin. In most animals during the early stages of immunization the molecular weight of the antibodies appears to be exclusively of the 7S globulin type; however, in two of seven animals there was, in addition, a small amount of insulin antibody of 19S globulin type early during the immunization period. The purpose in estimating a molecular weight equivalent of the insulin-antibody complex relates to the possibility that the distinctive features of the angiopathies of diabetes may depend upon certain physicochemical characteristics of this complex.

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“…Free maternal insulin has been reported not to cross the normal maternofetal barrier (1,2). However, insulin-binding antibodies of class IgG have been found in newborn infants ofdiabetic mothers who had received insulin therapy (3)(4)(5). Here, we describe the transfer of insulin across the placenta when specifically bound to maternal antibody.…”

mentioning

confidence: 88%

Transplacental passage of insulin complexed to antibody.

Bauman¹,

Yalow²

1981

Proc. Natl. Acad. Sci. U.S.A.

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The passage of plasma proteins across the pla. cental barrier in humans is known to be highly selective. Thus, free maternal insulin has been reported not to cross the normal maternofetal barrier, although insulin-binding antibodies have been detected in newborn infants whose diabetic mothers received insulin therapy. In this report we demonstrate, with the use of a human antiserum that permits distinction between human and animal insulins, that insulin in the cord blood of each of two neonates of insulin-treated diabetic mothers was, in part, animal insulin. The higher the antibody titer of the mother the greater was the total insulin in the cord plasma and the greater was the fraction that was animal insulin. In case 1 cord plasma insulin was 0.7 unit/ liter, ofwhich 10% was animal insulin; in case 2 cord plasma insulin was 3.5 units/liter, of which 25% was animal insulin. The demonstration that antigen restricted from transplacental passage can be transferred while complexed to antibody raises the question whether such fetal exposure would induce partial or total immunologic unresponsiveness subsequently if the fetus were rechallenged with the same antigen.

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Insulin Antibodies in Pregnancy

Cited by 49 publications

References 27 publications

Transient Neonatal Diabetes Mellitus in Sibs

Transient Neonatal Diabetes Mellitus in Sibs

Studies on Experimental Insulin Immunity: I. Dynamics of Insulin Immunity in the Guinea Pig

Transplacental passage of insulin complexed to antibody.

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