Strong association of insulin autoimmune syndrome with HLA-DR4

Uchigata, Yasuko; Eguchi, Yoko; Takayama-Hasumi, Sumiko; Omon, Y.; Hirata, Yoshihiro; Kuwata, Shoji; Tokunaga, Katsushi; Miyamoto, M.; Juji, Takeo

doi:10.1016/0140-6736(92)90080-m

Cited by 105 publications

(79 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The clinical relevance of very high AIA titres remains to be assessed, since in some cases it may lead to interruption of therapy. Two of our patients, one male and one female (both HLA DR4) whose AIA titres were very high, up to 40 %, suffered from clinical symptoms similar to the "insulin autoimmune syndrome" [14] such as a dramatic nocturnal fall in blood glucose (5.5 to 11 mmol/1 despite a complete pump stop for 6 to 8 h) and a very severe insulin resistance during the day.…”

Section: Consequences Of Metabolic Controlmentioning

confidence: 82%

Immunogenicity of intraperitoneal insulin infusion using programmable implantable devices

et al. 1995

View full text Add to dashboard Cite

SummaryIntraperitoneal insulin infusion using implantable devices in insulin-dependent diabetic (IDDM) patients is promising since it improves diabetic control and decreases frequency of hypoglycaemia. However, preliminary data show a striking increase in plasma levels of anti-insulin antibodies with this therapy. In order to more precisely evaluate the immunogenicity and its consequences, anti-insulin antibody levels in 62 IDDM patients were assessed every 3 months during a 2-year period following pump implantation. At the same time, diabetes control was evaluated with HbA~c , mean blood glucose levels, standard deviation of the daily blood glucose levels and the frequency of low blood glucose (< 3.58 mmol/1). Factors involved in antibody formation such as age, gender, HLA typing, and complement C4 alleles were also studied. After implantation, anti-insulin antibody levels increased significantly from 3.14 % (range 0-26 %) to 8.34 % (0-49 %) after 1 year and remained elevated. Patients were divided into two groups: responders able to show at least one antiinsulin antibody titre higher than 15 % and non-responders whose titres were always lower than 6 %. None of the factors studied was shown to statistically influence the anti-insulin antibody titres. Non-respouders had significantly better metabolic results than the responders. Severe hypoglycaemic episodes decreased dramatically in both groups. Insulin requirements were comparable at time 0 and decreased initially in both groups. They remained low for the non-responders but returned to pre-implantation values for responders. Intraperitoneal insulin infusion led to a high immunogenetic response towards insulin in about half of the patients, leading to only moderately deleterious effects on metabolic control. Further studies are necessary to document other consequences (such as the role of circulating immune complexes). [Diabetologia (1995) que mainly due to the improvement in quality of life. The first results of efficacy studies are encouraging [3] since they demonstrate a drastic reduction in the incidence of severe hypoglycaemic episodes when compared to subcutaneous insulin administration [2,4]. However, preliminary data from our group and from others have shown a striking increase in anti-insulin antibody levels (AIA) in plasma during longterm i.p. insulin infusion using implanted devices [5][6][7][8][9]. The aim of this study was to evaluate more precisely the immunogenicity of this new method of treatment, to define the different factors involved and to assess the eventual clinical and metabolic consequences of this immune reaction.

show abstract

Section: Consequences Of Metabolic Controlmentioning

confidence: 82%

Immunogenicity of intraperitoneal insulin infusion using programmable implantable devices

et al. 1995

View full text Add to dashboard Cite

show abstract

“…The cases reported in Japan have shown strong association between IAS and HLA-DR4 status, haplotype 20 times more common in Asians compared with non-Asian subjects, or the use of medications containing sulfhydryl (thiol) group. Cases reported from other parts of the world are more frequently associated with autoimmune disorders and plasma cell dyscrasias [3,4]. The majority of the cases reported outside Asia come from Europe (50%) and the United States (41%).…”

Section: Introductionmentioning

confidence: 99%

A Case of Autoimmune Hypoglycemia in Switzerland

Stefanescu¹,

Bart²

2018

J Clin Case Rep

View full text Add to dashboard Cite

In this report, we describe a white man with symptomatic hypoglycemia whose medical work-up revealed an excessively elevated serum insulin level (867 mIU/l). The need to measure IAA in patients with extraordinarily high measured levels of total insulin is essential because of the possible artifactual elevation (in a conventional insulin immunoassay) caused by IAA. In the present case, the elevated IAA level (>50 kIU/l) confirmed the diagnosis of autoimmune hypoglycemia and allowed to avoid unnecessary surgical intervention.

show abstract

“…Se ha descrito una predisposición genética asociada al haplotipo HLA, siendo de mayor riesgo el haplotipo DRB1*0406, DQA1*0301 y DQB1*0302 12 , más frecuente en población asiática. En nuestro segundo caso el HLA resultó concordante con dos de los alelos descritos en estudios previos (DQB1*0302 y DQA1* 0301).…”

Section: Discussionunclassified