Clinical and genetic characteristics of autoimmune polyglandular syndrome type 3 variant in the Japanese population

Objective: Type 1 diabetes (T1D) iscommonlyassociated withautoimmunethyroid disease (AITD),and the occurrence of both T1D and AITD in a patient is defined as autoimmune polyglandular syndrome type 3 variant (APS3v). We aimed to clarify the differences in the clinical and genetic characteristics of APS3v patients and T1D patients without AITD [T1D/AITD(-)] in the Japanese population. Design/Patients: Our subjects were 54 APS3v patients and 143 T1D/AITD(-) patients who were consecutively diagnosed at Nagasaki University Hospital from 1983 to the present. Results: A remarkable female predominance, a slow and older age onset of T1D, and a higher prevalence of glutamic acid decarboxylase autoantibodies were observed in APS3v patients compared to T1D/AITD(-) patients. The older onset age of T1D in APS3v patients was associated with a higher proportion of slow-onset T1D. Among the two major susceptible human leukocyte antigen (HLA) class II haplotypes in Japanese T1D, DRB1*0405- DQB1*0401, but not DRB1*0901-DQB1*0303, was associated with APS3v patients. Furthermore, DRB1*0803-DQB1*0601 was not protective in patients with APS3v. The frequencies of the GG genotype in +49G>A and +6230G>A polymorphism in the CTLA4 gene were significantly higher in T1D/AITD(-) patients, but not in APS3v patients, compared to control subjects. Conclusions: In conclusion, we found notable differences in the clinical and genetic characteristics of APS3v patients and T1D/AITD(-) patients in the Japanese population, and the differences in the clinical characteristics between the two groups may reflect distinct genetic backgrounds including the HLA DRB1-DQB1 haplotypes and CTLA4 gene polymorphisms

Autoantibodies to insulin, insulinoma-associated antigen-2, and zinc transporter 8 improve the prediction of early insulin requirement in adult-onset autoimmune diabetes

Objective: The aim of this study was to indentify the predictive marker for early insulin requirement in adult-onset autoimmune diabetes in the Japanese populations.Design/Patients: We analyzed insulin autoantibodies (IAA), IA-2 autoantibodies (IA-2icA), and ZnT8 autoantibodies (ZnT8A) by radioimmunoassay in 47 Japanese patients with adult-onset autoimmune diabetes who were identified by native GAD autoantibody (nGADA) screening in ~3,000 non-insulin-requiring diabetes and in 302 nGADA-negative type 2 diabetes. Furthermore, GAD65 autoantibody-specific epitopes were also analyzed using GAD65/GAD67 chimeric constructs.Results: The prevalence of IAA, IA-2icA and ZnT8A in nGADA-positive patients was 26%, 15%, and 19%, respectively, which was significantly higher than that in nGADA-negative type 2 diabetes (2%, 2%, and 2%, P<0.0001). Among nGADA-positive patients, 38% had one or more of IAA, IA-2icA, or ZnT8A, and 15% had two or more of these autoantibodies, compared with none of the nGADA-negative patients (P<0.0001). Thirty-six % of nGADA-positive patients subsequently required insulin therapy, and high nGADA titer (log-rank P=0.003), middle epitope recognition of GAD65A (P=0.002), and the presence of one or more of IAA, IA-2icA, or ZnT8A (P=0.002) at diagnosis marked the risk for early requirement of insulin therapy. Multivariate logistic regression analysis showed the multiple islet autoantibodeis to be independently associated with the risk for insulin requirement (Odds ratio=13.77, 95%CI: 2.77-68.45, P=0.001).Conclusions: These results indicate that the determination of IAA, IA-2icA, and ZnT8A improves the prediction of a future insulin insufficiency in adult-onset autoimmune diabetes, which appears to be superior to GADA titer and GAD65A-specific epitopes

On the Morphology of Rod-like Trigonal Polyoxymethylene Single Crystals

A new type of single crystals of trigonal polyoxymethylene was found in a cationic polymerization system of trioxane sigened to grow needle-like polyoxymethylene single crystals (0olymer whisker). A number of small particles of polyoxymethylene (Figure 2) were observed on the thin film of t-POM formed over the inner wall of the reaction vessel. The particle samples were comprising a lots of small rod-like transparent crystalline units packed at random. It has been clarified that the particles consist of the trigonal crystalline form of polyoxymethylene, moreover these rod-like single crystals consist of the extended chain structures from the infrared spectra

On the Morphology of Rod-like Trigonal Polyoxymethylene Single Crystals

A new type of single crystals of trigonal polyoxymethylene was found in a cationic polymerization system of trioxane sigened to grow needle-like polyoxymethylene single crystals (0olymer whisker). A number of small particles of polyoxymethylene (Figure 2) were observed on the thin film of t-POM formed over the inner wall of the reaction vessel. The particle samples were comprising a lots of small rod-like transparent crystalline units packed at random. It has been clarified that the particles consist of the trigonal crystalline form of polyoxymethylene, moreover these rod-like single crystals consist of the extended chain structures from the infrared spectra

Autoantibodies to insulin, insulinoma-associated antigen-2, and zinc transporter 8 improve the prediction of early insulin requirement in adult-onset autoimmune diabetes

Objective: The aim of this study was to indentify the predictive marker for early insulin requirement in adult-onset autoimmune diabetes in the Japanese populations.Design/Patients: We analyzed insulin autoantibodies (IAA), IA-2 autoantibodies (IA-2icA), and ZnT8 autoantibodies (ZnT8A) by radioimmunoassay in 47 Japanese patients with adult-onset autoimmune diabetes who were identified by native GAD autoantibody (nGADA) screening in ~3,000 non-insulin-requiring diabetes and in 302 nGADA-negative type 2 diabetes. Furthermore, GAD65 autoantibody-specific epitopes were also analyzed using GAD65/GAD67 chimeric constructs.Results: The prevalence of IAA, IA-2icA and ZnT8A in nGADA-positive patients was 26%, 15%, and 19%, respectively, which was significantly higher than that in nGADA-negative type 2 diabetes (2%, 2%, and 2%, P<0.0001). Among nGADA-positive patients, 38% had one or more of IAA, IA-2icA, or ZnT8A, and 15% had two or more of these autoantibodies, compared with none of the nGADA-negative patients (P<0.0001). Thirty-six % of nGADA-positive patients subsequently required insulin therapy, and high nGADA titer (log-rank P=0.003), middle epitope recognition of GAD65A (P=0.002), and the presence of one or more of IAA, IA-2icA, or ZnT8A (P=0.002) at diagnosis marked the risk for early requirement of insulin therapy. Multivariate logistic regression analysis showed the multiple islet autoantibodeis to be independently associated with the risk for insulin requirement (Odds ratio=13.77, 95%CI: 2.77-68.45, P=0.001).Conclusions: These results indicate that the determination of IAA, IA-2icA, and ZnT8A improves the prediction of a future insulin insufficiency in adult-onset autoimmune diabetes, which appears to be superior to GADA titer and GAD65A-specific epitopes

Differences in the humoral autoreactivity to zinc transporter 8 between childhood- and adult-onset type 1 diabetes in Japanese patients.

The aim of this study was to evaluate the humoral autoreactivity to zinc transporter 8 (ZnT8) depending on the clinical phenotype of type 1 diabetes (T1D). ZnT8 autoantibodies (ZnT8A) were determined by radioimmunoassay using carboxy-terminal ZnT8 constructs in 57 childhood-onset, 97 adult-onset, and 85 fulminant T1D. The ZnT8A frequency was higher in childhood-onset patients and decreased with increasing age of onset from 70% to 24% (P(trend)<0.005). None of the patients with fulminant T1D was positive for ZnT8A. There were at least two distinct ZnT8A epitope patterns associated with the aa325-restriction, childhood-onset patients have aa325-nonrestricted response more frequently compared to the adult-onset group (P<0.05). The level of ZnT8A was inversely associated with the copy number of HLA-DR4 allele (P<0.05). These results suggest differences in the humoral autoreactivity to ZnT8 depending on the clinical phenotype, which should provide strategy for autoantibody measurement in subjects to allow early diagnosis of autoimmune T1D