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Islet cell antibodies, but not glutamic acid decarboxylase antibodies, are decreased by plasmapheresis in patients with newly diagnosed insulin-dependent diabetes mellitus

Sundkvist, Göran LU ; Hagopian, William A. ; Landin-Olsson, Mona LU ; Lernmark, Åke LU orcid ; Ohlsson, Lawe ; Ericsson, Clas and Ahlmén, Jarl (1994) In Journal of Clinical Endocrinology and Metabolism 78(5). p.1159-1165
Abstract

The effects of plasmapheresis on islet autoantibody levels, C-peptide (β-cell function), and hemoglobin-A1c (HbA1c, metabolic control) were tested in a prospective blinded study of 18 newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients randomly assigned to receive plasmapheresis (P), carried out as double filtration, or sham (S) treatment at diagnosis and 3 months thereafter. At diagnosis, 6 of 8 patients (75%) in group P and 9 of 10 patients (90%) in group S had islet cell antibodies (ICA), whereas 4 of 8 (50%) and 7 of 10 (70%) patients, respectively, had glutamic acid decarboxylase antibodies (GAD65-Ab), with no significant differences between the groups in ICA and GAD65-Ab levels. After 6 months, P patients showed... (More)

The effects of plasmapheresis on islet autoantibody levels, C-peptide (β-cell function), and hemoglobin-A1c (HbA1c, metabolic control) were tested in a prospective blinded study of 18 newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients randomly assigned to receive plasmapheresis (P), carried out as double filtration, or sham (S) treatment at diagnosis and 3 months thereafter. At diagnosis, 6 of 8 patients (75%) in group P and 9 of 10 patients (90%) in group S had islet cell antibodies (ICA), whereas 4 of 8 (50%) and 7 of 10 (70%) patients, respectively, had glutamic acid decarboxylase antibodies (GAD65-Ab), with no significant differences between the groups in ICA and GAD65-Ab levels. After 6 months, P patients showed significantly lower ICA levels than S patients (11 ± 6 and 128 ± 47 Juvenile Diabetes Foundation International Units, respectively; P < 0.02) due to an increase in ICA levels in 8 of 9 (88%) of the S patients not seen in P patients (P < 0.002). Concurrently, HbA1c stabilized in P, but not in S, patients and was significantly lower by 24 months (6.58 ± 0.54% vs. 9.76 ± 1.21%; P < 0.05). Moreover, fasting C-peptide increased significantly (214 ± 11 pmol/L; P < 0.05) over the first 6 months in P. After the initial 6 months, ICA levels tended to decrease in all patients and were not detected after 60 months. GAD65-Ab levels were not influenced by plasmapheresis and, also in contrast to ICA, increased significantly (P < 0.05) in the whole study population after 60 months. In fact, 4 initially negative patients became GAD65-Ab positive after diagnosis (in 2 patients > 24 months after diagnosis). We conclude that plasmapheresis of newly diagnosed IDDM patients does not change subsequent GAD65-Ab levels, but ICA are significantly decreased with associated improved C-peptide and HbA1c levels.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Endocrinology and Metabolism
volume
78
issue
5
pages
1159 - 1165
publisher
Oxford University Press
external identifiers
  • scopus:0028256460
  • pmid:8175973
ISSN
0021-972X
DOI
10.1210/jcem.78.5.8175973
language
English
LU publication?
yes
id
ebbcc6ea-755b-4464-a366-e300ed3ec8aa
date added to LUP
2019-12-12 23:20:07
date last changed
2024-03-13 08:08:00
@article{ebbcc6ea-755b-4464-a366-e300ed3ec8aa,
  abstract     = {{<p>The effects of plasmapheresis on islet autoantibody levels, C-peptide (β-cell function), and hemoglobin-A1c (HbA1c, metabolic control) were tested in a prospective blinded study of 18 newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients randomly assigned to receive plasmapheresis (P), carried out as double filtration, or sham (S) treatment at diagnosis and 3 months thereafter. At diagnosis, 6 of 8 patients (75%) in group P and 9 of 10 patients (90%) in group S had islet cell antibodies (ICA), whereas 4 of 8 (50%) and 7 of 10 (70%) patients, respectively, had glutamic acid decarboxylase antibodies (GAD65-Ab), with no significant differences between the groups in ICA and GAD65-Ab levels. After 6 months, P patients showed significantly lower ICA levels than S patients (11 ± 6 and 128 ± 47 Juvenile Diabetes Foundation International Units, respectively; P &lt; 0.02) due to an increase in ICA levels in 8 of 9 (88%) of the S patients not seen in P patients (P &lt; 0.002). Concurrently, HbA1c stabilized in P, but not in S, patients and was significantly lower by 24 months (6.58 ± 0.54% vs. 9.76 ± 1.21%; P &lt; 0.05). Moreover, fasting C-peptide increased significantly (214 ± 11 pmol/L; P &lt; 0.05) over the first 6 months in P. After the initial 6 months, ICA levels tended to decrease in all patients and were not detected after 60 months. GAD65-Ab levels were not influenced by plasmapheresis and, also in contrast to ICA, increased significantly (P &lt; 0.05) in the whole study population after 60 months. In fact, 4 initially negative patients became GAD65-Ab positive after diagnosis (in 2 patients &gt; 24 months after diagnosis). We conclude that plasmapheresis of newly diagnosed IDDM patients does not change subsequent GAD65-Ab levels, but ICA are significantly decreased with associated improved C-peptide and HbA1c levels.</p>}},
  author       = {{Sundkvist, Göran and Hagopian, William A. and Landin-Olsson, Mona and Lernmark, Åke and Ohlsson, Lawe and Ericsson, Clas and Ahlmén, Jarl}},
  issn         = {{0021-972X}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{5}},
  pages        = {{1159--1165}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of Clinical Endocrinology and Metabolism}},
  title        = {{Islet cell antibodies, but not glutamic acid decarboxylase antibodies, are decreased by plasmapheresis in patients with newly diagnosed insulin-dependent diabetes mellitus}},
  url          = {{http://dx.doi.org/10.1210/jcem.78.5.8175973}},
  doi          = {{10.1210/jcem.78.5.8175973}},
  volume       = {{78}},
  year         = {{1994}},
}