In search of predictive markers of remission from insulin dependence in type 1 diabetes: a preliminary report.
We studied 18 newly diagnosed diabetic patients (8 males and 10 females, aged 18-26 years, within 10-120 days from the onset of symptoms) who were submitted for 15 days to intensive insulin therapy performed via subcutaneous insulin infusion (CSII). We investigated some metabolic and immunological parameters in order to identify a possible marker to predict the selection of patients potentially more responsive to CSII treatment for the remission of type 1 diabetes. In accordance with the International Diabetes Immunology Group we considered clinical remission as being the withdrawal of insulin therapy for at least 3 months. In order to assess beta-cell function a fasting and post-prandial serum C-peptide, blood glucose and HbA1c were performed on all patients before, and 3 days after, the discontinuation of CSII. Islet cell antibodies were determined in all sera by indirect immunofluorescence. Analysis of T-lymphocyte subpopulations was carried out before starting the therapy. The following monoclonal antibodies were used: CD4, CD8, CD57, CD25, HLA-DR. The levels of C3 and C4 and serum IgG, IgA and IgM were also evaluated. After CSII, 11 of 18 patients showed remission. At the beginning of the study we observed no major difference in metabolic parameters between the two groups. Interestingly, the patients who exhibited remission presented a statistically higher percentage of positive cells for CD57, HLA-DR and CD25 surface antigens, significantly lower C4 levels and CD4/CD8 ratio and significantly higher IgG levels compared with patients who did not show any remission.(ABSTRACT TRUNCATED AT 250 WORDS)
Guastamacchia
E
E
Istituto di Clinica Medica, Endocrinologia e Malattie Metaboliche, Bari, Italy.
Ciampolillo
A
A
Lattanzi
V
V
Lollino
G
G
Rosco
M
M
Lucivero
G
G
Dell'Osso
A
A
Giorgino
R
R
Nardelli
G M
GM
D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000276:immunology; D004435:Eating; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D016176:T-Lymphocyte Subsets / Q000276:immunology; D013997:Time Factors
D015703:Antigens, CD; D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007136:Immunoglobulins; D007328:Insulin