title: Frequency and specificity of protamine antibodies in diabetic and control subjects.
abstract: Protamines are cationic fish chromosomal proteins that retard absorption of isophane (NPH) insulins. Protamines are also administered in large doses for heparin neutralization in cardiac procedures. This study used a rapid enzyme-linked immunosorbent assay to examine frequency of protamine antibodies in diabetic and control populations. Antigen specificity of the IgG binding to protamine-coated plates was verified by competitive inhibition with other protamines, histone, glucagon, thyroid-stimulating hormone, arginine, and lysine. All antibodies tested cross-reacted completely with all protamines. Only 4 of 18 had any cross-reactivity with histones. None cross-reacted with the other inhibitors. In population surveys, 122 (38%) of 319 NPH insulin-treated diabetic subjects, 3 (8%) of 39 diabetic subjects treated with protamine-free lente insulins, and 5 (2.5%) of 202 normal control subjects had protamine antibody. No correlation was found between insulin and protamine antibodies. Because more than one-third of insulin-treated diabetic subjects have circulating IgG specific for protamine, they are potentially at risk for acute immunologic or anaphylactoid reactions when protamine is administered for heparin neutralization.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas 77030.
authors.forename: L J
authors.initials: LJ
authors.lastname: Nell
authors.forename: J W
authors.initials: JW
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis*; D000918:Antibody Specificity; D002648:Child; D002675:Child, Preschool; D003429:Cross Reactions; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007223:Infant; D007328:Insulin / Q000276:immunology / Q000627:therapeutic use; D008875:Middle Aged; D011479:Protamines / Q000276:immunology* / Q000378:metabolism
chemical_list: D000906:Antibodies; D007074:Immunoglobulin G; D007328:Insulin; D011479:Protamines