Insulin-dependent diabetes mellitus during alpha-interferon therapy for chronic viral hepatitis.
A 29-year-old man was observed to develop insulin-dependent diabetes mellitus following a 5-month treatment with recombinant alpha-2b-interferon for chronic hepatitis C. After the onset of the disease, serum samples that had, respectively, been collected before therapy commencement, at month 3, and at the onset of insulin-dependent diabetes mellitus were tested for islet-cell (ICA-IgG), glutamic acid decarboxylase (GAD-Abs), IA2 (IA2-Abs) and insulin (IA-Abs) autoantibodies. The following results were obtained: ICA-IgG, 5, >80, and >80 JDF-U, respectively; GAD-Abs: >100 U/ml in all three measurements; IA2-Abs and IA-Abs: negative. During treatment, thyroid microsomal autoantibodies increased markedly (from 1:100 to 25,600 titer); thyroid-stimulating hormone was persistently normal. HLA class II typing revealed a genetic predisposition to insulin-dependent diabetes mellitus as demonstrated by the presence of DRB1* 04/08, DQ A1 52 Arg+/Arg+, and DQB1 57 N-Asp/Asp alleles. One year after the onset of insulin-dependent diabetes mellitus, the patient is still receiving 30 IU insulin daily; the liver function tests are normal and HCV-RNA is negative. These data support the hypothesis that, in predisposed patients, alpha-interferon therapy can enhance an ongoing autoimmune process against pancreatic beta-cells and induce overt insulin-dependent diabetes mellitus. We therefore suggest that, in patients with a documented predisposition to insulin-dependent diabetes mellitus, alpha-IFN therapy should be administered with caution.
Fabris
P
P
Department of Infectious Diseases, S. Bortolo Hospital, Vicenza, Italy.
Betterle
C
C
Greggio
N A
NA
Zanchetta
R
R
Bosi
E
E
Biasin
M R
MR
de Lalla
F
F
D000328:Adult; D015551:Autoimmunity / Q000276:immunology; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology* / Q000235:genetics; D020022:Genetic Predisposition to Disease; D006525:Hepatitis, Viral, Human / Q000628:therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D010179:Pancreas / Q000276:immunology; D012189:Retrospective Studies
D015415:Biomarkers; D016898:Interferon-alpha