Prevalence of autoantibodies to autonomic nervous tissue structures in Type 1 diabetes mellitus.
OBJECTIVE
The pathogenesis of diabetic autonomic neuropathy is multifactorial, but recent studies have suggested a link between the presence of autoantibodies to nervous tissue structures and severe, symptomatic autonomic neuropathy. The present study was designed to examine the true prevalence of these autoantibodies in a large clinic-based population of Type 1 diabetic patients compared to nondiabetic controls.


METHODS
The presence of complement fixing autoantibodies to vagus nerve (CF-VN), sympathetic ganglion (CF-SG) and adrenal medulla (CF-ADM) was assessed by immunofluorescence in a large cohort of patients (n = 394) of varying duration of Type 1 DM (median 28 years, range 6 months to 73 years) and 160 age and sex-matched nondiabetic control subjects.


RESULTS
All three autoantibodies were frequently detected in Type 1 DM (CF-VN, 22.1%; CF-SG, 30.7%; CF-ADM, 13.2%) but only rarely in healthy control subjects (4.4%, 4.4% and 3.1%, respectively; P < 0.0005 for all). There was no association between any of the autoantibodies and retinopathy (fundoscopy), peripheral somatic neuropathy (biothesiometry) or nephropathy (urinary albumin-creatinine ratio).


CONCLUSIONS
Our results on this large cohort establish the extensive presence of autonomic nervous tissue autoantibodies in Type 1 DM. Their role in reflecting, causing or predicting autonomic neuropathy remains to be determined.
Ejskjaer
N
N
King's Diabetes Centre, King's College Hospital, Department of Immunology, Guy's King's and St Thomas' School of Medicine, King's College London, UK.
Arif
S
S
Dodds
W
W
Zanone
M M
MM
Vergani
D
D
Watkins
P J
PJ
Peakman
M
M
D000293:Adolescent; D000313:Adrenal Medulla / Q000276:immunology; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D001341:Autonomic Nervous System / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003168:Complement Fixation Tests; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000276:immunology* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005728:Ganglia, Sympathetic / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D014630:Vagus Nerve / Q000276:immunology
D001323:Autoantibodies