title: Diabetes mellitus-related autoantibodies in childhood autoimmune hepatitis.
abstract: OBJECTIVE
  To determine the frequency and significance of diabetes mellitus (DM)-related autoantibodies in children with autoimmune hepatitis (AIH).
  
  
  METHODS
  Anti-islet cell antibodies (ICA), insulin autoantibodies (IAA), and anti-glutamic acid decarboxylase (GAD65) antibodies were assessed in 28 children (25 female) with AIH before and after 3-9 years of therapy with azathioprine and prednisone.
  
  
  RESULTS
  There was biochemical and clinical remission of AIH activity in 76% of the children after 1 year of immunosuppressive therapy. Positive ICA and IAA were found in 60.7% and 18.5% of the patients, decreasing to 38.5% and 12% after 3-9 years of therapy. Anti-GAD autoantibodies were present in only one patient who had Graves' disease, high ICA titer, and developed type 1 DM after 3 years. After 3-9 years of follow up, all had normal fasting glycemia, glycosylated hemoglobin (HbA1c), and, with a single exception, normal responses to oral glucose tolerance testing. No increase in the frequencies of HLA antigens was observed in ICA- and IAA-positive patients compared to antibody-negative patients or a control population. The majority of the patients with HLA-DRB1*03 or DRB1*04, however, were positive for ICA (7/10), and three of them had IAA. The frequency of high risk HLA DQB1*0302 or DQB1*02 alleles was low and similar to control frequencies, indicating low-risk for DM despite the presence of DM-related autoimmunity markers.
  
  
  CONCLUSIONS
  AIH in childhood is associated with high frequency of ICA and IAA, with less than expected rates of progression to DM. Immunosuppression reduced ICA and IAA frequency and titers.
authors.affiliation: Laboratory of Medical Investigation, São Paulo Medical School, Brazil.
authors.forename: Maria E R
authors.initials: ME
authors.lastname: da Silva
authors.forename: Gilda
authors.initials: G
authors.lastname: Porta
authors.forename: Anna C
authors.initials: AC
authors.lastname: Goldberg
authors.forename: Paulo L
authors.initials: PL
authors.lastname: Bittencourt
authors.forename: Rosa T
authors.initials: RT
authors.lastname: Fukui
authors.forename: Marcia R S
authors.initials: MR
authors.lastname: Correia
authors.forename: Irene K
authors.initials: IK
authors.lastname: Miura
authors.forename: Renata S
authors.initials: RS
authors.lastname: Pugliese
authors.forename: Vera L
authors.initials: VL
authors.lastname: Baggio
authors.forename: Eduardo L R
authors.initials: EL
authors.lastname: Cançado
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.forename: Rosa F
authors.initials: RF
authors.lastname: Santos
authors.forename: Dalva M
authors.initials: DM
authors.lastname: Rochal
authors.forename: Bernardo L
authors.initials: BL
authors.lastname: Wajchenberg
authors.forename: Mileni J M
authors.initials: MJ
authors.lastname: Ursich
authors.forename: Arlan L
authors.initials: AL
authors.lastname: Rosenbloom
authors.forename: Ana C
authors.initials: AC
authors.lastname: Golberg
mesh_terms: D000199:Actins / Q000276:immunology; D000293:Adolescent; D000818:Animals; D000974:Antibodies, Antinuclear / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis / Q000096:biosynthesis*; D002648:Child; D002675:Child, Preschool; D019389:Cytochrome P-450 CYP2D6 / Q000276:immunology; D003600:Cytosol / Q000276:immunology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000276:immunology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000276:immunology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005968:Glutamate Decarboxylase / Q000276:immunology; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000276:immunology*; D006801:Humans; D007328:Insulin / Q000276:immunology; D007515:Islets of Langerhans / Q000276:immunology; D007527:Isoenzymes / Q000276:immunology; D008297:Male; D009130:Muscle, Smooth / Q000276:immunology; D051381:Rats; D017208:Rats, Wistar
chemical_list: D000199:Actins; D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D007328:Insulin; D007527:Isoenzymes; D019389:Cytochrome P-450 CYP2D6; D005968:Glutamate Decarboxylase; C401141:glutamate decarboxylase 2