title: GAD65 autoantibody responses in Japanese latent autoimmune diabetes in adult patients.
abstract: OBJECTIVE
  To determine whether development of insulin requirement in patients with latent autoimmune diabetes in adults (LADA) is accompanied with the emergence of a type 1 diabetes-like autoimmune response.
  
  
  METHODS
  We correlated beta-cell-specific autoimmunity reflected in autoantibodies to the 65-kDa isoform of GAD (GAD65) with insulin requirement. We determined GAD65Ab epitope specificities in type 1 diabetic patients, LADA patients without insulin requirement (nonprogressed), and LADA patients that had developed insulin requirement (progressed).
  
  
  RESULTS
  Recognition of a type 1 diabetes-specific GAD65Ab epitope was more pronounced in type 1 diabetic patients than in nonprogressed (P < 0.001) or progressed (P < 0.01) LADA patients, with no significant differences between the two LADA cohorts. These differences were particularly pronounced in samples with GAD65Ab titers <1,000 units/ml, with no differences in epitope specificities in samples with higher GAD65Ab titers. Disease duration (initial diabetes diagnosis until sample collection or development of insulin requirement) in nonprogressed and progressed LADA patients, respectively, was not correlated with epitope specificity, suggesting lack of epitope maturation. This was supported by epitope analyses of longitudinal samples from LADA patients during progression to insulin requirement.
  
  
  CONCLUSIONS
  First, the GAD65Ab-specific autoimmune reaction in type 1 diabetic patients with low and moderate GAD65Ab titers differs from that in LADA patients, irrespective of insulin requirement. Second, the GAD65Ab-specific autoimmune response in LADA patients does not change after their initial diabetes diagnosis. Finally, LADA patients with high GAD65Ab titers resemble type 1 diabetic patients in their GAD65Ab epitope specificity.
authors.affiliation: Department of Internal Medicine, Saitama Social Insurance Hospital, Saitama, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Maruyama
authors.forename: Shilpa
authors.initials: S
authors.lastname: Oak
authors.forename: Akira
authors.initials: A
authors.lastname: Shimada
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hampe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000917:Antibody Formation; D001323:Autoantibodies / Q000097:blood*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000201:enzymology / Q000276:immunology*; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D050417:Insulin-Secreting Cells / Q000276:immunology; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001323:Autoantibodies; D007328:Insulin; D005968:Glutamate Decarboxylase; C401141:glutamate decarboxylase 2