Ketosis-prone type 2 diabetes mellitus and human herpesvirus 8 infection in sub-saharan africans.
BACKGROUND
An atypical form of type 2 diabetes mellitus (DM-2) is revealed by ketosis (ketosis-prone type 2 diabetes mellitus), frequently occurring in individuals who are black and of African origin, and characterized by an acute onset requiring transient insulin therapy. Its sudden onset suggests precipitating factors.


OBJECTIVE
To investigate the putative role of human herpesvirus 8 (HHV-8) in the pathogenesis of ketosis-prone DM-2.


METHODS
A cross-sectional study in which antibodies were searched against latent and lytic HHV-8 antigens using immunofluorescence. The presence of HHV-8 in genomic DNA was investigated in 22 of the participants at clinical onset of diabetes. We also tested whether HHV-8 was able to infect human pancreatic beta cells in culture in vitro. The study was conducted at Saint-Louis University Hospital, Paris, France, from January 2004 to July 2005. All participants were black and of African origin: 187 were consecutive diabetic patients of whom 81 had ketosis-prone DM-2 and 106 had nonketotic DM-2, and 90 individuals were nondiabetic control participants who were matched for age and sex.


METHODS
Seroprevalence of HHV-8 and percentage of patients with HHV-8 viremia at onset in ketosis-prone DM-2.


RESULTS
HHV-8 antibodies were found in 71 patients (87.7%) with ketosis-prone DM-2 vs 16 patients (15.1%) with nonketotic DM-2 (odds ratio, 39.9; 95% confidence interval, 17.1-93.4; P < .001) and 36 of the control participants (40.0%) (odds ratio, 10.7; 95% confidence interval, 4.9-23.4; P < .001). HHV-8 in genomic DNA was present in 6 of 13 patients with ketosis-prone DM-2 tested at acute onset and in 0 of 9 patients with nonketotic DM-2. HHV-8 proteins were present in human islet cells that were cultured for 4 days in the presence of HHV-8.


CONCLUSIONS
In this preliminary cross-sectional study, the presence of HHV-8 antibodies was associated with ketosis-prone DM-2 in patients of sub-Saharan African origin. Longitudinal studies are required to understand the clinical significance of these findings.
Sobngwi
Eugène
E
Department of Endocrinology and Diabetes, Saint-Louis University Hospital, 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France.
Choukem
Siméon Pierre
SP
Agbalika
Felix
F
Blondeau
Bertrand
B
Fetita
Lila-Sabrina
LS
Lebbe
Céleste
C
Thiam
Doudou
D
Cattan
Pierre
P
Larghero
Jérôme
J
Foufelle
Fabienne
F
Ferre
Pascal
P
Vexiau
Patrick
P
Calvo
Fabien
F
Gautier
Jean-François
JF
D017954:Africa South of the Sahara; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D044383:Black People; D002478:Cells, Cultured; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000503:physiopathology* / Q000821:virology*; D016883:Diabetic Ketoacidosis / Q000208:ethnology / Q000821:virology*; D005260:Female; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D019288:Herpesvirus 8, Human / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D050417:Insulin-Secreting Cells / Q000821:virology; D008297:Male; D008875:Middle Aged; D010641:Phenotype
D000914:Antibodies, Viral; D004279:DNA, Viral