title: Membranous nephropathy and cerebellar degeneration with anti-GAD antibodies in type 2 diabetes mellitus.
abstract: OBJECTIVE
  To study the potential pathogenic significance of the coexistence of membranous nephropathy, cerebellar degeneration and anti-glutamic acid decarboxylase (GAD) autoantibodies in patients with diabetes.
  
  
  METHODS
  We performed a direct immunocytochemistry on human kidney slides, electron microscopy on human kidney biopsy, direct immunofluorescence on human kidney biopsy. Baboon and rat kidney cell lines were fractionated and subjected to western blotting with antibodies to GAD.
  
  
  RESULTS
  In this patient we demonstrate the presence of autoantibodies to GAD, which is highly enriched in podocytes plasma membrane and tubular cells of the kidney as well as sub-endothelial IgG and complement C3 deposits in the glomerular basement membrane (GBM).
  
  
  CONCLUSIONS
  We hypothesize the existence in this patient of a common autoimmune pathogenic mechanism with GAD as the autoantigenic determinant, underlying cerebellar degeneration and membranous nephropathy.
authors.affiliation: Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. folli@uthscsa.edu.|Departamento de Clinica Medica, Faculdade de Ciencias Medicas (FCM), Obesity and Comorbidities Research Center (O.C.R.C.), Universidade Estadual de Campinas (UNICAMP), Campinas, S.P., Brazil. folli@uthscsa.edu.
authors.forename: Franco
authors.initials: F
authors.lastname: Folli
authors.affiliation: Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Daniele
authors.affiliation: Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Sherry
authors.initials: S
authors.lastname: Werner
authors.affiliation: Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: Subash
authors.initials: S
authors.lastname: Kamath
authors.affiliation: Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Jose Velez
authors.initials: JV
authors.lastname: Munera
authors.affiliation: Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Hanna
authors.initials: H
authors.lastname: Abboud
authors.affiliation: Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fanti
mesh_terms: D000368:Aged; D000818:Animals; D001323:Autoantibodies / Q000032:analysis*; D002524:Cerebellar Ataxia / Q000276:immunology; D002526:Cerebellar Diseases / Q000276:immunology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000276:immunology*; D003928:Diabetic Nephropathies / Q000276:immunology*; D019085:Fluorescent Antibody Technique, Direct; D015433:Glomerulonephritis, Membranous / Q000276:immunology*; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000276:immunology; D008297:Male; D051381:Rats
chemical_list: D001323:Autoantibodies; D005968:Glutamate Decarboxylase
keywords: Anti-glutamic acid decarboxylase (GAD) autoantibodies; Cerebellar degeneration; Membranous nephropathy; Type 2 diabetes mellitus