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  • 1
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; Type 2 diabetes ; islet cell antibodies ; complement fixing islet cell antibodies ; immune complexes ; thyro-gastric autoantibodies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Islet cell antibodies (ICA), complement fixing islet cell antibodies, immune complexes and thyro-gastric autoantibodies were studied in newly diagnosed diabetic patients not requiring insulin at diagnosis. Particular attention was focussed on that minority of patients who are initially treated with diet or oral agents but show ICA in their serum. One hundred and six non-insulin-requiring patients were studied at clinical diagnosis. Seventeen who had ICA in their serum were compared with a control group of 89 who did not. The 17 ICA-positive diabetic patients were followed serologically for approximately 1 year from diagnosis. Patients were followed clinically for 3 years. Forty-seven percent of ICA-positive and 19% of ICA-negative patients had immune complexes in their serum. Eleven of the 17 ICA-positive patients also had serum complement fixing islet cell antibodies. Thyro-gastric antibodies were found in 29% of ICA-positive and 18% of ICA-negative diabetic patients. ICA, complement fixing antibody and immune complex positivity declined with time. Ten of the 17 ICA-positive and two of the 89 ICA-negative patients required insulin within 3 years of diagnosis. There was a positive trend for the presence of complement fixing islet cell antibodies at diagnosis to be associated with the early development of insulin dependency. The type of diabetes in ICA-positive patients not requiring insulin at diagnosis has strong immunological and clinical similarities to classical Type 1 (insulin-dependent) diabetes.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 19 (1980), S. 89-92 
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; anti-insulin antibodies ; islet cell antibodies ; immune complexes ; C1q solid phase assay ; conglutinin binding test ; monocomponent insulins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In 41 Type 1 (insulin-dependent) diabetic patients, islet cell antibodies, anti-insulin antibodies, and immune complexes measured by two different methods (the C1q solid phase assay and the conglutinin binding test) were studied at diagnosis, and the influence of treatment with insulins of different purity was investigated during the first year of treatment. Twenty subjects were treated with conventional insulins (group 1) while 21 were treated with monocomponent porcine insulins (group 2). The prevalence of islet cell antibodies significantly decreased during the 12-month study period in the 41 patients. From the first month anti-insulin antibodies were always significantly higher in group 1 than in group 2. At diagnosis the prevalence of both types of immune complexes in the 41 patients was higher than in normal subjects. The immune complexes measured by the C1q solid phase method showed a significant and progressive reduction during the follow-up period, whereas the immune complexes assayed by conglutinin showed no significant variation in the same period. The presence of C1q immune complexes was found to correlate with the occurrence of islet cell antibodies both at diagnosis and during the follow-up period. The presence of conglutinin immune complexes, on the other hand, tended to parallel the increase of anti-insulin antibody levels.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0428
    Keywords: Key words Insulin-dependent diabetes mellitus ; arterial hypertension ; borderline hypertension ; microalbuminuria ; diabetic nephropathy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Arterial hypertension and poor glycaemic control are central to the development of microalbuminuria in insulin-dependent diabetes mellitus (IDDM). Recent consensus has established sensitive criteria for their detection and treatment, although the proportion of patients who may benefit is unclear. Between 1988 and 1990, we measured urinary albumin to creatinine concentration ratio (A/C) in 3,636 adult out-patients with IDDM of more than 3 years duration, serum creatinine under 133 μmol/l and who were not undergoing antihypertensive treatment. A/C indicating microalbuminuria (≥ 2.38/2.96 mg/mmol, male/female) was found in 620 of 3,451 patients without proteinuria, and associated with hypertension (blood pressure ≥ 140 and/or 90 mm Hg; p = 0.0016; rate: 39.6 %), independent of diabetes duration (p = 0.0082) and male gender (p = 0.0350; relative risk = 1.16; 95 % confidence interval: 1.01–1.32). Hypertension was less common among those with normal A/C (27.5 %, p 〈 0.0001) but was positively related with diabetes duration. Of the 1,015 patients with A/C ≥ 2.0 mg/mmol 529 were reexamined. Glycated haemoglobin levels exceeded 3 SD above the mean of normal in 84.3 % of the 198 microalbuminuric patients (AER = 20–200 μg/min), but were comparably poor (79.2 %) in normoalbuminuria. Duration of diabetes was inversely related to glycated haemoglobin only in microalbuminuria (0.05 〈 p 〈 0.1). Intervention to lower blood pressure remains mainly restricted to those patients with long-term diabetes and slower development of kidney disease. Near-normalisation of glycaemia remains the priority for the majority of patients with microalbuminuria. [Diabetologia (1994) 37: 1015–1024]
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0428
    Keywords: Gangliosides ; pancreatic islets ; beta-cell autoimmunity ; autoantigen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Recent studies have indicated that GM2-1, a pancreatic islet monosialo-ganglioside, is an islet-specific component whose expression is metabolically regulable and represents one of the target antigens of cytoplasmic islet cell antibodies. In the present study we aimed to biochemically characterize this molecule using a panel of biochemical techniques including gas chromatography, thin layer chromatography, enzymatic digestion and mass spectrometry. GM2-1 ganglioside was extracted from human pancreas and purified by thin-layer chromatography. Fatty acids in the ceramide (the hydrophobic portion of the molecule), identified by gas chromatography ranged from C16:1 to C24:1. The oligosaccharide chain was enzymatically digested by the sequential application of various exoglycosidases (neuraminidase followed by Β-galactosidase, followed by Β-hexosaminidase) and characterized by gas chromatography identification of the liberated sugars. The following structure was deducted from enzymatic studies and confirmed by mass spectrometry analysis: N-acetyl neuraminic acid-galactose-galactosamine-galactosamine-glucose-ceramide. This is a novel ganglioside structure, not yet described, which shares characteristics with a neuronal glycolipid autoantigen: the LM1 ganglioside. Both GM2-1 and LM1 have a single sialic acid residue in the terminal position, the same migration position on thin layer chromatography and the same number of carbohydrate moieties. In conclusion, we have characterized a novel islet-specific ganglioside molecule with unusual characteristics, such as the terminal sialic acid and the galactosamine residues, which may facilitate both its anti-genicity and its involvement in beta-cell autoimmunity.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-0428
    Keywords: Islet cell antibody ; Type 1 (insulin-dependent) diabetes ; standards ; quality control ; Juvenile Diabetes Foundation units
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Forty-one assays were analysed at the 3rd International Workshop on the standardisation of islet cell antibodies. Analysis of precision demonstrated assays consistently detecting blind duplicates within one doubling dilution and capable of discriminating one doubling dilution differences in islet cell antibody concentration. Some assays, however, reported duplicates discrepantly by more than seven doubling dilutions, and consequently could not distinguish even large quantities of islet cell antibodies. Precision was best in assays from laboratories which had participated in all three Standardisation Workshops and was not dependent upon methodology. The use of the Juvenile, Diabetes Foundation reference islet cell antibody standard and standard curves reduced the scatter of results, and was best amongst assays with better precision. Twenty-seven assays reported all ten blood donor sera as negative. However, 14 assays did not, and specificity (negativity in health) was 〈50% in three assays. Low specificity was strongly associated with poor precision. The detection limit of assays ranged from 〈5 to 50 JDF units and was partially dependent upon methodology. Assays incorporating extended incubation had the lowest detection limits without a decrease in the specificity of the ten blood donor sera. Precise quantification is fundamental for the standardisation and comparability of islet cell antibodies. Precise quantitative assays have been identified and reference standards and common units established.
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  • 7
    ISSN: 1432-0428
    Keywords: d-Lysine ; Maillard reaction ; non-enzymatic glycation ; proteins ; diabetes mellitus ; streptozotocin rat model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary d-Lysine, the non-physiological isomer of l-lysine, can competitively reduce protein non-enzymatic glycation in vitro. To study the effect of d-lysine in vivo, 6–8-week old Sprague-Dawley rats with streptozotocin-induced diabetes mellitus were treated from diagnosis for 45 days with two daily subcutaneous injections of d-lysine (0.5 g·ml−1·day−1). Another group of diabetic rats was only injected with equal volumes of physiological saline (0.9% NaCl). Glycated haemoglobin was measured by ion exchange chromatography, and glycated serum and lens proteins by boronate affinity gel chromatography. Serum and urinary creatinine concentrations were evaluated by the alkaline-picrate reaction. Urinary lysine concentrations at mid- and end-study were evaluated by cation exchange chromatography. Blood glucose concentrations, serum creatinine levels and creatinine clearances, measured at the end of the study, were similar in both diabetic groups (〉 22.0 mmol/l, ≤ 106 μmol/l and ≈ 0.02 ml/s, respectively). Urinary lysine concentration in d-lysine-treated diabetic animals was more than 50-fold higher than in placebo-treated diabetic rats. In d-lysine-treated vs placebo-treated diabetic animals, a statistically significant reduction was found in the levels of glycated haemoglobin (stable HbA1; mean ± SD=3.00±0.74% vs 4.02±0.46%, p〈0.05; labile HbA1=3.92±0.89% vs 5.84±0.61%, p〈0.005), glycated serum proteins (1.40±0.47% vs 2.52±1.15%, p〈0.05) and glycated lens proteins (4.90±0.96% vs 5.98±0.65 %,p〈0.05). Thus, d-lysine (i) is not nephrotoxic and (ii) causes a significant reduction of the early glycation products at the protein level. Therefore, the d-amino acid could be useful in attempting to control damaging phenomena associated with or due to an enhanced protein non-enzymatic glycation.
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  • 8
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes mellitus ; arterial hypertension ; borderline hypertension ; microalbuminuria ; diabetic nephropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Arterial hypertension and poor glycaemic control are central to the development of microalbuminuria in insulin-dependent diabetes mellitus (IDDM). Recent consensus has established sensitive criteria for their detection and treatment, although the proportion of patients who may benefit is unclear. Between 1988 and 1990, we measured urinary albumin to creatinine concentration ratio (A/C) in 3,636 adult out-patients with IDDM of more than 3 years duration, serum creatinine under 133 Μmol/l and who were not undergoing antihypertensive treatment. A/C indicating microalbuminuria (≥2.38/ 2.96 mg/mmol, male/female) was found in 620 of 3,451 patients without proteinuria, and associated with hypertension (blood pressure ≥140 and/or 90 mm Hg; p=0.0016; rate: 39.6%), independent of diabetes duration (p=0.0082) and male gender (p=0.0350; relative risk=1.16; 95% confidence interval: 1.01–1.32). Hypertension was less common among those with normal A/C (27.5%, p〈0.0001) but was positively related with diabetes duration. Of the 1,015 patients with A/C〉2.0 mg/mmol 529 were reexamined. Glycated haemoglobin levels exceeded 3 SD above the mean of normal in 84.3% of the 198 microalbuminuric patients (AER=20–200 Μg/min), but were comparably poor (79.2%) in normoalbuminuria. Duration of diabetes was inversely related to glycated haemoglobin only in microalbuminuria (0.05〈p〈0.1). Intervention to lower blood pressure remains mainly restricted to those patients with long-term diabetes and slower development of kidney disease. Near-normalisation of glycaemia remains the priority for the majority of patients with microalbuminuria.
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  • 9
    ISSN: 1432-0428
    Keywords: Keywords Extracellular matrix ; transforming growth factor-β ; prostaglandins ; thromboxane ; mesangial cell ; diabetes mellitus.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Accumulation of extracellular matrix in the mesangium and altered renal eicosanoid synthesis are two prominent features of diabetic glomerular disease. We investigated the relationship between eicosanoid and extracellular matrix production in rat mesangial cells cultured under high glucose vs normal glucose conditions. Long-term exposure of rat mesangial cells to high glucose, but not to iso-osmolar mannitol, significantly increased extracellular matrix accumulation and gene expression and transforming growth factor-β (TGF-β) mRNA levels, and decreased prostaglandin (PG) E2 synthesis without affecting production of either thromboxane (TX) B2 or PGF2 a, with respect to cells incubated in normal glucose. Addition of exogenous PGE2 resulted in a dose-dependent reduction of matrix protein and mRNA levels and TGF-β gene expression in cells cultured in either normal or high glucose conditions, whereas exposure to exogenous PGF2α produced a significant increment in matrix production and matrix and TGF-β gene expression in cells grown in normal glucose, but only a slight increase in those cultured in high glucose. Stimulation of endogenous endoperoxide metabolism towards PGE2 and PGF2α synthesis with FCE-22,178, a drug originally developed as TXA2 synthase inhibitor, resulted in a dose-dependent decrease in matrix accumulation and matrix and TGF-β gene expression which was suppressed by co-incubation with the cyclo-oxygenase inhibitor fenoprofen blocking the FCE-22,178-enhanced PG production. In both cell lines, the rate of synthesis of TXA2 was very low and the selective blockade of its synthesis (by two other TXA2 synthase inhibitors, OKY-046 and Ridogrel) or action (by the TXA2 receptor antagonist BM-13,177) did not alter matrix production or TGF-β mRNA levels. These results suggest that the cyclo-oxygenase pathway is involved in the regulation of matrix changes induced by high glucose in rat mesangial cells; the reduced production of PGE2 may enhance the synthesis or potentiate the effect of stimulators of ECM formation such as TGF-β, whereas TXA2 does not appear to be involved. These data also indicate that glucose-enhanced mesangial matrix accumulation may be prevented by exogenous PGE2 or by drugs capable of increasing endogenous PGE2 synthesis. [Diabetologia (1996) 39: 1055–1062]
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  • 10
    ISSN: 1432-0428
    Keywords: Keywords Mesangium ; diabetes mellitus ; protein kinase C ; capacitative Ca2 + influx ; store-operated Ca2 + channels.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In cultured mesangial cells (MC), capacitative Ca2 + influx via store-operated channels (SOC) is potentiated by agents that release Ca2 + from intracellular stores, and inhibited by protein kinase C (PKC). Cells grown under high glucose conditions, as a model of the diabetic microenvironment, display reduced Ca2 + signalling in response to vasoconstrictors, probably due to downregulation by elevated PKC activity. Since SOC might be relevant to this phenomenon, we assessed Ca2 + influx by microfluorometry of fura-2-loaded rat MC cultured for 5 days in normal (5.5 mmol/l, NG) or high glucose (30 mmol/l, HG). The addition of 1–10 mmol/l Ca2 + to NG cells equilibrated in Ca2 + -free media induced an immediate Ca2 + influx with a free cytosolic Ca2 + ([Ca2 + ]i) plateau of 155 ± 50 and 318 ± 114 nmol/l, respectively. Basal influx was reduced to 88 ± 8 and 145 ± 17 nmol/l [Ca2 + ]i (1–10 mmol/l Ca2 + , p 〈 0.01) by 30 mmol/l d-glucose. This effect of HG was confirmed by Mn2 + quenching of fura-2, indicating reduced entry of divalent cations via the capacitative pathway. Equimolar l-glucose had no effect on Ca2 + influx, consistent with a non-osmotic mechanism. Arginine vasopressin (10 μmol/l) elicited weaker release of stored Ca2 + and subsequent influx in HG cells (191 ± 33 vs 153 ± 24 nmol/l, 400 ± 76 vs 260 ± 33 nmol/l, 1–10 mmol/l Ca2 + , NG/HG, p 〈 0.05). To examine the involvement of PKC in the effect of HG on capacitative Ca2 + influx, the enzyme was activated or downregulated by treatment with 0.1 μmol/l phorbol myristate acetate (PMA) for 3 min or 24 h, respectively. PMA acutely inhibited Ca2 + influx in NG cells, while PKC downregulation restored it in HG cells. Similarly, the PKC inhibitors staurosporin or H-7 normalized SOC activity in HG cells. In summary, impairment of Ca2 + influx via SOC by HG is one mechanism of the reduced MC [Ca2 + ]i responsiveness to vasoconstrictors. This event is mediated by PKC and may contribute to the glomerular haemodynamic changes in the initial stages of diabetes mellitus. [Diabetologia (1997) 40: 521–527]
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