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- Title
Screening for insulinoma antigen 2 and zinc transporter 8 autoantibodies: a cost-effective and age-independent strategy to identify rapid progressors to clinical onset among relatives of type 1 diabetic patients.
- Authors
Gorus, F. K.; Balti, E. V.; Vermeulen, I.; Demeester, S.; Van Dalem, A.; Costa, O.; Dorchy, H.; Tenoutasse, S.; Mouraux, T.; De Block, C.; Gillard, P.; Decochez, K.; Wenzlau, J. M.; Hutton, J. C.; Pipeleers, D. G.; Weets, I.
- Abstract
In first-degree relatives of type 1 diabetic patients, we investigated whether diabetes risk assessment solely based on insulinoma antigen 2 ( IA-2) and zinc transporter 8 ( ZnT8) antibody status ( IA-2 A, respectively, ZnT8A) is as effective as screening for three or four autoantibodies [antibodies against insulin ( IAA), glutamate decarboxylase 65 kDa ( GAD) glutamate decarboxylase autoantibodies ( GADA) and IA-2A with or without ZnT8A] in identifying children, adolescents and adults who progress rapidly to diabetes (within 5 years). Antibodies were determined by radiobinding assays during follow-up of 6444 siblings and offspring aged 0-39 years at inclusion and recruited consecutively by the Belgian Diabetes Registry. We identified 394 persistently IAA+, GADA+, IA-2A+ and/or ZnT8A+ relatives (6·1%). After a median follow-up time of 52 months, 132 relatives developed type 1 diabetes. In each age category tested (0-9, 10-19 and 20-39 years) progression to diabetes was significantly quicker in the presence of IA-2 A and/or ZnT8A than in their joint absence ( P < 0·001). Progression rate was age-independent in IA-2A+ and/or ZnT8A+ relatives but decreased with age if only GADA and/or IAA were present ( P = 0·008). In the age group mainly considered for immune interventions until now (10-39 years), screening for IA-2A and ZnT8A alone identified 78% of the rapid progressors ( versus 75% if positive for ≥ 2 antibodies among IAA, GADA, IA-2A and ZnT8A or versus 62% without testing for ZnT8A). Screening for IA-2 A and ZnT8A alone allows identification of the majority of rapidly progressing prediabetic siblings and offspring regardless of age and is more cost-effective to select participants for intervention trials than conventional screening.
- Subjects
AUTOANTIBODY analysis; INSULINOMA; ANTIGENS; ZINC transporters; COST effectiveness; PEOPLE with diabetes; GLUTAMATE decarboxylase
- Publication
Clinical & Experimental Immunology, 2013, Vol 171, Issue 1, p82
- ISSN
0009-9104
- Publication type
Article
- DOI
10.1111/j.1365-2249.2012.04675.x