Characterization of CD4+ T cells specific for glutamic acid decarboxylase (GAD65) and proinsulin in a patient with stiff-person syndrome but without type 1 diabetes

摘要

Glutamic acid decarboxylase GAD is a rate-limiting enzyme in the synthesis of GABA and an important autoantigen in both type 1 diabetes (T1D) and in stiff-person syndrome (SPS). Autoantibodies (GADA) to the 65kD isoform of GAD are a characteristic feature in both diseases. Approximately 30% of SPS patients develop diabetes, yet, it is unclear to which extent co-existing autoimmunity to GAD65 and other islet autoantigens determines the risk of developing T1D. In this study we monitored CD4+ T-cell responses to GAD65 and proinsulin in a patient with SPS who remained normoglycemic during the 46-month follow-up. Fluctuating but persistent T-cell reactivity to GAD65 was identified, as well as T-cell reactivity to proinsulin at one time point. The majority of the T-cell clones isolated from the SPS patient produced high levels of Th2 cytokines (IL-13, IL-5 and IL-4). We also examined levels of GADA, insulin and IA-2 autoantibodies, and epitope specificity of GADA. In both serum and cerebrospinal fluid GADA levels were high, and GADA persisted throughout the follow-up. Despite T-cell reactivity to both GAD65 and proinsulin, autoantibodies to other islet autoantigens did not develop. Further follow-up will determine whether or not the beta-cell autoimmunity observed in this patient will eventually lead to T1D.