T Cells Recognize Multiple GAD65 and Proinsulin Epitopes in Human Type 1 Diabetes, Suggesting Determinant Spreading

Human type 1 diabetes is thought to be mediated by autoreactive T cells specific for antigens expressed by pancreatic beta cells. However, it is unclear which autoantigens and determinants thereof are the targets of the autoimmune attack. Using comprehensive peptide libraries that cover the entire sequence of two major candidate autoantigens, GAD65 and proinsulin, we measured the in vivo frequencies of peptide-specific, IFN-gamma-producing memory T cells in 27 diabetic patients, 14 high risk individuals, and 15 partially HLA-matched healthy controls. Compared to the controls, both a higher number of determinants on the islet cell antigens were recognized and the frequencies of peptide specific cells were increased in patients and high risk individuals. Inclusion of signal enhancing anti-CD28 antibody further accentuated this difference. Considerable heterogeneity in peptide recognition was seen even in DRB1*04, DQB1*0302 matched individuals. Unlike its peptides, the GAD protein antigen did not recall a T cell memory response. The highly heterogeneous recognition of a multitude of peptide determinants on both autoantigens, occurring in the absence of protein recognition, and the low functional avidity of the memory cells involved jointly suggest that the autoimmune T cell repertoire in human type 1 diabetes primarily targets cryptic determinants engaged by determinant spreading.     

1型糖尿病及肥胖儿童血清瘦素水平及与其它常用指标相关性分析

目的比较1型糖尿病及肥胖儿童血清瘦素水平。方法以EL1SA方法测定35例1型糖尿病、32例肥胖及35例健康儿童的血清瘦素水平。35例1型糖尿病患者中 ,7例为新患糖尿病伴酮症酸中毒的患者。通过测定C -肽水平来评估胰岛素的分泌。C -肽、血糖、糖化血红蛋白按常规方法测定。结果糖尿病患者血清瘦素水平低于对照组 (P<0.001)。肥胖儿童血清瘦素及C -肽水平高于糖尿病组及对照组。在糖尿病新患者中 ,经1个月的胰岛素治疗后 ,血清瘦素水平未有任何变化 (P>0.05)。在联合组中 ,瘦素与体重指数 (bodymassindex,BMI)及C -肽呈正相关(P<0.001) ,而与血糖及糖化血红蛋白呈负相关(P<0.05)。结论1型糖尿病患儿血清瘦素水平低可能与代谢控制有关的慢性胰岛素缺乏引起的。瘦素及胰岛素在保持身体体重稳定的过程中可能起着补充作用。     

急性胰腺炎患者空腹高血糖发生率及其危险因素分析

目的:回顾性分析急性胰腺炎(AP)患者空腹高血糖发生率及其危险因素。方法:收集2018-01—2018-12武汉大学人民医院胰腺外科133例AP且无糖尿病(DM)病史的住院患者病历资料,按照不同性别、年龄、AP临床分型、病因、CT指数评分(CISI)等分组,χ2检验分析各组临床因素与空腹高血糖(FPG≥6.1mmol/L)发生率的关系,多因素二元logistic回归分析空腹高血糖独立危险因素。结果:AP临床分型(χ2=5.494,P=0.019)和CTSI(χ2=6.236,P=0.013)与AP患者空腹高血糖相关(P<0.05)。CTSI≥6分(P=0.015,OR=2.920,95%Cl=1.234—6.905)为AP患者空腹高血糖的独立危险因素(P<0.05)。结论:临床分型中重症+重症及CTSI≥6分的AP患者易发生空腹高血糖,尤其CTSI≥6分是AP后空腹高血糖的独立危险因素,临床应高度关注。     

TNF-alpha impairs peripheral tolerance towards beta-cells,and local costimulation by B7.1 enhances the effector function of diabetogenic T cells

Maintenance of peripheral tolerance and inactivation of autoreactive T cells is based on a delicate balance between pro-inflammatory and protective cytokines that is poorly understood. We have here addressed how the local expression of the inflammatory cytokine TNF-alpha can impair peripheral tolerance and lead to autoreactivity. After transplantation of pancreata that are immunogenic due to beta-cell expression of B7.1 and TNF-alpha, into thymectomized and euthymic syngeneic mice, we found that only euthymic mice rejected the grafts. This result suggests that under normal circumstances autoreactive T cells are functionally inactivated, and initiation of an autoreactive response requires de-novo generation of T cells. By contrast, thymectomized mice expressing TNF-alpha on the endogenous islets rejected the grafts, showing that expression of TNF-alpha prevents functional silencing of the autoreactive T cells. Thus, this study provides a mechanism by which TNF-alpha and possibly chronic inflammatory responses may promote autoimmune diseases. Furthermore, we have investigated whether B7.1 can enhance T cell responses of already activated T cells leading to islet rejection. By transplantation of wild-type and B7.1-expressing islets into overtly diabetic mice we found that only the wild-type islets could restore normoglycemia, suggesting that costimulation by B7.1 is required in the expansion or effector phase of the response.     

Diet selection and metabolic fuels in three models of diabetes mellitus

Dietary self-selection and circulating metabolic fuels (glucose, free fatty acids, ketones) were examined in three forms of experimental diabetes mellitus in rats: pancreatectomy and streptozotocin treatment in adult and neonatal rats. Changes in diet selection resulting from insulin replacement also were examined. Differences were found in diet selection and circulating metabolic fuels between these types of diabetes. Mildly diabetic rats selected large amounts of fat while more severely diabetic rats primarily selected protein. Insulin treatment enhanced carbohydrate intake of diabetic rats and nearly normalized diet selection and circulating metabolic fuels. All diabetic groups exhibited severe glucose intolerance. These results support the observations of the beneficial effects of low-carbohydrate diets, question the generality of the use of high-fat diets, and suggest a more important role for high-protein diets in energy regulation in severely diabetic rats.     

糖尿病患者红细胞形态和渗透脆性的初步研究

应用扫描电镜观察了22例糖尿病人4400个红细胞形态的异常百分比，并测定红细胞的渗透脆性。结果表明随着糖尿病病程延长、糖化血红蛋白升高，口形、嵴形红细胞的百分比明显升高（2．64±1．27比4．29±1．03，P＜0.001），细胞渗透脆性明显上升（0．17±0．04比0．33±0．17，P＜0.05）。提示，糖尿病人异常形态红细胞的出现不仅与红细胞的能量代谢障碍外，还可能与红细胞所处的高血糖、高血脂、高血液粘度的环境有关。而影响红细胞的渗透脆性的因素较为复杂，红细胞的圆形隆起在降低其渗透脆性方面起了重要作用。     

Cell signalling-mediating insulin increase of mRNA expression for cationic amino acid transporters-1 and -2 and membrane hyperpolarization in human umbilical vein endothelial cells

Insulin induces vasodilatation in human subjects and increases l-arginine transport and NO synthesis in human umbilical vein endothelial cells (HUVEC). Cell signalling events associated with insulin effects on activity and mRNA expression of the human cationic amino acid transporters 1 (hCAT-1) and 2B (hCAT-2B) are unknown. l-Arginine transport and eNOS activity were determined in HUVEC exposed to insulin. mRNA levels for hCAT-1, hCAT-2B and eNOS were quantitated by real time RT-PCR and endothelial NO synthase (eNOS) protein was identified by Western blot analysis. Intracellular Ca²⁺, l-arginine and l-citrulline levels, l-[³H]citrulline formation from l-[³H]arginine, cGMP formation, nitrite level, ATP release and membrane potential were determined. Insulin increased l-arginine transport and the mRNA levels for hCAT-1 and hCAT-2B and eNOS expression and activity. Insulin also induced membrane hyperpolarization and increased intracellular Ca²⁺, l-[³H]citrulline, cGMP and nitrite formation. Insulin-mediated stimulation of the l-arginine/NO pathway is thus associated with increased hCAT-1 and hCAT-2B mRNA, and eNOS expression, via mechanisms involving membrane hyperpolarization, mitogen-activated protein kinases p42 and p44, phosphatidylinositol 3-kinase, NO and protein kinase C. We have characterized a cell signalling pathway by which hyperinsulinaemia could lead to vasodilatation in human subjects, and which could have implications in patients in whom plasma insulin levels are altered, such as in diabetes mellitus.     

Estradiol and insulin: independent effects on eating and body weight in rats.

The effects of ovariectomy and estradiol replacement were determined in streptozotocin-diabetic female rats maintained on daily injections of protamine zinc insulin. Similar changes in food intake and body weight in these animals and in nondiabetic control animals indicate that the effects of estradiol on these measures are probably not dependent on changes in pancreatic insulin secretion. Acute and chronic insulin challenges in ovariectomized rats maintained on estradiol benzoate, nafoxidine or oil were also examined. The effects of insulin were not attenuated by prior estrogen conditioning, and there was no evidence of insulin resistance. These experiments suggest that the effects of estradiol on body weight and food intake in female rats are not dependent upon altered insulin levels nor attenuation of the effects of insulin. Estradiol may exert its influence on eating and body weight via separate and possibly more direct pathways. The data also are consistent with the suggestion that ovariectomy-induced and hypothalamic obesities are separate phenomena.     

On the various manifestations of spontaneous autoimmune diabetes in rodent models

Autoimmune (type 1) diabetes mellitus in mouse, rat, and humans shares several features, including T lymphocyte infiltration into pancreatic islets and a dependence on permissive class II major histocompatibility complex (MHC) alleles. We report here on an experimental model involving mice that express influenza hemagglutinin (HA) under the control of the insulin promoter and, at the same time, a transgenic class II MHC-restricted T cell receptor (TcR) specific for an HA peptide. These mice spontaneously develop islet infiltrates resembling those found in NOD mice and most animals become diabetic within 8 weeks of age. Because of the availability of a clonotypic TcR antibody, we can be confident that the Ins-HA transgene does not induce any measurable alterations in the vast majority of T cells with the transgenic TcR in primary and secondary lymphoid organs. Continuous export of large numbers of HA-specific lymphocytes from the thymus was not required for the manifestation of the disease since mice thymectomized at 3 days after birth still developed the disease albeit with smaller infiltrates.     

茶色素治疗糖尿病前后血液流变性和微循环检测分析

目的：观察茶色素治疗糖尿病前后血液流变微循环的变化。方法：糖尿病人88例，男71例，女17例，年龄32～64岁。口服茶色素2粒（250mg），每日3次，疗程为30天。结果：血液流变学参数、微循环积分值、血生化指标、RIA都有明显改善（P＜0．01或P＜0．05）。结论：茶色素可以明显改善糖尿病人血液流变性和微循环多项检测指标，值得临床推广应用。