SummaryInsulin-dependent diabetes mellitus (IDDM) is associated with autoreactivity against GAD but the diagnostic sensitivity (positivity in disease) and specificity (negativity in health) of isoform-specific GAD antibodies have yet to be defined in assay systems suitable for screening large number of samples. One set of IDDM patient (n = 10) and control (n = 50) standard sera were used to develop quantitative antibody assays with in vitro synthesized recombinant 35S-methionine-labelled GAD65 and GAD67, respectively, and protein A-Sepharose to separate free from antibody-bound ligand. Binding levels were not normally distributed (p < 0.0001) and therefore, the diagnostic accuracy of GAD antibodies was analysed by the ROC plots in population-based, consecutively-diagnosed, recent onset, 0-14year-old patients (n = 105), and matched, healthy control subjects (n = 157). The ROC plots showed that the diagnostic sensitivity of GAD65 antibodies was 77 % and the specificity 92 % compared with 8 % and 98 %, respectively for GAD67 antibodies. In the IDDM sera, GAD65 and GAD67 antibodies were concordant in 7% (6 of 81) and GAD65 antibodies and ICA in 89 % (72 of 81) without a correlation between the autoantibody levels. Autoantibodies to recombinant human islet GAD65 are specific and sensitive markers for childhood IDDM in this immunoassay with in vitro synthesized 35S-methioninelabelled recombinant GAD. [Diabetologia (1994) Abbreviations: IDDM, insulin-dependent diabetes mellitus; GAD, glutamic acid decarboxylase; ROC, receiver-operating characteristic; ICA, islet cell antibodies; JDF, Juvenile Diabetes Foundation 10p11.3-p12 [7]. GAD65 shows 65 % amino acid identity with GAD67, the isoform coded for by the GAD1 gene on chromosome 2q31 [7][8][9]. The molecular cloning of full-length human islet GAD65 [7] and rat islet GAD67 [10] cDNA has made it possible to demonstrate autoreactivity in diabetes to the recombinant proteins in both eukaryotic [11,12] and bacterial [13] expression systems. GAD65 (but not GAD67) is expressed in human islets [11,14], however, variable reactivity of patient sera has been reported [12,13,[15][16][17][18][19]. GAD65 specificity of IDDM sera was first demonstrated in our immunoprecipitation assay with recombinant GAD expressed in transfected cells [12] and recently confirmed in other assays with recombinant antigens [18,20]. The use of different assay systems and species-specific GAD65 and GAD67 may explain the lower frequency of GAD67 antibodies in these compared to previous reports [13,16]. We now report the

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