Autoimmunity in diabetic autonomic neuropathy: does the immune system get on your nerves?

Abstract

Symptomatic autonomic neuropathy is a devastating occasional complication of diabetes mellitus, especially Type 1. Although the full-blown clinical syndrome is not common, dysfunction of the autonomic nerves is detectable in up to 40% of Type 1 diabetic patients but its aetiopathogenesis is poorly understood. There is evidence to suggest that the damage to the autonomic nerves may be immune-mediated. This evidence is reviewed in the following article.

Humoral Autoimmunity in Type 1 Diabetes: Prediction, Significance, and Detection of Distinct Disease Subtypes

“…Although the presence of these autoantibodies reacting with neuronal tissues is thoughtprovoking and may somehow play a role in the pathophysiology of a subset of diabetic neuropathy, definite data establishing their role as causal factors remains elusive (Ejskjaer et al 1998). The examination of inflammatory responses in peripheral and autonomic nervous structures is becoming a growing area of investigation.…”

Qualitative and quantitative studies of autoantibodies to phospholipids in diabetes mellitus

“…However, the presence of aPA or identification of the B cells that might produce them still must be reckoned with the conundrum of whether these cause or result from disease. Evidence seems to be emerging that damage to autonomic nerves in type I diabetics may be immunologically mediated [55], and there is a wealth of reports that implicate an immunological basis for vascular lesions in other diseases [8][9][10]. It is hoped that our investigation of qualitative and quantitative parameters of aPA in diabetics will prompt other studies of the role of these antibodies in neurological and vascular complications of this common disease.…”

Prevalence of autoantibodies to autonomic nervous tissue structures in Type 1 diabetes mellitus

“…Abnormalities of autonomic function are common in longstanding diabetes and occur in some 20–40% of Type 1 diabetic patients[22–24]. Long‐term prospective observations will be needed to discover whether the presence of autoantibodies predicts the development of autonomic dysfunction, although our previous observations established their presence in some long‐term Type 1 diabetic patients with normal autonomic function[14, 15]. Sympto‐matic autonomic neuropathy, however, remains relatively rare: the discrepancy between the high prevalence of autonomic dysfunction and the rare occurrence of symptomatic autonomic neuropathy remains unexplained and since this study has not examined autonomic function specifically it cannot provide the answer.…”

“…Slides were read independently by a minimum of two observers blinded to the clinical details. Reference positive sera[15, 19] and normal serum were used as positive and negative controls, respectively, with positivity assigned according to previously defined immunofluorescence patterns[14, 15].…”