Novel Flow Cytometric Immunoassay for Detection of Proinsulin Autoantibodies in Diabetes Mellitus Employing a Recombinant Autoantigen Expressed in E. coli.

Introduction: Insulin and proinsulin autoantibodies (IAA/PAA) are usually the first markers to appear in patients with type 1 Diabetes Mellitus (T1DM) and their prevalence ranges from 10 to 60% in the child-adolescent population. The reference method for IAA/PAA detection is the Radioligand Binding Assay (RBA), a highly specific and sensitive technique, but expensive and polluting. The aim of this work was to develop a novel flow cytometric microsphere-based immunoassay (FloCMIA) for PAA detection, employing recombinant human proinsulin (PI), as an alternative method to RBA, less expensive and harmful to the environment. Materials and Methods: Human PI was expressed as Thioredoxin fusion protein (TrxPI) in E. coli and a fraction was biotinylated. A double paratope model was used in which samples were incubated with TrxPI-biotin and microspheres adsorbed with TrxPI. The immune complexes were revealed using Streptavidin-Phycoerythrin. The geometric mean of the signals was analyzed, and the results were expressed as Standard Deviation scores (SDs). Sera from 100 normal human control and from 111 type 1 diabetic patients were evaluated by FloCMIA. To correlate the novel assay with RBA, 51 diabetic patients were selected, spanning a wide range of PAA reactivity by RBA. Results: The study of ROC curves allowed choosing a cut-off value of 3.0 SDs and the AUC was 0.705, indicating that FloCMIA has fair ability to distinguish between samples from each group. A prevalence of 50% for PAA was obtained in the population of diabetic patients studied. The specificity was 96% and the analytical sensitivity (percentage of patients RBA positive, also positive by FloCMIA) was 69%. There was a substantial agreement between methods (kappa statistic=0.700). Conclusions: A novel immunoassay based on flow cytometry that uses easy-to produce recombinant PI was developed. This assay constitutes an innovative and cost-effective alternative to RBA for the determination of PAA in patients' sera. The method developed here, presents good performance and a wide dynamic range together with a small required sample volume. Furthermore, these results make it possible to develop multiplex immunoassays that allow the combined detection of autoantibodies present in T1DM and other related autoimmune diseases.

Novel prokaryotic expression of thioredoxin-fused insulinoma associated protein tyrosine phosphatase 2 (IA-2), its characterization and immunodiagnostic application.

BACKGROUND: The insulinoma associated protein tyrosine phosphatase 2 (IA-2) is one of the immunodominant autoantigens involved in the autoimmune attack to the beta-cell in Type 1 Diabetes Mellitus. In this work we have developed a complete and original process for the production and recovery of the properly folded intracellular domain of IA-2 fused to thioredoxin (TrxIA-2ic) in Escherichia coli GI698 and GI724 strains. We have also carried out the biochemical and immunochemical characterization of TrxIA-2icand design variants of non-radiometric immunoassays for the efficient detection of IA-2 autoantibodies (IA-2A). RESULTS: The main findings can be summarized in the following statements: i) TrxIA-2ic expression after 3 h of induction on GI724 strain yielded ≈ 10 mg of highly pure TrxIA-2ic/L of culture medium by a single step purification by affinity chromatography, ii) the molecular weight of TrxIA-2ic (55,358 Da) could be estimated by SDS-PAGE, size exclusion chromatography and mass spectrometry, iii) TrxIA-2ic was properly identified by western blot and mass spectrometric analysis of proteolytic digestions (63.25 % total coverage), iv) excellent immunochemical behavior of properly folded full TrxIA-2ic was legitimized by inhibition or displacement of [35S]IA-2 binding from IA-2A present in Argentinian Type 1 Diabetic patients, v) great stability over time was found under proper storage conditions and vi) low cost and environmentally harmless ELISA methods for IA-2A assessment were developed, with colorimetric or chemiluminescent detection. CONCLUSIONS: E. coli GI724 strain emerged as a handy source of recombinant IA-2ic, achieving high levels of expression as a thioredoxin fusion protein, adequately validated and applicable to the development of innovative and cost-effective immunoassays for IA-2A detection in most laboratories.

Detección y caracterización de autoanticuerpos anti-ZnT8 en pacientes argentinos con diabetes mellitus tipo 1 / Detection and characterisation of zinc transporter 8 autoantibody in Argentinian patients with type 1 diabetes mellitus

Introducción y objetivos: El transportador de Zn8 (ZnT8), identificado como el cuarto autoantígeno inmunodominante en la diabetes mellitus (DM) tipo 1, presenta un polimorfismo en el residuo 325 (Arg/Trp). Sin embargo, aún no se encuentra suficientemente definido el papel de este residuo en la inmunorreactividad de los autoanticuerpos anti-ZnT8 (ZnT8A). En este contexto, el objetivo del presente trabajo involucró la detección y caracterización inmuno-química de los ZnT8A en DM tipo 1 empleando diferentes variantes antigénicas de ZnT8 con Arg o Trp en la posición 325, o bien construcciones quiméricas con ambos aminoácidos en dicha posición. Materiales y métodos: Se evaluaron 100 sueros de pacientes argentinos con reciente diagnóstico de DM tipo 1. La determinación de ZnT8A se realizó mediante el ensayo de unión de radioligando, utilizando distintas variantes antigénicas: ZnT8-Arg325, ZnT8-Trp325, ZnT8- Arg-Trp325, ZnT8-Arg-Arg325 y ZnT8-Trp-Trp325. Paralelamente se determinó la presencia de los otros marcadores de autoinmunidad para DM por ensayo de unión de radioligando. Resultados: De los 100 pacientes estudiados, 65 fueron ZnT8A+ para al menos alguna de las variantes antigénicas empleadas. Ocho reconocieron todas las formas recombinantes de ZnT8. La mayoría (56) resultaron positivos para el heterodímero (ZnT8-Arg-Trp325), 25 de los cuales reconocieron además el homodímero ZnT8-Arg-Arg325 y el monómero ZnT8-Arg325. Nueve pacientes presentaron únicamente ZnT8A como marcador de autoinmunidad. Por otro lado, los niveles de señales obtenidos con el heterodímero fueron significativamente mayores a los niveles alcanzados empleando cualquiera de las otras variantes antigénicas (mediana 17,99 vs. 10,71; 6,32; 5,66 y 4,44 SD scores para ZnT8-Arg325, ZnT8-Trp325, ZnT8-Arg-Arg325 y ZnT8-Trp-Trp325, respectivamente; p < 0,05, test t de Mann-Whitney). Conclusiones: Se logró caracterizar inmunoquímicamente los ZnT8A presentes en pacientes argentinos con DM tipo 1 empleando diferentes variantes antigénicas de ZnT8. Se observó que la incorporación de ZnT8A, en combinación con los marcadores clásicos, incrementa la sensibilidad diagnóstica de autoinmunidad. La reactividad exclusiva de ZnT8A por las variantes antigénicas que contienen arginina en el residuo 325 evidencia la existencia de epítopes dependientes del aminoácido presente en dicho residuo. Además, la aplicación de variantes diméricas reveló la existencia de epítopes definidos por la estructura cuaternaria de ZnT8. La construcción heterodimérica fue la que mostró la mejor combinación de sensibilidad y especificidad a los fines del screening rutinario de ZnT8A.

Introduction and objectives: The aim of this study involved the detection and immunochemical characterisation of ZnT8 autoantibodies (ZnT8A) in new-onset type 1 Argentinian diabetic patients. Material and methods: One hundred sera from type 1 diabetic patients were tested for ZnT8A. The antigens employed were obtained using cDNA plasmids encoding the C-terminal domains of ZnT8 carrying 325Arg, 325Trp and 3 dimeric constructs (ZnT8-Arg-Trp325, ZnT8- Arg-Arg325 and ZnT8-Trp-Trp325). ZnT8A were assessed by radioligand binding assay (RBA). Other islet-autoantibodies were also tested by RBA. Results: Among the 100 type 1 diabetic patients, the prevalence of ZnT8A was 65.0%, 8 recognized all recombinant forms of ZnT8. Most patients (56) were positive for the heterodimer (ZnT8-Arg-Trp325), being 25 of them also positive for the homodimer ZnT8-Arg-Arg325 and monomer ZnT8-Arg325. Single reactivity against ZnT8A was found in 9.0% of the group. Besides, the highest signal values were obtained with the heterodimeric variant (median 17.99 vs. 10.71, 6.32, 5.66 and 4.44 SD scores for ZnT8-Arg325, ZnT8-Trp325, ZnT8-Arg-Arg325 y ZnT8-Trp-Trp325, respectively; p < 0.05, Mann-Whitney t test). Conclusion: Immunochemical characterisation of ZnT8A present in type 1 Argentinian diabetic patients was accomplished, employing different variants of ZnT8. An increased detection of autoimmunity was found when ZnT8A was employed in combination with the other islet-autoantibodies. The presence of autoantibodies that recognized only constructions containing Arg reveals the existence of epitopes dependent of the amino acid present at residue 325. Furthermore, application of dimeric constructions revealed the existence of quaternary structure-defined epitopes which were recognized by type 1 diabetic patients. Finally, the highest combined sensitivity and specificity for routine screening of ZnT8A was accomplished with the heterodimeric construction.

Autoinmunidad contra la célula beta en el adulto mayor con diabetes tipo 2: impacto clínico, metabólico y terapéutico / Beta cell autoimmunity in elederly with type 2 diabetes: clinical, metabolic and therapeutic impact

Introducción: se estudiaron 111 pacientes con diabetes diagnosticada después de los 65 ó más años de edad no obesos (IMC<30 kg/m2). Materiales y métodos: se determinaron cuatro anticuerpos marcadores de autoinmunidad para células ß pancreáticas: GADA, ZnT8, IA2A y PAA. Se midieron variables metabólicas, bioquímicas, antropométricas, clínicas y terapéuticas. Resultados: el 32% de los pacientes presentó autoanticuerpos. El autoanticuerpo más hallado fue el PAA 58,3%, seguido del GADA 30,5%, el ZnT8 27,7% y el IA2A 5,5%. Los pacientes con anticuerpos presentaron mayor circunferencia de cintura, insulinorresistencia (HOMA-IR), secreción de insulina (HOMAß) y complicaciones microangiopáticas. Entre ellos también fue más común que requirieran de insulina pero la diferencia no fue significativa. Conclusiones: estos resultados son diferentes de los que se esperaría tanto en diabéticos 2 como en diabéticos LADA más jóvenes, lo que sugiere que esta población tendría rasgos fenotípicos particulares y merece ser analizada con mayor extensión y profundidad. Proponemos la denominación LADE (latent autoimmune diabetes in elderly) para estos pacientes mayores de 65 años no obesos DM2 Au+

Expression and characterization of human proinsulin fused to thioredoxin in Escherichia coli.

Native proinsulin (PI) belongs to the class of the difficult-to-express proteins in Escherichia coli. Problems mainly arise due to its high proteolytic decay and troubles to reproduce the native disulphide pattern. In the present study, human PI was produced in E. coli as a fusion thioredoxin protein (Trx-PI). Such chimeric protein was obtained from the intracellular soluble fraction, and it was purified in one step by affinity chromatography on immobilized phenylarsine oxide. Trx-PI was also recovered from inclusion bodies and purified by anion exchange chromatography. The product identity and integrity were verified by mass analysis (22,173.5 Da) and mapping with Staphylococcus aureus V8 protease. Native PI folding was evaluated by biochemical and also by immunochemical analysis using specific sera from PI antibody-positive diabetic patients that recognise conformational discontinue epitopes. Dose-response curves showed identity between standard PI and Trx-PI. Moreover, surface plasmon resonance technique verified the correct conformation of the recombinant protein. The biochemical and immunochemical assays demonstrated the integrity of the chimera and the epitopes involved in the interaction with antibodies. In conclusion, it was possible to obtain with high-yield purified human PI as a fusion protein in E. coli and useful for analytical purposes.