Autoantibodies against autonomic nervous tissues in Type 2 diabetes mellitus: No association with cardiac autonomic dysfunction

Summary:

There is evidence that autoimmune factors contribute to the pathogenesis of cardiac autonomic dysfunction in Type 1 Diabetes mellitus (DM). To evaluate the presence of autoantibodies against autonomic nervous tissues in Type 2 DM, 127 patients were studied for complement-fixing sympathetic and parasympathetic ganglia (CF-SG and CF-PSG) autoantibodies with an indirect immunofluorescence technique. Five cardiac reflex tests were performed to investigate cardiac autonomic neuropathy. QTc interval was assessed in all patients. As a control group, 60 healthy non-diabetic subjects were also tested for CF-SG and CF-PSG autoantibodies.

CF-SG autoantibodies were detected in 11 (9%) and CF-PSG autoantibodies were observed in 7 (6%) Type 2 DM patients, whereas in control subjects, the frequency was 1 (2%) and 0 (0%) respectively (ns vs. Type 2 DM patients). In Type 2 DM patients with cardiac autonomic neuropathy (n = 31, 24%), CF-SG autoantibodies and CF-PSG autoantibodies were detected in 3 (10%) patients, respectively, compared to 8 (8%) and 4 (4%) in Type 2 DM patients without cardiac autonomic neuropathy (n = 96, 76%, ns v. Type 2 DM with cardiac autonomic neuropathy). Both CF-SG autoantibodies and CF-PSG autoantibodies were observed in 2 (7%) Type 2 DM patients with cardiac autonomic neuropathy and 3 (3%) Type 2 DM patients without cardiac autonomic neuropathy. Type 2 DM patients with cardiac autonomic neuropathy demonstrated a longer QTc-interval (446 ± 42 ms) than Type 2 DM patients without cardiac autonomic neuropathy (413 ± 45 ms, p = 0.0001). In Type 2 DM patients with a prolonged QTc-interval (> 440 ms: n = 29, 23%), 2 (7%) patients presented with CF-SG and 3 (10%) had CF-PSG autoantibodies.

In Type 2 DM, CF-SG and CF-PSG autoantibodies are not frequently observed. The results do not give evidence, that immunological factors - like in Type 1 DM - play a role in the pathogenesis of cardiac autonomic dysfunction in Type 2 DM.

Key words:

Diabetes mellitus - neuropathy - nervous tissue autoantibodies - QT interval - GAD - IA-2

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