Skip to main content
NCBI home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1983 Jan 15;286(6360):176–178. doi: 10.1136/bmj.286.6360.176

Plasmapheresis in the initial treatment of insulin-dependent diabetes mellitus in children.

J Ludvigsson, L Heding, G Liedén, B Marner, A Lernmark
PMCID: PMC1546360  PMID: 6401518

Abstract

Several factors indicate that autoimmune mechanisms may play a part in the aetiology of insulin-dependent diabetes mellitus. At the onset of the disease in 10 children (aged 11-16 years) plasmapheresis was performed four times over one to two weeks. Seventeen age-matched children with the same clinical features served as controls. The C-peptide concentrations at onset were the same in the two groups, but after one month the children treated with plasmapheresis had significantly higher values. This difference became even more pronounced after three, nine, and 18 months, both during fasting and at the maximum response to a standardised meal. The study group also had a significantly more stable metabolism, longer partial remission, and no higher insulin requirement. Of the 10 treated children islet-cell cytoplasmic antibodies were present in seven before plasmapheresis and in nine during treatment. The antibodies remained detectable in five and six out of nine patients at one and six months respectively after plasmapheresis. Although the mechanisms are obscure, plasmapheresis performed at the onset of insulin-dependent diabetes mellitus may help to preserve beta-cell function.

Full text

PDF
176

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Auerbach R., Bystryn J. C. Plasmapheresis and immunosuppressive therapy. Effect on levels of intercellular antibodies in pemphigus vulgaris. Arch Dermatol. 1979 Jun;115(6):728–730. doi: 10.1001/archderm.115.6.728. [DOI] [PubMed] [Google Scholar]
  2. Bottazzo G. F., Florin-Christensen A., Doniach D. Islet-cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiencies. Lancet. 1974 Nov 30;2(7892):1279–1283. doi: 10.1016/s0140-6736(74)90140-8. [DOI] [PubMed] [Google Scholar]
  3. Bystryn J. C., Graf M. W., Uhr J. W. Regulation of antibody formation by serum antibody. II. Removal of specific antibody by means of exchange transfusion. J Exp Med. 1970 Dec 1;132(6):1279–1287. doi: 10.1084/jem.132.6.1279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dahlberg P. A., Holmlund G., Karlsson F. A., Säfwenberg J. HLA-A, -B, -C and -DR antigens in patients with Graves' disease and their correlation with signs and clinical course. Acta Endocrinol (Copenh) 1981 May;97(1):42–47. doi: 10.1530/acta.0.0970042. [DOI] [PubMed] [Google Scholar]
  5. Dau P. C., Lindstrom J. M., Cassel C. K., Denys E. H., Shev E. E., Spitler L. E. Plasmapheresis and immunosuppressive drug therapy in myasthenia gravis. N Engl J Med. 1977 Nov 24;297(21):1134–1140. doi: 10.1056/NEJM197711242972102. [DOI] [PubMed] [Google Scholar]
  6. Handwerger B. S., Fernandes G., Brown D. M. Immune and autoimmune aspects of diabetes mellitus. Hum Pathol. 1980 Jul;11(4):338–352. doi: 10.1016/s0046-8177(80)80030-x. [DOI] [PubMed] [Google Scholar]
  7. Heding L. G. Radioimmunological determination of human C-peptide in serum. Diabetologia. 1975 Dec;11(6):541–548. doi: 10.1007/BF01222104. [DOI] [PubMed] [Google Scholar]
  8. Imbach P., Barandun S., d'Apuzzo V., Baumgartner C., Hirt A., Morell A., Rossi E., Schöni M., Vest M., Wagner H. P. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet. 1981 Jun 6;1(8232):1228–1231. doi: 10.1016/s0140-6736(81)92400-4. [DOI] [PubMed] [Google Scholar]
  9. Lanoe R., Soria J., Thibult N., Soria C., Eschwege E., Tchobroutsky G. Glycosylated haemoglobin concentrations and clinitest results in insulin-dependent diabetes. Lancet. 1977 Dec 3;2(8049):1156–1157. doi: 10.1016/s0140-6736(77)91541-0. [DOI] [PubMed] [Google Scholar]
  10. Lockwood C. M., Rees A. J., Pearson T. A., Evans D. J., Peters D. K., Wilson C. B. Immunosuppression and plasma-exchange in the treatment of Goodpasture's syndrome. Lancet. 1976 Apr 3;1(7962):711–715. doi: 10.1016/s0140-6736(76)93089-0. [DOI] [PubMed] [Google Scholar]
  11. Ludvigsson J., Heding L. G. beta-cell function in children with diabetes. Diabetes. 1978;27 (Suppl 1):230–234. doi: 10.2337/diab.27.1.s230. [DOI] [PubMed] [Google Scholar]
  12. Muggeo M., Flier J. S., Abrams R. A., Harrison L. C., Deisserroth A. B., Kahn C. R. Treatment by plasma exchange of a patient with autoantibodies to the insulin receptor. N Engl J Med. 1979 Mar 1;300(9):477–480. doi: 10.1056/NEJM197903013000906. [DOI] [PubMed] [Google Scholar]
  13. Nerup J., Lernmark A. Autoimmunity in insulin-dependent diabetes mellitus. Am J Med. 1981 Jan;70(1):135–141. doi: 10.1016/0002-9343(81)90420-4. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES