Characterization of circulating insulin and proinsulin-binding antibodies in autoimmune hypoglycemia.

J Goldman, D Baldwin, AH Rubenstein… - The Journal of …, 1979 - Am Soc Clin Investig
J Goldman, D Baldwin, AH Rubenstein, DD Klink, WG Blackard, LK Fisher, TF Roe…
The Journal of clinical investigation, 1979Am Soc Clin Investig
Five patients with fasting and (or) postprandial hypoglycemia were found to have insulin
antibodies in the absence of previously documented immunization. Studies on the
equilibrium-binding of insulin to the autoantibodies revealed two classes of binding sites
with association constants and binding capacities analogous to those of insulin antibodies
from insulin-treated diabetic patients. Similarly, no consistent differences in these
parameters were found in both groups of patients with insulins of bovine, porcine, and …
Five patients with fasting and(or) postprandial hypoglycemia were found to have insulin antibodies in the absence of previously documented immunization. Studies on the equilibrium-binding of insulin to the autoantibodies revealed two classes of binding sites with association constants and binding capacities analogous to those of insulin antibodies from insulin-treated diabetic patients. Similarly, no consistent differences in these parameters were found in both groups of patients with insulins of bovine, porcine, and human origin. Proinsulin (C-segment directed) antibodies capable of binding bovine or porcine proinsulin were present in 10 of 10 and 9 of 10 insulin-treated diabetics serving as controls, respectively, and, when present, provide incontrovertible evidence of exogenous insulin administration. No such antibodies could be detected in the hypoglycemic patients with autoimmune insulin antibodies. The kinetics of dissociation of the insulin-antibody complexes were consistent with the existence of two classes of antibody sites. The corresponding dissociation rate constants were large enough to predict that significant amounts of free hormone may be generated by this mechanism and provide a plausible pathogenesis for the hypoglycemia in these patients.
The Journal of Clinical Investigation