1 – Unidade de Endocrinologia Pediátrica; Área de Pediatria Médica; Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE; Lisboa, Portugal
2 – CEDOC, Chronic diseases research center – NOVA Medical School; Lisboa, Portugal
3 – MHH, Medizinische Hochschule Hannover; Hannover, Alemanha.
- 42 nd Annual Meeting of ISPAD, 26-29/10/ 2016, Valencia, Espanha (Poster)
- Pediatric Diabetes 2016, 17 (Suppl 24): 143-4 (Resumo)
Introduction: The natural history of T1D develops through distinct phases with particular immunologic and metabolic features. In remission phase a partial and transient restoration of endogenous insulin production occurs.
Objective: To identify clinically useful biomarkers for longer remission phase.
Methods: Prospective evaluation of 28 T1D children along three disease time-points (T1-onset; T2-remission phase; T3-established disease). Patients and 28 age-matched controls PB samples were analyzed by flow cytometry. Metabolic data were prospectively collected. In this data subset, relations between cellular populations, metabolic data and remission phase duration were explored.
Results: 28 T1D children aged 5-16y (mean 10±2,6y), 46% male. T1 samples were collected 4±2 days after diagnosis (mean±SD); T2 occured at 111±45 and T3 at 397±106 days. C-peptide level was positively related to remission time (r=0,389; p=0,05). Children with C-peptide levels >0,4 at T1 had higher neutrophil counts (p=0,03). Relative neutrophil count at onset was positively related to remission duration (r=0,412; p=0,03). Inversely, NK count in T1 was negatively related to remission phase duration (r=-0,538; p=0,003). At remission phase entrance, children with lower C-peptide (<0,4) had significantly lower neutrophil levels (p=0,02), higher Th1 (p=0,04) and total IFN-producing cells (p=0,05). Neither Th17/Tc17, Th1/Tc1 nor Treg related significantly with remission phase time.
Conclusions: Higher peripheral neutrophil levels may signal less pancreatic infiltration and therefore a less severe initial beta-cell mass destruction. That translates into higher C-peptide levels at disease onset and eventually a longer remission phase. Lower NK counts may predict a longer remission phase due to increased pancreatic migration with a possible protective role in insulitis. Immunologic characterization along the natural history of the disease may disclose biomarkers to direct future immune interventions.
Palavras-chave: diabetes