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A case of insulin-dependent diabetes mellitus with CD8+ T-lymphocyte-predominant insulitis in a pancreatic biopsy specimen



A case of insulin-dependent diabetes mellitus with CD8+ T-lymphocyte-predominant insulitis in a pancreatic biopsy specimen



Journal of the Japan Diabetes Society 36(11): 875-880



A 22-year-old female developed diabetic ketoacidosis and was diagnosed as having IDDM with positive tests for islet cell antibodies (ICA) and HLA-DR4/9. The patient also had Graves' disease. Four months after the onset of IDDM, we performed laparoscopic biopsy of the pancreas to evaluate immunohistological abnormalities in the islets. Immunohistochemical analysis of the biopsy specimens revealed a decrease in the number of beta-cells, preservation of alpha and delta-cells, and mononuclear cell infiltration of the islets (insulitis). The infiltrating cells consisted of T-lymphocytes, B -lymphocytes and macrophages, and the most predominant subpopulation was CD8+ T-lymphocytes. As regards T-cell receptors, both alpha-beta- and gamma-delta-T-lymphocytes were observed in the islets. The biopsy specimen also showed hyperexpression of MHC class I antigens in the islet cells and of MHC class I and II antigens in the endothelial cells. These findings suggest that CD8+ T-lymphocytes, which predominantly infiltrated the islets, recognize beta-cell-autoantigens in conjunction with the hyperexpressed self-MHC-class I antigens, and may then have mediated beta-cell destruction. The positive ICA test and association with Graves' disease support the involvement of immunological abnormalities in the destruction of beta-cells in this case.

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Accession: 008025104

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