Research article

Severe anaphylactic reactions to glutamic acid decarboxylase (GAD) self peptides in NOD mice that spontaneously develop autoimmune type 1 diabetes mellitus

Rosetta Pedotti^{* 1,4} , Maija Sanna^{* 2} , Mindy Tsai³ , Jason DeVoss¹ , Lawrence Steinman¹ , Hugh McDevitt² and Stephen J Galli³

¹Department of Neurology and Neurological Science, Stanford University School of Medicine, Stanford, California, USA

²Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA

³Department of Pathology, Stanford University School of Medicine, Stanford, California, USA

⁴Neuroimmunology Unit, Instituto Neurologico C. Besta, Milan, Italy

author email corresponding author email* Contributed equally

BMC Immunology 2003, 4:2doi:10.1186/1471-2172-4-2

Published:	22 February 2003

Abstract

Background

Insulin dependent (i.e., "type 1") diabetes mellitus (T1DM) is considered to be a T cell mediated disease in which T_H1 and T_c autoreactive cells attack the pancreatic islets. Among the beta-cell antigens implicated in T1DM, glutamic acid decarboxylase (GAD) 65 appears to play a key role in the development of T1DM in humans as well as in non-obese diabetic (NOD) mice, the experimental model for this disease. It has been shown that shifting the immune response to this antigen from T_H1 towards T_H2, via the administration of GAD65 peptides to young NOD mice, can suppress the progression to overt T1DM. Accordingly, various protocols of "peptide immunotherapy" of T1DM are under investigation. However, in mice with experimental autoimmune encephalomyelitis (EAE), another autoimmune T_H1 mediated disease that mimics human multiple sclerosis, anaphylactic shock can occur when the mice are challenged with certain myelin self peptides that initially were administered with adjuvant to induce the disease.

Results

Here we show that NOD mice, that spontaneously develop T1DM, can develop fatal anaphylactic reactions upon challenge with preparations of immunodominant GAD65 self peptides after immunization with these peptides to modify the development of T1DM.

Conclusions

These findings document severe anaphylaxis to self peptide preparations used in an attempt to devise immunotherapy for a spontaneous autoimmune disease. Taken together with the findings in EAE, these results suggest that peptide therapies designed to induce a T_H1 to T_H2 shift carry a risk for the development of anaphylactic reactivity to the therapeutic peptides.