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- Ludvigsson, Johnny, et al.
(författare)
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GAD65 antigen therapy in recently diagnosed type 1 diabetes mellitus
- 2012
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 366:5, s. 433-442
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The 65-kD isoform of glutamic acid decarboxylase (GAD65) is a major autoantigen in type 1 diabetes. We hypothesized that alum-formulated GAD65 (GAD-alum) can preserve beta-cell function in patients with recent-onset type 1 diabetes.METHODS: We studied 334 patients, 10 to 20 years of age, with type 1 diabetes, fasting C-peptide levels of more than 0.3 ng per milliliter (0.1 nmol per liter), and detectable serum GAD65 autoantibodies. Within 3 months after diagnosis, patients were randomly assigned to receive one of three study treatments: four doses of GAD-alum, two doses of GAD-alum followed by two doses of placebo, or four doses of placebo. The primary outcome was the change in the stimulated serum C-peptide level (after a mixed-meal tolerance test) between the baseline visit and the 15-month visit. Secondary outcomes included the glycated hemoglobin level, mean daily insulin dose, rate of hypoglycemia, and fasting and maximum stimulated C-peptide levels.RESULTS: The stimulated C-peptide level declined to a similar degree in all study groups, and the primary outcome at 15 months did not differ significantly between the combined active-drug groups and the placebo group (P=0.10). The use of GAD-alum as compared with placebo did not affect the insulin dose, glycated hemoglobin level, or hypoglycemia rate. Adverse events were infrequent and mild in the three groups, with no significant differences.CONCLUSIONS: Treatment with GAD-alum did not significantly reduce the loss of stimulated C peptide or improve clinical outcomes over a 15-month period.
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| 3. |
- Pulgarín-R, Paulo C., et al.
(författare)
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Migratory birds as vehicles for parasite dispersal? Infection by avian haemosporidians over the year and throughout the range of a long-distance migrant
- 2019
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Ingår i: Journal of Biogeography. - : Wiley. - 0305-0270 .- 1365-2699. ; 46:1, s. 83-96
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The role of migratory birds in the spread of parasites is poorly known, in part because migratory strategies and behaviours potentially affecting transmission are not easy to study. We investigated the dynamics of infection by blood parasites through the annual cycle of a long-distance Nearctic–Neotropical migratory songbird to examine the role of this species in dispersing parasites between continents. Location: The Americas. Taxon: Grey-cheeked Thrush (Catharus minimus, Aves, Passeriformes, Turdidae), Birds. Methods: We used molecular and microscopy screening of haemosporidian parasites (Plasmodium, Haemoproteus, and Leucocytozoon) to examine the prevalence, distribution, and diversity of lineages through the annual cycle (breeding, migration, and wintering) of the grey-cheeked thrush in North and Central America, Santa Marta mountains, the Andes, and the Amazon. We aimed to identify transmission areas, to examine the degree of sharing of haemosporidian lineages with resident birds in various areas and to assess the potential role of immunologically naïve juvenile individuals in parasite transmission. Results: Prevalence and lineage diversity of haemosporidians varied significantly over time, being higher during breeding and fall and spring migration, and declining during wintering. Grey-cheeked thrush shared few parasite lineages with tropical resident birds and slightly more lineages with other migratory and resident boreal species. We detected gametocytes in blood during spring migration stopover, but these were of lineages not found in resident tropical birds, indicating relapses of parasites transmitted elsewhere. Transmission likely occurs mostly on the breeding grounds, where juveniles and adults carried lineages restricted to closely related species of thrushes and other species of boreal birds. Main conclusions: Long-distance migratory songbirds are likely not important dispersers of blood parasites because there are ecological and evolutionary barriers to the interchange of parasites across vastly separated areas. Further work with thorough spatial and temporal sampling across other species, and considering the role of vectors, is necessary to understand the ecological and evolutionary factors explaining the distribution of parasites over broad scales.
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