Check GAD antibody positivity with the Diamyd anti-GAD RIA plate*

Lars Klareskog, MD, Ph.D., is Professor of Rheumatology and Head ofthe Rheumatology Research group at the Karolinska Hospital inStockholm and formerly Professor of Medical Immunology and Headof Clinical Immunology at the Uppsala Teaching Hospital. Klareskog'sresearch is specifically aimed at the causes and treatment of autoimmunedisorders. Klareskog is a member of the Nobel Foundation.Comments on Diamyd Diabetes Vaccineby Hans WigzellThat the human immune system can react against selfstructures is well known. Most such reactions do notcause disease – but some do.In the efforts to fight autoimmune disease such as Type1 diabetes, one therapeutic approach is to modify the immune reactionand induce functional tolerance to potentially relevant moleculessuch as GAD by administration of the autologous antigen itself.Similar approaches have been successful before. For exampleadministration of autoantigens have alleviated autoimmune diseasein animal models. Hyposensitization (where increasing doses of allergenare used to treat allergies) is another example.How should GAD be used to induce functional tolerance?Using our knowledge from conventional as well as from autologousvaccines it seems logical to use doses from a few micrograms to 500Hans Wigzell, MD, D.Sc, is Professor of Immunology, Dean of theKarolinska Institute and Chief Scientific Advisor to the SwedishGovernment. Wigzell is one of Sweden´s most prominent and internationallyrenowned scientists in the field of Immunology. Wigzellwas Director General of the National Bacteriological Laboratory1988-1993; Director General of the Swedish Institute for InfectiousDiseases 1993-1994; Wigzell is since 1990 Chairman of the ECConcerted Research Programme: European Vaccine against AIDS(EVA). Wigzell was Chairman of the Nobel Committee 1990-1992and is Chairman of the Nobel Foundation.micrograms.To use alum as adjuvant seems highly recommendable. It is conventionaland it is biased to the humoral rather than the cellularimmune response which is logical when the cellular response is to bereduced.Subcutaneous administration is recommendable and conventional.Intravenous administration is much more problematic and intramuscularis less efficient in terms of immunogenicity.The GAD-vaccine differs from a conventional vaccine in that theadministered antigen is already present naturally in the body. Thisprobably means that the vaccine needs to be injected a couple oftimes. Therefore a prime and boost strategy seems logical.In summary, the diamyd approach to induce functional tolerance toGAD seems logical.dmccad june 2003page 5