Antiinsulin receptor antibodies in an insulin-dependent diabetic may arise as autoantiidiotypes

An insulin-requiring diabetic patient with intermittent periods of increased insulin requirements and insulin resistance was studied. The patient was found to have high titers of antiinsulin antibodies; subfractionation of the patient's serum revealed several populations of antiinsulin antibodies with differing affinities and titers for insulin. The ability of one of the insulin antibody fractions to bind [125I]iodoinsulin was markedly inhibited by the patient's serum (insulin depleted) and by purified total immunoglobulin G from which antiinsulin antibodies and insulin were removed. These findings suggested an antiidiotypic antibody in the patient's immunoglobulin G fraction reacting specifically with the antiinsulin antibody subfraction. Finally, the patient's serum contained an antiinsulin receptor antibody, as demonstrated by the ability of serum to specifically immunoprecipitate covalently labeled soluble insulin receptors. In conclusion, these results suggest that this patient generated a widespread polyclonal response to insulin, with the development of several populations of antiinsulin antibodies. An antiidiotypic antibody to a specific insulin antibody subfraction was present in the patient's serum which we believe had structural similarity to the binding site of the insulin molecule, accounting for the reactivity of the antiidiotypic antibody with the insulin receptor.