Is Type 1 Diabetes Transmissible by Bone Marrow Allograft?

A review published in the Lancet in 1993 suggested that type 1 diabetes in a bone marrow allograft donor might be transmitted to the recipient after a successful transplant. A 21- year follow-up report of this study after a successful allograft for aplastic anemia indicated that the recipient had developed a number of antibodies against pancreatic islet cells, and although these persisted for a number of years, she did not develop diabetes. The donor had type 1-diabetes at the time of transplant. 

In a bone marrow transplant that occurred in 1979, the donor had been diagnosed with type 1 diabetes seven years prior to transplantation, and was negative for islet cell antibodies (ICAs).  Overtime, the recipient developed ICAs and high levels of anti-GAD (glutamic acid decarboxylase) antibodies.  The patient also had chronic GVHD (Graft versus host disease), a condition in which multiple autoantibodies are commonly found.  The presence of ICAs and anti-GAD antibodies might not be related to the fact that the donor had type 1 diabetes. Alternatively, the autoimmune process observed in the recipient may have been modified by the Azathioprine therapy, which was in place for 6 years immediately post-transplant.  Blood glucose measurements over the past 21 years have shown no evidence of type 1 diabetes.

References:

1. Lampeter EF, Homberg M, Quabeck K, Schaefer UW, Werner P, Bertrams J, Grosse- Wilde H, Gries FA, Kolb H: Transfer of insulin-dependent diabetes between HLA- identical siblings by bone marrow trans- plantation. Lancet 341:1243–1244, 1993.

 2. Lampeter EF, McCann SR, Kolb H: Transfer of insulin-dependent diabetes by bone marrow transplantation. Lancet 351:568 – 569, 1998.

3. Kulmala P, Savola K, Reijonen H, Veijola R, Vahasalo P, Karjalainen J, Tuom- ilehto-Wolf E, Ilonen J, Tuomilehto J, Akerblom HK, Knip M, the Childhood Diabetes in Finland Study Group: Genetic markers, humoral autoimmunity, and prediction of type 1 diabetes in sib- lings of affected children. Diabetes 49: 48 –58, 2000.

4. Quaranta S, Shulman H, Ahmed A, Shoenfeld Y, Peter J, McDonald GB, Van de Water J, Coppel R, Ostlund C, Worman HJ, Rizzetto M, Tsuneyama K, Na- kanuma Y, Ansari A, Locatelli F, Paganin S, Rosina F, Manns M, Gershwin ME: Autoantibodies in human chronic graft- versus-host disease after hematopoietic cell transplantation. Clinical Immunology 91:106 –116, 1999.