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Production of insulin antibody associated with relapsed hodgkin’s lymphoma

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Abstract

A 72-year-old man with type 2 diabetes mellitus with good glucose control for 20 years and maintained on oral hypoglycaemic agents was diagnosed with Hodgkin’s Lymphoma (HL) and started on insulin glargine for glycaemic control. Despite increased doses of insulin, his blood glucose levels went up dramatically. The anti-insulin antibody test proved to be positive, and Scatchard plot analysis showed 2 binding sites with relatively low-affinity constants: K1 = 0.0032, K2 = 0.0002 (108/M); and high binding capacities: R1 = 98.4, R2 = 372 (10−8 M), which were compatible with the features of antibody of insulin autoimmune syndrome (IAS). However, hypoglycaemia was not noted throughout the course of treatment. Since the insulin binding ratio of the antibody decreased from 87.3% to 62% after the termination of insulin treatment, it was suggested that the antibody reacted mainly to exogenously injected insulin. Switching insulin preparations or introducing insulin secretagogues did not improve elevated blood glucose levels. The initiation of brentuximab vedotin (BV), a therapeutic agent for relapsed HL, resulted in a remarkable improvement in glycaemic control despite the absence of insulin therapy and partial remission of HL. This case suggested that HL triggered anti-insulin antibody production, which resulted in poor glycaemic control, and that BV could be a new treatment option for autoimmune diseases associated with HL.

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Acknowledgements

The authors would like to thank Hiroyuki Ito for performing polyethylene glycol insulin assay and Enago (www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan

    Masatoshi Ikeda & Futoshi Iioka

  2. Department of Endocrinology, Tenri Hospital, Tenri, Japan

    Masaki Fujimura, Kentaro Kurosawa, Shunsuke Tsugawa, Yui Sakuramachi, Kiyoko Takano, Shintaro Okamura, Masako Kitatani, Satoru Tsujii & Yasuaki Hayashino

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  1. Masatoshi Ikeda
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Contributions

MI collected the data, interpreted the results, searched the literature, wrote the first draft of most sections of the manuscript, revised the manuscript. MF, FI, and YH supervised the study, interpreted the results, and revised the manuscript. KK, ST, YS, KT, SO, MK and ST revised the manuscript. All authors provided critical feedback and helped shape the manuscript.

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Correspondence to Masatoshi Ikeda.

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Conflict of interest

Yasuaki Hayashino received research funding from Ono Pharmaceutical Co. Ltd.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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Ikeda, M., Fujimura, M., Kurosawa, K. et al. Production of insulin antibody associated with relapsed hodgkin’s lymphoma. Diabetol Int 13, 456–460 (2022). https://doi.org/10.1007/s13340-021-00550-1

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  • DOI: https://doi.org/10.1007/s13340-021-00550-1

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