La ricerca degli anticorpi anti-insula pancreatica in immunofluorescenza è ancora necessaria nell'inquadramento diagnostico del diabete autoimmune?

Abstract

Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus and autoantibody assays are increasingly available to clinicians. However, the quality of the scientific evidence supporting the use of these tests varies substantially. The aim of this review is to evaluate the state of the art of antibody diagnostics in type 1 diabetes mellitus (T1D), examine all available autoantibodies, their frequency of use and the most established combinations, including advantages and disadvantages of the related dosages and alternative methods of detection. The use of autoantibody tests in diabetes must be optimized based on age, type of patient and diagnostic suspicion suggested by the clinical picture. To date, the combination of islet cell antibodies now available with sensitive, specific, and automated methods, allows the identification of 95-98% of T1D cases and the positive predictive value of the combination of autoantibody markers (GADA, IA-2A, ZnT8A) immunometrically measured is much higher than that provided by the anti-islet cell antibodies (ICA) test in immunofluorescence (IIF). According to the current literature, it is increasingly clear that measurement of ICA in IIF is no longer recommended, as it could reasonably be replaced by the direct measurement of individual autoantibodies.