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The underlying insulin receptor in patients with antireceptor autoantibodies: demonstration of normal binding and immunological properties.

Antibodies against self-antigens occur in a variety of autoimmune disorders. In most cases, it has been impossible to determine whether this is the result of some alteration in the endogenous antigen (perhaps induced by an infectious or toxic agent) or of a disorder in immunoregulation which allows selftolerance to be broken. In the present study, we have attempted to characterize the underlying insulin receptor in patients with insulin resistance due to autoantibodies against the receptor (Anti-R) by both its functional and immunological features. Freshly isolated peripheral monocytes obtained from patients with Anti-R characteristically show reduction in receptor affinity and loss of negative cooperativity. This defect appears to be the consequence of cell-bound Anti-R by several criteria. Thus, when the freshly isolated monocytes were exposed to an acidglycine buffer (pH 3.5), a procedure which removes cell-bound antibodies, there was an increase in receptor affinity toward normal and a return of negat...