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PANDA PROGRAMME

Prospective assessment in new-born of diabetes auto-immunity or PANDA is the technique of screening

the newborns through genetic markers at the time of birth which is then followed up by en US

exhaustive rounds of genetic counseling of the parents whose infants belong to the high risk group. This

is an US based study initiated in 2000.

INTRODUCTION:

Diabetes mellitus is one of the most common genetic as well as metabolic syndrome e in the western

countries. With the advancement of life quality and increasing population stress correlated with

increasing this disease has become common in most urban population. It is an auto-immune disease

that either is linked to impaired insulin secretion or destruction of insulin-secreting pancreatic -cells.

Recent research has identified specific genes located on the short arm of chromosome 6, the HLA region

that confers susceptibility to diabetes. If the disease is genetic it can be detected early for sure and this

remains the thrust for PANDA and similar study programs.

THE TECHNIQUE:

The first step is consent from pregnant women for genetic screening. Additionally metabolomic studies

might also be carried out. Amniocentesis is often performed. Mothers are then contacted at the time of

their childs birth and were asked for permission to screen the newborn for the presence of the high risk

HLA-DQ B1 /DQ 8 alleles using blood spots on filter paper. Early studies included islet- cell auto-antibody

(ICA) detection. Contacts were then made only with the mothers whose child was at increased risk for

diabetes. Further siblings were also included in the study.

As simple as the study may sound, there often arise ethical issues that jeopardize the program. The

study is initially conducted 3.5 weeks, 4 months and year after the risk notification. Hispanic mothers

with high anxiety levels were often given more importance. Studies have related the disease prevalence

with stress levels during and after pregnancy, education and nutritional life-value of the family.

SIMILAR PROGAMS:

.German based BABYDIAB

.DAISY

.TEDDY

CONCLUSION:

New born screening programs are complicated because precise markers difficult are either absent or are

difficult to study. But relatively long period between the antibody detection and clinical symptoms in

diabetes is linked with transient changes in the immune system that can be studied and capitalized upon

by programs such as PANDA.

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References:

1) Catherine Pihoker, Lisa K. Gilliam, Christiane S. Hampe, and ke Lernmark Autoantibodies inDiabetes, DIABETES, VOL. 54, SUPPLEMENT 2, DECEMBER 2005

2) Matej Ore i c , 1 Satu Simell , 2 Marko Sysi-Aho , 1 Kirsti N nt -Salonen , 2Tuulikki Sepp nen-Laakso , 1 Vilhelmiina Parikka , 2 Mikko Katajamaa , 1Anne Hekkala , 4 Ismo Mattila , 1 P ivi Keskinen , 5 Laxman Yetukuri , 1Arja Reinikainen , 6 Jyrki L hde , 5 Tapani Suortti , 1 JariHakalax , 2Tuula Simell , 2 Heikki Hy ty , 7,8 Riitta Veijola , 4 Jorma Ilonen , 3,9Riitta Lahesmaa , 6 Mikael Knip , 5,10 and Olli Simell 2 Dysregulation of lipid and amino acidmetabolism precedes islet autoimmunity in children who later progress to type 1 diabetes,J. Exp. Med. Vol. 205 No. 13 2975-2984

3) SUZANNE BENNETT JOHNSON,AMY E. BAUGHCUM, STACY K. CARMICHAEL,JIN-XIONGSHE, DESMOND A. SCHATZ Maternal Anxiety Associated With Newborn Genetic ScreeningFor Type 1 DiabetesDiabetes Care 27:392397, 2004

4)Stacy K Carmichael1, Suzanne Bennett Johnson2, Amy Baughcum1, Kerri North3, Diane Hopkins3,Margaret G Dukes4, Jin-Xiong She3and Desmond A Schatz5Prospective assessment in newborns ofdiabetes autoimmunity (PANDA): Maternal understanding of infant diabetes riskGenetics in Medicine(2003) 5, 7783

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