Autism Both GAD65 and GAD67 experience significant downregulation in cases of
autism. In a comparison of autistic versus control brains, GAD65 and GAD67 experienced a downregulation average of 50% in parietal and cerebellar cortices of autistic brains. Cerebellar
Purkinje cells also reported a 40% downregulation, suggesting that affected cerebellar nuclei may disrupt output to higher order motor and cognitive areas of the brain. Injections with GAD65 in ways that induce immune tolerance have been shown to prevent type 1 diabetes in rodent models. In clinical trials, injections with GAD65 have been shown to preserve some insulin production for 30 months in humans with type 1 diabetes. A
Cochrane systematic review also examined 1 study showing improvement of C-peptide levels in cases of Latent Autoimmune Diabetes in adults, 5 years following treatment with GAD65. Still, it is important to highlight that the studies available to be included in this review presented considerable flaws in quality and design.
Stiff person syndrome High
titers of autoantibodies to glutamic acid decarboxylase (GAD) are well documented in association with
stiff person syndrome (SPS). Glutamic acid decarboxylase is the rate-limiting enzyme in the synthesis of γ-aminobutyric acid (GABA), and impaired function of GABAergic neurons has been implicated in the pathogenesis of SPS. Autoantibodies to GAD might be the causative agent or a disease marker.
Schizophrenia and bipolar disorder Substantial dysregulation of GAD
mRNA expression, coupled with downregulation of
reelin, is observed in
schizophrenia and
bipolar disorder. The most pronounced downregulation of GAD67 was found in hippocampal
stratum oriens layer in both disorders and in other layers and structures of hippocampus with varying degrees. GAD67 is a key enzyme involved in the synthesis of inhibitory neurotransmitter
GABA and people with schizophrenia have been shown to express lower amounts of GAD67 in the
dorsolateral prefrontal cortex compared to healthy controls. The mechanism underlying the decreased levels of GAD67 in people with schizophrenia remains unclear. Some have proposed that an immediate early gene, Zif268, which normally binds to the
promoter region of GAD67 and increases transcription of GAD67, is lower in schizophrenic patients, thus contributing to decreased levels of GAD67.
Cerebellar disorders Intracerebellar administration of GAD autoantibodies to animals increases the excitability of motoneurons and impairs the production of
nitric oxide (NO), a molecule involved in learning. Epitope recognition contributes to cerebellar involvement. Reduced GABA levels increase glutamate levels as a consequence of lower inhibition of subtypes of GABA receptors. Higher glutamate levels activate microglia and activation of xc(−) increases the extracellular glutamate release.
Neuropathic pain Peripheral nerve injury of the sciatic nerve (a
neuropathic pain model) induces a transient loss of GAD65 immunoreactive terminals in the
spinal cord dorsal horn and suggests a potential involvement for these alterations in the development and amelioration of pain behaviour. ==Other anti-GAD-associated neurologic disorders==