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Kuppan P, Wong J, Kelly S, Lin J, Worton J, Castro C, Paramor J, Seeberger K, Cuesta-Gomez N, Anderson CC, Korbutt GS, Pepper AR. Long-Term Survival and Induction of Operational Tolerance to Murine Islet Allografts by Co-Transplanting Cyclosporine A Microparticles and CTLA4-Ig. Pharmaceutics 2023; 15:2201. [PMID: 37765170 PMCID: PMC10537425 DOI: 10.3390/pharmaceutics15092201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
One strategy to prevent islet rejection is to create a favorable immune-protective local environment at the transplant site. Herein, we utilize localized cyclosporine A (CsA) delivery to islet grafts via poly(lactic-co-glycolic acid) (PLGA) microparticles to attenuate allograft rejection. CsA-eluting PLGA microparticles were prepared using a single emulsion (oil-in-water) solvent evaporation technique. CsA microparticles alone significantly delayed islet allograft rejection compared to islets alone (p < 0.05). Over 50% (6/11) of recipients receiving CsA microparticles and short-term cytotoxic T lymphocyte-associated antigen 4-Ig (CTLA4-Ig) therapy displayed prolonged allograft survival for 214 days, compared to 25% (2/8) receiving CTLA4-Ig alone. CsA microparticles alone and CsA microparticles + CTLA4-Ig islet allografts exhibited reduced T-cell (CD4+ and CD8+ cells, p < 0.001) and macrophage (CD68+ cells, p < 0.001) infiltration compared to islets alone. We observed the reduced mRNA expression of proinflammatory cytokines (IL-6, IL-10, INF-γ, and TNF-α; p < 0.05) and chemokines (CCL2, CCL5, CCL22, and CXCL10; p < 0.05) in CsA microparticles + CTLA4-Ig allografts compared to islets alone. Long-term islet allografts contained insulin+ and intra-graft FoxP3+ T regulatory cells. The rapid rejection of third-party skin grafts (C3H) in islet allograft recipients suggests that CsA microparticles + CTLA4-Ig therapy induced operational tolerance. This study demonstrates that localized CsA drug delivery plus short-course systemic immunosuppression promotes an immune protective transplant niche for allogeneic islets.
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Affiliation(s)
- Purushothaman Kuppan
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Jordan Wong
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Sandra Kelly
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Jiaxin Lin
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Jessica Worton
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Chelsea Castro
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Joy Paramor
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Karen Seeberger
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Nerea Cuesta-Gomez
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Colin C. Anderson
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Gregory S. Korbutt
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
| | - Andrew R. Pepper
- Alberta Diabetes Institute, University of Alberta, Edmonton, AL T6G 2E1, Canada; (P.K.); (J.W.); (S.K.); (J.L.); (J.W.); (C.C.); (J.P.); (K.S.); (N.C.-G.); (C.C.A.)
- Department of Surgery, University of Alberta, Edmonton, AL T6G 2E1, Canada
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The Spleen as an Optimal Site for Islet Transplantation and a Source of Mesenchymal Stem Cells. Int J Mol Sci 2018; 19:ijms19051391. [PMID: 29735923 PMCID: PMC5983746 DOI: 10.3390/ijms19051391] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 01/09/2023] Open
Abstract
This review demonstrates the unique potential of the spleen as an optimal site for islet transplantation and as a source of mesenchymal stem cells. Islet transplantation is a cellular replacement therapy used to treat severe diabetes mellitus; however, its clinical outcome is currently unsatisfactory. Selection of the most appropriate transplantation site is a major factor affecting the clinical success of this therapy. The spleen has long been studied as a candidate site for islet transplantation. Its advantages include physiological insulin drainage and regulation of immunity, and it has recently also been shown to contribute to the regeneration of transplanted islets. However, the efficacy of transplantation in the spleen is lower than that of intraportal transplantation, which is the current representative method of clinical islet transplantation. Safer and more effective methods of islet transplantation need to be established to allow the spleen to be used for clinical transplantation. The spleen is also of interest as a mesenchymal stem cell reservoir. Splenic mesenchymal stem cells contribute to the repair of damaged tissue, and their infusion may thus be a promising therapy for autoimmune diseases, including type 1 diabetes mellitus and Sjogren’s syndrome.
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Abstract
BACKGROUND In addition to ischemia and immunologic factors, immunosuppressive drugs have been suggested as a possible contributing factor to the loss of functional islets after allogeneic islet cell transplantation. Using our previously described islet-kidney (IK) transplantation model in miniature swine, we studied whether an islet-toxic triple-drug immunosuppressive regimen (cyclosporine+azathioprine+prednisone) affects the islet engraftment process and thus long-term islet function. METHODS Donor animals underwent partial pancreatectomy, autologous islet preparation, and injection of these islets under the autologous kidney capsule to prepare an IK. Experimental animals received daily triple-drug immunosuppression during the islet engraftment period. Control animals did not receive any immunosuppression during this period. Four to 8 weeks later, these engrafted IK were transplanted across a minor histocompatibility mismatched barrier into pancreatectomized, nephrectomized recipient animals at an islet dose of approximately 4500 islet equivalents/kg recipient weight. Cyclosporine was administered for 12 days to the recipients to induce tolerance of the IK grafts and the animals were followed long-term. RESULTS Diabetes was corrected by IK transplantation in all pancreatectomized recipients on both the control arm (n=3) and the experimental arm (n=4) of the study and all animals showed normal glucose regulation over the follow-up period. Intravenous glucose tolerance tests performed at 1, 2, and 3 or more months after IK transplantation showed essentially equivalent glycemic control in both control and experimental animals. CONCLUSION In this preclinical in vivo large animal model of islet transplantation, the effect of triple-drug immunosuppression on islet function does not negatively affect islet engraftment as assessed by the long-term function of engrafted islets.
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