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De Paep DL, Van Hulle F, Ling Z, Vanhoeij M, Hilbrands R, Distelmans W, Gillard P, Keymeulen B, Pipeleers D, Jacobs-Tulleneers-Thevissen D. Utility of Islet Cell Preparations From Donor Pancreases After Euthanasia. Cell Transplant 2022; 31:9636897221096160. [PMID: 35583214 PMCID: PMC9125111 DOI: 10.1177/09636897221096160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Patients fulfilling criteria for euthanasia can choose to donate their organs after circulatory death [donors after euthanasia (DCD V)]. This study assesses the outcome of islet cell isolation from DCD V pancreases. A procedure for DCD V procurement provided 13 pancreases preserved in Institut Georges Lopez-1 preservation solution and following acirculatory warm ischemia time under 10 minutes. Islet cell isolation outcomes are compared with those from reference donors after brain death (DBD, n = 234) and a cohort of donors after controlled circulatory death (DCD III, n = 29) procured under the same conditions. Islet cell isolation from DCD V organs resulted in better in vitro outcome than for selected DCD III or reference DBD organs. A 50% higher average beta cell number before and after culture and a higher average beta cell purity (35% vs 24% and 25%) was observed, which led to more frequent selection for our clinical protocol (77% of isolates vs 50%). The functional capacity of a DCD V islet cell preparation was illustrated by its in vivo effect following intraportal transplantation in a type 1 diabetes patient: injection of 2 million beta cells/kg body weight (1,900 IEQ/kg body weight) at 39% insulin purity resulted in an implant with functional beta cell mass that represented 30% of that in non-diabetic controls. In conclusion, this study describes procurement and preservation conditions for donor organs after euthanasia, which allow preparation of cultured islet cells, that more frequently meet criteria for clinical use than those from DBD or DCD III organs.
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Affiliation(s)
- Diedert L De Paep
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Beta Cell Bank, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Freya Van Hulle
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zhidong Ling
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Beta Cell Bank, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marian Vanhoeij
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Robert Hilbrands
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Diabetes Clinic, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wim Distelmans
- Supportive and Palliative Care, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pieter Gillard
- Diabetes Clinic, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Keymeulen
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Diabetes Clinic, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Pipeleers
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Jacobs-Tulleneers-Thevissen
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Beta Cell Bank, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Use of Culture to Reach Metabolically Adequate Beta-cell Dose by Combining Donor Islet Cell Isolates for Transplantation in Type 1 Diabetes Patients. Transplantation 2021; 104:e295-e302. [PMID: 32433237 DOI: 10.1097/tp.0000000000003321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical islet transplantation is generally conducted within 72 hours after isolating sufficient beta-cell mass. A preparation that does not meet the sufficient dose can be cultured until this is reached after combination with subsequent ones. This retrospective study examines whether metabolic outcome is influenced by culture duration. METHODS Forty type 1 diabetes recipients of intraportal islet cell grafts under antithymocyte globulin induction and mycophenolate mofetil-tacrolimus maintenance immunosuppression were analyzed. One subgroup (n = 10) was transplanted with preparations cultured for ≥96 hours; in the other subgroup (n = 30) grafts contained similar beta-cell numbers but included isolates that were cultured for a shorter duration. Both subgroups were compared by numbers with plasma C-peptide ≥0.5 ng/mL, low glycemic variability associated with C-peptide ≥1.0 ng/mL, and with insulin independence. RESULTS The subgroup with all cells cultured ≥96 hours exhibited longer C-peptide ≥0.5 ng/mL (103 versus 48 mo; P = 0.006), and more patients with low glycemic variability and C-peptide ≥1.0 ng/mL, at month 12 (9/10 versus 12/30; P = 0.005) and 24 (7/10 versus 6/30; P = 0.007). In addition, 9/10 became insulin-independent versus 15/30 (P = 0.03). Grafts with all cells cultured ≥96 hours did not contain more beta cells but a higher endocrine purity (49% versus 36%; P = 0.03). In multivariate analysis, longer culture duration and older recipient age were independently associated with longer graft function. CONCLUSIONS Human islet isolates with insufficient beta-cell mass for implantation within 72 hours can be cultured for 96 hours and longer to combine multiple preparations in order to reach the desired beta-cell dose and therefore result in a better metabolic benefit.
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De Paep DL, Gillard P, Ling Z, Verbeke H, Maleux G, Vandecaveye V, Debaveye Y, Keymeulen B, van der Merwe S, Pipeleers D, Pirenne J, van Malenstein H, Jacobs-Tulleneers-Thevissen D. Use of hyperglycemic clamp to assess pancreatectomy and islet cell autotransplant in patient with heterotaxy syndrome and dorsal pancreas agenesis leading to chronic pancreatitis. Am J Transplant 2020; 20:3662-3666. [PMID: 32476268 DOI: 10.1111/ajt.16084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Patients with heterotaxy syndrome (HS) can present with an associated complete dorsal pancreas agenesis (DPA). They are considered to be at increased risk for developing diabetes due to a reduced functional beta cell mass (FBM) as well as for chronic pancreatitis leading to unmanageable pain. We report the case of a young woman with chronic pancreatitis due to HS and associated DPA. She presented with a severe persisting upper abdominal pain refractory to nonsurgical treatment. Unlike in previously reported cases, she had a high FBM (ie, 150% of normoglycemic controls) as determined by hyperglycemic clamp. She underwent a total pancreatectomy followed within 24 hours by an intraportal autologous islet cell transplant containing 4 × 106 beta cells (4700 islet equivalent)/kg body weight. After surgery, the pain resolved, eliminating the need for analgesics. The intraportal implant established an adequate FBM (72% of controls at posttransplant month 2), achieving glycemic control without need for insulin administration. A hyperglycemic clamp can assess the utility and efficacy of an intraportal islet cell autotransplant following total pancreatectomy in patients with HS and complete DPA.
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Affiliation(s)
- Diedert L De Paep
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pieter Gillard
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Zhidong Ling
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Hilde Verbeke
- Center for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Yves Debaveye
- Clinical Division of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Bart Keymeulen
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Pipeleers
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery and Transplantation Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Jacobs-Tulleneers-Thevissen
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Abdominal Transplant Surgery and Transplantation Coordination, University Hospitals Leuven, Leuven, Belgium
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4
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Roels S, Costa OR, Tersey SA, Stangé G, De Smet D, Balti EV, Gillard P, Keymeulen B, Ling Z, Pipeleers DG, Gorus FK, Mirmira RG, Martens GA. Combined Analysis of GAD65, miR-375, and Unmethylated Insulin DNA Following Islet Transplantation in Patients With T1D. J Clin Endocrinol Metab 2019; 104:451-460. [PMID: 30203041 PMCID: PMC6310912 DOI: 10.1210/jc.2017-02520] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Abstract
AIM Several biomarkers have been proposed to detect pancreatic β cell destruction in vivo but so far have not been compared for sensitivity and significance. METHODS We used islet transplantation as a model to compare plasma concentrations of miR-375, 65-kDa subunit of glutamate decarboxylase (GAD65), and unmethylated insulin DNA, measured at subpicomolar sensitivity, and study their discharge kinetics, power for outcome prediction, and detection of graft loss during follow-up. RESULTS At 60 minutes after transplantation, GAD65 and miR-375 consistently showed near-equimolar and correlated increases proportional to the number of implanted β cells. GAD65 and miR-375 showed comparable power to predict poor graft outcome at 2 months, with areas under the curve of 0.833 and 0.771, respectively (P = 0.53). Using receiver operating characteristic analysis, we defined likelihood ratios (LRs) for rationally selected result intervals. In GADA-negative recipients (n = 28), GAD65 <4.5 pmol/L (LR = 0.15) and >12.2 pmol/L (LR = ∞) predicted good and poor outcomes, respectively. miR-375 could be used in all recipients irrespective of GAD65 autoantibody status (n = 46), with levels <1.4 pmol/L (LR = 0.14) or >7.6 pmol/L (LR = 9.53) as dual thresholds. The posttransplant surge of unmethylated insulin DNA was inconsistent and unrelated to outcome. Combined measurement of these three biomarkers was also tested as liquid biopsy for β cell death during 2-month follow-up; incidental surges of GAD65, miR-375, and (un)methylated insulin DNA, alone or combined, were confidently detected but could not be related to outcome. CONCLUSIONS GAD65 and miR-375 performed equally well in quantifying early graft destruction and predicting graft outcome, outperforming unmethylated insulin DNA.
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Affiliation(s)
- Sarah Roels
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
| | - Olivier R Costa
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
- Department of Clinical Biology, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Sarah A Tersey
- Department of Pediatrics, IU Center for Diabetes and Metabolic Disease, Indiana University School of Medicine, Indianapolis, Indiana
| | - Geert Stangé
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
| | - Dieter De Smet
- Department of Laboratory Medicine, AZ Delta, Roeselare, Belgium
| | - Eric V Balti
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven – Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bart Keymeulen
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
- Department of Clinical Biology, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Zhidong Ling
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
- Department of Clinical Biology, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | | | - Frans K Gorus
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
| | - Raghavendra G Mirmira
- Department of Pediatrics, IU Center for Diabetes and Metabolic Disease, Indiana University School of Medicine, Indianapolis, Indiana
- Departments of Biochemistry and Molecular Biology, Medicine, and Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Geert A Martens
- Diabetes Research Center, Brussels Free University, Brussels, Belgium
- Department of Laboratory Medicine, AZ Delta, Roeselare, Belgium
- Correspondence and Reprint Requests: Geert A. Martens, MD, PhD, Diabetes Research Center, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium. E-mail:
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Age and Early Graft Function Relate With Risk-Benefit Ratio of Allogenic Islet Transplantation Under Antithymocyte Globulin-Mycophenolate Mofetil-Tacrolimus Immune Suppression. Transplantation 2017; 101:2218-2227. [DOI: 10.1097/tp.0000000000001543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jeng KS, Huang CC, Lin CK, Lin CC, Liang CC, Chung CS, Weng MT, Chen KH. Early Detection of a Hepatic Artery Pseudoaneurysm After Liver Transplantation Is the Determinant of Survival. Transplant Proc 2016; 48:1149-55. [PMID: 27320576 DOI: 10.1016/j.transproceed.2015.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/16/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hepatic artery pseudoaneurysm (PA) after liver transplantation (LT) is a rare but potentially fatal complication. Among a series of 50 patients of LT, we experienced 3 such cases. Some authors also have reported cases of PA, either intrahepatic or extrahepatic. The aim of this study was to investigate the important factors that affect the treatment outcome. METHODS Three patients were presented. To analyze the factors, not only our patients but also the patients with PA reported in the literature (including 10 case series and 23 case reports) were enrolled for analysis. The possible factors probably affecting the survival were compared statistically, including age, sex, clinical manifestation as bleeding (including gastrointestinal bleeding, hemobilia, or intra-abdominal bleeding), treatment (with embolization or surgical exploration or stent), diagnosis establishment before or after bleeding, and so forth. RESULTS From univariate analysis, the significant factors that affect survival are sex (female) (P = .036), stent treatment (P = .006), and early detection (P = .036), whereas age (P = .493) and presentation with hemorrhage (P = .877) are not significant factors. However, according to multivariate analysis, stent treatment has a borderline significance (P = .056). CONCLUSIONS Early detection of such a life-threatening complication is a key determinant of survival. "Early" does not refer to early postoperative days but means the detection prior to the rupture of the pseudoaneurysm. Postoperative imaging studies such as computed tomographic scan or magnetic resonance cholangiopancreatography early and periodically to follow up the graft status is recommended, especially for those who had received other interventions before or after the liver transplantation.
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Affiliation(s)
- K-S Jeng
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
| | - C-C Huang
- Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-K Lin
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-C Lin
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-C Liang
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-S Chung
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - M-T Weng
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - K-H Chen
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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7
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Ling Z, De Pauw P, Jacobs-Tulleneers-Thevissen D, Mao R, Gillard P, Hampe CS, Martens GA, In't Veld P, Lernmark Å, Keymeulen B, Gorus F, Pipeleers D. Plasma GAD65, a Marker for Early β-Cell Loss After Intraportal Islet Cell Transplantation in Diabetic Patients. J Clin Endocrinol Metab 2015; 100:2314-21. [PMID: 25816051 PMCID: PMC5393519 DOI: 10.1210/jc.2015-1216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT AND OBJECTIVE Intraportal islet transplantation can restore insulin production in type 1 diabetes patients, but its effect is subject to several interfering processes. To assess the influence of β-cell loss before and during engraftment, we searched for a real-time marker of β-cell destruction. Previous studies showed that 65-kDa isoform of glutamate decarboxylase (GAD65) is discharged by chemically damaged rat β-cells. We therefore examined the utility of the GAD65 assay to detect and quantify destruction of human β-cells in vitro and in vivo. DESIGN AND PARTICIPANTS A time-resolved fluorescence immunoassay was used to measure GAD65 discharge from β-cells after administration of toxins or after intraportal transplantation. The study in patients involved type 1 diabetes recipients of 56 implants. RESULTS GAD65 was discharged from cultured human β-cells between 4 and 24 hours after acute insult and proportional to the number of dying cells. It was also detected in plasma during the first 24 hours after intraportal transplantation of human islet cell grafts. Diabetic nude rat recipients without hyperglycemic correction exhibited higher plasma GAD65 levels than those with normalization. In type 1 diabetes recipients of grafts with 2-5 × 10(6) β-cells per kilogram of body weight, five of six with plasma GAD65 greater than 1 ng/mL failed to increase plasma C-peptide by greater than 0.5 ng/mL at posttransplant month 2, whereas five of six with undetectable plasma GAD 65 and 15 of 19 with intermediate levels did result in such increase. CONCLUSION Plasma GAD65 qualifies as a marker for early β-cell loss after intraportal transplantation. Further studies are needed to extend its clinical utility.
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Affiliation(s)
- Zhidong Ling
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Pieter De Pauw
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Daniel Jacobs-Tulleneers-Thevissen
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Rui Mao
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Pieter Gillard
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Christiane S Hampe
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Geert A Martens
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Peter In't Veld
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Åke Lernmark
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Bart Keymeulen
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Frans Gorus
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
| | - Daniel Pipeleers
- Diabetes Research Center and Universitair Ziekenhuis Brussel (Z.L., P.D.P., D.J.-T.-T., R.M., G.A.M., P.I.V., B.K., F.G., D.P.), Brussels Free University-VUB, B-1090 Brussels, Belgium; Department of Endocrinology (P.G.), Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven-KUL, B-3000 Leuven, Belgium; Department of Medicine (C.S.H.), University of Washington, Seattle, Washington 98109; and Department of Clinical Sciences (Å.L.), Lund University, Skåne University Hospital, SE-20502 Malmö, Sweden
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Early alteration of kidney function in nonuremic type 1 diabetic islet transplant recipients under tacrolimus-mycophenolate therapy. Transplantation 2014; 98:451-7. [PMID: 24770614 DOI: 10.1097/tp.0000000000000086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transplant patients on tacrolimus therapy exhibit a reduced glomerular filtration rate (GFR). The type of graft and immune treatment protocol may influence the extent and reversibility of this side effect. METHODS The present single-center study is conducted in 48 nonuremic type 1 diabetic recipients of an intraportal islet-cell graft under maintenance immunosuppression (IS) with tacrolimus and mycophenolate mofetil. Estimated GFR (eGFR) and albuminuria were followed up to 5 years posttransplantation. RESULTS Mean eGFR values decreased by 19 mL/min/1.73 m after 1 to 2 weeks of IS (P<0.0001) and then remained stable throughout the complete treatment period. The decrease was related to predose trough tacrolimus concentrations or doses and disappeared upon its discontinuation; it was also associated with the presence of albuminuria at the time of transplantation. Tacrolimus treatment resulted in a reduction of albuminuria; its discontinuation restored albuminuria to the initial levels. CONCLUSIONS The use of tacrolimus in our islet-cell transplant protocol caused an initial 20% reduction in eGFR, which was reversible following its discontinuation, at least within the 5-year follow-up period. The associated reduction in albuminuria was also reversible, compatible with a tacrolimus-induced preglomerular vasoconstriction. These observations support further use of our tacrolimus regimen in this patient population.
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Hilbrands R, Gillard P, Van der Torren CR, Ling Z, Verheyden S, Jacobs-Tulleneers-Thevissen D, Roep BO, Claas FHJ, Demanet C, Gorus FK, Pipeleers D, Keymeulen B. Predictive factors of allosensitization after immunosuppressant withdrawal in recipients of long-term cultured islet cell grafts. Transplantation 2013; 96:162-9. [PMID: 23857001 DOI: 10.1097/tp.0b013e3182977afc] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Islet transplantation has been reported to induce allosensitization in the majority of type 1 diabetic recipients of fresh or shortly incubated islet grafts prepared from one to three donors. METHODS We examined the appearance of human leukocyte antigen (HLA) antibodies after withdrawal of immunosuppressants in 35 type 1 diabetic recipients of islet cell grafts prepared from a median of 6 donors (range, 2-11), cultured for longer periods, and characterized for their cellular composition. Immunosuppression consisted of antithymocyte globulin induction followed by mycophenolate mofetil plus calcineurin inhibitors (n=28, with 7 also receiving steroids) or sirolimus with (n=3) or without calcineurin inhibitors (n=4). Both the complement-dependent cytotoxicity (CDC) assay (class I) and the solid-phase flow-based Luminex method (class I and II) were used to identify HLA antibodies. RESULTS Immunosuppressant withdrawal resulted in CDC positivity for class I antibodies in only 6% of patients. However, the majority became positive for class I antibodies (72%) or class II antibodies (72%) in the Luminex assay; positivity was not correlated to a higher number of donors or HLA mismatches, but with a lower β-cell purity; use of steroids reduced de novo positivity for Luminex class I antibodies. CONCLUSION Allosensitization to cultured human islet cell grafts was low when assessed by CDC assay but high in Luminex. No correlation was found with the number of donors but risk was higher for grafts with lower β-cell purity.
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Affiliation(s)
- Robert Hilbrands
- Diabetes Research Center and Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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10
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Bozkurt NC, Peixoto EML, Froud T, Herrada E, Corrales A, Ricordi C, Alejandro R. Hepatic hematoma after islet cell transplantation. Transplantation 2013; 95:e73-6. [PMID: 23774776 PMCID: PMC3810207 DOI: 10.1097/tp.0b013e31829468e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Nujen Colak Bozkurt
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06580, Turkey
| | | | - Tatiana Froud
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Radiology, Jackson Memorial Hospital, Miami, FL, 33136, USA
| | - Eva Herrada
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Andrea Corrales
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Camillo Ricordi
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Jackson Memorial Hospital-University of Miami Transplant Institute, University of Miami Miller School of Medicine, FL, 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Rodolfo Alejandro
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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11
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Jahansouz C, Jahansouz C, Kumer SC, Brayman KL. Evolution of β-Cell Replacement Therapy in Diabetes Mellitus: Islet Cell Transplantation. J Transplant 2011; 2011:247959. [PMID: 22013505 PMCID: PMC3195999 DOI: 10.1155/2011/247959] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 08/08/2011] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus remains one of the leading causes of morbidity and mortality worldwide. According to the Centers for Disease Control and Prevention, approximately 23.6 million people in the United States are affected. Of these individuals, 5 to 10% have been diagnosed with Type 1 diabetes mellitus (T1DM), an autoimmune disease. Although it often appears in childhood, T1DM may manifest at any age, leading to significant morbidity and decreased quality of life. Since the 1960s, the surgical treatment for diabetes mellitus has evolved to become a viable alternative to insulin administration, beginning with pancreatic transplantation. While islet cell transplantation has emerged as another potential alternative, its role in the treatment of T1DM remains to be solidified as research continues to establish it as a truly viable alternative for achieving insulin independence. In this paper, the historical evolution, procurement, current status, benefits, risks, and ongoing research of islet cell transplantation are explored.
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Affiliation(s)
- Cyrus Jahansouz
- School of Medicine, University of Virginia, Charlottesville, VA 22102, USA
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12
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Evaluation of wedged arterial injection as a new technique for delivery of experimental therapeutic substances into the porcine pancreas. EXPERIMENTAL DIABETES RESEARCH 2011; 2011:976910. [PMID: 22007190 PMCID: PMC3189563 DOI: 10.1155/2011/976910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/26/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To prospectively evaluate the technical feasibility and efficacy of wedged arterial injection (WAI) as a potential route for experimental selective therapy to the pancreas of healthy pigs. MATERIALS AND METHODS Selective angiographies were completed in ten pigs under general anaesthesia. By superselective angiography, the catheter was inserted and wedged into the major pancreatic artery, blocking the blood flow. In order to evaluate the efficacy of the WAI method, a DNA-specific fluorescent dye (Hoechst 33258) was used. RESULTS Histological study revealed a uniform distribution of the fluorescent dye within the nuclei of the endocrine and exocrine pancreatic cells. Pancreatic and liver enzymes as well as histopathology of the pancreas were normal. CONCLUSION WAI is a highly effective minimally invasive methodology to target the porcine pancreas. The findings suggest that WAI may contribute to developing preclinical assays of pancreas gene or cell-transfer therapies in swine model.
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Gillard P, Mathieu C. Immune and cell therapy in type 1 diabetes: too little too late? Expert Opin Biol Ther 2011; 11:609-21. [PMID: 21406028 DOI: 10.1517/14712598.2011.560568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Type 1 diabetes is caused by autoimmune destruction of insulin-producing β-cells. Intensive insulin therapy protects most patients against chronic complications of diabetes, but exposes patients to acute complications like hypoglycaemia and impacts on quality of life. Therapies that aim at protecting or restoring endogenous insulin secretion might help in decreasing the risk of severe hypoglycemia and long-term complications. AREAS COVERED This article reviews the literature of clinical immunotherapy and β-cell transplantation in treatment of type 1 diabetes with specific focus on the effect on preserving and restoring β-cell mass. EXPERT OPINION Several studies in recent-onset type 1 diabetic patients have provided proof of principle that immunotherapy can preserve residual functional β-cell mass. The observation that this strategy is most effective early in the disease process opens possibilities of arresting and even preventing type 1 diabetes. In patients with too few or no surviving β-cells, current protocols of β-cell transplantation can restore functional β-cell mass up to 25% of levels in healthy controls. Unfortunately, both strategies to date are followed by progressive decline of endogenous insulin secretion later on. Strategies to restore functional β-cell mass to a higher level and to restore immune tolerance are thus needed.
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Affiliation(s)
- Pieter Gillard
- University Hospital Leuven, Department of Experimental Medicine and Endocrinology, KULeuven, Herestraat 49, B-3000 Leuven, Belgium
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14
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Graham ML, Mutch LA, Rieke EF, Dunning M, Zolondek EK, Schutten MM, Hering BJ, Schuurman HJ. Long-Term Hepatic Vascular Access in the Nonhuman Primate for Recurrent Portal Vein Infusion. J INVEST SURG 2011; 24:59-66. [DOI: 10.3109/08941939.2010.540073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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Modulation of Early Inflammatory Reactions to Promote Engraftment and Function of Transplanted Pancreatic Islets in Autoimmune Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 654:725-47. [DOI: 10.1007/978-90-481-3271-3_32] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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16
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Hilbrands R, Huurman VA, Gillard P, Velthuis JH, De Waele M, Mathieu C, Kaufman L, Pipeleers-Marichal M, Ling Z, Movahedi B, Jacobs-Tulleneers-Thevissen D, Monbaliu D, Ysebaert D, Gorus FK, Roep BO, Pipeleers DG, Keymeulen B. Differences in baseline lymphocyte counts and autoreactivity are associated with differences in outcome of islet cell transplantation in type 1 diabetic patients. Diabetes 2009; 58:2267-76. [PMID: 19602536 PMCID: PMC2750206 DOI: 10.2337/db09-0160] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The metabolic outcome of islet cell transplants in type 1 diabetic patients is variable. This retrospective analysis examines whether differences in recipient characteristics at the time of transplantation are correlated with inadequate graft function. RESEARCH DESIGN AND METHODS Thirty nonuremic C-peptide-negative type 1 diabetic patients had received an intraportal islet cell graft of comparable size under an ATG-tacrolimus-mycophenolate mofetil regimen. Baseline patient characteristics were compared with outcome parameters during the first 6 posttransplant months (i.e., plasma C-peptide, glycemic variability, and gain of insulin independence). Correlations in univariate analysis were further examined in a multivariate model. RESULTS Patients that did not become insulin independent exhibited significantly higher counts of B-cells as well as a T-cell autoreactivity against insulinoma-associated protein 2 (IA2) and/or GAD. In one of them, a liver biopsy during posttransplant year 2 showed B-cell accumulations near insulin-positive beta-cell aggregates. Higher baseline total lymphocytes and T-cell autoreactivity were also correlated with lower plasma C-peptide levels and higher glycemic variability. CONCLUSIONS Higher total and B-cell counts and presence of T-cell autoreactivity at baseline are independently associated with lower graft function in type 1 diabetic patients receiving intraportal islet cells under ATG-tacrolimus-mycophenolate mofetil therapy. Prospective studies are needed to assess whether control of these characteristics can help increase the function of islet cell grafts during the first year posttransplantation.
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Affiliation(s)
- Robert Hilbrands
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
| | - Volkert A.L. Huurman
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter Gillard
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Catholic University of Leuven, Leuven, Belgium
| | - Jurjen H.L. Velthuis
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Marc De Waele
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Chantal Mathieu
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Catholic University of Leuven, Leuven, Belgium
| | - Leonard Kaufman
- Department of Biostatistics, Brussels Free University-VUB, Brussels, Belgium
| | - Miriam Pipeleers-Marichal
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Zhidong Ling
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
| | - Babak Movahedi
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
| | - Daniel Jacobs-Tulleneers-Thevissen
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
| | - Diethard Monbaliu
- Department of Surgery, Universitair Ziekenhuis Gasthuisberg, Catholic University of Leuven, Leuven, Belgium
| | - Dirk Ysebaert
- Department of Surgery, Universitair Ziekenhuis Antwerpen, University of Antwerp, Antwerp, Belgium
| | - Frans K. Gorus
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
| | - Bart O. Roep
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel G. Pipeleers
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
| | - Bart Keymeulen
- Diabetes Research Center and Universitair Ziekenhuis Brussels, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for β-Cell Therapy in Diabetes, Brussels, Belgium
- Corresponding author: Bart Keymeulen,
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Abstract
The liver is the current site for pancreatic islet transplantation, but has many drawbacks due to immunologic and nonimmunologic factors. We asked whether pancreatic islets could be engrafted in the bone marrow (BM), an easily accessible and widely distributed transplant site that may lack the limitations seen in the liver. Syngeneic islets engrafted efficiently in the BM of C57BL/6 mice rendered diabetic by streptozocin treatment. For more than 1 year after transplantation, these animals showed parameters of glucose metabolism that were similar to those of nondiabetic mice. Islets in BM had a higher probability to reach euglycemia than islets in liver (2.4-fold increase, P = .02), showed a compact morphology with a conserved ratio between alpha and beta cells, and affected bone structure only very marginally. Islets in BM did not compromise hematopoietic activity, even when it was strongly induced in response to a BM aplasia-inducing infection with lymphocytic choriomeningitis virus. In conclusion, BM is an attractive and safe alternative site for pancreatic islet transplantation. The results of our study open a research line with potentially significant clinical impact, not only for the treatment of diabetes, but also for other diseases amenable to treatment with cellular transplantation.
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18
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Roelen DL, Huurman VAL, Hilbrands R, Gillard P, Duinkerken G, van der Meer-Prins PWM, Versteeg-van der Voort Maarschalk MFJ, Mathieu C, Keymeulen B, Pipeleers DG, Roep BO, Claas FHJ. Relevance of cytotoxic alloreactivity under different immunosuppressive regimens in clinical islet cell transplantation. Clin Exp Immunol 2009; 156:141-8. [PMID: 19161445 PMCID: PMC2673752 DOI: 10.1111/j.1365-2249.2008.03812.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2008] [Indexed: 10/21/2022] Open
Abstract
Islet or beta cell transplantation provides a promising cure for type 1 diabetes patients, but insulin-independency decreases frequently over time. Immunosuppressive regimens are implemented attempting to cope with both auto- and alloimmunity after transplantation. We analysed the influence of different immunotherapies on autoreactive and alloreactive T cell patterns and transplant outcome. Patients receiving three different immunosuppressive regimens were analysed. All patients received anti-thymocyte globulin induction therapy. Twenty-one patients received tacrolimus-mycophenolate mofetil maintenance immunosuppression, whereas the other patients received tacrolimus-sirolimus (SIR, n = 5) or SIR only (n = 5). Cellular autoreactivity and alloreactivity (CTL precursor frequency) were measured ex vivo. Clinical outcome in the first 6 months after transplantation was correlated with immunological parameters. C-peptide levels were significantly different between the three groups studied (P = 0.01). We confirm that C-peptide production was correlated negatively with pretransplant cellular autoreactivity and low graft size (P = 0.001, P = 0.007 respectively). Combining all three therapies, cellular autoimmunity after transplantation was not associated with delayed insulin-independence or C-peptide production. In combined tacrolimus-SIR and SIR-treated patients, CTL alloreactivity was associated with less insulin independence and C-peptide production (P = 0.03). The percentage of donors to whom high CTLp frequencies were measured was lower in insulin-independent recipients (P = 0.03). In this cohort of islet cell graft recipients, clinical outcome in the first 6 months after transplantation correlates with the applied immunosuppressive regimen. An association exists between insulin-independence and lower incidence of CTL alloreactivity towards donor human leucocyte antigen. This observational study demonstrates the usefulness of monitoring T cell reactivity against islet allografts to correlate immune function with graft survival.
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Affiliation(s)
- D L Roelen
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands.
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Huurman VAL, Velthuis JHL, Hilbrands R, Tree TIM, Gillard P, van der Meer-Prins PMW, Duinkerken G, Pinkse GGM, Keymeulen B, Roelen DL, Claas FHJ, Pipeleers DG, Roep BO. Allograft-specific cytokine profiles associate with clinical outcome after islet cell transplantation. Am J Transplant 2009; 9:382-8. [PMID: 19067657 DOI: 10.1111/j.1600-6143.2008.02479.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Islet cell transplantation can cure type 1 diabetes, but allograft rejection and recurrent autoimmunity may contribute to decreasing insulin independence over time. In this study we report the association of allograft-specific proliferative and cytokine profiles with clinical outcome. Peripheral blood mononuclear cells were obtained of 20 islet recipients. Cytokine values in mixed lymphocyte cultures (MLC) were determined using stimulator cells with graft-specific HLA class II. Qualitative and quantitative cytokine profiles were determined before and after islet transplantation, blinded from clinical outcome. Cytotoxic T Lymphocyte precursor (CTLp) assays were performed to determine HLA class I alloreactivity. Allograft-specific cytokine profiles were skewed toward a Th2 or regulatory (Treg) phenotype after transplantation in insulin-independent, but not in insulin-requiring recipients. IFNgamma/IL10 ratio and MLC proliferation decreased after transplantation in insulin-independent recipients (p = 0.006 and p = 0.01, respectively). Production of the Treg cytokine IL10 inversely correlated with proliferation in alloreactive MLC (p = 0.008) and CTLp (p = 0.005). Production of IL10 combined with low-MLC reactivity associated significantly with insulin independence. The significant correlation between allograft-specific cytokine profiles and clinical outcome may reflect the induction of immune regulation in successfully transplanted recipients. Islet donor-specific IL10 production correlates with low alloreactivity and superior islet function.
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Affiliation(s)
- V A L Huurman
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
The interest in hepatocyte transplantation has been growing continuously in recent years and this treatment may represent an alternative clinical approach for patients with acute liver failure and liver-based metabolic disorders. This chapter presents an overview of liver cell transplantation, from the basic research to human experience. It summarizes the pre-clinical studies and present status of clinical hepatocyte transplantation and identifies some possible areas of future research in this area.
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Affiliation(s)
- Juliana Puppi
- Institute of Liver Studies, King's College London School of Medicine London, UK
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21
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Huurman VAL, Hilbrands R, Pinkse GGM, Gillard P, Duinkerken G, van de Linde P, van der Meer-Prins PMW, Versteeg-van der Voort Maarschalk MFJ, Verbeeck K, Alizadeh BZ, Mathieu C, Gorus FK, Roelen DL, Claas FHJ, Keymeulen B, Pipeleers DG, Roep BO. Cellular islet autoimmunity associates with clinical outcome of islet cell transplantation. PLoS One 2008; 3:e2435. [PMID: 18560516 PMCID: PMC2426735 DOI: 10.1371/journal.pone.0002435] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 04/22/2008] [Indexed: 02/04/2023] Open
Abstract
Background Islet cell transplantation can cure type 1 diabetes (T1D), but only a minority of recipients remains insulin–independent in the following years. We tested the hypothesis that allograft rejection and recurrent autoimmunity contribute to this progressive loss of islet allograft function. Methodology/Principal Findings Twenty-one T1D patients received cultured islet cell grafts prepared from multiple donors and transplanted under anti-thymocyte globulin (ATG) induction and tacrolimus plus mycophenolate mofetil (MMF) maintenance immunosuppression. Immunity against auto- and alloantigens was measured before and during one year after transplantation. Cellular auto- and alloreactivity was assessed by lymphocyte stimulation tests against autoantigens and cytotoxic T lymphocyte precursor assays, respectively. Humoral reactivity was measured by auto- and alloantibodies. Clinical outcome parameters - including time until insulin independence, insulin independence at one year, and C-peptide levels over one year- remained blinded until their correlation with immunological parameters. All patients showed significant improvement of metabolic control and 13 out of 21 became insulin-independent. Multivariate analyses showed that presence of cellular autoimmunity before and after transplantation is associated with delayed insulin-independence (p = 0.001 and p = 0.01, respectively) and lower circulating C-peptide levels during the first year after transplantation (p = 0.002 and p = 0.02, respectively). Seven out of eight patients without pre-existent T-cell autoreactivity became insulin-independent, versus none of the four patients reactive to both islet autoantigens GAD and IA-2 before transplantation. Autoantibody levels and cellular alloreactivity had no significant association with outcome. Conclusions/Significance In this cohort study, cellular islet-specific autoimmunity associates with clinical outcome of islet cell transplantation under ATG-tacrolimus-MMF immunosuppression. Tailored immunotherapy targeting cellular islet autoreactivity may be required. Monitoring cellular immune reactivity can be useful to identify factors influencing graft survival and to assess efficacy of immunosuppression. Trial Registration Clinicaltrials.gov NCT00623610
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Affiliation(s)
- Volkert A. L. Huurman
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Robert Hilbrands
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Gabriëlle G. M. Pinkse
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Pieter Gillard
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
- Laboratory for Experimental Medicine & Endocrinology (LEGENDO), University Hospital Gasthuisberg, Catholic University of Leuven-KUL, Leuven, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Gaby Duinkerken
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Pieter van de Linde
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Petronella M. W. van der Meer-Prins
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | | | - Koen Verbeeck
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Behrooz Z. Alizadeh
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Chantal Mathieu
- Laboratory for Experimental Medicine & Endocrinology (LEGENDO), University Hospital Gasthuisberg, Catholic University of Leuven-KUL, Leuven, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Frans K. Gorus
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Dave L. Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Frans H. J. Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Bart Keymeulen
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Daniel G. Pipeleers
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
| | - Bart O. Roep
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- JDRF Center for Beta Cell Therapy in Diabetes, Brussels, Belgium
- * E-mail:
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Comparison of Sirolimus Alone With Sirolimus Plus Tacrolimus in Type 1 Diabetic Recipients of Cultured Islet Cell Grafts. Transplantation 2008; 85:256-63. [DOI: 10.1097/tp.0b013e31815e8926] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Keymeulen B, Gillard P, Mathieu C, Movahedi B, Maleux G, Delvaux G, Ysebaert D, Roep B, Vandemeulebroucke E, Marichal M, In 't Veld P, Bogdani M, Hendrieckx C, Gorus F, Ling Z, van Rood J, Pipeleers D. Correlation between beta cell mass and glycemic control in type 1 diabetic recipients of islet cell graft. Proc Natl Acad Sci U S A 2006; 103:17444-9. [PMID: 17090674 PMCID: PMC1859948 DOI: 10.1073/pnas.0608141103] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Islet grafts can induce insulin independence in type 1 diabetic patients, but their function is variable with only 10% insulin independence after 5 years. We investigated whether cultured grafts with defined beta cell number help standardize metabolic outcome. Nonuremic C-peptide-negative patients received an intraportal graft with 0.5-5.0 x 10(6) beta cells per kilogram of body weight (kg BW) under antithymocyte globulin and mycophenolate mofetil plus tacrolimus. Metabolic outcome at posttransplant (PT) month 2 was used to decide on a second graft under maintenance mycophenolate mofetil/tacrolimus. Graft function was defined by C-peptide >0.5 ng/ml and reduced insulin needs, metabolic control by reductions in HbA(1c), glycemia coefficient of variation, and hypoglycemia. At PT month 2, graft function was present in 16 of 17 recipients of >2 x 10(6) beta cells per kg BW versus 0 of 5 with lower number. The nine patients with C-peptide >1 ng/ml and glycemia coefficient of variation of <25% did not receive a second graft; five of them were insulin-independent until PT month 12. The 12 others received a second implant; it achieved insulin-independence at PT month 12 when the first and second graft contained >2 x 10(6) beta cells per kg BW. Of the 20 recipients of at least one graft with >2 x 10(6) beta cells per kg BW, 17 maintained graft function and metabolic control up to PT month 12. At PT month 12, beta cell function in insulin-independent patients ranged around 25% of age-matched control values. Thus, 1-year metabolic control can be reproducibly achieved and standardized by cultured islet cell grafts with defined beta cell number.
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Affiliation(s)
- Bart Keymeulen
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Pieter Gillard
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Babak Movahedi
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Geert Maleux
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Georges Delvaux
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Dirk Ysebaert
- Department of Surgery, Universitair Ziekenhuis Antwerpen, University of Antwerp, B-2650 Antwerp, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Bart Roep
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Evy Vandemeulebroucke
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Miriam Marichal
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Peter In 't Veld
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Marika Bogdani
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Christel Hendrieckx
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Frans Gorus
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Zhidong Ling
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Jon van Rood
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
- To whom correspondence may be addressed. E-mail:
| | - Daniel Pipeleers
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
- **To whom correspondence may be addressed at:
Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium. E-mail:
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Keymeulen B. New therapies aimed at the preservation or restoration of beta cell function in type 1 diabetes. Acta Clin Belg 2006; 61:275-85. [PMID: 17240745 DOI: 10.1179/acb.2006.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Type 1 diabetes is caused by an immune-mediated destruction of the insulin-secreting beta cells in the pancreas. The disease can become clinically apparent at any age. At diagnosis, there is invariably some residual beta cell function and more so in adults than in children. Recent studies--including one conducted mainly in Belgium--have provided proof of principle that short-term anti-T-cell antibody treatment is able to preserve residual beta cell function for at least 18 months. The resultant stabilizing effect on metabolic control is expected to delay or limit chronic complications in these patients. With a similar goal in mind, nonuremic C-peptide negative patients are offered beta cell transplantation. The outcome of these implants looks promising but their final applicability hinges on finding ways to induce immune tolerance to the donor beta cells. A widespread application, however, will only occur if the shortage of viable human donor cells can be overcome. Both xenotransplantation and stem cell therapy provide possible strategies to solve this problem and represent areas of intense investigation. The ultimate goal is prevention of clinical disease. Studies by the Belgian Diabetes Registry and others in first degree family members of type 1 diabetic patients have refined the identification of individuals at very high risk of hyperglycaemia so that new immunological treatments can be tested in the prediabetic phase.
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Affiliation(s)
- B Keymeulen
- Academisch Ziekenhuis and Diabetes Research Centre -Brussels Free University-VUB, Laarbeeklaan 103, B-1090 Brussels, Belgium.
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N/A, 程 英. N/A. Shijie Huaren Xiaohua Zazhi 2006; 14:2112-2115. [DOI: 10.11569/wcjd.v14.i21.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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