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Dantas JR, Araújo DB, Silva KR, Souto DL, de Fátima Carvalho Pereira M, Luiz RR, Dos Santos Mantuano M, Claudio-da-Silva C, Gabbay MAL, Dib SA, Couri CEB, Maiolino A, Rebelatto CLK, Daga DR, Senegaglia AC, Brofman PRS, Baptista LS, de Oliveira JEP, Zajdenverg L, Rodacki M. Adipose tissue-derived stromal/stem cells + cholecalciferol: a pilot study in recent-onset type 1 diabetes patients. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:342-351. [PMID: 33939911 PMCID: PMC10065343 DOI: 10.20945/2359-3997000000368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective Adipose tissue-derived stromal/stem cells (ASCs) and vitamin D have immunomodulatory actions that could be useful for type 1 diabetes (T1D). We aimed in this study to investigate the safety and efficacy of ASCs + daily cholecalciferol (VIT D) for 6 months in patients with recent-onset T1D. Methods In this prospective, dual-center, open trial, patients with recent onset T1D received one dose of allogenic ASC (1 × 106 cells/kg) and cholecalciferol 2,000 UI/day for 6 months (group 1). They were compared to patients who received chol-ecalciferol (group 2) and standard treatment (group 3). Adverse events were recorded; C-peptide (CP), insulin dose and HbA1c were measured at baseline (T0), after 3 (T3) and 6 months (T6). Results In group 1 (n = 7), adverse events included transient headache (all), mild local reactions (all), tachycardia (n = 4), abdominal cramps (n = 1), thrombophlebitis (n = 4), scotomas (n = 2), and central retinal vein occlusion at T3 (n = 1, resolution at T6). Group 1 had an increase in basal CP (p = 0.018; mean: 40.41+/-40.79 %), without changes in stimulated CP after mixed meal (p = 0.62), from T0 to T6. Basal CP remained stable in groups 2 and 3 (p = 0.58 and p = 0.116, respectively). Group 1 had small insulin requirements (0.31+/- 0.26 UI/kg) without changes at T6 (p = 0.44) and HbA1c decline (p = 0.01). At T6, all patients (100%; n = 7) in group 1 were in honeymoon vs 75% (n = 3/4) and 50% (n = 3/6) in groups 2 and 3, p = 0.01. Conclusion Allogenic ASC + VIT D without immunosuppression was safe and might have a role in the preservation of β-cells in patients with recent-onset T1D. ClinicalTrials.gov: NCT03920397.
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Affiliation(s)
- Joana Rodrigues Dantas
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| | - Débora Batista Araújo
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| | - Karina Ribeiro Silva
- Laboratório de Bioengenharia de Tecidos, Instituto Nacional de Metrologia, Qualidade e Tecnologia (Inmetro), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Débora Lopes Souto
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil,
| | | | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Pública, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Cesar Claudio-da-Silva
- Departamento de Cirurgia Plástica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Angelo Maiolino
- Departamento de Hematologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Débora Regina Daga
- Core Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | | | | | - Leandra S Baptista
- Centro Multidisciplinar de Pesquisas Biológicas (Numpex-Bio), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; Laboratório de Bioengenharia de Tecidos, Instituto Nacional de Metrologia, Qualidade e Tecnologia (Inmetro), Rio de Janeiro, RJ, Brasil
| | | | - Lenita Zajdenverg
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
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Habib T, Long SA, Samuels PL, Brahmandam A, Tatum M, Funk A, Hocking AM, Cerosaletti K, Mason MT, Whalen E, Rawlings DJ, Greenbaum C, Buckner JH. Dynamic Immune Phenotypes of B and T Helper Cells Mark Distinct Stages of T1D Progression. Diabetes 2019; 68:1240-1250. [PMID: 30894366 PMCID: PMC6610015 DOI: 10.2337/db18-1081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/15/2019] [Indexed: 01/01/2023]
Abstract
Multiple studies of B- and T-cell compartments and their response to stimuli demonstrate alterations in established type 1 diabetes (T1D). Yet it is not known whether these alterations reflect immune mechanisms that initiate islet autoimmunity, promote disease progression, or are secondary to disease. To address these questions, we used samples from the TrialNet Pathway to Prevention study to investigate T-cell responses to interleukin (IL)-2 and regulatory T cell-mediated suppression, the composition of the B-cell compartment, and B-cell responses to B-cell receptor and IL-21 receptor engagement. These studies revealed stage-dependent T- and B-cell functional and immune phenotypes; namely, early features that differentiate autoantibody-positive at-risk first-degree relatives (FDRs) from autoantibody-negative FDRs and persisted through clinical diagnosis; late features that arose at or near T1D diagnosis; and dynamic features that were enhanced early and blunted at later disease stages, indicating evolving responses along the continuum of T1D. We further explored how these specific phenotypes are influenced by therapeutic interventions. Our integrated studies provide unique insights into stable and dynamic stage-specific immune states and define novel immune phenotypes of potential clinical relevance.
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Affiliation(s)
- Tania Habib
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - S Alice Long
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Peter L Samuels
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Archana Brahmandam
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA
| | - Megan Tatum
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Andrew Funk
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Anne M Hocking
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Karen Cerosaletti
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Michael T Mason
- Translational Research Program, Benaroya Research Institute, Seattle, WA
| | - Elizabeth Whalen
- Diabetes Clinical Research Program, Benaroya Research Institute, Seattle, WA
| | - David J Rawlings
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA
- Departments of Pediatrics and Immunology, University of Washington School of Medicine, Seattle, WA
| | - Carla Greenbaum
- Diabetes Clinical Research Program, Benaroya Research Institute, Seattle, WA
| | - Jane H Buckner
- Translational Research Program, Benaroya Research Institute, Seattle, WA
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3
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Walicka M, Milczarczyk A, Snarski E, Jedynasty K, Halaburda K, Torosian T, Urbanowska E, Król M, Jędrzejczak WW, Franek E. Lack of persistent remission following initial recovery in patients with type 1 diabetes treated with autologous peripheral blood stem cell transplantation. Diabetes Res Clin Pract 2018; 143:357-363. [PMID: 30036612 DOI: 10.1016/j.diabres.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022]
Abstract
AIMS To assess metabolic control in patients with newly diagnosed type 1 diabetes mellitus who underwent immunoablation followed by autologous peripheral blood stem cell transplantation (APBSCT) as a treatment of diabetes. METHODS APBSCT was performed in 23 patients. Control group comprised 8 non-APBSCT patients in whom after diagnosis insulin therapy was initiated. Fasting plasma glucose, glycated hemoglobin, fasting and postprandial C-peptide were assessed in all subjects and continuous glucose monitoring was performed at 6th, 12th, 24th, 36th, 48th month after transplantation. The APBSCT group was observed for 72 months. RESULTS Six months after the procedure, 22 of 23 transplant patients remained insulin-free, but after 6 years, there was only one APBSCT insulin-free patient. Good glycemic control was observed in all patients throughout the observation period, although fasting plasma glucose in control group was significantly higher in comparison with the both transplanted groups up to the 36th month. HbA1c values were significantly lower in the insulin-free group only at the 24th and 36th month. Fasting and postprandial C-peptide concentrations were higher in APBSCT group as compared with control group. The most serious adverse event was a fatal case of Pseudomonas aeruginosa sepsis. CONCLUSIONS The effectiveness of APBSCT as a treatment for newly diagnosed DM1 seems to be limited in time. The metabolic control of APBSCT patients is similar to conventionally treated patients. The lower fasting plasma glucose and higher C-peptide achieved with APBSCT seem to not exceed the risks associated with the procedure.
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Affiliation(s)
- Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1).
| | - Alicja Milczarczyk
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1).
| | - Emilian Snarski
- Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2)
| | - Krystyna Jedynasty
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1).
| | - Kazimierz Halaburda
- Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2).
| | - Tigran Torosian
- Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2).
| | - Elżbieta Urbanowska
- Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2).
| | - Małgorzata Król
- Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2).
| | - Wiesław Wiktor Jędrzejczak
- Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2).
| | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1); Department of Human Epigenetics, Mossakowski Medical Research Centre Polish Academy of Sciences, Ul. 02-106 Warsaw, 5 Pawińskiego Street, Poland(3).
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Weir GC, Ehlers MR, Harris KM, Kanaparthi S, Long A, Phippard D, Weiner LJ, Jepson B, McNamara JG, Koulmanda M, Strom TB. Alpha-1 antitrypsin treatment of new-onset type 1 diabetes: An open-label, phase I clinical trial (RETAIN) to assess safety and pharmacokinetics. Pediatr Diabetes 2018; 19:945-954. [PMID: 29473705 PMCID: PMC6030471 DOI: 10.1111/pedi.12660] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the safety and pharmacokinetics of alpha-1 antitrypsin (AAT) in adults and children. RESEARCH DESIGN AND METHODS Short-term AAT treatment restores euglycemia in the non-obese mouse model of type 1 diabetes. A phase I multicenter study in 16 subjects with new-onset type 1 diabetes studied the safety and pharmacokinetics of Aralast NP (AAT). This open-label, dose-escalation study enrolled 8 adults aged 16 to 35 years and 8 children aged 8 to 15 years within 100 days of diagnosis, to receive 12 infusions of AAT: a low dose of 45 mg/kg weekly for 6 weeks, followed by a higher dose of 90 mg/kg for 6 weeks. RESULTS C-peptide secretion during a mixed meal, hemoglobin A1c (HbA1c), and insulin usage remained relatively stable during the treatment period. At 72 hours after infusion of 90 mg/kg, mean levels of AAT fell below 2.0 g/L for 7 of 15 subjects. To identify a plasma level of AAT likely to be therapeutic, pharmacodynamic ex vivo assays were performed on fresh whole blood from adult subjects. Polymerase chain reaction (PCR) analyses were performed on inhibitor of IKBKE, NOD1, TLR1, and TRAD gene expression, which are important for activation of nuclear factor-κB (NF-κB) and apoptosis pathways. AAT suppressed expression dose-dependently; 50% inhibition was achieved in the 2.5 to 5.0 mg/mL range. CONCLUSIONS AAT was well tolerated and safe in subjects with new-onset type 1 diabetes. Weekly doses of AAT greater than 90 mg/kg may be necessary for an optimal therapeutic effect.
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Affiliation(s)
- Gordon C Weir
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Mario R Ehlers
- Immune Tolerance Network, Clinical Trials Group, San Francisco, California
| | - Kristina M Harris
- Immune Tolerance Network, Biomarker & Discovery Research, Bethesda, Maryland
| | - Sai Kanaparthi
- Immune Tolerance Network, Biomarker & Discovery Research, Bethesda, Maryland
| | - Alice Long
- Benaroya Research Institute at Virginia Mason, Translational Research Program, Seattle, Western Australia
| | - Deborah Phippard
- Immune Tolerance Network, Biomarker & Discovery Research, Bethesda, Maryland
| | - Lia J Weiner
- Rho Federal Systems Division, Chapel Hill, North Carolina
| | - Brett Jepson
- Rho Federal Systems Division, Chapel Hill, North Carolina
| | - James G McNamara
- National Institute of Allergy and Infectious Diseases, Division of Allergy, Immunology and Transplant, Bethesda, Maryland
| | - Maria Koulmanda
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Terry B Strom
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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5
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Poudel A, Savari O, Striegel DA, Periwal V, Taxy J, Millis JM, Witkowski P, Atkinson MA, Hara M. Beta-cell destruction and preservation in childhood and adult onset type 1 diabetes. Endocrine 2015; 49:693-702. [PMID: 25605478 PMCID: PMC4511725 DOI: 10.1007/s12020-015-0534-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/12/2015] [Indexed: 01/09/2023]
Abstract
Previous studies describing the symptomatic onset of type 1 diabetes (T1D) and rate of beta-cell loss (C-peptide) support the notion that childhood onset T1D exhibits more severe beta-cell depletion compared to adult onset T1D. To test this notion, we performed whole pancreas analyses in two T1D cases, one of childhood onset (7-year old, onset at 1.5-year) along with an adult onset case (43-year old with onset at 27-year). Both cases were matched for age and gender with control subjects. Striking regional differences in beta-cell loss were observed in both T1D cases, with severity of loss in the order of tail > body > head regions. In contrast, pancreatic alpha- and delta-cell mass was similar in controls and T1D patients. In the childhood onset T1D case, no intra-islet beta-cells were detected while in the adult onset case, beta-cell containing islets were found, exclusively in the head region. In the latter case, considerable numbers of small cellular clusters negative for three major endocrine hormones were observed, in islets with or without beta-cells. Ultrastructural analysis suggests these cells correspond to degenerating beta-cells, with empty granular membranes and abnormal morphology of nuclei with intranuclear pseudo-inclusions, adjacent to healthy alpha- and delta-cells. These results support a hypothesis that during T1D development in childhood, beta-cells are more susceptible to autoimmune destruction or immune attack is more severe, while beta-cell death in the adult onset T1D may be more protracted and incomplete. In addition, T1D may be associated with the formation of "empty" beta-cells, an interesting population of cells that may represent a key facet to the disorder's pathogenesis.
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Affiliation(s)
- Ananta Poudel
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Omid Savari
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Deborah A. Striegel
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Vipul Periwal
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jerome Taxy
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | | | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Mark A. Atkinson
- Department of Pathology, The University of Florida, Gainesville, Florida
| | - Manami Hara
- Department of Medicine, The University of Chicago, Chicago, Illinois
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6
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von Laer Tschudin L, Schwitzgebel VM, von Scheven-Gête A, Blouin JL, Hofer M, Hauschild M, Ansari M, Stoppa-Vaucher S, Phan-Hug F. Diabetes and immune thrombocytopenic purpura: a new association with good response to anti-CD20 therapy. Pediatr Diabetes 2015; 16:138-45. [PMID: 24552605 DOI: 10.1111/pedi.12128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/23/2013] [Accepted: 01/10/2014] [Indexed: 12/19/2022] Open
Abstract
Type 1 diabetes (T1D) is rarely a component of primary immune dysregulation disorders. We report two cases in which T1D was associated with thrombocytopenia. The first patient, a 13-year-old boy, presented with immune thrombocytopenia (ITP), thyroiditis, and, 3 wk later, T1D. Because of severe thrombocytopenia resistant to immunoglobulins, high-dose steroids, and cyclosporine treatment, anti-cluster of differentiation (CD20) therapy was introduced, with consequent normalization of thrombocytes and weaning off of steroids. Three and 5 months after anti-CD20 therapy, levothyroxin and insulin therapy, respectively, were stopped. Ten months after stopping insulin treatment, normal C-peptide and hemoglobin A1c (HbA1c) levels and markedly reduced anti-glutamic acid decarboxylase (GAD) antibodies were measured. A second anti-CD20 trial for relapse of ITP was initiated 2 yr after the first trial. Anti-GAD antibody levels decreased again, but HbA1c stayed elevated and glucose monitoring showed elevated postprandial glycemia, demanding insulin therapy. To our knowledge, this is the first case in which insulin treatment could be interrupted for 28 months after anti-CD20 treatment. In patient two, thrombocytopenia followed a diagnosis of T1D 6 yr previously. Treatment with anti-CD20 led to normalization of thrombocytes, but no effect on T1D was observed. Concerning the origin of the boys' conditions, several primary immune dysregulation disorders were considered. Thrombocytopenia associated with T1D is unusual and could represent a new entity. The diabetes manifestation in patient one was probably triggered by corticosteroid treatment; regardless, anti-CD20 therapy appeared to be efficacious early in the course of T1D, but not long after the initial diagnosis of T1D, as shown for patient two.
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Affiliation(s)
- Letizia von Laer Tschudin
- Division of Endocrinology Diabetology and Obesity, Department of Pediatrics, University Hospital, Lausanne, Switzerland
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7
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Gianchecchi E, Crinò A, Giorda E, Luciano R, Perri V, Russo AL, Cappa M, Rosado MM, Fierabracci A. Altered B cell homeostasis and toll-like receptor 9-driven response in type 1 diabetes carriers of the C1858T PTPN22 allelic variant: implications in the disease pathogenesis. PLoS One 2014; 9:e110755. [PMID: 25333705 PMCID: PMC4205012 DOI: 10.1371/journal.pone.0110755] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/18/2014] [Indexed: 01/10/2023] Open
Abstract
Type 1 diabetes is an autoimmune disease caused by the destruction of pancreatic beta cells by autoreactive T cells. Among the genetic variants associated with type 1 diabetes, the C1858T (Lyp) polymorphism of the protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene alters the function of T cells but also of B cells in innate and adaptive immunity. The Lyp variant was shown to diminish interferon production and responses upon Toll-like receptor stimulation in macrophages and dendritic cells, possibly leading to uncontrolled infections as triggers of the diabetogenic process. The aim of this study was to unravel the yet uncharacterized effects that the variant could exert on the immune and autoimmune responses, particularly regarding the B cell phenotype, in the peripheral blood lymphocytes of diabetic patients and healthy controls in basal conditions and after unmethylated bacterial DNA CpG stimulation. The presence of the Lyp variant resulted in a significant increase in the percentage of transitional B cells in C/T carriers patients and controls compared to C/C patients and controls, in C/T carrier patients compared to C/C controls and in C/T carrier patients compared to C/C patients. A significant reduction in the memory B cells was also observed in the presence of the risk variant. After four days of CpG stimulation, there was a significant increase in the abundance of IgM+ memory B cells in C/T carrier diabetics than in C/C subjects and in the groups of C/T carrier individuals than in C/C individuals. IgM- memory B cells tended to differentiate more precociously into plasma cells than IgM+ memory B cells in heterozygous C/T subjects compared to the C/C subjects. The increased Toll-like receptor response that led to expanded T cell-independent IgM+ memory B cells should be further investigated to determine the putative contribution of innate immune responses in the disease pathogenesis.
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Affiliation(s)
- Elena Gianchecchi
- Autoimmunity Laboratory, Immunology and Pharmacotherapy Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonino Crinò
- Division of Endocrinology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ezio Giorda
- B cell Development Laboratory, Immunology and Pharmacotherapy Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rosa Luciano
- Research Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Perri
- Autoimmunity Laboratory, Immunology and Pharmacotherapy Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Anna Lo Russo
- Autoimmunity Laboratory, Immunology and Pharmacotherapy Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Cappa
- Division of Endocrinology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - M. Manuela Rosado
- B cell Development Laboratory, Immunology and Pharmacotherapy Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandra Fierabracci
- Autoimmunity Laboratory, Immunology and Pharmacotherapy Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Han MX, Craig ME. Research using autologous cord blood - time for a policy change. Med J Aust 2013; 199:288-99. [PMID: 23984789 DOI: 10.5694/mja12.10835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/22/2013] [Indexed: 11/17/2022]
Abstract
• Type 1 diabetes results from the loss of normal immunological self-tolerance, which may be attributable to the failure of Foxp3+ regulatory T cells (Tregs). Umbilical cord blood is rich in Tregs and therefore has the potential to prevent or delay the onset of type 1 diabetes. A pilot trial is currently underway in Australia to examine whether infusion of autologous cord blood can prevent type 1 diabetes in high-risk children with serum antibodies to multiple β-cell antigens. • A number of other potential therapeutic indications for autologous cord blood have been proposed, including cerebral palsy and hypoxic-ischaemic encephalopathy. • Recruitment to clinical trials using cord blood is influenced by divergent public and private cord blood banking policy in Australia. The burgeoning consumer demand for storage of cord blood highlights the need for regulatory bodies to develop and adapt policies to facilitate research that may extend the use of cord blood beyond currently recognised indications. • Consumers, researchers and policymakers must also recognise specific ethical issues associated with collection and storage of cord blood, including storage in public and private banks, informed consent, ownership, access and the principle of beneficence.
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Affiliation(s)
- Michael X Han
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
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Abstract
Genome-wide association studies (GWASs) have been heralded as a major advance in biomedical discovery, having identified ~2,000 robust associations with complex diseases since 2005. Despite this success, they have met considerable scepticism regarding their clinical applicability; this scepticism arises from such aspects as the modest effect sizes of associated variants and their unclear functional consequences. There are, however, promising examples of GWAS findings that will or that may soon be translated into clinical care. These examples include variants identified through GWASs that provide strongly predictive or prognostic information or that have important pharmacological implications; these examples may illustrate promising approaches to wider clinical application.
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10
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Hari Kumar KVS, Shaikh A, Prusty P. Addition of exenatide or sitagliptin to insulin in new onset type 1 diabetes: a randomized, open label study. Diabetes Res Clin Pract 2013; 100:e55-8. [PMID: 23490599 DOI: 10.1016/j.diabres.2013.01.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/04/2013] [Accepted: 01/21/2013] [Indexed: 12/21/2022]
Abstract
Incretin based therapies are known to have pleotropic benefits in type 2 diabetes but have not been studied in new onset type 1 diabetes. In this randomized, open label study, we investigated the effect of the addition of exenatide or sitagliptin to insulin in patients with new onset type 1 diabetes. Our data suggest that the addition of exenatide and sitagliptin decreases insulin requirements without increasing endogenous insulin production and hypoglycemic events.
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Affiliation(s)
- K V S Hari Kumar
- Department of Endocrinology, Command Hospital, Lucknow 226002 Uttar Pradesh, India.
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11
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Sarikonda G, Sachithanantham S, Manenkova Y, Kupfer T, Posgai A, Wasserfall C, Bernstein P, Straub L, Pagni PP, Schneider D, Calvo TR, Coulombe M, Herold K, Gill RG, Atkinson M, Nepom G, Ehlers M, Staeva T, Garren H, Steinman L, Chan AC, von Herrath M. Transient B-cell depletion with anti-CD20 in combination with proinsulin DNA vaccine or oral insulin: immunologic effects and efficacy in NOD mice. PLoS One 2013; 8:e54712. [PMID: 23405091 PMCID: PMC3566105 DOI: 10.1371/journal.pone.0054712] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/17/2012] [Indexed: 01/10/2023] Open
Abstract
A recent type 1 diabetes (T1D) clinical trial of rituximab (a B cell-depleting anti-CD20 antibody) achieved some therapeutic benefit in preserving C-peptide for a period of approximately nine months in patients with recently diagnosed diabetes. Our previous data in the NOD mouse demonstrated that co-administration of antigen (insulin) with anti-CD3 antibody (a T cell-directed immunomodulator) offers better protection than either entity alone, indicating that novel combination therapies that include a T1D-related autoantigen are possible. To accelerate the identification and development of novel combination therapies that can be advanced into the clinic, we have evaluated the combination of a mouse anti-CD20 antibody with either oral insulin or a proinsulin-expressing DNA vaccine. Anti-CD20 alone, given once or on 4 consecutive days, produced transient B cell depletion but did not prevent or reverse T1D in the NOD mouse. Oral insulin alone (twice weekly for 6 weeks) was also ineffective, while proinsulin DNA (weekly for up to 12 weeks) showed a trend toward modest efficacy. Combination of anti-CD20 with oral insulin was ineffective in reversing diabetes in NOD mice whose glycemia was controlled with SC insulin pellets; these experiments were performed in three independent labs. Combination of anti-CD20 with proinsulin DNA was also ineffective in diabetes reversal, but did show modest efficacy in diabetes prevention (p = 0.04). In the prevention studies, anti-CD20 plus proinsulin resulted in modest increases in Tregs in pancreatic lymph nodes and elevated levels of proinsulin-specific CD4+ T-cells that produced IL-4. Thus, combination therapy with anti-CD20 and either oral insulin or proinsulin does not protect hyperglycemic NOD mice, but the combination with proinsulin offers limited efficacy in T1D prevention, potentially by augmentation of proinsulin-specific IL-4 production.
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MESH Headings
- Administration, Oral
- Animals
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antigens, CD20/immunology
- B-Lymphocytes/cytology
- B-Lymphocytes/drug effects
- B-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Drug Therapy, Combination/methods
- Female
- Hyperglycemia/drug therapy
- Hyperglycemia/immunology
- Insulin/administration & dosage
- Insulin/genetics
- Insulin/immunology
- Interleukin-4/immunology
- Lymph Nodes/drug effects
- Lymph Nodes/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Pancreas/drug effects
- Pancreas/immunology
- Proinsulin/administration & dosage
- Proinsulin/genetics
- Proinsulin/immunology
- Spleen/drug effects
- Spleen/immunology
- Vaccines, DNA/administration & dosage
- Vaccines, DNA/genetics
- Vaccines, DNA/immunology
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Affiliation(s)
- Ghanashyam Sarikonda
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
| | - Sowbarnika Sachithanantham
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
| | - Yulia Manenkova
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
| | - Tinalyn Kupfer
- University of Colorado Denver, Aurora, Colorado, United States of America
| | - Amanda Posgai
- University of Florida, Gainesville, Florida, United States of America
| | - Clive Wasserfall
- University of Florida, Gainesville, Florida, United States of America
| | - Philip Bernstein
- Immune Tolerance Network, San Francisco, California, United States of America
| | - Laura Straub
- Immune Tolerance Network, San Francisco, California, United States of America
| | - Philippe P. Pagni
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
| | - Darius Schneider
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
| | - Teresa Rodriguez Calvo
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
| | - Marilyne Coulombe
- University of Colorado Denver, Aurora, Colorado, United States of America
| | - Kevan Herold
- Yale University, New Haven, Connecticut, United States of America
| | - Ronald G. Gill
- University of Colorado Denver, Aurora, Colorado, United States of America
| | - Mark Atkinson
- University of Florida, Gainesville, Florida, United States of America
| | - Gerald Nepom
- Benaroya Research Institute, Seattle, Washington, United States of America
| | - Mario Ehlers
- Immune Tolerance Network, San Francisco, California, United States of America
| | - Teodora Staeva
- JDRF International, New York, New York, United States of America
| | - Hideki Garren
- Bayhill Therapeutics, San Mateo, California, United States of America
| | - Lawrence Steinman
- Bayhill Therapeutics, San Mateo, California, United States of America
- Stanford University, Stanford, California, United States of America
| | - Andrew C. Chan
- Genentech, Inc, South San Francisco, California, United States of America
| | - Matthias von Herrath
- La Jolla Institute for Allergy and Immunology, Diabetes Center, La Jolla, California, United States of America
- * E-mail:
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12
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Chiang JL, Haller MJ, Schatz DA. Update on global intervention studies in type 1 diabetes. Endocrinol Metab Clin North Am 2012; 41:695-712. [PMID: 23099265 DOI: 10.1016/j.ecl.2012.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Remarkable progress has been made in strategies to arrest pancreatic β-cell destruction in type 1 diabetes. Although knowledge of the disease has increased, a safe therapeutic intervention to reverse or prevent it remains elusive. The interaction of genes, immune system, and environment result in a complex disease process that has delayed hopes for a cure. Several well-designed prevention and intervention studies have aspired to test potentially efficacious and safe therapies. This article updates the principles used to design prevention and intervention trials, reviews clinical trials, addresses controversial issues, and provides a framework for future efforts to interdict this condition.
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Affiliation(s)
- Jane L Chiang
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA 94305, USA.
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13
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Affiliation(s)
- Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Dresden University of Technology, Dresden, Germany.
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14
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Bollepalli S, Smith LB, Vasquez A, Rodriguez H, Vehik K. Addressing the burdens of Type 1 diabetes in youth. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/cpr.12.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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