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Saravanan PB, Kalivarathan J, McClintock K, Mohammed S, Burch E, Morecock C, Liu J, Khan A, Levy MF, Kanak MA. Inflammatory and hypoxic stress-induced islet exosomes released during isolation are associated with poor transplant outcomes in islet autotransplantation. Am J Transplant 2024; 24:967-982. [PMID: 38364959 DOI: 10.1016/j.ajt.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
Islets experience enormous stress during the isolation process, leading to suboptimal endocrine function after total pancreatectomy with islet autotransplantation (TPIAT). Our investigation focused on inducing isolation stress in islets ex vivo, where proinflammatory cytokines and hypoxia prompted the release of stress exosomes (exoS) sized between 50 and 200 nm. Mass spectrometry analysis revealed 3 distinct subgroups of immunogenic proteins within these exoS: damage-associated molecular patterns (DAMPs), chaperones, and autoantigens. The involvement of endosomal-sorting complex required for transport proteins including ras-associated binding proteins7A, ras-associated binding protein GGTA, vacuolar protein sorting associated protein 45, vacuolar protein sorting associated protein 26B, and the tetraspanins CD9 and CD63, in exoS biogenesis was confirmed through immunoblotting. Next, we isolated similar exoS from the islet infusion bags of TPIAT recipients (N = 20). The exosomes from infusion bags exhibited higher DAMP (heat shock protein family A [Hsp70] member 1B and histone H2B) levels, particularly in the insulin-dependent TPIAT group. Additionally, elevated DAMP protein levels in islet infusion bag exosomes correlated with increased insulin requirements (P = .010) and higher hemoglobin A1c levels 1-year posttransplant. A deeper exploration into exoS functionality revealed their potential to activate monocytes via the toll-like receptor 3/7: DAMP axis. This stimulation resulted in the induction of inflammatory phenotypes marked by increased levels of CD68, CD80, inducible nitric oxide synthase, and cyclooxygenase-2. This activation mechanism may impact the successful engraftment of transplanted islets.
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Affiliation(s)
- Prathab Balaji Saravanan
- Department of Surgery, School of Medicine, VCU, Richmond, Virginia, USA; VCU Hume-Lee Islet Cell Transplant Lab, VCU Health System, Richmond, Virginia, USA.
| | - Jagan Kalivarathan
- VCU Hume-Lee Islet Cell Transplant Lab, VCU Health System, Richmond, Virginia, USA
| | - Kaeden McClintock
- Department of Surgery, School of Medicine, VCU, Richmond, Virginia, USA
| | | | - Elijah Burch
- VCU Hume-Lee Islet Cell Transplant Lab, VCU Health System, Richmond, Virginia, USA
| | - Christiane Morecock
- Department of Biostatistics, School of Medicine, VCU, Richmond, Virginia, USA
| | - Jinze Liu
- Department of Biostatistics, School of Medicine, VCU, Richmond, Virginia, USA
| | - Aamir Khan
- Department of Surgery, School of Medicine, VCU, Richmond, Virginia, USA; VCU Hume-Lee Islet Cell Transplant Lab, VCU Health System, Richmond, Virginia, USA
| | - Marlon F Levy
- Department of Surgery, School of Medicine, VCU, Richmond, Virginia, USA; VCU Hume-Lee Islet Cell Transplant Lab, VCU Health System, Richmond, Virginia, USA
| | - Mazhar A Kanak
- Department of Surgery, School of Medicine, VCU, Richmond, Virginia, USA; VCU Hume-Lee Islet Cell Transplant Lab, VCU Health System, Richmond, Virginia, USA
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Taylor PN, Collins KS, Lam A, Karpen SR, Greeno B, Walker F, Lozano A, Atabakhsh E, Ahmed ST, Marinac M, Latres E, Senior PA, Rigby M, Gottlieb PA, Dayan CM. C-peptide and metabolic outcomes in trials of disease modifying therapy in new-onset type 1 diabetes: an individual participant meta-analysis. Lancet Diabetes Endocrinol 2023; 11:915-925. [PMID: 37931637 DOI: 10.1016/s2213-8587(23)00267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Metabolic outcomes in type 1 diabetes remain suboptimal. Disease modifying therapy to prevent β-cell loss presents an alternative treatment framework but the effect on metabolic outcomes is unclear. We, therefore, aimed to define the relationship between insulin C-peptide as a marker of β-cell function and metabolic outcomes in new-onset type 1 diabetes. METHODS 21 trials of disease-modifying interventions within 100 days of type 1 diabetes diagnosis comprising 1315 adults (ie, those 18 years and older) and 1396 children (ie, those younger than 18 years) were combined. Endpoints assessed were stimulated area under the curve C-peptide, HbA1c, insulin use, hypoglycaemic events, and composite scores (such as insulin dose adjusted A1c, total daily insulin, U/kg per day, and BETA-2 score). Positive studies were defined as those meeting their primary endpoint. Differences in outcomes between active and control groups were assessed using the Wilcoxon rank test. FINDINGS 6 months after treatment, a 24·8% greater C-peptide preservation in positive studies was associated with a 0·55% lower HbA1c (p<0·0001), with differences being detectable as early as 3 months. Cross-sectional analysis, combining positive and negative studies, was consistent with this proportionality: a 55% improvement in C-peptide preservation was associated with 0·64% lower HbA1c (p<0·0001). Higher initial C-peptide levels and greater preservation were associated with greater improvement in HbA1c. For HbA1c, IDAAC, and BETA-2 score, sample size predictions indicated that 2-3 times as many participants per group would be required to show a difference at 6 months as compared with C-peptide. Detecting a reduction in hypoglycaemia was affected by reporting methods. INTERPRETATION Interventions that preserve β-cell function are effective at improving metabolic outcomes in new-onset type 1 diabetes, confirming their potential as adjuncts to insulin. We have shown that improvements in HbA1c are directly proportional to the degree of C-peptide preservation, quantifying this relationship, and supporting the use of C-peptides as a surrogate endpoint in clinical trials. FUNDING JDRF and Diabetes UK.
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Affiliation(s)
- Peter N Taylor
- Department of Infection and Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | | | - Anna Lam
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | | | - Simi T Ahmed
- The New York Stem Cell Foundation Research Institute, New York, NY, USA
| | | | | | - Peter A Senior
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Mark Rigby
- Critical Path Institute, Tucson, AZ, USA
| | | | - Colin M Dayan
- Department of Infection and Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK.
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3
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Quijano JC, Wedeken L, Ortiz JA, Zook HN, LeBon JM, Luo A, Rawson J, Tremblay JR, Mares JM, Lopez K, Chen MH, Jou K, Mendez-Dorantes C, Al-Abdullah IH, Thurmond DC, Kandeel F, Riggs AD, Ku HT. Methylcellulose colony assay and single-cell micro-manipulation reveal progenitor-like cells in adult human pancreatic ducts. Stem Cell Reports 2023; 18:618-635. [PMID: 36868230 PMCID: PMC10031308 DOI: 10.1016/j.stemcr.2023.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/05/2023] Open
Abstract
Progenitor cells capable of self-renewal and differentiation in the adult human pancreas are an under-explored resource for regenerative medicine. Using micro-manipulation and three-dimensional colony assays we identify cells within the adult human exocrine pancreas that resemble progenitor cells. Exocrine tissues were dissociated into single cells and plated into a colony assay containing methylcellulose and 5% Matrigel. A subpopulation of ductal cells formed colonies containing differentiated ductal, acinar, and endocrine lineage cells, and expanded up to 300-fold with a ROCK inhibitor. When transplanted into diabetic mice, colonies pre-treated with a NOTCH inhibitor gave rise to insulin-expressing cells. Both colonies and primary human ducts contained cells that simultaneously express progenitor transcription factors SOX9, NKX6.1, and PDX1. In addition, in silico analysis identified progenitor-like cells within ductal clusters in a single-cell RNA sequencing dataset. Therefore, progenitor-like cells capable of self-renewal and tri-lineage differentiation either pre-exist in the adult human exocrine pancreas, or readily adapt in culture.
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Affiliation(s)
- Janine C Quijano
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Lena Wedeken
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Jose A Ortiz
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA; Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, CA 91010, USA
| | - Heather N Zook
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA; Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, CA 91010, USA
| | - Jeanne M LeBon
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Angela Luo
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Jeffrey Rawson
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Jacob R Tremblay
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Jacob M Mares
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Kassandra Lopez
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Min-Hsuan Chen
- Integrative Genomics Core, City of Hope, Duarte, CA 91010, USA
| | - Kevin Jou
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Carlos Mendez-Dorantes
- Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, CA 91010, USA
| | - Ismail H Al-Abdullah
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Debbie C Thurmond
- Department of Molecular & Cellular Endocrinology, City of Hope, Duarte, CA 91010, USA
| | - Fouad Kandeel
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA; Department of Clinical Diabetes, Endocrinology & Metabolism, City of Hope, Duarte, CA 91010, USA
| | - Arthur D Riggs
- Department of Diabetes & Drug Discovery, City of Hope, Duarte, CA 91010, USA
| | - Hsun Teresa Ku
- Department of Translational Research & Cellular Therapeutics, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, USA; Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, CA 91010, USA
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Pretransplant HOMA-β Is Predictive of Insulin Independence in 7 Patients With Chronic Pancreatitis Undergoing Islet Autotransplantation. Transplant Direct 2022; 8:e1367. [PMID: 36204182 PMCID: PMC9529061 DOI: 10.1097/txd.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
Islet and β-cell function is intrinsic to glucose homeostasis. Pancreatectomy and islet autotransplantation (PIAT) for chronic pancreatitis (CP) treatment is a useful model for assessing islet function in the absence of immune-suppression and to perform extensive presurgical metabolic evaluations not possible from deceased donors. We recently showed that in CP-PIAT patients, preoperative islet identity loss presented with postoperative glycemic loss. Here, we examine presurgical islet function using Homeostatic Model Assessment-Beta Cell Function (%) (HOMA-β) and glycemic variables and compared them with postsurgical insulin independence and their predicted alignment with Secretory Unit of Islet Transplant Objects (SUITO) and beta cell score after transplantation (BETA-2) scores.
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Lam A, Oram RA, Forbes S, Olateju T, Malcolm AJ, Imes S, Shapiro AMJ, Senior PA. Estimation of Early Graft Function Using the BETA-2 Score Following Clinical Islet Transplantation. Transpl Int 2022; 35:10335. [PMID: 35874309 PMCID: PMC9301872 DOI: 10.3389/ti.2022.10335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022]
Abstract
Little is known about how early islet graft function evolves in the clinical setting. The BETA-2 score is a validated index of islet function that can be calculated from a single blood sample and lends itself to frequent monitoring of graft function. In this study, we characterized early graft function by calculating weekly BETA-2 score in recipients who achieved insulin independence after single transplant (group 1, n = 8) compared to recipients who required a second transplant before achieving insulin independence (group 2, n = 7). We also determined whether graft function 1-week post-transplant was associated with insulin independence in individuals who received initial transplant between 2000–2017 (n = 125). Our results show that graft function increased rapidly reaching a plateau 4–6 weeks post-transplant. The BETA-2 score was higher in group 1 compared to group 2 as early as 1-week post-transplant (15 + 3 vs. 9 + 2, p = 0.001). In an unselected cohort, BETA-2 at 1-week post-transplant was associated with graft survival as defined by insulin independence during median follow up of 12 months (range 2–119 months) with greater survival among those with BETA-2 score >10 (p < 0.001, log-rank test). These findings suggest that primary graft function is established within 4–6 weeks post-transplant and graft function at 1-week post-transplant predicts long-term transplant outcomes.
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Affiliation(s)
- Anna Lam
- Clinical Islet Transplant Program, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- *Correspondence: Anna Lam,
| | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Shareen Forbes
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tolu Olateju
- Clinical Islet Transplant Program, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - Andrew J. Malcolm
- Clinical Islet Transplant Program, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - Sharleen Imes
- Clinical Islet Transplant Program, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - A. M. James Shapiro
- Clinical Islet Transplant Program, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - Peter A. Senior
- Clinical Islet Transplant Program, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
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Kawahara T, Suzuki G, Mizuno S, Inazu T, Kasagi F, Kawahara C, Okada Y, Tanaka Y. Effect of active vitamin D treatment on development of type 2 diabetes: DPVD randomised controlled trial in Japanese population. BMJ 2022; 377:e066222. [PMID: 35613725 PMCID: PMC9131780 DOI: 10.1136/bmj-2021-066222] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess whether eldecalcitol, an active vitamin D analogue2, can reduce the development of type 2 diabetes among adults with impaired glucose tolerance. DESIGN Double blinded, multicentre, randomised, placebo controlled trial. SETTING Three hospitals in Japan, between June 2013 and August 2019. PARTICIPANTS People aged 30 years and older who had impaired glucose tolerance defined by using a 75 g oral glucose tolerance test and glycated haemoglobin level. INTERVENTIONS Participants were randomised to receive active vitamin D (eldecalcitol 0.75 μg per day; n=630) or matching placebo (n=626) for three years. MAIN OUTCOMES The primary endpoint was incidence of diabetes. Prespecified secondary endpoints were regression to normoglycaemia and incidence of type 2 diabetes after adjustment for confounding factors at baseline. In addition, bone densities and bone and glucose metabolism markers were assessed. RESULTS Of the 1256 participants, 571 (45.5%) were women and 742 (59.1%) had a family history of type 2 diabetes. The mean age of participants was 61.3 years. The mean serum 25-hydroxyvitamin D concentration at baseline was 20.9 ng/mL (52.2 nmol/L); 548 (43.6%) participants had concentrations below 20 ng/mL (50 nmol/L). During a median follow-up of 2.9 years, 79 (12.5%) of 630 participants in the eldecalcitol group and 89 (14.2%) of 626 in the placebo group developed type 2 diabetes (hazard ratio 0.87, 95% confidence interval 0.67 to 1.17; P=0.39). Regression to normoglycaemia was achieved in 145 (23.0%) of 630 participants in the eldecalcitol group and 126 (20.1%) of 626 in the placebo group (hazard ratio 1.15, 0.93 to 1.41; P=0.21). After adjustment for confounding factors by multivariable fractional polynomial Cox regression analysis, eldecalcitol significantly lowered the development of diabetes (hazard ratio 0.69, 0.51 to 0.95; P=0.020). In addition, eldecalcitol showed its beneficial effect among the participants with the lower level of basal insulin secretion (hazard ratio 0.41, 0.23 to 0.71; P=0.001). During follow-up, bone mineral densities of the lumbar spine and femoral neck and serum osteocalcin concentrations significantly increased with eldecalcitol compared with placebo (all P<0.001). No significant difference in serious adverse events was observed. CONCLUSIONS Although treatment with eldecalcitol did not significantly reduce the incidence of diabetes among people with pre-diabetes, the results suggested the potential for a beneficial effect of eldecalcitol on people with insufficient insulin secretion. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000010758.
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Affiliation(s)
- Tetsuya Kawahara
- University of Occupational and Environmental Health, Kitakyushu, Japan
- Shin Komonji Hospital, Kitakyushu, Japan
| | - Gen Suzuki
- International University Health and Welfare Clinic, Ohtawara, Japan
| | | | | | | | - Chie Kawahara
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yosuke Okada
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Kitakyushu, Japan
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Abdulateef DS, Salih JM. Detection of C-Peptide in Scalp Hair of Healthy Adults. Diabetes Metab Syndr Obes 2020; 13:227-236. [PMID: 32099429 PMCID: PMC7006852 DOI: 10.2147/dmso.s240785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The C-peptide level from blood and urine samples represents endogenous insulin secretion and has clinical implications for individuals with and without diabetes. However, the study results are inconsistent and the available methods can only measure short-term C-peptide levels, which can be substantially affected by concurrent glycaemia. In this study, we evaluated whether C-peptide can be detected from hair? Hair C-peptide if detected could potentially represent long-term, insulin secretion. And to know whether there is any correlation between hair C-peptide with certain biochemical and demographic parameters. METHODS In a prospective observational study on 120 normal healthy individuals, hair samples were taken from the scalp and C-peptide was extracted. The hair C-peptide levels were measured in pg/mg of hair using electrochemiluminescence immunoassay (ECLISA) after methanol extraction and were compared among different age and body-type groups. Serum C-peptide, fasting plasma glucose (FPG) and HbA1c were assessed and their levels were correlated with anthropometric parameters. RESULTS A detectable range of C-peptide was found in the hair samples of all the subjects with a median of 63.59 pg/mg hair and it was positively correlated with FPG but no significant correlation was found between hair C-peptide and serum C-peptide levels. The hair C-peptide level, along with FPG and HbA1c, was significantly different according to age. CONCLUSION These results conclude that C-peptide can be detected from and measured in the scalp hair of humans and it is positively correlated with FPG, and it is significantly different according to age. This technique, if validated, may verify its usefulness in future studies of both healthy and diseased subjects.
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Affiliation(s)
- Darya S Abdulateef
- Physiology Department, College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
| | - Jamal M Salih
- Physiology Department, College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq
- Diabetes Physician, Diabetes and Endocrine Centre, Sulaymaniyah, Kurdistan Region, Iraq
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8
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Saravanan PB, Vasu S, Yoshimatsu G, Darden CM, Wang X, Gu J, Lawrence MC, Naziruddin B. Differential expression and release of exosomal miRNAs by human islets under inflammatory and hypoxic stress. Diabetologia 2019; 62:1901-1914. [PMID: 31372667 DOI: 10.1007/s00125-019-4950-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/29/2019] [Indexed: 01/24/2023]
Abstract
AIMS/HYPOTHESIS Pancreatic islets produce non-coding microRNAs (miRNAs) that regulate islet cell function and survival. Our earlier investigations revealed that human islets undergo significant damage due to various types of stresses following transplantation and release miRNAs. Here, we sought to identify and validate exosomal miRNAs (exo-miRNAs) produced by human islets under conditions of cellular stress, preceding loss of cell function and death. We also aimed to identify islet stress signalling pathways targeted by exo-miRNAs to elucidate potential regulatory roles in islet cell stress. METHODS Human islets were subjected to proinflammatory cytokine and hypoxic cell stress and miRNA from exosomes was isolated for RNA sequencing and analysis. Stress-induced exo-miRNAs were evaluated for kinetics of expression and release by intact islets for up to 48 h exposure to cytokines and hypoxia. A subset of stress-induced exo-miRNAs were assessed for recovery and detection as biomarkers of islet cell stress in a diabetic nude mouse xenotransplant model and in patients undergoing total pancreatectomy with islet auto-transplantation (TPIAT). Genes and signalling pathways targeted by stress-induced exo-miRNAs were identified by Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and direct interactions of miRNAs with downstream signalling targets were validated in human islet cells using the miRNA Tests for Read Analysis and Prediction (MirTrap) system. RESULTS Global exo-miRNA sequencing revealed that 879 miRNA species were released from human islets and 190 islet exo-miRNAs were differentially expressed in response to proinflammatory cytokines, hypoxia or both. Release of exo-miRNAs hsa-miR-29b-3p and hsa-miR-216a-5p was detected within 6 h of exposure to cytokines and hypoxia. The remaining subset of stress-induced exo-miRNAs, including hsa-miR-148a-3p and islet cell damage marker hsa-miR-375, showed delayed release at 24-48 h, correlating with apoptosis and cell death. Stress and damage exo-miRNAs were significantly elevated in the circulation in human-to-mouse xenotransplant models and in human transplant recipients. Elevated blood exo-miRNAs negatively correlated with post-transplant islet function based on comparisons of stress and damage exo-miRNA indices with Secretory Unit of Islet Transplant Objects (SUITO) indices. KEGG analysis and further validation of exo-miRNA targets by MirTrap analysis revealed significant enrichment of islet mRNAs involved in phosphoinositide 3-kinase/Akt and mitogen-activated protein kinase signalling pathways. CONCLUSIONS/INTERPRETATION The study identifies exo-miRNAs differentially expressed and released by islets in response to damage and stress. These exo-miRNAs could serve as potential biomarkers for assessing islet damage and predicting outcomes in islet transplantation. Notably, exo-miRNAs 29b-3p and 216a-5p could be detected in islets prior to damage-released miRNAs and indicators of cellular apoptosis and death. Thus, these stress-induced exo-miRNAs may have potential diagnostic value for detecting early islet stress prior to progressive loss of islet cell mass and function. Further investigations are warranted to investigate the utility of these exo-miRNAs as early indicators of islet cell stress during prediabetic conditions.
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Affiliation(s)
- Prathab Balaji Saravanan
- Division of Transplantation, Department of Surgery, Virginia Commonwealth University, Medical Center, Richmond, VA, USA
| | - Srividya Vasu
- Islet Cell Laboratory, Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Gumpei Yoshimatsu
- Islet Cell Laboratory, Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Carly M Darden
- Islet Cell Laboratory, Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Xuan Wang
- Islet Cell Laboratory, Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Jinghua Gu
- Islet Cell Laboratory, Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA
| | - Michael C Lawrence
- Islet Cell Laboratory, Baylor Scott and White Research Institute, 3434 Live Oak Street, Dallas, TX, 75204, USA.
| | - Bashoo Naziruddin
- Islet Cell Laboratory, Baylor Simmons Transplant Institute, 3410 Worth Street, Suite 950, Dallas, TX, 75246, USA.
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9
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Gołębiewska JE, Bachul PJ, Fillman N, Basto L, Kijek MR, Gołąb K, Wang LJ, Tibudan M, Thomas C, Dębska-Ślizień A, Gelrud A, Matthews JB, Millis JM, Fung J, Witkowski P. Assessment of simple indices based on a single fasting blood sample as a tool to estimate beta-cell function after total pancreatectomy with islet autotransplantation - a prospective study. Transpl Int 2018; 32:280-290. [PMID: 30353611 DOI: 10.1111/tri.13364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
We investigated six indices based on a single fasting blood sample for evaluation of the beta-cell function after total pancreatectomy with islet autotransplantation (TP-IAT). The Secretory Unit of Islet Transplant Objects (SUITO), transplant estimated function (TEF), homeostasis model assessment (HOMA-2B%), C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr) and BETA-2 score were compared against a 90-min serum glucose level, weighted mean C-peptide in mixed meal tolerance test (MMTT), beta score and the Igls score adjusted for islet function in the setting of IAT. We analyzed values from 32 MMTTs in 15 patients after TP-IAT with a follow-up of up to 3 years. Four (27%) individuals had discontinued insulin completely prior to day 75, while 6 out of 12 patients (50%) did not require insulin support at 1-year follow-up with HbA1c 6.0% (5.5-6.8). BETA-2 was the most consistent among indices strongly correlating with all reference measures of beta-cell function (r = 0.62-0.68). In addition, it identified insulin independence (cut-off = 16.2) and optimal/good versus marginal islet function in the Igls score well, with AUROC of 0.85 and 0.96, respectively. Based on a single fasting blood sample, BETA-2 score has the most reliable discriminant value for the assessment of graft function in patients undergoing TP-IAT.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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10
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Benedini S, Ermetici F, Briganti S, Codella R, Terruzzi I, Maffi P, Caldara R, Secchi A, Nano R, Piemonti L, Alejandro R, Ricordi C, Luzi L. Insulin-mimetic effects of short-term rapamycin in type 1 diabetic patients prior to islet transplantation. Acta Diabetol 2018; 55:715-722. [PMID: 29654388 DOI: 10.1007/s00592-018-1141-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The immunosuppressive drug rapamycin may influence insulin sensitivity in insulin-responsive tissues. AIMS This study aimed at evaluating the effectiveness of rapamycin pre-treatment before pancreatic islet allotransplantation (ITx) in patients with type 1 diabetes mellitus (T1DM). METHODS Forty-one T1DM patients were studied. Thirteen patients with poor glycemic control underwent a short-term rapamycin treatment before ITx (Group 1), and they were compared to 28 patients undergoing ITx without rapamycin pre-treatment (Group 2). Outcomes were daily insulin requirement (DIR), fasting blood glucose, HbA1c, C-peptide and the SUITO index of beta-cell function. A subgroup of patients pre-treated with rapamycin before ITx underwent euglycemic hyperinsulinemic clamp with [6,6-2H2] glucose before and after ITx to evaluate insulin sensitivity. RESULTS We found a significant reduction in DIR after rapamycin pre-treatment (- 8 ± 6 U/day, mean ± SD, p < 0.001) and 1 year after ITx. DIR reduction 1 year after ITx was greater in Group 1 as compared to Group 2 (- 37 ± 15 vs. - 19 ± 13 U/day, p = 0.005) and remained significant after adjusting for gender, age, glucose and baseline HbA1c (beta = 18.2 ± 5.9, p = 0.006). Fasting glucose and HbA1c significantly decreased 1 year after ITx in Group 1 (HbA1c: - 2.1 ± 1.4%, p = 0.002), while fasting C-peptide (+0.5 ± 0.3 nmol/l, p = 0.002) and SUITO index increased (+57.4 ± 39.7, p = 0.016), without differences between the two groups. Hepatic glucose production decreased after rapamycin pre-treatment (- 1.1 ± 1.1 mg/kg/min, p = 0.04) and after ITx (- 1.6 ± 0.6 mg/kg/min, p = 0.015), while no changes in peripheral glucose disposal were observed. CONCLUSIONS Rapamycin pre-treatment before ITx succeeds in reducing insulin requirement, enhancing hepatic insulin sensitivity. This treatment may improve short-term ITx outcomes, possibly in selected patients with T1DM complicated by insulin resistance. CLINICAL TRIAL Clinicaltrials.gov NCT01060605; NCT00014911.
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Affiliation(s)
- Stefano Benedini
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Federica Ermetici
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
| | - Silvia Briganti
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
| | - Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Maffi
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Rossana Caldara
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Secchi
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Rita Nano
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Piemonti
- Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Rodolfo Alejandro
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Camillo Ricordi
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Livio Luzi
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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11
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Gołębiewska J, Solomina J, Kijek MR, Kotukhov A, Basto L, Gołąb K, Bachul PJ, Konsur E, Ciepły K, Fillman N, Wang LJ, Thomas CC, Philipson LH, Tibudan M, Krenc A, Dębska-Ślizień A, Fung J, Witkowski P. External Validation of the Newly Developed BETA-2 Scoring System for Pancreatic Islet Graft Function Assessment. Transplant Proc 2018; 49:2340-2346. [PMID: 29198674 DOI: 10.1016/j.transproceed.2017.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND BETA-2 score using a single fasting blood sample was developed to estimate beta-cell function after islet transplantation (ITx) and was validated internally by a high ITx volume center (Edmonton). The goal was to validate BETA-2 externally, in our center. METHODS Areas under receiver operating characteristic curves (AUROCs) were obtained to see if beta score or BETA-2 would better detect insulin independence and glucose intolerance. RESULTS We analyzed values from 48 mixed meal tolerance tests (MMTTs) in 4 ITx recipients with a long-term follow-up to 140 months (LT group) and from 54 MMTTs in 13 short-term group patients (ST group). AUROC for no need for insulin support was 0.776 (95% confidence interval [CI] 0.539-1, P = .02) and 0.922 (95% CI 0.848-0.996, P < .001) for beta score and 0.79 (95% CI 0.596-0.983, P = .003) and 0.941 (95% CI 0.86-1, P < .001) for BETA-2, in LT and ST groups, respectively, and did not differ significantly. In LT group BETA-2 score ≥ 13.03 predicted no need for insulin supplementation with sensitivity of 98%, specificity of 50%, positive predictive value (PPV) of 93%, and negative predictive value (NPV) of 75%. In ST group the optimal cutoff was ≥13.63 with sensitivity of 92% and specificity, PPV, and NPV 82% to 95%. For the detection of glucose intolerance BETA-2 cutoffs were <19.43 in LT group and <17.23 in ST group with sensitivity > 76% and specificity, PPV, and NPV > 80% in both groups. CONCLUSION BETA-2 score was successfully validated externally and is a practical tool allowing for frequent and reliable assessments of islet graft function based on a single fasting blood sample.
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Affiliation(s)
- J Gołębiewska
- Department of Surgery, University of Chicago, Chicago, Illinois, USA; Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Solomina
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - M R Kijek
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Kotukhov
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - L Basto
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - K Gołąb
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - P J Bachul
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - E Konsur
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - K Ciepły
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - N Fillman
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - L-J Wang
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - C C Thomas
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - L H Philipson
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - M Tibudan
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Krenc
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Fung
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - P Witkowski
- Department of Surgery, University of Chicago, Chicago, Illinois, USA.
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12
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Gołębiewska JE, Solomina J, Thomas C, Kijek MR, Bachul PJ, Basto L, Gołąb K, Wang LJ, Fillman N, Tibudan M, Ciepły K, Philipson L, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Comparative evaluation of simple indices using a single fasting blood sample to estimate beta cell function after islet transplantation. Am J Transplant 2018; 18:990-997. [PMID: 29218834 DOI: 10.1111/ajt.14620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 01/25/2023]
Abstract
Six single fasting blood sample-based indices-Secretory Unit of Islet Transplant Objects (SUITO), Transplant Estimated Function (TEF), Homeostasis Model Assessment (HOMA)2-B%, C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr), and BETA-2 score-were compared against commonly used 90-minute mixed meal tolerance test (MMTT) serum glucose and beta score to assess which of them best recognizes the state of acceptable blood glucose control without insulin supplementation after islet allotransplantation (ITx). We also tested whether the indices could identify the success of ITx based on the Igls classification of beta cell graft function. We analyzed values from 47 MMTT tests in 4 patients with up to 140 months follow-up and from 54 MMTT tests in 13 patients with up to 42 months follow-up. SUITO, CP/G, HOMA2-B%, and BETA-2 correlated well with the 90-minute glucose of the MMTT and beta-score (r 0.54-0.76), whereas CP/GCr showed a modest performance (r 0.41-0.52) while TEF showed little correlation. BETA-2 and SUITO were the best identifiers and predictors of the need for insulin support, glucose intolerance, and ITx success (P < .001), while HOMA2-B% and TEF were unreliable. Single fasting blood sample SUITO and BETA-2 scores are very practical alternative tools that allow for frequent assessments of graft function.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Julia Solomina
- Department of Surgery, University of Chicago, Chicago, IL
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL
| | - Kamil Ciepły
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL
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13
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Clinical Benefit of Islet Xenotransplantation for the Treatment of Type 1 Diabetes. EBioMedicine 2016; 12:255-262. [PMID: 27592597 PMCID: PMC5078586 DOI: 10.1016/j.ebiom.2016.08.034] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Allogeneic islet transplantation has become a viable option for the treatment of unstable type 1 diabetes. However, the donor shortage and the necessity of the immunosuppressive drugs are two major issues. To solve these issues, we performed islet xenotransplantation using encapsulated neonatal porcine islets without immunosuppressive drugs. METHODS Two different doses (approximately 5000IEQ/kg and 10,000IEQ/kg) of encapsulated neonatal porcine islets were transplanted twice (total approximately 10,000IEQ/kg and 20,000IEQ/kg) into four type 1 diabetic patients in each group (total 8 patients). FINDINGS In the higher dose group, all four patients improved HbA1c. This was maintained at a level of <7% for >600days with significant reduction of the frequency of unaware hypoglycemic events. INTERPRETATION The clinical benefit of islet xenotransplantation with microencapsulation has been shown.
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14
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Abstract
PURPOSE OF REVIEW This article provides a summary of the current outcomes of β-cell replacement strategies, an algorithm for choosing a specific modality while highlighting associated advantages and disadvantages, and outlines remaining challenges and areas of active investigation in β-cell replacement therapy. RECENT FINDINGS The most recent reports of islet cell allotransplantation have shown improvements over previous eras and now rival some outcomes of pancreas alone transplantation. Active areas of investigation are focused on improving techniques for islet isolation, graft monitoring, and managing challenges posed by the innate and alloimmune systems. SUMMARY Patients with insulin-dependent diabetes who continue to experience life threatening hypoglycemia despite maximal medical management can benefit from β-cell replacement. Emerging nontransplant technologies have not provided a physiologic euglycemic state to the extent offered by transplantation. Islet transplantation eliminates hypoglycemic episodes/unawareness, facilitates normalization of hemoglobin A1c (HbA1c), decreases microvascular disease progression, and improves quality of life for patients with problematic diabetes. Mid- and long-term outcomes of islet transplantation performed at expert centers approximate those of registry reports of solitary pancreas transplant, whereas the complication profile is quite favorable.
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15
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Matsumoto S, Tan P, Baker J, Durbin K, Tomiya M, Azuma K, Doi M, Elliott RB. Clinical porcine islet xenotransplantation under comprehensive regulation. Transplant Proc 2015; 46:1992-5. [PMID: 25131091 DOI: 10.1016/j.transproceed.2014.06.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Xenotransplantation with porcine islets is a promising approach to overcome the shortage of human donors. This is the first report of phase 1/2a xenotransplantation study of encapsulated neonatal porcine islets under the current framework of regulations for xenotransplantation in New Zealand. METHODS Newborn piglets were anesthetized and bled, and the pancreata were removed with the use of sterile technique and processed. Encapsulated neonatal porcine islets were implanted with the use of laparoscopy into the peritoneal cavity of 14 patients with unstable type 1 diabetes without any immunosuppressive drugs. The patients received encapsulated islets of 5,000 (n = 4; group 1), 10,000 (n = 4; group 2), 15,000 (n = 4; group 3), or 20,000 (n = 2; group 4) islet equivalents per kg body weight. Outcome was determined from adverse event reports, HbA1c, total daily insulin dose, and frequency of unaware hypoglycemic events. To assess graft function, transplant estimated function (TEF) scores were calculated. Sufficient or marginal numbers of encapsulated neonatal porcine islets were transplanted into streptozotocin-induced diabetic B6 mice as an in vivo functional assay. RESULTS There were 4 serious adverse events, of which 3 were considered to be possibly related to the procedure. Tests for porcine endogenous retrovirus DNA and RNA were all negative. The numbers of unaware hypoglycemia events were reduced after transplantation in all groups. Four of 14 patients attained HbA1c <7% compared with 1 at baseline. The average TEF scores were 0.17, 0.02, -0.01, and 0.08 in groups 1, 2, 3, and 4 respectively. The in vivo study demonstrated that a sufficient number of the transplanted group reversed diabetes with positive porcine C-peptide. CONCLUSIONS Transplantation of encapsulated neonatal porcine islets was safe and was followed by a reduction in unaware hypoglycemia events in unstable type 1 diabetic patients. The mouse in vivo assessment data demonstrated certain graft function.
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Affiliation(s)
- S Matsumoto
- Otsuka Pharmaceutical Factory, Naruto, Japan.
| | - P Tan
- Living Cell Technologies, Auckland, New Zealand
| | - J Baker
- Centre for Clinical Research and Effective Practice, Middlemore Hospital, Auckland, New Zealand
| | - K Durbin
- Living Cell Technologies, Auckland, New Zealand
| | - M Tomiya
- Otsuka Pharmaceutical Factory, Naruto, Japan
| | - K Azuma
- Otsuka Pharmaceutical Factory, Naruto, Japan
| | - M Doi
- Otsuka Pharmaceutical Factory, Naruto, Japan
| | - R B Elliott
- Living Cell Technologies, Auckland, New Zealand
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16
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O'Gorman D, Kin T, Pawlick R, Imes S, Senior PA, Shapiro AMJ. Clinical islet isolation outcomes with a highly purified neutral protease for pancreas dissociation. Islets 2013; 5:111-5. [PMID: 23756701 PMCID: PMC4049837 DOI: 10.4161/isl.25222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pancreas dissociation is a critical initial component of the islet isolation procedure and introduces high variability based on factors including the enzyme type, specificity and potency. Product refinement and alterations to the application strategies have improved isolation outcomes over time; however, islet utilization from donor organs remains low. In this study we evaluate a low endotoxin-high activity grade neutral protease in clinical islet isolation. MATERIALS AND METHODS The use of a non-collagenolytic enzyme, either thermolysin or high active neutral protease, was randomized in clinical islet isolations to evaluate efficacy. Additionally a retrospective comparison to neutral protease NB was conducted. RESULTS The thermolysin group had lower trapped islet population and increased purity and post-culture islet mass in comparison to high active grade neutral protease. Comparison of neutral protease NB GMP grade to high active neutral protease displayed no measurable difference in islet mass or viability and transplantation outcomes at 1 mo post-transplant were favorable for both groups. CONCLUSIONS High activity neutral protease can generate clinical grade islets and may prove beneficial to islet function and viability based on a reduced endotoxin load but dosing of neutral protease requires ongoing optimization.
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Affiliation(s)
- Doug O'Gorman
- Clinical Islet Transplant Program; Department of Transplant Services; Alberta Health Services; Edmonton, AB Canada
| | - Tatsuya Kin
- Clinical Islet Transplant Program; Department of Transplant Services; Alberta Health Services; Edmonton, AB Canada
| | - Rena Pawlick
- Department of Surgery; Alberta Diabetes Institute; University of Alberta; Edmonton, AB Canada
| | - Sharleen Imes
- Clinical Islet Transplant Program; Department of Transplant Services; Alberta Health Services; Edmonton, AB Canada
| | - Peter A Senior
- Clinical Islet Transplant Program; Department of Transplant Services; Alberta Health Services; Edmonton, AB Canada
| | - AM James Shapiro
- Clinical Islet Transplant Program; Department of Transplant Services; Alberta Health Services; Edmonton, AB Canada
- Correspondence to: AM James Shapiro,
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