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Clarke BM, Kireta S, Johnston J, Christou C, Greenwood JE, Hurtado PR, Manavis J, Coates PT, Torpy DJ. In Vivo Formation of Adrenal Organoids in a Novel Porcine Model of Adrenocortical Cell Transplantation. Endocrinology 2024; 165:bqae086. [PMID: 39028678 DOI: 10.1210/endocr/bqae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
Recognizing the limitations of current therapies for Addison's disease, novel treatments that replicate dynamic physiologic corticosteroid secretion, under control of ACTH, are required. The aim of these experiments was to evaluate the feasibility of adrenocortical cell transplantation (ACT) in a large animal model, adapting methods successfully used for intracutaneous pancreatic islet cell transplantation, using a fully biodegradable temporizing matrix. Autologous porcine ACT was undertaken by bilateral adrenalectomy, cell isolation, culture, and intracutaneous injection into a skin site preprepared using a biodegradable temporizing matrix (BTM) foam. Hydrocortisone support was provided during adrenocortical cell engraftment and weaned as tolerated. Blood adrenocortical hormone concentrations were monitored, and the transplant site was examined at endpoint. Outcome measures included cellular histochemistry, systemic hormone production, and hydrocortisone independence. Transplanted adrenocortical cells showed a capability to survive and proliferate within the intracutaneous site and an ability to self-organize into discrete tissue organoids with features of the normal adrenal histologic architecture. Interpretation of systemic hormone levels was confounded by the identification of accessory adrenals and regenerative cortical tissue within the adrenal bed postmortem. Corticosteroids were unable to be completely ceased. ACT in a large animal model has not previously been attempted, yet it is an important step toward clinical translation. These results demonstrate rhe potential for ACT based on the development of adrenal organoids at the BTM site. However, the inability to achieve clinically relevant systemic hormone production suggests insufficient function, likely attributable to insufficient cells through delivered dose and subsequent proliferation.
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Affiliation(s)
- Brigette Marie Clarke
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
- Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Adelaide 5011, Australia
| | - Svjetlana Kireta
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Julie Johnston
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Chris Christou
- Preclinical Imaging Research Laboratories, South Australian Health and Medical Research Institute, Gilles Plains 5086, Australia
| | | | - Plinio R Hurtado
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Jim Manavis
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - Patrick Toby Coates
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - David J Torpy
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
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Gürün E, Akdulum İ. Shear-wave elastography evaluation of adrenal glands in healthy newborns: a preliminary study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1724-1728. [PMID: 34909905 DOI: 10.1590/1806-9282.20210825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Establishing standard shear-wave elastography (SWE) values for healthy newborns can help distinguish normal conditions of the adrenal gland (AG) from pathological conditions. We aimed to establish a reference data set for AG stiffness values using SWE in healthy newborns. METHODS The quantitative stiffness of the AG was measured in the coronal plane in kilopascal (kPa). The quantitative descriptive statistics were presented as mean with standard deviation and median with range. The relationship between the quantitative variables was calculated using "Spearman's rank correlation coefficient test." The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability. A p-value <0.05 was considered statistically significant. RESULTS A total of 120 AGs of 60 healthy newborns (30 females and 30 males) was examined. The mean stiffness values of the right AG for the first and second visits were 7.51±2.45 and 7.54±2.49 kPa, respectively, and those of the left AG for the first and second visits were 7.60±2.03 and 7.42±1.97 kPa, respectively. There was no statistically significant difference between the mean values of adrenal stiffness and the length and width of AG and weight, height, and age (p>0.05). The ICC values for mean stiffness values of each AG were >0.80-0.90, indicating good intraobserver agreement. CONCLUSIONS This study is the first SWE study to evaluate the AG in healthy newborns. Our study's data can be used as a reference for future research.
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Affiliation(s)
- Enes Gürün
- Samsun University, Department of Radiology - Samsun, Turkey
| | - İsmail Akdulum
- Gazi University, Department of Radiology - Ankara, Turkey
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Wilson JB, Zopey M, Augustine J, Schaffer R, Chiang M, Friedman TC. High Prevalence of Adrenal Remnant Tissue in Patients Undergoing Bilateral Adrenalectomy for Cushing's Disease. Horm Metab Res 2021; 53:161-168. [PMID: 33091942 PMCID: PMC8570053 DOI: 10.1055/a-1253-2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Bilateral adrenalectomy (BLA) is a treatment option for patients with Cushing's Disease (CD) if transsphenoidal pituitary surgery fails or is not a therapeutic option. For most patients, BLA eliminates endogenous glucocorticoid and mineralocorticoid production, but for a small number of patients, endogenous secretion of adrenal hormones from adrenal tissue continues or recurs, leading to signs and symptoms of hypercortisolism. If adrenal tissue is confined to the adrenal bed, it is considered adrenal remnant tissue, while if it is outside the adrenal bed, it is considered adrenal rest tissue. We retrospectively evaluated morning serum cortisol, nighttime serum cortisol, nighttime salivary cortisol, and 24-h urine free cortisol on at least three occasions in 10 patients suspected of having endogenous cortisol production. Imaging of adrenal remnant tissue was also reviewed. Ten of 51 patients who underwent BLA during this time period had adrenal remnant/rest tissue marked by detectable endogenous glucocorticoid production; 9 of the 10 patients had signs and symptoms of hypercortisolism. Localization and treatment proved difficult. We conclude that the incidence of adrenal remnant/rest tissue in those undergoing BLA following unsuccessful pituitary surgery was 12% although there may have been a selection bias affecting this prevalence. The first indication of remnant tissue occurrence is a reduction in glucocorticoid replacement with symptoms of hypercortisolism. If this occurs, endogenous cortisol production should be tested for by cortisol measurements using a highly specific cortisol assay while the patient is taking dexamethasone or no glucocorticoid replacement. Endocrinologists need to monitor the development of both adrenal remnant tissue and Nelson's syndrome following BLA.
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Affiliation(s)
- Julian B. Wilson
- Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Mohan Zopey
- Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Jaimie Augustine
- Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Randolph Schaffer
- Department of Surgery, Scripps Green Hospital, La Jolla, CA, 92037, USA
| | - Manfred Chiang
- Brookfield Surgical Associates, Brookfield, WI 53005, USA
| | - Theodore C. Friedman
- Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
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