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Keymeulen B, Gillard P, Mathieu C, Movahedi B, Maleux G, Delvaux G, Ysebaert D, Roep B, Vandemeulebroucke E, Marichal M, In 't Veld P, Bogdani M, Hendrieckx C, Gorus F, Ling Z, van Rood J, Pipeleers D. Correlation between beta cell mass and glycemic control in type 1 diabetic recipients of islet cell graft. Proc Natl Acad Sci U S A 2006; 103:17444-9. [PMID: 17090674 PMCID: PMC1859948 DOI: 10.1073/pnas.0608141103] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Islet grafts can induce insulin independence in type 1 diabetic patients, but their function is variable with only 10% insulin independence after 5 years. We investigated whether cultured grafts with defined beta cell number help standardize metabolic outcome. Nonuremic C-peptide-negative patients received an intraportal graft with 0.5-5.0 x 10(6) beta cells per kilogram of body weight (kg BW) under antithymocyte globulin and mycophenolate mofetil plus tacrolimus. Metabolic outcome at posttransplant (PT) month 2 was used to decide on a second graft under maintenance mycophenolate mofetil/tacrolimus. Graft function was defined by C-peptide >0.5 ng/ml and reduced insulin needs, metabolic control by reductions in HbA(1c), glycemia coefficient of variation, and hypoglycemia. At PT month 2, graft function was present in 16 of 17 recipients of >2 x 10(6) beta cells per kg BW versus 0 of 5 with lower number. The nine patients with C-peptide >1 ng/ml and glycemia coefficient of variation of <25% did not receive a second graft; five of them were insulin-independent until PT month 12. The 12 others received a second implant; it achieved insulin-independence at PT month 12 when the first and second graft contained >2 x 10(6) beta cells per kg BW. Of the 20 recipients of at least one graft with >2 x 10(6) beta cells per kg BW, 17 maintained graft function and metabolic control up to PT month 12. At PT month 12, beta cell function in insulin-independent patients ranged around 25% of age-matched control values. Thus, 1-year metabolic control can be reproducibly achieved and standardized by cultured islet cell grafts with defined beta cell number.
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Affiliation(s)
- Bart Keymeulen
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Pieter Gillard
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Babak Movahedi
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Geert Maleux
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Georges Delvaux
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Dirk Ysebaert
- Department of Surgery, Universitair Ziekenhuis Antwerpen, University of Antwerp, B-2650 Antwerp, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Bart Roep
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Evy Vandemeulebroucke
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Miriam Marichal
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Peter In 't Veld
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Marika Bogdani
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Christel Hendrieckx
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Frans Gorus
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Zhidong Ling
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
| | - Jon van Rood
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
- To whom correspondence may be addressed. E-mail:
| | - Daniel Pipeleers
- *Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium
- Juvenile Diabetes Research Foundation Center for Beta Cell Therapy in Diabetes, B-1090 Brussels, Belgium
- **To whom correspondence may be addressed at:
Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium. E-mail:
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Farag SS, Bacigalupo A, Eapen M, Hurley C, Dupont B, Caligiuri MA, Boudreau C, Nelson G, Oudshoorn M, van Rood J, Velardi A, Maiers M, Setterholm M, Confer D, Posch PE, Anasetti C, Kamani N, Miller JS, Weisdorf D, Davies SM. The Effect of KIR Ligand Incompatibility on the Outcome of Unrelated Donor Transplantation: A Report from the Center for International Blood and Marrow Transplant Research, the European Blood and Marrow Transplant Registry, and the Dutch Registry. Biol Blood Marrow Transplant 2006; 12:876-84. [PMID: 16864058 DOI: 10.1016/j.bbmt.2006.05.007] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 05/17/2006] [Indexed: 11/28/2022]
Abstract
Matching for HLA class I alleles, including HLA-C, is an important criterion for outcome of unrelated donor transplantation. However, haplotype-mismatched transplantations for myeloid malignancies, mismatched for killer immunoglobulin-like receptor (KIR) ligands in the graft-versus-host (GVH) direction, is associated with lower rates of graft-versus-host disease (GVHD), relapse, and mortality. This study investigated the effect of KIR ligand mismatching on the outcome of unrelated donor transplantation. The outcomes after 1571 unrelated donor transplantations for myeloid malignancies where donor-recipient pairs were HLA-A, -B, -C, and -DRB1 matched (n = 1004), GVH KIR ligand-mismatched (n = 137), host-versus-graft (HVG) KIR ligand-mismatched (n = 170), and HLA-B and/or -C-mismatched but KIR ligand-matched (n = 260) were compared using Cox regression models. Treatment-related mortality (TRM), treatment failure, and overall mortality were lowest after matched transplantations. Patients who received grafts from donors mismatched at the KIR ligand in the GVH or HVG direction and mismatched at HLA-B and/or C but matched at the KIR ligand had similar rates of TRM, treatment failure, and overall mortality. There were no differences in leukemia recurrence between the 4 groups. These results do not support the choice of an unrelated donor on the basis of KIR ligand mismatch determined from HLA typing.
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