1
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Carbone A, Santelli F, Bottino R, Attena E, Mazzone C, Parisi V, D'Andrea A, Golino P, Nigro G, Russo V. Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Older age was associated to inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.
Methods and results
Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥ 80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR=3,15 (95% IC 1.45–6.83); p<0,01], coronary artery disease [OR= 3,6 (95% IC 1.41–9.1); p<0,01] and body mass index [OR=1,27 (1.14–1.41); p<0,01]. Overdosage was independently associated with diabetes mellitus [OR= 18 (3.36–96); p<0,01]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p<0,001).
Conclusion
In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs' overdosage (diabetes mellitus type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage resulted in less survival.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Carbone
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - F Santelli
- Federico II University of Naples, Naples, Italy
| | - R Bottino
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - E Attena
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - C Mazzone
- Cardiovascular Center, Trieste, Italy
| | - V Parisi
- Federico II University of Naples, Naples, Italy
| | - A D'Andrea
- Hospital Umberto I, Nocera Inferiore, Italy
| | - P Golino
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - G Nigro
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - V Russo
- university of Campania Luigi Vanvitelli, Naples, Italy
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2
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Islas F, Bottino R, Jimenez P, Nombela L, Marcos Alberca P, D'Amato M, Lepori A, Olmos C, Perez De Isla L, De Agustin A. Ventricular-arterial coupling in hypertensive patients after TAVR. It is not all about the valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In severe aortic stenosis, the left ventricle faces the challenge of the valvular load and the arterial load caused by abnormalities in systemic arterial compliance and systemic vascular resistance. The aim of this study is to assess the effect of hypertension control on left ventricular performance in patients that underwent TAVR.
Methods
68 consecutive patients who underwent TAVR were analyzed; all patients were evaluated to confirm severe aortic stenosis with transthoracic echo (TTE). Conventional echo parameters were assessed as well as left ventricular mechanics parameters and vascular parameters such as arterial elastance (Ea), ventricular elastance (Ees) and V/Ac; besides all patients underwent TTE prior to TAVR, at discharge and 90 days follow-up visit.
Results
Mean age was 82±5; mean aortic valve area was 0.69±0.19, mean left ventricular ejection fraction was 58.3±12.1 and mean ventricular-arterial coupling was 1.6±0.9. At 90 days follow up we observed a significant worsening in V/Ac in those patients with poor control of blood pressure (>140/90mmHg), (1.8±0.5 vs 2.1±0.3, p=0.03). Aortic impedance was significantly higher (4.4±1.4 vs 3.5±1.2, p=0.05); Ea and Ees were also significantly higher in hypertensive patients (2.3±0.8 vs 1.7±0.6, p=0.05) and (1.4±0.7 vs 0.9±0.6, p=0.01) respectively. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed a slightly reduction in hypertensive patients, although not statistically significant.
Conclusions
Control of blood pressure seems to be an important factor that contributes to a better or rather worse LV performance and could have a potential role in systolic function and clinical outcome of patients after TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - R Bottino
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Marcos Alberca
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - M D'Amato
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Lepori
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Perez De Isla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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3
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Schulte BM, Kers-Rebel ED, Bottino R, Piganelli JD, Galama JMD, Engelse MA, de Koning EJP, Adema GJ. Distinct activation of primary human BDCA1(+) dendritic cells upon interaction with stressed or infected β cells. Clin Exp Immunol 2016; 184:293-307. [PMID: 26888163 DOI: 10.1111/cei.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 12/16/2022] Open
Abstract
Derailment of immune responses can lead to autoimmune type 1 diabetes, and this can be accelerated or even induced by local stress caused by inflammation or infection. Dendritic cells (DCs) shape both innate and adaptive immune responses. Here, we report on the responses of naturally occurring human myeloid BDCA1(+) DCs towards differentially stressed pancreatic β cells. Our data show that BDCA1(+) DCs in human pancreas-draining lymph node (pdLN) suspensions and blood-derived BDCA1(+) DCs both effectively engulf β cells, thus mimicking physiological conditions. Upon uptake of enterovirus-infected, but not mock-infected cells, BDCA1(+) DCs induced interferon (IFN)-α/β responses, co-stimulatory molecules and proinflammatory cytokines and chemokines. Notably, induction of stress in β cells by ultraviolet irradiation, culture in serum-free medium or cytokine-induced stress did not provoke strong DC activation, despite efficient phagocytosis. DC activation correlated with the amount of virus used to infect β cells and required RNA within virally infected cells. DCs encountering enterovirus-infected β cells, but not those incubated with mock-infected or stressed β cells, suppressed T helper type 2 (Th2) cytokines and variably induced IFN-γ in allogeneic mixed lymphocyte reaction (MLR). Thus, stressed β cells have little effect on human BDCA1(+) DC activation and function, while enterovirus-infected β cells impact these cells significantly, which could help to explain their role in development of autoimmune diabetes in individuals at risk.
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Affiliation(s)
- B M Schulte
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E D Kers-Rebel
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R Bottino
- Department of Pediatrics, Diabetes Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - J D Piganelli
- Department of Pediatrics, Diabetes Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - J M D Galama
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen
| | - M A Engelse
- Department of Nephrology, Leiden University Medical Center, Leiden
| | - E J P de Koning
- Department of Nephrology, Leiden University Medical Center, Leiden.,Department of Endocrinology, Leiden University Medical Center, Leiden.,Hubrecht Institute, Utrecht, the Netherlands
| | - G J Adema
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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4
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Bottino R, Wijkstrom M, van der Windt D, Hara H, Ezzelarab M, Murase N, Bertera S, He J, Phelps C, Ayares D, Cooper D, Trucco M. Pig-to-monkey islet xenotransplantation using multi-transgenic pigs. Am J Transplant 2014; 14:2275-87. [PMID: 25220221 PMCID: PMC4169326 DOI: 10.1111/ajt.12868] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/28/2014] [Accepted: 06/07/2014] [Indexed: 01/25/2023]
Abstract
The generation of pigs with genetic modifications has significantly advanced the field of xenotransplantation. New genetically engineered pigs were produced on an α1,3-galactosyltransferase gene-knockout background with ubiquitous expression of human CD46, with islet beta cell-specific expression of human tissue factor pathway inhibitor and/or human CD39 and/or porcine CTLA4-lg. Isolated islets from pigs with 3, 4 or 5 genetic modifications were transplanted intraportally into streptozotocin-diabetic, immunosuppressed cynomolgus monkeys (n = 5). Immunosuppression was based on anti-CD154 mAb costimulation blockade. Monitoring included features of early islet destruction, glycemia, exogenous insulin requirement and histopathology of the islets at necropsy. Using these modified pig islets, there was evidence of reduced islet destruction in the first hours after transplantation, compared with two series of historical controls that received identical therapy but were transplanted with islets from pigs with either no or only one genetic modification. Despite encouraging effects on early islet loss, these multi-transgenic islet grafts did not demonstrate consistency in regard to long-term success, with only two of five demonstrating function beyond 5 months.
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Affiliation(s)
- R. Bottino
- Division of Immunogenetics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M. Wijkstrom
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - D.J. van der Windt
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - H. Hara
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M. Ezzelarab
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - N. Murase
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - S. Bertera
- Division of Immunogenetics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J. He
- Division of Immunogenetics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - C. Phelps
- Revivicor, Inc., Blacksburg, VA, USA
| | - D. Ayares
- Revivicor, Inc., Blacksburg, VA, USA
| | - D.K.C. Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M. Trucco
- Division of Immunogenetics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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5
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Stalder J, Tennstedt D, Deleuran M, Fabbrocini G, de Lucas R, Haftek M, Taieb C, Coustou D, Mandeau A, Fabre B, Hernandez-Pigeon H, Aries M, Galliano M, Duplan H, Castex-Rizzi N, Bessou-Touya S, Mengeaud V, Rouvrais C, Schmitt A, Bottino R, Cottin K, Saint Aroman M. Fragility of epidermis and its consequence in dermatology. J Eur Acad Dermatol Venereol 2014; 28 Suppl 4:1-18. [DOI: 10.1111/jdv.12509] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 12/11/2022]
Affiliation(s)
- J.F. Stalder
- Department of Dermatology; University Hospital of Nantes; Nantes France
| | - D. Tennstedt
- Department of Dermatology; Saint-Luc University Clinics; Brussels Belgium
| | - M. Deleuran
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - G. Fabbrocini
- Department of Dermatology; University Hospital of Naples; Naples Italy
| | - R. de Lucas
- Department of Dermatology; University Hospital La Paz; Madrid Spain
| | | | | | | | - A. Mandeau
- Herbal Product Laboratory; Institut de Recherche Pierre Fabre; Toulouse France
| | - B. Fabre
- Herbal Product Laboratory; Institut de Recherche Pierre Fabre; Toulouse France
| | | | - M.F. Aries
- Pierre Fabre Dermo-Cosmétique; Pharmacologie in vitro; Toulouse France
| | - M.F. Galliano
- Pierre Fabre Dermo-Cosmétique; Pharmacologie in vitro; Toulouse France
| | - H. Duplan
- Pierre Fabre Dermo-Cosmétique; Pharmacologie in vitro; Toulouse France
| | - N. Castex-Rizzi
- Pierre Fabre Dermo-Cosmétique; Pharmacologie in vitro; Toulouse France
| | - S. Bessou-Touya
- Pierre Fabre Dermo-Cosmétique; Pharmacologie in vitro; Toulouse France
| | - V. Mengeaud
- Pierre-Fabre Dermo-Cosmétique; European Center of Skin Research; Hôtel Dieu Toulouse France
| | - C. Rouvrais
- Pierre-Fabre Dermo-Cosmétique; European Center of Skin Research; Hôtel Dieu Toulouse France
| | - A.M. Schmitt
- Pierre-Fabre Dermo-Cosmétique; European Center of Skin Research; Hôtel Dieu Toulouse France
| | - R. Bottino
- Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - K. Cottin
- Pierre Fabre Dermo-Cosmétique; Lavaur France
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6
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Walsh RM, Saavedra JRA, Lentz G, Guerron AD, Scheman J, Stevens T, Trucco M, Bottino R, Hatipoglu B. Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. J Gastrointest Surg 2012; 16:1469-77. [PMID: 22673773 DOI: 10.1007/s11605-012-1914-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/15/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total pancreatectomy (TP) with auto-islet transplant (AIT) is an extreme treatment for chronic pancreatitis, and we reviewed our experience to assess the impact on quality of life (QOL). METHODS A prospective cohort study from 2007 through 2010 with pre- and postoperative assessments of the Depression Anxiety Stress Scale, Pain Disability Index, and visual analogue pain scale was performed. RESULTS Twenty patients underwent TP-AIT with a median follow-up of 12 months (6.75-24 months). All patients reported moderate (45 %) to severe (55 %) pain prior to surgery. TP-AIT resulted in significant decreases in abdominal pain (p < 0.001), 80 % reporting no or mild pain. Despite pain improvement, only 30 % discontinued narcotics. Improvements in all PDI QOL domains improved from 79 to 90 % (p = 0.002), with greatest improvements seen in those without prior pancreatic surgery, younger patients, and in those with higher levels of preoperative pain. Patients were less affected by depression and anxiety prior to surgery, but 60 and 70 % did show improvement in depression and anxiety, respectively (p = 0.033). Sixteen patients (80 %) required exogenous insulin at last follow-up (mean total dose of insulin 11.6 U/day). CONCLUSIONS TP-AIT significantly improves pain and QOL measures in appropriately selected patients with CP.
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Affiliation(s)
- R M Walsh
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
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7
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Van Der Windt DJ, Smetanka C, Macedo C, He J, Lakomy R, Bottino R, Ekser B, Echeverri GJ, Metes D, Ijzermans JNM, Trucco M, Cooper DKC, Lakkis FG. Investigation of lymphocyte depletion and repopulation using alemtuzumab (Campath-1H) in cynomolgus monkeys. Am J Transplant 2010; 10:773-783. [PMID: 20420638 DOI: 10.1111/j.1600-6143.2010.03050.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
As the target CD52 molecule is expressed on erythrocytes of most nonhuman primate strains, using alemtuzumab in these species would cause massive hemolysis. Six cynomolgus monkeys of Indonesian origin, screened by agglutination assay for absence of CD52 on erythrocytes, were administered alemtuzumab in a cumulative dose to a maximum of 60 mg/kg. In two monkeys, mycophenolate mofetil (MMF) was added as maintenance therapy. Complete depletion of T and B lymphocytes (>99.5%) was achieved with 20 mg/kg alemtuzumab and was more profound than in monkeys treated with antithymocyte globulin (n = 5), as quantified by flow cytometry. Repopulation was suppressed by weekly injections of 10 mg/kg. Without MMF, repopulation of CD20(+)B cells and CD8(+)T cells was complete within 2 and 3 months, respectively, and repopulation of CD4(+)T cells was 67% after 1 year. MMF significantly delayed CD4(+)T-cell repopulation. Among repopulating CD4(+) and CD8(+) T cells, a phenotypic shift was observed from CD45RA(hi)CD62L(hi) naïve cells toward CD45RA(lo)CD62L(lo) effector memory cells. In lymph nodes, the depletion of naïve cells was more profound than of memory cells, which may have initiated a proliferation of memory cells. This model offers opportunities to investigate lymphocyte depletion/repopulation phenomena, as well as the efficacy of alemtuzumab in preclinical transplantation models.
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Affiliation(s)
- D J Van Der Windt
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.,Department of Pediatrics, Division of Immunogenetics, Children's Hospital of Pittsburgh, Pittsburgh, PA.,Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C Smetanka
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - C Macedo
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - J He
- Department of Pediatrics, Division of Immunogenetics, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - R Lakomy
- Department of Pediatrics, Division of Immunogenetics, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - R Bottino
- Department of Pediatrics, Division of Immunogenetics, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - B Ekser
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - G J Echeverri
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.,Transplantation Unit, Fundacion Valle del Lili, Cali, Colombia
| | - D Metes
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA
| | - J N M Ijzermans
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Trucco
- Department of Pediatrics, Division of Immunogenetics, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - D K C Cooper
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - F G Lakkis
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA
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8
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van der Windt DJ, Bottino R, Casu A, Campanile N, Smetanka C, He J, Murase N, Hara H, Ball S, Loveland BE, Ayares D, Lakkis FG, Cooper DKC, Trucco M. Long-term controlled normoglycemia in diabetic non-human primates after transplantation with hCD46 transgenic porcine islets. Am J Transplant 2009; 9:2716-26. [PMID: 19845582 DOI: 10.1111/j.1600-6143.2009.02850.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Xenotransplantation of porcine islets into diabetic non-human primates is characterized by (i) an initial massive graft loss possibly due to the instant blood-mediated inflammatory reaction and (ii) the requirement of intensive, clinically unfriendly immunosuppressive therapy. We investigated whether the transgenic expression of a human complement-regulatory protein (hCD46) on porcine islets would improve the outcome of islet xenotransplantation in streptozotocin-induced diabetic Cynomolgus monkeys. Immunosuppression consisted of thymoglobulin, anti-CD154 mAb for costimulation blockade, and mycophenolate mofetil. Following the transplantation of islets from wild-type pigs (n = 2) or from 1,3-galactosyltransferase gene-knockout pigs (n = 2), islets survived for a maximum of only 46 days, as evidenced by return to hyperglycemia and the need for exogenous insulin therapy. The transplantation of islets from hCD46 pigs resulted in graft survival and insulin-independent normoglycemia in four of five monkeys for the 3 months follow-up of the experiment. One normalized recipient, selected at random, was followed for >12 months. Inhibition of complement activation by the expression of hCD46 on the pig islets did not substantially reduce the initial loss of islet mass, rather was effective in limiting antibody-mediated rejection. This resulted in a reduced need for immunosuppression to preserve a sufficient islet mass to maintain normoglycemia long-term.
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Affiliation(s)
- D J van der Windt
- Division of Immunogenetics, Department of Pediatrics, Children's Hospital of Pittsburgh, of UPMC Pittsburgh, PA, USA
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9
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Echeverri GJ, McGrath K, Bottino R, Hara H, Dons EM, van der Windt DJ, Ekser B, Casu A, Houser S, Ezzelarab M, Wagner R, Trucco M, Lakkis FG, Cooper DKC. Endoscopic gastric submucosal transplantation of islets (ENDO-STI): technique and initial results in diabetic pigs. Am J Transplant 2009; 9:2485-96. [PMID: 19775318 DOI: 10.1111/j.1600-6143.2009.02815.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The results of transplantation of human donor islets into the portal vein (PV) in patients with diabetes are encouraging. However, there are complications, for example, hemorrhage, thrombosis and an immediate loss of islets through the 'instant blood-mediated inflammatory reaction' (IBMIR). The gastric submucosal space (GSMS) offers potential advantages. Islets were isolated from adult pigs. Recipient pigs were made diabetic by streptozotocin. Donor islets were injected into the GSMS through a laparotomy (Group 1A, n = 4) or endoscopically (Group 1B, n = 8) or into the PV through a laparotomy (Group 2, n = 3). The pigs were followed for a maximum of 28 days. Monitoring of C-peptide in Group 1 indicated that there was minimal immediate loss of islets whereas in Group 2 there was considerable loss from IBMIR. In Group 1, there were significant reductions in mean blood glucose and mean exogenous insulin requirement between pretransplantation and 20 days posttransplantation. In Group 2, there was no significant reduction in either parameter. Insulin-positive cells were seen in the GSMS in Group 1, but not in the liver in Group 2. Endoscopic gastric submucosal transplantation of islets (ENDO-STI) offers a minimally invasive and quick approach to islet transplantation, avoids IBMIR and warrants further exploration.
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Affiliation(s)
- G J Echeverri
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Pearson T, Shultz LD, Lief J, Burzenski L, Gott B, Chase T, Foreman O, Rossini AA, Bottino R, Trucco M, Greiner DL. A new immunodeficient hyperglycaemic mouse model based on the Ins2Akita mutation for analyses of human islet and beta stem and progenitor cell function. Diabetologia 2008; 51:1449-56. [PMID: 18563383 PMCID: PMC2719841 DOI: 10.1007/s00125-008-1057-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/24/2008] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS To develop and validate a new immunodeficient mouse strain that spontaneously develops a non-autoimmune hyperglycaemia to serve as a diabetic host for human islets and human beta stem and progenitor cells without the need for induction of hyperglycaemia by toxic chemicals with their associated side effects. METHODS We generated and characterised a new strain of immunodeficient spontaneously hyperglycaemic mice, the NOD-Rag1null Prf1null Ins2Akita strain and compared this strain with the NOD-scid Il2rgammanull (also known as Il2rg) immunodeficient strain rendered hyperglycaemic by administration of a single dose of streptozotocin. Hyperglycaemic mice were transplanted with human islets ranging from 1,000 to 4,000 islet equivalents (IEQ) and were monitored for normalisation of blood glucose levels. RESULTS NOD-Rag1null Prf1null Ins2Akita mice developed spontaneous hyperglycaemia, similar to Ins2Akita-harbouring strains of immunocompetent mice. Histological examination of islets in the host pancreas validated the spontaneous loss of beta cell mass in the absence of mononuclear cell infiltration. Human islets transplanted into spontaneously diabetic NOD-Rag1null Prf1null Ins2Akita and chemically diabetic NOD-scid Il2rgammanull mice resulted in a return to euglycaemia that occurred with transplantation of similar beta cell masses. CONCLUSIONS/INTERPRETATION The NOD-Rag1null Prf1null Ins2Akita mouse is the first immunodeficient, spontaneously hyperglycaemic mouse strain described that is based on the Ins2Akita mutation. This strain is suitable as hosts for human islet and human beta stem and progenitor cell transplantation in the absence of the need for pharmacological induction of diabetes. This strain of mice also has low levels of innate immunity and can be engrafted with a human immune system for the study of human islet allograft rejection.
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Affiliation(s)
- T. Pearson
- Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | | | - J. Lief
- Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | | | - B. Gott
- The Jackson Laboratory, Bar Harbor, ME, USA
| | - T. Chase
- The Jackson Laboratory, Bar Harbor, ME, USA
| | - O. Foreman
- The Jackson Laboratory, Bar Harbor, ME, USA
| | - A. A. Rossini
- Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - R. Bottino
- Division of Immunogenetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - M. Trucco
- Division of Immunogenetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - D. L. Greiner
- Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
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Casu A, Bottino R, Balamurugan AN, Hara H, van der Windt DJ, Campanile N, Smetanka C, Cooper DKC, Trucco M. Metabolic aspects of pig-to-monkey (Macaca fascicularis) islet transplantation: implications for translation into clinical practice. Diabetologia 2008; 51:120-9. [PMID: 17960359 DOI: 10.1007/s00125-007-0844-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 08/30/2007] [Indexed: 01/03/2023]
Abstract
AIMS/HYPOTHESIS Attempts to use an alternative source of islets to restore glucose homeostasis in diabetic patients require preclinical islet xenotransplantation models to be tested. These models raise questions about metabolic compatibility between species and the most appropriate metabolic parameters to be used to monitor graft function. The present study investigated and compared relevant gluco-metabolic parameters in pigs, monkeys and the pig-to-monkey islet transplantation model to gain insight into the potential clinical outcome of pig-to-human islet transplantation. METHODS Basal and IVGTT-stimulated blood glucose, C-peptide, insulin and glucagon levels were assessed in non-diabetic pigs and monkeys. The same parameters were used to evaluate the performance of porcine islet xenografts in diabetic monkeys. RESULTS Non-diabetic cynomolgus monkeys showed lower levels of fasting and stimulated blood glucose but higher levels of C-peptide and insulin than non-diabetic pigs. The reported levels in humans lie between those of monkeys and pigs, and differences in metabolic parameters between pigs and humans appear to be smaller than those between pigs and cynomolgus monkeys. The transplantation data indicated that the degree of graft function (evaluated by the measurement of C-peptide levels) necessary to normalise blood glucose in the recipient was determined by the recipient levels rather than by the donor levels. CONCLUSIONS/INTERPRETATION The differences between donor and recipient species may affect the transplantation outcome and need to be considered when assessing graft function in xenotransplantation models. Given the differences between monkeys and humans as potential recipients of pig islets, it should be easier to reach glucose homeostasis in pig-to-human than in pig-to-non-human primate islet xenotransplantation.
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Affiliation(s)
- A Casu
- Division of Immunogenetics, Department of Pediatrics, Children's Hospital of Pittsburgh, Rangos Research Centre, Rm 6103, 3460 Fifth Avenue, Pittsburgh, PA 15213, USA.
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12
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Abstract
The promising results obtained using the "Edmonton protocol" for human islet transplantation has resulted in increased interest and growth of various clinical and basic science programs worldwide. Despite these encouraging results two major drawbacks remain: first, the immunosuppressive regimen necessary to prevent the rejection of this allotransplant dramatically affects the lifestyle of the treated patients precluding its implementation in younger diabetic individuals. Second, there continues to be an inadequate amount of islet tissue available to fulfill the needs of an increasing population of diabetic patients possibly interested in receiving this type of treatment. Besides the limited number of cadaveric organ donors, the current procedure used to isolate islets from their pancreata activates metabolic processes that promote the loss of beta cells in the islets. Thus, it becomes necessary to use more than one donor for a single recipient. To fulfill the continuously growing need for more transplantable islets, an immediately available, unlimited source of islets may be found in animals, which are able to produce a type of insulin that is very similar to the human one, and carry islets in quantities that may satisfy the metabolic requirements of diabetic patients: the pigs.
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Affiliation(s)
- M Trucco
- Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy.
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13
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Balamurugan AN, Chang Y, Bertera S, Sands A, Shankar V, Trucco M, Bottino R. Suitability of human juvenile pancreatic islets for clinical use. Diabetologia 2006; 49:1845-54. [PMID: 16783471 DOI: 10.1007/s00125-006-0318-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 04/20/2006] [Indexed: 01/07/2023]
Abstract
AIMS/HYPOTHESIS The limited availability of deceased donor pancreases suitable for pancreas and islet transplantation calls for a broader utilisation of donor tissue for transplantation purposes. Young donors, representing, fortunately, a minor but significant pool of individuals, have been largely under-employed, mainly because of anatomical and functional incompatibilities with potential recipients. For islet transplantation, the isolation of pancreatic islets from young donors rarely occurs, because of technical problems. As a result of the peculiar characteristics of young donor pancreases, the standard isolation procedure does not allow efficient separation of the islets from the surrounding exocrine tissue, and favours the generation of mantled islets. Nonetheless, young donor islets offer high qualitative and clinically appealing characteristics. SUBJECTS AND METHODS We standardised a modified methodology to obtain purified and mantle-free human islets from young donors. This method principally involves efficient delivery of isolation enzyme with reduced mechanical disruption of the pancreas combined with additional filtration steps. RESULTS We were able to obtain purified and mantle-free human islets from donors as young as 6 months of age with good morphological and functional properties. The good qualitative characteristics of the islets, evidenced in vitro, were proven in vivo, as they were qualitatively superior to islets of older donors in transplantation studies. CONCLUSIONS/INTERPRETATION This study justifies the utilisation of islets derived from young donors for islet transplantation.
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Affiliation(s)
- A N Balamurugan
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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14
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Rood PPM, Buhler LH, Bottino R, Trucco M, Cooper DKC. Pig-to-nonhuman primate islet xenotransplantation: a review of current problems. Cell Transplant 2006; 15:89-104. [PMID: 16719044 DOI: 10.3727/000000006783982052] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Islet allotransplantation has been shown to have potential as a treatment for type 1 diabetic patients. Xenotransplantation, using the pig as a donor, offers the possibility of an unlimited number of islets. This comprehensive review focuses on experience obtained in pig-to-nonhuman primate models, particularly with regard to the different types of islets (fetal, neonatal, adult) and isolation procedures used, and the methods to determine islet viability. The advantages and disadvantages of the methods to induce diabetes (pancreatectomy, streptozotocin) are discussed. Experience in pig-to-nonhuman primate islet transplantation studies is reviewed, including discussion of the possible mechanisms of rejection and the immunosuppressive regimens used. The research carried out to date has led to workable animal models to study islet xenotransplantation, but several questions regarding methodology remain unanswered, and details of these practicalities require to be adequately addressed. The encouraging porcine islet survival reported recently provides an indicator for future immunosuppressive regimens.
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Affiliation(s)
- P P M Rood
- Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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15
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Cattarelli D, Spandrio M, Gasparoni A, Bottino R, Offer C, Chirico G. A randomised, double blind, placebo controlled trial of the effect of theophylline in prevention of vasomotor nephropathy in very preterm neonates with respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 2006; 91:F80-4. [PMID: 16204359 PMCID: PMC2672685 DOI: 10.1136/adc.2005.073650] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Vasomotor nephropathy is a common renal dysfunction in very preterm neonates. OBJECTIVE To determine whether theophylline could prevent vasomotor nephropathy in very preterm infants with respiratory distress syndrome. METHODS A randomised, double blind, placebo controlled trial of 50 preterm infants of gestational age < or = 32 weeks needing assisted ventilation. Infants received an intravenous dose of theophylline (1 mg/kg) or placebo for three days. The 24 hour urine volume was measured daily. On days 2, 5, and 11, blood samples and 12 hour urine collections were analysed for electrolytes, creatinine, and urea. RESULTS On day 1, urine output was significantly higher in the theophylline (2.4 (0.9) ml/kg/h) than the placebo (1.6 (1.0) ml/kg/h; p = 0.023) group (values are mean (SD)). The incidence of oligoanuria was significantly lower in the theophylline treated (5%) than the placebo (33%) group. Twenty four hours after the first administration of theophylline/placebo, serum creatinine concentration was significantly lower in the theophylline (0.76 (0.23) mg/dl) than the placebo (1.0 (0.41) mg/dl; p = 0.025) group. On day 5 an increase in serum creatinine was observed in both groups. On day 11 a significant reduction in serum creatinine was observed, compared with day 5, with no difference between the two groups. CONCLUSION The results suggest that, in very preterm infants with respiratory distress syndrome, early theophylline administration improves renal function during the first two days of life.
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Affiliation(s)
- D Cattarelli
- Department of Neonatology and Neonatal Intensive Care, Spedali Civili, 25123 Brescia, Italy
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16
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Rehman KK, Wang Z, Bottino R, Balamurugan AN, Trucco M, Li J, Xiao X, Robbins PD. Efficient gene delivery to human and rodent islets with double-stranded (ds) AAV-based vectors. Gene Ther 2005; 12:1313-23. [PMID: 15858610 DOI: 10.1038/sj.gt.3302530] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Transplantation of allogeneic pancreatic islets is an effective approach to treat type 1 diabetes. To bypass the need for systemic administration of immunosuppression drugs following transplantation, approaches to genetically modify allogeneic islets to express anti-inflammatory, immunosuppressive, or antiapoptotic proteins prior to transplantation are being developed. Adeno-associated viral (AAV) based vectors have been used for gene transfer to islets, but the efficiency of functional transduction is low. Recently, double-stranded (ds) or double-copy (dc) based AAV vectors have been developed that allow for more rapid and efficient AAV-mediated transgene expression following transduction. Here we demonstrate that intact human and murine islets can be transduced with dsAAV2-eGFP efficiently compared to single-stranded AAV2-eGFP. Furthermore, our results demonstrate that murine islets transduced with dsAAV2-eGFP have normal islet glucose responsiveness, viability, and islet insulin content. Transplantation of the dsAAV2-eGFP transduced islet restored normal glycemia in diabetic mice without eliciting an immune response. Significant dsAAV2-mediated eGFP expression was observed in the islet grafts for at least 6 months post-transplant. Finally, we demonstrated that dsAAV serotypes 2, 6, and 8 infect human islets efficiently. Taken together, these results suggest that dsAAV based vectors are highly appropriate for gene transfer to islets to facilitate transplantation.
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Affiliation(s)
- K K Rehman
- Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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17
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Machen J, Bertera S, Chang Y, Bottino R, Balamurugan AN, Robbins PD, Trucco M, Giannoukakis N. Prolongation of islet allograft survival following ex vivo transduction with adenovirus encoding a soluble type 1 TNF receptor–Ig fusion decoy. Gene Ther 2004; 11:1506-14. [PMID: 15229635 DOI: 10.1038/sj.gt.3302320] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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] [Indexed: 11/09/2022]
Abstract
Islet transplantation is a viable long-term therapeutic alternative to daily insulin replacement for type I diabetes. The allogeneic nature of the transplants poses immunological challenges for routine clinical utility. Gene transfer of immunoregulatory molecules and those that improve insulin release kinetics provides rational approaches to facilitate allogeneic islet transplantation as a potential therapy. We have examined the efficacy of a soluble type 1 tumor necrosis factor receptor (TNFR) immunoglobulin-Fc fusion transgene (TNFR-Ig) to protect human islets from cytokine-induced apoptosis in culture, as well as in facilitating allogeneic islet transplants in diabetic mice. Cultured human islets were transduced with an adenoviral vector encoding human TNFR-Ig (Ad-TNFR-Ig). TNFR-Ig protein was secreted by cultured islets, as well as by transduced mouse islet transplants recovered from mouse recipients. Glucose-induced insulin release kinetics were comparable among untransduced, Ad-TNFR-Ig-infected human islets and vector-transduced islets exposed to cytokines. In parallel, Ad-TNFR-Ig-infected islets were protected from cytokine-induced apoptosis activation. Finally, diabetic mice transplanted with allogeneic islets expressing TNFR-Ig returned to and maintained normoglycemia significantly longer than untransduced islet recipients. These data support the potential utility of TNFR-Ig gene transfer to islets as a means of facilitating allogeneic islet transplantation.
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Affiliation(s)
- J Machen
- Diabetes Institute, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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18
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Abstract
AIM To reduce the problems caused by prolonged artificial ventilation in babies with Congenital Central Hypoventilation syndrome (CCHS). METHODS Two term infants with CCHS, weighing 4030 g and 3100 g, respectively, at the beginning of treatment and aged 53 and 31 d, respectively, were successfully ventilated with a Nasal Bilevel Positive Airway Pressure (N-BiPAP) device. RESULTS In the first patient the tcPO2 recordings (mean +/- SD) during sleep were 46 +/- 12 mmHg before using N-BiPAP and 58 +/- 13 mmHg after using the device, while those for tcPCO2 were 75 +/- 9 mmHg and 49 +/- 11 mmHg, respectively. In the second patient tcPO2 during sleep was 42 +/- 3 mmHg before, and 55 +/- 5 after N-BiPAP, and for tcPCO2 the recordings were 119 +/- 24 mmHg and 55 +/- 6 mmHg, respectively, showing a significant improvement. One infant had persistent gastro-oesophageal reflux, and frontal skin abrasion caused by the face mask. Nevertheless, these complications did not necessitate the discontinuation of N-BiPAP ventilation, thus precluding prolonged use of intubation and tracheotomy. CONCLUSION In infants with CCHS, early use of non-invasive, positive-pressure ventilation with N-BiPAP, in association with careful monitoring, can decrease problems caused by prolonged intubation and tracheotomy.
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Affiliation(s)
- C Migliori
- Division of Neonatology and Neonatal Intensive Care, Spedali Civili, Brescia, Italy.
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19
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Abstract
Type 1 diabetes mellitus, an autoimmune disorder is an attractive candidate for gene and cell-based therapy. From the use of gene-engineered immune cells to induce hyporesponsiveness to autoantigens to islet and beta cell surrogate transplants expressing immunoregulatory genes to provide a local pocket of immune privilege, these strategies have demonstrated proof of concept to the point where translational studies can be initiated. Nonetheless, along with the proof of concept, a number of important issues have been raised by the choice of vector and expression system as well as the point of intervention; prophylactic or therapeutic. An assessment of the current state of the science and potential leads to the conclusion that some strategies are ready for safety trials while others require varying degrees of technical and conceptual refinement.
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Affiliation(s)
- R Bottino
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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20
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Gasparoni A, Ciardelli L, De Amici D, Castellazzi AM, Autelli M, Bottino R, Polito E, Bartoli A, Rondini G, Chirico G. Effect of general and epidural anaesthesia on thyroid hormones and immunity in neonates. Paediatr Anaesth 2002; 12:59-64. [PMID: 11849577 DOI: 10.1046/j.1460-9592.2002.00752.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to verify if variations of thyroid hormones related to circumstances of delivery and mode of maternal anaesthesia can contribute to neonatal neutrophil respiratory burst and natural killer cell activity. METHODS We evaluated 10 infants born by vaginal delivery (group A), 10 infants born by caesarean section after epidural anaesthesia with lidocaine (group B) and 10 infants born by caesarean section after general anaesthesia with sevoflurane (group C). RESULTS A significant reduction of neutrophil respiratory burst test was found in groups A and C compared with group B. Natural killer cell (NK) activity with an effector : target ratio of 30 : 1 (NK30) and 10 : 1 (NK10) was significantly higher in group A compared with the B and C groups. In addition, thyroid stimulating hormone (TSH) concentration was significantly reduced in group A compared with the B and C groups. A significant negative correlation was found between TSH and NK30 or NK10. CONCLUSIONS Our results suggest that the mode of delivery and anaesthesia can significantly modify the endocrine-immune system in the newborn. Caesarean section delivery with regional anaesthesia seems to produce fewer modifications of neonatal immune function compared with general anaesthesia.
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Affiliation(s)
- A Gasparoni
- Research Laboratories, Policlinico San Matteo, IRCCS, Pavia, Italy.
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21
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Angelico MC, Alejandro R, Nery J, Webb M, Bottino R, Kong SS, Karatzas T, Olson L, Tzakis AG, Ricordi C. Transplantation of islets of Langerhans in patients with insulin-requiring diabetes mellitus undergoing orthotopic liver transplantation--the Miami experience. J Mol Med (Berl) 1999; 77:144-7. [PMID: 9930950 DOI: 10.1007/s001090050323] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 01/12/2023]
Abstract
Most patients with cirrhosis of the liver have detectable insulin resistance. In 60-80% of patients with cirrhosis, impaired glucose tolerance can be uncovered; approximately 20% of these patients eventually develop overt diabetes. Theoretically, insulin resistance and glucose intolerance could be improved or reversed by orthotopic liver transplantation alone or in association with a simultaneous transplant of pancreatic islet cells from the same donor. To investigate these possibilities we initiated a pilot study of simultaneous liver and pancreatic islet cell transplantation in seven patients with diabetes and liver cirrhosis. Donor bone marrow cells were also infused to enhance the acceptance of the grafts. Seven patients who received only orthotopic liver transplantation and donor bone marrow cells were used as historical controls. The preliminary results of this pilot trial suggest that islet cell transplantation in conjunction with orthotopic liver transplantation improves glucose metabolism in patients with liver cirrhosis in association with reduced insulin requirements and HbA1c levels. These results were evident in spite of pre- and post-transplant basal C-peptide levels that were unchanged. Further evaluation of the effects of orthotopic liver transplantation with or without islet cell transplantation will require a randomized prospective trial including accurate metabolic evaluation with the euglycemic insulin clamp technique.
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Affiliation(s)
- M C Angelico
- Cell Transplant Center, Diabetes Research Institute, Miami, FL 33136, USA
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22
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Lehmann R, Fernandez LA, Bottino R, Szabo S, Ricordi C, Alejandro R, Kenyon NS. Evaluation of islet isolation by a new automated method (Coulter Multisizer Ile) and manual counting. Transplant Proc 1998; 30:373-4. [PMID: 9532086 DOI: 10.1016/s0041-1345(97)01314-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Lehmann
- Diabetes Research Institute, Miami, FL 33136, USA
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23
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Bottino R, Fernandez LA, Ricordi C, Lehmann R, Tsan MF, Oliver R, Inverardi L. Transplantation of allogeneic islets of Langerhans in the rat liver: effects of macrophage depletion on graft survival and microenvironment activation. Diabetes 1998; 47:316-23. [PMID: 9519734 DOI: 10.2337/diabetes.47.3.316] [Citation(s) in RCA: 202] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Early impairment of islet function and graft loss limit the success of allogeneic islet transplantation. Nonspecific inflammatory events occurring at the transplant site immediately after grafting, involving the production of cytokines and free radicals and sinusoidal endothelial cell (SEC) activation, may contribute to islet cell damage. To evaluate whether Kupffer cell inactivation would result in prolonged allograft survival in a model system of intrahepatic islet transplantation in rats, we systemically administered either gadolinium chloride (GdCl3) or dichloromethylene diphosphonate (Cl2MDP) to assess the effects of macrophage inactivation on rejection and on the release of proinflammatory molecules, as well as to assess the functional profile of SEC. The results obtained were compared with those observed in untreated, sham-injected animals and in rats receiving intraportal infusions of microbeads. Transient macrophage inhibition, particularly in hepatic Kupffer cells, is associated with significant prolongation of graft survival after intraportal islet allotransplantation (ITx) in rats: 7.2 days in the control group versus 11.9 days in the GdCl3 group (P < 0.01) and 15.6 days in the Cl2MDP group (P < 0.0006), respectively. Although systemic release of inflammatory mediators was observed only when islet transplantations were performed and it could be inhibited by macrophage-targeting treatments, perturbation of the functional profile of endothelial cells was also observed when microembolization was induced by the use of microbeads and could not be prevented by macrophage inhibition. These experiments provide evidence to support the concept that macrophages play a key role in early inflammatory events known to adversely affect islet engraftment and suggest that manipulation of nonspecific immune activation by inhibition of macrophage function may facilitate hepatic engraftment of islet allografts. The mechanisms mediating this effect are likely to include prevention of release of tumor necrosis factor-alpha, interleukin-1beta, and NO and interference with the rate of immune response to the islets.
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Affiliation(s)
- R Bottino
- Diabetes Research Institute, Cell Transplant Center, University of Miami School of Medicine, Florida 33136, USA
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24
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Abstract
Enzymatic digestion of donor pancreases is a vital step in human and large mammalian islet isolation. The variable enzymatic activities of different batches of commercially available collagenase is a major obstacle in achieving reproducibility in islet isolation procedures. In the present work, the effectiveness of Liberase, a standardized mixture of highly purified enzymes recently developed for the separation of human islets, was compared with that of a traditional collagenase preparation (type P). The results of 50 islet isolations using Liberase enzyme were compared with those of 36 isolations with collagenase, type P. No significant differences in donor age, cold ischemia time, digestion time, or weight of the pancreases were observed between the two groups. Islet yield was significantly higher in the group where the Liberase enzyme was used. All parameters examined (islet number, islet number per gram of tissue, islet equivalent number, and islet equivalent number per gram of tissue) were significantly improved when Liberase enzyme was used. Different lots of Liberase enzyme were tested, and no difference was observed. Islets isolated with Liberase enzyme were also of larger size and were much less fragmented, suggesting a gentler enzymatic action and better preservation of anatomical integrity. Islets isolated with Liberase enzyme, assessed both in vitro and in vivo, revealed a functional profile similar to that of islets separated with collagenase. Liberase enzyme appears, therefore, to represent a new powerful tool for improving the quality of human islet isolation.
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Affiliation(s)
- E Linetsky
- Diabetes Research Institute, University of Miami School of Medicine, and the Miami Veterans Administration Medical Center, Florida 33136, USA
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25
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Fernandez L, Lehmann R, Selvaggi G, Kong SS, Bottino R, Li H, Linetsky E, Kenyon NS, Alejandro R, Ricordi C. Influence of variables on canine islet isolation results. Transplant Proc 1997; 29:1950. [PMID: 9193466 DOI: 10.1016/s0041-1345(97)00171-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- L Fernandez
- Diabetes Research Institute, University of Miami, Florida, USA
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26
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Fernandez L, Bottino R, Oliver R, Lehmann R, Ricordi C, Fu Tsan M, Inverardi L. Endothelial cell dysfunction after intraportal islet cell transplant in rats. Transplant Proc 1997; 29:2064-5. [PMID: 9193528 DOI: 10.1016/s0041-1345(97)00233-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- L Fernandez
- Diabetes Research Institute, University of Miami, Florida, USA
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27
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Affiliation(s)
- E Linetsky
- Diabetes Research Institute, University of Miami School of Medicine, FL 33136, USA
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28
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Bartlett RJ, Secore SL, Bottino R, Fernandez L, Inverardi L, Ricordi C. Use of biolistic particle accelerator to introduce genes into isolated islets of Langerhans. Transplant Proc 1997; 29:2201-2. [PMID: 9193589 DOI: 10.1016/s0041-1345(97)00295-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R J Bartlett
- Diabetes Research Institute, University of Miami, FL 33136, USA
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29
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Linetsky E, Li H, Fernandez L, Bottino R, Lehmann R, Selvaggi G, Ricordi C. Variables affecting human vertebral body marrow yields. Transplant Proc 1997; 29:1959. [PMID: 9193474 DOI: 10.1016/s0041-1345(97)00179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Linetsky
- Diabetes Research Institute, University of Miami School of Medicine, FL 33101, USA
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30
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Bottino R, Fernandez L, Ricordi C, Oliver R, Lehmann R, Tsan MF, Inverardi L. Transient macrophage inactivation decreases the occurrence of early graft loss in rodents. Transplant Proc 1997; 29:2057. [PMID: 9193523 DOI: 10.1016/s0041-1345(97)00228-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R Bottino
- Diabetes Research Institute, University of Miami, School of Medicine, Florida, USA
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31
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Bottino R, Inverardi L, Valente U, Ricordi C. Serum-free medium and pyruvate improve survival and glucose responsiveness of islet beta cells in culture. Transplant Proc 1997; 29:1978. [PMID: 9193486 DOI: 10.1016/s0041-1345(97)00191-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R Bottino
- Diabetes Research Institute, University of Miami, School of Medicine, Florida, USA
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Bottino R, Fernandez L, Oliver R, Inverardi L, Ricordi C. Iothalamate and ioversol radiocontrasts do not affect islet survival and production of nitric oxide after intrahepatic transplant in rodents. Transplant Proc 1997; 29:2079. [PMID: 9193535 DOI: 10.1016/s0041-1345(97)00240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R Bottino
- Diabetes Research Institute, University of Miami School of Medicine, Florida, USA
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Ricordi C, Angelico MC, Alejandro R, Nery J, Webb M, Bottino R, Kong SS, Karatzas T, Olson L, Mintz DH, Tzakis AG. Liver-islet transplantation in type 2 diabetes. Transplant Proc 1997; 29:2240. [PMID: 9193608 DOI: 10.1016/s0041-1345(97)00314-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C Ricordi
- Department of Surgery, University of Miami School of Medicine, Florida, USA
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Kong SS, Selvaggi G, Fernandez LA, Bottino R, Alejandro R, Ricordi C. Effect of extrapancreatic collagenase concentration on canine islet isolation outcome. Transplant Proc 1997; 29:1954. [PMID: 9193470 DOI: 10.1016/s0041-1345(97)00175-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S S Kong
- Cell Transplant Center, University of Miami School of Medicine, FL 33136, USA
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Affiliation(s)
- G Selvaggi
- Diabetes Research Institute, University of Miami, Florida, USA
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Ricordi C, Alejandro R, Angelico MC, Fernandez LA, Nery J, Webb M, Bottino R, Selvaggi G, Khan FA, Karatzas T, Olson L, Mintz DH, Tzakis AG. Human islet allografts in patients with type 2 diabetes undergoing liver transplantation. Transplantation 1997; 63:473-5. [PMID: 9039943 DOI: 10.1097/00007890-199702150-00025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Most patients with cirrhosis have insulin resistance and impaired glucose tolerance, and 20% eventually develop diabetes. Although diabetes in this setting may be reversible after orthotopic liver transplantation (OLTx), immunosuppressive agents administered after transplantation could exacerbate this disease. We report the results of the first pilot trial of islet cell transplantation (ICTx) in patients with diabetes undergoing OLTx. METHODS Five patients with diabetes and liver cirrhosis underwent OLTx and ICTx. Donor bone marrow cells were also infused to enhance the acceptance of the graft. We identified seven patients who received only OLTx and donor bone marrow cells as historical controls. RESULTS Preliminary results suggest that ICTx in conjunction with OLTx may improve glucose metabolism (insulin requirement, hemoglobin A1c) in patients with liver cirrhosis. However, there was virtually no change in pre- and posttransplant basal C-peptide levels in the recipients of OLTx + ICTx. CONCLUSIONS We are planning to further evaluate the effect of OLTx with or without ICTx in a randomized prospective trial, using euglycemic insulin clamp studies.
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Affiliation(s)
- C Ricordi
- Department of Surgery, University of Miami School of Medicine, Florida 33136, USA
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Selvaggi G, Ricordi C, Bottino R, Tzakis AG. Liver transplantation without immunosuppression: future perspectives. Ital J Gastroenterol 1996; 28:246-9. [PMID: 8842842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It has been hypothesized that a state of microchimerism in recipients of organ transplants may result in donor-specific tolerance to the graft. Numerous studies show that infusion of donor-derived bone marrow cells can, indeed, achieve systemic chimerism in the recipient and effectively prolong allograft survival. We have compared organ and patient survival in recipients of liver allografts alone (controls) or in combination with single or multiple infusions of donor bone marrow cells; recipients were infused either at day 0 (perioperatively) or at day 0 and 11 post-transplant. The incidence of rejection episodes and survival of the liver allograft were significantly reduced in recipients of two bone marrow infusions compared to controls; recipients of one infusion, conversely, experienced a higher number of rejection episodes when compared to controls, pointing to a possible sensitizing role of a single bone marrow infusion if administered perioperatively. Variables such as timing, number and composition of the bone marrow inocula still remain to be elucidated but may be of critical importance for the attainment of a state of donor-specific tolerance without the need for immunosuppressive therapy in recipients of organ allografts.
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Affiliation(s)
- G Selvaggi
- Diabetes Research Institute, Cell Transplant Center, Miami, FL 33136, USA
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Affiliation(s)
- R Bottino
- Cell Transplant Center, University of Miami School of Medicine, Florida 33136, USA
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Bottino R, Linetsky E, Selvaggi G, Kong SS, Qian T, Ricordi C. Human vertebral body bone marrow harvest: comparison between manual and automated methods. Transplant Proc 1995; 27:3340. [PMID: 8539981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R Bottino
- Department of Cell Transplant, University of Miami, School of Medicine, FL 33136, USA
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Linetsky E, Selvaggi G, Bottino R, Kong SS, Qian T, Alejandro R, Ricordi C. Comparison of collagenase type P and Liberase during human islet isolation using the automated method. Transplant Proc 1995; 27:3264. [PMID: 8539944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- E Linetsky
- Diabetes Research Institute, University of Miami School of Medicine, FL 33101, USA
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Ricordi C, Angelico MC, Alejandro R, Bottino R, Linetsky E, Selvaggi G, Mintz DH, Tzakis A. Islet transplantation in type II diabetes. Transplant Proc 1995; 27:3166. [PMID: 8539892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C Ricordi
- Diabetes Research Institute, University of Miami School of Medicine, FL 33136, USA
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Ricordi C, Karatzas T, Selvaggi G, Neri J, Fernandez H, Ruiz MP, Linetsky E, Kong SS, Webb M, Bottino R. Enhanced allograft acceptance by multiple infusions of donor bone marrow in humans. Transplant Proc 1995; 27:3381. [PMID: 8540006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C Ricordi
- Diabetes Research Institute, University of Miami School of Medicine, FL 33136, USA
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Kenyon NS, Xu XM, Knapp J, Selvaggi GS, Bottino R, Kong SS, Qian T, Linetsky E, Ricordi C. Automated processing of human vertebral body bone marrow yields preparations with stem cell content similar to that obtained with traditional manual preparation. Transplant Proc 1995; 27:3418. [PMID: 8540030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- N S Kenyon
- Diabetes Research Institute, University of Miami School of Medicine, Florida 33101, USA
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Kong SS, Selvaggi G, Kenyon N, Bottino R, Linetsky E, Ricordi C. A simple method for depletion of bone fragments from human vertebral body marrow. Transplant Proc 1995; 27:3417. [PMID: 8540029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- S S Kong
- Diabetes Research Institute, University of Miami School of Medicine, FL 33101, USA
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Spinillo A, Ometto A, Bottino R, Piazzi G, Iasci A, Rondini G. Antenatal risk factors for germinal matrix hemorrhage and intraventricular hemorrhage in preterm infants. Eur J Obstet Gynecol Reprod Biol 1995; 60:13-9. [PMID: 7635224 DOI: 10.1016/0028-2243(95)02052-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study was designed to evaluate the effect of antenatal risk factors on the occurrence of germinal matrix hemorrhage or intraventricular hemorrhage in preterm infants. STUDY DESIGN Antenatal factors were evaluated in 302 infants delivered between 24 and 33 completed weeks gestation. Ultrasonographic screening of intracranial hemorrhage was carried out in all the infants. The association between risk factors and neonatal intracranial hemorrhage was evaluated with both univariate and multivariate models. RESULTS In stepwise logistic regression analysis, birthweight was a better predictor of neonatal germinal matrix hemorrhage than gestational age. Conversely, gestational age better predicted intraventricular hemorrhage than did birthweight. Risk factors for neonatal germinal matrix hemorrhage and intraventricular hemorrhage were dissimilar. A history of heavy (> 10 cigarettes/day) maternal smoking on admission increased the risk of germinal matrix hemorrhage three-fold (odds ratio = 3.35; 95% C.I. 1.24-9.07). Antenatal corticosteroid use reduced the risk of intraventricular hemorrhage by 76% (odds ratio = 0.24; 95% C.I. 0.09-0.61). Among patients with spontaneous preterm delivery or premature rupture of fetal membranes, the presence of labor was a significant effect modifier of the gestational-age associated risk of germinal matrix hemorrhage-intraventricular hemorrhage. CONCLUSIONS Risk factors for neonatal germinal matrix hemorrhage are different from those for intraventricular hemorrhage. Most antenatal factors, especially those affecting fetal maturity, could influence the progression rather than the onset of intracranial hemorrhage.
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Affiliation(s)
- A Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S. Matteo, Italy
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Viviani GL, Bottino R, Zecchi A, Sanna R, Cavo M, Fontana I, Arcuri V, Lione L, Stubinski R, Falzetti G. Application of the hydraulic shaking system method to isolation of human pancreatic islets. Transplant Proc 1994; 26:3436-7. [PMID: 7998208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- G L Viviani
- Department of Endocrinology and Metabolism, University of Genova, Italy
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Hurley AC, Bottino R, Volicer L. Nursing role in advance proxy planning for Alzheimer patients. Caring 1994; 13:72-6. [PMID: 10171933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Patients with Alzheimer's disease or other types of dementia become unable to make decisions regarding their care. Advance proxy planning provides a mechanism for protecting these patients' self-determination.
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Affiliation(s)
- A C Hurley
- E.N. Rogers Memorial Veterans Hospital, Bedford, MA
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48
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Fontana I, Arcuri V, Tommasi GV, Viviani GL, Pellicci R, Bottino R, Casolino V, Stubinski R, Valente U. Long-term follow-up of human islet autotransplantation. Transplant Proc 1994; 26:581. [PMID: 8171565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- I Fontana
- Department of Surgery, University of Genoa, S. Martino Hospital, Italy
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49
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Viviani GL, Fontana I, Zecchi A, Bottino R, Sanna R, Lione L, Sacchi G, Falzetti G, Valente U, Adezati L. Isolation of pig pancreatic islets by a new method with hydraulic shaking: preliminary report. Transpl Int 1992. [DOI: 10.1111/tri.1992.5.s1.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Viviani GL, Fontana I, Zecchi A, Bottino R, Sanna R, Lione L, Sacchi G, Falzetti G, Valente U, Adezati L. Isolation of pig pancreatic islets by a new method with hydraulic shaking: preliminary report. Transpl Int 1992; 5 Suppl 1:S272-3. [PMID: 14621799 DOI: 10.1007/978-3-642-77423-2_86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The limited availability of human pancreas represents a serious problem in islet transplantation. In the past few years many efforts have been made to isolate pancreatic islets from large mammals in order to achieve valid and reproducible isolation methods. For several reasons swine may be considered an ideal source of islet tissue because of the similarity between human and porcine insulin and because of the easy availability of pig pancreata. Some papers have been published recently on this topic with good results. However, some problems, such as islet dissociation into single cells after collagenase digestion, are not completely solved. In this article, an automated method involving a hydraulic shaking system is described for islet isolation from the pig pancreas, developed in our laboratory and derived from Ricordi's model.
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Affiliation(s)
- G L Viviani
- Department of Endocrinology and Metabolism, University of Genova, Genova, Italy
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