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Elhabashy SA, Sherif EMM, Salah NY, Elkader MAEA, Youssef DAH. Uncontrolled type 1 diabetes among Egyptian adolescents; risk determinants and clinical outcomes. DIABETES EPIDEMIOLOGY AND MANAGEMENT 2022; 6:100051. [DOI: 10.1016/j.deman.2022.100051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Akil AAS, Yassin E, Al-Maraghi A, Aliyev E, Al-Malki K, Fakhro KA. Diagnosis and treatment of type 1 diabetes at the dawn of the personalized medicine era. J Transl Med 2021; 19:137. [PMID: 33794915 PMCID: PMC8017850 DOI: 10.1186/s12967-021-02778-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 12/21/2022] Open
Abstract
Type 1 diabetes affects millions of people globally and requires careful management to avoid serious long-term complications, including heart and kidney disease, stroke, and loss of sight. The type 1 diabetes patient cohort is highly heterogeneous, with individuals presenting with disease at different stages and severities, arising from distinct etiologies, and overlaying varied genetic backgrounds. At present, the “one-size-fits-all” treatment for type 1 diabetes is exogenic insulin substitution therapy, but this approach fails to achieve optimal blood glucose control in many individuals. With advances in our understanding of early-stage diabetes development, diabetes stratification, and the role of genetics, type 1 diabetes is a promising candidate for a personalized medicine approach, which aims to apply “the right therapy at the right time, to the right patient”. In the case of type 1 diabetes, great efforts are now being focused on risk stratification for diabetes development to enable pre-clinical detection, and the application of treatments such as gene therapy, to prevent pancreatic destruction in a sub-set of patients. Alongside this, breakthroughs in stem cell therapies hold great promise for the regeneration of pancreatic tissues in some individuals. Here we review the recent initiatives in the field of personalized medicine for type 1 diabetes, including the latest discoveries in stem cell and gene therapy for the disease, and current obstacles that must be overcome before the dream of personalized medicine for all type 1 diabetes patients can be realized.
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Affiliation(s)
- Ammira Al-Shabeeb Akil
- Department of Human Genetics-Precision Medicine Program, Sidra Medicine, P.O. Box 26999, Doha, Qatar.
| | - Esraa Yassin
- Department of Human Genetics-Precision Medicine Program, Sidra Medicine, P.O. Box 26999, Doha, Qatar
| | - Aljazi Al-Maraghi
- Department of Human Genetics-Precision Medicine Program, Sidra Medicine, P.O. Box 26999, Doha, Qatar
| | - Elbay Aliyev
- Department of Human Genetics-Precision Medicine Program, Sidra Medicine, P.O. Box 26999, Doha, Qatar
| | - Khulod Al-Malki
- Department of Human Genetics-Precision Medicine Program, Sidra Medicine, P.O. Box 26999, Doha, Qatar
| | - Khalid A Fakhro
- Department of Human Genetics-Precision Medicine Program, Sidra Medicine, P.O. Box 26999, Doha, Qatar.,Department of Genetic Medicine, Weill Cornell Medicine, P.O. Box 24144, Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University, P.O. Box 34110, Doha, Qatar
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3
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Nilsen L, Santos BND, Leopoldo VC, Reis PEDD, Oliveira MCD, Clark AM, Silveira RCDCP. Nursing interventions in autologous stem cell transplantation for autoimmune diseases. J Adv Nurs 2020; 76:3473-3482. [PMID: 32989824 DOI: 10.1111/jan.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/16/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022]
Abstract
AIMS To identify clinical symptoms and nursing interventions for stem cell therapy in autoimmune diseases. DESIGN This is a retrospective, cross-sectional study. METHODS This study was undertaken with patients diagnosed with type 1 diabetes or multiple sclerosis, undergoing autologous haematopoietic stem cell transplantation from January 2004 - December 2018. Data were registered in a questionnaire, taken during the conditioning regimen comprising cyclophosphamide and rabbit anti-thymocyte globulin. Descriptive statistics and Fisher's exact test were used for data analysis. RESULTS There were 68 and 23 patients in the multiple sclerosis and type 1 diabetes groups respectively. Skin rash, nausea, vomiting and fever were more frequent and diverse in the type 1 diabetes group. Steroids were used as prophylaxis for anti-thymocyte globulin-associated allergic reactions in 97% of multiple sclerosis patients. Most of the identified symptoms and nursing interventions were more associated with one or other disease group (p < .05) and were more frequent in the type 1 diabetes group. CONCLUSION Patients with autoimmune diseases who underwent stem cell therapy present differences in their repertoire of adverse events and require disease-specific nursing actions. IMPACT Our results may enable nurses to establish transplant and disease-specific guidelines to improve prevention and management of adverse events and therefore optimize patient care and therapeutic success.
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Affiliation(s)
- Loren Nilsen
- Ribeirão Preto Medical School Clinical Hospital, University of São Paulo, Ribeirão Preto, Brazil
| | - Bruna N Dos Santos
- Ribeirão Preto Medical School Clinical Hospital, University of São Paulo, Ribeirão Preto, Brazil
| | - Vanessa C Leopoldo
- Ribeirão Preto Medical School Clinical Hospital, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria C de Oliveira
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Loretelli C, Assi E, Seelam AJ, Ben Nasr M, Fiorina P. Cell therapy for type 1 diabetes. Expert Opin Biol Ther 2020; 20:887-897. [PMID: 32299257 DOI: 10.1080/14712598.2020.1748596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Type 1 diabetes (T1D) is a lifelong condition resulting from autoimmune destruction of insulin-producing β-cells. Islet or whole-pancreas transplantation is limited by the shortage of donors and need for chronic immune suppression. Novel strategies are needed to prevent β-cell loss and to rescue production of endogenous insulin. AREAS COVERED This review covers the latest advances in cell-based therapies for the treatment and prevention of T1D. Topics include adoptive transfer of cells with increased immunoregulatory potential for β-cell protection, and β-cell replacement strategies such as generation of insulin-producing β-like cells from unlimited sources. EXPERT OPINION Cell therapy provides an opportunity to prevent or reverse T1D. Adoptive transfer of autologous cells having enhanced immunomodulatory properties can suppress autoimmunity and preserve β-cells. Such therapies have been made possible by a combination of genome-editing techniques and transplantation of tolerogenic cells. In-vitro modified autologous hematopoietic stem cells and tolerogenic dendritic cells may protect endogenous and newly generated β-cells from a patient's autoimmune response without hampering immune surveillance for infectious agents and malignant cellular transformations. However, methods to generate cells that meet quality and safety standards for clinical applications require further refinement.
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Affiliation(s)
- Cristian Loretelli
- International Center for T1D, Pediatric Clinical Research Center "Romeo Ed Enrica Invernizzi", Department of Biomedical and Clinical Science L. Sacco, Università Degli Studi Di Milano , Milan, Italy
| | - Emma Assi
- International Center for T1D, Pediatric Clinical Research Center "Romeo Ed Enrica Invernizzi", Department of Biomedical and Clinical Science L. Sacco, Università Degli Studi Di Milano , Milan, Italy
| | - Andy Joe Seelam
- International Center for T1D, Pediatric Clinical Research Center "Romeo Ed Enrica Invernizzi", Department of Biomedical and Clinical Science L. Sacco, Università Degli Studi Di Milano , Milan, Italy
| | - Moufida Ben Nasr
- International Center for T1D, Pediatric Clinical Research Center "Romeo Ed Enrica Invernizzi", Department of Biomedical and Clinical Science L. Sacco, Università Degli Studi Di Milano , Milan, Italy.,Nephrology Division, Boston Children's Hospital, Harvard Medical School , Boston, MA, USA
| | - Paolo Fiorina
- International Center for T1D, Pediatric Clinical Research Center "Romeo Ed Enrica Invernizzi", Department of Biomedical and Clinical Science L. Sacco, Università Degli Studi Di Milano , Milan, Italy.,Nephrology Division, Boston Children's Hospital, Harvard Medical School , Boston, MA, USA.,Division of Endocrinology, ASST Fatebenefratelli-Sacco , Milan, Italy
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Yamauchi T, Takasawa K, Kamiya T, Kirino S, Gau M, Inoue K, Hoshino A, Kashimada K, Kanegane H, Morio T. Hematopoietic stem cell transplantation recovers insulin deficiency in type 1 diabetes mellitus associated with IPEX syndrome. Pediatr Diabetes 2019; 20:1035-1040. [PMID: 31322807 DOI: 10.1111/pedi.12895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022] Open
Abstract
Immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome is an autoimmune disorder caused by the dysfunction of FOXP3, which leads to regulatory T-(Treg) cell dysfunction and subsequently autoimmunity including type 1 diabetes mellitus (T1D). Presently, allogeneic hematopoietic stem cell transplantation (HSCT) is a potential curative therapy for IPEX syndrome, but not for T1D. Generally, after complete loss of pancreatic β-cells, HSCT cannot improve the prognosis of T1D. Here, we report the case of a 16-year-old adolescent with late-onset of FOXP3 R347H mutation associated IPEX syndrome with T1D, where insulin dependency was ameliorated following HSCT. This patient with insulin-dependent diabetes mellitus required insulin dosage of 1.28 U/kg/day for 1 month before HSCT. Although the results of glucose homeostasis before HSCT revealed impaired insulin secretion and low ΔC-peptide immunoreactivity (CPR, 1.0 ng/mL), the patient withdrew insulin infusion and remained euglycemic at 15 months after HSCT, and had normal β-cell function with improved ΔCPR (3.4 ng/mL) at 20 months after HSCT. The present case suggests that HSCT for T1D-associated IPEX syndrome improves Treg deficiency and prevents elimination of β-cells. We speculate that the period from the onset of T1D to HSCT could affect the therapeutic efficacy for T1D with IPEX, and early intervention with HSCT before or immediately after the onset of DM can rescue β-cells and remit T1D completely. Our study elaborates not only the therapeutic strategy for T1D with IPEX, but also the pathogenic mechanism in general T1D.
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Affiliation(s)
- Takeru Yamauchi
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takahiro Kamiya
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shizuka Kirino
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Maki Gau
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kento Inoue
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akihiro Hoshino
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Carvalho AL, Massaro B, Silva LTPE, Salmon CEG, Fukada SY, Nogueira-Barbosa MH, Elias J, Freitas MCF, Couri CEB, Oliveira MC, Simões BP, Rosen CJ, de Paula FJA. Emerging Aspects of the Body Composition, Bone Marrow Adipose Tissue and Skeletal Phenotypes in Type 1 Diabetes Mellitus. J Clin Densitom 2019; 22:420-428. [PMID: 30100221 DOI: 10.1016/j.jocd.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 12/12/2022]
Abstract
Anthropomorphic measures among type 1 diabetic patients are changing as the obesity epidemic continues. Excess fat mass may impact bone density and ultimately fracture risk. We studied the interaction between bone and adipose tissue in type 1 diabetes subjects submitted to two different clinical managements: (I) conventional insulin therapy or (II) autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST). The study comprised 3 groups matched by age, gender, height and weight: control (C = 24), type 1 diabetes (T1D = 23) and type 1 diabetes treated with AHST (T1D-AHST = 9). Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by dual X-ray absorptiometry (DXA). 1H Magnetic resonance spectroscopy was used to assess bone marrow adipose tissue (BMAT) in the L3 vertebra, and abdominal magnetic resonance imaging was used to assess intrahepatic lipids (IHL), visceral (VAT) and subcutaneous adipose tissue (SAT). Individuals conventionally treated for T1D were more likely to be overweight (C = 23.8 ± 3.7; T1D = 25.3 ± 3.4; T1D-AHST = 22.5 ± 2.2 Kg/m2; p > 0.05), but there was no excessive lipid accumulation in VAT or liver. Areal BMD of the three groups were similar at all sites; lumbar spine TBS (L3) was lower in type 1 diabetes (p < 0.05). Neither SAT nor VAT had any association with bone parameters. Bone marrow adipose tissue (BMAT) lipid profiles were similar among groups. BMAT saturated lipids were associated with cholesterol, whereas unsaturated lipids had an association with IGF1. Overweight and normal weight subjects with type 1 diabetes have normal areal bone density, but lower trabecular bone scores. Adipose distribution is normal and BMAT volume is similar to controls, irrespective of clinical treatment.
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Affiliation(s)
- Adriana L Carvalho
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Bianca Massaro
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Luciana T P E Silva
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Carlos E G Salmon
- Department of Physics, Faculty of Philosophy, Sciences and Arts of Ribeirao Preto, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Sandra Y Fukada
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Jorge Elias
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Maria C F Freitas
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Carlos E B Couri
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Maria C Oliveira
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Belinda P Simões
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Francisco J A de Paula
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil.
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7
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Penaforte-Saboia JG, Couri CEB, Fernandes VO, Montenegro APDR, Batista LADA, Zajdenverg L, Negrato CA, Malmegrim KCR, Moraes DA, Dias JBE, Oliveira MC, Hussain A, Gomes MB, Montenegro RM. Lower Insulin-Dose Adjusted A1c (IDAA1c) Is Associated With Less Complications in Individuals With Type 1 Diabetes Treated With Hematopoetic Stem-Cell Transplantation and Conventional Therapy. Front Endocrinol (Lausanne) 2019; 10:747. [PMID: 31803138 PMCID: PMC6877543 DOI: 10.3389/fendo.2019.00747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the association between insulin-dose adjusted A1C (IDAA1c) and microvascular complications (MC) and hypoglycemia in a representative Brazilian population of Type 1 diabetes mellitus (T1DM) patients. Research Design and Methods: This was a cross-sectional study based on a previous study, "Microvascular Complications in Type 1 Diabetes: a comparative analysis of patients treated with autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST) and conventional medical therapy (CT)". The 168 patients in that study (144 from CT plus 24 from AHST) were re-subdivided into two groups, according to their IDAA1c values (30 patients had IDAA1c ≤ 9; 138 had IDAA1c > 9). Then, the prevalence of MC (diabetic renal disease, neuropathy, and retinopathy), hypoglycemia (blood glucose <60 mg/dL), and severe hypoglycemic (episode of hypoglycemia that required the assistance of another person to treat) events were compared between the groups. The groups were well-matched on these factors: duration of disease, sex, and age at the time of diagnosis of T1DM. Results: After an average of 8 years after diagnosis, only 6.6% (2/30) of the patients from IDAA1c ≤ 9 group developed any MC, whereas 21.0% (29/138) from the IDAA1c > 9 group had at least one complication (p = 0.044). Regarding hypoglycemic events, the proportion of individuals who reported at least 1 episode of hypoglycemia in the last month was 43.3 and 64.7% from the IDAA1c ≤ 9 and IDAA1c > 9 groups, respectively (p = 0.030). Regarding severe hypoglycemia, the proportion of patients presenting at least one episode in the last month and the rate of episode/patient/month were similar between groups (6.7 vs. 13.2%; p = 0.535; and 0.1/patient/month vs. 0.25/patient/month; p = 0.321). Conclusion: In a representative Brazilian population of T1DM patients, those with IDAA1c ≤ 9 presented a lower frequency of MC, as well as fewer episodes of hypoglycemia, in the month prior to the analysis.
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Affiliation(s)
- Jaquellyne Gurgel Penaforte-Saboia
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
| | - Carlos Eduardo Barra Couri
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Virginia Oliveira Fernandes
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Ana Paula Dias Rangel Montenegro
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Lívia Aline De Araújo Batista
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Lenita Zajdenverg
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Kelen Cristina Ribeiro Malmegrim
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniela Aparecida Moraes
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana Bernardes Elias Dias
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Carolina Oliveira
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Akhtar Hussain
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Faculty of Health Sciences, Nord University, Bodø, Norway
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Marilia Brito Gomes
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renan Magalhães Montenegro
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
- *Correspondence: Renan Magalhães Montenegro Jr.
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Alekberzade AV, Krylov NN, Adzhun Z, Laftavi MR, Shakhbazov RO, Zuykova KS. [Current state of the problem of allotransplantation of Langerhans cells (achievements and prospects)]. Khirurgiia (Mosk) 2018:80-88. [PMID: 30531761 DOI: 10.17116/hirurgia201811180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Literature data devoted to transplantation of Langerhans cells have been analyzed. The main stages, indications, dissection of islets, immunosuppressive therapy, complications and data of the latest clinical trials were discussed.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - N N Krylov
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - Z Adzhun
- Upstate Medical University, Syracuse, NY, USA
| | - M R Laftavi
- Upstate Medical University, Syracuse, NY, USA
| | | | - K S Zuykova
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
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Gaipov A, Taubaldiyeva Z, Askarov M, Turebekov Z, Kozina L, Myngbay A, Ulyanova O, Tuganbekova S. Infusion of autologous bone marrow derived mononuclear stem cells potentially reduces urinary markers in diabetic nephropathy. J Nephrol 2018; 32:65-73. [PMID: 30406605 DOI: 10.1007/s40620-018-0548-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/11/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Previous studies demonstrated safety and efficacy of autologous bone marrow-derived mononuclear cells (ABM-MNCs) in induced type-1 diabetes mellitus (T1DM) rats. However, the effect of ABM-MNCs on urinary markers of DN in humans is not well studied. We evaluated the therapeutic effect of ABM-MNCs on the urinary markers microalbuminuria (MAU), urinary type-IV collagen and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in T1DM patients with and without nephropathy. METHODS This prospective open-label pilot study included 15 patients with T1DM, who had completed 2 visits within 6 months. Patients were divided into two groups according to the presence (DN, n = 7) and absence of nephropathy (T1DM, n = 8). ABM-MNCs were injected at each visit as per study protocol. Routine laboratory data, diabetes tests (fasting serum C-peptide and insulin, glycated hemoglobin, fasting and postprandial glucose), 24-h MAU and urinary type-IV collagen were measured at each visit. uNGAL levels were studied before and after 3 days of ABM-MNCs infusion at each visit. RESULTS Mean age of patients was 29.2 ± 10.4 years, 33% were male, and 27% of the overall group had hypertension. MAU was significantly reduced in the overall group (- 26.0%, p = 0.037), including in DN (- 83.2%, p = 0.021). A short-term significant reduction of uNGAL levels was observed 3 days after ABM-MNCs administration during the both the 1st visit (median 13.4 vs. 9.5 ng/ml, p = 0.027) and 2nd visit (median 8.8 vs. 6.4 ng/ml, p = 0.042) in both groups. However this reduction did not remain significant at the 6-month follow-up. Urinary type-IV collagen did not respond significantly to ABM-MNCs infusion. CONCLUSION Infusion of autologous bone marrow-derived mononuclear cells significantly reduced levels of MAU in DN patients. Further studies with larger sample size are needed to confirm these observations.
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Affiliation(s)
- Abduzhappar Gaipov
- Department of Extracorporeal Hemocorrection, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009.
| | - Zhannat Taubaldiyeva
- Department of Endocrinology, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009
| | - Manarbek Askarov
- Department of Stem Cell Technology, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009
| | - Zaiyrkhan Turebekov
- Department of Internal Medicine, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009
| | - Larisa Kozina
- Department of Biochemistry, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009
| | - Askhat Myngbay
- Private Institution "National Laboratory Astana", Nazarbayev University, Astana, Kazakhstan
| | - Olga Ulyanova
- Department of Endocrinology, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009
| | - Saltanat Tuganbekova
- Department of Internal Medicine, JSC National Scientific Medical Research Center, Avenue Abylai-Khan #42, Astana, Kazakhstan, 010009
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10
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Couri CEB, Malmegrim KCR, Oliveira MC. New Horizons in the Treatment of Type 1 Diabetes: More Intense Immunosuppression and Beta Cell Replacement. Front Immunol 2018; 9:1086. [PMID: 29868031 PMCID: PMC5968392 DOI: 10.3389/fimmu.2018.01086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/01/2018] [Indexed: 12/12/2022] Open
Abstract
Since the discovery of autoimmunity as the main pathophysiologic process involved in type 1 diabetes, many attempts have tried to delay or stop beta cell destruction. Most research protocols in humans have investigated the effects of therapeutic agents targeting specific steps of the autoimmune response. In spite of safety and some degree of beta cell preservation, the clinical impact of such approaches was similar to placebo. Recently, research groups have analyzed the effects of a more intense and wider immunologic approach in newly diagnosed type 1 diabetic individuals with the “immunologic reset,” i.e., high-dose immunosuppression followed by autologous hematopoietic stem cell transplantation. This more aggressive approach has enabled the majority of patients to experience periods of insulin independence in parallel with relevant increments in C-peptide levels during mixed meal tolerance test. However, on long-term follow-up, almost all patients resumed exogenous insulin use, with subsequent decrease in C-peptide levels. This has been at least in part explained by persistence of islet-specific T-cell auto-reactivity. Here, we discuss future steps to induce immune tolerance in individuals with type 1 diabetes, with emphasis on risks and possible benefits of a more intense transplant immunosuppressive regimen, as well as strategies of beta cell replacement not requiring immunomodulation.
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Affiliation(s)
- Carlos E B Couri
- Center of Cell-Based Therapy, Regional Blood Center of Ribeirao Preto, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Kelen C R Malmegrim
- Center of Cell-Based Therapy, Regional Blood Center of Ribeirao Preto, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Clinical, Toxicological and Bromotological Analysis, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Maria C Oliveira
- Center of Cell-Based Therapy, Regional Blood Center of Ribeirao Preto, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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